SOCIAL DETERMINANTS OF HEALTH

Posted on November 20, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Dr. David Edward Marcinko MBA MEd

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Shaping Well-being Beyond Medicine

Health is often thought of as the result of medical care, but in reality, it is deeply influenced by the conditions in which people are born, grow, live, work, and age. These conditions, known as social determinants of health, include a wide range of social, economic, and environmental factors that shape health outcomes. They are responsible for many of the differences in health status between individuals and communities. Understanding these determinants is essential for promoting fairness in health and designing policies that reduce disparities.

Economic Stability

Economic stability is one of the most powerful determinants of health. Individuals with steady income can afford nutritious food, safe housing, and preventive healthcare. Conversely, poverty increases vulnerability to chronic diseases, mental health challenges, and limited access to medical services. Families with fewer financial resources may struggle to afford medications or healthy diets, leading to higher rates of obesity, diabetes, and cardiovascular disease. Unemployment or unstable work further exacerbates stress, which itself is linked to poor health outcomes. Economic inequality directly translates into health inequality.

Education

Education shapes health both directly and indirectly. Higher educational attainment is associated with better employment opportunities, higher income, and improved health literacy. People with more education are more likely to understand medical information, adopt healthy behaviors, and navigate healthcare systems effectively. Limited education can perpetuate cycles of poverty and poor health. For instance, children who grow up in underfunded schools may face restricted opportunities, leading to lower lifetime earnings and poorer health outcomes. Education is therefore a critical lever for breaking intergenerational cycles of disadvantage.

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Neighborhood and Physical Environment

The environment in which individuals live plays a crucial role in determining health. Safe neighborhoods with clean air, accessible parks, and reliable transportation promote physical activity and reduce exposure to pollutants. In contrast, communities with high crime rates, poor housing, and environmental hazards contribute to stress, injury, and illness. Food deserts—areas with limited access to affordable, healthy food—are a striking example of how environment shapes health. Residents in these areas often rely on processed foods, increasing risks of obesity and related diseases. Housing quality also matters: overcrowding, mold, or lead exposure can lead to respiratory illnesses and developmental delays.

Healthcare Access and Quality

Access to healthcare is a fundamental determinant, but it is shaped by social and economic factors. Insurance coverage, affordability, and cultural competence of providers influence whether individuals receive timely and effective care. Marginalized groups often face barriers such as discrimination, language differences, or lack of nearby facilities. Even when healthcare is available, disparities in quality persist. For example, minority populations may receive less aggressive treatment for certain conditions compared to others. Addressing these inequities requires systemic reforms that prioritize inclusivity and affordability.

Social and Community Context

Social relationships and community support networks significantly affect health. Strong social ties provide emotional support, reduce stress, and encourage healthy behaviors. Communities with high levels of trust and civic engagement often experience better health outcomes. Conversely, discrimination, racism, and social exclusion undermine health by increasing stress and limiting opportunities. Social cohesion and equity are therefore vital for fostering healthier societies.

Conclusion

The social determinants of health highlight that medicine alone cannot ensure well-being. Economic stability, education, environment, healthcare access, and social context collectively shape health outcomes and drive disparities. Addressing these determinants requires a holistic approach that integrates public health, social policy, and community action. By investing in education, reducing poverty, improving neighborhoods, and ensuring equitable healthcare, societies can move closer to achieving health equity. Ultimately, health is not just about treating illness—it is about creating conditions in which everyone has the opportunity to thrive.

COMMENTS APPRECIATED

EDUCATION: Books

SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit an RFP for speaking engagements: CONTACT: Ann Miller RN MHA at MarcinkoAdvisors@outlook.com -OR- http://www.MarcinkoAssociates.com

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SINGULARITY: In Medicine Today?

Posted on November 18, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Dr. David Edward Marcinko MBA MEd

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The singularity promises to revolutionize medicine by accelerating diagnostics, treatment, and longevity—but it also demands ethical vigilance and systemic transformation.

The concept of the technological singularity refers to a hypothetical future moment when artificial intelligence (AI) surpasses human intelligence, triggering exponential advances in technology. In medicine, this could mark a turning point where AI-driven systems outperform human clinicians in diagnosis, treatment planning, and even biomedical research. While the singularity remains speculative, its implications for healthcare are profound and multifaceted.

One of the most promising impacts is in diagnostics and precision medicine. AI systems trained on vast datasets of medical images, genetic profiles, and patient histories could detect diseases earlier and more accurately than human doctors. For example, algorithms already outperform radiologists in identifying certain cancers from imaging scans. As we approach the singularity, these systems may evolve into autonomous diagnostic agents capable of real-time analysis and personalized recommendations, tailored to each patient’s unique biology.

Another transformative area is drug discovery and development. Traditional pharmaceutical research is slow and costly, often taking over a decade to bring a new drug to market. AI could dramatically shorten this timeline by simulating molecular interactions, predicting therapeutic targets, and optimizing clinical trial designs. With superintelligent systems, the pace of innovation could accelerate to the point where treatments for currently incurable diseases—like Alzheimer’s or certain cancers—become feasible within months.

The singularity also opens doors to radical longevity and human enhancement. Advances in nanotechnology, genomics, and regenerative medicine may converge to extend human lifespan significantly. AI could help decode the aging process, identify biomarkers of cellular decline, and engineer interventions that slow or reverse it. Some theorists even envision a future where aging is treated as a curable condition, and mortality becomes a choice rather than a biological inevitability.

However, these breakthroughs come with serious ethical and societal challenges. Data privacy, algorithmic bias, and access inequality are critical concerns. If singularity-level AI is controlled by a few corporations or governments, it could exacerbate global health disparities. Moreover, the replacement of human clinicians with machines raises questions about empathy, trust, and accountability in care. Who is responsible when an AI makes a life-altering mistake?

To navigate this future responsibly, medicine must embrace interdisciplinary collaboration. Ethicists, technologists, clinicians, and policymakers must work together to ensure that AI systems are transparent, equitable, and aligned with human values. Regulatory frameworks must evolve to keep pace with innovation, and medical education must prepare practitioners to work alongside intelligent machines.

In conclusion, the singularity represents both a promise and a peril for medicine. It offers unprecedented opportunities to enhance human health, but also demands careful stewardship to avoid unintended consequences.

As we edge closer to this horizon, the challenge will be not just technological, but deeply human: to harness intelligence beyond our own in service of healing, compassion, and justice.

COMMENTS APPRECIATED

EDUCATION: Books

SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit an RFP for speaking engagements: CONTACT: Ann Miller RN MHA at MarcinkoAdvisors@outlook.com 

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SINGULARITY: In Finance and Investing

Posted on November 11, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Dr. David Edward Marcinko MBA MEd

SPONSOR: http://www.MarcinkoAssociates.com

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The singularity promises to revolutionize medicine by accelerating diagnostics, treatment, and longevity—but it also demands ethical vigilance and systemic transformation.

The concept of the technological singularity refers to a hypothetical future moment when artificial intelligence (AI) surpasses human intelligence, triggering exponential advances in technology. In medicine, this could mark a turning point where AI-driven systems outperform human clinicians in diagnosis, treatment planning, and even biomedical research. While the singularity remains speculative, its implications for healthcare are profound and multifaceted.

One of the most promising impacts is in diagnostics and precision medicine. AI systems trained on vast datasets of medical images, genetic profiles, and patient histories could detect diseases earlier and more accurately than human doctors. For example, algorithms already outperform radiologists in identifying certain cancers from imaging scans. As we approach the singularity, these systems may evolve into autonomous diagnostic agents capable of real-time analysis and personalized recommendations, tailored to each patient’s unique biology.

Another transformative area is drug discovery and development. Traditional pharmaceutical research is slow and costly, often taking over a decade to bring a new drug to market. AI could dramatically shorten this timeline by simulating molecular interactions, predicting therapeutic targets, and optimizing clinical trial designs. With superintelligent systems, the pace of innovation could accelerate to the point where treatments for currently incurable diseases—like Alzheimer’s or certain cancers—become feasible within months.

The singularity also opens doors to radical longevity and human enhancement. Advances in nanotechnology, genomics, and regenerative medicine may converge to extend human lifespan significantly. AI could help decode the aging process, identify biomarkers of cellular decline, and engineer interventions that slow or reverse it. Some theorists even envision a future where aging is treated as a curable condition, and mortality becomes a choice rather than a biological inevitability.

However, these breakthroughs come with serious ethical and societal challenges. Data privacy, algorithmic bias, and access inequality are critical concerns. If singularity-level AI is controlled by a few corporations or governments, it could exacerbate global health disparities. Moreover, the replacement of human clinicians with machines raises questions about empathy, trust, and accountability in care. Who is responsible when an AI makes a life-altering mistake?

To navigate this future responsibly, medicine must embrace interdisciplinary collaboration. Ethicists, technologists, clinicians, and policymakers must work together to ensure that AI systems are transparent, equitable, and aligned with human values. Regulatory frameworks must evolve to keep pace with innovation, and medical education must prepare practitioners to work alongside intelligent machines.

In conclusion, the singularity represents both a promise and a peril for medicine. It offers unprecedented opportunities to enhance human health, but also demands careful stewardship to avoid unintended consequences.

As we edge closer to this horizon, the challenge will be not just technological, but deeply human: to harness intelligence beyond our own in service of healing, compassion, and justice.

COMMENTS APPRECIATED

EDUCATION: Books

SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit a RFP for speaking engagements: MarcinkoAdvisors@outlook.com

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PUBLIC RELATIONS: In Medicine

Posted on November 9, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Dr. David Edward Marcinko MBA MEd and Copilot A.I.

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Public relations (PR) in medicine is a specialized field that focuses on managing communication between healthcare organizations, medical professionals, and the public. Unlike traditional marketing, which emphasizes selling services, PR in medicine emphasizes trust, credibility, and education. In a sector where lives and well-being are at stake, effective communication is not optional—it is essential.

1. Building Trust and Reputation

Healthcare institutions rely heavily on public trust. Patients must feel confident in the competence and integrity of hospitals, clinics, and medical professionals. PR strategies such as press releases, community outreach, and media engagement help establish credibility. For example, when hospitals share success stories of medical breakthroughs or highlight patient-centered initiatives, they reinforce their reputation as reliable and compassionate providers.

2. Health Education and Awareness

One of the most important functions of PR in medicine is educating the public. Medical jargon can be complex, and PR professionals translate it into accessible language. Campaigns about preventive care, vaccination, or chronic disease management empower communities to make informed health decisions. By bridging the knowledge gap, PR ensures that medical information is not confined to professionals but reaches the wider population in a clear and actionable way.

3. Crisis Communication

Healthcare organizations often face crises—ranging from disease outbreaks to medical errors. In such moments, PR becomes the frontline defense. Transparent communication, timely updates, and empathy are crucial in maintaining public confidence. For instance, during the COVID-19 pandemic, hospitals and health agencies relied on PR to disseminate accurate information, counter misinformation, and reassure anxious populations. Effective crisis communication can prevent panic and sustain trust even in challenging times.

4. Advocacy and Community Engagement

PR in medicine also involves advocacy for public health policies and community engagement. Hospitals and medical associations often use PR campaigns to support initiatives such as mental health awareness, anti-smoking drives, or nutrition education. By engaging with communities through events, seminars, and social media, healthcare organizations position themselves as partners in public well-being rather than distant institutions.

5. Digital Transformation in Medical PR

The rise of digital media has transformed healthcare PR. Social media platforms, blogs, and online forums allow medical institutions to communicate directly with patients. This immediacy enhances transparency but also requires careful management to avoid misinformation. Digital PR strategies now include online reputation management, patient testimonials, and interactive health campaigns. In this way, PR adapts to modern communication channels while maintaining its core mission of trust and education.

6. Ethical Responsibility

Unlike other industries, PR in medicine carries a profound ethical responsibility. Misleading information can have life-threatening consequences. Therefore, PR professionals in healthcare must prioritize accuracy, sensitivity, and compassion. Their role is not only to protect the image of institutions but also to safeguard public health.

Conclusion

Public relations in medicine is more than a communication tool—it is a bridge between science and society. By fostering trust, educating communities, managing crises, and advocating for health, PR ensures that medical institutions remain credible and compassionate. In an era of rapid medical advancements and global health challenges, the importance of PR in medicine continues to grow, making it an indispensable part of modern healthcare.

COMMENTS APPRECIATED

EDUCATION: Books

SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit an RFP for speaking engagements: CONTACT: Ann Miller RN MHA at MarcinkoAdvisors@outlook.com 

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CRYONICS: Search to Preserve Human Life?

Posted on October 30, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Dr. David Edward Marcinko MBA MEd

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Cryonics is a scientific and philosophical endeavor that seeks to preserve human life by freezing individuals at ultra-low temperatures after legal death, with the hope that future medical advancements may allow for revival and healing. Though still a speculative and controversial field, cryonics has captured the imagination of futurists, scientists, and ethicists alike.

What Is Cryonics?

Cryonics involves the process of cryopreservation—cooling the body, or sometimes just the brain, to -196°C using liquid nitrogen. The goal is to halt all biological activity, particularly decay, immediately after death. This is not the same as freezing; rather, it involves vitrification, a process that turns bodily fluids into a glass-like state to prevent ice crystal formation, which can damage cells. Once preserved, the body is stored indefinitely in a cryogenic chamber until such time that revival is theoretically possible.

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Scientific and Technological Challenges

Despite its futuristic appeal, cryonics remains highly experimental. No human has ever been revived from a cryopreserved state, and current technology cannot reverse the damage caused by the preservation process itself. While scientists have successfully frozen and revived small biological samples like sperm and embryos, scaling this to entire human bodies presents enormous challenges.

The hope lies in future breakthroughs in nanotechnology, regenerative medicine, and artificial intelligence that could repair cellular damage and cure the diseases that led to death in the first place.

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Transform Your Financial Insights into Lasting Change

Posted on October 26, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

Turn Financial A-Ha Moments Into Lasting Change With Memory Re-Consolidation

By Rick Kahler MSFS CFP™

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Have you ever had a light bulb moment about money?

Maybe you leave a workshop, a therapy session, or a conversation with a financial advisor, feeling as if you have finally cracked the code. You understand why you keep overspending. You see the pattern that keeps you procrastinating about saving and investing. You feel the reason you panic about money, even when you know you are okay. In that moment, it all seems so clear.

Yet a week later, you are right back at it. Swiping the credit card. Avoiding the budget. Losing sleep over the same worries you thought you had just solved. What happened to that breakthrough? Why did it not last?

BRAIN ANCHORING: https://medicalexecutivepost.com/2024/10/22/anchoring-initial-mental-brain-trickery/

I’ve experienced this myself, more times than I’d like to admit. Recently, I found a book that explains why: Unlocking the Emotional Brain by Bruce Ecker, Robin Ticic, and Laurel Hulley. The authors explain that lasting change happens through something called “memory re-consolidation.” It is the brain’s way of updating emotional patterns we have carried for years—often since childhood.

Most of us have old money stories tucked away in our emotional memory. Suppose, for example, as a child you were scolded for asking a neighbor how much money they earned. This and other similar experiences that left you feeling shamed or dismissed taught you that it was rude to talk about money.

Such early experiences are filed away as emotional truths. They shape what feels true, even years later as an adult, whether or not that “truth” is still relevant.

NEUROLINK: https://medicalexecutivepost.com/2023/03/07/neurolink-brain-chips-rejected-by-the-fda/

As an adult, you may have come to understand that talking about money is often essential for your emotional and financial well being. But when the moment comes to have a money conversation, your body still freezes up. That is not weakness. That is your brain pulling up the old file.

Here is where memory re-consolidation comes in. The brain does not update the file just because you think new thoughts. It updates when you have a new experience that feels different. Maybe someone listens without judgment, or you realize you are talking about money and still feel safe. That emotional mismatch tells the brain, “Maybe this file is not true anymore.”

But the update is not finished. To make the change stick, you have to hold both the old belief and the new experience together for a little while. It is like showing your brain two pictures: here is how it used to feel, and here is how it feels now. That moment of holding both is when the rewrite happens.

Even more interesting, the brain keeps the file open for several hours after the shift. What you do in that window can help the change settle in—or not. If you rush back into busyness or distractions, you might accidentally let the old version save itself again.

BRAIN HEALTH: https://medicalexecutivepost.com/2025/02/19/brain-health-bilingualism/

So what can we do to give those shifts a better chance of sticking? I have noticed that insights gained during a retreat or workshop, with ample time to focus and reflect, are more likely to last. Even in our everyday lives, we can slow down, even for a few minutes, to write about what we felt, check in with our bodies, or talk with someone who supports us. We can protect a little bit of quiet space before diving back into the noise.

The next time you have a money breakthrough, try giving yourself that space. Consciously notice both the old belief and the new experience. Give the re-consolidation time to settle in.

Then, the next time your brain pulls up that old money story, you’ll have access to the updated, more accurate version.

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EDUCATION: Books

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Understanding the Boomerang Effect in Psychology and Medicine

Posted on October 21, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

DEFINITION

By Staff Reporters

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Classic Definition: The Boomerang[ing] paradox is a feedback loop or cycle where events come back positively or negatively. It is an interconnection between people that looks like an ecosystem.

Modern Circumstance: When our thoughts and words energetically go out into the world, it has the same effect as the boomerang. It will go all the way out and come back around. That part of the creation model is our thinking and speaking. We’re unconscious and co-creating our reality. The Boomerang effect is everywhere: politics, business, relationships, economics, environment, marketing, psychology and healthcare, etc.

PSYCHOLOGY

Paradox Example: Research has found that teaching people and patients about psychological biases can help counteract biased behavior. On the other hand, due to the innate need for preservation of a positive self-image, it is likely that teaching people about biases they hold, may cause a boomerang paradoxical effect in cases where being associated with a specific bias implies negative social connotations

MEDICINE

Paradox Example: Recent examples of a boomerang paradoxical drug effects is with osteoporosis medications such as Actonel, Boniva and Fosamax. These all belong to a class of drugs called bisphosphonates. They are supposed to strengthen bones, but some doctors report that long-term use of these drugs may actually pose a risk of certain unusual fractures.

ECONOMICS

Paradox Example: A characteristic of advanced economies like Australia is continual growth in household income and plunging costs of electric appliances, resulting in rapid growth in peak demand. The power grid in turn requires substantial incremental generating and network capacity, which is utilized momentarily at best. The result is the Boomerang Paradox, in which the nation’s rising wealth has created the pre-conditions for fuel poverty.

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PHILOSOPHY: Five Major Branches

Posted on August 31, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By A.I.

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Philosophy (‘love of wisdom’) is a systematic study of general and fundamental questions concerning topics like existence, reason, knowledge, value, mind and language. It is a rational and critical inquiry that reflects on its methods and assumptions.

Philosophy is broadly divided into several main branches that explore fundamental questions about reality, knowledge, ethics, logic, and values, each addressing different aspects of human thought and existence.

STOIC: https://medicalexecutivepost.com/2022/11/20/stoic-the-philosophy-of-knowing-and-doing/

Major Branches of Philosophy

  1. Metaphysics
    This branch explores the nature of reality and existence. It addresses questions about what things exist, the nature of objects and their properties, time and space, causality, and the mind-body relationship.
  2. Epistemology
    Epistemology studies knowledge and belief. It concerns how we know what we know, the nature and limits of knowledge, justification, and skepticism.
  3. Ethics (Moral Philosophy)
    Ethics examines what is right and wrong, good and bad. It investigates moral values, principles, and theories about how people ought to act and what constitutes a good life.
  4. Logic
    Logic deals with the rules of correct reasoning. It studies principles of valid inference, argument structure, deduction, and induction, enabling critical thinking and sound judgment.
  5. Aesthetics
    This branch explores questions related to beauty, art, and taste. It considers what constitutes aesthetic value and how art influences human experience.
PODCAST: What is Epistemic Ambivalence?

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PARADOX OF EDUCATION: Cumulative Advantage and Disadvantage

Posted on August 26, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Dr. David Edward Marcinko MBA MEd

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A paradox is a self-contradictory statement. And, the ancient Greeks were well aware that a paradox can take us outside our usual way of thinking. They combined the prefix para – (“beyond” or “outside of”) with the verb dokein (“to think”), forming paradoxos, an adjective meaning “contrary to expectation.” Latin speakers used that word as the basis for a noun paradoxum, which English speakers borrowed during the 1500s to create paradox.

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Paradox of Education: Cumulative Advantage and Disadvantage

Classic Definition: Social status snowballs in either direction because people like associating with successful people, so doors are opened for them. And, folks avoid associating with unsuccessful people, for whom doors are closed.

SALARY PARADOX: https://medicalexecutivepost.com/2025/08/20/paradox-physician-compensation-v-medical-practice-value/

Modern Circumstance: Education’s positive effect on health gets larger as people age. The large socioeconomic differences in health among older Americans mostly accrue earlier in adulthood on gradients set by educational attainment. Education develops abilities that help individuals gain control of their own lives, encouraging and enabling a healthy life.

Paradox Example: The health-related consequences of education cumulate on many levels, from the socioeconomic (including work and income) and behavioral (including health behaviors like exercising) to the physiological and intra-cellular. Some accumulations even influence each other.

FINANCIAL PARADOX: https://medicalexecutivepost.com/2025/05/26/financial-paradox-compounding-interest-and-time/

In particular, a low sense of control over one’s own life accelerates physical impairment, which in turn decreases the sense of control. That feedback progressively concentrates good physical functioning and a firm sense of personal control together in the better educated while concentrating physical impairment and a sense of powerlessness together in the less well educated, creating large differences in health in old age.

SOCIAL MEDIA PARADOX: https://medicalexecutivepost.com/2025/06/29/paradox-social-media/

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EDUCATION: Books

SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit an RFP for speaking engagements: CONTACT: Ann Miller RN MHA at MarcinkoAdvisors@outlook.com -OR- http://www.MarcinkoAssociates.com

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Beware of Borrowing That Helps Your Advisor – Not You

Posted on July 21, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Rick Kahler MSFP CFP™

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When Maria needed $400,000 for a down payment on a new home, her broker at a large Wall Street firm offered a solution: “Don’t sell investments and trigger capital gains. Just take out a margin loan.”

A margin loan is a line of credit from a brokerage firm, secured by the client’s investment portfolio. It offers quick access to cash with no immediate tax consequences and minimal paperwork. But the convenience comes at a cost. As of mid-2025, margin loan interest rates range from 6.25% to over 11%.

Margin loan recommendations are often presented by brokers as tax-savvy strategies that allow clients to access “tax-free” cash while keeping their portfolios intact. In many cases, however, the math benefits the advisor more than the investor. The cost of borrowing often exceeds what an investor is likely to earn by holding on.

For example, let’s assume an interest rate of 7.5% on Maria’s $400,000 margin loan. While borrowing delayed the payment of $20,000 in capital gains tax, she will eventually have to pay that tax anyway unless she holds the investments until her death. Two years later, with portfolio returns of 4% annually, she had earned around $32,000 from the $400,000 in investments she might have sold. Meanwhile, she had paid $60,000 in interest—leaving her some $28,000 worse off. That’s without factoring in ongoing interest payments, or the risks of a margin call if the investments securing the loan drop in value.

Why do advisors keep recommending margin loans? Because selling investments reduces the portfolio size and the advisor’s fee. Borrowing keeps the portfolio intact and the compensation unchanged—while the firm receives additional income from interest on the loan. In some cases, advisors suggest using margin loans to buy more investments, increasing both the portfolio and the fee they collect.

None of this is illegal. But when the borrowing cost is higher than expected returns and the advisor benefits financially, the ethics are questionable. The client takes the risk, while the advisor keeps the revenue.

This kind of conflict appears more often in portfolios where compensation is tied to asset volume and the company’s primary culture rewards gathering assets over delivering unbiased advice. By contrast, fee-only financial planning and investment advisors typically operate on simpler hourly, flat, or tiered fee structures. Their compensation doesn’t depend on whether a client borrows, sells, or holds. The culture of the firm focuses on conflict-free advice aligned with the client’s best interest.

Wall Street brokers are often held to a fiduciary standard, but structure still matters. In 2024 the SEC reported their examinations of brokers would continue to focus on advisor recommendations unduly influenced by the company’s compensation and incentives.

There are rare situations where a margin loan may be appropriate. A client with large unrealized gains might use a short-term margin loan to minimize taxes. An elderly investor might borrow tax-free rather than sell assets that will receive a step-up in basis at their death. Even in those cases, the math must be exact and the client must clearly understand the risks, including the possibility of a margin call.

If your advisor recommends a margin loan, especially to buy more investments, ask strong questions. What’s the interest rate? What return is realistic? What are the tax consequences of selling? How does this affect the advisor’s income?

If you don’t get direct answers, that’s a warning sign.

In a high-rate, low-return environment, margin loans rarely favor the client. The exceptions are narrow. The risks are significant. And the conflict of interest is measurable.

Sometimes the smartest move is the simplest: sell what you need, pay the tax, and leave leverage out of your plan.

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Do Political Biases Shape Your Financial Planner’s Advice?

Posted on July 19, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

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BIAS: Beware Overconfident Investing

Posted on July 13, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters and A.I.

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OVERCONFIDENT INVESTING BIAS

Overconfident Investing Bias happens when we believe we can out-smart other investors via market timing or through quick, frequent trading. This causes the results of a study to be unreliable and hard to reproduce in other research settings.

Example: Data convincingly shows that people and financial planners/advisors and wealth managers who trade most often under-perform the market by a significant margin over time. Active traders lose money.

Example: Overconfidence Investing Bias moreover leads to: (1) excessive trading (which in turn results in lower returns due to costs incurred), (2) underestimation of risk (portfolios of decreasing risk were found for single men, married men, married women, and single women), (3) illusion of knowledge (you can get a lot more data nowadays on the internet) and (4) illusion of control (on-line trading).

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IADLs: Instrumental Activities of Daily Living

Posted on July 10, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

DEFINITIONS

By Staff Reporters

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Instrumental Activities of Daily Living (IADLs)

According to Leslie Kernisan MD MPH, these are the basic self-care tasks that we initially learn as very young children. These are the self-care tasks we then learn as teenagers. They require more complex thinking skills, including organizational skills. They include:

  • Managing finances, such as paying bills and managing financial assets.
  • Managing transportation, either via driving or by organizing other means of transport.
  • Shopping and meal preparation. This covers everything required to get a meal on the table. It also covers shopping for clothing and other items required for daily life.
  • Housecleaning and home maintenance. This means cleaning kitchens after eating, keeping one’s living space reasonably clean and tidy, and keeping up with home maintenance.
  • Managing communication, such as the telephone and mail.
  • Managing medications, which covers obtaining medications and taking them as directed.

Because managing IADLs requires a fair amount of cognitive skill, it’s common for IADLs to be affected when an older person is having difficulty with memory or thinking. For those older adults who develop Alzheimer’s disease or a related dementia, IADLs will usually be affected before ADLs are.

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IADLs were defined about ten years after ADLs, by a psychologist named M.P. Lawton. Dr. Lawton felt there were more skills required to maintain independence than were listed on the original Katz ADL index, and hence created the “Lawton Instrumental Activities of Daily Living Scale.”

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THOUGHT EXPERIMENT: The Colorblind Neuroscientist

Posted on June 2, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters and AI

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THOUGHT EXPERIMENT DEFINED

A thought experiment is a mental exercise where you imagine a situation or scenario to explore an idea, test a theory, or examine a problem. It does not involve physical experiments or data. Instead, it uses reasoning, imagination, and logic to draw conclusions or raise important questions.

INATTENTIONAL BLINDNESS: https://medicalexecutivepost.com/2025/03/11/inattentional-blindness/

Colorblind Neuroscientist [Inverted Spectrum Problem]

Sometimes referred to as the Inverted Spectrum Problem or the Knowledge Argument, this thought experiment is meant to stimulate discussions against a purely physical view of the universe, namely the suggestion that the universe, including mental processes, is entirely physical. This thought experiment tries to show that there are indeed non-physical properties — and attainable knowledge — that can only be learned through conscious experience.

MARYS ROOM: A Thought Experiment

The originator of the concept, Frank Jackson, explains it this way:

Mary is a brilliant scientist who is, for whatever reason, forced to investigate the world from a black and white room via a black and white television monitor. She specializes in the neuro-physiology of vision and acquires, let us suppose, all the physical information there is to obtain about what goes on when we see ripe tomatoes, or the sky, and use terms like ‘red’, ‘blue’, and so on. She discovers, for example, just which wavelength combinations from the sky stimulate the retina, and exactly how this produces via the central nervous system the contraction of the vocal cords and expulsion of air from the lungs that results in the uttering of the sentence ‘The sky is blue’…What will happen when Mary is released from her black and white room or is given a color television monitor? Will she learn anything or not?

Put another way, Mary knows everything there is to know about color except for one crucial thing: She’s never actually experienced color consciously. Her first experience of color was something that she couldn’t possibly have anticipated; there’s a world of difference between academically knowing something versus having actual experience of that thing.

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DONOR ADVISED FUND: Defined

Posted on June 1, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

WHAT IS A DONOR ADVISED FUND?

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A donor-advised fund is a private account created to manage and distribute charitable donations on behalf of an organization, family, or individual. Donor-advised funds can democratize philanthropy by aggregating the contributions of multiple donors, thus multiplying their impact on worthy causes. Donor-advised funds also have abundant tax advantages.

DONOR DEPENDENCY: https://medicalexecutivepost.com/2025/01/02/culture-donation-dependency/

Donor-advised funds have become increasingly popular, as they offer the donor greater ease of administration while still allowing them to maintain significant control over the placement and distribution of charitable gifts. But, unlike private foundations, donor-advised fund holders enjoy a federal income tax deduction of up to 60% of adjusted gross income (AGI) for cash contributions and up to 30% of AGI for the appreciated securities they donate. Donors to these funds can contribute cash, stock shares, and other assets. When they transfer assets such as limited-partnership interests, they can avoid capital gains taxes and receive immediate fair market value tax deductions.

MEDICAL ETHICS: https://medicalexecutivepost.com/2024/06/20/medical-ethics-physician-and-financial-organizations/

According to the National Philanthropic Trust’s 2023 Donor-Advised Fund Report, these funds have continued to grow in recent years, despite some headwinds including the Covid-19 pandemic and occasional stock market setbacks. Total grants awarded by donor-advised funds in 2022 increased by 9% to $52.16 billion, while total contributions rose by 9% to $85.5 billion.

Many donor-advised funds accept non-cash assets—such as checks, wire transfers, and cash positions from a brokerage account—in addition to cash and cash equivalents.

Donating non-cash assets may be more beneficial for individuals and businesses, leading to bigger tax bigger write-offs.

PHILANTHROPY: https://medicalexecutivepost.com/2021/11/15/national-philanthropy-day-2021/

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RIP: Robert Jarvik MD; 79

Posted on May 31, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

BREAKING NEWS!

By Staff Reporters

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Robert Jarvik, who developed the first artificial heart to be permanently implanted in a human — a breakthrough that captured the world’s imagination even as it triggered debates about medical ethics — died May 26th at his home in Manhattan, NY. He was 79.

Heart Attack: https://medicalexecutivepost.com/2021/01/08/heart-attack-symptoms/

Heart Disease Prevention for Caregivers

The cause was complications from Parkinson’s disease, said his wife, writer Marilyn vos Savant.

MORE: https://en.wikipedia.org/wiki/Robert_Jarvik

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GIVING CIRCLES: Defined

Posted on May 26, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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Giving circles are kick starting a new era of philanthropy where individuals give together to make social change happen.

A giving circle brings a group of people with shared values together to collectively discuss and decide where to make a pooled gift.

Philanthropy: https://medicalexecutivepost.com/2021/11/15/national-philanthropy-day-2021/

Giving circles support with their dollars, but also build awareness, volunteer, become board members and more. Individuals multiply their impact and knowledge, have fun, and connect with their local community.

Ethics: https://medicalexecutivepost.com/2024/06/22/medical-ethics-managing-risk-is-a-component-of-caring/

People are coming together around the world to create the change they want to see in the world. Giving circles are a growing global movement with more than 2,500 active circles around the world giving intentionally and thoughtfully.

Donor Advised Funds: https://medicalexecutivepost.com/2024/11/27/a-thanksgiving-donation-in-name-only/

Giving circles are a modern form of collective giving with roots in cultures across the globe for many decades!

EDUCATION: Books

Cite: https://johnsoncenter.org/2023-us-collective-giving-research-initiative/

Visit WhatIsAGivingCircle.com for more on this collective giving model and why people-centered philanthropy is so powerful.

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DAILY UPDATE: UnitedHealth Group Alert as Stocks End Slightly Mixed

Posted on May 16, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

MEDICAL EXECUTIVE-POST – TODAY’S NEWSLETTER BRIEFING

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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants

“Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily“

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CITE: https://www.r2library.com/Resource

The Justice Department is investigating UnitedHealth Group for possible criminal Medicare fraud, the WSJ reported. The healthcare-fraud unit of the Justice Department’s criminal division is overseeing the investigation and it has been an active probe since at least last summer. Apparently the federal investigation is focusing on the company’s Medicare Advantage business practices. UnitedHealth said in a statement it hadn’t been notified by the Justice Department of the criminal investigation. The statement said the company stands “by the integrity of the Medicare Advantage program.”

CITE: https://tinyurl.com/2h47urt5

🟢 What’s up

  • Foot Locker exploded 85.70% on the news that Dick’s Sporting Goods will acquire the footwear retailer for $2.4 billion. Dick’s shares sank 14.58%.
  • Speaking of shoes, Boot Barn soared 16.66% thanks to the Western footwear seller’s record revenue last quarter.
  • And in more shoe news, Birkenstock gained 5.89% after the purveyor of the world’s ugliest sandals missed revenue estimates but beat on profits.
  • Under Armour rose 4.47% after the sportswear retailer issued a “meh” earnings report and pulled its fiscal forecast.
  • Cisco climbed 4.85% after the networking company beat Wall Street analysts’ expectations and also issued better-than-expected fiscal guidance.
  • Hopefully you botta ’da stock: Ibotta rocketed 20.01% higher on strong earnings for the cash-back app.

What’s down

  • Apple fell 0.41% on news that President Trump scolded Tim Cook for trying to build iPhones in India.
  • Meta Platforms dropped 2.35% thanks to a Wall Street Journal report that the social media giant has delayed the debut of its flagship AI model.
  • UnitedHealth Group plummeted 10.93% on a Wall Street Journal report that the health insurer is being investigated for criminal Medicare fraud.
  • Ubisoft plunged 13.28% after the video game studio reported a 20.5% decline in net bookings last quarter.
  • Coinbase crumbled 7.20% on news that hackers bribed employees to steal customer information and that it will take $400 million to fix the mess.
  • DXC Technology sank 3.26% thanks to shockingly low fiscal guidance from the IT company.
  • Fiserv’s CFO said that the fintech’s retail payment system will see similar volume next quarter. Shareholders hoping for stronger growth were disappointed and pushed shares down 16.19%.

CITE: https://tinyurl.com/tj8smmes

Visualize: How private equity tangled banks in a web of debt, from the Financial Times.

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LONG TERM CARE INSURANCE: A Hobson’s Choice Decision?

Posted on May 3, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

SPONSOR: http://www.CertifiedMedicalPlanner.org

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Long Term Care Insurance [LTCI]

Some retired people live on a fixed income and many of them live right on the edge of their financial capability.  At some time in their life, they may have to make a choice regarding many purchases.  

In this case, we will illustrate “choice” using a couple’s purchase of Long-Term-Care Insurance [LTCI]. Of course, economics is the study of choice; wants, needs and scarcity, etc. In our case, if they decide to make the purchase they commit to a lifetime of premium payments. The financial tradeoff is this; if they make the commitment to purchase LTCI, they must give up something else.

EXAMPLE: In order to maintain a monthly premium of $100 ($1,200per year), an elderly patient, retired layman or couple must essentially relegate about $30,000 of financial assets to generate the $100 necessary to make an average premium payment (assumes a 7% rate of return with 4% withdrawal rate) or [4% X $30,000 = $1,200 year]. Thus, if the monthly premium cost is $500 per month, the elder must give up the use of $150,000 of retirement asset just to generate enough cash flow to pay for the LTC insurance. 

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The married elder couple has to make the Hobson’s Choice decision among lifestyle (dinners, vacations, gifts to children, prescription drugs, medical care or food and shelter) versus paying an insurance premium to provide for nursing home coverage for a need, which may be very real, but will not occur until sometime in the ambiguous future. 

And so, when faced with such a tough economics Hobson’s Medicine Choice, neither of which delivers peace of mind or a respectable solution; many will simply decide that, in either case, they may already end up impoverished. Thus, many will often opt for the better lifestyle now … while they can enjoy it … together. 

Cite: Anonymous Health Insurance Agent, Norcross, Georgia

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Daily posts are organized by subject. ME-P administrators moderate the activity. Moderation may also conducted by community-specific moderators who are unpaid volunteers.

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Registered Investment Advisor VERSUS Hedge Fund Manager

Posted on April 7, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

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By Staff Reporters

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A hedge fund is a limited partnership of private investors whose money is pooled and managed by professional fund managers. These managers use a wide range of strategies, including leverage (borrowed money) and the trading of nontraditional assets, to earn above-average investment returns. A hedge fund investment is often considered a risky, alternative investment choice and usually requires a high minimum investment or net worth. Hedge funds typically target wealthy investors.

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The Hedge Fund manager I am considering is a Registered Investment Adviser [RIA]

QUESTION: What is a Registered Investment Advisor?

If the fund manager is an entity, then any individual you deal with will be a registered investment adviser representative. If the fund manager is an individual, then that individual is a registered investment adviser. In either case, the designation implies several steps have been taken.

In order to become a registered investment adviser, an individual must register for and pass the Series 65 Uniform Investment Adviser Law Exam, a three-hour, 130-question computer-based exam administered by the North American Securities Administrators Association. Topics covered include economics and analysis, investment vehicles, investment recommendations and strategies, and ethics and legal guidelines. A passing score is 70 percent or higher.

Once an individual has passed the Series 65, he or she must then apply via Form ADV to become a registered investment adviser. This application is made to either a state authority or to the SEC, depending on the adviser’s assets under management. If assets under management exceed $30 million, then the adviser must register with the SEC.

Form ADV consists of two parts. Part I provides general information to the regulatory authority. Part II is designed to be distributed to potential clients, and includes disclosure of a decent amount of information about the adviser. If the manager is a registered investment adviser, then you should expect to receive as part of the offering documentation either a current copy of Part II of the adviser’s Form ADV or a brochure that contains all the current information in Part II of Form ADV.

In addition to filing Form ADV and paying a small fee, the registered investment adviser becomes subject to extra administrative/regulatory burden as well as capital adequacy requirements that state the Adviser must maintain certain net worth levels.

By and large, because of the extra administrative burden as well as restrictions on certain activities, hedge fund managers attempt to avoid registering as investment advisers. Whether such managers can or cannot avoid such registration is largely dependent upon the state in which the manager operates. In California, for instance, hedge fund managers must register as investment advisers. In New York, such registration is not necessary. Not surprisingly, hedge fund managers located in California are rare, while they are quite plentiful in New York. 

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HEDGE FUND: Wrap Fees?

Posted on April 5, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

Staff Reporters

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A hedge fund is a limited partnership of private investors whose money is pooled and managed by professional fund managers. These managers use a wide range of strategies, including leverage (borrowed money) and the trading of nontraditional assets, to earn above-average investment returns. A hedge fund investment is often considered a risky, alternative investment choice and usually requires a high minimum investment or net worth. Hedge funds typically target wealthy investors.

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My stock broker is telling me about a “wrap-fee” program involving a hedge fund manager.

QUESTION: What is a Wrap Fee?

A wrap fee program is a service that provides investment advice and portfolio management to clients for one all-inclusive fee. The fee pays for the services provided to the client, including but not limited to securities transactions, portfolio management, research, brokerage, and administrative services. Wrap fee programs also provide an understanding of a client’s financial goals and objectives; research and selection of assets; implementation of investment decisions; account statements, and access to real-time financial data.

The Investment Advisers Act of 1940 regulates investment advisors when they offer these wrap fee programs and requires them to provide comprehensive disclosure documents before investing. This act helps ensure clients have access to all important information that affects their investment decisions.

QUESTION: Why do I need my stock broker? Can I just go directly to the hedge fund manager?

Yes, you can, but you may find a different fee arrangement when you reach the hedge fund manager, and you may be participating in an unethical transaction. When hedge fund managers set up separate accounts for wrap-fee clients, they agree to take a set fee in exchange for managing this money. They also enter into agreements with one or more brokers to help market this aspect of their money management business. A portion of the wrap fee you pay goes to the broker, and a portion goes to the manager. Incentive compensation is not generally used.

When approached directly, hedge fund managers will typically offer only the hedge fund, complete with incentive compensation and pooled investment features. However, if the hedge fund manager is willing to set up a separate account, it is possible that the investor will find the set fee much less than what he or she would have paid in a wrap fee account through a broker.

Finally, the very large caveat to all this is that the ethics of a hedge fund manager who steals clients from brokers with whom he has a marketing relationship ought to be called into question. And when it comes to hedge funds, the ethics of the manager are of paramount importance.

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BIAS: In Podiatric Medicine

Posted on March 16, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

DOCTOR PODIATRIC MEDICINE

By Staff Reporters

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Background: Survey research is common practice in podiatry literature and many other health-related fields. An important component of the reporting of survey results is the provision of sufficient information to permit readers to understand the validity and representativeness of the results presented. However, the quality of survey reporting measures in the body of podiatry literature has not been systematically reviewed.

Objective: To examine the reporting of response rates and nonresponse bias within survey research articles published in the podiatric literature in order to provide a foundation with regard to the development of appropriate research reporting standards within the profession.

Methods: This study reports on a secondary analysis of survey research published in the Journal of the American Podiatric Medical Association, the Foot, and the Journal of Foot and Ankle Research. 98 surveys published from 2000 to 2018 were reviewed and data abstracted regarding the report of response rates and non-response bias.

Results: 67 surveys (68.4%) report a response rate while only 36 articles (36.7%) mention non-response bias in any capacity.

Conclusions: The findings suggest that there is room for improvement in the quality of reporting response rates and nonresponse in the body of podiatric literature involving survey research. Both nonresponse and response rate should be reported to assess survey quality. This is particularly problematic for studies that contribute to best practices.

READ: https://pubmed.ncbi.nlm.nih.gov/31216499/

Keywords: Bias; Health; Research; Response rate; Survey.

READ: https://podiatrym.com/pdf/2017/9/Shapiro917web.pdf

READ: https://www.apma.org/apmamain/document-server/?cfp=/apmamain/assets/file/public/about/code-of-ethics.pdf

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MORALITY Priming

Posted on January 5, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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Morality Priming refers to subtle reminders of ethical principles that can make us behave more responsibly. It’s like an internal nudge that brings our conscience to the surface.

And, according to colleague Dan Ariely PhD, by focusing on moral standards, people are often encouraged to act more honestly, even in small, everyday decisions.

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OBEDIENCE: To Authority is “Shocking”

Posted on October 24, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

QUESTION EVERYTHING?

By Staff Reporters

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Question: Why do we follow orders, even when they seem wrong?

According to colleague Dan Ariely PhD, Obedience to Authority is a powerful force, making us do things we wouldn’t normally do. Think of the infamous Milgram experiment, where people shocked others because a guy in a lab coat told them to do so. It’s our brain’s way of outsourcing decision-making to someone else. While it can keep society orderly, it also explains why people sometimes follow questionable orders.

Cite: https://www.simplypsychology.org/milgram.html

Milgram’s experiments posed the question: Would people obey orders, even if they believed doing so would harm another person?

Milgram’s findings suggested the answer was yes, they would. The experiments have long been controversial, both because of the startling findings and the ethical problems with the research. More recently, experts have re-examined the studies, suggesting that participants were often coerced into obeying and that at least some participants recognized that the other person was just pretending to be shocked. Such findings call into question the study’s validity and authenticity, but some replications suggest that people are surprisingly prone to obeying authority.

So, question authority [doctor, financial advisor, accountant, clergy, professor and lawyer, etc] – just not your GPS.

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MEDICAL ETHICS: Managing Risk is a Component of Real Health Caring

Posted on June 22, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

Demanding High Moral Standards of Self … and Economic HEALTHCARE Organizations

Dr. David Edward Marcinko MBA MEd CMP®

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It has been argued that physicians have abdicated the “moral high ground” in health care by their interest in seeking protection for their high incomes, their highly publicized self-referral arrangements, and their historical opposition toward reform efforts that jeopardized their clinical autonomy. 

Experts Speak

In his book Medicine at the Crossroads, colleague and Emory University professor Melvin Konnor, MD noted that “throughout its history, organized medicine has represented, first and foremost, the pecuniary interests of doctors.” He lays significant blame for the present problems in health care at the doorstep of both insurers and doctors, stating that “the system’s ills are pervasive and all its participants are responsible.” 

In order to reclaim their once esteemed moral position, physicians must actively reaffirm their commitment to the highest standards of the medical profession and call on other participants in the health care delivery system also to elevate their values and standards to the highest level.

Evolution

In the evolutionary shifts in models for care, physicians have been asked to embrace business values of efficiency and cost effectiveness, sometimes at the expense of their professional judgment and personal values.  While some of these changes have been inevitable as our society sought to rein in out-of-control costs, it is not unreasonable for physicians to call on payers, regulators and other parties to the health care delivery system to raise their ethical bar. 

Harvard University physician-ethicist Linda Emmanuel noted that “health professionals are now accountable to business values (such as efficiency and cost effectiveness), so business persons should be accountable to professional values including kindness and compassion.” 

Within the framework of ethical principles, John La Puma, M.D., wrote in Managed Care Ethics, that “business’s ethical obligations are integrity and honesty.  Medicine’s are those plus altruism, beneficence, non-maleficence, respect, and fairness.”

Incumbent in these activities is the expectation that the forces that control our health care delivery system, the payers, the regulators, and the providers will reach out to the larger community, working to eliminate the inequities that have left so many Americans with limited access to even basic health care. 

Charles Dougherty clarified this obligation in Back to Reform, when he noted that “behind the daunting social reality stands a simple moral value that motivates the entire enterprise”. 

ASSESSMENT

Health care is indeed grounded in caring. And, managing risk is a component of caring. It arises from a sympathetic response to the suffering of others.

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MEDICAL ETHICS: Physician and Financial Organizations

Posted on June 20, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

Demanding High Professional Moral Standards of Self and Financing Organizations

By Dr. David Edward Marcinko MBA MEd

By Render Davis MBA

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It has been argued that physicians have abdicated the “moral high ground” in health care by their interest in seeking protection for their high incomes, their highly publicized self-referral arrangements, and their historical opposition toward reform efforts that jeopardized their clinical autonomy.

In his book Medicine at the Crossroads, Emory University professor Melvin Konnor, M.D., noted that “throughout its history, organized medicine has represented, first and foremost, the pecuniary interests of doctors.” He goes on to lay significant blame for the present problems in health care at the doorstep of both insurers and doctors, stating that “the system’s ills are pervasive and all its participants are responsible.” In order to reclaim their once esteemed moral position, physicians must actively reaffirm their commitment to the highest standards of the medical profession and call on other participants in the health care delivery system also to elevate their values and standards to the highest level.

In the evolutionary shifts in models for care, physicians have been asked to embrace business values of efficiency and cost effectiveness, sometimes at the expense of their professional judgment and personal values. While some of these changes have been inevitable as our society sought to rein in out-of-control costs, it is not unreasonable for physicians to call on payers, regulators and other parties to the health care delivery system to raise their ethical bar.

Harvard University physician-ethicist Linda Emmanuel noted that “health professionals are now accountable to business values (such as efficiency and cost effectiveness), so business persons should be accountable to professional values including kindness and compassion.

”Within the framework of ethical principles, John La Puma, M.D., wrote in Managed Care Ethics, that “business’s ethical obligations are integrity and honesty. Medicine’s are those plus altruism, beneficence, nonmaleficence, respect, and fairness.”

Incumbent in these activities is the expectation that the forces that control our health care delivery system, the payers, the regulators, and the providers will reach out to the larger community, working to eliminate the inequities that have left so many Americans with limited access to even basic health care. Charles Dougherty clarified this obligation in Back to Reform, when he noted that “behind the daunting social reality stands a simple moral value that motivates the entire enterprise. Health care is grounded in caring. It arises from a sympathetic response to the suffering of others.”

MORE: https://medicalexecutivepost.com/2017/02/23/healthcare-policy-on-health-and-ethics/

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PRISONER’S DILEMMA: In Health Economics

Posted on May 11, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

DEM white shirt

By Dr. David Edward Marcinko MBA MEd CMP

Understanding the Prisoner’s Dilemma

[From Wikipedia, the free encyclopedia]

As all economists and psychologists know, the prisoner’s dilemma is a standard example of a game analyzed in game theory that shows why two completely “rational” individuals might not cooperate, even if it appears that it is in their best interests to do so. It was originally framed by Merrill Flood and Melvin Dresher working at RAND in 1950. Albert W. Tucker formalized the game with prison sentence rewards and named it, “prisoner’s dilemma” (Poundstone, 1992), presenting it as follows:

Two members of a criminal gang are arrested and imprisoned. Each prisoner is in solitary confinement with no means of communicating with the other. The prosecutors lack sufficient evidence to convict the pair on the principal charge. They hope to get both sentenced to a year in prison on a lesser charge.

Simultaneously, the prosecutors offer each prisoner a bargain. Each prisoner is given the opportunity either to: betray the other by testifying that the other committed the crime, or to cooperate with the other by remaining silent.

The offer is:

  • If A and B each betray the other, each of them serves 2 years in prison
  • If A betrays B but B remains silent, A will be set free and B will serve 3 years in prison (and vice versa)
  • If A and B both remain silent, both of them will only serve 1 year in prison (on the lesser charge)

It is implied that the prisoners will have no opportunity to reward or punish their partner other than the prison sentences they get, and that their decision will not affect their reputation in the future. Because betraying a partner offers a greater reward than cooperating with him, all purely rational self-interested prisoners would betray the other, and so the only possible outcome for two purely rational prisoners is for them to betray each other.

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thats-outrageous-prisoners-rights-to-free-medical-care-af

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The interesting part of this result is that pursuing individual reward logically leads both of the prisoners to betray, when they would get a better reward if they both kept silent.

In reality, humans display a systemic bias towards cooperative behavior in this and similar games, much more so than predicted by simple models of “rational” self-interested action. A model based on a different kind of rationality, where people forecast how the game would be played if they formed coalitions and then they maximize their forecasts, has been shown to make better predictions of the rate of cooperation in this and similar games given only the payoffs of the game.

An extended “iterated” version of the game also exists, where the classic game is played repeatedly between the same prisoners, and consequently, both prisoners continuously have an opportunity to penalize the other for previous decisions. If the number of times the game will be played is known to the players, then (by backward induction) two classically rational players will betray each other repeatedly, for the same reasons as the single shot variant. In an infinite or unknown length game there is no fixed optimum strategy, and Prisoner’s Dilemma tournaments have been held to compete and test algorithms.

In Health Economics

Advertising is sometimes cited as a real-example of the prisoner’s dilemma.

When cigarette advertising was legal in the United States, competing cigarette manufacturers had to decide how much money to spend on advertising. The effectiveness of Firm A’s advertising was partially determined by the advertising conducted by Firm B. Likewise, the profit derived from advertising for Firm B is affected by the advertising conducted by Firm A. If both Firm A and Firm B chose to advertise during a given period, then the advertising cancels out, receipts remain constant, and expenses increase due to the cost of advertising. Both firms would benefit from a reduction in advertising.

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cigarette+smoke

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However, should Firm B choose not to advertise, Firm A could benefit greatly by advertising. Nevertheless, the optimal amount of advertising by one firm depends on how much advertising the other undertakes. As the best strategy is dependent on what the other firm chooses there is no dominant strategy, which makes it slightly different from a prisoner’s dilemma. The outcome is similar, though, in that both firms would be better off were they to advertise less than in the equilibrium. Sometimes cooperative behaviors do emerge in business situations.

For instance, cigarette manufacturers endorsed the making of laws banning cigarette advertising, understanding that this would reduce costs and increase profits across the industry. This analysis is likely to be pertinent in many other business situations involving advertising

Without enforceable agreements, members of a cartel are also involved in a (multi-player) prisoners’ dilemma. ‘Cooperating’ typically means keeping prices at a pre-agreed minimum level. ‘Defecting’ means selling under this minimum level, instantly taking business (and profits) from other cartel members. Anti-trust authorities want potential cartel members to mutually defect, ensuring the lowest possible prices for consumers.

More Healthcare Examples:

Assessment

The prisoner’s dilemma game can be used as a model for many real world situations involving cooperative behavior. In casual usage, the label “prisoner’s dilemma” may be applied to situations not strictly matching the formal criteria of the classic or iterative games: for instance, those in which two entities could gain important benefits from cooperating or suffer from the failure to do so, but find it merely difficult or expensive, not necessarily impossible, to coordinate their activities to achieve cooperation.

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Medical School Ethics VERSUS Business School Ethics

Posted on April 10, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

Is Business Finally Embracing Medical Values?

[By Render S. Davis MHA CHE]

[By David Edward Marcinko MBA MEd]

dr-david-marcinko

In the evolutionary shifts in models for medical care, physicians have been asked to embrace business values of efficiency and cost effectiveness, sometimes at the expense of their professional judgment and personal values.

While some of these changes have been inevitable as our society sought to rein in out-of-control costs, it is not unreasonable for physicians to call on payers, regulators and other business parties to the health care delivery system to raise their ethical bar.

Tit-for-Tat

Harvard University physician-ethicist Linda Emmanuel noted that “health professionals are now accountable to business values (such as efficiency and cost effectiveness), so business persons should be accountable to professional values including kindness and compassion.”

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face-off

[Medicine versus Business]

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Assessment

Within the framework of ethical principles, John La Puma, M.D., wrote in Managed Care Ethics, that “business’s ethical obligations are integrity and honesty.

Medicine’s are those plus altruism, beneficence, non-maleficence, respect, and fairness.”

About the Author

Render Davis was a Certified Healthcare Executive, now retired from Crawford Long Hospital at Emory University, in Atlanta, GA He served as Assistant Administrator for General Services, Policy Development, and Regulatory Affairs from 1977-95.  He is a founding board member of the Health Care Ethics Consortium of Georgia and served on the consortium’s Executive Committee, Advisory Board, Futility Task Force, Strategic Planning Committee, and chaired the Annual Conference Planning Committee, for many years.

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BEYOND: Advance Care Planning for Financial Advisors & Lawyers from Doctors on April 16-17th.

Posted on April 17, 2023 by Dr. David Edward Marcinko MBA MEd CMP™

APRIL 17th. IS NATIONAL HEALTHCARE DECISION DAY 2023

By Dr. David Edward Marcinko MBA CMP

SPONSOR: http://www.CertifiedMedicalPlanner.org

Staff Reporters via National Institute of Health

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National Healthcare Decisions Day (NHDD) exists to inspire, educate and empower the public and providers about the importance of advance care planning. NHDD is an initiative to encourage patients to express their wishes regarding healthcare and for providers and facilities to respect those wishes, whatever they may be.

NHDD was founded in 2008 by Nathan Kottkamp, a Virginia-based health care lawyer, to provide clear, concise, and consistent information on healthcare decision-making to both the public and providers/facilities through the widespread availability and dissemination of simple, free, and uniform tools (not just forms) to guide the process.

NHDD is a series of independent events held across the country, supported by a national media and public education campaign. In all respects, NHDD is inclusive and brings a variety of players in the larger healthcare, legal, and religious community together to work on a common project, to the benefit of patients, families, and providers. A key goal of NHDD is to demystify healthcare decision-making and make the topic of advance care planning inescapable. Among other things, NHDD helps people understand that advance healthcare decision-making includes much more than living wills; it is a process that should focus first on conversation and choosing an agent.

As of June 2016, The Conversation Project has been responsible for the management, finances, and structure of NHDD.  NHDD’s founder, Nathan Kottkamp, continues to be involved in NHDD and provides leadership by ensuring the maintenance of NHDD’s high quality resources and support for the community.

Read more about NHDD’s founding: https://theconversationproject.org/nhdd/origins/

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DEFINITION: What is advance care planning for financial advisors and lawyers?

Advance care planning involves discussing and preparing for future decisions about your medical care if you become seriously ill or unable to communicate your wishes with your estate planning attorney or financial advisor. Having meaningful conversations with your loved ones is the most important part of advance care planning. Many people also choose to put their preferences in writing by completing legal documents called advance directives.

What are advance directives?

Advance directives are legal documents that provide instructions for medical care and only go into effect if you cannot communicate your own wishes.

The two most common advance directives for health care are the living will and the durable power of attorney for health care.

  • Living will: A living will is a legal document that tells doctors how you want to be treated if you cannot make your own decisions about emergency treatment. In a living will, you can say which common medical treatments or care you would want, which ones you would want to avoid, and under which conditions each of your choices applies. Learn more about preparing a living will.
  • Durable power of attorney for health care: A durable power of attorney for health care is a legal document that names your health care proxy, a person who can make health care decisions for you if you are unable to communicate these yourself. Your proxy, also known as a representative, surrogate, or agent, should be familiar with your values and wishes. A proxy can be chosen in addition to or instead of a living will. Having a health care proxy helps you plan for situations that cannot be foreseen, such as a serious car accident or stroke. Learn more about choosing a health care proxy.

Think of your advance directives as living documents that you review at least once each year and update if a major life event occurs such as retirement, moving out of state, or a significant change in your health.

CITE: https://www.r2library.com/Resource

Who needs an advance care plan?

Advance care planning is not just for people who are very old or ill. At any age, a medical crisis could leave you unable to communicate your own health care decisions. Planning now for your future health care can help ensure you get the medical care you want and that someone you trust will be there to make decisions for you.

  • Advance care planning for people with dementia. Many people do not realize that Alzheimer’s disease and related dementias are terminal conditions and ultimately result in death. People in the later stages of dementia often lose their ability to do the simplest tasks. If you have dementia, advance care planning can give you a sense of control over an uncertain future and enable you to participate directly in decision-making about your future care. If you are a loved one of someone with dementia, encourage these discussions as early as possible. In the later stages of dementia, you may wish to discuss decisions with other family members, your loved one’s health care provider, or a trusted friend to feel more supported when deciding the types of care and treatments the person would want.

What happens if you do not have an advance directive?

If you do not have an advance directive and you are unable to make decisions on your own, the state laws where you live will determine who may make medical decisions on your behalf. This is typically your spouse, your parents if they are available, or your children if they are adults. If you are unmarried and have not named your partner as your proxy, it’s possible they could be excluded from decision-making. If you have no family members, some states allow a close friend who is familiar with your values to help. Or they may assign a physician to represent your best interests. To find out the laws in your state, contact your state legal aid office or state bar association.

Will an advance directive guarantee your wishes are followed?

An advance directive is legally recognized but not legally binding. This means that your health care provider and proxy will do their best to respect your advance directives, but there may be circumstances in which they cannot follow your wishes exactly. For example, you may be in a complex medical situation where it is unclear what you would want. This is another key reason why having conversations about your preferences is so important. Talking with your loved ones ahead of time may help them better navigate unanticipated issues.

There is the possibility that a health care provider refuses to follow your advance directives. This might happen if the decision goes against:

  • The health care provider’s conscience
  • The health care institution’s policy
  • Accepted health care standards

In these situations, the health care provider must inform your health care proxy immediately and consider transferring your care to another provider.

Other advance care planning forms and orders from doctors

You might want to prepare documents to express your wishes about a single medical issue or something else not already covered in your advance directives, such as an emergency. For these types of situations, you can talk with a doctor about establishing the following orders:

  • Do not resuscitate (DNR) order: A DNR becomes part of your medical chart to inform medical staff in a hospital or nursing facility that you do not want CPR or other life-support measures to be attempted if your heartbeat and breathing stop. Sometimes this document is referred to as a do not attempt resuscitation (DNR) order or an allow natural death (AND) order. Even though a living will might state that CPR is not wanted, it is helpful to have a DNR order as part of your medical file if you go to a hospital. Posting a DNR next to your hospital bed might avoid confusion in an emergency. Without a DNR order, medical staff will attempt every effort to restore your breathing and the normal rhythm of your heart.
  • Do not intubate (DNI) order: A similar document, a DNI informs medical staff in a hospital or nursing facility that you do not want to be on a ventilator.
  • Do not hospitalize (DNH) order: A DNH indicates to long-term care providers, such as nursing home staff, that you prefer not to be sent to a hospital for treatment at the end of life.
  • Out-of-hospital DNR order: An out-of-hospital DNR alerts emergency medical personnel to your wishes regarding measures to restore your heartbeat or breathing if you are not in a hospital.
  • Physician orders for life-sustaining treatment (POLST) and medical orders for life-sustaining treatment (MOLST) forms:These forms provide guidance about your medical care that health care professionals can act on immediately in an emergency. They serve as a medical order in addition to your advance directive. Typically, you create a POLST or MOLST when you are near the end of life or critically ill and understand the specific decisions that might need to be made on your behalf. These forms may also be called portable medical orders or physician orders for scope of treatment (POST). Check with your state department of health to find out if these forms are available where you live.
  • MORE: https://www.kevinmd.com/2023/04/april-16th-is-national-healthcare-decisions-day-plan-for-your-end-of-life-care-now.html

Medicare Enrollment at CMS?

At enrollment, Medicare in the future could offer three advance directives with goals of care: Directive A: CONSENT to treat — inpatient medical treatment Directive B: CONSENT to comfort — home bound holistic care Directive C: CHOOSE against medical advice — outpatient palliative resources.

CITE: https://www.kevinmd.com/2023/04/the-heartbreaking-story-of-jimmy-carter-a-call-for-medicare-reform-in-end-of-life-care.html

You may also want to document your wishes about organ and tissue donation and brain donation. As well, learning about care options such as palliative care and hospice care can help you plan ahead.

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ME-P Complaints & Corrections

Posted on October 7, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Setting the Record Straight

By Ann Miller RN MHA

[Executive Director]

The Medical Executive-Post is growing, and with your help we will penetrate our market even deeper. And so, in order to maintain the quality publication we envisioned at inception, please contact us with any post concerns and/or commentary corrections you may have.

Assessment

We may not be perfect; but we will strive to set the record straight for our readers and valued ME-P subscribers. All valid e-mails may be published unless you tell us otherwise.

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