Analysis

An at least temporarily pulled study that shows the low costs of urgent care centers compared to free-standing emergency departments in Texas shed light on the infighting that can exist in the seemingly staid world of academic papers.

The conflict over the paper for the Annals of Emergency Medicine,  the journal of the official publication of the American College of Emergency Physicians, exposes the much lamented “silos” in healthcare, and interest groups trying to demonstrate the advantages of either urgent care centers or emergency departments and their impacts on patients.

Or do they?  Or does the situation show that researchers and physicians are addressing far different scenarios in a search for truth that the journal editors just feel uncomfortable about, at this point, and don’t believe is fully documented?

Those are the among the issues that are likely to be explored in the days, weeks, or months ahead in the wake of the Journal of Emergency Medicine’s decision to pull from its website the study that determined that, for instance, a patient can be charged as much as 10 times more in a free-standing emergency room than in an urgent care center for the same diagnosis.

Some emergency department officials complained about flaws of the findings, raising questions about the data. The top author, however, has said the criticism was unfounded and appeared to be political.  HealthDataBuzz revealed the removal from the website on May 8.

The complaints in question about the study centered on data about reimbursement rates paid to doctors, journal editor-in-chief  Michael  Callaham told the Houston Chronicle. Lead author Vivian Ho, a health economist at Rice University’s Baker Institute,  had said officials of the journal had complained mostly about data in an appendix in the study that was later corrected.  Retraction Watch also has reported on the controversy.

Blue Cross Blue Shield of Texas Says the Controversial Study is Right On

Recently, the paper by Ho and colleagues gained a big boost for its accuracy from Blue Cross Blue Shield of Texas, whose researchers also participated in the study.

“This important study highlights the unnecessary increase in cost associated with the use of freestanding emergency rooms, particularly at a time when healthcare costs continue to rise,” BCBS’s Chris Callahan, senior director, media and public relations, said in a statement.  “The facts remain, freestanding emergency rooms charge up to 10 times more than urgent care centers with more than 75% overlap in diagnoses.”

The statement said that the BCBS “firmly supports the work done” by Ho and other authors from Texas academic institutions in the paper.

On the surface, the BCBS statement — similar to one given and first reported by the Houston Chronicle —  appears to be a strong backing of the study. Game over. A home run. Get the study back in the journal and published, no?

Not Ready Yet

But…hold on.

The BCBS statement was immediately criticized, as a top official representing free-standing emergency departments accused Blue Cross Blue Shield of engaging in a scheme against emergency medicine doctors, the Chronicle reported.

Meanwhile, in  email exchanges with HealthDataBuzz within the past two weeks, Callaham, the journal editor, professor emeritus of emergency medicine at the University of California-San Francisco,  said that although BCBS told the press it validated the findings, it had yet to send him information “attesting to the completeness of the data.”

The journal’s editor said he wanted BCBS  to share the data or at “least provide an important third party assessment of it.”

However, Blue Cross Blue Shield of Texas said it would communicate with Ho, not the editor.  “The communication channel has been between the journal and Dr. Ho,” the BCBS spokesman said. “As lead author, it’s probably best to keep that as the primary channel.”

That disappointed Callaham, the journal editor.  Callaham said he would have liked a “specific executive to be responsible for the completeness of the data, not an anonymous” quote to the press from BCBS.

“There should be an identified individual who stands behind the data and vouches that it is accurate and complete,” Callaham said.

The data. There’s the rub.

In the meantime, Ho is planning a follow-up response, and both sides are hoping to work toward a resolution, though judging from the statements and feelings of the parties involved, it may not be an easy task.

Whatever decision is reached can be a boon for care for patients, the ultimate priority, when they figure out the numbers.

— Joe Cantlupe

Part 2 The Opioid Crisis

Americans are mostly good-hearted people and rush to make food or visit their neighbors who return from a hospital stay.

But what about when someone returns home from a drug-rehabilitation stint after an opioid abuse incident?

Any balloons around the mailboxes? Any proposed get-togethers to celebrate?

Don’t count on it, says Leslie R. Dye, MD, FACMT, Editor-in-Chief, Point of Care Content for Elsevier and President of the Medical Toxicology Foundation.

“Much of the public and medical community still does not realize that addiction is a disease and not a moral failing,” she says. “Addiction is not a casserole disease. When someone has cancer the neighbors bring casseroles; when someone goes to treatment for addiction, the family is often ashamed and shamed.”

“If we try to treat hypertension by telling people that they’re bad people and need medication, how effective would that be? An addict also needs medication, even if it is going to regular 12 step meetings.”

“The fact that addiction is a disease does not excuse the problem. Those with the disease have the responsibility to treat it,” Dye says.”

Opioid involved deaths have continued to increase and overdose deaths have quadrupled since 1999. In Part 1 Dye discussed many factors surrounding the national epidemic of opioid and heroin abuse,  including over-treatment of pain, the explosive marketing of pharmaceuticals, and uneven regulations. Dye continues her conversation with HealthDataBuzz about the wide-ranging problem. She focuses on attitudes in the opioid crisis, which has riveted the nation’s attention but the discussion often has not often focused on our day-to-day human perception about the issue.

“Attitudes must change if we are to overcome and treat the opioid epidemic,” says Dye, also past president of the American College of Medical Toxicology

“There is a difference between ‘calling something’ a chronic disease and having evidence to support that it is,” she said. “Addiction is a chronic, relapsing, progressive and often fatal disease. There is medical evidence to support that. Until we recognize and accept that, the solution will be elusive,” she says

That ignorance also extends to the doctor’s office as well, she adds.

“One of the big issues now is that doctors are advised to be very careful when prescribing opioids. Therefore, a person with the addiction will turn to street drugs. They are also cheaper,” she says.

A year ago, the Centers for Disease Prevention and Control issued new guidelines recommending that doctors first prescribe non-opioid medications or non-drug treatments for pain, such as physical therapy, the Boston Globe reported.

“The policy-makers seem to think that we can apply a simple solution, and that creates a lot of adverse and unintended consequences,” said Bob Twillman, director of the American Academy of Pain Management,  according to ClinicPainAdvisor.

Sometimes the medical community feels caught in the middle. When doctors don’t prescribe opioids they are seeking, some patients with addictions may lash out, or turn to the streets for heroin. Derivatives of fentanyl are also becoming an increasing concern; they are more deadly and cheaper than prescription drugs, Dye says.

There’s still a way for physicians to take steps that can improve prescribing patterns and concerns, Dye says.

“Perhaps by affecting prescribing habits, we can decrease the initial trigger for addiction, but the disease model suggests that even short- term use can uncover the disease,” Dye says. “We definitely need to consider alternatives to opioids for pain.”

The many tentacles of the abuses of opioids and impacts are well documented. Questions also surround the ramifications of the key medications for opioid addiction. “There are really no good alternative antidotes for the treatment of acute overdose,” she says. First responders to opioid emergency cases administer Narcan, and the antidote also is sent home with addicts and their families.

“I have heard physicians complain that, by administering Narcan or sending it home with patients, we are ‘enabling’ addicts. That’s nonsense”, she says. “Should we withhold inhalers to those with emphysema if they continue to smoke? Should we withhold insulin from a patient because they don’t follow the appropriate diet?”

“Unfortunately, many in healthcare could be called people who “enable.” Yet there is power to that, in a positive way. “I always saythe EM (mergency medicine) could be called “enabling medicine.’”

Training and Education Needed

The American Society of Addiction Medicine is trying to train more physicians to treat addiction, which is much-needed, as well as others in the medical workforce, Dye says. “We also need to improve access to and availability of treatment.

At the White House, Congress and elsewhere, opioid abuse is a continual focus, although some are concerned it may be out-of-focus.

President Trump’s  budget was criticized for putting more people at risk. His budget calls for $500 million increase from the 2016 funding levels for opioid abuse prevention efforts, and to expand treatment. “But the budget never provides specifics as to how much the administration would like to see invested in mental health or where the money it calls to fight opioid addiction CDC block grants would come from,” says Modern Healthcare.

Trump has signed an executive order creating a high-level opioids commission led by New Jersey Gov. Chris Christie, prioritizing treatment, yet the panel includes Attorney General Jeff Sessions, who maintains a strict tough-on-crime approach.

“I don’t want to get political, nor do I think this epidemic is about politics,” Dye says. “However, I fear that it will get politicized.”

Dye says the country has no choice but to confront the opioid issue, with education a vital element.

“I do think that this epidemic MUST be addressed head-on,” Dye says. “I don’t think we need any more evidence that the problem exists. What we do need is a focus on prevention and treatment. Education and experience (from addicts and those who treat them) need to be provided to parents and children, even as young as grade school.”

She adds: “I think that the more children are educated, they will not only be better equipped to address their own problems but more importantly, may be able to more effectively help a peer. Scare tactics don’t generally work, especially when employed by parents.”

Dye wrote to the White House and offered to help in any way to address the problem. So far there’s been no answer. No matter what, Dye continues to deliver a message that the nation can work together to meet the tyranny of opioid abuse, starting with attitude readjustments, a day at a time.

.– Joe Cantlupe

As some urgent care centers try to open up new businesses or expand, some operators say are being shut out by insurers who may not want to have any new urgent care centers in an area because of perceived over-saturation.

Urgent care centers thrive on treating a patient’s cough or checking out that bruised elbow or twisted ankle.  But insurers keeping them out of certain networks appear to be giving them a big headache, some urgent care operators tell me in a story I wrote for athenainsight.

The story notes: “A lot of urgent care providers are facing a narrowing of networks,” says Laurel Stoimenoff, CEO of the Urgent Care Association of America, which represents 2,700 urgent care centers in the U.S. and abroad.

Those rules hamstring “the entrepreneur who wants to build an urgent care center right now,” Stoimenoff says. “You may have spent a million dollars on the place, even before applying for a contract. Then you apply to one of the major payers and they say, ‘sorry, we’re not accepting more urgent care clients. We have enough of them in our network.'”

In a follow-up email exchange with Stoimenoff, she said payers add more requirements on urgent care centers that they might not otherwise impose on primary care physician offices. That may effectively shut out an avenue for urgent care centers, although the insurers may not actually say they are narrowing their networks, she says.

That is a confusing situation, she says. “(Urgent care centers)  practice acute primary care so we are perplexed as to why UCCs are being held to standards in excess of (primary care physicians),” Stoimenoff says.

Some contractual language written into urgent care center contracts also are problematic, she adds.  Stoimenoff gives the following scenario:

Say a patient goes to an urgent care center and it is determined that patient has pneumonia. A follow-up would seem to make sense, but contracted language with the insurer prohibits follow-up care “as the insurer (would try) to ensure that the urgent care is only providing care for singular episodic visits,” Stoimenoff says.

That could create logistical problems for patients. “A patient may be 2,000 miles from home and/or without a primary care doctor,” Stoimenoff says. “Who then is to follow that patient who has a condition that medical best practice would say needs follow up?” she asks.

Urgent care centers are also limited in prevention practices. Stoimenoff offers this scenario as an example: Someone works in an area that is  “high risk for tetanus,”  and wants a tetanus vaccine from an urgent care center because that person didn’t have one for a decade or more. The urgent care center would have to tell the patient: “We couldn’t give you one and get paid by the payer in most cases because they consider it ‘wellness’ versus ‘episodic illness or injury,” says Stoimenoff.

Baffling, no?

Such scenarios — i.e. real life – seem to go against the idea of having an open marketplace for the full spectrum of a patient’s needs. That is a crucial part of the conversation as the government again moves in some possibly new direction in healthcare.

Franz Ritucci, MD, President of the American Academy of Urgent Care Medicine, agreed with Stoimenoff’s assessments, saying some urgent care centers “are having difficulty contracting with insurance carriers,” he told me for the athenainsight story.

Despite obstacles, urgent care centers believe they are finding their rightful place in helping patients, according to Stoimenoff.

The “issue of receiving the right care in the right place at the right time is likely to finally get attention as we move into value-based care models and there are financial incentives to do the right thing,” Stoimenoff says. “There are numerous studies that support the fact that many patients being seen in emergency departments do not need to be there.”

Change may rest on patient education and advocacy along with physician discussion.

Healthcare is tough: there’s no question it’s scary when someone faces a 3 a.m. sharp pain and doesn’t even think twice about going to the emergency department. It’s another issue for the patient who has a cough and sniffles, then maybe it’s  time for urgent care instead of an overcrowded, expensive emergency department.

One person at a time, it becomes a national issue about cost and quality of care.

“If there is an opportunity to save what is undoubtedly in the billions (of dollars) we should all be open to problem-solving,” Stoimenoff says.

— Joe Cantlupe

I can picture a good president – no, not this one – playing golf in beautiful Bedminster, N.J.

The president may be tooling around the golf course, something he holds very dear, and feels incredibly thankful for the past 100 plus days on the job.

He may think about what he said on that first day in office, how not enough people were sharing the wealth of this great land and how the establishment “protected itself, not the citizens of our country.”

As he may go from tee to tee and even bogey a few holes in that lush green carpet as he gets angry about poverty, racial inequities, and hopes for better health and well-being of the country.

That’s the picture of a good president.

Not our president. He went on the golf course, and he was indeed angry not about injustice against our citizenry, but about then FBI Director James B. Comey and the continued investigation into Russian connections involving the election.

Our president was terribly upset about perceived injustice against himself.

He’s going to feel worse. Truth wins.

— Joe Cantlupe

HealthDataBuzz Investigative Analysis

A recent study that examined the cost of hospital-based and freestanding emergency departments compared to urgent care centers in Texas had some intriguing findings: The prices for patients who were treated at emergency departments instead of urgent care centers paid as much as 10 times higher for similar diagnoses.

This morning, The Washington Post ran a front-page story that said: “Free-standing emergency departments offer convenience, but they may drive up costs.” The article quoted one of the study authors.

Yet the study’s findings are controversial and so is the behind-the-scenes maneuvering involving the study itself, Health Data Buzz has learned.  At the center is the publisher of the manuscript, the Annals of Emergency Medicine, which pulled the study for further review following “serious concerns” over data in the article, even after it was the focus of stories in Texas publications.

The dispute apparently began after emergency department physicians complained about the study although those in the urgent care community certainly have applauded the article fact-finding and conclusions.  The  Annals of Emergency Medicine (AEM) is the official journal of the American College of Emergency Physicians, the Texas-based organization whose more than 31,000 members run emergency departments, not urgent care centers.

The unfolding review process has been so intense the editor-in-chief said he has never had such an experience before involving a manuscript, while the top author says she has never felt so mistreated in the handling of the study.

Recently, the AEM halted publication of the study, Dr. Michael L. Callaham, editor-in-chief of the Annals of Emergency Medicine, confirmed in an email exchange. Callaham is founding chair and professor emeritus of emergency medicine at the University of California-San Francisco Medical Center at Parnassus.

Callaham said the journal’s concerns were about accuracy and interpretation of the study, which led to complaints from emergency department physicians. Those complaints come after the study was made available to the press.  “I had never had a similarly difficult and prolonged assessment experience with a research paper in my decades of editing,” he said.  That editorial review is still ongoing, Callaham added.

While the journal has begun an inquiry into the study, questions also have been raised by the principal co-author, Vivian Ho, PhD, director of the Center for Health and Biosciences at Rice University’s Baker Institute for Public Policy, about the AEM actions.

During a journal editors’ review of the study, an issue involving data transcription errors was uncovered, but that has been used by AEM officials to wrongly cast doubt on the entire document, she said. “In my entire 20-plus years as a professor, I have never been mistreated like this,” Ho said.

Emergency department physicians have indeed complained about the study, Ho said. But she suggested that they objected to the study’s findings because they were favorable to urgent care centers. While some minor tabulation errors were made, Ho said the study findings should stand, once corrected.

Researchers from multiple state institutions, including Rice University, Baylor College of Medicine, University of Texas Health Science at Houston, the Michael E. DeBakey VA Medical Center and the Blue Cross Blue Shield of Texas, were involved in authorship of the study.

The study researchers examined over 16 million claims submitted between 2012 and 2015 by Blue Cross Blue Shield of Texas. They reviewed how often patients visited freestanding and hospital-based emergency departments and urgent care centers in Texas metropolitan areas.

The dispute underlies the economics of urgent care centers and emergency departments, whether freestanding or hospital-based. Patients routinely go to urgent care centers for relatively mild injuries and illnesses, but sometimes go to emergency departments for similar concerns, although they are more costly and are designed to handle more serious patient needs.

At certain points, their business models collide, which was an important element of the Texas study, and just another interesting element in the sometimes chaotic nature of healthcare politics and pricing.

Study Gets Media Attention

Like many studies, advance copies of the Texas study were received by the media, which treated it as big news, which it is.

The Dallas Morning News, ran a major story March 27:
Patients in Texas who felt sticker shock after a visit to an emergency room often could have saved thousands if they had gone to urgent care, a new study says. Whether back problems, bronchitis or abdominal pain, patients paid $1,000 or more for treatments that would have cost them under $200 in a less expensive facility.

The Washington Post’s story today quoted Ho as having “found a big overlap in the types of conditions for which people seek care: Three-quarters of the 20 most common diagnoses at freestanding ERs were the same as at urgent-care centers.”

In the study that was initially made available to the press, researchers said they compared prices for the top 20 diagnoses and procedures. Texans use hospital-based emergency departments (EDs) and urgent care centers much more than freestanding EDS, but freestanding ED utilization increased 236% between 2012 and 2015, the study said. It added: The average price per visit was lower for freestanding EDs versus hospital-based EDS in 2012 ($1,431 versus $1,842) but prices in 2015 were comparable, ($2,199  versus $2,259.) Prices for urgent care centers  “were only $164 and $168 in 2012 and 2015,” according to the study. “Out of pocket liability for consumers for all these facilities increased slightly from 2012 to 2015,” it added.

In addition, the study said “there was a 75% overlap in the 20 most common diagnoses at freestanding EDs versus urgent care centers and 60% overlap for hospital-based EDs and urgent care centers. However, prices for patients with the same diagnosis were on average almost 10 times higher at freestanding and hospital-based EDs relative to urgent care centers.”

The Journal’s Controversial Change of Heart

Weeks after stories appeared in the Texas media, Callaham and editor journals halted further publication of the study online, pending further reviews. Initially, when asked about it, Callaham would say only that the journal’s initial reviews “raised some issues that needed clarification and the authors themselves later found and reported to us a tabular error.”
When asked for elaboration, Callaham said the paper was published electronically following a number of revisions. At that time, “a number of emergency physicians not directly associated with Annals expressed concern about data accuracy and integrity,” he said.

Callaham noted most of the physicians were members of the ACEP. At that point, the paper was removed from public access, Callaham said. He mentioned there were “new concerns” from “credible expert sources and were of a serious nature,” he noted.
Ho disputes the findings, saying concerns raised “about the integrity of the data analyzed in this study are unfounded.” The “article had undergone peer review, was accepted for publication,” she said. Despite the relatively minor transcription error, “the main results of the paper remain unchanged and are still correct,” she said.

Specifically, the problems unfolded after Dr. Paul Kivela, the incoming president of the American College of Emergency Physicians, citing the transcription errors, then argued that the entire manuscript was unreliable and convinced the editor-in-chief to “pull the article from the internet until an independent third-party can examine the data,” Ho said.

“We are still in the midst of disputing Dr. Kivela’s accusations,” Ho said.

Ho said  the ACEP “controls the journal, and they are receiving complaints from emergency physicians, particularly those who could earn a substantial share of their income from the freestanding ER model.”

Callaham said only he and senior editors decided about the status of the study. They relied on guidelines recommended by the World Association of Medical Editors, the International Committee of Medical Journal Editors and the Council of Publication Ethics (COPE). The COPE algorithms were particularly important, he said.

“All the prepublication discussions and revisions were handled entirely within our traditional peer review process by Annals editors only, although we did engage a larger number of reviewers than is routine,” Callaham said.

He added: “All decisions about this manuscript to date have been made entirely by myself and the senior editors of the journal and will continue to be so as we work through the COPE algorithm. As soon as we have the remaining materials we are waiting, we will proceed so that uncertainty for all parties can be ended as soon as possible.”

“As soon as we have the remaining materials we are waiting, we will proceed so that uncertainty for all parties can be ended as soon as possible,” Callaham added.
It is uncertain what the inevitable repercussions of the study will be: whether it will eventually be reworked or changed substantially or withdrawn.

“That is exactly what we need to determine, whether there are remaining issues that could change the conclusions of the paper, and how to correct them if that is the case,” Callaham said. “Obviously we do not want to publish erroneous information no matter what, but we also do not wish to interfere with the dissemination of accurate and useful research.”

Despite the constant flow of newspaper or media headlines of the study’s findings, the journal itself will still be reviewing how the manuscript got to where it is, and that may take awhile.

“Resolving all these issues needs to be done carefully and will take time; when this is done to the journal’s satisfaction or if it becomes apparent it cannot be done, we will issue a final decision and implement it,” Callaham concluded.

“Resolving all these issues needs to be done carefully and will take time; when this is done to the journal’s satisfaction or if it becomes apparent it cannot be done, we will issue a final decision and implement it,” Callaham concluded.

— By Joe Cantlupe

So President Trump goes to the Rose Garden and lets his new GOP House pals run around outside the White House and soak in a victory of Trumpcare health bill passage. Wow. What a pathetic victory. They remind me of a baseball team soaking themselves in champagne after a 162-game season and then go on to lose a one-game playoff.  Coming up next is the Senate. Hopefully, the voices of pained patients and facts will have the upper-hand in the upper house.  Comm’n, moderate Republicans in the Senate, there are still a few of you left.  Just think of all the people with pre-existing conditions, whose lives could be damaged by Trump and his cronies. All for a teeny victory that can be held in a little hand.

Ok, America lost in the House, which voted to take away healthcare from the aging and the poor. The Republicans slapped high-fives in the White House backyard. Even the losing Democrats were childish.  They are singing “Na na hey hey Goodbye.”  They referred to predictions that Republicans would lose elections after yesterday’s vote.

Gee, Congress this is serious. And it’s not about you.

A hex on the House, I say the heck with you.  Send In the Clowns Oh, yeah, they are there, in Congress.

And then there’s Trump, like his hero Andrew Jackson, running a victory lap, but meaningful?  Jackson won the Battle of New Orleans weeks after the War of 1812 was over. Great for symbolism at the time. That’s what Trump is all about. Symbolism. Show.

For Trump, though, the reality war is just beginning in healthcare reform. People are going to face up to his nonsense and despicable one-liners, or statements that have no thoughts behind them. And the lies. Oh yeah. The pre-existing conditions, coverage for everyone. Sure, Donald, sure.

And this is a 70-year-old man who didn’t show us his, er, clean-bill-of-health,  or the taxes either.

Of course, the Republicans rushed through the legislation to get that little “victory.” And it is little, despite the headlines today. Isn’t Ryan supposed to be the wonk who loves counting pennies and spreadsheets?  Sure. But why wait for the fiscal experts at the Congressional Budget Office to review it? Nah. Remember the first time the Republicans tried: The CBO put a big F grade on that one: 24 million more Americans would lose health insurance, adding to those millions already who don’t have it.  I guess the GOP didn’t want to hear the bad news again.

Lots of people detested this bill that passed the House.  Check out Twitter and see all those comments from people who say #IAmAPreexistingCondition. But what do Trump and the gang care?  Polls were already showing people wanted changes to Obamacare and don’t throw it in the trash.  The Republicans said they were waiting seven long years to see Obamacare in the Dumpster. So what if many untruths are attached?

When you live by the lie, what difference does it make?

“Mr. Trump, in particular, has been spreading misinformation and lies about health care, arguing that the legislation would lower costs while guaranteeing that people with pre-existing health conditions could get affordable health insurance,” the New York Times said in an editorial.

As the bill goes to the Senate, many are  watching, chomping at the bit,

The AARP is one.  It represents 38 million people.

AARP Executive Vice President Nancy LeaMond said the organization is “deeply disappointed” that the House passed a “deeply flawed bill.”

She said the bill puts at risk 25 million “older adults with pre-existing conditions, such as cancer and diabetes, who would likely find health care  unaffordable or unavailable to them.”  LeaMond also pointed to the “age tax on us as we age, harming millions of American families with health insurance, forcing many to lose coverage or pay thousands of dollars more for health care.”

“We promised to hold members of Congress accountable for their vote on this bill,” she said.

— Joe Cantlupe

Ayana Elizabeth Johnson is a marine biologist who admittedly has a “crush” on the scientific method.

“It is elegant and reliable and able to answer questions how the world around us works,” she said earlier this month at the National Press Club in Washington, DC. “Science forms the foundation of policy decisions.” But she added emphatically: “Our government has been less committed to that principle.”

The adjunct professor at New York University is deep into science, yes, but she never thought she would be taking to the streets on its behalf. But she is.

After Donald Trump was elected President, Johnson’s scientific colleagues rushed to preserve their archive material, worried about the removal of data. Now she is one of the organizers of today’s March for Science, which is expected to coordinate about 428 marches in this country and around the world, with 100 partner organizations. Scientists are worried about governments – the U.S. and elsewhere – becoming increasingly hostile toward science. A teach-in also will be part of the event, co-coordinated by the Earth Day Network.

“I’d never thought I’d be helping to organize a March for Science because I never expected in my entire professional career to be threatened,” Johnson said. “But the silencing of scientists,” she added, “hit my core.” The prospect that the administration would “simply eliminate data” that sets the course of evidence-based policy was untenable, she added.

Johnson told the Observer she thinks her profession is “at risk” under President Donald Trump. She is the founder of the Ocean Collectiv consulting group, which “employs a social justice-oriented approach to the preservation and protection of the sea,” the Observer said..

Trump’s proposed budget is leaving scar tissue on health and science plans. For example, the administration’s proposed spending plan for the National Institute of Health includes a $5.8 billion to $25.9 billion.

“Science and evidence-based policy making is under attack,” Caroline Weinberg, national co-chair of the Science March, said during the Press Club forum, noting an array of issues, ranging from cutbacks to the EPA, and “aggressive silencing” of scientists.

There has been “heightened anxiety and distrust,” added Christine McEntee, executive director of the American Geophysical Union.

Johnson, co-director of partnerships for the Science March,  said the team’s effort is only beginning in the continual fight for truthful science and policymaking that is  “broad, diverse and inclusive.”

— By  Joe Cantlupe-

For too many Americans, unfortunately, Earth Day is a once a year event to think about the planet, and the rest of the time who cares about those paper cups tossed into the trash, not the recycling bin, after the barbecue. About a quarter of us never recycle. Then, there are those “climate-change deniers,” yeah, the group of folks running the country starting at 1600 Pennsylvania Avenue.

Maybe President Donald Trump or the head of the EPA and some others walking backward on the environment and science should take a crash course in how they are helping to head us to disaster. Or have a conversation with Kathleen Rogers, the President of the  Earth Day Network, the people coordinating the marches and other events today in Washington DC and in 500 cities around the globe.

Perhaps this Earth Day may take on even greater significance because there seems to be more of the “earth is flat” mentality in leadership than there has for awhile. Scientists are also taking the stage too, with the first ever  March for Science, in which Rogers’ group is an organizing partner.

“I went to the Capitol and there are so many climate deniers,” Rogers said in an interview with Health Data Buzz recently. “I want it to be in history books, the way the bad guys are listed in history books. I want a lineup of the climate deniers in every history book forever for the rest of human history. Some pages in all our history books need to line up all those people on Capitol Hill that were climate deniers, and memorialize their stupidity.’’

Rogers is not one to mince words. Under Rogers’ leadership, Earth Day Network says it has developed a “significant role in advancing the new green economy and has emerged as a dynamic year-round policy and activist organization.” Earth Day Network says it reaches into 192 countries and “integrates civic participation” into each of Earth Day Network’s programs and activities, particularly aiming toward young people.

Rogers, an attorney, has 20 years advocacy experience, notably senior positions with the National Audubon Society, the Environmental Law Institute, and two U.S. Olympic Organizing Committees.

For Rogers and millions of people, Earth Day comes 365 days a year, as it should. Rogers believes deeply in the cause, with always more work to be done.

The Evidence Is ‘Crystal Clear’

Even during the years of Presidents Ronald Reagan, and George W. Bush, there were environmental pushbacks, to be sure. Under Trump and this administration, it feels different. It is different, but not only because of the politics, Rogers says.

Now, scientists know about the environment and the damage that is being caused.

“I wasn’t around all these 46 years (of Earth Day), but the difference between now and say Ronald Reagan, and George Bush II, who undid (environmental restrictions) for awhile, what they did hurt, but what is different from what happened in the 1970s, the science is so crystal clear now that the fossil fuel industries and economies are leading us to an existential crisis,” Rogers says. “It’s methane, it’s land production, and it’s cutting down trees, building the wrong way in the wrong places. It’s overpopulation.”

“People have a tendency to think about what they can see,” Rogers says. “Earth Day was built at a time when you could see a lot of this stuff. You couldn’t see across the street in L.A. during rush hour. We cleaned up a lot of junk. Now  all of a sudden you can’t see it, you cannot imagine it, and you can’t own it.”

Then Rogers taps off a list of environmental crises.

“The tell-tale signs aren’t just storms. There are beetles from Central and South America, eating their way north, killing our forests,” Rogers says. “There is burning of the Amazon. There are extraordinary changes when you continue to burn fossil fuels. We’re slowly eroding the basis for life on earth.”

Yet the current administration coughs up advances, rolling back mining rules, and “pulling back the lead rules, ” Rogers adds.

Rogers referred to the polluted water fiasco in Flint, Mich. and what she termed the lack of caring in impoverished areas, with an attitude of “we don’t really care, we won’t change the outcome of the election, they are poor and vote Democrat, and screw them.”

“My (water) pipes are fine, but where there is poverty they don’t invest in infrastructure, and these people don’t have a voice; they aren’t fine,” Rogers says. “There are people with completely brown water. Do you think they would put up with that (where I live)?”

Of the Trump administration and leadership, “the kings of status quo are back in power. It’s not fun to change,” Rogers says. “People are creatures of habit. If you are making boatloads of oil and gas, you don’t like to see that change.”

Of Trump himself, she says, “It’s hard to know what he focuses on, except anything that’s what is in front of him.”

LOOKING BACK AND AHEAD

The environmental cutbacks and other moves hurting science are inexcusable, Rogers says. “I can’t understand it. Why would they want to step backward in time?”

Rogers loves to read about the industrial revolution, and the fits and starts we’ve had since then. She pointed to a story about one of the famous automobile brands of the last half-century, the Studebaker. The company was in the “horse and buggy” business, but adroitly made the turn toward making automobiles, still keeping horse and wagons, when other companies didn’t see the future in the car. Studebaker went forward and maintained a business for decades when others “went out of business,” Rogers says.

A key point of the Studebaker story, she says, is a vision, even if it may be that of a lonely visionary. “There’s a reason Silicon Valley is the ‘center of the universe. Look at this one state, this one little area, but it’s the center of the universe for computers and technology. They got smart,” Rogers says.

“We can be that way for green energy. Every single thing has to be rewritten, everything – the chairs we sit on, the plastic cups we drink out of. That all has to change,” Rogers says. “The person who gets that technology straight is going to be the next Rockefeller or Carnegie. Scientists already have the capacity to move us in the right direction. But we are dragging our feet and being stunningly stupid.”

“What’s going on now – we are all dumber than a box of rocks not to see it. I feel like I should load up the industrial revolution history books and dump it on the desks of people who are taking giant steps backward and say, ‘read this.”

When I raised the specter of ”anger” about environmental and science reversals, Rogers dismissed it. “I don’t do anger, I don’t have that capacity maybe because I’m a lawyer. I don’t necessarily feel anger. Scientists might feel that way because they are all being called liars. These are scientists with PhDs from incredible universities around the world; they are not doing this to get rich. That’s their personality and who they are. They love discovery and they love seeking and understanding. They stand for hours and pondering and asking questions and try to get to the truth.”

“And then some bozo comes along and says you are a bunch of liars, and science is a fake,” she says.

“The world was on this momentum for a green economy; there was the climate agreement, and people really cared, and all of a sudden….” Rogers adds.

As Rogers looks to Earth Day and the March for Science, her attitude is:“You get back by working really hard. We’re going to live through this tragedy.”

“It’s going to be about people coming to their senses. Things may start going south,” Rogers says. “All this stuff. Even those ‘die hard’ supporters of what’s happening now. They will wake up, ‘I have no insurance, oh, my kids are getting sick, ooh, I’ve got mercury in my water, I’ve got lead in my water.’ All that crap they want to bring back.”

Around the globe, there is a sensitivity that attitudes toward the environment must change and many people are moving in the right direction, she says.

“I travel around the world and I go in the trenches and speak to policy makers and scientists and NGOs (non-government organizations), and talk to faith-based groups and I talk to government officials and scientists. It’s all the same, they are moving forward.”

For the U.S., its people have to ask a question as we stumble along to preserve the Earth: “Do you want to own it or do you want to give it to China or India or some other nation?” Rogers asks.

Still, Rogers has faith in this country’s ultimate resolve, reflected in people like Mona Hanna-Attisha, who exposed the water crisis in Flint. There are many more Monas in this country, Rogers says. “I believe in the American public. We will move forward. We are moving towards a green world.”

— By Joe Cantlupe