Jake Page. Source: Rio Nuevo
I didn’t know Jake Page. Until his death, I wasn’t even aware of him.
But reading his obituary, I see a kindred spirit.
Page was a young editor at Doubleday when he was given responsibility for an imprint called “Natural History Books.” He’d never taken a science course in high school (how is that possible?) or college, and was suddenly in charge of making science books accessible to regular people.
“My job was to edit them so that any idiot could read them,” he told an interviewer. “I was any idiot then for the next seven years.”
He eventually wrote a monthly column for Smithsonian Magazine called “Phenomena, Comment and Notes.”
His style was to report on science by imbuing his writing with humor. “Science, which always seems earnest to the point of stuffiness, is too important to leave only to scientists.”
Amen, I say. The same holds true for medicine.
One other note about Mr. Page: Apparently, he had a good eye. Early in his career, he recommended publishing a series by a British author named J.R.R. Tolkien, only to be rebuffed by his boss.
Recalling his life in publishing, Page recalled, “Most memorably, the editor…shot down my notion that we should publish a fascinating trilogy by an English author, so the whole billion-dollar Hobbit enterprise was taken on by Ballantine.”
My son and I recently saw the Oscar-winning documentary “Citizen Four” about NSA contractor and leaker Edward Snowden. It’s a riveting film, because it not only covers the topic of unwarranted government surveillance, but it was made in ‘real time,’ as Laura Poitras, the filmmaker, was in Hong Kong filming Snowden and reporter Glenn Greenwald as the first stories broke and Snowden’s identity became known.
It’s an interesting coincidence, then, to read the obituary of an almost-whistleblower by the name of Dr. Irwin Schatz. Schatz is remembered for writing a letter to the authors of a medical journal article in 1965 about the infamous “Tuskegee Syphilis Study,” in which black men in the South, primarily Alabama, were followed without treatment for decades to learn about the ‘natural history’ of untreated syphilis. The study was administered by the United States Public Health Service, and is widely remembered and taught as an egregious example of bad medical ethics. If the profession’s dictum is “First, do no harm,” the Tuskegee study caused irreparable harm by not treating an illness for which there was a surefire cure: penicillin.
The obituary contains all of Schatz’ three-line letter, which was sent to the study’s senior author:
“I am utterly astounded by the fact that physicians allow patients with potentially fatal disease to remain untreated when effective therapy is available. I assume you feel that the information which is extracted from observation of this untreated group is worth their sacrifice. If this is the case, then I suggest the United States Public Health Service and those physicians associated with it in this study need to re-evaluate their moral judgments in this regard.”
Unfortunately, when his letter went unanswered, he did not persist. It took the whistleblowing of a Public Health Service investigator named Peter Buxtun to finally bring the study to a close in 1972. Unsurprisingly, it took Buxtun a number of tries to bring the unethical nature of the study to light. He first tried to go through official channels, as early as 1966, but was met with resistance on several occasions. It wasn’t until he leaked the information to a reporter at the Washington Star that the story received enough attention to stop the study.
Snowden registered his concerns with his superiors, too, before ultimately deciding to go to the media because no one in the hierarchy seemed poised to question the status quo.
Senator Chuck Grassley of Iowa, as of this month the Chair of the Senate Judiciary Committee, has led a decade-long crusade to make our nation’s non-profit hospitals more accountable to the public.
After all, the reasoning goes, non-profit hospitals are tax exempt because they provide community benefit. How this standard is defined has been the crux of the issue.
Hospitals always face a share of patients that are uninsured, who are therefore unable to meet the high costs of hospitalization. Depending on their location, some non-profits care for more non-insured patients than others. Of course, the Affordable Care Act (Obamacare) was designed in part to greatly lessen the number of uninsured among us — a win for those patients, and for the hospitals that struggle financially because of non-collected fees. The American Hospital Association (AHA) supported the passage of the Affordable Care Act under the premise that nearly all patients would become paying customers.
Since not all states (>20) have agreed to expand their Medicaid pools in spite of generous new federal funding, there are still millions of uninsured patients straining the finances of hospitals. Businesses (non-profit hospitals included) have a right to collect payment for services rendered. But how aggressive should non-profit hospitals be in pursuit of unpaid fees?
Propublica, a non-profit investigative journalism enterprise, has researched the billing practices of non-profit hospitals in six states. What they found ‘astounded‘ Senator Grassley: aggressive collection practices including lawsuits, wage garnishing, and the placement of liens on personal property. These practices are legal, but skirt the ethical notion of helping our fellow humans. If sick people are rendered health care services but then put into collections, the results can be emotionally, financially, and even physically catastrophic. To me it certainly seems counterproductive to bully members of your community, who more than likely will continue to be customers.
Stay tuned to find out if Sen. Grassley and his committee do anything to rein in these practices. My guess is we’ll see an attempt made to more clearly define the community benefit standard and put limits on what extent hospitals can go to for collecting unpaid bills. One option: taking away a hospital’s non-profit status if it continues engaging in such aggressive collection practices.
RIP: EB (1931-2015)
“Let’s play two!”