The history of Medicine has always involved a clash between the human need for compassion, unders... more The history of Medicine has always involved a clash between the human need for compassion, understanding, and partnership, and the rigors of scientific discovery and advancing technology. At the interface of these two forces are human societies that struggle to remain forward looking and hopeful while managing complex human relations. The question has been "How can science and technology improve health without undermining humans' freedom of choice and rights to selfdetermination." The rapid rise of Artificial Intelligence (AI) feels especially destabilizing because it promises, on the one hand, great promise, and on the other, great risk.
Over the past year, the general popularization of AI or Artificial Intelligence has captured the ... more Over the past year, the general popularization of AI or Artificial Intelligence has captured the world's imagination. Of course, academicians often emphasize historical context. But entrepreneurs tend to agree with Thomas Jefferson who said, "I like dreams of the future better than the history of the past." This particular dream however is all about language, its standing and significance in human society. Throughout history, language has been a species accelerant, a secret power that has allowed us to dominate and rise quickly (for better or worse) to the position of "masters of the universe." Well before ChatGPT became a household phrase, there was LDT or the laryngeal descent theory. It professed that humans unique capacity for speech was the result of a voice box, or larynx, that is lower in the throat than other primates. This permitted the "throat shape, and motor control" to produce vowels that are the cornerstone of human speech. Speech-and therefore language arrival-was pegged to anatomical evolutionary changes dated at between 200,000 and 300,000 years ago.
On the evening of December 29, 1940, with election to his 3rd term as President secured, FDR deli... more On the evening of December 29, 1940, with election to his 3rd term as President secured, FDR delivered these words as part of his sixteenth “Fireside Chat”: “There can be no appeasement with ruthlessness…No man can tame a tiger into a kitten by stroking it." Now, 83 Christmases later, with warnings of “poisoning the blood of our people,” we find ourselves contending with our own Hitler here at home. What has the rest of the civilized world learned in the meantime?
Context Empathy is a major component of a satisfactory doctor-patient relationship and the cultiv... more Context Empathy is a major component of a satisfactory doctor-patient relationship and the cultivation of empathy is a learning objective proposed by the Association of American Medical Colleges (AAMC) for all American medical schools. Therefore, it is important to address the measurement of empathy, its development and its correlates in medical schools. Objectives We designed this study to test two hypotheses: firstly, that medical students with higher empathy scores would obtain higher ratings of clinical competence in core clinical clerkships; and secondly, that women would obtain higher empathy scores than men. Materials and subjects A 20-item empathy scale developed by the authors (Jefferson Scale of Physician Empathy) was completed by 371 third-year medical students (198 men, 173 women). Methods Associations between empathy scores and ratings of clinical competence in six core clerkships, gender, and performance on objective examinations were studied by using t-test, analysis of variance, chi-square and correlation coefficients. Results Both research hypotheses were confirmed. Empathy scores were associated with ratings of clinical competence and gender, but not with performance in objective examinations such as the Medical College Admission Test (MCAT), and Steps 1 and 2 of the US Medical Licensing Examinations (USMLE). Conclusions Empathy scores are associated with ratings of clinical competence and gender. The operational measure of empathy used in this study provides opportunities to further examine educational and clinical correlates of empathy, as well as stability and changes in empathy at different stages of undergraduate and graduate medical education.
In view of many changes taking place in today’s health care marketplace, the theme of empathy in ... more In view of many changes taking place in today’s health care marketplace, the theme of empathy in health provider-patient relations needs to be revisited. It has been proposed that patients benefit when all members of the health care team provide empathic care. Despite the role of empathy in patient outcomes, empirical research on empathy among health professionals is scarce partly because of a lack of a psychometrically sound tool to measure it. In this study, we briefly describe the development and validation of the Jefferson Scale of Physician Empathy (JSPE), an instrument that was specifically developed to measure empathy among health professionals (20 Likert-type items). The purpose of this study was to compare nurses and physicians on their responses to the JSPE. Study participants were 56 female registered nurses and 42 female physicians in the Internal Medicine postgraduate medical education program at Thomas Jefferson University Hospital. The reliability coefficients (Chronb...
The present study was designed to develop a brief instrument to measure empathy in health care pr... more The present study was designed to develop a brief instrument to measure empathy in health care providers in patient care situations. Three groups participated in the study: Group 1 consisted of 55 physicians, Group 2 was 41 internal medicine residents, and Group 3 was composed of 193 third-year medical students. A 90-item preliminary version of the Empathy scale was developed based on a review of the literature and distributed to Group 1 for feedback. After pilot testing, a revised and shortened 45-item version of the instrument was distributed to Groups 2 and 3. A final version of the Jefferson Scale of Physician Empathy containing 20 items based on statistical analyses was constructed. Psychometric findings provided support for the construct validity, criterion-related validity (convergent and discriminant), and internal consistency reliability (coefficient alpha) of the scale scores.
Two Poltical Scientists have concluded that that there has been a “polarity reversal…the New Deal... more Two Poltical Scientists have concluded that that there has been a “polarity reversal…the New Deal core constituencies of the two main US parties—low-education/low-income voters for the Democrats and high-education/high-income voters for the Republicans—have become swing groups; the former swing groups are the parties’ new core constituencies (high-education/low-income voters for the Democrats and low-education/high-income voters for the Republicans).” This paper explores whether this might allow broad support for "Medicare for All."
VER THE PAST DECADES, a variety of global forces and trends have collided and conspired to fundam... more VER THE PAST DECADES, a variety of global forces and trends have collided and conspired to fundamentally transform the delivery of health care. These forces include the emergence of the health consumer movement, the creation of the Internet, an explosion of scientific discoveries, the aging of populations worldwide, the emergence of evidence-based medicine, the monetarization of medicine with associated evolving strategies for cost control, and renewed interest in relationship-based health care models. 1 Sociologists like James Coleman 2 , Nan Lin 3 and Ron Burt 4 have demonstrated that enduring social relationships are properly understood as investments in social capital, which through the reciprocal exchange of information and support, create new resources for individuals which otherwise would be impossible were they to go it alone. Recent studies in the United States have revealed that citizens believe the patient-physician relationship is second in importance only to family relationship in their society and that it far exceeds in importance spiritual relationships, financial relationships and coworker relationships.5 This relation-Relationship-Based Health Care in the United
This study was designed to investigate the impact of physicians' perceptions of the health care s... more This study was designed to investigate the impact of physicians' perceptions of the health care system on their discontent with their profession. By using a random digit dialing technique, a structured telephone interview was conducted with 401 generalist physicians (343 men, 56 women) who were practicing medicine at least for five years and were younger than 65 years. Physicians' willingness to choose medicine again was correlated with their perceptions of different aspects of the health care system. Of the total participants, 288 (72 percent) indicated that they would choose medicine again, 91 (23 percent) would not choose medicine, and 22 (5 percent) were not sure. Results of the stepwise logistic regression showed that after adjustment for physicians' gender and age, those who would not choose medicine again were more than twice as likely as other physicians who would choose medicine to believe that the health care environment will deteriorate more in the future (odds ratio = 2.1, p < .01), were less than half as likely to believe that physicians nowadays share more responsibilities with other health care professionals (odds ratio = .42, p < .01), and were less than half as likely to confirm that patients understand their health insurance better than before (odds ratio = .46, p < .01). Findings suggest that physicians' discontent can be predicted by their negative perceptions of the health care environment. Findings have implications for improving the quality of professional and personal life of the physician, thus improving the quality of care and satisfaction of the patient.
America’s attention is once again on health reform. Even as Republican governors preach caution, ... more America’s attention is once again on health reform. Even as Republican governors preach caution, the Republican controlled Congress continues to vow to repeal the Affordable Care Act and turn Medicaid into block grants.This historical comparative analysis of the two countries explores next steps in American health policy.
America’s attention is once again on health reform. Even as Republican governors preach caution, ... more America’s attention is once again on health reform. Even as Republican governors preach caution, the Republican controlled Congress continues to vow to repeal the Affordable Care Act and turn Medicaid into block grants. Canada’s health care system is by no means perfect. But as this historical comparative analysis suggests, their embrace of universality, diversity, transparency and flexibility, could well inform America's next steps.
The power of the Medical Industrial Complex derives from shared resources, shared rewards, and sh... more The power of the Medical Industrial Complex derives from shared resources, shared rewards, and shared career paths. But to leverage these assets, the various collaborators must also share liability. By choosing a decentralized system, whose credentialing and licensure and regulatory framework are largely controlled by fifty state regimes, doctors, hospitals and pharmaceutical manufacturers have had to accept a liability system based on state tort laws, one that all agree serves both patients and the Medical Industrial Complex poorly.
The power of the Medical Industrial Complex derives from shared resources, shared rewards, and sh... more The power of the Medical Industrial Complex derives from shared resources, shared rewards, and shared career paths. But to leverage these assets, the various collaborators must also share liability. By choosing a decentralized system, whose credentialing and licensure and regulatory framework are largely controlled by fifty state regimes, doctors, hospitals and pharmaceutical manufacturers have had to accept a liability system based on state tort laws, one that all agree serves both patients and the Medical Industrial Complex poorly.
The right to prescribe medicines has been a privilege granted by the United States with near excl... more The right to prescribe medicines has been a privilege granted by the United States with near exclusivity to physicians. It has been protected from encroachment by physician organizations usually based on the claim that the physician's education and training is clearly superior to others and translates into better prescribing decisions. This privilege has also been actively supported by the pharmaceutical industry that has drawn comfort from tort law's identification of the physician as a " learned intermediary " , a designation that provides some measure of liability protection from mishaps that occur in the use of their products. But as the recent issues surrounding the Oxycontin-led opioid addiction and the Adderall-led explosion of treatment of children and adults for ADHD reveal, the system is highly vulnerable to collusion, fraud and abuse. 1,2
The right to prescribe medicines has been a privilege granted by the United States with near excl... more The right to prescribe medicines has been a privilege granted by the United States with near exclusivity to physicians. It has been protected from encroachment by physician organizations usually based on the claim that the physician’s education and training is clearly superior to others and translates into better prescribing decisions. This privilege has also been actively supported by the pharmaceutical industry that has drawn comfort from tort law’s identification of the physician as a “learned intermediary”, a designation that provides some measure of liability protection from mishaps that occur in the use of their products. But as the recent issues surrounding the Oxycontin-led opioid addiction and the Adderall-led explosion of treatment of children and adults for ADHD reveal, the system is highly vulnerable to collusion, fraud and abuse.1,2
When, how, and why were physicians granted the sole right to prescribe in America?
The history of Medicine has always involved a clash between the human need for compassion, unders... more The history of Medicine has always involved a clash between the human need for compassion, understanding, and partnership, and the rigors of scientific discovery and advancing technology. At the interface of these two forces are human societies that struggle to remain forward looking and hopeful while managing complex human relations. The question has been "How can science and technology improve health without undermining humans' freedom of choice and rights to selfdetermination." The rapid rise of Artificial Intelligence (AI) feels especially destabilizing because it promises, on the one hand, great promise, and on the other, great risk.
Over the past year, the general popularization of AI or Artificial Intelligence has captured the ... more Over the past year, the general popularization of AI or Artificial Intelligence has captured the world's imagination. Of course, academicians often emphasize historical context. But entrepreneurs tend to agree with Thomas Jefferson who said, "I like dreams of the future better than the history of the past." This particular dream however is all about language, its standing and significance in human society. Throughout history, language has been a species accelerant, a secret power that has allowed us to dominate and rise quickly (for better or worse) to the position of "masters of the universe." Well before ChatGPT became a household phrase, there was LDT or the laryngeal descent theory. It professed that humans unique capacity for speech was the result of a voice box, or larynx, that is lower in the throat than other primates. This permitted the "throat shape, and motor control" to produce vowels that are the cornerstone of human speech. Speech-and therefore language arrival-was pegged to anatomical evolutionary changes dated at between 200,000 and 300,000 years ago.
On the evening of December 29, 1940, with election to his 3rd term as President secured, FDR deli... more On the evening of December 29, 1940, with election to his 3rd term as President secured, FDR delivered these words as part of his sixteenth “Fireside Chat”: “There can be no appeasement with ruthlessness…No man can tame a tiger into a kitten by stroking it." Now, 83 Christmases later, with warnings of “poisoning the blood of our people,” we find ourselves contending with our own Hitler here at home. What has the rest of the civilized world learned in the meantime?
Context Empathy is a major component of a satisfactory doctor-patient relationship and the cultiv... more Context Empathy is a major component of a satisfactory doctor-patient relationship and the cultivation of empathy is a learning objective proposed by the Association of American Medical Colleges (AAMC) for all American medical schools. Therefore, it is important to address the measurement of empathy, its development and its correlates in medical schools. Objectives We designed this study to test two hypotheses: firstly, that medical students with higher empathy scores would obtain higher ratings of clinical competence in core clinical clerkships; and secondly, that women would obtain higher empathy scores than men. Materials and subjects A 20-item empathy scale developed by the authors (Jefferson Scale of Physician Empathy) was completed by 371 third-year medical students (198 men, 173 women). Methods Associations between empathy scores and ratings of clinical competence in six core clerkships, gender, and performance on objective examinations were studied by using t-test, analysis of variance, chi-square and correlation coefficients. Results Both research hypotheses were confirmed. Empathy scores were associated with ratings of clinical competence and gender, but not with performance in objective examinations such as the Medical College Admission Test (MCAT), and Steps 1 and 2 of the US Medical Licensing Examinations (USMLE). Conclusions Empathy scores are associated with ratings of clinical competence and gender. The operational measure of empathy used in this study provides opportunities to further examine educational and clinical correlates of empathy, as well as stability and changes in empathy at different stages of undergraduate and graduate medical education.
In view of many changes taking place in today’s health care marketplace, the theme of empathy in ... more In view of many changes taking place in today’s health care marketplace, the theme of empathy in health provider-patient relations needs to be revisited. It has been proposed that patients benefit when all members of the health care team provide empathic care. Despite the role of empathy in patient outcomes, empirical research on empathy among health professionals is scarce partly because of a lack of a psychometrically sound tool to measure it. In this study, we briefly describe the development and validation of the Jefferson Scale of Physician Empathy (JSPE), an instrument that was specifically developed to measure empathy among health professionals (20 Likert-type items). The purpose of this study was to compare nurses and physicians on their responses to the JSPE. Study participants were 56 female registered nurses and 42 female physicians in the Internal Medicine postgraduate medical education program at Thomas Jefferson University Hospital. The reliability coefficients (Chronb...
The present study was designed to develop a brief instrument to measure empathy in health care pr... more The present study was designed to develop a brief instrument to measure empathy in health care providers in patient care situations. Three groups participated in the study: Group 1 consisted of 55 physicians, Group 2 was 41 internal medicine residents, and Group 3 was composed of 193 third-year medical students. A 90-item preliminary version of the Empathy scale was developed based on a review of the literature and distributed to Group 1 for feedback. After pilot testing, a revised and shortened 45-item version of the instrument was distributed to Groups 2 and 3. A final version of the Jefferson Scale of Physician Empathy containing 20 items based on statistical analyses was constructed. Psychometric findings provided support for the construct validity, criterion-related validity (convergent and discriminant), and internal consistency reliability (coefficient alpha) of the scale scores.
Two Poltical Scientists have concluded that that there has been a “polarity reversal…the New Deal... more Two Poltical Scientists have concluded that that there has been a “polarity reversal…the New Deal core constituencies of the two main US parties—low-education/low-income voters for the Democrats and high-education/high-income voters for the Republicans—have become swing groups; the former swing groups are the parties’ new core constituencies (high-education/low-income voters for the Democrats and low-education/high-income voters for the Republicans).” This paper explores whether this might allow broad support for "Medicare for All."
VER THE PAST DECADES, a variety of global forces and trends have collided and conspired to fundam... more VER THE PAST DECADES, a variety of global forces and trends have collided and conspired to fundamentally transform the delivery of health care. These forces include the emergence of the health consumer movement, the creation of the Internet, an explosion of scientific discoveries, the aging of populations worldwide, the emergence of evidence-based medicine, the monetarization of medicine with associated evolving strategies for cost control, and renewed interest in relationship-based health care models. 1 Sociologists like James Coleman 2 , Nan Lin 3 and Ron Burt 4 have demonstrated that enduring social relationships are properly understood as investments in social capital, which through the reciprocal exchange of information and support, create new resources for individuals which otherwise would be impossible were they to go it alone. Recent studies in the United States have revealed that citizens believe the patient-physician relationship is second in importance only to family relationship in their society and that it far exceeds in importance spiritual relationships, financial relationships and coworker relationships.5 This relation-Relationship-Based Health Care in the United
This study was designed to investigate the impact of physicians' perceptions of the health care s... more This study was designed to investigate the impact of physicians' perceptions of the health care system on their discontent with their profession. By using a random digit dialing technique, a structured telephone interview was conducted with 401 generalist physicians (343 men, 56 women) who were practicing medicine at least for five years and were younger than 65 years. Physicians' willingness to choose medicine again was correlated with their perceptions of different aspects of the health care system. Of the total participants, 288 (72 percent) indicated that they would choose medicine again, 91 (23 percent) would not choose medicine, and 22 (5 percent) were not sure. Results of the stepwise logistic regression showed that after adjustment for physicians' gender and age, those who would not choose medicine again were more than twice as likely as other physicians who would choose medicine to believe that the health care environment will deteriorate more in the future (odds ratio = 2.1, p < .01), were less than half as likely to believe that physicians nowadays share more responsibilities with other health care professionals (odds ratio = .42, p < .01), and were less than half as likely to confirm that patients understand their health insurance better than before (odds ratio = .46, p < .01). Findings suggest that physicians' discontent can be predicted by their negative perceptions of the health care environment. Findings have implications for improving the quality of professional and personal life of the physician, thus improving the quality of care and satisfaction of the patient.
America’s attention is once again on health reform. Even as Republican governors preach caution, ... more America’s attention is once again on health reform. Even as Republican governors preach caution, the Republican controlled Congress continues to vow to repeal the Affordable Care Act and turn Medicaid into block grants.This historical comparative analysis of the two countries explores next steps in American health policy.
America’s attention is once again on health reform. Even as Republican governors preach caution, ... more America’s attention is once again on health reform. Even as Republican governors preach caution, the Republican controlled Congress continues to vow to repeal the Affordable Care Act and turn Medicaid into block grants. Canada’s health care system is by no means perfect. But as this historical comparative analysis suggests, their embrace of universality, diversity, transparency and flexibility, could well inform America's next steps.
The power of the Medical Industrial Complex derives from shared resources, shared rewards, and sh... more The power of the Medical Industrial Complex derives from shared resources, shared rewards, and shared career paths. But to leverage these assets, the various collaborators must also share liability. By choosing a decentralized system, whose credentialing and licensure and regulatory framework are largely controlled by fifty state regimes, doctors, hospitals and pharmaceutical manufacturers have had to accept a liability system based on state tort laws, one that all agree serves both patients and the Medical Industrial Complex poorly.
The power of the Medical Industrial Complex derives from shared resources, shared rewards, and sh... more The power of the Medical Industrial Complex derives from shared resources, shared rewards, and shared career paths. But to leverage these assets, the various collaborators must also share liability. By choosing a decentralized system, whose credentialing and licensure and regulatory framework are largely controlled by fifty state regimes, doctors, hospitals and pharmaceutical manufacturers have had to accept a liability system based on state tort laws, one that all agree serves both patients and the Medical Industrial Complex poorly.
The right to prescribe medicines has been a privilege granted by the United States with near excl... more The right to prescribe medicines has been a privilege granted by the United States with near exclusivity to physicians. It has been protected from encroachment by physician organizations usually based on the claim that the physician's education and training is clearly superior to others and translates into better prescribing decisions. This privilege has also been actively supported by the pharmaceutical industry that has drawn comfort from tort law's identification of the physician as a " learned intermediary " , a designation that provides some measure of liability protection from mishaps that occur in the use of their products. But as the recent issues surrounding the Oxycontin-led opioid addiction and the Adderall-led explosion of treatment of children and adults for ADHD reveal, the system is highly vulnerable to collusion, fraud and abuse. 1,2
The right to prescribe medicines has been a privilege granted by the United States with near excl... more The right to prescribe medicines has been a privilege granted by the United States with near exclusivity to physicians. It has been protected from encroachment by physician organizations usually based on the claim that the physician’s education and training is clearly superior to others and translates into better prescribing decisions. This privilege has also been actively supported by the pharmaceutical industry that has drawn comfort from tort law’s identification of the physician as a “learned intermediary”, a designation that provides some measure of liability protection from mishaps that occur in the use of their products. But as the recent issues surrounding the Oxycontin-led opioid addiction and the Adderall-led explosion of treatment of children and adults for ADHD reveal, the system is highly vulnerable to collusion, fraud and abuse.1,2
When, how, and why were physicians granted the sole right to prescribe in America?
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Papers by Mike Magee
Affordable Care Act and turn Medicaid into block grants.This historical comparative analysis of the two countries explores next steps in American health policy.
When, how, and why were physicians granted the sole right to prescribe in America?
Affordable Care Act and turn Medicaid into block grants.This historical comparative analysis of the two countries explores next steps in American health policy.
When, how, and why were physicians granted the sole right to prescribe in America?