What Financial Risk Management Has To Do With Climate Change – And The Price Of Inaction (Forbes)

FORBES | When we talk about the long-term risks of climate change, it’s hard for the American public, for company executives, and for lawmakers alike to accurately picture what the implications of climate inaction will mean ten, twenty, or fifty years from now. We hear stories of worst-case scenarios, but sometimes it sounds more like science-fiction than reality.

To better understand this issue, I turned to my friend Bob Litterman, a financial risk expert who managed risk for Goldman Sachs for two and a half decades. He explained that, “Financial risk management has several simple principles that apply to managing climate risk.” First, it involves identifying the “worst case” scenarios. Second, the objective of financial risk management isn’t to minimize risk, but rather to price and allocate risk appropriately. Third, is recognizing the value of time – it’s a scarce resource. Let’s examine these three principles more closely in relation to climate change.

Imagining “Worst Case” Scenarios

We know climate risks are large, but just how large is hard to anticipate. Traditional risk-modeling techniques rely on historical data to make future projections – but we are in uncharted territory. Human-caused climate change has a short history, surging in the mid-20th century through present day, and its impact is cumulative, building year to year. According to NASA atmospheric scientist David Crisp, “Half of the increase in atmospheric carbon dioxide concentrations in the last 300 years has occurred since 1980, and one quarter of it since 2000.” And unlike some other gases, carbon dioxide stays in the atmosphere for centuries, between 300 to 1,000 years. Regulators and financial market participants are handicapped in their ability to make informed decisions, as forward-looking analysis methodologies are still being developed.

Read more at Forbes: https://www.forbes.com/sites/billfrist/2023/07/10/what-financial-risk-management-has-to-do-with-climate-change–and-the-price-of-inaction/?sh=2670b7a33304

The Nashville Movement: How Students, Nonviolence, Discipline, And Organization Enduringly Advanced Equality And Justice (Forbes)

FORBES | Today, we honor Juneteenth. We honor the sacrifice, resilience, and perseverance taught by civil rights leaders. And we honor those that continue the fight for racial justice today.    

More work remains to be done. But we can use history and the lessons from those before us to continue paving the path forward. As a former colleague of mine in the U.S. Congress, the civil rights activist John Lewis, said over 60 years ago: “If not us, then who? If not now, then when? Will there be a better day for it tomorrow or next year?”   

Back in 2004 while I was Majority Leader of the U.S. Senate, I joined Congressman Lewis on his annual civil rights pilgrimage with the Faith and Politics Institute to Alabama and Tennessee. I had worked with Lewis over the previous decade on issues of health care disparities, but it was this four-day journey with him that opened my eyes to the realities that had been endured by so many. And I was introduced to his humility and leadership – and his willingness to face violence and intimidation, injustice and oppression, with steadfast love and bravery.    

 A year later I returned with him on the next pilgrimage, this time to Selma to recognize, remember, and pay our respects on the 40th anniversary of Bloody Sunday. There are no words for this complicated moment in our nation’s history. But later, reflecting on that day walking alongside Congressman Lewis across the Edmund Pettus Bridge, I remarked, “It is difficult for me to find the words to express the power of standing shoulder-to-shoulder with Congressman John Lewis as we crossed that bridge… We walked in the footsteps of giants.”   

Read more at Forbes: https://www.forbes.com/sites/billfrist/2023/06/18/the-nashville-movement-how-students-nonviolence-discipline-and-organization-enduringly-advanced-equality-and-justice/

How A Changing Climate Is A Threat To The Stability Of Our Federal Budget (Forbes)

FORBES | According to recent data from the National Oceanic and Atmospheric Administration (NOAA) and NASA, 2022 tied as the fifth warmest year on record. Why does this matter? Well, a warming climate directly affects the health of you as an individual – and your family, communities, businesses, and our overall economy. We are seeing these effects now and scientists anticipate that they will grow.

Yes, climate change and changing weather patterns create an environmental crisis, but increasingly we are realizing they create a health crisis, and a food crisis, and ultimately a threat to our economic security and to the stability of our federal budget.

The budgeting agencies of both the White House (Office of Management and Budget) and the United States Congress (the nonpartisan Congressional Budget Office or CBO), have both projected sizable budgetary impacts from climate change. The CBO states it succinctly: “Climate change increases federal budget deficits, on net.” A reduction in economic output related to lower worker productivity and damage to physical capital and the corresponding drop in income and payroll taxes will create a drag on federal revenues, while mandatory and discretionary spending demands will increase.  

Indeed, climate change touches nearly all aspects of what in the aggregate comprises our national economy. And it is through this policy lens of the federal budget (The author served on the Budget Committee of the U.S. Senate from 1995 until 2002 and testified before that committee on May 10, 2023) that our elected public officials are called upon to look to the future, assess, and react to public risk. While Congress is notorious for delaying action until absolutely necessary — as we saw with the recent debt limit debate — I hope our elected officials will begin in earnest to address climate change and its impact, as we are in uncharted territory and there will come an unpredictable time in the future when failure to act will balloon budget costs exponentially.

Read more at Forbes: https://www.forbes.com/sites/billfrist/2023/06/14/how-a-changing-climate-is-a-threat-to-the-stability-of-our-federal-budget/?sh=3d750c565650

It’s World Ocean Day: Here’s Why Life Depends On Our Oceans (Forbes)

FORBES | June is the month when the global community honors the crucial services the ocean provides. From World Ocean Day (June 8 this year) to the United Nations Ocean Conference (June 27-July 1), we celebrate that the ocean sustains all life on the planet and call attention to the threats to its future.

Many don’t realize the diverse ways in which our daily life is impacted and sustained by Earth’s marine ecosystems. First, more than half the oxygen in our atmosphere comes from the ocean (primarily from phytoplankton), regardless of where we live and breathe. The ocean also regulates the global climate and influences weather patterns, driving storms that often move far inland. Third, it feeds a lot of us: at least 3.3 billion people, including the world’s poorest, rely significantly on marine products for sustenance, according to the U.N.’s Food and Agriculture Organization. And the seas contribute considerably to the global economy, with about 600 million livelihoods depending on fisheries and aquaculture.

That includes the U.S. economy. More than three-quarters of all U.S. trade relies, at least in part, on maritime transportation routes. In 2019, the U.S. “blue economy” supported 2.4 million jobs and contributed approximately $397 billion to the nation’s gross domestic product.

Read more at Forbes: https://www.forbes.com/sites/billfrist/2023/06/08/its-world-ocean-day-heres-why-life-depends-on-our-oceans/?sh=2114284f196d

How Ecuador Serves As A Solutions Incubator To Restore The Planet’s Water Health: The Nature Conservancy Model For The World (Forbes)

FORBES | Clean and accessible water is essential to life, and closely linked to economic vitality. As the World Health Organization explains, “Improved water supply and sanitation, and better management of water resources, can boost countries’ economic growth and can contribute greatly to poverty reduction.” Yet water insecurity affects one in four people globally, with an estimated 2 billion people lacking access to clean and safe drinking water, while about 3.6 billion lack access to sanitation services (an astounding 46% of the world’s population). This has a ripple effect that increases disease burden, reduces food supply, and reinforces cycles of poverty.  

As global water consumption doubles every 20 years, finding clean water solutions that are replicable and scalable to cities and countries globally might seem out of reach. This is where The Nature Conservancy (TNC) comes in. TNC is the largest conservation organization in the world, working in 79 nations and territories, and its size, impact, and science-based approach has cemented its role as a global innovator that can collaboratively help solve the most complex environmental challenges. Its ability to smartly problem-solve at scale, with international reach, is what initially drew me to The Nature Conservancy, where I currently serve as Global Board Chair.

The Pivotal, Global Role of Water Funds

Over 20 years ago, The Nature Conservancy pioneered a watershed investment approach known as “Water Funds,” and it has since become a too-rare example of scalable innovation. My wife Tracy and I were able to witness the impact of the first of the Water Funds last month when we traveled to Ecuador, visiting the Galapagos Islands, the Andean mountains, and the Amazon basin, hosted by the in-country TNC team led by Galo Medina.

It was in the capital city of Quito that we learned the remarkable story of the pioneering role of TNC in Water Funds and their subsequent expansion worldwide. What began as a mere $20,000 contribution towards the establishment of watershed conservation area in 2000 has grown exponentially into a replicable system that today helps provide 2.6 million people access to fresh water. This first-of-its-kind approach has become a model for countries worldwide.

Read more at Forbes: https://www.forbes.com/sites/billfrist/2023/05/31/how-ecuador-serves-as-a-solutions-incubator-to-restore-the-planets-water-health-the-nature-conservancy-model-for-the-world/?sh=3557e6b374c5

We know firsthand: Public health security is national security (The Hill)

THE HILL | Nearly two decades ago, Congress passed the Pandemic and All-Hazards Preparedness Act (PAHPA) to protect our country and prepare for natural disasters and biological, chemical and radiological threats. Since then, the provisions enacted in that legislation and subsequent reauthorizations have proven critical to shoring up our public health infrastructure and protecting our national health security. 

With PAHPA up for reauthorization again this year, we applaud the bipartisan leadership of the Senate Health, Education, Labor and Pensions and House Energy & Commerce Committees for beginning the critical work of ensuring that our nation’s preparedness programs are properly funded, sustained and improved.

The origins of PAHPA lie in our country’s response to the terrorist attacks on Sept. 11, 2001, and the anthrax attacks that followed shortly thereafter. We intimately experienced these attacks, as one of the sitting members targeted with anthrax via the mail (Daschle) and the Senate’s public spokesman on anthrax and bioterrorism charged with easing public fears (Frist).

Together, we worked to build the legislative framework to respond to this new threat. In 2002, Congress passed the Public Health Security and Bioterrorism Preparedness and Response Act, establishing the Office of Public Health Emergency Preparedness, which was responsible for coordinating efforts to prepare for bioterrorism and other public health threats. Today, those efforts are run by the Department of Health and Human Service’s Administration for Strategic Readiness and Response.

Read more at The Hill: https://thehill.com/opinion/national-security/4020626-we-know-firsthand-public-health-security-is-national-security/

he Massive New Public Health Threat To Kids: What Policies Would You Consider To Address Gun Safety? (Forbes)

FORBES | On Monday March 27th, Nashville was forever changed. Six people, including three nine-year old children, died in a mass shooting at The Covenant School. Since then, I have been asked repeatedly: what can we do to keep this from happening again? At the time, I didn’t have an answer. But since then, I’ve been studying, asking questions, and listening, and I’ve been working to find commonsense policy responses that we might all consider, recognizing that there is no single point solution and that each of us views the highly charged issue of gun safety from a different, frequently contrasting perspective. What we can do now, and as responsible citizens really should do, is at least consider what options might be on the table to bring us together around the absolute goal of the safety and security of our children and families.

I am a gun owner and a hunter. I have always and will continue to strongly support Second Amendment rights. I had a 12-year Senate career where I consistently backed responsible gun ownership. But times are different today – misuse of guns has grown much worse, substantially worse – with markedly more death and tragedy in our neighborhoods, than even a decade ago. This demands a fresh look, free of past biases and partisan tones which have ruled so much of our earlier discussions and debate. These honest revaluations should be carried out in local communities, in homes and at schools, civic gatherings, and places of faith, and likely will include changes in the larger policy framework in response to these new tragic realities.

Yes, over the last decade, deaths from firearms has grown into an official public health crisis. The facts are stark: Now, according to the latest CDC data, firearms are the leading cause of death for children and teens in America. In 2020, gun deaths reached the highest number ever recorded in the United States, killing over 45,000 Americans (a 25% increase from five years earlier and a 43% increase from 10 years prior). And in 2021, we surpassed the 2020 record with nearly 49,000 gun deaths nationwide.

Read more at Forbes: https://www.forbes.com/sites/billfrist/2023/05/03/the-massive-new-public-health-threat-to-kids-what-policies-would-you-consider-to-address-gun-safety/?sh=3a1dd9891567

On Earth Day 2023, here’s how we can think globally and act locally | Opinion (The Tennessean)

THE TENNESSEAN | More people than ever are coming together around a unified cause — the health of our planet, which is inextricably connected to the health and well-being of our people.

While not created for Earth Day, the slogan “think globally, act locally” rings true this month as we are reminded to consider the health of our shared planet in our day-to-day activities. We are doing the same at The Nature Conservancy (TNC), the world’s largest conservation organization where I chair the Global Board.

Today our planet faces the accelerating loss of plant and animal species at an alarming rate, while rapidly shifting weather patterns and progressive climate change is disrupting human and natural habitats alike. As a physician, I view both crises – biodiversity loss and climate change – through a lens of their impact on the health and well-being of people.

The continuing loss of our planet’s biodiversity — such as birds, bees, butterflies, insects and other pollinators — jeopardizes food production around the world. The destruction of natural environments increases the likelihood of human exposure to novel viruses and other pathogens for which we have no cure. And increasingly volatile weather — from extreme rain events and subsequent flooding to lengthy droughts — places unprecedented pressures on our electrical grid, our nation’s aging infrastructure, our agriculture sector and on health systems responding to natural disasters.  With expanding flood zones, whole communities are at increased risk.

Read more at The Tennessean: https://www.tennessean.com/story/opinion/contributors/2023/04/21/earth-day-2023-heres-how-we-can-think-globally-and-act-locally/70136312007/

Your Health Data Is Not Secure: What Can We Do About It? (Forbes)

FORBES | When it comes to protecting health data privacy, where do we find balance?

Health and health-related data are fundamental to informing medical innovations and advances that save lives and better outcomes for all patients. These data include a wide range of metrics such as prescriptions, lab results, race/ethnicity, gender, and income and, more recently, they’ve come to include data collected on our fitness devices and social media posts.

But, the misuse – whether unintentionally or otherwise – of personal heath data and information can lead to feelings of discrimination, an encroachment on privacy, and even a loss of trust in our health care system.

Back in 2002, on the Senate floor, I stated: “Scientific advances hold the promise of higher quality medical care, yet there is a pressing need for federal legislation to reassure the public that learning this information will not result in a loss of health insurance coverage or in the loss of a job.”

Yes, medical advances demand robust, comprehensive data and information that allow clinicians and researchers to more effectively and efficiently diagnose and treat illness and disease. But we – as a society and as individuals – demand privacy protections and regulations to protect our autonomy. The former cannot and should not exist without the latter.

Read more at Forbes: https://www.forbes.com/sites/billfrist/2023/04/20/your-health-data-is-not-secure-what-can-we-do-about-it/?sh=7337312c4e99

Gun violence is the No. 1 killer of children; here are common-sense steps to address it (The Tennessean)

THE TENNESSEAN | The perfect storm of easy access to firearms combined with a pandemic-fueled mental health crisis has brought us to a boiling point.

On March 31, 9-year-old Evelyn Dieckhaus was scheduled to sing Louis Armstrong’s classic song “What A Wonderful World” at a play at Nashville’s Covenant School. Instead, country music artist Vince Gill stood in the sanctuary of Woodmont Christian Church and sang it at her funeral, just four days after the mass school shooting that devastated our hometown. 

We are a former U.S. Senate Majority Leader representing the State of Tennessee, a Nashville-based orthopaedic trauma surgeon who has treated far too many gunshot victims, and the pastor who officiated over Evelyn’s funeral. And we are begging – on behalf of those weeping in our nation’s pews and hospitals and on the steps of our corridors of power – for an end to America’s epidemic of firearms-driven death.   

We were heartened by recent news that Tennessee Gov. Bill Lee signed an executive order strengthening background checks and called on the state legislature to do more. But we, as a state and a nation, need to do more.

Read more at The Tennessean: https://www.tennessean.com/story/opinion/contributors/2023/04/17/gun-violence-common-sense-steps-address-top-killer-of-children/70122206007/?fbclid=IwAR0IU26-dw813ma3_XjcSbOYXDYozHpp0HdcOCg-mXFmKK_q7k2jsCH03NM

Mitch McConnell: The 100 Most Influential People of 2023 (Time)

TIME | Mitch McConnell this year became the longest-serving Senate leader of either party in history—and for a reason. He leads exceptionally, every two years overwhelmingly affirmed by his colleagues. My perspective is colored by the four years he served as whip when I was leader. Every day I saw his style: leadership with clarity, uncanny command of persuasion, and unwavering conviction, anchored in Republican principles. His mastery of Senate rules is legendary, and his transformation of the federal judiciary is widely known, but what most might not see is his willingness to negotiate and achieve a greater good by working with the “other side.” In the past year, he led bipartisan efforts to find and secure funding for the war in Ukraine, and President Biden told him the massive bipartisan infrastructure law of 2021 “wouldn’t have happened without your hand.” Mitch knows when and how to cut a deal.

Read more at Time: https://time.com/collection/100-most-influential-people-2023/6269859/mitch-mcconnell-2023/?fbclid=IwAR3YictA9iB4SxvDeGIi7yfZC9wyDY_mg2Ori_gfZTkD4aGpuTO72KW3bWo

How The Robert Wood Johnson Foundation Has Influenced Health Policy – And My Own Life – For Five Decades (Forbes)

FORBES | Private foundations in America play a unique and vital role in advancing social progress. That is well known.  What is less recognized is the impact such Foundations have on individuals who work within them. This story is a personal one.

In January, I completed a decade of service on the Board of the Robert Wood Johnson Foundation, America’s largest philanthropy devoted to health. While many Americans may not be familiar with this organization, it has made a major impact on U.S. health policy and on the health of all Americans. More personally, it has transformed my own life and thinking as well.

Understanding the Impact of the Foundation

My experience with the Robert Wood Johnson Foundation (RWJF) began in 1975. Almost 50 years ago, it was my first time in the RWJF board room. I was accompanying Anne Somers, professor, healthcare expert, and co-author with her husband Herman Somers of the classic Doctors, Patients and Health Insurance: The Organization and Financing of Medical Care. I had spent a year with her while a student at Princeton, assisting with research in updating her book.

Entering the striking new Foundation building, I was in awe of the place. I met Gustav O. Lienhard, the storied Chairman of the Board of Trustees, who had served for years at Johnson & Johnson with CEO Robert Wood Johnson, and was personally selected by Mr. Johnson to head the Foundation. The Foundation had been “propelled to full growth” as explained in its 1972 annual report, transitioning from a local philanthropy to one of national importance nearly overnight as Mr. Johnson left a bequest of over 10 million Johnson & Johnson shares (valued at about $1 billion) to launch the Foundation to new heights. The report explained, “The Robert Wood Johnson Foundation’s resources represent the largest single source of private capital to support new efforts in the health field.”

Read more at Forbes: https://www.forbes.com/sites/billfrist/2023/03/16/how-the-robert-wood-johnson-foundation-has-influenced-health-policy–and-my-own-life–for-five-decades/?sh=71a684aa36dd

A Road Map For Action On Health Care Spending And Value: Part IV – Value-Based Payment (Forbes)

FORBES | This is the fourth and final installment for my series on the Health Affairs Council on Health Care Spending and Value’s February 2023 report, “A Road Map for Action.” Each piece details one of the four priority areas within the report, which include recommendations on how the U.S. can take a more deliberate approach to moderating health care spending growth while maximizing value. I served as co-chair of this initiative, along with former FDA Commissioner Dr. Margaret Hamburg. This final piece outlines our recommended actions on value-based payment. Click here to read Part I, Part II and Part III

Over the past few years, the health care sector has undergone a cultural shift toward not only prioritizing better value and more comprehensive care but also in how these services are paid for. The days of strictly fee-for-service payment models – where physicians or health centers are paid for each individual service provided – are dwindling. And value-based payment models have stepped into the fold for both public and private sectors. 

In an effort to drive down rapidly growing healthcare costs, value-based care and payment models have garnered a lot of attention for their potential to curb costs while simultaneously improving outcomes. These models come in variety of shapes and sizes, combining innovative arrangements that prioritize quality of care rather than quantity of services provided. Some examples of these models include bundled payment, accountable care organizations, and even full global capitation.  

But the emergence of value-based payment models has not come without challenges.  

Read more at Forbes: https://www.forbes.com/sites/billfrist/2023/03/10/a-road-map-for-action-on-health-care-spending-and-value-part-iv–value-based-payment/?sh=2da6363f5d7a

Food-borne illness is a public health crisis: Congress must act (The Hill)

THE HILL | On Jan. 31, the Food and Drug Administration proposed a redesign of its human food program in response to several ongoing food crises impacting public safety and the health of millions of Americans.

The redesign attempts to solve leadership and funding problems identified by an expert panel in December. 

Unfortunately, the proposal does little to fix the most urgent or fundamental problems within the agency and the safety of our food. Only Congress has the necessary tools to do that.

The festering food leadership failures at FDA were brought to public attention in part by the recent shortage of infant formula. In response to criticism over their role in the shortage, FDA appointed an expert panel to investigate the root causes of the problems and to recommend solutions, sparking a broader conversation about the various ways FDA’s food programs have recently fallen short. 

Read more at The Hill: https://thehill.com/opinion/healthcare/3883327-food-borne-illness-is-a-public-health-crisis-congress-must-act/

A Road Map For Action On Health Care Spending And Value: Part III – Spending Growth Targets (Forbes)

FORBES | This is the third in a four-part series on the Health Affairs Council on Health Care Spending and Value’s newly released report, “A Road Map for Action.” Each piece details one of the four priority areas within the report, which provides recommendations on how the U.S. can take a more deliberate approach to moderating health care spending growth while maximizing value. Part three focuses on our recommendations on setting spending growth targets. Read parts one and two here and here.

The Health Affairs Council on Health Care Spending and Value looked to states to be laboratories for policy experimentation and innovation. One area the Council members spent time investigating, with presentations from experts over several meetings, is state efforts to set spending growth targets. Two states in particular have led in this area: Maryland and Massachusetts.

The Maryland Example

Maryland has a long-standing history of setting growth targets dating back to the 1970s when they established all-payer rate-setting for hospital payments. Enabled by a Medicare waiver, Maryland was exempted from certain federal health care regulations in exchange for ensuring that Medicare inpatient payments per admission grew at a rate below the national growth rate. The state set rates for hospital inpatient services, and all third parties paid the same rate. This effort evolved in 2014 to a global hospital budget that encompassed inpatient and outpatient hospital services. Under what became known as the Maryland All-Payer Model, the state created a prospective annual budget for each hospital based on historical spending trends, whereby annual revenues were subject to a fixed cap. Hospitals continued to receive fee-for-service payments, but had the ability to adjust their rates nominal amounts throughout the year to stay within budget.  

Read more at Forbes: https://www.forbes.com/sites/billfrist/2023/02/28/a-road-map-for-action-on-health-care-spending-and-value-part-iii–spending-growth-targets/?sh=1911a1843e35

A Road Map For Action On Health Care Spending And Value: Part II – Price Regulation And Supports For Competition (Forbes)

FORBES | This is the second in a four-part series on the Health Affairs Council on Health Care Spending and Value’s February 2023 report, “A Road Map for Action.” Each piece details one of the four priority areas within the report, which include recommendations on how the US can take a more deliberate approach to moderating health care spending growth while maximizing value. I served as co-chair of this initiative, along with former FDA Commissioner Dr. Margaret Hamburg. This piece outlines our recommended actions on price regulation and supports for competition.

Why does the US spend more per capita on health care than any other nation? Well, according to renowned health care economist Dr. Uwe Reinhardt, “It’s the prices, stupid.”

While that’s putting it simply, many believe, like Dr. Reinhardt so often stated, that our health care spending is more in large part because we are willing to pay more for it. And recent data suggest that we are indeed willing to pay a lot more for health care services. In fact, about 20% of our nation’s GDP was attributed to health care in 2020.

But it’s not just our willingness to pay more for health care in the US – and spending more or paying higher prices than other countries isn’t necessarily a bad thing. But doing either without seeing an improvement in quality of care is a problem. And this is exactly what is happening: high rates of growth when it comes to prices that are disproportional to the health and equity produced. This places a significant and increasing burden on everyone including our families, companies, and government.

Read more at Forbes: https://www.forbes.com/sites/billfrist/2023/02/21/a-road-map-for-action-on-health-care-spending-and-value-part-ii–price-regulation-and-supports-for-competition/?sh=b6115f63a2f1

A Road Map For Action On Health Care Spending And Value: Part I – Administrative Waste And Inefficiencies (Forbes)

FORBES | This is the first in a four-part series on the Health Affairs Council on Health Care Spending and Value’s newly released report, “A Road Map for Action.” Each piece will detail one of the four priority areas within the report, which provides recommendations on how the U.S. can take a more deliberate approach to moderating health care spending growth while maximizing value.

On February 3rd, the Health Affairs Council on Health Care Spending and Value released its report, “A Road Map for Action.” It’s the culmination of four years of study, debate, and collaboration between 21 experts in the healthcare field, each representing diverse sectors of the industry. Our goal was to take a nonpartisan, evidence-based approach to understanding our nation’s growing health care spending, the value we get from that spending, and to make recommendations on how we can maximize value while slowing spending growth.

I served as co-chair of this effort, along with former FDA Commissioner Dr. Margaret Hamburg. When we first embarked on this journey in January of 2019, we knew it would be a difficult challenge – reining in health care spending has been a stated goal of policymakers for decades, with little to show for it. Yet our task became even more complex with the upheavals in health brought on by the pandemic, and by the needed spotlight on inequities in all aspects of American life – including health care – that was raised by George Floyd’s tragic murder. As the world around us shifted, we worked to adjust, and extended our Council work by a year. We released our report this month, the product of four years of research and collaboration.

Read more at Forbes: https://www.forbes.com/sites/billfrist/2023/02/13/a-road-map-for-action-on-health-care-spending-and-value-part-i–administrative-waste-and-inefficiencies/?sh=1e8dc3a9fd74

Recommendations On Health Care Spending And Value From 21 Experts: Why We Should Implement This Road Map For Action Now (Health Affairs)

HEALTH AFFAIRS | Four years ago, an ambitious group of twenty-one diverse health care experts came together at the invitation of Health Affairs to collectively develop recommendations to maximize our nation’s investment in health care. With national health care spending levels reaching nearly a fifth of our economy, it was the right time to evaluate our spending priorities and the value we receive from those expenditures. 

At the time, we anticipated that the Health Affairs Council on Health Care Spending and Value, which we co-chaired, would be a three-year effort.  We did not foresee the first global pandemic in decades, leading to trillion-dollar federal investments in public health, nor the national reckoning on racial and gender-based disparities that brought to light many of the inequities in health care today.  The council continued to meet throughout, although our in-person meetings became virtual, and we continued to adjust and hone our analysis and recommendations as the world around us shifted. 

Even with these changes, we remained steadfast that this work needed to be done. As physicians first, we recognize that patients still struggle with the cost of care, despite policy changes like the Affordable Care Act. We’re seeing increased care avoidance, as a shocking 47 percent of U.S. adults say that it is very or somewhat difficult for them to afford their health care costs. One in 10 Americans has medical debt, which continues to be the number one cause of bankruptcy. Despite the United States outstripping all other nations in per capita health care spending, our life expectancy is surprisingly on the decline. And in the midst of a crisis, when our physicians and nurses were our frontline defense against COVID-19, our health care systems needed billions in federal dollars to keep them afloat. Finally, our health spending continues to grow as a percentage of gross domestic product (GDP) and our federal budget. Taken together, this paints a picture of a system that is failing its people and where change is needed now. 

Read more at the Health Affairs blog: https://www.healthaffairs.org/content/forefront/recommendations-health-care-spending-and-value-21-experts-why-we-should-implement-road?vgo_ee=UmoGs8ja9YHQTo0EO2edhvlMy%2BOWWuyaZunZiCXh6gI%3D

In a Divided Congress, Four Opportunities for Cooperation on Nature (Nature.org)

NATURE.ORG | December closed one of the most productive U.S. federal legislative sessions for nature ever. By the time the 117th U.S. Congress gaveled out, it had advanced the country’s largest investment in climate action; a massive bipartisan infrastructure package that heavily invests in nature, clean energy, and climate resilience; and a host of bills related to water infrastructure, natural climate solutions, coastal and ocean resilience.

Any one of these advances would have been impressive in itself, but to do them all in just two years shows how far we’ve come in making conservation and climate action central and urgent policy issues in the United States. Some of these victories passed on party-line votes, but the vast majority of measures passed last Congress had strong bipartisan support. 

For The Nature Conservancy (TNC), it has never been about who controls Congress or the White House that defines our policy objectives, but where the science tells us we must act. As the 118th Congress settles in, there are several opportunities to build on the progress of the last Congress and continue bipartisan support for nature.

Read more at nature.org: https://www.nature.org/en-us/about-us/who-we-are/how-we-work/policy/frist-vetter-opportunities-congress-nature/

How The Busiest Heart Transplant Center In The World Got Its Start – An Inside Story Of The First Decade (Forbes)

FORBES | The Vanderbilt Transplant Center is currently the busiest heart transplant center in the world. This is the story of building the foundation for what the Center has become today — a narrative of the initial decade of the 34 years since the founding of this first-of-its-kind, multidisciplinary, multi-organ transplant center. Over 12,300 adult and pediatric transplants have been performed at Vanderbilt. Not only does Vanderbilt perform more heart transplants annually than any other center, but it is where the longest surviving lung transplant patient was transplanted over three decades ago.

It started with a phone call.

In 1985 I was a Fellow in transplant surgery at Stanford University Medical School, operating under the tutelage of Dr. Norman Shumway. Shumway is considered the “Father of Heart Transplantation,” a title fitting for my mentor who was a research-grounded, scientist-surgeon. For more than two decades prior to my arrival at Stanford, Shumway had systematically conducted basic science and pre-clinical transplant research that culminated in his performing the first human heart transplant in the United States on January 6, 1968 (Dr. Christiaan Barnard, using techniques and knowledge that Shumway had developed over decades, performed the first human-to-human heart transplant in South Africa a month before.).

It was while completing my fellowship program under Shumway that late one evening my phone rang. On the other end of line was Dr. Harvey Bender, Chief of Cardiac Surgery at Vanderbilt: “Bill,” he said, “Ike Robinson (then Vanderbilt’s Vice-Chancellor) and I would like for you to come back home to Nashville to join Walter (Merrill, MD) to start and build a heart transplant program.”

Read more at Forbes: https://www.forbes.com/sites/billfrist/2023/02/06/how-the-busiest-heart-transplant-center-in-the-world-got-its-start–an-inside-story-of-the-first-decade/?sh=23f42c8d49bb

Healthcare Paradox: How The Industry Designed To Keep Us Well Is Also Making Our Planet – And Our Bodies – Sick (Forbes)

FORBES | Healthcare systems undertake a fundamental and challenging mission: keeping us healthy. But true health and wellbeing extends beyond hospital walls and examination rooms. Our bodies and minds, after all, can only be as healthy as the environments that nourish them.  

 It should go without saying then that what is bad for our environment — or planet — is equally bad for our health. Sure, loss of nature and biodiversity, upticks in pollution, and poor stewardship of our farmlands all have a direct impact on the natural, wondrous world around us. But our individual, human health is paying the price, too.

As a physician, I took an oath to do no harm. As a policy maker in Washington, I honored this oath through my focus on healthcare systems and global health. And now as a voice for nature and health in my role as Chair of the Global Board of The Nature Conservancy, I’ve begun to more closely examine that intersection between the health of our bodies and the health of our natural world, as well as the larger, more direct impact broader industries like the healthcare sector are having on our environment.

Read more at Forbes: https://www.forbes.com/sites/billfrist/2023/01/30/healthcare-paradox-how-the-industry-designed-to-keep-us-well-is-also-making-our-planet–and-our-bodies–sick/?sh=3df7c20c35d7

Bringing Modernized Kidney Care To The Home: How Monogram Health Is Transforming Polychronic Care (Forbes)

FORBES | Nowhere has innovation been more prevalent in recent years than in healthcare – but this astounding progress has not been evenly distributed throughout all sectors of medicine, or among all Americans.

Some types of care – such as cancer care – have seen a night and day difference in clinical outcomes where once terminal diagnoses have become manageable chronic conditions or, in some cases, even entirely curable. Another is my own specialty of heart disease where risk of death from a heart attack in 2015 was half of what it was in 1960.

Other areas of clinical care, however, have been much slower to evolve, failing to modernize to the full benefit of patients and families. For proof, look no further than the care of patients with renal (or kidney) disease, where a patient on dialysis today looks almost identical to a patient on dialysis in the year 2000.

Such was the case until Monogram Health came onto the scene in 2019.

Read more at Forbes: https://www.forbes.com/sites/billfrist/2023/01/12/bringing-modernized-kidney-care-to-the-home-how-monogram-health-is-transforming-polychronic-care/?sh=4eedcafe5751

Addressing childhood obesity also supports US military readiness (The Hill)

THE HILL | Our childhood obesity epidemic here in the U.S. is as concerning as it is well-documented.  It’s no secret that obesity trends have been on the rise for the last 20 years. In fact, in 2016, 18.5 percent of youth ages 2-19 were classified as obese. And it’s only getting worse. 

The implications of these data and the impact of poor nutrition on our overall health and well-being are disheartening and demand action. And while the broad strokes of this challenge may be familiar to you, what is less well known is the way childhood obesity is inextricably linked to our country’s long-term national security.

Nationwide, 11 percent of our 17- to 24-year-olds do not qualify for military service strictly due to excess weight. If you combine this with other eligibility factors such as crime or drug abuse or even academic issues, this shocking ineligibility figure has held steady at 71 percent for years.  

However, the Department of Defense’s most recent figures show that an astonishing 77 percent of Americans of prime recruiting age would be ineligible for military service. This is a massive increase. Over three-quarters of American young people are ineligible due to some combination of factors, chief among them obesity.

Read the full article here: https://thehill.com/opinion/national-security/3774831-addressing-childhood-obesity-also-supports-us-military-readiness/

Tennessee must refocus our education system to help more students succeed (The Tennessean)

THE TENNESSEAN | For the better part of two decades, Tennessee has been on a journey to significantly improve public education and workforce opportunities for all Tennesseans.

And by working together, we have made significant progress, moving from the back of the pack to one of the most improved and innovative states in the country on multiple K-12 and higher education measures.  

However, as we emerge from the global pandemic and head into 2023, it is clear we still have much more work to do if we are to build a strong bridge between our education and workforce systems and truly create a lifetime of opportunity for all Tennesseans.

Education opens doors to economic independence, and we must rally around the goal of ensuring our students are part of the best-prepared and best-educated workforce in the nation.

Read the full article here: https://www.tennessean.com/story/opinion/contributors/2022/12/08/tennessee-must-refocus-education-system-to-help-more-students-succeed/69703226007/

Congress: Close the gap between funding for nutrition research and the toll diet-related disease takes on Americans (Stat)

STAT | You are what you eat. Every year, new scientific discoveries make clear that food is critical to health. In recent years, nutrition research trials have shown that a Mediterranean diet reduces cardiovascular disease; ultra-processed foods increase weight gain; omega-3 fatty acids improve IQ in preterm babies; cocoa prevents heart attacks; and vitamin D supplements do — well, almost nothing.

But many questions remain: What’s the best diet for weight loss? Do supplements really work? Can certain foods or better nutrition help cancer treatment, maintain brain health, treat autism, or improve immunity? What’s the best way to nurture the gut microbiome?

It will take years before answers to these and many other questions emerge — time the U.S. does not have as obesity and diet-related diseases rise at alarming rates. What’s needed right now is a national nutrition science moonshot.

Diet-related conditions are the leading cause of death and disability in the U.S. Not only is poor nutrition deadly, it’s expensive: The combined health care spending and lost productivity from suboptimal eating costs the economy $1.1 trillion each year. Obesity alone has far-reaching consequences for the education system, American workplace, and national defense, with 1 in 3 young adults disqualified to serve in the military because of excess weight. Americans who live in rural areas, have lower incomes, or are part of certain racial or ethnic groups often face higher rates of diet-related diseases like diabetes, obesity, stroke, and heart disease. The combined toll of poor nutrition is astronomical.

Read the full article here: https://www.statnews.com/2022/12/02/congress-close-the-gap-funding-nutrition-research-toll-diet-related-disease/

How A Rock Star, A Physician-Legislator, And An Evangelical Senator Bonded To Help End The Global AIDS Pandemic: A Backstory (Forbes)

FORBES | In 1998 before I was Senate Majority Leader, and before Bono’s name became synonymous with addressing the AIDS pandemic and the RED campaign, he visited my Senate office to lobby me, and then collaborate with me, on the Heavily Indebted Poor Country (HIPC) initiative to provide debt relief to the world’s poorest nations, in exchange for the nations investing in clean water and public health initiatives at home.

This early, successful collaboration led us to many later conversations, including in 2002 discussing how to change conservative and evangelical hearts and minds to see the moral imperative of addressing AIDS globally.

I suggested to Bono at the time, “to move policy into legislation, you have to capture the views of mainstream, Middle America. If you as a rock star, who speaks so effectively to hearts of millions around the world through music, can do that, then you will demonstrate that we can move the U.S. Congress to support legislation to address global HIV/AIDS in a big way,” which at that time was killing 3 million people a year globally.

Bono took those words to heart – and months later on World AIDS Day (December 1, 2002) he embarked on his “Heart of America Tour.” Different than his dazzling rock concerts, Bono personally spent eight days on the ground directly engaging people on their home turf with his message of how America can lead the world in reversing the relentless, global scourge of HIV/AIDS. He made stops in Nebraska, Iowa, Illinois, Indiana, Ohio, and Kentucky, culminating on December 8,2002 with a final event in Nashville, Tennessee. I joined him as he spent two hours raising awareness about AIDS, played a few songs, and visibly moved the audience. Earlier on his tour at a stop at the University of Iowa, he had shared, “I’m told you can grow anything here. We’re here to grow a movement.”

Read the full article here: https://www.forbes.com/sites/billfrist/2022/12/01/how-a-rock-star-a-physician-legislator-and-an-evangelical-senator-bonded-to-help-end-the-global-aids-pandemic-a-backstory/?sh=77b05f292fdd

Let’s harness our heritage to revitalize Tennessee main streets and communities (The Tennessean)

THE TENNESSEAN |Tennessee is rich in history, but the physical evidence of our heritage is increasingly threatened by our state’s dramatic growth. The structures that have served for generations as the center of spiritual, social, cultural and economic vitality are being torn down or left in disrepair because of the misguided notion that it’s always cheaper to build something new rather than restore and preserve the old.

For example, in rural areas across the state the inability to save important historic structures or landscapes that once played a vital role in the success and identity of those communities is widespread. Buildings around our many courthouse squares, within “Main Street” districts or places that were once farming homesteads are disappearing due to neglect, the lack of adequate financial resources or, like our cities, threatened by uncontrolled development.

Just in my hometown of Nashville, the nationally celebrated Music Row, which tells the story of country music and planted the seeds that built Music City USA, is being demolished at an alarming rate. Between 2013 and 2019, at least 55 music-related buildings were torn down, replaced by apartment and condominium buildings. The places that defined the heart and soul of Nashville, and of Tennessee, are quickly disappearing.

There is a way to save and revitalize the storied buildings of our downtowns and communities while repurposing them to spur economic growth at the local level. The answer is enacting a state historic preservation tax credit. The credit works by incentivizing substantial rehabilitation of historic buildings for income-producing or business use. It requires preservation of the historic character of the property and makes it feasible to preserve older structures that would otherwise be too cost-prohibitive to renovate or restore. Simultaneously, it can save our state’s tangible past in a way that conserves resources, reduces waste and creates jobs.

Read the full article here: https://www.tennessean.com/story/opinion/contributors/2022/12/01/opinion-harness-heritage-to-revitalize-our-main-streets-communities/69687722007/

Tracy R. Frist Establishes Fund To Support Ferrum College and Blue Ridge Institute’s Preservation of Appalachian Literature and Folktales

This November, former Ferrum College student and longtime supporter of the College, Tracy R. Frist, made a generous gift to Ferrum College to support the College’s Appalachian Literature project (AppLit) and the digitizing and archiving needs of the Blue Ridge Institute & Museum (BRIM).

Tracy Frist at Ferrum’s annual folklife festival in Ferrum, Virginia

“Tracy’s generous gift to the BRIM archive will provide us with the resources we need to digitize collections of folktales and songs so that they will be easily available for public use,” affirmed Bethany Worley, director of the Blue Ridge Institute & Museum.

AppLit is an online resource created by Tina L. Hanlon, professor of English at Ferrum College, to serve as an archive of Appalachian literature for children and young adults. Frist’s own original animal tale, “Mountain Marbles: An Appalachian Tale,” is archived on the site and is an example of how the project includes student and faculty authored works as well those gathered from oral traditions.

Frist’s support will help in preserving folk literature of the region and enhance the educational resources available to students.

“One of the magical threads in the tale of my three decades in Virginia has allowed me to cross paths with Tracy Roberts Frist periodically: from studying Appalachian folktales in a graduate course in the 1990s, to publishing Tracy’s original animal tale and teaching materials in our website AppLit, collaborating in Ferrum’s Teaching Appalachian Literature project, discussing Appalachian books at conferences, and bumping into Tracy and her sweet mother at Ferrum’s folklife festival over the years,” Hanlon recalled. “I’m so grateful Tracy has established this fund that will enable us to upgrade AppLit as well as continuing to engage students and alumni in the important work of preserving and sharing folklore and literature of the region.”  

The AppLit project was originally funded in 2000 by the National Endowment for the Humanities and serves as a resource for educators and dramatists. Reflecting Hanlon’s background as a librarian, it features a rich bibliography of works as well.

In addition to Frist’s gift, Ferrum College received a Humanities Research for the Public Good grant from The Council of Independent Colleges to fund student work on the project. Abigail McGovern, a senior majoring in English with a concentration in Creative Writing, is one of four Ferrum College students whose work with the Blue Ridge Institute digitization as well as AppLit has been critical to these preservation projects. McGovern was invited to present at the Appalachian College Association Summit in September highlighting the college-community collaboration. 

“One of the things I learned from working on this project is how folklore can connect community. Folklore is perceived as historic and no longer relevant, but in reality, we create folklore daily – it represents values and culture that connect us all together from the past into the present,” said McGovern.

“The value of the AppLit resource and the BRIM archive is the themes and stories. What makes Ferrum College unique is the local culture and these resources celebrate it and drive engagement with it. Appalachian folklore is part of our story as students,” McGovern continued.

Frist shared how Hanlon’s course enlightened her about the value of folktales and inspired her to support the ongoing preservation work through Ferrum College.

“Dr. Tina Hanlon taught me preservation of culture, history and diversity lies in storytelling. Ferrum College and the greater Appalachian community is full of powerful and transformative stories. I wanted to be a part of saving these stories with this rich cultural evidence and making them accessible to everyone,” stated Frist.

To support the AppLit and digitizing efforts of Dr. Hanlon and the Blue Ridge Institute and Museum, select “Other” in the drop down menu and type “Tracy R Frist Fund” on Ferrum’s giving form here.

Bill and Tracy Frist enjoying Ferrum’s annual folklife festival in Ferrum, Virginia

# # #

Can Nature Be Our Climate Defender? Adaptive Strategies Lead To A Sustainable Future Where People And Nature Thrive (Forbes)

FORBES | Friday, November 18th marks the final day of COP27 – the United Nations 27th annual Climate Change conference. Each year this conference convenes leaders from nearly 200 nations. And each year, the stakes are higher.

This year seems especially poignant. The global community is under tremendous pressure to achieve the goals outlined in COP21’s Paris Agreement where nations pledged to limit global warming to 1.5 degrees Celsius (2.7 degrees Fahrenheit). Since then, nations have been working to drastically reduce greenhouse gas emissions to protect the health of our environment, natural resources, and people.

Reducing emissions alone, though, will not be enough. Indeed, we will not be able meet our climate action goals without also transitioning to cleaner and more sustainable energy sources and doubling down on investing in nature.

Nature-centric solutions – such as restoring, protecting, and managing our lands and wetlands — allow our natural environment to be our climate defender. This is better for the health of our ecosystems, our communities, and our planet. It is also a core value of The Nature Conservancy (TNC), the world’s largest conservation organization dedicated to creating a future where people and nature thrive.

Read the full article here: https://www.forbes.com/sites/billfrist/2022/11/16/can-nature-be-our-climate-defender-adaptive-strategies-lead-to-a-sustainable-future-where-people-and-nature-thrive/?sh=6684265b434a

How the ‘red ripple’ could impact health policy in 2023 and beyond (The Hill)

THE HILL | Rather than a red wave, the 2022 congressional midterms brought a ‘red ripple’. 

With races still being decided and votes counted, Democrats have won control of the Senate, despite a runoff in Georgia. It looks like Republicans will take back the House — albeit with a much smaller majority than they had hoped. 

What does this all mean for health policy? With a divided Congress, President Biden’s ability to pass major, sweeping legislation along party lines (like the Inflation Reduction Act) falls to the wayside. But it doesn’t mean legislating comes to a standstill. Contrary to popular opinion, Congress has passed major health-related legislation with bipartisan support in recent years. This includes:

  • The No Surprises Act, which passed as part of 2020 appropriations legislation, established new federal protections against surprise medical bills;
  • Major opioid legislation of 2018, the SUPPORT for Patients and Communities Act;
  • The 21st Century Cures Act of 2016, which modernized the development and delivery of drugs and medical devices and advanced research into serious illness;
  • And the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which repealed the Medicare Sustainable Growth Rate formula and changed the way that Medicare rewards clinicians for value over volume.

Read the full article here: https://thehill.com/opinion/healthcare/3734558-how-the-red-ripple-could-impact-health-policy-in-2023-and-beyond/

Congress must not miss the chance to reform the Electoral Count Act (The Hill)

THE HILL | It was Jan. 6, and a United States Senator and a member of the House of Representatives had just issued a formal challenge to the electoral votes from one state — halting congressional ratification of the presidential election results. It was nearly unprecedented, and turned a civilized ceremony into what one publication referred to as “a political and historical drama.”

This moment in time was not Jan. 6, 2021, as one might assume, but rather Jan. 6, 2005. I was the Senate Majority Leader, and Sen. Barbara Boxer (D-Calif) and Rep. Stephanie Tubbs Jones (D-Ohio) had just launched an objection to President George W. Bush’s reelection, claiming Ohio’s results were tainted. 

While this challenge was rightly voted down, and President Bush’s victory certified, it set an unfortunate precedent where each party has begun to exploit ambiguities in the 1887 Electoral Count Act. This 136-year-old law established the process by which Congress certifies presidential elections, and while effective for a century, vague language in its drafting has led to challenges that increasingly undermine public confidence in our elections.

Despite extreme partisanship in the Capitol today, this is an area where both sides of the aisle agree: The Electoral Count Act must be modernized and dangerous loopholes that threaten the organized transfer of power in our democracy must be addressed. 

Read the full article here: https://thehill.com/opinion/campaign/3720056-congress-must-not-miss-the-chance-to-reform-the-electoral-count-act/

It’s Time To Prioritize Nutrition: Better Diet Quality Leads To Better Health And Wellbeing For Americans (Forbes)

FORBES | September should be a big month for nutrition. For too long, we have struggled and failed to curb food and nutrition insecurity, to mitigate rising rates of obesity, and to reduce the prevalence of diet-related chronic illnesses such as diabetes, hypertension, and coronary artery disease.

This issue is very real to many of us, but it is especially real to me.

For nearly 12 years as a cardiac surgeon, I operated five days a week on people’s hearts, palpating and coming face to face with fatty, calcified, and hardened coronary artery disease caused in large part by bad nutrition. I saw firsthand how, despite growing up hearing that “you are what you eat,” many of us fail to consume nutritious foods fundamental to promoting health and wellness. We know better.

Our nutrition – or lack thereof—has thwarted our nation’s health and wellbeing. And it’s costing many Americans their lives and their savings. It is time we act on what science, clinical medicine, and public health experts have long understood: our country must prioritize better nutrition policy.

Read the full article here: https://www.forbes.com/sites/billfrist/2022/09/23/its-time-to-prioritize-nutrition-better-diet-quality-leads-to-better-health-and-wellbeing-for-americans/?sh=3f65a8ed2ea3

65 Years Later: A School Bombing, A Steady Leader, And A Message Of Hope (Forbes)

FORBES | In times of uncertainty, we know leadership matters more than ever. I see this from leaders firsthand every day – leadership in improving health outcomes, in driving better policy, in rising to the moment to solve tough challenges – from conservation to economic mobility. Recently, I have been reflecting on the power and importance of great leadership in education, and marking the anniversary of a painful event in Nashville where leadership mattered.

This Saturday, September 10th, 2022 marks the 65th anniversary of the tragic bombing of the Hattie Cotton School, which occurred just after midnight following the very first day of mandated integration at six elementary schools in Nashville in 1957. This major cultural advance was spurred by the landmark Supreme Court decision in 1954, Brown v. Board of Education.

On that first day of school, Hattie Cotton had just one six-year-old black girl enrolled, Patricia Watson. My aunt Margaret Cate, who we lovingly called Aunt Bonnie, was the principal at Hattie Cotton and she had led the school since the day it opened seven years prior in 1950. Never married, her life was centered entirely around educating children, teaching with high values and high expectations, always gently and humbly — and later leading as principal in the style of servant leader. She was gentle but strong. Her convictions were ahead of the times.

From old letters, we know a close friend sensed an air of worry and concern when visiting with Aunt Bonnie the day before the opening of school because of planned, organized, community-wide protests. Little did she know that soon her beloved, tiny school would be making national headlines, and she would be called upon to unify and courageously lead the Hattie Cotton community after a vicious, violent attack.

Read the full article here: https://www.forbes.com/sites/billfrist/2022/09/09/65-years-later-a-school-bombing-a-steady-leader-and-a-message-of-hope/?sh=5bb97298c792

Cultivating A Culture Of Health: How Comprehensive Community-Wide Hypertension Data Are Inspiring Heath Equity (Forbes)

FORBES | It’s no secret that the best data often begets the best policy, especially when it comes to community health and wellness. Having accurate, timely, and well-informed data is often the difference maker that allows communities to dramatically move the needle on health disparities.

When it comes to health disparities, the city of Nashville can – and must – do better. Nashville is known nationally as a health services capital, yet our own community health and well-being statistics rank far worse than the cities we compete with on a daily basis.

For many, this comes as a surprise. Nashville is filled with top-level academic institutions, nationally renowned hospitals, and tremendous economic growth, and it is home to some of the largest health and hospital systems in the country. But when compared to cities like Austin, Charlotte, Denver, and Dallas, we have the worst life expectancy and highest rates of infant mortality, smoking, and number of poor mental health days by far.

How can Nashville, an otherwise thriving city, work to ensure that every single one of our community members has an opportunity for a healthy life?

Read more at Forbes: https://www.forbes.com/sites/billfrist/2022/08/18/cultivating-a-culture-of-health-how-comprehensive-community-wide-hypertension-data-are-inspiring-heath-equity/?sh=388ce0817018

The White House Conference on Hunger, Nutrition and Health is an opportunity for transformational change (Nature Food)

NATURE FOOD | More than 50 years ago, President Richard Nixon convened the 1969 White House Conference on Food, Nutrition and Health, bringing together all the agencies of the US government, Congress and other stakeholders to address widespread hunger in the United States. That conference — chaired and organized by Dr Jean Mayer, the founder of the Tufts Friedman School of Nutrition Science and Policy — was historic in its vision, bipartisanship and impact. The insights and recommendations of the 1969 conference established nearly all of the major US food and nutrition programmes that are in place today. This included major expansion and harmonization of the National School Lunch Program; major expansion and harmonization of the Food Stamp programme (now the Supplemental Nutrition Assistance Program (SNAP)); creation of the School Breakfast Program and the Special Supplemental Nutrition Program for Women, Infants and Children (WIC); and development of a new focus on food-based dietary guidelines and new consumer protections such as nutrition facts labelling2. Together, these policies achieved success in their major goal: to reduce caloric hunger nationally.

However, much has changed since 1969, and the United States and global community face stark new food and nutrition challenges. Chief among these are the intertwined pandemics of obesity and type 2 diabetes, as well as globally rising cardiovascular diseases, cancers and other diet-related diseases. In the United States, half of all adults have diabetes or prediabetes, while 3 in 4 are overweight or have obesity. In addition, undernutrition has still not been eradicated globally — a dire double burden of malnutrition. In 2020, about 3.9% of US households experienced very low food security, and an additional 6.6% experienced low food security.

In our nation and around the world, nutrition insecurity and diet-related chronic diseases also disproportionately afflict racial and ethnic minorities and lower income, rural and other underserved populations. At the same time, the industrialization of food, from the Green Revolution to food science, successfully mitigated the leading nutritional concerns of the twentieth century: mass starvation due to a soaring world population, endemic vitamin deficiency diseases, and common foodborne pathogens; however, it is not well designed for the needs of the twenty-first century: a fully healthy, just and sustainable food system. Together, these burdens on human health and natural resources are also producing tremendous economic losses in the United States and worldwide. The COVID-19 pandemic and the Russia–Ukraine war have further underscored fundamental weaknesses across our food systems, including fragile supply chains, persistent food and nutrition insecurity, and increasing inequities. COVID-19 also intersects directly with obesity, diabetes and hypertension, which are the top risk factors, beyond age, for poor outcomes from infection.

Read the full article here: https://www.nature.com/articles/s43016-022-00568-x

Twenty-Five Years After My House Call To Dolly: What Have We Learned About Cloning And How Did We Learn It? (Forbes)

FORBES | Twenty-five years ago, the scientific breakthrough of mammalian cloning marked a monumental moment in medicine and science. Anticipating the collision it would have with ethical decision making in medicine, I, the only physician-scientist in the U.S. Senate at the time, journeyed to the University of Edinburgh in Scotland to personally visit Sir Ian Wilmut at his research lab at the Roslin Institute.

Professor Wilmut just months before in 1996 had cloned a sheep from an adult somatic cell, shocking the world. This was the first successful attempt of its kind. All over the world people were wondering: would we be cloning a human being next? We talked science, we talked ethics, and we talked about his creation’s potential impact on altering the course of human history. I also met and examined the cloned sheep, Dolly, in her stall.

Dolly, named after Tennessee’s own Dolly Parton, was a Finnish Dorset sheep cloned from a single, adult mammary gland cell. Her creation, birth, and short life were scientific feats that immediately sparked global concern and discourse on the increasingly complex moral and ethical dilemmas posed by a sudden discovery of life-manipulating science.

Wilmut and colleagues published their achievement in February 1997, having kept Dolly secret for seven months. We, as a society, were quickly forced to answer difficult, probing questions. A few months later on the Senate floor, I borrowed a question that the Washington Post editorial board had posed a few years before: “Is there a line that should not be crossed even for scientific or other gain, and if so where is it?”

Read more at Forbes: https://www.forbes.com/sites/billfrist/2022/08/02/twenty-five-years-after-my-house-call-to-dolly-what-have-we-learned-about-cloning-and-how-did-we-learn-it/?sh=7e0ff3c759c0

Changed Hearts And Minds – A Personal (Ongoing) Journey To Better Understanding LGBTQ+ Equity Issues (Forbes)

FORBES | Last week, Supreme Court Justice Clarence Thomas opined that we should revisit several major Supreme Court decisions, including Obergefell v. Hodges, which legalized same-sex marriage. This startled me. But it also moved me to reflect on my own past. And some of these recollections are painful to look back upon.

Two decades ago I supported the official Republican platform and President George W. Bush’s public call for a constitutional amendment defining marriage as between one man and one woman. I can firmly say I was wrong then, and it would be a major step backwards for this country to even consider relitigating that issue in the future. Indeed, we have seen major, positive cultural and attitudinal shifts on LGBTQ+ issues for the country — and a parallel personal journey of awareness, enlightenment, and growth for me.

As Americans, we can all agree there’s been sizable cultural change in our nation over the last 20 years. Looking back on my time as a member of the United States Senate at the turn of the century, and later as its Majority Leader from 2003–2006, many of the issues we voted on and beliefs we held then – including my own – are totally out of step with today’s more enlightened understanding and prevailing viewpoints. And while many feel today’s culture wars may be reaching a boiling point, we should recognize that amidst current partisan infighting, we have also made huge, generational progress, always recognizing that much more must be done.

Read the full story here: https://www.forbes.com/sites/billfrist/2022/07/01/changed-hearts-and-minds–a-personal-ongoing-journey-to-better-understanding-lgbtq-equity-issues/?sh=402462b55737

Can We Unite Around Gun Safety? Yes, Think Local And Get The Data (Forbes)

FORBES | Earlier this week, as I was checking in at the Aspen Ideas Festival, a man approached me unexpectedly. He said, “Excuse me, Dr.-Senator Frist. I am a pastor in North Carolina. I want to bring people together on gun issues, right and left, Republican and Democrat, rural and urban. Is it possible? And how can I do it?”

Already late to my first meeting, I gave him my short, but direct, answer: “Yes. You must start locally. Most important, you must open the conversation with specific data that accurately describes their local community, information that they can relate to. Bring eight or ten people to the table and begin simply by asking specific, thought-provoking questions about gun safety in their own neighborhood. Likely they will not know the answers, but you will quickly establish a rapport and common foundation for a civil, mutually respectful discussion that can lead to deeper understanding, possibly even a change in culture and attitude, and, eventually, progress.”

I left him with these four, specific questions that I successfully use in starting similar conversations:

  • “Are any firearms kept in or around your home?”
  • “If so, are these firearms now loaded?”
  • “Are any of these loaded firearms unlocked?”
  • “Do you feel safer or less safe when there are firearms in your home or vehicle?”

Read the full article here: https://www.forbes.com/sites/billfrist/2022/06/24/can-we-unite-around-gun-safety-yes-think-local-and-get-the-data/?sh=5a67d5f8118e

Reducing The Health Harms Of Incarceration: Five Big Ideas From The Aspen Health Strategy Group (Forbes)

FORBES | Our nation has the highest incarceration rate in the world with 10 million people incarcerated each year, yet the health of these individuals is truly an afterthought. We must recognize that their experiences and their health outcomes are not contained in a vacuum. These individuals are often struggling with undiagnosed or untreated behavioral health issues and chronic illnesses prior to being jailed or imprisoned, and their health challenges before and after incarceration have a ripple effect that substantially impacts the health and well-being of their families and communities, and ultimately our country.

We know incarcerated Americans are sicker – those who have been jailed or imprisoned are associated with having an elevated risk for nearly all diseases, and they touch a much larger percentage of our population than many realize. In fact, 45% percent of Americans have had an immediate family member who has been incarcerated, and for these Americans, this connection to an incarcerated individual is correlated to a life expectancy that is two years less than for those without a family member who has been incarcerated. The carceral system is taking years off Americans’ lives, even if they haven’t served time.

For these reasons, we at the Aspen Health Strategy Group (AHSG) – which I co-chair with former U.S. Health and Human Services Secretary Kathleen Sebelius – have determined, “Incarceration is a primary source of poor health for individuals, families, communities, and our nation as a whole.” This is the issue AHSG’s 24 multi-sectoral leaders chose to study in 2021 as part of the Health, Medicine & Society program at the Aspen Institute. Tasked with exploring some of our nation’s greatest health challenges and preparing actionable solutions, we lay out five big ideas on “Reducing the Healthy Harms of Incarceration,” which we arrived at after extensive consultation with experts in the field, as well as with those who have personally experienced the health impacts of incarceration.

Our “five big ideas” center around expanding health coverage, providing coordinated care, implementing quality standards, and rethinking certain justice system approaches to prioritize health.

Read more here: https://www.forbes.com/sites/billfrist/2022/06/15/reducing-the-health-harms-of-incarceration-five-big-ideas-from-the-aspen-health-strategy-group/?sh=4d676b27156c

Nature And People Positive Solutions: The Nature Conservancy In Belize (Forbes)

FORBES | The Nature Conservancy (TNC) has a storied history of local, regional, and global environmental protection and conservation efforts centered on sound principles and comprehensive solutions. Since 1951, TNC has used a collaborative approach that engages communities, governments, the private sector, and other partners to combat some of our world’s toughest challenges like climate change and food and water sustainability.

TNC’s mission is centered on the fact that all life is connected and supported by land and water and, when these resources benefit, so do people. This duality of purpose in focusing on solutions that benefit nature and people alike, separates TNC from many other environmentally focused groups. Without a doubt, this has been key to TNC’s successes in 76 countries and territories: 37 by direct conservation impact and 39 through partnership.

Recently, Tracy—my wife and a member of the Tennessee TNC Board—and I traveled to the eastern coast of Central America to visit the on-the-ground team leading TNC’s Belize chapter. This chapter has played an active role in protecting the country’s vital ecosystems for 31 years and, more recently, the country’s economy.

Always eager to immerse ourselves in the fascinating conservation work being done globally, Tracy and I jumped at the opportunity to join a Belize TNC team retreat to learn more about innovative solutions underway, from Blue Bonds to sustainable seaweed farming, and how local conservation efforts in Belize are indeed having a powerful global impact. Here are some of the remarkable and eye-opening things we learned over our two-day visit:

Continue reading here: https://www.forbes.com/sites/billfrist/2022/06/09/nature-and-people-positive-solutions-the-nature-conservancy-in-belize/?sh=1d4b66225b24

Reevaluating, Reimagining, And Reinventing Healthcare: Innovation In A Post-Pandemic World (Forbes)

FORBES | Since its onset, COVID-19 has been the focal point of recent healthcare innovation and advancement. Though the past couple of years have been filled with innumerable advancements of health technologies, much opportunity for reevaluating, reimagining, and reinventing the future of healthcare remains. The next two years will set the scope for what is to come.

As our world successfully transitions from a pandemic to endemic stage, the landscape of healthcare innovation is wide-open for disruption, as health, wellness, and healthcare are taken more fundamentally into the digital age. Advancing technology will be the vigorous driver behind a much needed refocusing of healthcare delivery to put the patient experience and navigation of health services back where it belongs front and center.

What we can expect—at least in the near-term future—is more digital transformation, more cloud, more integration, more automation, and overall a more coherent, consistent, and comprehensive delivery of healthcare.

Though the endless number of possibilities are inspiring, here are six areas where I foresee the most disruption occurring:

Read the full article here: https://www.forbes.com/sites/billfrist/2022/05/04/reevaluating-reimaging-and-reinventing-healthcare-innovation-in-a-post-pandemic-world/?sh=22feaffd1bc8

Tennesseans Answer The Call: Volunteer State Leads Rapid Response Efforts For Ukrainian Requested Medical Supplies (Forbes)

FORBES | We have watched the tragedy in Ukraine unfold with a continual stream of shocking live video footage. Many of us seeing the struggle on our screens have been left wondering how something like this could possibly happen during this day and age. It seems so foreign, so distant, yet—at the same time—so close. Our natural impulse is to ask, how can I help? Is there something that I, as an individual or a family or a business, can do to lend a helping hand?

We each answer this question in our own way. But what I share today is the story of how a small group of concerned Tennesseans responded to this question, rallying their connections among friends, businesses, nonprofits, government, and public entities. All these groups and people came together to act quickly, creatively piecing the puzzle of logistics together, to generously provide critical, life-saving medical equipment and supplies directly to the Ukrainian people suffering from daily atrocities.

The first call for help came at midnight on March 2: a message from my friend, Kenney Isaacs, with whom I have traveled extensively over the past twenty-five years doing urgent international relief in response to natural and man-made disasters. Together, we traveled to sites within days of onset of multiple catastrophic events around the world, he with logistics and me, as a physician, with medical and surgical teams. We were in Sri Lanka immediately after the Indian Ocean tsunami in 2004, in New Orleans forty-eight hours after Katrina in 2005, in Haiti within thirty-six hours after the 2010 earthquake, and in Sudan on multiple occasions during the ongoing civil war in the late 1990s and early 2000s.

Read the full article here: https://www.forbes.com/sites/billfrist/2022/04/26/tennesseans-answer-the-call-volunteer-state-leads-rapid-response-efforts-for-ukrainian-requested-medical-supplies/?sh=4b10efb01238

The global crisis of COVID orphanhood (The Hill)

THE HILL | The flood of Ukrainian refugees fleeing Russia’s brutal invasion reminds us that the pain of war often falls most heavily on those with the least ability to cope, especially children.

The same is true of our battle with COVID-19, which has now left over 7 million children worldwide suffering from the loss of a loving parent or grandparent caregiver. Urgent action is needed to protect these children from the many threats they face. The Biden-Harris administration can lead by using the U.S.-hosted Global COVID-19 Summit this spring to rally the world to care for the hidden victims of the pandemic.

COVID-19-associated orphanhood and caregiver loss are increasing at unparalleled speed, with one new child affected every six seconds. It took the HIV-AIDS pandemic 10 years for 5 million children to become orphaned; it’s taken COVID-19 just two years to top that tragedy.

While equitable vaccine coverage can slow the rates of caregiver deaths, the numbers of children affected by COVID-19 orphanhood will continue to rise, especially in Africa where less than 10 percent of the population has been fully vaccinated. The lack of strong social safety nets exposes these children to extreme threats, including abuse, violence, high-risk sexual behavior, and institutionalization. These risks increase when breadwinners die — a sobering fact given that 75 percent of COVID-19 orphanhood involves paternal death.

Most children losing a parent or primary caregiver to COVID-19 have a living relative who, with adequate support, could care for them. But the time to act is now. Early intervention with educational, economic, and parenting support is needed to ensure that each affected child benefits from the healing hands of a safe and nurturing family — and does not end up in institutional care.

Read the full article here: https://thehill.com/blogs/congress-blog/healthcare/600129-the-global-crisis-of-covid-orphanhood/

Commissioner Califf needs to put the F back in FDA (Stat)

STAT | Robert Califf is taking the reins as commissioner of the Food and Drug Administration with the nation in a nutrition crisis. Americans are living shorter, less-healthy lives due to the foods they are being sold. The new commissioner can meet this challenge by harnessing the FDA’s effective but underused food-related regulatory powers, which were created with FDA itself for a similar food crisis more than 100 years ago.

At the turn of the 20th century, food was making Americans sick. Illnesses due to chemical and microbiological contaminants were among the top 10 causes of death. Food producers, eager to meet consumer demand for cheap, quick, appealing, and tasty food, were adding harmful ingredients without concern for people’s safety and were intentionally mislabeling food. Milk contained chalk and formaldehyde; canned foods had salicylic acid, borax, and copper sulfate; corn syrup was sold as honey; and colored animal fat from pig stomachs sold as butter. Food manufacturers were unchecked by government regulation, basic food safety, or labelling requirements.

Under the leadership of President Theodore Roosevelt and Harvey Wiley, a chemist working for the U.S. Department of Agriculture, the federal government was able to make the country’s food supply safer through research and policy. Wiley conducted groundbreaking research on food additives by testing them on a group of men that came to be known as “the poison guard.” This research culminated in sweeping food safety laws — and the founding of the FDA — through the 1906 Pure Food and Drug Act.

Read the full article here: https://www.statnews.com/2022/03/14/commissioner-califf-needs-to-put-the-f-back-in-fda/

Congress should create a national board on pandemic preparedness (The Hill)

THE HILL | As we approach the frightening, chilling milestone of nearly 1 million dead from COVID-19, it should go without question that preventing this loss of life again should be a top priority of our United States Congress, regardless of party affiliation.   

The recent release of a discussion draft of the bipartisan Prepare for and Respond to Existing Viruses, Emerging New Threats and Pandemics Act (PREVENT Pandemics Act) is a significant step forward toward enhancing our nation’s security. We applaud Senate Health, Education, Labor, and Pensions (HELP) Committee Chair Senator Patty Murray (D-Wash.) and Ranking Member Richard Burr (R-N.C.) for putting forth critical policies that would strengthen federal and state preparedness, improve our response capacity through data systems modernization, accelerate research and countermeasure discovery, modernize the supply chain for vital medical products, and enhance development and combat shortages of medical products. 

While the PREVENT Pandemics Act proposes a short-term task force to examine the initial emergence of the pandemic and the nation’s response, we also believe that the legislation should include a permanent oversight mechanism so that the United States is equipped to respond to future threats. There is currently no congressionally chartered body for evaluating the state of America’s pandemic preparedness system, leaving the nation vulnerable to a suboptimal response to public health emergencies and future pandemics. For this reason, we and our colleagues on the Bipartisan Policy Center’s Future of Health Task Force call on Congress to create a national board on pandemic preparedness. The independent board would establish a set of metrics and benchmarks for evaluation of federal and state pandemic preparedness capacity and capability; gauge how the nation is faring against these metrics; and develop an annual report to Congress on the state of pandemic preparedness with specific recommendations.  

The board should consider some broad thematic areas while developing metrics including, nonpharmaceutical and pharmaceutical mitigation measures; public health, emergency management, and health care system coordination; equity in emergency response planning; exercising of response plans; standardized data collection and reporting along with data privacy and security standards; real-time surveillance and systems; vaccination infrastructure, distribution and uptake; and, stockpiling and supply chain resiliency. Throughout the metric development process, Congress should require that the board consult with stakeholders, including relevant federal agencies, private sector organizations, and subject matter experts.  

Read the full article here: https://thehill.com/blogs/congress-blog/healthcare/594438-congress-should-create-a-national-board-on-pandemic/

“A Storm For Which We Are Entirely Unprepared …”: A 2005 Pandemic Prophecy & Call For A “Manhattan Project” For The 21st Century (Forbes)

FORBES | Two years ago this week, the United States declared a public health emergency in response to what was then being referred to as the 2019 Novel Coronavirus, now widely known to all as COVID-19. Few envisioned how all-encompassing and destructive this virus would become. Few would have believed that two years later, it would have led to nearly 900,000 deaths in the United States, with thousands more still suffering the effects of long COVID, as well as the devastating financial repercussions the pandemic has sowed.

Yet, it was predicted. A coming pandemic was certain. Tragically, it was not adequately prepared for. And now as we continue to recover and slowly enter a stage of endemicity, we must increase our resolve to prepare for the next pandemic — for there will be another.  

Seventeen years ago, I, serving then as Majority Leader of the United States Senate and one of the few physician-scientists in Congress, wrote a formal Declaration to serve as the foundation for a nationwide call-to-action to what I and a few others saw as the inevitability of a coming catastrophic pandemic that would cause massive loss of life and destruction of livelihood: “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.”

The Declaration, which I share in its entirety below, was the substance of a speech which I repeatedly delivered over the course of a year across the country in multiple venues, from large outdoor settings in San Francisco to the National Press Club in Washington, DC to the lecture halls at Harvard. The mission was urgent — to warn we were not prepared for what we would have to face and to lay out a proposal that would “dwarf the Manhattan Project.”  We knew that if left unprepared we would face a global pandemic that would devastate our economy, our livelihoods, our health systems, our way of life. We did not prepare.

Read the full article here: https://www.forbes.com/sites/billfrist/2022/02/02/a-storm-for-which-we-are-entirely-unprepared-a-2005-pandemic-prophecy–call-for-a-manhattan-project-for-the-21st-century/?sh=5452666513f2

Omicron And Our Economic Forecast: What’s Next For Fiscal And Monetary Policy? (Forbes)

FORBES | The COVID-19 pandemic has had significant impact on our domestic economy. It comes as no surprise that the ongoing pandemic will continue to influence our economic policies for years to come. The challenge lies, however, in predicting what this will look like and what the long-term ramifications will be.

At the start of the pandemic, I joined some of Princeton University’s brightest economic and health policy minds to attempt just this: to predict how a global pandemic would affect our country’s fiscal and monetary policy. It’s safe to say that in April 2020 when we first came together, we had no idea what our fight against COVID-19 would entail, nor would we have predicted we would be participating in our 5th iteration of this discussion just a couple weeks ago.

I recently sat down with Drs. Jessica Metcalf, Alan Blinder, and Bill Dudley to, once again, try and predict the future of our economy, to analyze how Omicron and future variants will impact our projected outlook, and to examine how our initial pandemic fiscal and monetary policy panned out.

Read the full article here: https://www.forbes.com/sites/billfrist/2022/01/25/omicron-and-our-economic-forecast-whats-next-for-fiscal-and-monetary-policy/?sh=505787264a2c

Your health (and you thought climate change was not about you) (The Hill)

THE HILL | New Year’s resolutions: chances are we’ve made — and broken — a few of them. And, chances are many of those resolutions have been related to our health: exercise more, eat better, stop smoking. But what if, in 2022, we resolved to improve our health by taking action against climate change?

According to recent data from National Oceanic and Atmospheric Administration (NOAA) and NASA, 2021 marked the sixth warmest year on record. Why does this matter? Well, a warming climate directly affects the health of individuals, communities, businesses and economies alike.

Climate change, if nothing else, is a background condition of our lives that shapes our health. As a social determinant of health, it is as much a public health crisis as it is an environmental and economic one. Things like access to clean air, clean and safe drinking water, healthy food supplies and housing are directly impacting our quality of life, as well as physical, mental and emotional health.

We’re seeing the effects of climate change on peoples’ health already — from increased cases of asthma in children to more heat-related illnesses like heat stroke and vector-borne diseases like malaria. If you’re not seeing these repercussions in your community now, chances are you will soon.  

Read the full article here: https://thehill.com/opinion/healthcare/590394-your-health-and-you-thought-climate-change-was-not-about-you/

Remembering Larry King: Master Of The Wise Interview, Who Cared To Listen (Forbes)

FORBES | I met Larry King for the first time over 33 years ago as an unknown heart transplant surgeon leading the Vanderbilt Multi-Organ Transplant Center in Nashville. Larry was just a few years into his hit show, “Larry King Live”, on CNN.  

He had invited my friend Barbara Mandrell, arguably the biggest female star in country music at that time, and me to the show to give us the opportunity to raise awareness about the shortage of organ donors. Those 30 minutes we spent together were plenty long enough for me to witness the profound skill, experience, and purpose of the “Master of the Interview.” 

While in the green room with Barbara just before going on air, the show’s producer abruptly announced that Larry’s questions would, to our surprise, all be focused on Barbara’s highly popular music career. We were stunned: Barbara’s whole purpose in setting up the interview and our trek to Los Angeles was to broadly educate others on the serious but commonly misunderstood issue of the national need for organ donors.  

On set—30 seconds before going on air—Barbara reminded Larry that we were there solely to highlight a life-changing message, not to aggrandize her career. Immediately, Larry tore up the prepared off-topic questions. He smoothly winged the entire interview, and still managed insightful, probing questions that allowed for thoughtful answers. Because of him, with his willingness to listen and his mastery of the interview process, we were able to help demystify the subject.

Read the full article here: https://www.forbes.com/sites/billfrist/2022/01/19/remembering-larry-king-master-of-the-wise-interview-who-cared-to-listen/?sh=1f6d00e47396

A Call For Data Equity: Using Pandemic Data Mishaps To Improve Health Outcomes (Forbes)

FORBES | Where we live determines how long we live. Read that again.

Health disparities, in large part, are determined by where we live. In Nashville—a city that prides itself on being a renowned healthcare hub—life expectancy increases 5 years by moving to the neighboring Williamson County. Similar patterns hold true in other cities all over the U.S.

For those of us in public health, this unfortunate reality is not surprising. Structural racism—the category of racism that stems from the very infrastructure of our communities—has long determined unjust resource allocation. Inequitable access to things like quality education, nutritional foods, and healthcare services can lead to poorer health outcomes.

Connecting the dots, it’s easy to see how ZIP code can be more predictive of health than genetic code.

Health disparities, especially those stemming from the location of our homes, were only heightened by the COVID-19 pandemic. Throughout the pandemic, ZIP code determined access to testing sites, personal protective equipment, and vaccine availability.

Read the full article here: https://www.forbes.com/sites/billfrist/2022/01/11/a-call-for-data-equity-using-pandemic-data-mishaps-to-improve-health-outcomes/?sh=4ba1f6485e65

Rethinking How And What We Eat With Dr. Mark Hyman (Forbes)

FORBES | If Dean Ornish is the father of lifestyle medicine, Dr. Mark Hyman is the food as medicine master. With his New York TimesNYT+1% best-selling books, a top-rated podcast, “The Doctor’s Farmacy,” and visionary leadership of the Center for Functional Medicine at Cleveland Clinic, Hyman is changing the conversation about the nation’s relationship with food to improve health—not just for brains and bodies, but for the planet.

I sat down with Hyman recently for my podcast, A Second Opinion, to talk about his latest book, “The Pegan Diet, 21 Practical Principles for Reclaiming your Health in a Nutritionally Confusing World.” As a heart surgeon who in the operating room daily witnessed the devastating consequences of diet-related disease, I truly appreciate Hyman’s no-nonsense and easily digestible guide to using food as a therapeutic tool for better health. And as a former policy maker in the Senate, I love his ability to connect the misaligned incentives of our government to the health of each of us—and what we can do about it.

Hyman’s innovative approach reminds me of the groundbreaking work of Ornish, who argued in our talk in 2020 that lifestyle change—including plant-based diets low in fat and sugar, regular moderate exercise, strength training, stress management and social support—can treat and often reverse life threatening conditions like heart disease and diabetes.

Read the full article here: https://www.forbes.com/sites/billfrist/2021/08/12/rethinking-how-and-what-we-eat-with-dr-mark-hyman/?sh=3d8b685dff23

Tennessean: In 1998, Tennessee Sen. Bill Frist ran to help during a deadly U.S. Capitol shooting

By Rachel Wegner | Published in the Tennessean on January 14, 2021

On July 24, 1998, a gunman went on a rampage through the halls of the U.S. Capitol, leaving two Capitol Police officers dead and a tourist seriously injured.

The gunman had been shot multiple times by an officer when then-Tennessee Sen. Bill Frist stepped in not as a senator, but a physician. 

Frist, a heart surgeon, said he ran two blocks to the Capitol building to help after a staffer told him what happened.

He first attended a wounded officer until emergency personnel arrived. Then he turned his attention to a second man, uncertain of his identity. That man turned out to be Russell Eugene Weston Jr., who police later named as the gunman. 

In the end, Frist resuscitated Weston. 

“It is not what a U.S. senator typically does, but it is what this senator has done all of his adult life,” Frist told reporters shortly after the shooting. “I didn’t do anything any other trauma surgeon wouldn’t have done.”

The 1998 shooting marked the last time a Capitol Police officer died in the line of duty before the deadly riot at the Capitol on Jan. 6 this year.

In a 2018 Forbes column, Frist said he had an informal agreement with the Capitol Physician’s office to notify him if there was a medical emergency on the grounds. He was the only doctor in the Senate at the time.

Frist was a heart transplant surgeon at Vanderbilt University Medical Center before entering politics four years before the shooting. The shooting marked the fourth time his medical training had come into play since becoming a senator. 

In 1995, Frist revived a 60-year-old constituent who collapsed inside a Senate office. In 1996, he tended to a woman who was choking while he was on vacation. In 1997, he came to the aid of Sen. Diane Feinstein when she became short of breath during an allergic reaction. 

In 2018, Frist wrote a column for Forbes on the anniversary of the Capitol shooting

“Twenty years ago tomorrow was one of the most memorable days in my U.S. Senate career. And it haunts me still,” Frist wrote. 

He detailed the harrowing events of the day and called for improvements in mental health care. The 1998 Capitol gunman was suffering from mental illness.

“On this anniversary, I reverentially reflect on the heroic sacrifices our men and women in uniform make every day,” Frist wrote. “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.” 

Senator Frist Statement on the Failed Insurrection at the U.S. Capitol

January 6, 2021 | Our U.S. Capitol: “It was all so surreal. Everything was out of context and not the way it was supposed to be….  I looked upward and saw the majestic dome of the Capitol with the American flag, fluttering against the bright blue sky and blazing sun. How could this assault and death, senselessness and tragedy, occur here [the Capitol] at the heart of our democracy?” These words I wrote in a Forbes article in 2018 on the 20-year anniversary of the 1998 Capitol shooting. They just as well could depict today. 

President-elect Joe Biden, hours ago, similarly described the terrifying and shameful events of today created by pro-Trump rioters when he said, “Our democracy is under precedented assault, unlike anything we have seen in modern times … an assault on the citadel of liberty, the Capitol itself.”  

This is not peaceful freedom of speech, this is an attack that puts innocent people in danger and deserves to be prosecuted to the fullest extent of the law.   

Democracy is fragile. We must come together. We must not tolerate anarchy, mob-like mentality, violence, physical confrontation, and lawlessness.  Whatever our differences and beliefs, we must unite around the peaceful transfer of power. We must rise to the expectations of being the world’s beacon of democracy. 

We have witnessed loss of life in the Capitol building today.  In 1998 two brave, honorable heroes — Capitol Police Officer Jacob Chestnut and Special Agent John Gibson — lost their lives defending us against a mentally ill shooter who stormed the Capitol.  Our condolences to all those individuals and families who have been so deeply hurt by these tragedies. 

Below is my Forbes op-ed from 2018 describing the experience of the 1998 Capitol shooting: 

https://www.forbes.com/sites/billfrist/2018/07/23/murder-in-the-capitol-honor-the-fallen-and-improve-mental-health/?sh=75a7239425e3

60% Of Americans Say Government Making Pandemic Worse. Here’s How We Restore Trust In Government & Science (Forbes)

September 4, 2020

Forbes | President Trump has said a COVID-19 vaccine could be ready before Election Day on November 3, and the Centers for Disease Control (CDC) just advised state public health officials to prepare to distribute one to high-risk populations as soon as late October or early November.

This comes on the heels of FDA Commissioner Stephen Hahn saying a vaccine could receive Emergency Use Authorization before the end of Phase III clinical trials—a statement that drew an outcry from public health experts concerned vaccine approval could be rushed for political reasons.

Top U.S. infectious diseases expert Dr. Anthony Fauci points to a slightly different timeline, saying in a September 3 CNN interview that, “I think most of the people feel it’s going to be November, December,” when we’ll see a vaccine released. “It is conceivable that you can have it by October, though I don’t think that that’s likely.” This was echoed by the Administration’s scientific adviser heading Operation Warp Speed, Dr. Moncef Slaoui, who agreed that, “There is a very, very low chance that the trials that are running as we speak” could be ready by the end of October.

Science shouldn’t be political. Our nation’s greatest scientific minds are working overtime to speed treatments and vaccines for SARS-CoV-2 to turn the tide on the global pandemic. There is no question that they are working for the good of the country and to save lives around the world.

But there is growing public opinion that politics is entering the vaccine development process. Several recent missteps on behalf of our nation’s public health agencies give the impression that they are bowing to pressure from the White House.

Read the full article here: https://www.forbes.com/sites/billfrist/2020/09/04/60-of-americans-say-government-making-pandemic-worse-heres-how-we-restore-trust-in-government–science/#2a9de7d476a5

Health security is national security (The Dallas Morning News)

The global coronavirus pandemic compels us to rethink how we approach development assistance, cooperation, innovation and international organizations.

The Dallas Morning News is publishing a multi-part series on important issues for voters to consider as they decide who to vote for president this year. This is the second installment of our What’s at Stake series, and it focuses on foreign policy. Find the full series here.

There are three things that the COVID-19 pandemic has made clear about public health: it’s global; it’s intrinsically tied to economic prosperity; and it is a part of our national security.

While we annually pour billions into our national defense, federal support of public health has been stagnant. Centers for Disease Control and Prevention funding specific to state and local public health preparedness has been cut from $939 million in fiscal year 2003 to $675 million in 2020. Over the last decade, frontline state and local health departments have lost more than 56,000 positions due to funding cuts. Yet America has lost more lives to COVID-19 than we did in the Vietnam War or World War I. And in just a few short months, we have already spent more in COVID-19 relief packages than we have on the Iraq War.

The cost of our lack of preparedness has been staggering, with economic devastation surpassing the Great Recession and unemployment rates on par with the Great Depression. This life-altering event needs more than emergency spending bills to plug holes. We need to fundamentally alter our approach to public health.

Read the Full Article Here: https://www.dallasnews.com/opinion/commentary/2020/08/16/health-security-is-national-security/

The US food system is killing Americans (CNN)

Opinion by Akash Goel, Michel Nischan, Bill Frist and Tom Colicchio

CNN | This global pandemic has given a new meaning to the idea of American exceptionalism. The United States is faring far worse than other countries and shoulders a disproportionate share of global disease burden — with 4% of the global population, yet, at the time of writing, nearly a quarter of global Covid-19 fatalities.

While much of the rationale has focused on our government’s flat-footed response and poor public health infrastructure, this ignores a significant and underrecognized risk factor — the exceedingly poor baseline health of our country’s population. Among the most significant risk factors for hospitalization and death in Covid-19 are the presence of diet-related chronic diseases such as hypertension, heart disease and obesity. America’s starting point? Nearly three out of four American adults are overweight or obese.

And half of US adults have diabetes or pre-diabetes. A 2018 study found that only 12% of Americans are metabolically healthy, which is defined as having optimal levels of blood markers and pressures as well as waist circumference. Diet-related diseases are no longer the things you have to worry about down the road. In a pandemic environment, they could hasten death next week.

Read the full article here: https://www.cnn.com/2020/08/02/opinions/us-nutrition-insecurity-snap-goel-nischan-frist-coliccio/index.html

COVID-19 has left millions of Americans without enough food. Here’s how Senate can help. (USA Today)

Today’s environment is unlike anything our nation has ever experienced. We are on the brink of an economic and food security disaster.

Bill Frist and Mark K. Shriver

USA Today | As a nation, we have a moral and economic obligation to address child hunger, food insecurity and avoid economic collapse in the wake of COVID-19. While we have different political viewpoints, we strongly agree that the Supplemental Nutrition Assistance Program is one of the most effective tools we have to fight the looming health and economic crises facing our great country.

The Senate is at a critical decision point as to how we use this tool. That’s why together, we are calling for a temporary 15 percent increase in SNAP benefits, bound to economic indicators, in the next federal coronavirus relief package.

Even in the best of economic times, far too many Americans struggle to put food on the table. This is especially concerning for families, where children need nutritious food to grow up healthy and strong.

Today’s environment is unlike anything our nation has ever experienced. We are on the brink of an economic and food security disaster that will impact every citizen, but disproportionately affect vulnerable individuals including children, the elderly, rural Americans, Black, indigenous and people of color.

For years, the number of hungry children was declining. But, a new Save the Children report shows that many children now face even greater risk. New estimates from Northwestern University based on Census Bureau data indicate the percentage of families who are considered food insecure has increased during the pandemic, is much higher than during the Great Recession, and, of great concern, disproportionately affect children and families of color.

Read the full article here: https://www.usatoday.com/story/opinion/2020/08/05/covid-19-has-led-surge-child-hunger-heres-how-we-can-help-column/5580099002/

Discrimination and Disparities in Health: Examination of racial inequality in Nashville (The Tennessean)

Bill Frist, M.D. and Andre L. Churchwell, M.D.

The Tennessean | As city and community leaders across the country wrestle with their own roles and responsibilities in addressing racial inequality, we believe specific attention to health equity and health disparities will lead to dismantling structural racism and a roadmap for a healthier future for all.

An example of how we are beginning that focus and journey can be found in Nashville, Tennessee.  But it could just as well be any town or city in the nation. 

We’ve known for years that minorities face health disparities nationally, and in our own experiences as physicians, we’ve seen first-hand how health inequities unfairly persist in communities of color when it comes to access and quality.

In Nashville, the simple zip code of your residence could lead to a six-year decrement to life expectancy, twice the rate of unemployment and five times difference in poverty.

The challenges of unconscious bias and racism that enable health inequities must be addressed to improve health outcomes.

Thanks to the recent Nashville Community Health and Well-Being Survey, we have a clearer picture of the challenges facing vulnerable populations, especially African Americans here in Davidson County, for the first time in 20 years. 

Read the full article here: https://www.tennessean.com/story/opinion/2020/07/31/examination-racial-inequality-nashvilles-healthcare/5540680002/

Tennessee’s COVID-19 Update – A Weekly Analysis (Week of July 19 – 25, 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 July 19 – 25 there were a total of 14,460 new cases. Comparing to the previous week, the average cases/day is 6% lower.

  • Davidson County – 1,782 new cases which is 30% lower than last week
  • Williamson County – 363 new cases which is 51% lower than last week
  • Other TN Counties – 12,315 cases which is 2% higher than last week

There were 126 fatalities. The previous week had 100. Hospitalizations are also at a new high averaging 78/day with a total of 547 for the week (65/day and 456 total for the week before). Testing for this week was 5% lower compared to last week. Average of 22,645/tests/day.


Virtual Care Advances Are The Silver Lining Of COVID-19. Here’s How We Make Them Permanent (Forbes)

Forbes | It is said that necessity is the mother of invention, and the explosion of telehealth and virtual care has been one of the most constructive advances to emerge from the COVID-19 crisis. The gains for the patient include convenience, affordability, and rapid access to quality care while eliminating the risk of viral spread. The field of virtual health care, delivered from a remote location by text, phone, or video, has been accelerated by five years or more.

But we must ensure our nation does not lose the gains made when this public health emergency comes to an end.

Indeed America’s health systems, notoriously slow to change, have transformed their approach to care with lightning speed. Prior to COVID, health systems saw telehealth use in a 3-4% range. Now, providers are planning and financially budgeting for a larger percentage of virtual care, at around 25 – 30%. Geisinger CEO Dr. Jaewon Ryu recently shared with me that as result of COVID, they have gone from perhaps a few hundred telemedicine visits a day to conducting 4,500 – 5,000 a day. Medicare-covered virtual visits have skyrocketed – jumping from 12,000 per week to a million per week. And Americans are increasingly comfortable with a virtual visit, with surveys showing 74% of consumers are comfortable using telemedicine to have a conversation with a doctor.

For years I have been heavily involved in virtual care, beginning with my days 30 years ago taking care of over a hundred transplant patients remotely. Today I serve on the board of two virtual health care companies, Teladoc Health (physical and mental health) and Smile Direct Club (dental health). I have seen firsthand how our recent policy changes at the federal and state levels have unleashed private sector innovation in an overwhelmingly positive way—stepping in to address care gaps created by the pandemic’s stay at home orders.

Read the full article here: https://www.forbes.com/sites/billfrist/2020/07/27/virtual-care-advances-are-the-silver-lining-of-covid-19-heres-how-we-make-them-permanent/#65fc0e2b2980

Science alone cannot beat the pandemic. We also need outreach about a Covid-19 vaccine (STAT)

By BILL FRIST, RICHARD PAN, and MAX G. BRONSTEIN

STAT | Americans anxiously await two key benefits that a Covid-19 vaccine will deliver: freedom from fear and a return to normal.

No single vaccine is likely to offer a panacea for this pandemic. And even if it did, it might not accomplish its job if we don’t deal with hesitance to get vaccinated and counter vaccine disinformation. By failing to do these things, we risk a perpetual cycle of infectious disease coupled with persistent economic decline.

Now is the time to make sure that all residents of the U.S. understand the value of a Covid-19 vaccine and the necessity of getting one.

Since the start of the Covid-19 pandemic, vaccination conspiracy theories have flourished, fueled by a potent combination of fear, misinformation, and social media amplification. According to new polling data, among adults who have heard of one or more Covid-19 conspiracy theories, 36% believe it to be probably or definitely true.

At first, many health professionals dismissed vaccine conspiracy theories as outlandish and unbelievable. Yet additional polling data indicates 20% of Americans would outright refuse a Covid-19 vaccine and 31% are unsure as to whether they would get vaccinated.

Read the full article here: https://www.statnews.com/2020/07/27/science-alone-cannot-beat-pandemic-need-outreach-about-covid-19vaccine/

COVID-19 Laid Bare America’s Need to Confront Its Racial Health Disparities (Morning Consult)

BY BILL FRIST & RHONDA MEDOWS

Morning Consult | Every one of us is feeling the stress of these uncertain times. For Black Americans, the pain of the past several months has been especially devastating. Two viruses have reared their ugly head: COVID-19 and racism — both of which are killing people of color at disproportionate rates. 

Although we may come to this conversation from different backgrounds — as physicians and leaders in the health care community — we both firmly believe that racism is detrimental to health in all its forms and that addressing the systemic devaluing of black lives is a moral imperative. 

Rev. Martin Luther King Jr. said, “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”

While COVID-19 itself may not discriminate, Black Americans and other minorities have had to bear the greatest brunt of this pandemic due to generations of racial health disparities and inequities — related to poverty, education, housing, access to transportation, healthy food and health care.

Black Americans were already disproportionately suffering from a higher rate of underlying conditions and chronic illnesses — including diabetes, heart disease, and obesity — all conditions which increase susceptibility to the ravages of COVID-19.

Read the full article here: https://morningconsult.com/opinions/covid-19-laid-bare-americas-need-to-confront-its-racial-health-disparities/

Tennessee’s COVID-19 Update – A Weekly Analysis (Week of July 12 – 18, 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 July 12 to July 18– There were a total of 15,330 new cases, which is a new high. Comparing to the previous week, the average cases/day is 41% higher.

  • Davidson County – 2,549 new cases which is 5% higher than last week
  • Williamson County – 741 new cases which is 68.4% higher than last week
  • Other TN Counties – 12,040 cases which is 51% higher than last week

There were 100 fatalities. The previous week had 101. Hospitalizations are also at a new high averaging 65/day with a total of 456 for the week (47.5/day and 333 total for the week before). Testing for this week was 30% higher compared to last week – average of 23,756/tests/day.

Let’s keep Tennessee in the forefront of telehealth advancement (The Tennessean)

The Tennessean | We must continue to lay the groundwork that will allow virtual care to flourish so all Tennesseans will benefit.

The physical distancing precautions Tennesseans have undertaken to slow the spread of the coronavirus has affected every aspect of our lives. These changes have necessitated hardships, especially in our workplaces, schools, and families.

All of us have had to innovate, whether working at home, educating students online, or gathering our families by teleconferencing across a computer screen.

Nowhere has innovation been more thorough, rapid, and important—literally, saving lives—than in the delivery of health care through telemedicine.

Prior to the onset of the pandemic in the United States, 11% of Americans told researchers they had used telemedicine. Since early March, McKinsey & Company consulting firm reports that number has soared to 46%, or 140 million Americans, who say they have used telemedicine in 2020.

Read the full article here: https://www.tennessean.com/story/opinion/2020/07/17/keep-tennessee-cutting-edge-virtual-care/5452878002/

Tennessee’s COVID-19 Update – A Weekly Analysis (Week of July 5 – 11, 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 July 5 to July 11– There were a total of 10,866 new cases, which is a new high. Comparing to the previous week, the average cases/day is 9% higher.
    • Davidson County – 2,436 new cases which is 19% higher than last week
    • Williamson County – 44 new cases which is 36.2% higher than last week
    • Other TN Counties – 7,990 cases which is 5% higher than last week
  • There were 101 fatalities which a new high. (previous high was week starting 6.14 at 74)
  • Hospitalizations are also at a new high averaging 47.5/day with a total of 333 for the week (42.3/day and 296 total for the week before)
  • Testing for this week was flat compared to last week. Average of 18,341/tests/day

Tennessee’s COVID-19 Update – A Weekly Analysis (Week of June 28 – July 4, 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 June 28 to July 4– There were a total of 9,968 new cases. Comparing to the previous week, the average cases/day is 74% higher.

  • Davidson County – 2,051 new cases which is 86% higher than last week
  • Williamson County – 323 new cases which is 90.0% higher than last week
  • Other TN Counties – 7,594 cases which is 71% higher than last week
  • There were 53 fatalities
  • Hospitalizations average 42.3/day with a total of 296 for the week (42.5/day and 198 total for the week before)
  • Testing for this week was 78% higher compared to last week. Average of 18,500/tests/day

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.
 

Seniors are becoming COVID-19 collateral damage. They’re dying because of it, not of it. (USA Today)

Dr. Martha K. Presley and Dr. Bill Frist – Opinion contributors

USAToday.com | Coronavirus has led to social isolation and lack of caregiver support. That can be fatal for fragile elderly people who don’t have the virus.

Coronavirus has changed the way we see life and health care. The immediate focus has been on infected patients. However, the effects of the pandemic are more widespread. Here are two patient stories that emphasize the far-reaching impact of COVID-19:

Mr. Smith was an 83-year-old man who was in good physical and mental health, until he fell and broke his hip. He underwent surgery, but as many elderly patients do, suffered delirium from the surgical anesthesia. His delirium worsened with new medications and no family to help orient him to a normal daily routine. In bed with medical devices, new medications and no family is a recipe for disaster. But Mr. Smith could not have his family visit because of the appropriate visitation policies. He spent 30 days alone in the hospital. His delirium worsened, and eventually his wife chose to transition to hospice so she could be with him. He died a week later.

Ms. Jones was a 93-year-old with Alzheimer’s disease. She was living in a memory care unit and was social, interacting with others and enjoying activities. When she was isolated because of COVID-19 precautions, she became confused and anxious. She could only see her family through a window. Because of her increasing agitation, her medications were increased. The amount of nursing oversight was decreased. One morning, she was found on the floor with bruises to her chin, a broken hip and a bleed in her brain. Her family did not want to put her through the stress of a hospitalization and surgery. She was admitted to a hospice house so her family could visit. She died a week later.

Coronavirus is particularly deadly for the elderly. In 14 states, half of COVID-19 deaths are in long-term care facilities, and the deaths of the residents and workers account for a third of the national death toll. But those are just the deaths from infected patients. Mr. Smith and Ms. Jones did not die from COVID-19. They died because of it.

Read the full article here: https://www.usatoday.com/story/opinion/2020/06/15/coronavirus-dangerous-for-uninfected-elderly-column/5322589002/

The Value of Home Health Care (Morning Consult)

BY TOM DASCHLE & BILL FRIST

Morning Consult | For the first time in our modern history, staying at home has become a “new” normal. And with more than 1.5 million Americans now infected with COVID-19, never before in our lifetime has accessing care in a person’s home been so important.

Smartly, our federal and state policymakers quickly expanded reimbursement for telehealth and removed barriers that have now allowed more providers to care for patients virtually via video and phone, eliminating the risk of COVID-19 exposure during provider visits. But not all care can be provided through telehealth – and we would be shortsighted to not also address the growing need for home-based care.

Long before the COVID-19 emergency, health care policy experts have increasingly recognized the value of home-based health care. A recent AARP survey found that three in four adults 50 years and older would prefer to age in their homes and communities. And a growing body of evidence suggests it is less expensive to deliver care in the home. Indeed, for years we’ve seen hospitalized patients more quickly returning to their homes and communities to heal and recover safely, reducing costs for themselves and the health care system.

Read the full article here: https://morningconsult.com/opinions/the-value-of-home-health-care/

Health leaders: We stuck together to #StayHome, now we can start together to #OpenSafely | Opinion (USA Today)

USA Today | Americans want our country to open up safely.

We have been at this for a number of difficult weeks since the global coronavirus pandemic began, and it has taken a toll.

It has been a time of unprecedented challenge. To our health. To our jobs. To our social connections. To our health care communities.

We have sacrificed with great unity to #StayHome in order to reduce the infection rate and save lives.

We want a sense of normalcy back — to go to work, to go to restaurants, to see sports again, to send our kids to school, to hug our families — but not at the expense of the lives of our friends, families and neighbors.

We want a good economy and public safety, but we are afraid if we open too quickly, or don’t have plans to adjust if spread recurs, we will have neither.

Read the Full Article Here: https://www.usatoday.com/story/opinion/2020/05/20/coronavirus-still-spreading-america-must-open-safely-column/5216824002/

Health leaders: We stuck together to #StayHome, now we can start together to #OpenSafely (USA Today)

We don’t believe we need to wait until there is zero risk. Many states are already beginning to reopen and this must happen in the safest way possible.

USA Today | Americans want our country to open up safely. We have been at this for a number of difficult weeks since the global coronavirus pandemic began, and it has taken a toll. It has been a time of unprecedented challenge. To our health. To our jobs. To our social connections. To our health care communities.

Still growing, contagious and lethal

COVID-19 is still spreading, but at a steadier rate. While it is shrinking in places like New York, it is still growing rapidly in some areas where there had been fewer cases. The virus is still equally contagious. The virus is still lethal to many. The virus still spreads through unsuspecting asymptomatic people. Some places are especially hard hit: nursing homes, meatpacking plants, prisons, detention centers, public housing, and the communities around them as people move in and out. People are still dying at an alarming rate, and that will continue unless we follow the path like the one outlined by Dr. Deborah Birx at the White House: a steady, gated reopening that avoids accelerated growth in cases, hospitalizations and deaths.

Read the full article here: https://www.usatoday.com/story/opinion/2020/05/20/coronavirus-still-spreading-america-must-open-safely-column/5216824002/

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