by Elizabeth D. Wickham, PhD
Executive Director, LifeTree
Lest there be any doubt. Covid-19 is as much political as it is medical. Actually, it would be more accurate to say that a lot of what was once purely medical has become political, thanks in part to the euthanasia movement. Medicine is being fundamentally transformed to make sure that euthanasia has a primary role in the standard of care for the seriously ill.
Please take time to follow this essay to its conclusion and you should end with a realization that indeed palliative medicine was just the beginning of a major transformation in medicine. We will end where we begin, with what is happening at the National Academy of Medicine, formerly the National Institute of Medicine.
The National Academy of Medicine is led by Chinese American-born and pandemic expert Dr. Victor Dzau. The NAM is working on a new era of healthcare delivery known as Precision Medicine. The description uses words such as data, algorithms and precision molecular tools, high value, improving outcomes and decreasing cost. A key element is merging an individual’s health data into an entire community’s data so that they can use artificial intelligence and algorithms to specify a patient’s medical treatment. (See the NAM Sept, 2016 Discussion Paper “Realizing the Full Potential of Precision Medicine in Health and Health Care: A Vital Direction for Health and Health Care” https://nam.edu/realizing-the-full-potential-of-precision-medicine-in-health-and-health-care-a-vital-direction-for-health-and-health-care/).
To understand Dr. Dzau’s role in transforming healthcare is a major project. You might want to listen to Amazing Polly’s video titled “More Public Health Mafia Connections” which is the first video at https://www.amazingpolly.net/videos.html. She says he is everywhere!
How to establish a pervasive role for palliative medicine now that medicine has been shaken by a serious pandemic is an important task for these people of the Third Path. A couple of videos might help you understand what evolved rather quickly during these last two months. Both videos feature Dr. Diane Meier of the Center to Advance Palliative Care. The first one is a public webinar of Meier and others including the important Dr. Sean Morrison of the National Palliative Care Research Center (NPCRC) and the second is a Diane Meier interview by Alexandra Drane of the Coalition to Transform Advance Care. They help us understand how the palliative model is changing during this pandemic.
The first video takes place at the Center to Advance Palliative Care on March 31, 2020. CAPC is located adjacent to Mt. Sinai Hospital in Manhattan which was in the epicenter of the pandemic. Attached is a transcription of that video and hyperlink.
(From Video #1): “…A couple things we thought might be helpful but in fact turned out not to be helpful. The first was, our initial thought was that we could train front line providers in core communication skills and core pain and symptom management skills that would relieve pressure on palliative care teams; that turned out not to be true; that what was seen and what we have seen happening is that Emergency Departments, ICU’s and even Hospital Services are so overwhelmed with patients that people only really have time to manage clinical symptoms, intubate where necessary and provide critical care…”
Hence, Diane Meier and her CAPC members decided to move at least one palliative care professional into every ED and ICU of the Mt. Sinai Healthcare System.
Meier and Morrison talk about getting sufficient numbers of their palliative people into the critical sections of hospitals during the surge. One in ER and one in ICU won’t be enough. Remember, up until this point in time, palliative-trained specialists in hospitals appeared as part of formal palliative care teams (physician, nurse, chaplain, social worker). Now, with the pandemic riding rough shod on all actions taken within the hospital, the process of deciding on goals of care had to be compressed.
They decided to make a palliative expert who was experienced at “having those conversations” available 24/7 by phone on the front line. A hotline available straight through to someone trained in the palliative philosophy could solve the numbers problem.
Also on video #1 they talk about making available to frontline clinicians palliative care protocols for symptom management (pain, shortness of breath, etc.).
” …but what our system has done to try to support non-Palliative Care clinicians that are taking care of sick patients, is put pocket cards with scripts, literally, how do you talk to a family about this and very easy to read and interpret symptom management… almost recipes (14:49). What’s the starting dose of opioids for shortness of breath? What do you have to do if that doesn’t work? When do you increase the dose? So, having those types of resources ready before you need them, would be really helpful. We’ve been scrambling to get them done 3 – 5 days after we needed them and… so… most of those resources are available for… virtually all of them are available for free, for download, on the CAPC website.”
The second video was released last week on CAPC’s blogsite — getpalliativcare.org. You can listen to Sunday in May, 2020 interview of Diane Meier by Alexandra Drane of the Coalition to Transform Advance Care (a policy making organization for the Third Path Euthanasia Movement). For those who want to study this video more carefully, the transcript of text is attached. Here is the video hyperlink.
Diane Meier describes the change in palliative care due to the pandemic, especially how the hotline to a palliative care professional now has a bridge-like role. She relates a specific case and how it progresses from her to the clinician and then from her to the family.
Remember, the hotline from the hospital to a cell phone somewhere is manned by a palliative care specialist (e.g. Diane Meier) who is trained in “having family conversations.”
Here’s how it works. The patient arrives and someone at the hospital calls the cell phone number. The palliative care specialist at the other end of the phone number gets in touch with the clinician (physician) in charge of the patient. The palliative care specialist asks the clinician to describe the patient’s condition — “how does the patient look”, etc. Then the palliative care specialist calls the patient’s family and waits for everyone to get on line. The palliative care specialist relates to the family the conversation he/she just had with the clinician. Then they probably discuss whether the patient has an advance directive. If there are no directives the palliative person asks the family what the patient would want in the way of medical treatment. Then the palliative person asks the family if the patient’s choice would change should the patient become worse…. Yada, yada, yada.
The stark reality is that the patient whose life is at stake is not a party to either conversation! Because of the new CMS guidelines for isolating patients with Coronavirus-19 symptoms from their families a new protocol for palliative care is developing. Now there are cell phone numbers to palliative experts that take the Coronavirus-19 patient out of the picture. The palliative professional becomes a bridge upstream to the doctor and downstream to the patient’s family. They are the bridge Soros built to medical care for patients with Coronavirus-19.
A comment on the death rates due to this virus. I would venture to say that the death rate due to coronavirus-19 has been inflated by multiple decisions to give “comfort care only” guided by a Palliative Care Specialist. These people have a different goal than most of us!!
Monumental Changes in process
Now let me take you back to the beginning of our journey to understand the monumental changes in healthcare and how they are changing with the pandemic. At the beginning I mentioned Dr. Victor Dzau of the National Academy for Medicine and the NAM initiative to develop what they call “Precision Medicine.” Isn’t it a coincidence that the SUPPORT Study was conducted at 5 medical centers including the one at Duke starting in the late 1980s and ending in the early 1990s. See the part 2 of lifetree’s timeline at https://www.lifetree.org/timeline/part2.htm.
Along the way Dr. Victor Dzau was CEO and President of Duke University Health System and on the Board of Health Governors of the World Economic Forum, chairing its Global Agenda Council on Personalized and Precision Medicine. He is on the Expert Board of the Imperial College Health Partners, UK which provided some of the outrageous models for mitigating pandemics.
Fast forward to November, 2019. Now we have that same Dr. Victor Dzau co-hosting a symposium event at Duke called “Vital Direction for Health and HealthCare: The North Carolina Experience” with Dr. Mandy Cohen who in the 2010s was in charge of rolling out the Affordable Care Act! She is now head the NC Dept of Health and Human Services.
I believe “Precision Medicine” is about using Artificial Intelligence and developing algorithmic tools to determine what medical treatments will be given and paid for. (or not.) “Precision Medicine” is one step beyond Palliative Care which has always been sold as a cost effective medical tool.
Republished with permission of its author
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