How Images (And Hugs) Can Change the World

How Images (And Hugs) Can Change the World

12-year-old Devonte Hart, Sgt. Bret Barnum share hug at Ferguson rallyIn 1604 Christopher Marlowe wrote these lines about Helen of Troy: “was this the face that launch’d a thousand ships and burnt the topless towers of Ilium?” The power of an image and its ability to evoke passion and emotion is ingrained in our history and social consciousness. This picture – and the story behind it – evoked so many personal feelings and emotions that I have had to sit quietly and alone for quite a while this Thanksgiving weekend determining what it was I wanted to share.

The photo above was caught by Johnny Nguyen at the start of a Ferguson rally being held in Portland, Oregon last Tuesday. Twelve-year-old Devonte Hart was holding a “Free Hugs” sign (more on that below) as he stood in front of a police barricade obviously upset.  Devonte’s mother, Jen Hart, is white, and she shared with reporters how her son has been struggling terribly to understand and reconcile his perceptions and understanding of what happened in Ferguson – and how race relations in his country will affect him as he grows into a man.

The officer pictured above, Sgt. Bret Barnum, works in the traffic division of the Portland police department and was at the site of the rally for crowd control. Standing about 10 feet from Devonte, officer Barnum noticed he was upset and called him over. They shook hands, chatted politely, Barnum expressing an interest in where Devonte went to school and what he had done this past summer. When asked why he was crying Devonte shared his concerns with the officer who empathized with those concerns. After they were done Barnum asked whether he might get one of the free hugs being offered. And thus be to infamy – maybe.

There was another time in our history when the camera captured an image that made a tremendous impact on the perception of race relations, but according to most accounts that image was not what it appeared to be. In his latest book, David & Goliath, Malcolm Gladwell relates the story behind this famous photograph of the civil rights movement in Birmingham, Alabama. The picture was taken by Bill Hudson of the Associated Press and shows 15-year-old Walter Gasden apparently being attacked by two police dogs during a May 3, 1963 protest in Birmingham.

But Walter Gasden was not a protester – he was a bystander who had been arrested by the officer in the photograph (Dick Middleton) for refusing an order to leave the street. It is believed that the police in the photograph are actually trying to hold the dogs back as Gasden strikes the dog with his left knee, causing it injury that required treatment by a veterinarian.

Diane McWhorter related this story in her book, Carry Me Home. Gladwell relied in part upon McWhoter’s account to relate how Wyatt Walker – an African American pastor and civil rights leader – had worked to confuse local authorities from being unable to distinguish protestors from bystanders in order to create chaos and a picture-perfect moment that had the purpose and effect Walker had hoped: it was printed in newspapers across the country with the understandable byline imagery of police using German Shepherds to attack a peaceful civil rights protestor.

Images can be incredibly powerful even when perception may not match reality (as in, perception is reality). A solitary image can profoundly impact a national cause just as a face can launch a thousand ships. Just as the image of a police officer accepting a free hug from a confused, scared and innocent youth can hopefully reset the dialogue we still desperately need to continue in this country on race relations, away from the hateful and destructive images of Ferguson that have perceptually hijacked that dialogue.

And what about those free hugs? The Free Hugs Campaign was started in 2004 by an Australian known under the pseudonym of Juan Mann (i.e., one man) in the Pitt Street Mall of Sydney.

imageI was first introduced to Free Hugs in 2010 when Sister Jill Bond of Catholic Health Service of Miami shared this 2006 video of the campaign shot in Hollywood, California (click on picture for link to the video). Set to the music of the late Israel Kamakawiwo’ole’s version of Over the Rainbow, it is one of the most captivating, inspiring and thought-provoking videos I have ever seen, and I have used it multiple times since in client workshops.

That it serves as an underpinning of the story behind the image of Devonte and Officer Barnum is emotionally compelling to me on multiple levels. In a time when technology has done so much to keep us connected it truly amazes – and depresses – me to realize just how disconnected we have become. And how way too often it seems our preference is to remain that way unless someone – like an innocent 12-year-old boy whose heart is full of love and wonder – has the courage to help us understand how simply powerful one hug can be – especially when it’s captured as an image that can be shared with others.

Cheers,
  Sparky

New Payment Models’ Impact on Innovation

New Payment Models’ Impact on Innovation

getimageThe backdrop for this week’s feature article in Modern Healthcare by Jaimy Lee and Sabriya Rice is last week’s annual conference of the Advanced Medical Technology Association. Known as AdvaMed 2014, it is the leading MedTech Conference in North America, representing more than 1,000 companies. Commensurate with the event, AdvaMed released a new white paper that expresses concern over the potential impact risk-based payment models could have on provider adoption of emerging medical technologies.

The “Show me the data” headline connotes the growing demand of private insurers, as well as policymakers and governmental agencies, that the efficacy of such technologies be supported with evidence. And while AdvaMed, ”generally supports the movement toward new payment models that encourage providers to reduce costs through greater coordination of care,” its not too thinly veiled concern, of course, is whether and to what extent the demand for data will serve as a tactical smokescreen supporting cost control at the expense of patient care – as well as those companies’ financial success. Regardless of the relative priorities of those two objectives, pressure to control costs under risk-based contracting will certainly affect future provider decision-making impacting the adoption of un (or, at least, under) proven technologies.

I don’t think one has to belie their political persuasion to reasonably understand the pragmatically challenging conflict of this discussion. The overwhelming trends of transparency and evidence-based care in healthcare necessitate that manufacturers make the required investment to understand and be able to articulate their product’s cost/benefit story (i.e., the value proposition). The MH article shares the experience of Medtronic, a medical-device manufacturer whose research uncovered a tangential benefit of being able to reduce hospital readmissions that it could use to enhance market value.

But we also know from experience that data supporting patient benefit often trails substantial initial investment, trial and error and the ability to assess that benefit over years of a patient’s life. In a delivery system that has been able to support waste and largesse the need for patience has been a tolerable frustration. In a system where a major focus of all participants is now cost containment there’s a lot less patience.

The recurring policy challenge, as if there was just one, is in cutting through the individual agendas of industry participants to try and find some sense of balance between cost reduction and what is in the best interest of patients while not artificially stifling the enormous benefits we have enjoyed in this country from medical technology.

In Malcolm Gladwell’s latest jewel, David and Goliath, he profiles the work of Dr. Jay Freireich in the mid-50s through mid-60s. Freirech and his colleague, Dr. Tom Frei, pioneered the treatment of childhood leukemia by first transfusing patients with platelets to stop chronic bleeding. Following that they advanced the then novel approach of chemotherapy to include multiple drugs rather than a single drug.

In both instances, Freireich and Frei didn’t have to contend with whether or not insurers would underwrite the cost of their efforts. Rather, at the time they could not even get the support of their academic and clinical colleagues, so outlandish and absurd were their unorthodox approaches, which often caused great pain and hardship to their young patients. Except that in 1965 they published, “Progress and Perspectives in the Chemotherapy of Acute Leukemia,” in which they described their successful treatment of childhood leukemia. Today the cure rate is greater than 90 percent, and thousands of children’s lives have since been saved.

Is AdvaMed right to warn us against the impact risk-based payment models will have in the name of cost containment? Could the next Freireich & Frei team of innovators be kept from achieving a dramatic life-saving achievement because cost-containment will trump the patience needed to evidence results? Or is AdvaMed understandably overstating the case in doing what it is expected to do: advocate for the members funding that organization’s existence?

Cheers,
  Sparky