Time to update the AOTA Position Paper on Nondiscrimination and Inclusion

Politically controversial conversations continue to spew from the social media accounts of AOTA leaders.  These conversations represent perspectives that are not reflective of the broad membership and are highly partisan.  The steady stream of ideological thinking is concerning because it represents a pattern where some leaders don't know how to separate their personal political inclinations from the mission of a diverse professional association.

We often associate topics of diversity and nondiscrimination and inclusion in racial or ethnic or religious perspectives.  However, in what is supposed to be a politically neutral environment like a professional association, we can also consider the negative impact that is caused when leadership adopts a partisan and biased political agenda.

This is not a new problem with the American Occupational Therapy Association.  The inclusion of Social Justice in the Code of Ethics was the first major foray of leaders into political partisanship.  What makes this situation challenging is that many who supported Social Justice in the AOTA Code of Ethics refused to acknowledge that Social Justice itself was even a political concept!  Those refusals to accept the political realities of the term are well documented.  

This week we have a blog post that supports of the role of occupational therapy to assist in data mining to improve population health.  That AOTA leader writes: "As occupational therapy practitioners we can contribute to understanding the needs of individuals, communities and populations, help to design interventions at all levels and help interpret big data to translate it to meeting the needs of individuals."

On its surface, the objective here is hardly arguable - who would NOT want to help design multi-level interventions that prevent disease or illness or dysfunction?   That is a very noble goal.

However, consider what needs to happen in order to achieve that.  The Carolinas Health Care System has been using EHR data to predict patient health and medical system use.  Buried deep in their own admission of data mining is this statement: "Earlier this year, Carolinas HealthCare System also joined the Data Alliance Collaborative; a first-of-its-kind initiative aimed at improving population health on a national scale through data analytics and shared business intelligence."

Well what does that mean exactly?  Watch this brief video of Bloomberg Health Reporter Shannon Pettypiece discussing the problem:

For a more detailed discussion, read Pettypiece's original article entitled "Hospitals are mining patient's credit card data to predict who will get sick.

It is true that a very large healthcare system in the United States is playing around the edges of this extremely controversial marriage between 'Big Data' and our health - and that is unfortunate.  That does not mean that occupational therapists want to or even should jump on this kind of very controversial bandwagon that infringes on personal liberties and is associated with a political ideology of increasing State control.  

In another incident, last week it was disappointing to see one of our AOTA leaders re-tweet a statement that was overtly political and that was not reflective of the broad diversity of political opinion that AOTA members hold.  That tweet was:

"The opposite of disease is not health or wellness. The opposite of disease is justice."

That AOTA leader has since deleted the re-tweet that was sent out after I responded to it and called it 'Newspeak.'

What I wish that AOTA leader realized, and what is important for members to know, is that this statement that was re-tweeted was made by a presenter at the Institute for Healthcare Improvement's (IHI) annual conference.   The IHI is a group that purports to promote healthcare improvement but they are also known to be heavily populated by very partisan thinkers.  The group admits the following: "As we entered our third decade, we recognized a new need for health care as a complete social, geopolitical enterprise. To accelerate the path to the health and care we need, IHI created the Triple Aim, a framework for optimizing health system performance by simultaneously focusing on the health of a population, the experience of care for individuals within that population, and the per capita cost of providing that care."  www.ihi.org/.../History.aspx

In simple terms, they promote a socialized model of health care.  Their founder has heaped praise on the British model.

Dr. Berwick (founder and former CEO) was an Obama appointee as head of Centers for Medicare and Medicaid. www.whitehouse.gov/.../president-obama-nominates-dr-donald-berwick-administrator-centers-medicare-and-medi

What the White House release does not tell you is that he had to be appointed through a recess appointment and that he ended up resigning because there was no way he would ever be confirmed.  www.nytimes.com/.../dr-donald-m-berwick-resigns-as-head-of-medicare-and-medicaid.html

Dr. Berwick is (in)famous for quotes including (easy reference on Wikipedia page en.wikipedia.org/.../Donald_Berwick):

1. "The decision is not whether or not we will ration care - the decision is whether we will ration with our eyes open."

2. "Any health care funding plan that is just, equitable, civilized and humane must, must redistribute wealth from the richer among us to the poorer and the less fortunate. Excellent health care is by definition redistributional."
These are Marxist statements.  Berwick has attempted to dance around these statements and claims that people take him out of context but it is difficult to interpret these statements in any way other than what they plainly say.

The point here is that the IHI is a liberal think-tank that is eyeball deep in its connections to a partisan agenda to socialize our healthcare system.  It is not shocking at all when statements get tweeted out of that conference like "The opposite of disease is not health or wellness. The opposite of disease is justice."

It is very difficult to understand how there can be any equivocation about the politicization of our profession when our leaders re-Tweet this kind of partisan nonsense.

I ask all of our leadership to respect the political diversity of our profession and to keep politics out of our association.  I also ask the leadership to steer clear of other politically controversial initiatives like 'Big Data' mining.

At this point in time it is becoming evident that some AOTA leaders are either tone deaf or they simply don't care and they are willfully infusing controversial politics into the profession.  We have reached a point where it is now necessary to make a specific procedural request that our profession avoids partisan ideologies and toxic political agendas that alienate members who do not share those political philosophies.


In a recent blog post, Dr. Brent Braveman stated, "While privacy must be a high priority and abuses of information are concerning and there is nothing partisan about the application of big data to healthcare." http://otconnections.aota.org/community_blogs/b/brentbraveman/archive/2014/12/28/more-about-big-data.aspx

The purpose of his post was to list pros and cons of 'big data' but in that post he also stated, "It makes no sense for us to sit on the sidelines and miss opportunities for us to influence the application and analysis of data as it is turned into health information."

In the United States context, larger and more invasive forms of government are indeed 'partisan.' Although liberal political inclinations tend to favor larger and more powerful government, it is also true that more conservative politics see that they need to be 'in the game' with use of big data in order to even have a chance at relevancy (power). So, the entire political system swings toward methods that limit the freedoms and privacy of individuals (from their consumer experiences, to their health care decisions, to their voting tendencies).

EVERYTHING about the use of Big Data is political, and power driven, and subsequently partisan - as it pushes our entire system into a structure that favors governmental/other control. A good primer in this topic can be seen here: Tufekci, Z. (2014 July). Engineering the public: Big data, surveillance and computational politics. First Monday, 19(7), http://firstmonday.org/ojs/index.php/fm/article/view/4901/4097 doi: http://dx.doi.org/10.5210/fm.v19i7.4901

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