Books and Articles Worth a Review… 

Towards Sensitive or Get Specific – Marc Ringel, MD – one of my colleagues in the healthcare arena – recently posted an article in Chicago Life entitled, Sensitive or Specific?  It’s a good piece for all of us the healthcare types who read The Fickenscher Files to read and consider. He points out that the current focus of the USA health care system heads toward sensitivity which rewards the practitioner and the system with more procedures resulting in more money. However, if the system were focused on specific, we’d be right much more often than wrong in our initial impressions. So, the issue for the healthcare community is the balance between sensitive and specific. His example is the diagnosis of diabetes. If we set the diagnostic blood level high enough, it will always be correct in making the diagnosis of “diabetes”. However, if it’s too low, the number of people captured with the diagnosis will be too large since many of them will not have diabetes. Such was the case set by the National Institutes of Health back in 2021 when it set the recommended blood level for a diagnosis at a level that captured 38% of US adults as at least pre-diabetic. Upon a more judicious analysis, it became clear that by setting the sensitivity level too high, far too many people were diagnosed and ended up having all sorts of further diagnostic AND unnecessary workups. The reason I recommend reading the article is this issue – the balance between specificity and sensitivity is the crux of why we need to be moving toward a “value-based care delivery model” of healthcare not only in the USA but around the world. Consider it…

Books and Articles worth a Review…

Good To The Last Drop – During my recent vacation to the Nordics, I learned much about water. First, the glaciers have made a massive retreat throughout the Nordic region. But, during our stop at the Kon Tiki Museum, I learned much about water – something we generally take for granted in the USA. First, we need to remember that Thor Heyerdahl led the Kon Tiki expedition as a quest to prove that Chilean natives could have crossed the Pacific to the Polynesian islands in the past – a quest that many experts at the time responded as a “preposterous” concept. I remember reading the book as a kid in the late 50s, so it was a real treat to visit the museum and actually see the Kon Tiki vessel.

What I did not know is that Thor Heyerdahl in the 1960s led a similar expedition on the Ra, a similar vessel he traveled on from Africa to South America. What’s important about that trip is that the Ra team – when they cleaned their toothbrushes in the ocean water – came up with small, black drops of crude oil. The team learned that the ocean-going tankers were simply cleansing their tanks by using ocean water and discharging it into the ocean. He brought the issue to the United Nations and precipitated an international governmental response that made engaging in such a process illegal. As a result, ocean waters were cleansed through his efforts.

Then, the next day I opened the latest issue of Science News to an overview of a new book – “The Last Drop” by Tim Smedley. I haven’t read it yet BUT, the review has put it on my “ToDo” list. It provides a primer on the problems we are facing related to water supplies and the requirements we must adopt for fixing the problems the world faces related to agricultural water use, technology, water harvesting, solutions for our homes, changes required in the production of goods and services as well as the obvious fuels we use to propel ourselves around the world.

So, why am I mentioning this in a healthcare blog? Because the health of the planet and the resources we use is an increasing problem for the entire world. It’s not confined to one nation – but, to all of us around the world. It’s also part and parcel on the need for much greater attention to the “public health” components of healthcare – an issue that has been neglected for far too long by the traditional healthcare community. 

Books and Articles Worth a Review…

I am currently on a 4-month (yes, 4-month) road trip starting in Maine and traveling across the USA in a big circle through the south, into the West and Northwest, and coming back through Canada. It’s been a dream of my wife for many years and I was “encouraged” to go along with it. I finally succumbed to her advice and we’ve been on the road for just over a month at this point. However, I digress.

My reason for writing this section is to offer up an open-access book for your consideration, entitled: The Search for the First Americans: Science, Power, Politics by Robert Davis, Jr. a former federal government employee who retired and has focused his writings on the interactions between science and public policy (download available at: JSTOR, EBSCO, Internet Archive, OAPEN, and/or Project MUSE). The book provides an overview of all the research completed to date on the source of humankind in the Americas. It’s a fascinating read and it is ABSOLUTELY clear that beyond Native Americans, the Clovis peoples, and other population groups from long, long ago – European settlers are only very recent interlopers on this beautiful land.

I share the book because I think it puts in context many of the socio-political dynamics we face as a society. And, as importantly, we need to get out and explore our nation more. I’ve been a traveler since the early days of my Mom and Dad’s travels in the Midwest where they slept in small, one-room motels with my littlest brother as we traveled about and Mark (my second younger brother) and I slept in the locked car in the parking lot traveling around as we visited national and state parks, museums and the like. But, I clearly missed a lot despite those early-day travels. Just as one example, I spent the better part of a day this past week at the Three Rivers Petroglyph north of Alamogordo, NM. The area is literally covered with more than 21,000 petroglyphs – many of which are older than 5,000 years – marked on stones across the mountain. It’s clear that art as a hobby didn’t start with us contemporary folks in the last thousand or so years. Anyway, consider getting out and exploring the lands of the Americas. There’s much to learn and even more to ponder!! Then, head into Canada for even more learnings…

Books and Articles worth a Review…

 Fresh Air –In case you missed the mid-January interview of Uche Blackstock, MD, Ph.D. on Fresh Air, it is definitely worth a listen. Tanya Mosley conducted the interview and it dealt with issues related to health equity that are outlined in her new book, “Legacy.” It provides an overview of health inequity in America and all of us who are involved in care delivery need to listen to her thoughts and advice.