Consulo Indicium - 11/15/22

Information for your Consideration…

North Dakota – Leading The Nation!! – I’m from North Dakota and when I was growing up, it always seemed like the “Top 10” lists ignored us even though we had the bluest of blue skies, the cleanest of clean air, the flattest of flat prairie lands, the nicest of nice people and the like. I have also frequently regaled people with the fact that when I left North Dakota for my residency in New York City, I was at first intimidated and self-conscious of my origin. Why? Because I had not gone to one of those “special” East Coast schools. However, I very quickly came to the realization that my clinical skills were every bit as good – if not better in most instances – than my colleagues from those “named” medical schools. So…imagine to my surprise and excitement when I learned that North Dakota was able to capture the designation for four of the Top 10 Cities in the USA in a special survey. The North Dakota winners came in on positions: #2: Grand Forks (where I practiced for 10 years); #3: Williston; #4: Fargo; and, #8: Bismarck (where I grew up). The only problem with the rating is that it was for the Top 10 “Coldest” Cities in the USA. However, as noted above global climate change is affecting North Dakota as much as other states. In fact, I’ve predicted that if the trends continue North Dakota will be the new Napa Valley due to Global Warming. For the interim, we’ll stick with our “coldest city” status. After all, we’re proud of our ability to wear short sleeved shirts on cold winter days…😊…

American Medical Association Advocacy On Track – While I have been a vocal critic of the American Medical Association on many issues since my days as a medical student when I served as the President of the American Medical Student Association – when an organization does the right thing – it needs to be called out. So, I wanted to call attention to a policy established at the 2022 AMA House of Delegates that I only recently learned about on the issue of “government interference into the practice of medicine”. I’m simply going to restate (i.e. copy) the policy in whole. It states:

Our AMA opposes the interference of government in the practice of medicine, including the use of government-mandated physician recitations. Our AMA endorses the following statement of principles concerning the roles of federal and state governments in health care and the patient-physician relationship:

  • Physicians should not be prohibited by law or regulation from discussing with or asking their patients about risk factors, or disclosing information to the patient (including proprietary information on exposure to potentially dangerous chemicals or biological agents), which may affect their health, the health of their families, sexual partners, and others who may be in contact with the patient.
  • All parties involved in the provision of health care, including governments, are responsible for acknowledging and supporting the intimacy and importance of the patient-physician relationship and the ethical obligations of the physician to put the patient first.
  • The fundamental ethical principles of beneficence, honesty, confidentiality, privacy, and advocacy are central to the delivery of evidence-based, individualized care and must be respected by all parties.
  • Laws and regulations should not mandate the provision of care that, in the physician's clinical judgment and based on clinical evidence and the norms of the profession, are either not necessary or are not appropriate for a particular patient at the time of a patient encounter.

I agree. I support. I shout out!!

A Forewarning Of the Feast To Come – There’s a new report by a group of investigators that the timing of our meals affects hunger as well as appetite-regulating hormones, thereby causing weight gain. However, the study only included 16 obese individuals who maintained a strict schedule of a meal in the early morning and late in the evening – once a week in the lab with the remainder of their meals held to the same schedule at home. The study showed that they burned fewer calories, had an increase in fat tissue and also had increases in leptin and ghrelin – which control “hunger”. The student was published in Cell Metabolism. Long story short, don’t have a late evening Thanksgiving Dinner 😊.  Now, about that Maple Syrup Pie recipe I mentioned in my November 1, 2022 issue of The Fickenscher Files. Have you tried it yet? If not, the weight gain is worth it…

  • Consumers Weigh In: Virtual Primary Care Is A Positive – A new poll/survey by Elevance Health (formerly known as Anthem, Inc.) on the attitude of consumers toward virtual primary care points in the direction of “very positive” on the convenience and accessibility side of the equation. The key findings included:
  • 63% of Americans are living with or managing chronic health conditions with nearly 2/3 indicating that the believe primary care could help them with their care needs.
  • 73% of the respondents indicated that virtual primary care was appealing primarily due to convenience (35%), accessibility (31%), and overall ease of use (30%).
  • 31% of those who have not used telehealth services indicated that they prefer in-person visits and 21% were not sure if their health care policies covered telehealth services. 
  • Of those individuals who have used telehealth services, 94% indicated they were satisfied with their virtual care experience and 79% indicated that virtual care "has allowed them to take charge of their health."

Consulo Indicium - 10/17/22

Information for your Consideration…

By A Whisker – On Saturday mornings, CNN has a broadcast by Michael Smerconish – a commentator out of Philadelphia. It always has interesting twists and perspectives on the “news”. One part of the show is where he queries his viewers on a current topic. This past Saturday (2022-1008) he tried a new twist by asking the question: “Would you trust in your physician if you knew they struggled with undergraduate organic chemistry?” It obviously got my attention right away since I did “OK” in pre-med organic chemistry but, I was not the best in the class either. There were over 20+ thousand respondents to his in-the-moment poll with 60% indicating that it would not alter their trust and 40% responding that it would. Whew! Organic chemistry is most often viewed as the washout course for undergrad pre-medical students. And, I would argue that the organic chemistry professors relish their role. If you do well, you’ll be considered for medical school. If not, you’re likely washed out. I made it by a whisker 😊. When I was admitted, the Dean for Students – Dr. Wally Nelson – pulled me aside and said with a wink and a nod, “Sometimes, we admit students because we think they’ll make a difference in medicine.” Hmmm…I hope I met the expectations!

An Increased Uptake Of COVID-19 Boosters = Potential Decrease By Almost 90K Deaths. The Commonwealth Fund did an analysis of data on the immunization rates and results of subsequent COVID-19 infections. The results? “…if 80% of eligible people receive their booster dose” nearly 950,000 hospitalizations and 90,000 deaths would be prevented. On top of that over $50B in costs would be saved. The analysis is not only compelling – it’s distressing given the mis-information that’s been spread about the vaccinations. We need to get the word out in the various forums in which we are working…


The Malicious Virus Surges Again – Are we ever going to get ahead of it? Is the end of COVID on the horizon? Yes! And, No! I have faith in the ongoing research being conducted around the world that eventually we will get a handle on the effort by COVID to cause disease among the human species. At the same time, it’s evident that the fight is not over!! In fact, you can check out the state of the COVID infectivity and hospitalization rate at the site above. You’ll note that there is actually a bit of a gentle plateau or even a slight decline in the number of cases in the USA at the present time. However, the FDA issued yet another warning that while Omicron Subvariant BA.5 seems to be causing most of the new COVID-19 cases in the USA, it is the evolving number cases related to Omicron Subvariant BA4.6 that is causing concern. Why? It’s because the BA4.6 is not as responsive to the vaccine as the other variants. Regardless, it is VERY CLEAR that everyone should not only be getting their vaccination but also lining up for their boosters on a regular basis. As of this writing (2022-10 09), only about 8 million out of 200 million USA citizens who are eligible for the booster have received the repeat immunization. As the winter months come upon us, we’re going to be spending more time inside – with one another – which will increase the likelihood of viral spread. So, vaccination is the first preventive measure and, masking will come along again if we see an upsurge. Already, researchers are beginning to notice that wastewater Omicron viral levels are up in certain part of the country especially in the Northeast.  So, stay tuned!! This could be the canary in the coal mine for yet another surge in the coming couple of months. The European findings are a harbinger of a potential surge in the USA… 

Health Equity Accreditation: The Next Step – The National Committee for Quality Assurance (NCQA) recently announced the healthcare entities that have earned accreditation from the new Health Equity Accreditation Plus evaluation program. The new program was announced last fall. The recipients include two health systems and seven insurance plans around the country. It was the first time that health systems had been included in the evaluation process as part of the NCQA program. The message? Integration of health care systems and insurance plans continues at a slow pace but, integration nonetheless. The essential components of the evaluation process include the following elements:

  • Building cultures that link to external health equity initiatives,
  • Collecting race, ethnicity, and language (REaL) data to support individuals' cultural and linguistic needs; and,
  • Identifying health equity and related care needs such as: 1) data that assesses social risk and need, 2) in-depth patient and consumer engagement, 3) strong partnerships with community-based organizations; and, 4) social need referral systems and partners.

Guns, Again? – The use of firearms as the cause for homicides and suicides continues its ongoing growth across the USA. In 2021 compared to 2020 there was an increase in gun-related homicides (= 21,000 people or 57+ people/day) from 79% to 81% and for suicides (= 26,000 people or 71 people/day) from 53% to 55%. In fact, 2021 is now the highwater mark for gun-related deaths over the last 30 years. Gun purchases through 2021 were made by 18% of American households with about 5% purchasing a gun for the first time. Researchers who were involved in the data analysis noted that the findings “underscore the urgent need for prevention efforts…” such as more effective outreach, hospital-based interventions, and reducing access to firearms among people at risk of harming themselves or someone else. Hmmm? How about sensible gun control? When I talk with the gun owners I know, it seems that we could develop “sensible” gun control measures but, then again, the NRA would not find that acceptable.

The Path Toward Value-Based Care Delivery In an online study published in the Annals of Family Medicine the use of “facilitators” (i.e. trained professionals in health care counseling) was shown to be effective with better outcomes for selected cardiovascular-related problems. The types of facilitated conversations included aspirin use, smoking cessation, blood pressure control and other preventive care-focused areas. The review included the assessment of 162 facilitators employed at 1,630 small- to medium-sized primary care practices. The study shows the way for possible (? probable) improvement in other clinical areas such as CHF, kidney disease, diabetes, and other clinical problems with “high value” returns through the reduction of ongoing healthcare costs. This finding totally resonates with my personal experience as a clinician. When I was in active practice – oh, so many years ago – I found that the combination of my nurse practitioner, pharmacist and social worker working in collaboration as a team with me was MUCH more effective than me working alone. However, the changes in the reimbursement system over all of those years destroyed the incentives. We need to – no, we must – move toward value-based care delivery models if we’re going to be successful in simultaneously enhancing outcomes and reducing costs. 

Extending The Obvious – The Pew Charitable Trusts recently released a report regarding the Medicare Care Choices Model (MCCM) program which extended hospice services to those individuals who were suffering from other long-term illnesses aside from a terminal disease such as dementia, respiratory diseases, and other common problems. Originally, the Medicare hospice program was set up in 1982 to provide extended home care for those with cancer. Back then – as a newly minted physician – cancer was a grim diagnosis. We’ve come so very far in our treatments in today’s world. The study included 4500+ participants who received hospice support services over the period 2016 – 2020. The results are significant. Medicare expenditures for the MCCM participants were 17% lower than non-participants (i.e. $45,976 versus $53,229) over the course of the evaluation. Why did that occur? It was due to the 26% fewer inpatient hospital admissions, 38% fewer ICU stays; and, 30% fewer days in other inpatient hospital units. The study will be a big boost to making palliative care more available and helps in the shift toward “value-based care delivery” (See note immediately above). 

More On Medicare – I’m following the Medicare data points a lot more closely this year than last. Want to know why? It’s because I’m now part of the problem due to my total reliance upon Medicare as a source of coverage for health insurance 😊.  So, I was pleased to learn of the Biden Administration announcement that Part A and B premiums will drop in 2023 Medicare premium rates will drop in 2023. The changes will also apply to the 2023 Medicare Part D income-related monthly adjustment amounts. The reason the rates are going down (a “tish” – but, an important “tish” for those on limited incomes) relates to the lower-than-expected expenditures held in the contingency for the addition of the new dementia drug, ducanumab (= Aduhelm) as well as lower-than-expected costs for Part B services. But I would caution that this does not solve the longer term problem of potential Medicare insolvency! We need to deal with the whole structure and payment methods of the program to get a grip on that one. More on this later… 

Shifting The Problem – There was a recent report in The Washington Post noting that “more than 2.5 million adolescents were current e-cigarette users in 2022, with the majority choosing flavored, disposable products”. The report comes from a federal study conducted by the Centers for Disease Control (CDC) in collaboration with the Food and Drug Administration (FDA) as part of the National Youth Tobacco Survey. Current users were grouped according to the total number among all such youth with middle school users representing 3+% and high school users at 14% of the total populace. In the latter group, a full ¼ of them were daily users!! “Use” was defined as the use of e-cigarettes at least one day in the prior month. What is most disconcerting is that the study showed that 85% of the users favored vapes in fruit, dessert, or candy flavors. Aren’t we simply shifting the problem from smokers to vapers? What are the long-term implications of vaping? I bet (no data on my side at this point) that the data will show – very clearly – that vaping causes some time of long-term health problems… We are simply shifting the problem from cigarettes to another source. For the policy makers – how stupid is that?

Telehealth Continues To Climb – FAIR Health is “…an independent nonprofit that collects data for and manages the nation’s largest database of privately billed health insurance claims and is entrusted with Medicare Parts A, B and D claims data for 2013 to the present.” The organization conducts a Monthly Telehealth Regional tracking report on telehealth. The latest report reveals a continuing increase in utilization for three of the four US census regions. FAIR Health monitors claim lines, procedure codes, and diagnostic categories derived from the billing information on care delivery. Beyond the general increase, certain specialties are the leaders in use. For example, social workers are the highest users in all of the regions. Among the medical specialties, the psychiatrists take the lead and their use increased by 8.1%. The highest users in the Midwest were primary care non-physicians and psychologists which I surmise relates to the remoteness of care delivery in the rural areas – many of which can be better served through the application of telehealth services. As for diagnosis, the most frequent problems were acute respiratory disease with COVID-19 coming in #2. However, in the Northeast, acute respiratory diseases and infections fell out of the most frequent list of diagnosis.

Consulo Indicium - 9/20/22

Information for your Consideration…

 CDC Recommends Pfizer-BioNTech and Moderna Bivalent Boosters for COVID-19 Prevention - The CDC earlier this month “recommended...that millions of eligible Americans, including those as young as 12, get an updated Omicron-targeting booster shot to bolster defenses against serious illness and death during a potential fall or winter rise in COVID-19 cases.” The recommendation to proceed with the boosters was made by the Advisory Committee on Immunization Practices in a vote of 13-1. The goal is to make the boosters widely available across the country immediately. So, have you gotten your booster yet? If not and with the flu season upon us – both the booster and your annual flu shot would seem advisable! 

The Mask of a Different Type – The Biden administration recently announced  that it would be distributing to pharmacies and community health centers N95 and similar high-filtration masks that offer the best protection against COVID-19. The intent is to provide a mask that clearly has been shown to give better preventive support than the many options in use by the general public. The various “masks” often create confusion for the lay public. N95s, KN95s and KF94s are all of the high-filtration respirator type masks made with a material that has an electrostatic charge. It is the static electricity that increases the quality of the mask by trapping incoming virus particles. These type masks are about 90 – 95% effective in trapping airborne particles like the Covid 19 virus – which is way more effective than the basic cloth mask [NOTE: In case it is not obvious, this is especially true when the cloth masks are worn so they are only covering the mouth which is a common approach I’ve seen among the general public.] For a good comparison of masks, you can check out the work of Aaron Collins, how is known as the Mask Nerd here. Finally, it’s important to remember that the Omicron variant & its children are the viral loads that you need to be particularly concerned about for the coming season. In fact,  according to the CDC “Almost 40% of people hospitalized in the US with the COVID subvariant that circulated this spring were vaccinated and boosted, highlighting how new strains have mutated to more readily escape the immunity offered by current shots,” So, long story short – Use your discretion but Mask Up when the environment indicates caution!

Consulo Indicium - 8/1/22

Information for your Consideration…

The Webb Factor: Seeing Farther Than We’ve Ever Seen Before – I have many, many thoughts on the Webb Telescope project but the limitation of time has not allowed me to distill those thoughts. So, I will pass on sharing those thoughts for this edition of the FickFiles. However, count on further discussion related to the findings of the Webb Telescope. I believe the findings are going to alter – in VERY SIGNIFICANT ways – our entire perspective on what it means to be human, what our perspective on the universe is, how it was created and who is in charge. For example, in the Milky Way there are a billion stars AND there are now >200 billion galaxies like the Milky Way that can be identified and studied. These numbers are mind boggling… or, as a “rough order of magnitude” there are about 2 quintillion (= 2 with 18 zeros after it, if my math is correct) opportunities for solar systems like ours by my calculation (Correct me if I’m wrong). So, where does that place the human race in the hierarchy of intelligence around the universe, let alone the neighborhood? It’s a game changer. I encourage you to start here or here on the findings of the Webb Telescope so you can participate in the upcoming dialogue... More later…

Amazon Acquires One Medical – There have been any number of attempts by the business types to move into the health care space. The most prominent that seemingly never quite made it was Walmart! I was actually hopeful that Sears was going to make an effort when I gave a speech back in 1987-88 that I had resigned my position in rural health to take on the role as the Chief Medical Officer for Sears Health (I made it up!) but it got lots of attention and even stock buys. I proposed ripping out the carpet section and installing medical clinics instead. (Don’t worry, at the end of the speech I fessed up that I was pulling their leg.) But, it did portend the future of health care…

But now, a bigger company with even more resources has stepped into the medical abyss. Amazon – which has been toying with micro steps into the medical field for the last couple of years. The company recently announced plans for acquiring the technology-focused primary care provider One Medical for $3.9 billion (…a mere dent in the Amazon portfolio). The move augments other recent forays into health care like their virtual Amazon Care initiative, a support system offered as a medical management program, and PillPack – among other possibilities (no doubt) down the road. One Medical is actually an umbrella company with two operating components: 1) “1Life” for management services; and, 2) “One Medical” as the professional services corporation. In announcing the purchase, Amazon indicated that the intent is to foster efficiency in the primary care field by removing all of the obstacles that are created for access to quality medical care. We’ll be watching!!

All Things Covid: An Update – It feels like we are uncovering the potential problems associated with Covid infections layer by layer as additional research is brought to bear on questions emanating from patients around the word. Here are some of the important findings:

  • Brain Fog and Other Associated Symptoms (Sx) – In a recent small study completed by the National Institute of Neurological Disorders and Stroke (NINDS) it was discovered that the immune response to a viral infection – in some cases – causes damage to the brain’s blood vessels. The study was published in Brainand was derived from post-mortem examinations of brain tissue from a small number of patients who died suddenly after contracting COVID-19. It appears that the antibodies are involved in an attack on the cells lining the brain’s blood vessels which serve as the front line on the “blood-brain barrier” leading to inflammation and damage. The end result is damage to the barrier and leakage of proteins from the blood into the brain. Then come the clots and the associated symptoms of headache, fatigue, loss of taste and/or smell, sleep problems, and brain fog. All of these – in some patients – culminate a higher incidence of stroke.
  • Omicron Increases – Driven by the diffusion of Omicron across the globe, the WHO recently announced a 30% increase in Covid infections across 110 countries in the first two weeks of June. So…it’s not going away. As I’ve noted several times previously – Covid is becoming endemic! Meanwhile, the USA is in a steady state of ~100,000 reported cases per day or about 1M “true” cases per day according to researchers. The steady state is reflected in national wastewater with plateauing trends across every region.
  • Multi-Infection Experiences – More and more people appear to be contracting the virus (including new, evolving Covid variants) in successive experiences. Why? It is most likely that subvariants – we think? It could be that the “boosters” only partially cover viral changes? In fact, there could be a lot of “could be’s”. But, it is also clear that those who are vaccinated are the clear winners in the Covid survival debate. The issue of multi-Covid infections is discussed here. Check it out AND in the meantime, GET BOOSTED!!
  • Tracking Covid – If you’re into tracking the Covid infections check out these two sites!! They provide a plethora of information on the current state of Covid: 1) USA Covid Incidence Tracking by State; and, 2) Covid Incidence & Deaths.

 Kiddie Vax Update: Less Than Needed – The states are experiencing less than desirable uptake in vaccinations for Covid among the children less than 5 years of age. It is far slower than anticipated! How do we know? Because the states are ordering less vaccine than originally predicted based on population sizes (SEE CDC Chart).

Why? – is the big question. Kawsar Talaat, Ph.D., a Johns Hopkins School of Public Health pediatric vaccine expert attributes the problem to distrust. In a recent interview, she said: “The distrust in government, the distrust in public health and the distrust in science is growing and is very, very worrisome.” The Biden Administration is struggling with attempts to encourage parents to vaccinate their kids. I must say – we’ve never had a vaccine come out with this much prior experience that has been almost exclusively positive in terms of value. We all need to step forward and encourage Moms and Dads to get their kids vaccinated!! BTW – the even more alarming new is that childhood vaccinations are at their lowest in 30 years, according to a new report from the WHO

My Covid Observation – In my less than expert scientific mind, the Covid experience points us in the direction of sequelae of all kinds associated with “viral” infections – be they  Covid, Epstein-Barr or other associated viral causes. For example, the high incidence of Parkinson’s Disease among the Great Flu epidemic survivors points in this direction as well. It deserves further NIH funding and support!!! Scientists and researchers are eager to understand how COVID-19 impacts the brain, as it could help develop the future treatments for those impacted by lingering COVID-19 symptoms.

Rural Health Equity! – Approximately 60 million Americans reside in rural areas and require access to health care services. In a new report from the Cecil G. Sheps[1] Center for Health Services Research nearly 80 hospitals have closed and stopped providing services since 2011 AND the closure rate is increasing!! In 2020, there were a record-breaking 20 hospital closures across the USA. Commentary: My early career was spent in rural health as the Founding Director of the North Dakota Center for Rural Health at the University of North Dakota. We have an obligation, in my mind, to provide equitable services for those residing in rural areas, on reservations, in prisons, in inner cities or any other place that is underserved. That has been a premise of our national health policy for at least 50 years in my experience. We are failing and need to resolve the problem. Providing services in these underserved areas requires focus, attention, problem-solving and funds.


[1] Cecil Sheps, MD was one of my mentors when I set up the UND Center for Rural Health. He was an extraordinary health care professional who had a major impact on rural health care policy through his work with mentees and others in the early days of the 1980s rural health movement.

Consulo Indicium - 7/6/22

Information for your Consideration…

On The Alzheimer’s Front – Positive Results From Increased Omega 3 DHA Levels – In a new study reported in Nutrients, higher blood levels of Omega 3 DHA results in a nearly 50% reduction in the likelihood of developing Alzheimer’s disease compared to those who had lower levels. What it means is that simply increasing your dietary Omega-3 DHA – especially for those individuals who carry the ApoE4 gene (which increases the likelihood of developing Alzheimer’s by 50%) – dramatically slows the onset of the disease. Such a cost-effective, low-risk dietary intervention like this could potentially save billions in health care costs. The implications are very significant because of the very significant impact from a relatively simply dietary intervention. It is estimated that the health care costs for Alzheimer’s in 2021 exceeded $350 billion in the US in terms of formal costs. This does not include the cost of family care-giving or unpaid caregivers – which are a significant cost as well. 

Tattoos For Good, Not Just Show – Researchers at The University of Texas at Austin and Texas A&M University recently reported on a development that adds “function to show”. It comes in the form of an electronic tattoo that is worn on the wrist to deliver continuous blood pressure measurements. But the more remarkable feature is that the device is more accurate that virtually all available options for measuring blood pressure on a digital basis. This is a very important development because blood pressure monitoring has been shown to be an invaluable resource for the management of hypertension and other more long-term problems associated with the disease. The new devices use graphene which is a very strong, thin material for the e-tattoo. It is like the pencil graphite but instead of a random pattern to the graphite, it is organized into precise thin layers. The devices have a “stickiness” which allows them to comfortably lay on the skin for monitoring blood pressure.

Federation of State Medical Boards (FSMB) Promotes New Telemedicine Policy – Time seems to be slipping by too fast. Last April, the FSMB House of Delegates unanimously adopted a new telemedicine policy that will (hopefully) lead to more effective and efficient use of telemedicine by all physicians and clinical providers. The new policy came about through recommendations of a FSMB work group that included a broad array of leaders from across the provider sector. The intent of the new policy is to allow telemedicine and telehealth services across state lines without the need for a physician to be licensed in every state. Specifically, the new policy allows for physician-to-physician consultations, prospective patient screening for complex referrals, episodic follow-up care for established patients, follow-up after travel for surgical/medical treatment and patient interactions involving clinical trials. For a more comprehensive review of the policy and its implications, check out the AMA Advocacy Insights webinar series.

In general, there is strong interest among the physician community for the new policy. However, the new policy comes at a time when it could be particularly useful in support of the growing primary care shortage. However, a new report released a month ago from a Walmart-Medscape poll of physicians revealed paltry use of the tools at the present time. For example, only 28% of urban and 22% of rural health care providers currently use remote patient monitoring (RPM) practices. On the other hand, the patients are a bit ahead of the providers with 32% of urban and 29% of rural respondents using fitness apps, smartwatches, Fitbits, and other similar information devices. These results stand in contradistinction from the perceived benefits of the providers who by and large feel that RPM would be beneficial for their patients.

Based on my experience, there are two impediments to adoption. First, the vast majority of physicians and other health care providers have not been adequately trained on how to use these tools as adjuncts for their practices. Too frequently, it’s just “another thing to do” in the increasingly long list of requirements in patient care under a fee-for-service system. Second, the use of these tools requires a revision of the “process” on how the tools are integrated into the practice of the providers. Without revising the outpatient clinical process, RPM and other telemedicine tools can be seen as a distraction from the need for direct patient care. The end result? We – the medical care delivery leaders and educators – need to do a better job of helping these providers resolve these problems. There are existing programs that have been shown to make a difference. 

Ongoing COVID Update – As you no doubt heard, the CDC recently authorized the second mRNA COVID-19 vaccine booster (= the 4th shot for those who are keeping count like me). The approval was for middle-aged and older adults (= greater than 50 years of age). Their decision was based on two studies from Israel that included more than 1 million older adults as reported in the New England Journal of Medicine. In essence, the studies confirmed that protection from the fourth shot peaked roughly 4 weeks after injection. However, protection against “severe” COVID-19 infections continued for longer periods of time!! Long story short, I had my 4th booster in early May. They have not resolved the question of what to do after the period where coverage wanes (i.e., after 8 – 10 weeks following the 4th vaccination). It still seems to provide protection against “severe” infections at this point. So, it would still be advisable from my perspective to mask up, use prudence in attending large events especially if in compressed areas, and stay home if you’re not feeling well. We’ll keep an eye on it…

COVID & Impact On The Brain – One of the issues us “older folks” are concerned with is the potential impact of COVID-19 on brain function. A new study out of the United Kingdom Biobank databased documents important changes as reported in the April 2022 issues of Nature[1]. They studied individuals who had previously had an MRI (brain scan) as part of general longitudinal study of aging and who had experienced a COVID-19 infection. 401 cases of COVID-19 patients were compared to 384 controls that were matched for socioeconomic status, health status, age, sex, ethnicity and other factors. The COVID-19 patients had important changes in the brain, including: damage to the olfactory (= smell function) cortex, reduction in gray matter in the frontal cortex over the eyes and the areas around the hippocampal gyrus, general reduction in overall brain size, AND – most importantly – greater cognitive decline. So, the conclusion was that a COVID-19 infection definitely caused changes in the brain in areas that have been shown to exhibit clinical signs as well (e.g. loss of smell, confusion, etc.). Obviously, this is a big deal and relates to question of “Long COVID” and its potential impact. I suspect information on this topic will continue to percolate forward as the researchers “peel the onion” of COVID-19. 

A Final Note (This Time) On The Importance Of Coffee 😊 – There is a new report in the journal Kidney International Reports noting that coffee consumption may be protective of kidney function. If that’s the case, my kidneys are doing very well. The report notes that coffee consumptions appears to reduce the risk of acute kidney injury (AKI) with people who consumed any amount of coffee exhibiting a 15% lower risk of acute kidney industry but those who drank 2 – 3 cups per day has a 23% lower risk. I wonder what happens among those who consume more than 10 cups a day 😊.



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