Information for your Consideration…

 The Pathetic!! – Our newly minted DHHS Secretary – Robert F. Kennedy, Jr. – made a unilateral decision this past week to disallow COVID vaccinations for women who are pregnant and children. Not only was the US Centers for Disease Control not in the loop, but the combination of the Secretary plus the head of the Food and Drug Administration (FDA) simply reversed all of the recommendations on the topic unilaterally!! This is the implementation of the “de-sciencing of health care” by an unqualified leader who is simply exerting power without any rational data and/or process in place. Now – for my detractors who think I’m a shill for the Democrats, consider the following. This is not about being a “Republican” or anything similar. This is about the critical importance of science in making decisions related to public health and health care. I have supported prior Republican DHHS Secretaries, notably President Ronald Reagan’s first, Richard Schweiker (R), who, by the way, was a co-sponsor of Senator Ted Kennedy's (D-MA) Health Security Act, a bill proposing universal health coverage in America through a government-run program.^[1]. The irony made the current direction of health care oversight seem even more “pathetic,” a word I seldom use.

Wait A Minute – About 10 minutes after I sent off my final FickFiles for the first of June, I decided to turn on the news, which I have ignored for the last 3 weeks. The lead discussion that was announced shortly after I turned it on was that the CDC staff had posted a notice that immunizations for pregnant women and children was encouraged!! Was this a revolt among the scientists? And, will there be other revolts in the coming weeks and months? You be the judge as this story will no doubt change even further before you received the files.

The Case of Water Fluoridation – The vast majority of USA dentists and pediatricians believe that fluoride provided in small doses, akin to what you would find in the water of USA cities' water supply, has contributed to the marked decline since 1945. It was at that point that many cities made the decision to introduce fluoridation into the nation’s water supply. You can also check out the one study that compared over 70+ studies on the topic which showed equivocal results on IQ variation. In addition, the comprehensive study of fluoride addition to the water supply included 74 studies that were compared, of which 52 were set aside due to internal study biases. Of the remaining 22 rated with low bias, the differential impact (my assessment) was marginal. Finally, none of the studies were derived from the USA. Rather they were all conducted in a wide range of countries with variable infrastructure, including: “Canada (n = 3), Denmark (n = 1), India (n = 12), Iran (n = 4), Mexico (n = 4), New Zealand (n = 1), Pakistan (n = 2), Spain (n = 1), and Taiwan (n = 1)”. Furthermore, if we remove the fluoride from the water, we will face another national problem as parents – in an effort to prevent cavities – will potentially “over medicate” children, creating a societal problem. In addition, if the cavity rate increases to the pre-1945 levels, we will also face a major shortage of dentists in the nation.

Some GOOD News: Overdose Deaths Decline – In a recent data release by the US Centers for Disease Control (CDC), there were “30,000 fewer U.S. drug overdose deaths in 2024,” or a marked reduction of 27% from 2023 when the nation experienced 110,000 deaths.” This represents the largest year-on-year decline since data was gathered. The only states that did not see a decline were South Dakota and Nevada, versus the experience of states like West Virginia and Ohio, which experienced the largest declines. Experts cited the availability of naloxone, the availability of addiction treatment programs, and the availability of “opioid lawsuit settlement money” in the billions of dollars level. Such outcomes are the result of focused public health policies emanating from the states over the last decade. Unfortunately, these programs are now at risk as reductions in funding appear to be moving forward from Congress by pushing the responsibility solely to the states rather than a combined initiative. The health care community needs to aggressively monitor the results over the next couple of years…

 Gut Health and Longevity – I recently read an article by Heather Hurlock on the dietary contributions to our health. It’s a topic that I’ve taken greater interest in as a personal approach toward creating a more sustainable lifestyle. Or, as my wife chastises me on a regular basis: “Kevin, you need to eat six cups of fruits and vegetables every day.” What that means is putting aside the fast foods, fried foods and such. At the end of the day, our dietary intake impacts our “gut microbiota.” There is a framework that’s been developed by dietetics experts referred to as the Dietary Index for Gut Microbiota (DIGM). Items that many of us eat on a regular basis, which contribute to a reduction in gut health, include the following:

• Refined Grains – such as white bread and plain white rice.
• Processed Meats – sausage, bacon (Oy Vey!!!), deli meats, and any other meats that have high levels of nitrates.
• Red Meat – primarily from the high-fat red meats or highly processed meats due to the microbial shifts that are created in our intestinal systems.
• High-Fat Diets – where the percent of caloric intake exceeds 40% derived from fat.

So, why do these foods create such a negative impact? It relates to several factors that create ongoing, chronic damage to the intestinal barrier, resulting in systemic inflammation. The intestinal inflammation occurs because the intake of the above dietary items starves the bacteria, resulting in dietary wall inflammation. So, long story short, to reduce your DIGM score and increase your health, stay away from the above-noted processed foods and, in addition, reduce your risk of diabetes and other chronic diseases. Good luck. [NOTE: It’s hard for me to put aside “Carl’s Spicy Bacon”, a specialty available in Kittery, Maine. Perhaps I can reduce my intake to once per week 😊].

The Devastating Impact Of Staff Reductions At DHHS – While I truly believe that any large organization – such as DHHS, a multi-hospital system over multiple states, a large producer of technology services – can be improved through a thorough analysis of ongoing work and outcomes – the approach of “DOGE” will be catastrophic at best. DHHS staff have been reduced from a level of about 82,000 (which has not increased very much since the George W. Bush Administration) to about 62,000, or by about one-fourth of the existing staffing level. The final Musk Plan essentially consolidated the number of divisions and program areas from 28 to 15. For a comprehensive review and analysis, read about the staffing reductions published recently in Health Affairs. Simply “breaking” programs and initiatives through arbitrary staffing and program reductions is a massive national and global mistake. As the (previously premier) nation in the world, we hold an obligation (from my perspective) to help others develop their capabilities, services, infrastructure, and economies. Without healthy people, it is nearly impossible for nations to lift themselves out of poverty and economic distress. We can point to the destruction (I used that word intentionally) of the USAID program as an example of massive short-term thinking with long-range complications for the USA as an international leader. The health care community needs to take up this banner and push over the time in which this Administration exists to restore funding for international health programs!! It is our obligation to “make health care better” – not just for us in the USA but for the world as well!

Enhancing Medical Practice Through AI Integration – A recent study from the UK discovered that just over a quarter of physicians in the UK and Portugal used AI systems, with ChatGPT being the most popular of the available systems. In fact, in Portugal, it was reported that 87.1% of physicians report using AI systems on a daily basis for support of clinical decision-making. The concern is whether or not there is an evolving “over-reliance” upon AI systems to support care delivery, especially among the less experienced clinicians. Also, systems like ChatGPT cull information from a wide variety of available resources, some of which may not be fully vetted in a formal way – like the medical literature. In the present environment, AI systems provide variable analysis of information and inconsistent output that can confuse care delivery without adequate knowledge on the issues at hand. This becomes an important issue as some nations begin to use AI systems to support less trained clinicians (e.g., many countries in Africa) for delivering care services. While I am an “over-the-top” supporter of the evolving AI/ML systems and their potential contribution to care delivery – I also believe we need to be very prudent in how, where, and with whom these capabilities are delivered. All thoughts appreciated… For an overview of the topic, consider a review of a longer overview article in Medscape that provides a good analysis of the use and evolution of AI/ML in health care. In addition, there is an important report on the impact of AI integration in hospital operations through a survey of the nation’s hospitals. Check it out!!

Dementia and Hearing Loss – As an individual who is reaching the “elder” stage of life, I’ve become much more cognizant of not only dietary intake (SEE above note on gut microbiota 😊), I have also become aware of the literature on “hearing loss” and its association with dementia. In a recent study reported in MedPage Today a reported dementia may be accelerated with hearing lost playing “a bigger role in dementia than previously thought.” A sampling of about 3,000 elder adults revealed that upwards of 32% of incident dementia over a period of 8 years could be attributed to audiometric hearing loss. And, it relates to the severity of hearing loss. For example, those elders with mild hearing loss, the association was 16.2%. For moderate or greater hearing loss, 16.6%.” But, the associated incident was for “people ages 75 and older (30.5%), women (30.8%). For a review of the study, check out the publication in JAMA Otolaryngology-Heat & Neck Surgery.

Information for your Consideration…

A New Word For Our Lexicon – I attended a meeting this past week and learned a new word that encapsulates the evolving experience for many of us in the current environment. It is: exhausterwhelmulated. It represents the accumulated experience of three words that seem to be percolating forward for many. The words are: Exhausted / Overwhelmed / Stimulated. When smushed together they become “Exhausterwhelmulated”. Boy, that does seem to capture it – at least on this end!!

But, There Is A Downside – The rate of discontinuation among those who start on the GLP-1 drugs is more than 50% based on another research finding published in JAMA Network Open. This was especially prominent among those without Type 2 Diabetes or, the overweight individuals. And, despite the dramatic effect of the GLP-1 drugs, if individuals don’t stay on the drugs, there is clearly a high risk of fall back to their prior weight. It’s clear that we’re still at the formative stages of evaluating the impact of these medications as a first line of defense against obesity. 

Now, The Downside – A recent report by Netwrix noted that 84% of healthcare organizations identified a data breach in 2024! Of those reporting a breach or ransomware attack, 74% reported that the user- or administrator-source of the attack was in a cloud environment versus a comparatively lower 44% for in-house data centers. But, even more ominous is the fact that the year-over-year increase in incidents was 32%!! Check the data above!

Black Women In Childbirth = 3.5X Higher Death Rate Than White Women!! – The CDC released data in late January (before the purge of resources befalling the agency by DOGE) showing the pre-pandemic racial gaps continue for women during childbirth. The CDC issues a dire warning by stating “white women around the time of childbirth in 2023, as maternal mortality, fell below pre-pandemic levels overall but racial gaps widened” with the added caveat noting “the maternal death rate for white women dropped from 19 deaths per 100,000 live births in 2022 to 14.5 per 100,000 in 2023...” while “for Black women [the rate] went from 49.5 to a little above 50. Clearly, the ongoing problem of a differential in morbidity continues…  

The Potential Shift From Birds To Humans – Everyone seems to be a dither about the price of eggs, including me. But, the potential for a “bird flu epidemic” is also lurking in the background. As reported in the New York Times in late January, bird flu “has infected more than 900 herds and dozens of people, killing one, and the outbreak shows no signs of abating.” Most of the experts agree that a “human pandemic” is not necessarily inevitable although it is possible given the increasing prevalence of the flu. Louise Moncla, Ph.D. an Evolutionary Biologist at the University of Pennsylvania noted that: ”…a series of developments over the past few weeks indicates that the possibility [of a human pandemic] is no longer remote…[since the virus] “could circulate on farms indefinitely, finding opportunities to evolve into a more dangerous…‘high-risk’ scenario.

Information for your Consideration…

The Sweet Solution – There are many things we learn when we travel. In addition to learning about the people, the environment, the ambiance of places around the world, I also listen for interesting “healthcare tidbits.” Such was the case during my trip to New Zealand. I learned something that dermatologists already knew (as I found out from my dermatology wife) – Manuka honey in addition to being a fabulous sweetener is also an antibacterial, antioxidant, and anti-inflammatory accelerator with strong wound healing properties. It’s also used for treatment of coughs, ulcers, and oral health problems. The claim is based on the presence of Methylglyoxal (MGO), a major antibacterial agent contained in the honey. The level of MGO in the honey is used to create the Unique Manuka Factor (UMF) – and, the higher the UMF number, the better the health-supporting capabilities AND, the price goes up considerably as that number increases. So, how does this work? Evidently Manuka honey stimulates the inflammatory cells to release which assist in the early stages of healing. So, the next time your kids skin their knees playing on the driveway or you cut or cut your skin while working on the yard, consider a dab of Manuka honey. It’s the sweet solution. Now, as for the COVID challenge, I’m working on it but it never hurts to consider a home remedy like Manuka-infused cocktail if you start to get symptoms of upper respiratory problems.

Furthermore, I was informed that an infectious disease specialist from Australia did research on 20-some materials for the treatment of COVID at the start of the pandemic and Manuka honey came out as the #1 material for diminishing and preventing COVID infections. The initial COVID research study commissioned by the National Institute for Health and Care Excellence (NICE) and Public Health England (PHE) summarized their findings by stating:

“It is already proved that honey plays a potential role against several enveloped viruses. Honey may be beneficial for patients with COVID-19 which is caused by an enveloped virus SARS-CoV-2 by boosting the host immune system, improving comorbid conditions, and antiviral activities. Therefore, we can say that honey may have a protective/beneficial effect on COVID-19.” “…as a first-line treatment for cough due to upper respiratory tract infection, which is the main well-identified COVID-19 symptom. Honey might safely disinfect the throat and trap virus particles, beside a major advantage that it has no side effects and [is] of great nutritional value.”

So, it seems that there is support for the claim for moderating the course of COVID illness although it does not seem to be a “cure”. More likely, it serves as an adjunctive treatment modality. Long story short: A little honey in the morning will likely sweeten up the day as well as offer a bit of anti-viral protection ta boot!!

Medical Debt Removed From Credit Reports – To the relief of increasing numbers of Americans, medical debt will no longer be included in the evaluation of an individual’s credit score under new regulations adopted by the Consumer Financial Protection Bureau (CFPB). The bureau issued the new rules that will essentially remove about $49 billion in medical bills from consumer credit reports. It is estimated that around 15 million Americans will benefit from the change in policy. It represents a significant change in the credit ratings for individuals – especially with the increase in the amount of medical debts citizens are taking on due to lack of insurance coverage, reallocation of medical costs to consumers by insurance companies and other similar actions. Through the policy change, debt collectors will not even be aware of medical debt by consumers. The ruling will have an impact on the credit evaluations done related to long-term purchases such as home lending and other major purchases by consumers.

The Evolving GLP-1 Revolution – If GLP-1’s had been available 35 years ago, I would have been a prime candidate for taking this new, revolutionary drug. I weighed in at the time at a mere 395# - more of a linebacker than a leader at the time. I ended up with a Duodenal Switch procedure to promote sustained weight loss. And, it worked BUT there have been unexpected long-term implications which would cause the length of this blog to become too long. So, I will forego the assessment. But, the procedure worked!! I have weighed about 170# now for near 25 years. But, there’s a new wonder drug option that is taking over as the prime treatment for obesity – a major problem throughout the world!! It’s kind of amazing but 1 in 8 people worldwide live with the curse (= my opinion) of obesity, costs the global economy $2 trillion in productivity reductions and premature mortality. And, over the next decade those costs will nearly double for $4 trillion!

The new GLP-1s could be one of the major factors in creating economic development for many countries throughout the world – but, especially in the USA where obesity has become a major problem. Drugs like Lilly’s Tirsepatide (= Zepbound) can precipitate weight loss of up to 22% of body weight which is sustained following the weight loss without rebound. That’s impressive. In addition, the drug reduces the risk of diabetes by over 90%. Furthermore, the research is showing that people on the GLP-1’s experience sustained weight loss. In other words, there is no bounce back to the formerly obese state. I must admit that when the drugs first came out I was a bit skeptical but, the ongoing research is clearly showing a very positive course of treatment for those who choose to take action on losing excessive weight.

The final positive note to be highlighted are the findings of the initial pre-clinical trials that show a potential impact on neurodegenerative diseases. Specifically, in Parkinson’s disease patients, the medications have results in restoration of acceptable dopamine levels. And, for Alzheimer’s disease patients, there was less shrinkage in the brain. While the outcome of GLP-1 medications is yet to be firmly entrenched into the armamentarium, it seems that the medication is moving down the track of “antibiotics” whereby we are at the formative stages of development in the GLP-1 field. Stay tuned…

A Tidbit On Trivia Memory – I recently learned about Deepu V. who recently accomplished a Guinness Book of World Records feat by recalling and repeating aloud 14,000 digits in Euler’s number. It’s a “constant” number (= 2.71828…) that is found in many contexts and used as a base for natural logarithms including exponential growth, radioactive decay, and the growth of wealth calculations through compound interest calculations. It’s similar to “pi” which is a never-ending number as well. So, what is so special about Mr. Deepu V’s accomplishment? What’s remarkable is that he recited from memory the first 14,000 digits in Euler’s number. He accomplished the feat by organizing the number into detailed organizing of digits into rows and columns for precise recall. The prior record was 10,122 digits. Now…what is the phone number of my brother? And, where did I lay my pen last night so I would not forget it this morning?

Inauguration Trivia – For those watching the Presidential Inauguration, you may have noticed the number of CEOs sitting in the dais behind President Trump (e.g. Elon Musk – of course, Jeff Bezos, Tim Cook, among a couple of others). They got the good seats for support of him during the campaign but, also paid a slight fee of $1 million for the special privilege. Following the inauguration they all jetted off in their personal jets to the annual World Economic Forum confab in Davos, Switzerland. The cost for that event was a mere $300,000…

Information for your Consideration…

The Slippery Slope – A recent 2024 Gallup poll offered a somber outline on the perspective of Americans towards the medical and health system. Specifically, only 34% of Americans still trust the medical system! If only 34% TRUST the MEDICAL SYSTEM, the collective WE have our work cut out for us!!

Aging And Friendly Care Delivery – A new report released by the John A Hartford Foundation and completed in collaboration with Age Wave revealed a striking misstep in the USA health care system - widespread dissatisfaction among older adults with care delivery. The researchers combined information from a Harris Poll, focus group analysis, and recent research reports. The report deserves your attention and I would recommend downloading a copy of the report entitled Meeting the Growing Demand for Age-Friendly Care: Health Care at the Crossroads. For all of us who are leaders in health care and/or deliverers of care…an important read.

Oh No – Don’t Tell Me It’s True! – Sorry, but it does seem to be true. According to a recent article in the journal Nature, the Large Language Models (LLMs) used in AI products are beginning to get the drift of how to lie. Yes, lie!! There is logic to everything from structured information that gives answers to complete questions to how best to lie about some issue or topic. As a result – according to the article – the LLMs are becoming less reliable because they are increasingly recognizing that it is more important to “make things up” rather than to not provide an answer. “Millions of people are using general-purpose artificial intelligence (AI) systems based on large language models (LLMs), which have become commonplace in areas such as education⁶, medicine⁷, science^8,9 and administration^10,11” [NOTE: citations copied directly from the article]. Although the LLMs are increasing their reliability, they are also getting better at lying!

At the same time – as a proponent of learning how to effectively integrate AI/ML learning derived from LLMs into medical and healthcare delivery – there is reason to be positive. In a recent post, Azeem Azhar argued that humanity needs to embrace AI as a source for accelerating our knowledge development capabilities. I agree! Rather than rejecting AI/ML or putting it in a box, we need to determine how best to use it, what policies are required to assure its value to society, how to prevent misuse of the technology, and a host of other thoughts. It’s very clear that the path of Generative AI/ML development is on a much more accelerated pathway of development than either the use of personal computers or the Internet. I remember introducing the use of computers to office work in the early 1980s. Then, I was on the horn in the early 1990s learning about this new resource called “the web”. And, where we’ve come from those early days is incredible! And, the acceleration is even accelerating with the advent of OpenAI – the beginning tool of down-the-road tools that we will need to integrate into the medical and health system. AND, we are not educating or training our young health and medical graduates across the board in the effective use of AI/ML – let alone those who are in practice today.

Alzheimer’s Disease, Dementia, And Falls – In a new report from JAMA Network Open researchers found that when controlled study parameters were put in place death and falling were associated with a 21% increased risk of a subsequent dementia diagnosis. The metanalysis examined almost 2.5 million Medicare claims to derive the assessment. The claims were for older adults who had a traumatic injury leading to an emergency room visit as a result of a fall. The researchers found that within one year of the incident “new dementia diagnoses were more common in people with falls than other injuries.” They didn’t say anything about falling out of your office chair when you swivel around quickly – like I did yesterday. However, I was able to jump up right away and luckily no one was around to see the incident. Now about those stairs, I walk up and down from the kitchen at least 10x per day…hmmm…

Step It Up A Notch – Of late, I’ve become a lot more interested in the use of physical exercise as a mode for sustaining health. I guess that getting older has something to do with my enhanced interest. Nonetheless, the data shows very clearly that physical exercise is a proven modality of not only managing but also preventing chronic disease. This is especially apropos for any adults 65 and older such as an increased number of independent living years, reduced risk of falling – one of the major contributors to decline among the elderly – and improved brain health in the form of reduced dementia, including Alzheimer’s disease. If you’re looking for more immediate results consider the value of sleep quality, reduction in blood pressure, weight loss (a good thing unless you’re ill), bone health derived from exercise, and less anxiety. You should start early and go often. It makes a difference. I’m finding that it’s made life a lot better for me and increased my sense of well-being. So, step it up a notch to better in the end… 

Ubiquitous Microplastics Found In Brain Tissue – In another study from JAMA Network Open by Brazilian researchers, they found that microplastics were prevalent in brain tissue derived from human cadavers. The sampling was small where the olfactory bulb was sampled in 15 patients between the ages of 15 and 100. Samples from eight of the cadavers contained microplastics — tiny bits of plastic that ranged from 5.5 micrometers to 26.4 micrometers in size consisting of plastic fibers and particles. The composition of the plastics were polyethylene vinyl acetate, polypropylene, and polyamide – all common materials used in coverings for commercial products. Yikes!! It’s unclear what the presence of plastics means but foreign bodies inside the body for any reason are cause for concern. And, it’s clear that microplastics are a ubiquitous problem for the world. It’s another “world health” problem we need to be thinking about – and, more importantly – doing something about…

The Vaccination Dilemma – It was very disturbing to read an Associated Press release noting that: “…U.S. kindergarten vaccination rates dipped last year and the proportion of children with exemptions rose to an all-time high, according to federal data...where the percent “of kids exempted from vaccine requirements rose to 3.3%, up from 3% the year before.” Although a large percentage of kindergartners got their shots (=92.7%), the fact that we’re seeing a gradual increase in non-vaccinated kids over the last several years is a disturbing trend. In fact, vaccine exemptions increased in 40 of the states according to CDC data. And, it’s occurring across the board for measles, mumps, rubella, diphtheria, tetanus, and pertussis – diseases that we’ve been working to wipe out BUT that will no doubt recur without attention to effective vaccination programs. As a result of the vaccination decline, there were 13 measles outbreaks this past year compared to four in 2023. And, more generally the states with the greatest number of outbreaks have been in California, Florida, Illinois, Minnesota, New York, and Oregon. I’m of the age where I remember having playmates with sequelae from a number of these diseases. Let’s not let them come back. Once again, it seems that we need to counter the misinformation.