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

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

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

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

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

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

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

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

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

Heart transplants were once rare.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Read the full story at Forbes.

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

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

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

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

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

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

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

Preventable.

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

Read more at Forbes.

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

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

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

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

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

Read more at USA Today.

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

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

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

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

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

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

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

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

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

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

Read more at Forbes.

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

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

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

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

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

I’m Bill Frist and Uwe is my mentor.

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

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

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

What aspect of life did Uwe not love?

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

His teaching lives with us.

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

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

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

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

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

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

Uwe taught and lived with a powerful sense of justice.

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

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

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

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

 

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

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

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

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

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

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

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

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

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

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

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

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

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

Read more at The Hill.

Notes from the Road: Hadza and Clean Water

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

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

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

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

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

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

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

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

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

Water

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

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

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

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

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

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

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

Read more at Forbes.

Notes from the Road: Tuungane Program

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

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

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

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

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

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

I see unique aspects in the TNC/Pathfinder model:

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

Notes from the Road: Africa 2018

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

On a Samaritan’s Purse trip in 2007

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

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

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

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

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

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

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

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

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

 

 

 

 

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

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

Read more at The Hill.

Tennessee gubernatorial candidates discuss education in forum (The Tennessean)

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

Read more at The Tennessean.

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

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

Read more at STAT.

 

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

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

Read more at LinkedIn.

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

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

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

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

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

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

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

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

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

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

Read more at devex.

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

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

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

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

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

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

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

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

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

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

Read more at the Salt Lake Tribune

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

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

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

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

Read more at Knoxville News Sentinel

Notes From The Road: Bob Marshall Log, August 2017

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

 

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

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

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

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

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

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

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

Read more at Forbes.

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

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

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

Read more at The Washington Post.

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

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

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

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

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

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

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

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

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

The Science Behind How Nature Affects Your Health (Forbes)

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

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

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

Study after study has shown the answer is yes.

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

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

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

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

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

Updated Nutrition Labels Can Make Us Healthier Consumers (Forbes)

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

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

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

Read more at Forbes.

As Congress Debates, What Steps Shall I Take?

Written with Gary Dodd

There’s a lot of uncertainty in healthcare today including changes to the Affordable Care Act and changes at the Centers for Medicare and Medicaid Services. As healthcare professionals, we hope we are moving to a world of alternative payment models that will be focused on quality of care, not quantity of care. Palliative medicine, whether practiced by a generalist or a specialist, is an imperative and integral part of the care system. It matters to patients to be able to have frank and honest discussions with their providers about what will happen to them as their illness progresses and to be assured adequate management of symptoms to support their desired quality of life.

But regardless of what happens in Washington, we are not powerless. This week is dedicated to making our own healthcare decisions, taking back the power for how we want our care to progress and what we want the end of our lives to look like.

Discussions about end of life care are no one’s favorite subject, but in the fog of grief, those conversations become priceless.

This week is dedicated to National Healthcare Decisions, and we urge you to broach the uncomfortable subject, to give your family a gift they may not need today but will most certainly treasure later.

  1. Educate yourself about the decisions that you may need to make about healthcare in the future.  Study and understand the risks and benefits of cardiopulmonary resuscitation, the use of ventilators, artificial hydration and nutrition, and comfort care.  If you have any questions, make an appointment to discuss your end of life goals with your healthcare provider.
  2. Engage a person you trust to be your surrogate decision maker in case you are not able to make medical decisions at any point in the future.  The person you appoint to be your proxy for healthcare must to be informed of your personal values and desires for the type of healthcare you want to receive if you are ever unable to communicate your decisions on your own.
  3. Ease the burden on your loved ones by voicing your healthcare preferences in writing.  Many resources for completing advanced directives can be found online.  Make sure you adhere to your state government’s guidelines.  Then, provide a copy of your documents that express your healthcare decisions to your medical providers and the appropriate people in your relationship network.
  4. Review your plan each year, or as your health status changes. Make updates and share them as necessary.

On this National Healthcare Decisions Day—today—take control of your health future. Spend time thinking about your future needs and share your decisions with your family and your healthcare providers. Consider this an investment in your peace and theirs.

Gary W. Dodd, ANP-BC, M.S.N, M.Div., is a Board-Certified Adult Nurse Practitioner with Aspire Healthcare promoting holistic care.

Here’s how we can make Earth Day every day in Nashville (The Tennessean)

THE TENNESSEAN | Earth Day matters — to you and your health.

Earth Day was established in 1970 to make us think, for at least one day, about the health of our environment. We submit that every day should be Earth Day. Not just for the health of nature, but for your health and well-being.

When 90 percent of a person’s health is determined by something other than doctors and hospitals, we should naturally be spending some time understanding those other determinants. And the immediate environment in which we live is chief among them.

Community well-being is rooted in the environmental health of the city, and we are not the healthiest version of ourselves.

Read more at The Tennessean: https://www.tennessean.com/story/opinion/2017/04/20/heres-how-we-can-make-earth-day-every-day-nashville/100647794/

The National Academy Of Medicine’s Vital Directions For Health: Forging a Path for our Future (Forbes)

FORBES | Health is more than healthcare. Smart reform looks beyond the current conversation of repeal and replace. It must include an active and empowered consumer making choices that matter within a modern, connected, knowledge-driven system.

That is the powerful message of the National Academy of Medicine’s pivotal report released today. Drawing on the expertise of 150 health care policy experts, scientists, and researchers from across the country, the report was developed by a bipartisan steering committee that included former Governor and HHS Secretary Mike Leavitt, former FDA Commissioner and CMS Administrator Mark McClellan, former Senate Majority Leader Tom Daschle, and me, among others. Its core goals are better health and wellbeing; high-value healthcare; and strong science & technology. The report outlines actionable policy recommendations to further these goals.

Read more at Forbes: https://www.forbes.com/sites/billfrist/2017/03/21/the-national-academy-of-medicines-vital-directions-for-health-forging-a-path-for-our-future/#6dd5bc373e49

No. 1 killer of Nashville women may surprise you (The Tennessean)

THE TENNESSEAN | If you were asked to name the No. 1 cause of death in women in Davidson County, what would you say?

Some might suggest cancer, or perhaps Alzheimer’s. But the truth is that our number one “lady killer” is a condition that many consider a man’s disease.  And what’s even more striking is that its early symptoms can go unnoticed for years.

Cardiovascular disease kills one out of every three women in the United States. In Davidson County, it is women’s number one killer. For every one woman who dies of breast cancer, more than eight die from heart disease and stroke.

And even more are at risk: 22 percent of adults smoke; nearly one-third are obese; one in four are physically inactive; and more than 33  percent report having high blood pressure.

Read more at The Tennessean: https://www.tennessean.com/story/opinion/2017/03/21/no-1-killer-nashville-women-may-surprise-you/99172294/

Reconsider severe international affairs budget cuts (The Tennessean)

TENNESSEAN | While music, faith, health care, and even hot chicken have made Nashville famous, we also have a robust hub of research, work, and advocacy for global health and development.

Thanks to the dozens of humanitarian organizations providing excellent services for vulnerable populations worldwide, Vanderbilt’s Institute for Global Health research and development, and the missions of hundreds of places of worship throughout the city, Nashville understands the critical health needs of mothers, children, and families around the world.

More than half of Americans believe that our foreign assistance constitutes 25 percent of our U.S. budget. But they are wrong. Global health advocates in Nashville know that our international affairs budget is actually less than 1 percent of the U.S. budget.

President Trump has recommended to cut this fraction — already less than a penny of each budget dollar — by 37 percent. And if the severity of this cut passes through Congress, what does that mean for women and children around the world?

Over the past 25 years, the U.S. has led an historic initiative in the history of humankind. Since 1990, we have halved the number of people living on less than $1.25 per day, even with an increase in population. We have halved the number of people who die from malaria and tuberculosis.

We have halved the number of children who die under the age of five from preventable, treatable diseases like pneumonia, malaria, and diarrhea. We have halved the number of women who die from complications in pregnancy and childbirth. And we have turned the tide of the HIV/AIDS crisis.

In 2000, less than 50,000 people in Sub-Saharan Africa had access to anti-retroviral medication. But today, thanks to the leadership of many faith, music, and academic leaders in Nashville who helped lead the nation’s advocacy to support those suffering from HIV/AIDS in Africa and around the world, over 21.5 million people have access to life-saving anti-retroviral medicines. Imagine if we cut these programs by 37 percent. How many people will die? How many more people will contract the virus because we weren’t at the forefront of prevention?

Leading the world in providing foreign assistance, albeit less than 1 percent of our budget, is not only the compassionate, moral thing to do. It’s also the smart thing to do. We know that development is a critical component to national security.

Over 120 retired generals and admirals agree. Now is not the time to back down. Failed, collapsed countries are the breeding grounds of terrorism. But if we can provide a modicum of assistance, these same states have the wherewithal to pull their communities out of poverty to empower, educate, and build employment for sustainable governments and economies.

We have revolutionized the way that we provide foreign assistance over the last 15 years. Our leading global development agency, USAID, and bipartisan Presidential initiatives such as the President’s Emergency Plan for AIDS Relief (PEPFAR), the Millennium Challenge Corporation and the Feed the Future global agriculture program are using the newest and best interventions.

They are continuously conducting evaluations and learning agendas to ensure that our tax dollars are being spent effectively and responsibly. Because economic growth and country ownership are guiding principles for our development strategy, we ensure that our assistance is rooted in partnerships that empower developing countries to assume responsibility for their own future and to move beyond dependence on foreign aid.

We ask that the president reconsider these severe cuts to the international affairs budget — from moral, national security, and economic perspectives — to preserve the current level of funding that saves the lives of millions.

Bill Frist, M.D. is a nationally acclaimed heart and lung transplant surgeon, the  former U.S. Senate Majority Leader and the founder and Chairman of Hope Through Healing Hands. Pastor Mike Glenn is Senior Pastor of Brentwood Baptist Church in Brentwood. Colleen Conway-Welch, Ph.D., R.N., is Dean Emerita of the Vanderbilt University School of Nursing and has recently been named a Living Legend by the American Academy of Nursing.

Read more at The Tennessean.

Bill Frist: Foreign Aid Saves Lives—And Makes America Safer (Christianity Today)

CHRISTIANITY TODAY | For the past two decades, we have had a front-row seat in the bipartisan movement to end worldwide preventable, treatable diseases like AIDS, tuberculosis, and malaria, and to make poverty history.

Since 1990, the world has cut in half maternal and child deaths, infectious diseases, and poverty as well as turned the tide on HIV/AIDS. We have made unprecedented strides in human history.

This may be the legacy of our generation as historians analyze what we were able to accomplish worldwide during our lifetime. Central to this legacy, it is worth noting, is the progress led by the United States during the Bush Administration. Millions of mothers, babies, children, and families are alive today thanks to America’s great leadership in the world for health, food security, and education—all at a cost of less than 1 percent of our country’s spending. (Year after year, most Americans estimate that we spend far more than that.) As doctors say, an ounce of prevention is worth a pound of cure.

As President Donald Trump seeks to balance the US budget, it has been reported that the administration wants to dramatically cut foreign assistance by as much as 37 percent.

Read more at Christianity Today: https://www.christianitytoday.com/ct/2017/march-web-only/bill-frist-foreign-aid-saves-lives-and-makes-america-safer.html

Tackling Tobacco Use In The Volunteer State: Let’s Start With Tennessee Quit Week (FORBES)

Forbes | In the last six weeks, two critical reports have shined a spotlight on Tennessee’s high levels of tobacco use and inadequate prevention efforts.

In December, the Campaign for Tobacco-Free Kids and other public health organizations published a report that compared funding for tobacco cessation and prevention in each state, and Tennessee ranked a dismal 45th nationwide.  Tobacco-Free Kids noted that Tennessee provided only 1.5% of the CDC recommended $75 million in funding for tobacco cessation, despite receiving over $400 million in revenue from tobacco taxes and a long-standing settlement deal with tobacco companies (known as the Master Settlement Agreement).

In January, the American Lung Association (ALA) released its “State of Tobacco Control” report for 2016, and Tennessee received “F” grades nearly across the board.  The ALA pointed out that the Volunteer State “remains among the 22 states that have not passed comprehensive smoke-free laws and has one of the lowest tobacco taxes in the nation.”

Read more at Forbes: https://www.forbes.com/sites/billfrist/2017/02/14/tackling-tobacco-use-in-the-volunteer-state-lets-start-with-tennessee-quit-week/#5fee396e74b7

The Case for Keeping America’s AIDS Relief Plan (New York Times)

NEW YORK TIMES | Among global public health advocates, there is a growing concern that President Trump may cut back, or even eliminate, programs that have played a critical role in fighting diseases worldwide. While every administration should strongly review our nation’s overseas commitments, and there are undoubtedly programs that we should cut, I hope he recognizes the success and importance of one in particular: the President’s Emergency Plan for AIDS Relief.

I have been treating patients in Africa and Haiti for 20 years. When I was Senate majority leader in 2003, I led the Senate’s passage of the plan, called Pepfar, on an overwhelming voice vote. It has since been reauthorized twice. President Trump, like his predecessors, will have the chance to put his own stamp on this winning program.

Pepfar was created in a moment of crisis: In the late 1990s, H.I.V.-AIDS was the No. 4 killer worldwide, and No. 1 in Africa. The program aimed to bring reliable, proven measures like antiretroviral drugs, counseling and prevention services to underserved communities around the world — and it worked. Today, Pepfar reaches 11.5 million people with antiretroviral drugs, a 50 percent increase since just 2014. Two million babies with infected mothers have been born H.I.V.-free thanks to Pepfar interventions, and 6.2 million orphans and vulnerable children receive care from the program.

Read more at the New York Times.

Telemedicine can improve access to quality, affordable care in Texas (Texas Tribune)

TEXAS TRIBUNE | If you become ill and need a doctor tonight at 11, who will you call? What will you do?

Texans in Austin, Dallas, or Houston are probably surprised to learn that Texas ranks 47th in the nation in the number of active primary care physicians per capita. Among its 254 counties, 35 have no practicing physician, and 80 have five or fewer, according to research conducted in 2015 by Merritt Hawkins. And 185 counties — more than 70 percent — lack a psychiatrist. The doctor shortage is an issue that impacts most of the state.

In recent meetings with state legislators and other public officials, I have emphasized the importance of making telemedicine a priority in the current legislative session.

Read more at TribTalk.

Less salt in foods means longer lives — Trump’s administration can fix this (The Hill)

THE HILL | No state is an island when it comes to our food and its impact — good or bad — on our population’s health.

That’s why it’s critically important for the Food and Drug Administration (FDA) to continue its efforts to reduce sodium in our packaged and restaurant foods. In June, the FDA published a draft voluntary guidance to the food industry, establishing targets for sodium reduction in two years and in 10 years. It’s time to finalize that guidance.

Read more at The Hill.

Healthy Foods Are Good For Business And Deserve The Support Of President-Elect Trump

At the start of a new year, we often find ourselves making resolutions to eat healthier and get active (I know I’m one of those people!). But the good news is, America’s interest in healthier foods has become a year-round trend, not just a New Year’s fad.

More than 66% of shoppers say they want to make healthier choices while at the grocery store. Low-calorie options accounted for 82% of snack food sales growth in 2013. Restaurant chains that increased lower-calorie menu options reported increases in store sales, customer traffic, and servings sold.

With a new Congress and a new presidential Administration starting on Friday, we have an opportunity to continue to support business-driven successes in incorporating healthier choices into Americans’ diets.

Read more at Forbes: https://www.forbes.com/sites/billfrist/2017/01/17/healthy-foods-are-good-for-business-and-deserve-the-support-of-president-elect-trump/#252f79fd7a6d

Supporting Betsy DeVos for Secretary of Education

Betsy DeVos has been nominated for the next U.S. Secretary of Education, and I believe she is the best person for the position. I’ve known Betsy for many years, and I’ve seen firsthand her passion for education and for our children. Here is the letter I’ve just sent Lamar Alexander, Chairman of the Committee on Health, Education, Labor and Pensions in support of her confirmation. 

 

Dear Chairman Alexander:

In advance of Mrs. DeVos’s  January 17th confirmation hearing in your committee, I share my strong support for her confirmation as our next U.S. Secretary of Education.

Young people in America today are entering a workforce that is the most competitive we have seen in our lifetime.  Our economy is truly global, and how well our students are learning is being measured on an international scale.

We also know that, in too many communities across our country, students are receiving an education that is leaving them unprepared for next steps after high school—a reality that has a deep impact on the success and future of our citizens.

I devoted much of my post-U.S. Senate career to improving public education in Tennessee in an effort to jumpstart long-term educational change in our state and ensure that every child graduates high school prepared for college or a career.  As a surgeon, I also know that education impacts all aspects of our life, including health.  Studies I led for the Robert Wood Johnson Foundation found that education is one of the best predictors of health outcomes from life expectancy to the infant mortality rate.

It is for these reasons that I am both excited and hopeful about the nomination of Betsy DeVos as the next U.S. secretary of education.  I have known Mrs. DeVos for many years, and I know firsthand that her passion for education comes from a deep desire to do what’s best for our nation’s children.

In Tennessee, we have shown what is possible in improving public education.  Tennessee has gone from 46th in the nation to 25th in 4th grade math in just four years. We now rank 19th in the country in 4th grade science.  More Tennessee students are enrolling in and completing education beyond high school—education that will help them secure a bright future for themselves and their children.

This progress has been made due to the reforms Tennessee has committed to—stronger teacher evaluations, higher expectations for students, teacher tenure reform, and expanding high-quality school choices for parents, among others—and those reforms must continue in order to ensure success for all students.  As the center of gravity in education moves away from the federal government and into locals’ hands, we need a secretary of education who can both safeguard the flexibility states need to advance these reforms and inspire innovation that will challenge the status quo.  I believe Betsy DeVos is that leader.

She has more than 28 years of experience advocating for policies that are good for students, policies like more choices for parents, ensuring high-quality teachers in the classroom, and protecting the right for every child to receive an excellent publicly-funded education.  With a devotion to transforming our K-12 education system that has received wide-ranging bipartisan support at the local and national levels, Mrs. DeVos fits the bill for the trailblazer needed at the helm of federal education policy.

Most importantly, she puts children at the forefront of her advocacy efforts. As a mother and grandmother who, together with her husband, helped start a high-performing public charter school in Michigan, Mrs. DeVos is intimately familiar with education policy from all angles. In fact, West Michigan Aviation Academy is the top-rated public charter high school in the state of Michigan.

Betsy DeVos will bring a renewed sense of urgency and focus to improving schools in neighborhoods across America.  As someone who has worked with Mrs. DeVos for years, I urge the U.S. Senate to confirm her nomination.  She is the public servant our country needs leading the U.S. Department of Education.

Sincerely,

William H. Frist, MD

New Model Can Advance Treatments, Cures For Rare Diseases (Forbes)

FORBES | If your child suffered from a rare and incurable disease, what would you do to find a cure?

My former colleague and good friend Dr. Chip Chambers faced just such a challenge, and took the bull by the horns. Last month, Dr. Chambers organized a unique medical conference that should serve as a model for advancing research and treatment for newly discovered rare diseases. On November 11, 136 physicians and scientists from 16 countries came together in Bethesda, Maryland for the Inaugural International Conference on Deficiency of ADA2. The medical experts were joined by nearly 70 patients and family members from six countries who are affected by DADA2 (Deficiency of Adenosine Deaminase 2), providing a unique opportunity for shared learnings and global connections.

As far as we know this is the shortest time between a disease being first described in the medical literature and the convening of an international meeting of this scale—less than three years. Nearly every physician and researcher who in some way has touched this disease was present.

Read more at Forbes: https://www.forbes.com/sites/billfrist/2016/12/15/new-model-can-advance-treatments-cures-for-rare-diseases/#2c4033cf53ed

Groundbreaking 21st Century Cures Act

The US Senate just voted 94-5 to pass the 21st Century Cures Act. This is an historic moment for American medical innovation and the millions of patients who will benefit.

The Cures Act is groundbreaking. Over the 40 years I have been in medicine, there has never been a more exciting time for medical innovation than today. The Senate’s passage of this bill will impact millions of Americans and give a big voice to patients in improving their care. With an estimated 7,000–10,000 known molecular-based diseases without cures, we now have an opportunity to change that trajectory and find new cures and treatments for patients.

Chairman Lamar Alexander’s vision and steady leadership in spearheading the Senate version through the Health, Education, Labor and Pension Committee was vital to making today possible.  I worked with Senator Alexander and the Bipartisan Policy Center to bring in medical perspectives from across the county to develop key pieces of the final legislation, including language to advance regenerative cell therapies that hold promise for restoring vision, repairing hearts, and rebuilding damaged joints.

This legislation includes major investments in cancer research, precision medicine, opioid-abuse prevention, and neurological disorders, paired with the streamlining of regulations, that will advance treatments for the millions of Americans still suffering from untreatable illnesses.  No other legislation enacted this Congress will do as much good for so many.  Its passage today will pave the way for groundbreaking cures that will touch nearly every American family, and demonstrates that Washington can still work together to address the most pressing needs of the American public.

For more information, please see the press release from the Bipartisan Policy Center:

FOR IMMEDIATE RELEASE

December 7, 2016

Contact: Joann Donnellan
(703) 966-1990
jdonnellan@bipartisanpolicy.org

Congress Puts Patients First Passing Groundbreaking 21st Century Cures Act

Washington, D.C.– Today, Congress put patients first by passing the 21st Century Cures Act – groundbreaking medical innovation and research legislation that will help millions of Americans with life-threatening diseases and their families. The Bipartisan Policy Center applauds Congress for working together to achieve this rare bipartisan compromise. It signals an encouraging moment for the nation that their government can make progress on behalf of the American people.

“The Cures Act is groundbreaking. Over the 40 years I have been in medicine, there has never been a more exciting time for medical innovation than today,” said former Senate Majority Leader Bill Frist. “The Senate’s passage of this bill will impact millions of Americans and give a big voice to patients in improving their care. With an estimated 7,000–10,000 known molecular-based diseases without cures, we now have an opportunity to change that trajectory and find new cures and treatments for patients.”

“I congratulate my former colleagues on tackling this ambitious legislation and succeeding,” said former Rep. Bart Gordon. “It shows the American people that Congress can work together to create and pass meaningful legislation that will touch their lives. I am especially pleased to see the Senate honor Vice President Biden by renaming the cancer moonshot and NIH innovation projects in the bill for his son Beau, who lost his brave battle to cancer last year.”

BPC began its medical innovation initiative in 2014 under the leadership of former Senate Majority Leader Bill Frist, M.D., and former Rep. Bart Gordon. The Cures bill reflects many provisions outlined in its July 2015 report Advancing Medical Innovation for a Healthier America: bringing the voice of the patient into the drug development process, increasing the use of real-world evidence and drug development tools to improve the drug development process, advancing precision medicine to tailor treatments for patients, enhancing the FDA’s ability to hire and retain top scientific talent, improving interoperability and increasing regulatory clarity associated with health information technology, and improving the regulation of regenerative cell therapies.

“This legislation will accelerate the development of promising new treatments and cures for Alzheimer’s disease, Parkinson’s, heart disease, diabetes, and cancer,” said Janet Marchibroda, director of BPC Health Innovation. “Extending the existing FDA accelerated pathway to include regenerative cell therapy will preserve the gold standard for safety and efficacy. This is not only groundbreaking for patients, this is groundbreaking for their families and caretakers who can also be affected.”

“Ultimately, this legislation will accelerate the discovery, development and delivery of new drugs and devices in a safe and effective manner and modernize the Food and Drug Administration,” said former FDA Commissioner Andrew von Eschenbach, who serves on BPC’s medical innovation initiative advisory committee. “It will also empower the FDA to significantly enhance the scientific resources it requires to cope with the advances in the science and technologies of medical product development.”

The bill supports significant investment in innovation and research at the National Institutes of Health and the Food and Drug Administration, including President Obama’s precision medicine initiative so doctor’s can tailor treatments to patients; the Beau Biden Cancer Moonshot to fight cancer; the BRAIN initiative to find new cures and treatments for neurological disorders and brain diseases, and to address mental illness and opioid abuse.

How NashvilleHealth Is Maximizing Community Population Health (Health Affairs)

HEALTH AFFAIRS | How can Main Street, America, move the needle in a city’s population health and wellbeing? It begins with a solid, organizational structure built for the long term.

I fondly call my hometown, Nashville, the “Silicon Valley of Health Services.” With 18 publicly traded national health care companies headquartered here with annual global health care revenues of over $70 billion, our city takes health seriously. One in 10 workers in the Nashville metro area are health care providers, nurses, or health aides. Even more work in the broader health sector, such as health management, financial, and legal roles. We have two outstanding medical schools, six schools of nursing, a dental school, and two schools of pharmacy. Our city is in the business of providing multiple health services to every state in the country.

Here is the cruel irony. When you compare us to similar cities, the health of Nashvillians is poor. We smoke at rates higher than Charlotte. We have blood pressure rates that exceed those in Austin. Our obesity rate surpasses Cincinnati’s. Our infant mortality rates are not even competitive. Our babies are more likely to die in their first year of life than in countries like Croatia, Serbia, and Qatar.

How can that possibly be? One of the things they didn’t teach me in medical school is that health services delivered accounts for only 10 to 15 percent of a population’s health status. We can build the best hospitals, provide the richest health plans, and I can be the best heart surgeon possible, but behavior and how and where people live, eat, work, and play have a far greater impact on an individual’s health.

Read more at Health Affairs.

The time to act is now: Bipartisan action will accelerate cures for Americans (The Hill)

THE HILL | With the election over, speculation is rampant on what this means for politics and policy in 2017.  We need to take a step back however, and realize there is critical work to be completed by Congress in 2016, to set the stage for a new generation of medical innovation, and demonstrate to the American people that Washington is not broken.

Congress has four remaining work weeks in Washington to hash out the budget and hopefully finish work on the “21st Century Cures” legislation which will accelerate the discovery, development, and delivery of safe and effective medical therapies.  As medical doctors we have witnessed the potential of life-changing treatments, and as a former Senate Majority Leader and former Food and Drug Administration (FDA) Commissioner who have spent years in public service — we recognize this rare and exciting opportunity for Congress to pass legislation that will affect the health and well-being of millions of Americans suffering from diseases today with no cure.

The Cures legislation is the product of two years of negotiation, resulting in nearly unanimous support among members of the House of Representatives and the Senate Health, Education, Labor, and Pensions (HELP) Committee at a time when many believed Washington was incapable of compromise.  Indeed, in late September, Senate and House leadership, and bipartisan leaders in the Senate HELP Committee and House Energy and Commerce Committee committed to getting a bill passed this fall.

Read more at The Hill: http://thehill.com/blogs/congress-blog/healthcare/307116-the-time-to-act-is-now-bipartisan-action-will-accelerate-cures

TrumpCare: In The Beginning… (Forbes)

FORBES | The immediate question for those whose lives focus around lifting the health of individual Americans is, “What does Donald J. Trump’s presidency mean for health care in America?” At the heart of the answer is uncertainty. Trump is an “unknown unknown” when it comes to deep, thoughtful health policy. He has excelled in many fields, but at best he personally has only dabbled in the field of health care, which accounts for a fifth of our overall economy and affects literally every American. So, to begin to answer the question, we can only start with what he has said on the campaign trail and the bare-boned, seven-point “plan” on his website and conjecture from there.

Read more at Forbes.

It’s time for the U.S. to lead on combating global malnutrition (The Hill)

THE HILL | One single public health crisis accounts for nearly half (45%) of all child deaths under age five. Every 4 seconds, a person dies from this cause – approximately 21,000 every day. And shockingly, nearly one in nine people globally is affected.  What is this epidemic that has taken so many lives? That has wreaked havoc on so many families? It’s want of a most basic need: we still have 795 million people worldwide who suffer from various forms of malnutrition and undernourishment.

This is not a complex disease where we need to develop new treatments, build new clinics and health infrastructure, or educate patients on prevention and medication adherence. But it is a health challenge that requires bold leadership and the commitment of greater resources from developing and developed countries. The United States should lead the way, and our next President has a unique opportunity to mobilize the global community around this critical issue.

Read more at The Hill.

My Turn: Around the world, Ayotte is a force for good (Concord Monitor)

CONCORD MONITOR | Since entering the U.S. Senate in 2011, Sen. Kelly Ayotte has emerged as a leading voice on U.S. national security and foreign policy. Through her service on the Senate Armed Services Committee, Sen. Ayotte has established herself as a strong defense hawk, consistently leading efforts to protect national security spending and to call for strong U.S. global engagement.

What is less known is Sen. Ayotte’s equally strong record of support for increased investments in the tools of U.S. soft power. Sen. Ayotte has championed strategic investments in U.S. diplomacy and development programs, and she has been a particularly strong voice in Congress for women and girls around the world.

While many Americans assume that our foreign aid dollars make up a substantial percentage of the U.S. government’s budget and that those dollars are often wasted, this could not be further from the truth. U.S. foreign assistance programs represent less than 1 percent of the federal budget, yet these programs have achieved remarkable results with strong bipartisan backing over the last two decades.

Read more at Concord Monitor: https://www.concordmonitor.com/Ayotte-has-championed-investment-in-diplomacy-and-development-5754730

Tennessee Makes Huge Strides

In 2013, Tennessee’s progress on math and reading scores was considered a bright spot. Today, our students continue to excel and have made Tennessee the fastest improving state in science since 2009.

On behalf of our team at SCORE (State Collaborative on Reforming Education), I applaud our students and teachers for their tireless efforts to strive for better. Building on our record improvement in math and reading scores in 2013, there is no doubt in mind that the future of our Tennessee children is bright.

This morning, the 2015 National Assessment of Educational Progress (NAEP), known as the Nation’s Report Card, released its 2015 Science Assessment Results, and the Volunteer State has a reason to be proud.  Tennessee is the only state to grow faster than the nation in both fourth and eighth grades, with Tennessee students doubling the average national growth in science. Our state has moved into the top 25 in science — the highest ranking it has ever held — and is now 19th and 21st in the country for fourth and eighth grade. Data demonstrated that our gender gap was eliminated, and achievement gaps between white, African-American, and Latino students narrowed.

At SCORE, we have seen firsthand the long hours and hard work put in by our teachers, school and district leaders, parents, and especially our students to make today’s exciting achievement a reality.  SCORE’s focus on driving statewide collaboration on policy and practice to ensure student success is paying off.

“Since the state began raising expectations, strengthening teaching, and emphasizing post-secondary education and workforce readiness for all students, Tennessee academic growth has been fast and sustained in multiple subjects over multiple years,” SCORE CEO Jamie Woodson said. “Although proficiency levels are not yet as high as we know our students are capable of achieving, Tennessee’s trend is decidedly in the right direction.”

SCORE will continue to work hand-in-hand with our state’s education leaders, teachers, and students to sustain and build on this headline-worthy progress.

The Last Shall Be First: Haitian Women Taking Steps To End Poverty (Forbes)

FORBES | How is it possible that the people of the poorest country in the Western Hemisphere have to shoulder repeatedly the impact of one natural disaster after another?

And what can we do as one of its closest neighbors – and by far the wealthiest country in the hemisphere – to best empower the people of Haiti to respond and to rebuild and indeed eventually to prosper after disaster strikes?

These are the questions we ask today as we see a people struggling to recover from a devastating hurricane earlier this month and an ominous rise in cholera outbreaks.

These are also the questions that a delegation of faith-based influencers from Hope Through Healing Hands and CARE asked last month as we visited Haiti to see what’s working and what’s not in terms of social and economic progress since the destructive 7.0 magnitude earthquake in 2010.

Read more at Forbes.

Want a more resilient world? Give mothers access to the tools they deserve (The Hill)

THE HILL | In 2010, the world watched in horror as more than 200,000 people lost their lives to a devastating earthquake in Haiti. And we shuddered again earlier this month when Hurricane Matthew – the most powerful storm to hit Haiti in more than 60 years – killed hundreds of people and impacted more than 2.1 million.

As the country continues to respond and rebuild, and as the world mobilizes much needed relief and assistance, it’s instructive to understand how Haitians are making themselves more resilient to natural disasters. And it is important to believe that there are strategies for long-term answers for Haiti.

One way might surprise you: better family planning.

That might seem like a lower priority amid disasters such as Hurricane Matthew. But it is exactly in these situations that women and girls are often subjected to an increased risk of sexual violence, unwanted pregnancies due to a lack of access to contraceptives and an overall lack of control over their situation.

And the time for women and couples to really strengthen their family planning strategies is between disasters, something that was clear just a week prior to Hurricane Matthew’s landfall, when CARE and Hope Through Healing Hands hosted a Learning Tour to Haiti. During the visit, the group visited successful U.S. foreign assistance programs focused on supporting healthier mothers and families.

There, the group met a woman named Ermicile Joseph, a 49-year-old mother of twelve. Ermicile welcomed the group into her home and shared her life story. She explained how hard it was to feed and provide for her large family and her wish that she had been able to time and space her pregnancies.

Ermicile lives in rural Haiti in the Central Plateau region where access to quality health care and family planning services is practically non-existent. Haitian women are often marginalized and have unequal access to everything from education and land to health care. They often experience health challenges due to serious obstacles in accessing pre- and post-natal care and family planning services.

However, this all changed for Ermicile when a community health agent made a visit to her home as part of a new effort to give mothers the services they desperately need to live healthier lives. Until recently, her options were limited. But now, Ermicile has taken control over her life and has used this newfound knowledge to educate her 31-year-old daughter Raphael about her options to choose when to have a family. Given the struggles Raphael witnessed growing up, she has decided to delay her first pregnancy until she is more financially prepared.

The benefits of this decision will have a long-term ripple effect for Raphael, her family and her community. Family planning is a powerful tool to combat poverty, particularly for those women who are able to avoid adolescent pregnancy, finish their education and enter the labor force.

When another disaster strikes the poorest country in our hemisphere, Raphael and her husband will have more capacity to provide for themselves. She will be more resilient in the face of danger. And if she does become a mother, she will know how to space a future pregnancy to avoid falling further into poverty.

We know that if women had the means to time and space the births of their children, it could prevent one in three maternal and child deaths in the developing world. Family planning is literally a life-saving intervention.

Thanks to U.S. foreign assistance, maternal and child mortality rates have dropped drastically in the past decade, as more mothers time and space their pregnancies. At a time of budget constraints, we must ensure that all of our federal programs are effective and this is an investment that pays off in the short and long-term. We must continue to ensure mothers and their families have access to the tools they so desperately need and deserve. This is particularly important during times of crisis and disaster.

We applaud the Senate for passing international family planning at the level of $622.5 million in FY17, and we call on leaders in Congress to protect these funding levels when they finalize their appropriations work after the upcoming November election. We also urge the incoming presidential Administration and the next Congress to prioritize international family planning programs within their FY18 budget requests and appropriations bills next year.

The foreign assistance budget supports families around the globe through low-cost interventions – such as family planning – that generate high-impact results. Through investments in women and girls, these programs will help women fulfill their potential and build a more sustainable future for their families and communities. And in the face of danger, they will be able to better control their family’s destiny and face the future with strength and resiliency. As Haiti currently responds to Hurricane Matthew – including CARE’s efforts to provide clean meals, water and supplies to those in immediate need throughout the country – we must stand behind mothers like Ermicile and Josephine who are the promise of a more hopeful future for Haiti.

Our Abysmal Maternal Health Statistics And How To Improve Them (Forbes)

FORBES | This past year, the United States received the dubious distinction of being one of only 7 countries in the world, including Somalia and Afghanistan, which have seen an increase in maternal mortality.

While countries with far fewer resources such as India and Brazil have made great strides to decrease the number of women who die each year as a result of pregnancy, our nation has more than doubled its rate of maternal mortality in the last twenty-five years (28 maternal deaths per 100,000 births in 2013, up from 12 in 1990). Since 2005, it has increased more than 20%. According to the World Health Organization (WHO), as many as half of these maternal deaths are preventable. This begs the question: How can we lead the world in cutting-edge health innovation and medical discoveries, yet fall behind in this telling public health metric?

The reasons for the increase are complex.

Read more at Forbes: https://www.forbes.com/sites/billfrist/2016/10/12/our-abysmal-maternal-health-statistics-and-how-to-improve-them/#7b12711033b5

Hurricane Matthew & Haiti A Week Later

Hurricane Matthew, a category 4 storm, made landfall at about 7am this morning on the southwestern tip of Haiti.  Tracy and I just left Haiti a week ago, where we traveled with Hope Through Healing Hands and CARE to assess progress made since the massive 7.0 magnitude earthquake that struck in January 2010, resulting in 300,000 deaths and 1.5 million displaced people.

The full impact of Hurricane Matthew is not yet known, as the storm continues to linger over the island nation.  However, reports indicate communities under water, buildings stripped of roofs, and homes damaged or destroyed.  At least one citizen is dead and others are missing, although no formal figures have been released yet on the toll taken on human lives.

Haiti is the poorest nation in the Western Hemisphere, and much of its population still lives in shanty towns and tents following the earthquake.  Some Haitians were hesitant to evacuate for fear of leaving their homes and having their only possessions stolen.

Rapid emergency response following a disaster of this magnitude is vital to saving human lives, preventing spread of disease, and mitigating damage to infrastructure.  Hope Through Healing Hands is taking action to provide emergency relief and support again for our Haitian friends in Port au Prince and surrounding areas. You can help by donating to the HTHH Hurricane Matthew emergency relief fund here.  The funding we raise will be distributed, as we did after the earthquake, with trusted beneficiaries whom we know allocating directly for various relief efforts.

Our thoughts and prayers are with the Haitian people today.

The Newborn Illness That Nobody Is Talking About – And It’s Not Zika (Forbes)

FORBES | Nothing can prepare a mother for seeing her newborn seize multiple times an hour, refuse to eat or sleep, and shake uncontrollably. That’s what Julia found herself facing after severe chronic back pain from a car accident left her dependent on opioids. Julia had been a college student from a middle class family with a bright future, and never imagined she would end up an addict with a newborn diagnosed with Neonatal Abstinence Syndrome (NAS).

Read more at Forbes.

Back to Haiti

NOTES FROM THE ROAD | It’s no secret that I believe investing in global health is absolutely essential, and investments in women and girls—particularly maternal and child health—does nothing less than change a country’s trajectory.

Next week, Tracy is joining me as I lead a delegation from all over the United States on a learning tour to Haiti to see firsthand the changes being made in the lives of women and how those changes are building communities.

This will be my fourth trip to the country. I first visited immediately after the earthquake in 2010. Two days after the 7.0 magnitude quake hit right outside Port au Prince, I joined Samaritan’s Purse on a medical mission. At the same time, Hope Through Healing Hands—our global health nonprofit led by Executive Director Jenny Eaton Dyer PhD—launched the Haiti Disaster Relief Fund to provide medical services, equipment, and support for those who needed immediate clinical attention. We raised over $160,000 which was donated in full to trusted beneficiaries already on the ground.

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In the six and a half years since the earthquake, Hope Through Healing Hands has stayed vitally connected to Haiti. I was part of the founding board of the Clinton-Bush Haiti fund that raised over $60 million to help facilitate the long-term rebuilding and healing in the country. Hope Through Healing Hands has been sending midwives and nurses to serve in the country through our Frist Global Health Leaders program. Just last year Laurent Lamothe, the former Prime Minister of Haiti, joined me in Nashville to share a bit about Haiti’s future.

But next week our traveling group will see firsthand some of the things Hope Through Healing Hands has been sharing for the past several years.

In Haiti, we’ll be meeting with non-governmental organizations (NGOs), faith leaders, and the U.S. Mission. We’ll visit groups with longstanding efforts on the ground in Haiti including World Relief. We will meet with women and girls and hear from them how healthcare can break the cycle of poverty, and how education builds communities. We’ll tour a rural health clinic, a maternity ward, and a regional hospital.

Haiti has the highest maternal and child mortality rates in the Western Hemisphere. Just imagine how addressing those problems will strengthen families, stabilize communities, and support the entire nation.

We are particularly excited to be partnering with CARE on this trip. CARE has been actively fighting poverty in Haiti for more than 50 years, investing in programs of economic and food security for women and youth, sexual and reproductive health, and education.

I’m looking forward to sharing what we learn. It promises to be an eye-opening week.

(If you want to check out some videos from my very first trip, it’ll be amazing to compare how far the country has come!)

Systems Strategies for Better Health Throughout the Life Course: A Vital Direction for Health and Health Care (National Academy of Medicine)

NATIONAL ACADEMY OF MEDICINE | Health and health care outcomes for Americans should be better for most, and much better for some. This should be possible with currently available knowledge and resources. Capturing the potential will require adapting our strategies and approaches to the reality that health is not immutably determined at birth, but shaped by different factors over time. Similarly, caring for health cannot be confined to singular interactions within the walls of the health care system, but must fully engage powerful determining influences residing in other systems—e.g., education, employment, justice, transportation—which are natural parts of our lives. Exploring the nature and strategic opportunities inherent in these intersecting influences is the focus of this paper, and the implications for societal attention and resources suggest the promise of shifting emphases across the life span, across systems, and within the health care system.

Our assessment begins with an overview of the prominent health and health care challenges for Americans, and they are many. U.S. life expectancy at birth ranks 43rd in the global community, and has even recently declined among some specific groups. Unacceptable disparities in health outcomes and access persist among certain populations, in particular African Americans and Native Americans (Pearcy and Keppel, 2002). The U.S. health system ranked in a World Health Organization assessment only 37th in performance among 191 member nations (WHO, 2001), and in a recent study of 11 highly industrialized Organisation for Economic Co-operation and Development nations, the United States ranked last (Davis et al., 2014). These deficiencies are all the more glaring in the face of health expenditures that are clearly the highest in the world, about 50% higher than the country next behind us, and requiring investment of nearly 18% of our total economic productivity (GDP) in 2015 (Squires and Anderson, 2015). Why are we performing so poorly relative to our potential? A major reason lies in the fact that the primary foci of our attention, our resources (Murray, 2013) and our incentives, are too narrow and too late: despite an increasingly strong and specific understanding of the preventable elements in the development of many of our health challenges— social, behavioral, environmental—our investments are primarily directed to their biomedical manifestations, well after the problems have taken root.

Read more at The National Academy of Medicine: https://nam.edu/wp-content/uploads/2016/09/Systems-Strategies-for-Better-Health-Throughout-the-Life-Course.pdf

Thank you and best wishes to Risa Lavizzo-Mourey

Earlier today Risa Lavizzo-Mourey, MD, MBA, the first woman and the first African American to lead the Robert Wood Johnson Foundation (RWJF), announced that she was stepping down from her role as President and CEO of the Robert Wood Johnson Foundation.

I have been honored to serve with Risa on the RWJF Board. Her leadership is unparalleled: visionary and strategic, but with compassion and strong conviction. Risa is the origin of the “Culture of Health” movement that is sweeping the country now and will continue for years to come. She has put a face on the public health needs of the most vulnerable in this country, and made clear the essential role the private sector plays in building healthier, more equitable communities.

As an outspoken advocate of looking at health not just as healthcare, but as the conditions in which people are born, grow, live, work and play, Risa and RWJF are transforming our nation’s approach to wellness. Her work as CEO of the Robert Wood Johnson Foundation has personally touched thousands and will impact millions. She will be sorely missed, but her legacy will live on in the countless life-changing initiatives she has cultivated at the Foundation.

I wish her all the best.

Risa’s inspiring good-bye letter and charge for the future.
Robert Wood Johnson Foundation press release

Congress Must Preserve Quitlines and The Tips Program (Forbes)

FORBES | Smoking is the number one killer and public health challenge today, causing more deaths each year than automobile accidents, firearm-related injuries, HIV, illegal drug use, and alcohol abuse—combined. As a surgeon, it was the primary cause of the heart and lung disease that I operated on every day for 15 years.

In my home town of Nashville, Tennessee, approximately 110,000 people smoke—21% of the adult population. Each is cutting on average seven to ten years from their lifespan. Their habit is costing them years lost from family, friends, and loved ones. I take this issue seriously, and we recently launched a broadly supported, collective impact initiative called NashvilleHealth, which is rallying the community to address smoking as the number one health challenge to the vitality of our county.

Read more at Forbes: http://www.forbes.com/sites/billfrist/2016/09/09/congress-must-preserve-program-that-has-helped-nearly-a-half-million-americans-quit-smoking/#72fd6c785841

The right prescription for biomedical innovation (The Hill)

THE HILL | If you were a patient suffering from a disease, and you read about a treatment option for your illness, you would probably be eager to learn more. Imagine that the drug, device or other intervention had been on the market for several years, and studies showed that it was especially effective in some patients – but in others, it was useless, or even harmful. You’d want to know which group you were in, to make a fully informed decision about whether to use the drug or device, or not.

Welcome to the world of real-world evidence in health care – information derived from the practical or actual experience of patients.  This world can look very different from the idealized settings of randomized, controlled clinical trials (RCTs) that help regulators determine whether a drug or device can be allowed onto the market.

RCTs are considered the “gold standard” of scientific evidence. By assigning patients randomly either to a “study arm” in which they get the new intervention, or a “control arm” in which they get a placebo or the standard treatment, researchers can isolate those results produced by the new drug.  But these trials are typically filled with relatively small groups of carefully preselected patients, and usually are not reflective of the far broader population of people who may eventually use the new drug, or device, or the practices of the far larger circle of physicians who will prescribe it.

Read more at The Hill: http://thehill.com/blogs/congress-blog/healthcare/294045-the-right-prescription-for-biomedical-innovation

The Food We Eat Daily That Leads To Poor Heart Health For Our Children (Forbes)

FORBES | Earlier this year, I called attention to the dangers added sugars pose to cardiovascular health and other health outcomes.  In the months since, many people have told me how surprised they’ve been to learn about the sugar hidden in their healthy morning yogurt or afternoon energy bar.  Frankly, I was too.  And this lack of food literacy is a driving factor behind our nation’s growing health crisis and obesity epidemic.

Some health-conscious organizations are trying to bridge that information gap.  This week, the American Heart Association (AHA) came out with its first ever scientific statement on added sugar for children.  A team of scientists conducted an extensive review of the available evidence published in peer-reviewed studies examining the cardiovascular health effects of added sugars on children, and came to a powerful conclusion.

The AHA-backed experts recommended that children and teens should consume less than 6 teaspoons (25 grams) of added sugar a day, and those under the age of two should not consume any added sugars.  Additionally, those 2 – 18 should limit their intake of sugar-sweetened drinks to no more than eight ounces weekly (none for those under age two).  That means less than one soda or sugary fruit drink per week.

Read more at Forbes: https://www.forbes.com/sites/billfrist/2016/08/27/the-food-we-eat-daily-that-leads-to-poor-heart-health-for-our-children/#fe1f7e92075d

How Bundled Payments Can Change Healthcare (The Hill)

THE HILL | Rising health care costs are a top concern for Americans today, with 64% of voters in a January 2016 Kaiser Health tracking poll, citing a candidate’s position on the cost of health care, health insurance, and prescription drugs as “the single most important factor” or “a very important factor” in their vote for president.  With health care costs continuing to outstrip inflation, not surprisingly, many Americans are looking to curb their out-of-pocket health care spending. Tom Daschle and I believe that now is the time to find and implement innovative approaches to fundamentally transform our approach to health care. Bundled payments should play a critical role in that.

Read more at The Hill: http://thehill.com/blogs/congress-blog/healthcare/291918-moving-the-needle-on-health-care-transformation

FDA Draft Guidance on Real-World Data (Forbes)

FORBES | In a document issued this week, the Food & Drug Administration laid out for comment its draft guidance of how real-world evidence could support regulatory decision-making for medical devices. This is a positive step forward for improving the medical product development process. At the Bipartisan Policy Center, Representative Bart Gordon and I have been urging FDA to advance medical innovation with real-world evidence. FDA has limited this guidance to how real-world evidence may be used for regulatory review of medical devices. But the FDA is to be applauded for taking this step, and acknowledging the increasingly vital role real-world data (RWD) will have in healthcare.

Read more at Forbes.

Exploring the Social Determinants of Public Health with Robert Wood Johnson Foundation

NOTES FROM THE ROAD | Scotland—Survival of men and women in Scotland is the worst in Western Europe. So is their general health. Why is that? What is being done? How successful are the new, bold initiatives that were launched in 2010?

I am in Glasgow with the board of the Robert Wood Johnson Foundation (RWJF) to explore these fundamental questions to better inform us to shape what we can do in Nashville though our bold new, community wide initiative NashvilleHealth to improve our current poor population health at home.

Scotland’s ongoing commitment since 2010 to make Scotland the best place in the world to raise a child, with the long-term goal of improving the social and health outcomes over the course of a generation, is similar to our efforts at NashvilleHealth.

And Scotland shares many of the same political, economic, and demographic profiles as the US, and Nashville.

Glasgow is about the size of Nashville: home to 600,000 people, with another 600,000 in the surrounding metropolitan area. Nashville has worse health than similar cities like Charlotte, Austin, and Denver; Glasgow has worse health compared to other UK cities with similar characteristics, such as Liverpool and Manchester. Smoking rates are about 23% for both cities. And like Nashville, within the Glasgow metropolitan area, there are even greater disparities.

In both Nashville and Glasgow, explanations for these disparate health outcomes include inequities in income and educational attainment but also social isolation, excessive tobacco and other substance abuse, unhealthy diet, and high rates of adverse childhood experiences.

A starting point for my investigations in Glasgow is similar to what we as a community are doing through NashvilleHealth at home: examine how various sectors are working together to improve the outcomes of existing programs that are aimed at helping families and children in health need.

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When Regenerative Medicine Changes Everything (Forbes)

FORBES | Two weeks ago I led a panel discussion at the Bipartisan Policy Center (BPC) on medical innovation with my good friends Senator Lamar Alexander (R-TN), who chairs the Senate Health,Education, Labor and Pension (HELP) Committee, and former Congressman Bart Gordon (D-TN), who previously chaired the House Committee on Science and Technology.  We were joined by Nashville native Doug Oliver, who had a powerful story to share.

Senator Lamar Alexander (R-TN), Doug Oliver, former Congressman Bart Gordon (D-TN), and myself.

Senator Lamar Alexander (R-TN), Doug Oliver, former Congressman Bart Gordon (D-TN), and myself.

Doug inherited a rare condition called dry macular degeneration. His vision began rapidly deteriorating at age 32, and within a year he was legally blind–unable to recognize faces, read the paper, continue his IT job, or drive a car. His doctor told him told him there was no cure but encouraged him to monitor clinicaltrials.gov, the federal site we set up when I was in the Senate where NIH-approved clinical trials are listed, for any new experimental studies that specialized in his illness.  Doug was diligent and in time found a physician in Florida who was treating his condition with patients’ own stem cells.

Doug’s decision to participate in this clinical trial was life-changing. His own stem cells were isolated in a centrifuge from bone marrow drawn from his hip bone, and then injected into his retinas. Doug saw improvement overnight, and within months—after a decade of blindness—he passed the Tennessee driver’s test and got his license back.

Read more at Forbes.

How Real-World Data Could Change Medicine (US News & World Report)

US NEWS & WORLD REPORT | With continuing advances in science and technology, the pace of medical breakthroughs is accelerating. Today, we can treat or even cure conditions that significantly shortened life just a generation ago. The exciting promises of personalized medicine are now becoming reality.

Congressman Bart Gordon and I co-chair the Bipartisan Policy Center’s initiative on Advancing Medical Innovation, and we believe that real-world data – data already amassed in electronic health records and other clinical software, claims systems and even in patients’ personal health tracking devices – is a rich source of information that can play a key role in accelerating the Food and Drug Administration’s approval process for promising drugs and devices to patients in need.

Read more at US News & World Report.

From Volume To Value: Achieving Bold Change In Our Healthcare Payment Systems (Forbes)

FORBES | One question I hear repeatedly as I travel the country discussing healthcare is whether the transition from fee-for-service to value-based care can really be done in a way that lowers cost and improves patient care. The answer is: it can.

While there isn’t a one-size-fits-all solution, successful systems change requires the collaboration and coordination of payers, providers, physicians, regulators, and patient-consumers, taking them outside their comfort zone by flipping the current incentive structure on its head.

It’s useful to review why we should change the way we pay for our healthcare in the first place. The current, dominant fee-for-service (FFS) model incentivizes over-provision of services, which contributes nothing to improving health. Physicians are paid for each medical test they run, but they aren’t compensated for coordinating patient care among different providers, or spending time on patient education. There isn’t a billing code for that. As a result, care is fragmented and disjointed, leading to inefficient delivery and wasteful duplication of services. A patient feels overwhelmed by the care labyrinth he or she must navigate. One estimate put the overtreatment cost alone at $192 billion in 2011.

Read more at Forbes: https://www.forbes.com/sites/billfrist/2016/06/30/from-volume-to-value-achieving-bold-change-in-our-healthcare-payment-systems/#1a51fa989c82 

Better Healthcare at Lower Costs (AHIP 2016)

NOTES FROM THE ROAD | I had the privilege of speaking yesterday at America’s Health Insurance Plans Institute and Expo. Along with Bernard Tyson (Kaiser Permanente) and David Bernd (Sentara Healthcare), I discussed “Better Health Care at Lower Cost: Is It Possible?”

You know my answer: It is absolutely possible with technology. In case you weren’t able to join us, here’s my view of where we are, and where we can go.

 

I am a surgeon. I like to cut, and sew, and fix. I like to keep things simple. So my central organizing thesis is this: Health care delivery today fails because of a massive mis-allocation of resources toward the goal of a patient’s health. We overuse, underuse, and misuse existing resources.

We overuse health services, driven in part by a fee-for-service payment model.

We underuse prevention services and techniques.

We misuse our existing resources—doctors, facilities, medicines— by neglecting evidence-based medicine.

This can be fixed. These are exciting times; we will see more innovation in health service delivery in the next three years than we have in all the history of modern health care delivery.

Let me give two examples, and then toss out a challenge.

Aspire & A Better Way to Die

First, in America people don’t die the way they want to. They too often die chaotically and uncomfortably, with huge costs to the patient and the system. There are too many hospitalizations, too many trips at 2 AM to the emergency room, too many painful side effects from medicines, too much discomfort.

But it doesn’t have to be that way.

A company named Aspire Health is showing us the way.

Two years ago, a group of us founded the palliative care company Aspire Health to strike right at the heart of this end-of-life chaos and waste.

Aspire took the successful, decade-old model of inpatient, brick-and-mortar palliative care and modernized and transformed it using IT and specialized teams, moving it exclusively to the outpatient and post-acute space.

Aspire is pioneering the way, taking this new model to national scale, now in 13 states and 36 cities working with 14 insurers, including many of you in the room.

It has definitively given better results for much less cost. How?

  1. It focuses on not just physical care, but on emotional, on spiritual, and on mental health as well.
  2. It focuses on not just the patient, but the family and caregivers.
  3. It delivers care not just with any doctor, but a specially-trained, palliative care doctor and a tightly-knit team of a palliative-trained nurse practitioner, social worker, registered nurse and chaplain.

It’s highly specialized care—highly individualized for the patient at the end of life—and delivered in the home with intense attention to social determinants and environment.

What’s the secret sauce?

Analytics: Early, up-front and highly accurate identification of those specific patients who definitely will benefit. Everyone claims to have these algorithms and analytics, but they don’t. Aspire’s model is proven to work.

Specialists: Aspire’s care team features specially-trained palliative physicians and nurses. These are experts on end-of-life medicine. They know how to talk and treat, understand and empathize, with these specific patients and families.

Access: Aspire patients have 24/7 access to a physician or nurse practitioner. Patients and their families always have someone to call in a crisis. They don’t have to go to the emergency room.

Technology: The system is built on powerful IT-managed caregiver workflows, which ensure that the patient always has the right person, at the right place, at the right time.

The outcomes speak for themselves. For 12,000 end-of-life patients we found:

  • Higher satisfaction for both patient and family
  • Fewer hospitalizations (60% reduction), but more patient contacts in smarter settings (home)
  • Earlier referral to hospice (31 days vs 13 days) with continuity and communication ensured
  • Savings of $13,000 per patient served (from a study with two years data across five states with matched cohort comparison)

Better health at lower cost is possible as long as we use existing resources smartly.

Teladoc & Telemedicine

Today, narrow networks rule the day. Wait times for primary doctors continue to rise.

Emergency visits are going up with expanded coverage. And rural hospitals are closing.

But today’s technology can radically improve convenient and timely access to expert physicians. Telehealth is one of the few solutions that increases the capacity of the system by improving access to care while driving down costs.

There are a small handful of companies emerging in this space. Teladoc is by far the largest telemedicine company in the country.

It will approach one million doctor-patient visits over the next 12 months. A million individuals all of whom who would otherwise have had diagnosis and care delayed, and may have ended up in emergency rooms without a telemedicine option.

Imagine for a moment, it’s 10:30 at night and your child is suffering from a high fever or some other nonemergency illness. You either anxiously wait until the next morning to try to track down a doctor (good luck), or more likely you get in a car, drive 45 minutes to the emergency room, wait an hour, see a nurse or doctor in or out of network, and drive back home 5 hours later ending up with a $1400 bill from the hospital!

Or… within 10 minutes you reach a board certified doctor by phone or video, licensed in your state, who has an average of 8 years of clinical experience. At a cost of $45 out of pocket.

Yes, a full 50% of the more than 1.5 million doctor visits Teladoc has had to date occur on nights, weekends, and holidays, when doctors’ offices are closed, and the ER or Urgent Care Center is the only alternative.

Technology-enabled, remotely-delivered care provides equal outcomes delivered much more quickly and conveniently, yet at much much lower price. The purpose is not to replace the primary care doctor but to fill the gaping holes—to improve access and deliver quality care when and where it is needed for a fraction of the cost.

Every payer and system in this room will grow its reliance on telemedicine. Willis Towers Watson says that within a year and a half, over 80% of large employers will offer a telemedicine benefit.

How do you decide whom to partner with?

First, you must insist upon quality measures. Telemedicine has a low barrier of entry—it can get dumbed down quickly by inferior doctors—but a high barrier to scale.

Second, look for high patient engagement. Telehealth is an empty promise without active patient engagement. Without engagement and use by the patient, the value, and cost savings, will never be realized.

With the value of telemedicine so obvious, what has been the biggest barrier to more widespread adoption? To date it has been the resistance of some state medical societies who hold on to antiquated models of practice delivery. This is rapidly changing as quality and cost data so powerfully demonstrate the effectiveness and safety of remotely delivered, evidence-based medicine.

The Challenge

Imagine yourself in my 12th floor conference room in Nashville across from the park three days ago. 15 people are gathered around the table including the CEOs of the five largest employers in Nashville, the four largest health care companies—big public companies like HCA, Emdeon, Change—and representatives from the more than 120 nonprofits and churches in Nashville who have some interest in improving health.

It was the inaugural board meeting of NashvilleHealth, a new, county-wide collaborative that has come together to do a simple thing: Take the aggregate population health measures of Nashville, as reported by the Robert Wood Johnson Foundation—which are poor—and make them the best in the state. And then outperform our peer cities of Charlotte, Austin, Raleigh-Durham, and Cincinnati, all of whom are beating us badly now.

Our goal is to create a culture of health, to make the healthy choice the easy choice, and to focus on the social determinants of where and how we learn, live, work, play and pray.

Our discussion centered on a real example of how we REALLY improve health. Smoking rates in Tennessee are 23%, which means we have 110,000 smokers in Nashville. If we take that down to the national average of 15% or 70,000, that means we have 40,000 fewer smokers within 5 years. We have the knowledge and the proven tools today to do that. We didn’t five years ago.

40,000 fewer smokers translates conservatively into 200,000 years of life saved. Not across the country, or across the state, but within a 3 mile radius of where we were sitting in my conference room.

That reduces the burden of disease.

That conserves the health care dollar.

That improves wellbeing and productivity.

That saves lives.

So I close with a call to action. To maximally reduce cost and improve well-being, you lead the way in your home town of formalizing your own NashvilleHealth. It’s where the real cost savings and health determinants can be achieved.

Salty Stuff (The Hill)

THE HILL | When more than 75% of the sodium you eat comes from processed foods and restaurant meals, it can seem like the problem is out of your hands. How can you cut back on salt effectively when you can’t control those foods? The Food & Drug Administration feels the same way. In a draft guidance issued yesterday morning, FDA called for the processed food, restaurant and food service industries to reduce sodium in their products. It was a wise recommendation, and not a moment too soon.

Read the rest at The Hill.

The Most Helpful Illegal Medical Procedure (Fox News)

FOX NEWS | Last year 47,000 Americans had their blindness reversed through the transplantation of cells from a corneal donor’s final selfless act. It is safe, it is effective, and because it is curative, it is a relatively cost effective procedure. It is medicine at its most beautiful.

And according to FDA regulations, the distribution of this cell therapy is in violation of federal law.

That’s right. The regulation says that no matter how competent the surgeon, the FDA must first approve cells from donated corneas as if they were a drug—a process that takes over a decade and can costs billions of dollars — all for a practice that has been successfully restoring sight for more than 50 years.

The good news: the FDA doesn’t always adhere to its regulations and has not in this case.

The bad news: inconsistent enforcement creates uncertainty, deterring innovation for other unmet medical needs such as arthritis, back pain, and diabetic ulcers.

Read more at Fox News.

The Senate Must Streamline the Drug Regulatory Process (Wall Street Journal)

WALL STREET JOURNAL | Before the Senate is a powerful medical-innovation package of 19 bills—a companion to the House-approved 21st Century Cures Act—that will streamline the nation’s regulatory process for the discovery, development and delivery of safe and effective drugs and devices, bringing the process into the new century. This legislation, crafted by the Senate’s Health, Education, Labor and Pensions Committee, touches every American. Each of us has personal health battles or knows family members and friends who are fighting against devastating diseases. Passing this package will help ensure that patients’ perspectives are integrated into the drug-development and approval process and speed up the development of new antibiotics and treatments for those who need them most.

Read more at the Wall Street Journal (sub required)

Four Strategies to Save Lives, Curb Smoking (Forbes)

FORBES | This  month, FDA passed The Tobacco Control Act, which grants the Agency the authority to regulate cigarettes, cigarette tobacco, roll-your-own tobacco, smokeless tobacco, and any other tobacco products including e-cigarettes and hookah pipes. The truth is, smoking and tobacco take 500,000 lives in the US each year, and healthcare for a smoker costs the system $18,000 more than for nonsmokers.

This is an all-hands-on-deck issue and we need a combination of efforts and approaches to make lasting change. I present four effective approaches at Forbes.

Read more at Forbes.

Congress Must Act Now to Improve School Nutrition (The Hill)

THE HILL | While headlines harp that the U.S. is a nation “hopelessly divided,” there is something lawmakers can band together on: forging a solution to our obesity epidemic.  In addition to being one of the greatest health threats our nation has ever faced, it is a terrible burden for employers, who are forced to spend more than $73 billion in costs associated with overweight-related medical and lost productivity costs every year. Obesity also threatens national security, as the leading medical reason why 71 percent of young adults between the ages of 17 and 24 cannot qualify for military service.

Read more at The Hill.

Let’s stand with retired military leaders to get healthy school meals over the finish line (The Hill)

THE HILL | While headlines harp that the U.S. is a nation “hopelessly divided,” there is something lawmakers can band together on: forging a solution to our obesity epidemic.  In addition to being one of the greatest health threats our nation has ever faced, it is a terrible burden for employers, who are forced to spend more than $73 billion in costs associated with overweight-related medical and lost productivity costs every year. Obesity also threatens national security, as the leading medical reason why 71 percent of young adults between the ages of 17 and 24 cannot qualify for military service.

The good news is that Congress has the opportunity to sustain recent improvements to school nutrition programs—a major step forward since many young people consume up to half of their daily calories during the school day.

That’s the headline from Capitol Hill, thanks to the Senate Agriculture Committee unanimously passing the bipartisan Improve Child Nutrition Integrity and Access Act in January.

Last week, a House version of the child nutrition reauthorization was introduced, but without the strong bipartisan support the Senate garnered.  It is now up to the House Education and Workforce Committee to find common ground with the Senate to move this issue forward.

Read more at The Hill: http://thehill.com/blogs/congress-blog/healthcare/278659-lets-stand-with-retired-military-leaders-to-get-healthy-school

 

Spring Update (Newsletter)

So much of my work is a balance of progress and conservation. Now, more than ever, that’s playing out at home. Tracy and I are working to turn Old Town, our Williamson County home on the Old Natchez Trace, into a thriving farm while preserving and honoring the property’s centuries-old history. We welcomed new members to our family this month. Pryor Lillie the calf is named after Old Town’s 1846 builder. Two new colts, Risa and Ray, will join us at Old Town next month. And Nickle, our little Australian Shepherd, keeps us all in line. At the same time, we’re working closely with Kevin Smith, a local archaeologist and anthropologist to preserve the 800-year-old Mississippian temple mounds that serve as the foundation for Old Town.

As always, we love welcoming friends from all over the country to Nashville. With Kix and Barbara Brooks we hosted a delegation from California a few weeks ago, touring some of the best of Nashville: the Bluebird Café, Vanderbilt, and the Frist Visual Arts Center. And I never miss the Mule Day Parade: an annual event in Columbia, Tennessee, dating back to 1840.

Today we begin two weeks of travel that will encapsulate that same push and pull. Before we go, I wanted to share with you some of what we’ve been up to and some of the important work ahead of us. We will be sharing details of the trips and what we learn on social media. Follow along on Twitter (@bfrist) or Facebook (SenatorBillFrist).

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Cellular Horizons Conference, the Vatican

We will be representing Hope Through Healing Hands and the Bipartisan Policy Center at the Vatican this week at the Cellular Horizons conference (#UniteToCure) to discuss the latest in regenerative medicine. I’ll be speaking on the Speeding Cures panel—an issue that weighs heavily on me. Late last year BPC recently released a report that I co-chaired with Representative Bart Gordon on cellular therapeutics. In the report, we encourage Congress and others to work to advance medical innovation legislation. This will require changes at FDA and in how research is structured. There’s an act pending in Congress now to apply some of these needed changes. The REGROW Act is bipartisan, bicameral legislation based on the BPC’s December report and would create an expedited approval category for adult stem cell therapy that would allow for conditional approval after Phase I and Phase II trials are complete, and evidence of safety and effectiveness is demonstrated. This could make a huge difference for how quickly we can develop life-saving drugs.

The Nature Conservancy Global Board of Directors, China

For the first time ever, the Board of Directors will visit TNC’s projects in China, and we are thrilled to be able to see some of the conservation projects underway in Sichuan, Beijing, and at 3 Gorges Dam. TNC’s goals in China include establishing land trusts, reforestation efforts, and working with the 3 Gorges Company to ensure the survival of the fisheries and communities downstream from the dam. All of this is important work, and we are anxious to be on the ground and see the progress being made.

NashvilleHealth & Domestic Health Reform

Hope Through Healing Hands & Global Health

State Collaborative on Reforming Education (SCORE)

  • All children should be educated and equipped for their futures. But how to best do that? SCORE launched a SCORE Institute in partnership with Project Renaissance to look at how students move from poverty into the middle class.
  • Community partnerships are working for education in Tennessee. SCORE highlights four that can be models of success.
  • SCORE’s Executive Chairman and Chief Executive Officer, Jamie Woodson, explains the new statewide report Equitable Access to Highly Effective Teachers for Tennessee Students and lays out the first steps toward addressing Tennessee’s “effective teaching gap”.

Tomorrow Might Be The Most Important Day This Year (Forbes)

It’s true that we are all living longer: the percentage of American adults over 65 years old has doubled since 1940, now reaching 13%. By 2050 that number is expected to double again to 25%. In actual numbers this translates to an estimated 89 million “senior citizens” by 2050.

Advances in sanitation and the advent of antibiotics has been responsible for much of this shift, and researchers continue to probe how changes in diet, medications, and genetics can slow or stop the process of aging. Artificial life preserving technology, transplantation, and advanced chemotherapies have transformed once fatal diseases into chronic illnesses. But living longer does not necessarily mean living better. Our ability to maintain the basic presence of life with medicines or machines does not mean we can continue to preserve the essence of the person that came before. We are still mortal, and we do eventually die.

Therefore, it is vitally important that you think about the type of health care you desire to receive as you approach the end of life. Saturday is National Health Care Decisions Day—April 16, 2016. Plan a time now to write out or update your personal wishes for your end of life care.

Read more at Forbes.

Improving Access and Adding Value for Mental Health Care (Forbes)

“When you break a leg, you get a cast and people sign it and put smiley faces on it. When you’re given a mental illness diagnosis, you’re cast out,” 24-year old Amanda explained to Kaiser Health News. Amanda was diagnosed with bipolar disorder in college, after several years of manic-depressive behavior. The family struggled financially and emotionally to get Amanda the best possible care, fighting against an outdated health system that is failing those with behavioral health needs.

It shouldn’t have to be that hard. We must change how we offer mental health care.

Read more at Forbes.

Charleston Helps Mothers and Children Globally (The Post and Courier)

This week, global health non-profit Hope Through Healing Hands (HTHH) seeks to galvanize the work already being done in Charleston and South Carolina around an important health initiative. HTHH will co-host a luncheon with faith leaders, nonprofit leaders, university leaders, and others in Charleston to discuss how we can better unite on behalf of child and maternal health globally.

Read more at The Post and Courier

Global Health: The Most Effective Policy

As the 2016 primaries unfold, it’s time for candidates of both parties to focus on expanding the big-hearted policies that have made this nation so exceptional. In recent years, the most effective of those policies has been global health — that is, putting U.S. resources to work saving lives in developing nations by spreading health treatments that work here at home.

Read more at The Hill.

Cutting Sugar for Better Health

On a trip this month to the U.K., I noticed many of their food and beverage products labeled “No Added Sugar,” and the message floods the airwaves. Britain has already caught on to the evils of hidden sugars, and has been loudly making it known to consumers. America should follow suit.

Reducing sugar intake isn’t just about losing weight or preventing cavities. Americans’ excessive sugar consumption poses tangible health risks. An April 2014 study published in JAMA Internal Medicine found “a significant relationship” between added sugar consumption and increased risk for cardiovascular disease mortality. Those who consumed a quarter or more of their daily calories from sugar were twice as likely to die from heart disease than those with daily sugar intake of 7% or less! As a heart surgeon, these are numbers I notice.

Read more at Forbes.

Tennessee Quit Week a first step to healthier Nashville (The Tennessean)

THE TENNESSEAN | Of the thousands of heart and lung operations I have performed, the most common cause of the underlying disease in these patients was a single voluntary behavior: smoking.

That tragedy is what Tennessee Quit Week (Feb. 22-28) is all about.

Smoking absolutely leads to a shorter, poorer-quality life. It more than doubles a person’s risk of stroke or heart disease, and increases the risk of lung cancer by 25 times!

Read more at the The Tennessean: https://www.tennessean.com/story/opinion/contributors/2016/02/22/tennessee-quit-week-first-step-healthier-nashville/80705838/

Flint’s Water Crisis and Public Health 3.0

When looking at the ongoing crisis over safe drinking water in Flint one thing is abundantly clear, the decisions made–at multiple levels–were made without a comprehensive evaluation of the impact on public health.

Karen DeSalvo, Acting Assistant Secretary for Health and National Coordinator for Health Information Technology, and I take a look at the public health approaches  being used to help the residents of Flint react to, and recover from, the consequences of the elevated levels of lead in their drinking water. In our own practices as physicians, we know that a well-rounded care team is crucial. But in public health we tend to deploy this multi-sectorial approach only in response to public health failures rather than using their full potential to improve health outcomes and prevent public health emergencies like we see today in Flint.

We believe now is the time for public health professionals to take on larger, more engaged roles as civic leaders, and for business leaders to invest fully in the health of their communities.

Read more at Forbes: What the Flint Water Crisis Reveals About Public Health