Why are medical care guidelines kept behind journal paywalls?

Think you and your doctor can access the latest expert knowledge about your medical condition?  Think again.

Imagine you have cancer and receive chemotherapy. You develop a complication–a life-threatening blood clot, the second leading cause of death in cancer patients after the cancer itself. You’re frightened. What should your doctor do to save your life? Are there drugs available? If so, which one is best? At what dose? For how long? Will it interfere with your chemotherapy? How will you prevent a future clot? Where will you and your doctor look to find the answers to guide your treatment decisions?

You are in luck. You and your doctor don’t have to begin from scratch. In fact, an international team of experts in your very condition have reviewed all the research literature. Research which was likely tax-payer funded. Research which recruited patients like you to be volunteers in the clinical trials. At great time, effort and expense, this expert group met and debated about what is best to do in your very situation.

And extra lucky for you, this expert group after they reached a consensus wrote up their recommendations in a concise document and published it online in a major medical journal just so patients like you could one day benefit from their work—exactly what you and your doctor need to inform the next steps of your treatment

Sadly, this is where your luck runs out. Despite this wonderful life-saving document being published by a major, reputable medical journal, neither you nor your doctor has permission to read it. It is behind a website paywall and you lack access.

Welcome to the world of medical journal publishing, where a handful of corporations control public access to scientific research and evidence-based health care protocols.

Limited physician access

Institutional subscriptions are the most common way medical journals disseminate information and costs vary by customer. As example, the Annals of Internal Medicine quotes an annual access rate for a community library of $1,273 while the fee for a large hospital network is $6,207. This is merely for one journal subscription; there are hundreds of medical journals one must subscribe to for a comprehensive collection.  As journal subscriptions rise, libraries and individuals have been forced to cut back on the depth and breadth of journals purchased.

To download individual articles, fees ranging from $30–$50 for a single article are commonly charged.

It may come as a shock to those behind ivy walls, but there are still physicians in America who own their own practice, hire their own staff, pay their own bills, and must tap their own resources to keep up with the latest medical research. Nearly half of all US physicians are self-employed.

While some physicians enjoy subscriptions provided by their academic institutions many more do not. It may come as a shock to those behind ivy walls, but there are still physicians in America who own their own practice, hire their own staff, pay their own bills, and must tap their own resources to keep up with the latest medical research. Nearly half of all physicians are self-employed and not part of a hospital or academic teaching institution, according to the American Medical Association.

These physicians do not have the benefit of enjoying the deeper pockets of a large academic institution where journals are a comparatively smaller budget line-item.

No patient access

Price for 24 hours of online access

Patients engagement is the current buzz word in health care. We patients like to be informed and proactive in our care. We call upon Dr. Google without hesitation. Medical journals are the most reliable, scientifically-sound, evidence-based source of medical information available on the internet. Yet patients cannot access them.

Publishers say they support patient access, but fail to provide a clear pathway for it.

When queried, editors of major medical journals indicated to me they will send any article to a patient upon request. Yet, they fail to mention this at all on their website nor provide instruction as to whom or how a patient can request an article. The only option offered to patients is the ‘Pay-per-view’ option, which allows only 24 hours of access to view 1 article. See the fee chart above for a sampling of fees requested of patients.

For optimal health outcomes, it takes and informed patient partnering with an informed health care provider.  yet, patients are unable to access evidence-based medical information and scientific research results online.  Without access to quality publications, patients cannot contribute to informed decision making.

Record publisher profits

Medical journals are a for-profit publishing business. Yet, the product they provide often falls within the realm of public good. Can they afford to give more of their product away? Let’s go back to my initial example of the cancer patient and physician needing information about treating a blood clot complication. Where would one go to learn the answer?  And, could the publisher of that answer afford to provide free access to the information?

Lancet Oncology, published by Elsevier, recently published online a guideline titled 2019 international clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer.  This guideline was written by an independent academic working group aimed at establishing a global consensus for the treatment and prevention of blood clots in patients with cancer. These blood clots, known as venous thromboembolism (VTE) are the second leading cause of death in patients with cancer, after the cancer itself. Ninety-nine clinicians are named among this guideline’s authors and it 16-pages cover every imaginable cancer and clotting situation; so it’s a comprehensive and highly reputable—a gold standard guideline.  This guideline will answer our example patient and physician questions.

Yet, this guideline sits behind a paywall. A patient or physician trying to read the guideline will be prompted to either subscribe to the journal–at $195.00 for online-only–or pay $31.50 for 24 hours of online access of this one article.

Why? It clearly is not because the publisher Elsevier needs the additional cash flow. Last year, Elsevier charged its customers enough to yield a 37.1% profit–a margin higher than that of Apple, Google or Amazon. (Apple= 21.5%, Google= 21%, Amazon= 4.8%)

Medical journal publisher’s profit margin = higher than that of Apple, Google or Amazon

What does the journal say about access?

Since I could not read the guideline and knowing that fifty-five percent of cancer patients receive their care from a community oncology practice not affiliated with an academic institution which would provide journal access, I was compelled to ask the journal to make this and other guidelines publicly available. I emailed the Editor-in-chief and Publishing-Director of The Lancet Oncology, Dr. David Collingridge, asking him to drop the paywall for the above referenced guideline, as well as all guidelines. He declined to do so.

Elsevier is not alone with its profitable business model.  All five of the largest medical journal publishers have posted continued growth with high profit margins–Elsevier, Springer Nature, SAGE, Taylor & Francis and Wiley-Blackwell.

Further troubling is that many medical journals–such as Circulation and JAMA–are affiliated with nonprofit organizations whose very missions are to improve health care.  Yet, if a patient or physician wants to read an article, a pops up box appears requesting payment. 

Informed decision making…it’s a good thing.

Clinical care guidelines offer concise instructions on various clinical situations with a goal of improving the quality of care and improving patient outcomes. Why on earth would anyone not want all physicians and patients to have equal access to that? Yet that is exactly what is happening and for no discernible reason other than profit-motive.

It calls into question larger issues of: Who owns the results of medical research? What are the rights of patients and physicians to access the results of medical research? Is there an obligation to make public medical research which is funded by public sources..ie taxpayers? These are the issues our society has yet to full address.

Expert knowledge should not be kept hidden but widely disseminated–to both clinicians and patients. Clinical care guidelines are but one type of journal content and unique enough in nature that they should be considered a public good. Given the high profit margins of parent companies, it would seem medical journals could quite easily choose to place clinical care guidelines outside their paywalls as a public service. Publishers have a window of opportunity to do the right thing on their own before public pressure will invite government intervention.

I call upon each of the major medical journals–Elsevier, Springer Nature, SAGE, Taylor & Francis and Wiley-Blackwell–to make clinical care guidelines open access in their medical journals.  It’s a small step which can have great impact. The public deserves easy access to life-saving clinical care guidance.

 

 

Earth Day 2019: where my local wildlife lives

A photo essay featuring North Carolina wildlife alongside their polluted habitats, in the hope it will inspire positive change.


Bolin Creek at Franklin Street, Chapel Hill, NC

A beaver lies bead among the trash in Bolin Creek where it intersects Franklin Street in Chapel Hill.  This is a disturbing image which i debated whether to publish.  Yet, it sums up, in one image, the cause of my concern…our actions are unintentionally contributing to the deaths of the wildlife which we say we love. I also have found a dead fox beside the water upstream.  In this one section of urban creek, I’ve documented: rabbits, raccoon, opossum, hawks, heron, owls, beaver, nutria, woodchucks, deer, and far too many birds and reptiles to list.   The biodiversity of this urban, wetland environment is simply stunning.

 


Jordan Lake, Apex, NC

Bells Chapel Public Access at Jordan Lake, NC.  A large amount of plastic trash can be found in the water itself.  Do Not Litter signs seem to do little to discourage people.
Osprey nest near same section of Jordan Lake as the above image. Both osprey and bald eagles eat fish from the lake and mammals living along the lake’s woodlands.  Both have been documented bringing trash items and contaminated prey to nests and young.

Haw River at Bynum, NC

A bald eagle catching fish from just under the dam at Bynum Bridge—the EXACT same location as photographed above.

Little Creek at Meadowmont, Chapel Hill, NC

All in one photograph:   Bird drinking water alongside chemical containing litter in Little Creek at Meadowmont, Chapel Hill.  Wood ducks rear young in the pond fed by this creek and there are documented hawk and barred owl nests as well, both species eat crayfish, fish and mammals from along this waterway, increasing the potential for contaminated prey to be brought back to young.

Bolin Creek at Franklin Street, Chapel Hill, NC

This is Bolin Creek at Franklin Street in Chapel Hill (right beside the Enterprise Rental Car store).  See all the trash which has washed down and collected? The creek is in the Jordan Lake watershed….the lake is a drinking water source and boasts active bald eagle populations.
I took this standing at the EXACT same spot on Bolin Creek at Franklin Street as the above image…a woodchuck (aka groundhog) lives in a burrow along the banks.  She raised a family there last year.

 


Bolin Creek Trail, Chapel Hill, NC

Litter clean-up extraordinaire Daniel Toben with a sample of chemical waste he pulled from Bolin Creek near Franklin St. He’s doing great work cleaning up our community.  Thanks Daniel!
Barred owl photographed from the Bolin Creek Trail …owls, heron & hawks all eat crayfish & fish from the creek and mammals from it’s woodlands.
Baby barred owl on its first day out of the nest last summer. It was the sole chick to successfully fledge.  I’ll keep the exact location of this nest private so as not to invite harassment of the current owlets.  Of concern is that owl parents unwittingly bring contaminated prey to feed owlets.
A red-shouldered hawk catching a crayfish in Bolin Creek near Elizabeth St.   Red-tailed, red-shouldered and Cooper’s Hawks all have nesting sights along Bolin Creek.  Again, a clean environment is important as contaminated prey can lead to both adult and baby bird death.

 

Outer Banks, NC

Not in the Triangle nor the best images due to distance and lighting, but I thought this was a dramatic illustration of how wildlife incorporated our waste into their lives.  This particular osprey nest had a surprising amount of construction plastic wrap, foam ‘swim noodle’ and general plastic built into the nest.

Osprey bringing trash to the nest. Nags Head, NC

Thank you for taking time to view.

To see more of my photographic work, please visit BethWaldron.com

 

Please don’t let the first image, be the last image for which our advanced civilization is remembered.  We can do better.  We must do better.

 

 

 

Chapel Hill Groundhogs—yes really!

Groundhog Day–that oddest of holidays in which we look to a rodent to predict the duration of winter.  On February 2, if a groundhog sees its shadow, gets spooked and runs back in the burrow, it will be six more weeks of winter.  Cloudy day and no shadow?  Hey, it’s an early spring. Punxsutawney Phil may be the most famous groundhog, but did you know we have our own groundhog right here in Chapel Hill?

I’ve photographed a family of groundhogs living in an underground burrow quite literally under Franklin Street.  (I won’t give the exact spot to protect them.) Chapel Hill is at the southernmost extent of their range east of the Appalachian mountains.

Groundhogs are also called woodchucks, but they don’t eat wood. They are herbivorous and prefer the more tender parts of plants and grasses.

Groundhogs are accomplished critters…they can swim, climb, and dig.

If you want to see a groundhog, keep a look out in early morning or late afternoon–they are diurnal animals. A common place to see groundhogs is along the shoulder of a roadway, where they like to feed on the vegetation. Unfortunately, this desire to eat near the street leads to the potential for being hit by a car.  Life expectancy in the wild is only about 2-3 years.  In captivity, they’ve been known to live 14 years.

Will Chapel Hill’s groundhog see its shadow on February 2nd?  Well, that may depend if they are even awake.  Groundhogs hibernate from roughly November until February or March.

 

Statistical source:  NC Wildlife Resources Commission 

 

Wild Chapel Hill

There’s a side to the quiet Town of Chapel Hill most folks don’t know about….and it’s a wild one.

A barred owl fledgling rests on a log beside Bolin Creek, soon after leaving the nest for the first time.

Do you have to go ‘into the wild’ to see wildlife?  No! Even urban areas can have a surprising diversity of wildlife.  Case in point:  Chapel Hill, North Carolina is a university town of around 60,000 residents, making it the 15th largest community in the state.  It is one corner of the high-tech hub known as the Research Triangle (Raleigh-Durham-Chapel Hill).

Don’t let the ‘town’ in the official name fool you, Chapel Hill is a fairly densely populated area, with a greater number of persons living per square mile (2,687) than large cities such as that of Atlanta, GA (630) or Nashville, TN (1,300).  Only 7 percent of land remains undeveloped.

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Piebald white-tail deer seen on a town trail

I toss out these statistics to establish that Chapel Hill is truly an urban environment, with high population density and built-up environment.  Yet, it is home to a rich diversity of wildlife.

 

What’s around town?

I am a wildlife photographer living in Chapel Hill, so when I’m around town I usually have a camera with me.

Gray fox near Homestead Road

Over the past year, I’ve been documenting the wildlife I’ve encountered which I’d like to share because it is truly outstanding. Among the animals I’ve photographed:

  • Barred owl
  • Gray fox
  • Bald eagle
  • Raccoon
  • Opossum
  • Deer
  • Nutria
  • Beaver

    Nutria in Bolin Creek near Franklin Street
  • Woodchuck (groundhog)
  • Rabbit
  • Great blue heron
  • Three species of hawks
  • Monarch butterflies
  • And far too many birds, insects, and reptiles to list.

I set up some camera traps in my tiny backyard (I live on a quarter acre within in the city limits).  The animals which have been documented in my yard:  gray fox, raccoon, opossum, white-tailed deer, flying squirrel and a host of birds.   Some mornings, I hear the hoot of an owl and the call of a coyote.

Marsh rabbit from a town trail

Increasingly residents are living and working in close proximity to wild animals whose native habitats have been lost or fragmented by development.

owlWM
Barred owl at sunrise near Morgan Creek

I’ve lived either in or near Chapel Hill for around 30 years. The area has changed dramatically, with the region booming with new development.  Clear cutting is more commonplace than ever before.  Native wildlife habitats have been lost or fragmented.  Increasingly residents are living and working in close proximity to wild animals, who have adapted to city life and are attracted to man-made food sources.

Is living with wildlife safe?

When people and wildlife live in close proximity to each other, it can lead to conflict.  However, much of the issues are of our own making.  Leaving garbage or food out and getting too close to wildlife can lead to problem behaviors.

steeplevultures2 (1 of 1)
Black vultures atop Christ Church in Southern Village

Wildlife should not be feared, but we should have a respect that these are wild animals. I have encountered residents who, for example when I point out a barred owl roosting in a tree, are simply terrified.  They find it difficult to understand that unless they are the size and weight of a mouse, the owl has little interest in them!  Fear stems from a lack of knowledge and interaction with the natural world.

Barred owl near Franklin Street & Estes Drive.

Yet, I have also encountered residents (and photographers!) who don’t have enough fear and get entirely too close to a wild animal.  I have a long zoom lens so I can stay a good distance away from my subjects.  But many (far too many) times while I’m photographing a subject, a passerby will get way too close in an effort to snap a picture with their cell phone.  I’ve even seen naturalists with binoculars and photographers with zooms get too near an animal’s personal space proclaiming ‘oh, this one is used to people’.

Great Blue Heron at Finely Golf Course

Such harassing interactions always cause the animal to flee, creating a hazard for both the animal (who may be flushed from a safe spot into the open where it may face predators) and people—a frightened animal may perceive you as a threat and lash out towards you in self-defense.   Observe.  Appreciate.  Be respectful.  Don’t harass.

If you leave wildlife alone, they will leave you alone.  One exception…a sick or injured animal.

Baby raccoons on a backyard deck off Weaver Dairy Road

With most wild animals, if you leave them alone, they will leave you alone.  The exception being a sick or injured animal.  Rabies is an issue in the region; yet it seems far too many people mistakenly think ‘it must have rabies’ at the first sight of a fox, raccoon or bat.  Just because an animal can be a carrier of rabies does not mean every single animal is rabid.

Red-shouldered hawk at Bolin Creek

How do you know when an animal is sick?  A good rule of thumb:  wild animals should act wild, having a healthy fear of humans. As a wildlife photographer, I take great care to not be seen by my subjects because the moment I’m spotted, they will retreat. Even among urban animals who have been acclimated to people, they may tolerate your presence but they will never approach you.  If a wild animal chooses to approach you, that’s not normal behavior and a sign that you should keep your distance.

Where to see wildlife

  1. Look where you already go every day, close to home or work.  We are often so focused on where we are going that we don’t take time to truly look around us.  You might be surprised what’s in plain view!  I’ve seen owls at UNC, bald eagles over 15-501, fox off Weaver Dairy Road and a woodchuck raising a family in a burrow right under busy Franklin Street!

    woodchuck
    Who’s living a busy Franklin Street bridge?   A woodchuck, also known as a groundhog!
  2. Chapel Hill, Carrboro and Orange County has many great public trails.  Many are paved and easily accessible, such as Bolin Creek trail, Morgan Creek trail, and the Riverwalk.
  3. UNC owed lands contain public trails from which wildlife can be found. Carolina North Forest and the NC Botanical Garden’s Battle Park and Mason Farm Biological Preserve are great places.

Want to see more?

Wildlife of North Carolina note cards

 

 

Exclusive: NatGeo’s Yellowstone Live presents years old documentary footage as live

National Geographic Channel presents footage published 3 years ago as being from animals they filmed this week during the broadcast, Yellowstone Live.  

As a wildlife photographer, I abide by a few simple rules:

1) Respect the wildlife.

2) Get the shot honestly and ethically.

3) Present an image in the post-edit as close to how you actually experienced it.

In the era of photoshop and fake news banter, authentic photography is a fundamental ethic which National Geographic Magazine has historically promoted.  Editorial polices express the belief that what the reader sees, should be what the photographer saw naturally…no baiting of wildlife, no over-manipulation of images during post-processing, etc.

Unfortunately, this ethic apparently does not extend to National Geographic Channel with videography because it is purposefully and with shocking intent presenting stock footage filmed 3 years ago as being from animals they are following this week during a live TV and internet broadcast.

Yellowstone Live, is a four-night multi-platform production presenting the wildlife of Yellowstone National Park.  It premiered on the National Geographic Channel August 5, 2018 and is hosted by former CBS reporter Josh Elliott with co-hosting by animal expert Chris Packham and FS1 reporter Jenna Wolfe.  In the series press release, it says the production will use

“a complex network of 34 live cameras, 200 crew, cutting-edge, first-ever cell-phone bundling technology to broadcast in the most remote locations, live-audience interaction; digital coverage on multiple platforms and innovative technologies including the following:

A “Magma Cam,” a thermal imaging camera, which will reveal Yellowstone’s thermal features

Aerial views of essential wildfires

Aerial filming of a wolf pack in remote wilderness area

Footage from inside a beaver lodge”

Let’s examine that last bullet point…footage from inside a beaver lodge.  The co-hosts in both Episode 1 and 2, present multiple clips of beaver lodge footage as either ‘happening right now’ or with the introduction “these are pictures we got a little while ago”.   Yet, these are the exact same video images which appeared in Wild Yellowstone, a documentary published by National Geographic in 2015.  Not ‘sort of similar’ but exact frame for frame identical.  These animals were not filmed “a little while ago” as the host states, unless you count 3-4 years ago as fitting that criteria.  See the comparison for yourself:

Above Snip from 2015 documentary “Wild Yellowstone”
Snip from Yellowstone Live Episode 2

Host Josh Elliott introduces the Episode 2 clip by saying “Another family intensively studied is a family of beavers who we’ve been with all week long following this family out at Schwabacher’s Landing.  We want to check back in and see what they’ve been up to.”  In fact, the animal family in the footage was first published in a 2015 documentary Wild Yellowstone-Grizzly Summer.

“Another family intensively studied is a family of beavers who we’ve been with all week long following this family out at Schwabacher’s Landing.  We want to check back in and see what they’ve been up to.” In fact, the animal family in the footage was first published in a 2015 documentary.

Color footage of a beaver with a branch is shown while Christ Packham narrates. Then as the color footage transitions to a black-and-white infrared scene, Packham says Now these are some pictures we got a little while ago showing….” The footage airing during Packham’s narration is from the 2015 documentary.  Packham continues, “Let’s listen..remember this is in pitch blackness.” Both Packham and Elliott chat back and forth about how cute the images and sounds of the baby beaver chewing a stick are.  (See the full clip below).

A second clip is then played showing a beaver on a the bank felling a tree.  The image is of a single beaver first running towards then direction of where the tree will fall and then, changing direction and running away.  Eliiott wraps up the segment by saying “so that’s what we were capturing remotely”.  This is the exact same beaver footage from 2015.  Judge the comparison:

Above Snip from documentary Wild Yellowstone 2015
Above Snip from Yellowstone Live Ep 2

Emmy Award winning wildlife cinema-photographer Jeff Hogan was on the production crew of the 2015 Wild Yellowstone footage and is also featured prominently in Yellowstone Live photographing a beaver dam.

Jeff Hogan Yellowstone Live Ep 1

Hogan provides live commentary, indicating that he can ‘hear the young beavers squawking’.  He does not verbally present his footage from the 2015 production, rather it is co-hosts Elliott and Packham who pass the footage off as ‘a family of beavers  they’ve been following this week’.

Anyone who has ever tried to photograph wildlife knows that wild creatures are unpredictable…they don’t perform on demand. I personally think attempting a live show with wildlife is asking for disappointment…truly wild animals cannot be located on que, let alone photographed doing captivating things which might keep an audience’s attention for one or two hours.

Therefore, it is understandable that the production company would need to have some stock footage on hand for those  moments when their 34 live cameras and 200 crew (if that is indeed true) fail to capture anything at all worth sharing.  If they’ve done their homework, then those moments should be rare AND they should say so…the audience will understand.  The show would have been just as good without the false statements. But to present it as either happening right now or even within the past few days is dishonest.  And this is the impression the audience clearly received. 

 

In an era where the term ‘fake news’ proliferates and science is routinely questioned, educational programming should be beyond reproach.  Shame on National Geographic and the production company (Plimsoll Productions in association with Berman Productions) for not being more forthcoming in their presentation of wildlife. If we can’t trust what we see on a nature presentation from esteemed National Geographic, then it’s a sad commentary on where we are culturally–that the desire to entertain and fool the audience outweighs the desire for truth and transparency.  How is the public to trust anything else presented?

Watch a 2 minute clip from Yellowstone Live Episode 2 and judge for yourself if you get the impression the footage presented is live/recent from the week or from 3 years ago, links to exact same images from 2015’s Wild Yellowstone follows below:

 

The full Wild Yellowstone documentary containing the beaver footage can be viewed at time mark 7:45 and 34:00 of https://www.youtube.com/watch?v=LTjQJtr44Gk

 

 

 

North Carolina bald eagles: a comeback success story

Photo by Beth Waldron, taken at Haw River, Bynum, NC 2017
Haw River, Beth Waldron, 2017

I recently went to the Haw River near Bynum, North Carolina to try out a new lens and unexpectedly encountered two bald eagles. Unexpected because not a single pair of bald eagles were nesting in North Carolina in 1983 when State biologists first released juveniles into the wild as part of a recovery effort. Now there is a thriving eagle population with an estimated 300 eagle territories statewide and 125 nesting pairs. The Haw River feeds into Jordan Lake, where around 20 eagle pairs nest and many more visit.

Decline and recovery

We know bald eagles were part of the historic environment in North Carolina because they were mentioned in a 1709 publication (A New Voyage to Carolina) by explorer John Lawson.  The Cherokee Indians also have stories passed down about golden and bald eagles.  So we know eagles were in the state, but why did they disappear?  The NC Wildlife Resources Commission cites several reasons for the eagle population’s decline:

  • Deforestation
  • Hunting
  • Poor water quality
  • Agricultural pesticides
Bald eagle catching a fish at Jordan Lake. Beth Waldron 2017

The most dramatic of these threats came in the 1960’s & 70’s when fish and other animals were exposed to pesticides such as DDT and PCBs which washed into streams and lakes. When the bald eagles ate fish and prey animals containing the chemicals, they too ingested the toxic substances.  Female eagles laid eggs with much softer shells which crushed under the weight of the nesting mother. In 1972, Congress passed a series of bills banning these chemicals and creating protections for eagles and other raptors.

The NC Bald Eagle Project was launched in 1982 to re-establish an eagle population in the state.  At first, eagles were raised in captivity and released into the wild around Lake Mattamuskeet in eastern NC. Many of young eagles died due to avian malaria carried by the local mosquitoes (which the young eagles had no natural immunity to).  Attempts at further reintroduction ended but in 1984, the first post-DDT wild bald eagle nest was documented just 7 miles from the lake.

State activities evolved to include the identification and monitoring of new nests and providing technical assistance to landowners and timber companies on how to help identified eagle populations by protecting nesting sites.

In 1990, wildlife habitat management practices were implemented at man-made reservoirs Jordan Lake and Falls Lake in central NC to provide roosting and nesting habitats for bald eagles.  Now there is a thriving eagle population at the lakes with around 20 nesting pairs at Jordan Lake in the area where the photographs posted here were taken.  Statewide there is an estimated 300 eagle territories  and 125 nesting pairs.  Isn’t this is a lovely chart showing how humans can have impact when we change practices to help save species decimated by our own actions?

Source: NC Wildlife Resources Commission, Bald Eagle Fact Sheet 2005

Track an eagle!

 

Today’s technology allows for even more advanced study and management of the NC eagle population.  NC State University professors Ted Simmons and Roland Kays lead a project using state-of-the-art GPS transmitters to study bald eagle movements in North Carolina.  In January 2015, an immature bald eagle who had been successfully treated by rehabilitation experts for an injury was able to be released back into the wild with a solar-powered GPS transmitter affixed.   Since her release, the eagle, named Yangchen, has made extensive use of reclaimed phosphate pits and catfish ponds near the Albermarle Sound. Recent maps of the bird’s movements are available to the public online and updated four times a day by the Movebank animal tracker site. The scientists are hoping to track the immature bird to follow migratory movements, pair formation, and nesting behavior over the next several years.

The bald eagle population has made a remarkable comeback in North Carolina.  It will take continued effort to ensure we never again are without them.

Haw River, Beth Waldron, 2017

Want to see more local eagle photos?

Visit:  https://bethwaldron.smugmug.com/Eagles/

 

 

 

 

 

A dose of nature

“The best remedy for those who are afraid, lonely or unhappy is to go outside, somewhere where they can be quiet, alone with the heavens, nature and God. Because only then does one feel that all is as it should be and that God wishes to see people happy, amidst the simple beauty of nature.”
Anne Frank

When the world begins to feel scary (and lately, that seems far too often), I step away from the internet and the constant barrage of sensory overload to go for a walk.  I find peace in communion with nature. The trees are my cathedral, the birds my choir and the sunlight a reminder that there is always another daybreak after even the darkest of nights.

Don’t think you have to live in the country to find a quiet moment with nature.  I live within city limits and the following photos I took whilst on walks within a short distance of home in easily accessible public parks..just in the past week!

Serenity and wonder is all around….if you take time to look for it.  If you enjoy these, try visiting a new site I’m working on, Nature NC and share what you see on your walks.

Barred Owl at UNC’s Battle Park
Bald eagle catching a fish at Jordan Lake

Bolin Creek bath
Getting ready for cooler days ahead
Lovely song…wish you could hear.   (Get outside & you can!) 

Pre-existing condition: a palatable term for government sanctioned discrimination

We tend to think of health care as complicated.  Here’s a little secret:  it’s not.  It’s only evolved to be a complex system because we’ve made it that way.  When a physician sees a Medicare patient, an estimated 130,000 pages of rules and regulations influence that relationship. The Affordable Care Act and it’s supporting regulations are defined in over 20,000 pages.  Private insurance policies are as varied as the millions of firms offering employee health plans. Add to the mix that these coverage rules are in a state of constant revision.

Any interaction that is managed with volumes of legal-ease is bound to be one the ‘average American patient’ will not understand and with new health care proposals coming from Congress with little notice in rapid succession, it is next to impossible to comprehend how provisions buried in tens of thousands of pages may impact us far down the road.  It need not be this way.

At its core, our complex health system governs one very simple fact of life:  we get sick and need help to get better.   The devil in the details comes in how government chooses to manage this basic need of its populace.  It’s disheartening that the current health policy mentality doesn’t seem to appreciate this basic fact.

Humans are frail living creatures.  We don’t live forever.  We each die of something biological that causes our bodies to stop functioning. None of us will live our entire lives without having a single illness or accident.  Cut us and we bleed.  If we fall, our bones break. Our vision and hearing decline over time.  Our teeth rot.  And if we live enough years our hearts will eventually tire and fail.  Our cells easily mutate and multiply…cancer.  If you think of it, our bodies are so subject to ailments that it’s a wonder in ancient times we lived long enough to advance civilization at all!

Yet, this natural propensity towards illness is now given the ominous regulatory label of ‘pre-existing condition’, which has come to carry a negative connotation with penalize-the-patient policy proposals.  Don’t think illness is the natural order?  Health and Human Services analysis shows up to half of Americans under age 55 have a pre-existing condition and that number rises to 86 percent for those over age 55.  Fact is, most of us have already experiences some form of major illness in our lives and for those who haven’t, live long enough and your time is surely coming!

But alas, all is not lost!  Here comes science and medicine as the saviors of humanity.  Modern health care compensates for our physical frailties. Until this century, life was nasty, brutish and short. We now have the mind-blowing ability to have our vision corrected, repair our dental cavities, remove cancerous cells, mend a broken bone, treat a failing heart and stop a serious bleed.  Science and medicine extend not just our life, but improve the quality of that life.  That’s huge.

The rub is that life-extending scientific achievement comes with a price tag.  Our entire, complex health system is set up for no other reason than to sort out who in society can easily access these scientific accomplishments, when and how much they should pay for it.  That’s it. There is no other reason for private insurance, Medicare or Medicaid to exist…they are the more palatable modern version of ancient gladiatorial fights, with the winners (those who can access and afford care) being able to live another day.

The larger question is whether government’s rules for the fight should be applied equally to all persons regardless of age, gender, geography or any other criteria.  If we truly believe in equality, it must. To create layers of complex code which creates conditions in which only seniors, only the disabled, only the poor, only those without pre-existing conditions can access government facilitated care is contrary to ensuring the general Welfare as defined as an essential role in the Preamble of the US Constitution.

To create layers of complex code which creates conditions in which only seniors, only the disabled, only the poor, only those without pre-existing conditions can access government facilitated care is contrary to ensuring the general Welfare as defined as an essential role in the Preamble of the US Constitution.

There’s a fundamental inequity when government intervention results in a playing field in which a 68 year old cancer patient, retired with Medicare can access life-saving treatment, potentially, without paying a single dollar out of pocket but a 38 years old cancer patient, working full-time with employer sponsored insurance, cannot.  And, if the younger patient is lucky enough to survive, go back to work and pay off medical debt, they are penalized by not ever being able to get insurance again due to now having a ‘pre-existing condition’.  Such inequality created and endorsed by the federal Government via thousands of pages of regulation unintelligible to the ‘average American’ runs counter to its purpose of promoting the general Welfare.

If we accept as a fundamental starting place that we are all equal then why would this equality not apply to everything the government does, including insurance?  Otherwise, the federal Government is favoring one segment of people over another…the well over the sick, seniors over the middle aged and the young, the poor over the middle class, those who have lived long enough that the natural frailty of the human body has manifested in a “pre-existing condition” and those who have not.

To draw a line and say ‘this group is worthy of easily accessible and affordable medical care and this group does not’ is truly rather arbitrary.  It is not the federal Government’s role to divide us into segments, but rather to treat us all equally in its exercise of power.  If one segment deserves medical care, then we all do.  Few of us will escape this life without encountering an illness, accident or frailty. Any policy which does not reflect this undeniable fact is doomed to eventual failure.

Call it ‘Medicare for all’, call it ‘single payer’, call such a health system by any name you wish….but call our only fair option what it should be, an equal right to enjoy government’s promotion of the general Welfare.  That’s not socialism, it’s equality and that’s about as democratic as it gets.