Consulo Indicium - 4/15/24

Information for your Consideration…

Voices For Value-Based Care – Check out the quote above from Zameer Rizi who opined in a Medical Economics article that we need to take a serious look at moving toward “value-based care” (VBC) payment models as the foundation for American health care. As my long-time readers know, I’ve been a proponent of VBC for many years. By emphasizing “value” rather than simply “doing things”, the healthcare system will realize – based on the existing VBC pilot programs - not only improved productivity and enhanced outcomes – but, also service delivery at lower cost. It’s definitely where the USA needs to go from my perspective!   

Compounding the need for serious consideration of a national approach to VBC is the increasing consolidation of care delivery providers through the expansion of private equity control. For example, a report emanating from researchers at the University of California Berkeley clearly shows the consolidation pattern. They reviewed more than 300 metropolitan areas and the growth of private equity since 2012. In about 18% of the metro markets a single firm was shown to control more than half of the specialty service sites in that market. Such control while possibly creating some efficiencies also creates marketplaces that are unable to function without those services. The end result is that the system becomes beholden to them as a source of care delivery. The other concerning fact is that much consolidation has occurred in the “ology” fields – in particular, for urology, gastroenterology, obstetrics-gynecology, radiology, orthopedics, and oncology – all of which have seen a near doubling of private equity control in recent years. Not to be left out, there has even been a jump in consolidation related to the primary care fields as well.

As noted in the Zameer Rizi Medical Economics article cited above: “Although acquisition by a [private equity] firm can alleviate financial strain by providing capital and technology to the practice, it may also bring a focus on increasing short-term profits and a high debt burden…a focus on short-term profits may lead to overuse or misuse of lucrative treatments and services, an increase in prices, and substitution of lower-cost healthcare providers for physicians—all of which can compromise healthcare quality."

But, more importantly, the issues are not solely about the economics of private equity involvement in health care. The other major considerations relate to the burgeoning explosion of elders (I’m one of them) moving into the Medicare system and our need as a society to provide equitable health care for ALL Americans – not just those who have resources and employment status by allowing them to have insurance coverage. These two factors stress the resources of local, state, and federal resources. As a result, an emphasis on “value” via effective qualitative, quantitative, and evaluation methodologies with appropriate incentives is clearly in the best interest of society at large.

Advocacy most often precedes action. So, my suggestion is that we – as leaders in the healthcare community – need to step up to the plate and “advocate” a move toward value-based care delivery. The data seems clear that a move toward VBC will create better and more value for health care, the public, and the economy. Without it, I believe society and the greater needs of that society will suffer. Your thoughts are appreciated 

So, Is Concierge Primary Care Better? – First, a bit of explanation. “Concierge care” is the type of service accorded to those individuals who pay somewhere between $2500 - $5,000 (depending on your geographic region) to gain access to a primary care provider 24x7. Those who are concerned about access and cost express the notion that this type of model ultimately harms the healthcare system through increased costs and disparities (NOTE: I am among those arguing that perspective). In fact, researchers have found that overall costs of healthcare increase by 30 – 50% in total for those who are enrolled in concierge medicine practices. However, the proponents argue that the practice allows for those physicians who would otherwise retire to continue in the practice of medicine on a “scaled back” model so that the approach helps to resolve the workforce shortage issue. For a review of the topic, consider reading the full assessment of the practice in Concierge medicine is an important phenomenon since it is growing among not-for-profit and academic medical centers as a way of “upstreaming” patients with resources into those institutions.


These questions of economic drivers for access to health care are part of the dark side of health care – from my perspective – and, something that misses the mark. I believe that equitable health care should be available to all. Gamesmanship seen in health care delivery – while it has always been there – seems to be on the upswing. Something needs to be done… Then, again – as noted above: advocacy most often precedes action. So, where are the advocates?

Where Have All The Babies Gone? Back in the day, when the Boomettes or GenX were beginning their focus on having families, the USA broke the 1957 record for baby production by having 4,317,000 babies. That was in 2007. And, it was anticipated that the Millennials would even break that record when they came of age because of their size. But, then everything changed. Most analysts would argue that the onset of the Great Recession of 2008/9 clearly played a role in the early stages of a decline in baby production across the USA when over 10% of the workforce lost their jobs. It also affected other nations like China, Europe, and others, as well. By 2013, the Dow Jones Industrial Average was on an incredible growth pattern that continues to this date. But, the baby production did not return. It’s been difficult for analysts to identify any other specific factors that could account for the decline in baby-making not only here in the USA but worldwide. Although the data is unclear, there are some levers that seem to be at play, including: a growing concern among Millennials about the ecology of “too many people” inhabiting Mother Earth, the much higher uptake of highly effective contraception, and the economy – more generally – in recent years has been a force due to the costs associated with raising children. Many analysts point to the enhanced occupational opportunities for women and the ability to engage in such employment through more virtual means by both sexes. And, the high level of student debt has become an albatross for many young adults. But, the available research does not lend much support to these ideas as fundamental explanations for the decline in the overall birth rate. It’s an open question that does not seem to have a clear answer. Regardless, the Baby Bust is going to have major repercussions across society as we have seen with the closure of high schools now moving to colleges leading to a decline in trained workforce and the like. As a side note, Maine (where I reside) has the distinction of now being the “oldest” state in the USA – something discussed in the quiet corners of living rooms throughout the state. What to do? My personal perspective is that the issue is a societal and generational phenomenon that has not yet been adequately defined. There are lots of opinions but so far, not a lot of answers. BTW, those medical students considering Ob-Gyn should really think about moving into Family Practice 😊 – see the next item…

Regardless, Rural Maternity Care Is In Trouble – I got my start in healthcare (as distinct from “medical care”) when I took on the role of serving as the start-up Director for the Center for Rural Health at the University of North Dakota. During those formative years, we held on to the concept that “studying” rural health was not sufficient. We needed to “actively support and develop” rural health by working with rural communities across the Upper Midwest on the issues they faced in healthcare. One issue that falls into that bailiwick is maternity care.

It is within this context that a new study by the Center for Healthcare Quality and Payment Reform (CHQPR) in Pittsburgh caught my interest. The report – released in January 2024 –highlights the “crisis in rural maternity care.” The report goes on to note that it is insufficient to simply train more providers of any type. It is also essential to train “…medical and nursing students need to be recruited and trained specifically to deliver team-based care in rural areas.” I couldn’t agree more. And, again the problem comes down to people power and money – two consistent themes for healthcare, in general. Here are some of the data points highlighted from the study:

  • Roughly 20% of the USA populace resides in rural America – yet it is a populace that is often ignored or dismissed.
  • 55% of the rural hospitals across the USA do not currently offer labor and delivery services. And, in 10 states, the data is even worse where more than two-thirds do not offer this critical service. In fact, since the mid-1990s, more than 200 USA rural hospitals have stopped delivering babies.
  • Why? Because the vast majority were losing money on maternal care delivery services due to “all payor” forms of cost constraints as well as with liability increasing.

What makes these statistics particularly alarming is the fact that the USA has the highest infant and maternal rate of mortality rate among the G-20 economies throughout the world. That’s a sad statement for a nation that concurrently holds the position as one of the very richest in the world. The CHQPR study points out that pregnant women are 3X more likely to die in the USA compared to Australia, Britain, Canada, France, Germany, and other developed countries. And, to increase the urgency of the issue, the gap is getting wider!!

The CHQPR concluded its report with the following statement: “It is not an exaggeration to say that rural maternity care is in a state of crisis, and a crisis demands immediate action. Every day that steps are not taken to implement the changes in workforce recruitment and payments described above increases the likelihood that more women and babies will die unnecessarily.”

And, Then, There Are the Comparisons of Medicare Advantage vs. Traditional Medicare – In a recent study conducted by policy researchers at the American Enterprise Institute and Harvard Medical School, findings revealed that not only does Medicare Advantage cover a disproportionate share of the disadvantaged senior populace compared to traditional fee-for-service Medicare – it also outperforms on several key metrics. In particular, Advantage beneficiaries evidence experienced a 70% lower hospital readmission rate compared to their fee-for-service counterparts. Advantage members also had 35% lower rates of inappropriate medication use and comparable rates of medication adherence as well as fewer preventable inpatient admissions. One of the partners in the study was Inovalon, a healthcare cloud supplier to the healthcare industry. A copy of the full report is available at the Inovalon website. The conclusion of the study noted that it “…underscores the role that care management and coordination can play in promoting quality within the Medicare program. Furthermore, the study indicates that the lack of care management in Medicare’s fee-for-service program has negative ramifications for beneficiaries and that recent reforms to [fee-for-service Medicare]—such as the introduction of accountable care organizations and value-based initiatives—have clearly not brought sufficient care management to the fee-for-service program.” 

Oh Oh! Time To Make Some Dietary Adjustments – A recent research article in the British Medical Journal provided the results from a new “meta-analysis” study of over 45 studies covering about 10 million people. The results? The study found “convincing evidence that higher ultra-processed food intake was associated with about a 50% increased risk of cardiovascular disease-related death, a 48 to 53% higher risk of anxiety and common mental disorders, and a 12% greater risk of Type 2 diabetes.” The report also noted that there was “…highly suggestive evidence...indicated that diets high in ultra-processed foods were associated with a 21% greater risk of death from any cause.” This report comes on top of the daily admonishments that my wife is providing me on the value of fruits and vegetables as dietary staples that should be at the top of the list – rather than the bottom of my personal food pyramid. I guess I should be relieved that she would like to keep me alive 😊. 

The Transition of Mankind Into Some Form of Plastic! – Many of you may have read the disturbing news that microplastics are becoming ubiquitous abscesses across the entire earth extending from the personal “me” to the ocean across the entire earth. Yikes!!! They’re even found in soils and sediments that extend back to the early 1700s before microplastics were a production problem for humankind. Why? Because they are so small that they seep everywhere!! The results come from a study published in the journal Science Advances by European researchers who studied the sediment of three lakes in Latvia. It’s all part of the Anthropocene Epoch which is defined as the study of human impact on the environment since the 1950s.  and meant to delineate when humans started having a large impact on our environment. The more disturbing part of the study was the ubiquitous nature of microplastics which as so small that they are even found in human cells. Just imagine what will happen to Jupiter in another couple hundred years after humans form their colonies and such in the outlying planets😊.

Overdose Deaths From Smoking Accelerating – The US Centers for Disease Control (CDC) recently released a new report on the perils of drug overdose deaths. The report noted that the percentage of deaths from smoking drugs has overtaken the injection of drugs as the leading cause of death.  It increased by a whopping 74% from 13.3% to 23.1% over the two years of 2020-22. Meanwhile, the percentage of overdose deaths from injections fell from 22.7% to 16.1% over the same period. In essence, while drug users may be increasingly aware of the perils of injecting drugs, the message hasn’t caught on for snorting and such.

Consulo Indicium - 2/26/24

Information for your Consideration… 

The Changing Face Of Healthcare – I just finished an intensive two days with an immersion into the application of artificial intelligence (AI), machine learning (ML), Small Language Models (SML), and Large Language Models (LLM). Wow! My head’s a spinning. While I continue to have the perspective that we should be looking at all of the technologies that are rapidly coming down the track as useful for “clinically augmented intelligence” – it’s clear that the augmentation is getting quite good!! These systems are not only engaging the type of support that ChatGPT provides (if you’ve used it you know what I mean) but also real-time, interactive “discussions” and “empathetic support” from AI proxies in any number of areas from clinical to non-clinical. The world is changing and the healthcare community is not appropriately engaged in the topic. There are reasons to pay attention:

  • Systems are getting as good as expert clinicians in analyzing a patient’s information and providing diagnostic support.
  • Efficiencies are being provided that will help us to address the significant workforce shortage that exists within the healthcare community.
  • Effectiveness is enhanced through interventions and support that are too frequently missed by our lack of appropriate follow-up when patients are discharged from acute care.
  • Not only do the evolving systems provide “data” they also exhibit “empathy” that patients find attractive and supportive.

Wowzer!! I’m trying to keep up on all of these changes but my eyes were opened even further to the pace of change we are experiencing across the health care spectrum. From back office business to data analysis, to clinical decision support, to clinical staffing triage – and, beyond; these systems are rapidly changing the landscape of all the clinical and healthcare management fields. As a former leader of health systems, I urge all of my colleagues out there to get serious on this front and begin to actively explore, consider, and invest in these new evolving systems for helping to “make health care better” – my personal mantra for the last 50 years (whoa…is it that long? Yes, even longer but, let’s not go there…)

North Dakota In A Growth Spurt! – Even though I moved away some years ago from my home state of North Dakota, I follow the news and events – and the people – where I grew up. I was especially taken by the fact that the US CDC recently reported that the fertility rate in North Dakota came in as the second highest in the nation at 66.7, just after South Dakota at 68.6 which had the highest! But, that’s OK, we’ve always touted the fact that even with all of these second-place finishes, we know that the roads are longer and paved in North Dakota. And, the lowest? My newly adopted home state (now 10 years) at 49.9 = Maine, as well as New Hampshire. We were tied. But, in general, the Northeast has low fertility across the board. Why? It’s because so many more of us “retired” types are moving north to the good country. You see, Maine is just like North Dakota – except, it has mountains, ocean, and trees. Other than that – they’re almost identical…

It’s Back To The 50’s!! – The US CDC recently reported that the rate of syphilis increased by 80% from 2018 to 2022 with about 207,000 “reported” cases which also included 3,750 newborn infants or a 183% increase during that period. While we commonly associate syphilis with sexual transmission, it appears that a large portion of the increase was due to drug abuse associated with risky sexual behaviors. We also have way fewer sexual health programs in the schools than in prior years. We seem to be in a retrograde action since the new rate of infection is the highest since 1950!! Now, that is a sad commentary…

And, Let’s Not Forget the 60’s & 70’s – I will never forget my first – and pretty much last – experience with cannabis. I had eschewed the use of the drug because in North Dakota at the time, it was a felony that could land you in the state pen and…I wanted to go to medical school. But, one night – before medical school – I was cajoled into joining my good friend, Eddie (who shall remain anonymous). It was quite the experience. I think my lifetime “love” of pancakes came from that evening when at the local diner I consumed a whole bunch of them because of the ocean experience that exploded in my mind… But, let’s put that aside. I read an article recently that caused me great concern. It was from the last issue of Science Digest (February 10, 2024) on “Teen Brains and THC Don’t Mix Well”. For starters, I was only peripherally aware of the THC (the active agent) content of contemporary cannabis. Historically, the “weed” that my generation played with had a range of 2.5 – 5.0% (strong) potency. Now, “wax, budder, and shatter” have ranged from 20% - 95% potency ranges. As the article points out, “the availability of cannabis promotes the ideas that it’s safe.” Not so fast! So, what’s the concern?

The concern is the increasing amount of research data showing the adverse effects of cannabis consumption on the teen brain. Here’s a couple of data points for you to consider:

  • As it is inhaled, imbibed, and consumed, THC binds to a receptor CB1 in the endocannabinoid system – which influences many functions in the body such as problem-solving, pain management, memory and recall, motivation, anxiety management, and a host of other functions that are “actively” developing during the teen years. These are functions that are critical to function in the prefrontal cortex (i.e. “thinking”).
  • Use of cannabis as a teen is associated with a much higher dependency on alcohol, cocaine, nicotine, and illicit drugs as the teen ages. The increase goes from about 6% to 20% which is a very dramatic increase!!
  • Depression and anxiety are much more prevalent in the future years among those who started in their teens. This makes for difficulty in relationships and functioning.
  • While smoking among teens has decreased dramatically over the years – decreasing by 90 – 95% - vaping in recent years has increased from 25% to 34%. It’s just the tip of the iceberg since very few studies have been done on “vaping” – especially with the high potency products now available in most cannabis shops across the nation.

So, what to do? In Maine, we (the health care folks) are advocating that there should be restrictions on the presence of cannabis shops near schools but, from my perspective – while that’s a good first step, it’s not the only step. We need to step up the research on cannabis through the National Institutes of Health and other federal/state agencies to learn more before we have yet another epidemic on our hands.

Now, I still remember those pancakes from so many years ago. BUT, now I use an alternative. I use lots of Maine, Vermont, and New Hampshire (local) maple syrup on my pancakes and they are just as good as in that one experience. And, to top it off, there is no research that I’m aware of causing concern related to Maple Syrup consumption. It’s actually pure enjoyment – as long as you don’t gain too much weight. You heard it here first!!

Write It Down And Remember! – In a report from THE WEEK (February 16, 2024), it seems that those of us who continue to use cursive (writing) for taking notes did a much better job of remembering the material than those individuals who typed on a keyboard. The study comes from the Norwegian University of Science and Technology where they studied students using electroencephalogram (EEG) studies of students engaged in both types of note-taking. What was particularly interesting is that in using cursive the portion of the brain that forms memories and encodes information was more proactive in promoting learning. So, the message conveyed by the study is that we should put aside the laptops in the classroom or board room – as the case may apply – and re-adopt cursive as the format for taking notes that we want to remember. Now, what is that I was trying to say at the beginning of this short note…?

Consulo Indicium - 2/6/24

Information for your Consideration… 

The Good From AI/ML – Researchers at Microsoft have made a very significant discovery that will greatly help the extension of AI/ML capabilities. Specifically, one of the current concerns in the use of these new technologies is the dependence upon lithium ion batteries. The Microsoft researchers have created a new battery that is 70% LESS reliant upon lithium for moving the electrical charges through the battery. They were assisted by AI/ML capabilities where they examined 23.6 million candidate materials as potential replacements for the electrolytes and lithium atoms used in making such batteries. The work of the research team is moving ahead and there is hope that a viable commercial product will be available sometime in the not-too-distant future (i.e. not tomorrow, not next week, or even next year but beyond that “sometime”).

It’s Not Pontificating But ProtelyzingIn 1982 (I think that’s correct), I had an “event” that brought me to my knees at the ripe old age of 31. I was traveling in rural Montana for work on “rural health” near Cody, Wyoming when I developed chest pains and a very rapid heart rate. Being the physician that I was and inclined toward treating myself, I went to the hotel ice machine, got a bucket of ice, went back to my room, put the ice in the sink, ran some water into and stuck my face into it. Yes, my heart did slow down, but…too much. I ended up going to the hospital and being admitted with the missive that I should “cut down on my smoking.” I got home and was with one of my closest friends in life when I was smoking on a street corner and the same symptoms appeared. I vowed to quit…and, I did. You see – I was smoking four (yes, “4”) packs per day (NOTE: What a stupid doctor). So, I quit and have never regretted it but I’ve always been an evangelist for those who need to (i.e. must) stop smoking. I’ll support anything that prevents the onset of disease through passive means – like smoking.

Which takes me to my issue. Here are some myths that we need to dispose of ASAP for the good of society that relate to the use of cannabis and other similar products that offer people “other places to go” with their thoughts from smoking. Check out what the Family Physicians are sharing with patients. It’s right on the mark. The myths including the following:

  • Myth #1: E-cigs are a safer alternative to smoking cigarettes.

Fact: Makers claim that e-cigarettes don’t contain the harmful chemicals that cigarettes do. Of course, this is not true. Most devices contain nicotine. Plus, e-cigarettes may also contain ultrafine particles that can be inhaled and cause lung inflammation.

  • Myth#2: E-cigs aren’t addictive.

Fact: While there are some cartridges that don’t contain nicotine, most do. Any time a smoker inhales nicotine, they are inhaling an addictive and harmful chemical.

  • Myth #3: You can use e-cigs indoors.

Fact:  At first, makers of e-cigarettes said that e-cigarettes were appealing because they could be smoked in places that didn’t allow traditional cigarette smoking. This is no longer true. Most states have created laws that prohibit vaping in the same areas where traditional smoking is not allowed.

  • Myth #4: E-cigs are a way to quit smoking.

Fact: Marketers claim it is easier to quit smoking if you switch to vaping first. But e-cigarettes contain nicotine and may even lead to a user becoming a traditional cigarette smoker.

Now…Go out there and share the news. The harm we are causing across society is incredible. We can stop it now, if we just speak up. Now is the time. Now is the moment. Now requires action! And, it all happens at the state level. Speak up now or you may lose someone you love…

Listen Carefully – Perhaps it’s because my ears are attuned to the latest information on health care happenings but the number of ads and other forms of information flowing out to the public seems to be increasing at a dramatic rate. Of course, it could be that I’m listening carefully for “stuff” I may need as part of the aging process. But, putting that aside, there are any number of adverts that caught my eye this week. First, I was watching the National Geographic News – a politically neutral news source that often shares information you don’t hear on other channels. However, in the space of a couple of minutes there were ads for “Kardia Mobile” – a remote EKG to for individuals to check for tachycardia, afib, bradycardia, NSR or normal sinus rhythm. And, their web site had an interesting name =  Then came the ad that was looking for nursing staff to provide care for individuals residing at home on These were followed by an array of other ads on various aspects of “care.” While I’m a big fan of self-care – the ads seemed to overstep the line and gave assurances for better health that did not relate to the underlying problems. Hmmm – how to deal with digital, channel and virtual information that speaks “to” the problem but does not “deal with” the problem… 

Confirmation – For a whole bunch of decades I’ve been arguing that patients having a primary care physician as the first line of defense in the care delivery process is a priority for several reasons, including the management of cost! In fact (and, I’m not overstating here), the literature is replete with articles over that period of a “whole bunch of decades” that access to primary care enhances care delivery, results in better outcomes and reduces costs. So, why am I engaging in echolalia? The NEJM Journal Watch, Vol.44 No.3 in the February 1, 2024 issue posted an article, “Another Benefit of a Primary Care Continuity Relationship” by Thomas Schwenk, MD, Associate Editor. The article outlined the results of a Canadian study of 5 million Ontario residents over the period 2021-22. Rather than put it in my own words, let me quote directly from Dr. Schwenk’s report: “After controlling for sociodemographic variables, diagnoses, and timing of virtual visits, likelihood of an ED visit was 66% higher for patients who saw physicians who were not identified FPs than for patients who were seen by their own physicians. This difference corresponds to 1 additional ED visit for every 77 virtual visits. This difference was accentuated about fivefold when virtual visits were with direct-to-consumer telemedicine clinics.” This report is yet another strong statement of support for all individuals having access to a primary care provider – and, at the same time – we’ve got a massive, looming shortage of primary care providers on the immediate horizon (i.e., within the next five years). While it’s nice to have confirmation, we also need to recognize that: “Houston, we have a problem!” Need I say more?

When Is Enough, Enough? There was a recent report on, the media station noted a report from Oxfam outlining the fact that the five richest men in the world doubled their combined income over the period of 2020 – 2023 from $405B to $869B. During that same period almost 5 million people grew poorer across the world. I don’t know about you but an extra $464B in the pocket seems like a bit of excess retention by five (yes, “5”) individuals. I would think – but, then I’m sometimes considered pie-in-the-sky – that these five gents could do with just a bit (perhaps more than a bit) less than the mega–billions they hold in their pockets.

Value-Based Care Getting More Attention – The USA Centers for Medicare and Medicaid are continuing their march forward with an emphasis on value-based care delivery. Innovation is the key and it is getting support. Furthermore, it would appear that the managed care companies are also beginning to move toward fiscal consideration for support and reimbursement of value-based care delivery models. This is a trend that deserves the attention of all leaders in the healthcare community.

The Focus of the C-Suite – A new report was recently released by Sage Growth Partners, a healthcare advisory firm with extensive expertise in market research, strategy, and communications. The report consisted of a survey of 108 healthcare leaders from across the USA and is available at this site: The New Healthcare C-Suite Agenda: 2024-2025. The top two issues on the minds of the C-suite are: 1) investments in human resources, including technology integration of workforce needs and support. At the top of the list of workforce issues are recruitment, retention and workforce resilience of health care workers with the latter point garnering 61% of the C-suite recognizing the issues as a “top challenge”. The second issue that is highlighted in the report is the recognition of health IT investments as a way of protecting against unfavorable economic headwinds. The C-suite plans for 43% of the participants noted an increase in capital investments during 2024 which included: 20% for a new EMR, 15% for AI investments, and 13% related to virtual monitoring capacity. Of note was the fact that nearly 50% of the C-suite view AI integrations as supporting improvements in data quality and accessibility. Conversely 35% indicated that their organization had not realized any real benefit from AI investments at this point.

Vaping Declines Among High School Students – In November, the US Centers for Disease Control and Prevention (CDC) issued a report on the extent of vaping among high school students in 2023. It revealed that the use of vaping as a technique had declined from 14% in 2022 to 10% by late Spring 2023. That’s the good news. The not-so-good news was that vaping among middle school students over the same period increased from 3.3% to 4.6%. At the same time, use of tobacco products remained low at less than 2%. So, my take is that “education” matters and can have an impact since many schools have taken on the issue of educating their students on the trials and tribulations of vaping. It’s also an issue that many state legislatures are taking up in various forms by preventing access to flavored products – especially near schools.

Consulo Indicium - 1/22/24

Information for your Consideration…

Good News – It Takes Less Effort, So…Go For It! – In a new study from Washington University School of Medicine, lead author Cyrus A. Raji, MD, PhD reported in the December 7, 2023 issue of the Journal of Alzheimer’s Disease that only “moderate” levels of physical activity – such as 4,000 steps a day or even less – have a positive effect on brain health. So, while the 10,000 steps-a-day regime is excellent, you can still get a substantial benefit even with fewer steps. 4,000 steps are like walking 5 – 6 blocks. Now…isn’t that simple. So don’t just consider it. Do it!! I’m spoiled; however. My two dogs – Toto and Lole – expect it! So, I have to do it…

A Sad Commentary – A recent report in The New York Times noted that for the last year (2022-2023), Congress only passed 27 bills – yes, 27 bills out of more than 700 that were in the queue for consideration. Now one observation for those who don’t like government might be – “Thank goodness”. But, for me and mine, it means that Congress “Sure didn’t do very much”. In fact, it is the least productive Congress in more than 90 years. The 2020-2021 (117th Congress) legislative session passed 365 bills during its 2 years of work; and, to put it in perspective, the 2018-2019 (116th Congress) passed 344; and the 2016-2017 (115th Congress) passed 443 bills. So, calling it the “Do Nothing” Congress is not an exaggeration…

And A Lesson From Abroad To Prevent Sad Commentary – It seems that the USA is not the only nation dealing with the presence of “social media” as a major force in politics. Richard Correa in Estadao [NOTE: Forgive me if I got the wrong citation. My Portuguese is not so good] recently noted that it has turned politics into an ugly mud fight down in Brazil. Evidently, candidates are appealing the fringes on both the left and right social media users for support because that’s where the partisan trolls hang out. Does it sound increasingly familiar? He reported, “Your political survival depends on how you react to every fact…” so that even good conversations with colleagues from the other side of the aisle are scrutinized. He concluded that in Brazil soon the country will be “incapable of holding a rational debate.” This sounds so familiar to the recent hearings in Congress where one Member challenged a person giving testimony to a wrestling match right there in the room. Whew…We’ve all got to get a grip!!

Better Hearing = Reduced Risk of Death – Well, finally there is some good news about getting older. In a new study released by The Lancet Healthy Longevity study, it was noted that “wearing hearing aids if you need them may help protect you from early death…there was no difference in risk of death over the research period between people who used hearing aids occasionally and those who never wore them, but regular users were at a significant lower risk.” “It’s one of the few benefits of getting older.” said the author of The Fickenscher Blog.

Healthcare Employment A Major Contributor To USA Job Growth – The amount of growth occurring in the healthcare sector is really significant. In fact, 24% of all new jobs in 2023 in the USA were derived from healthcare with an average monthly job growth of 54,000 jobs. The total of 653,000 new jobs (2023) compared to 557,000 the prior year (2022) represents a 17% increase. Furthermore, half of the growth was in the ambulatory care sector. However, the unemployment rate held steady at 3.7% during the latter part of the year. The second largest growth areas were in government (52,000) and the hospitality industry (40,000).

Increased Private Equity Results In Lower Safety Performance – The alarm bells went off at a higher frequency when I heard the news about private equity where JAMA recently reported that hospitals saw a significant increase in central-line intravenous infections (an increase of 38%) and patient falls (an increase of 27%) after purchase by private equity firms. There was also an increase in infections in other areas as well (e.g. surgical sites). The research was completed by faculty from the University of Chicago and Harvard Medical School after comparing the Medicare Part A claims data for 51 equity-acquired hospitals compared to 259 non-equity-owned, matched controls. The culprit? According to the article, it would appear that staffing reductions that occurred following equity acquisition were the major factor.  For further information on this alarming study, check here. 

Sad Statistic #1: The United Nations recently reported that almost one-half of humanity live in nations where more is spent on servicing debt than on either health or education. It affects 3.3 billion people.

Sad Statistic #2: The World Health Organization reported that over 4.5 million women and babies die every year during pregnancy, childbirth or the first couple of weeks following birth primarily related to preventable and/or treatable problems if the right care was provided. This death rate is the equivalent 1 death every 7 seconds to put it in stark terms.

Ignoring A Good Thing – Nirmatrelvir/Ritonavir For Treating COVID-19: In a recent study from the NIH, it was noted that “only about 15%” of eligible individuals diagnosed with COVID-19 took medication that has been shown to make a marked difference in outcomes – and, that’s Nirmatrelvir/Ritonavir (= Paxlovid)!! BTW, I learned about the issue in New York Times. The reluctance is on both the provider (doctor) side as well as the consumer side for different reasons. Physicians have been worried about drug-drug interactions and patients about side effects like the metallic aftertaste that can evolve for some individuals. While I’m only a case of 1 – it made a huge difference for me. Within 36 hours, my COVID+ symptoms had essentially disappeared, and I was back at it (and, behind 😊) in my work. Check out the research findings here. We still have a problem with nearly 1,500 USA citizens dying each week from COVID-19. Spread the word…

And, If You Survive COVID-19 – Start A Daily Multivitamin – For those of us in the over 60 crowd (there are a few of us 😊), a new study reported in the American Journal of Clinical Nutrition shows that a “One-A-Day” (there are other brands as well…) multivitamin slows memory loss by nearly two years. That’s significant! Furthermore, the research reported in the journal is not the only one touting the benefits of a daily multi-vitamin. So, do as I do – and take one every morning. That way you’ll be able to continuing reading – and, understanding – The Fickenscher Files!! I’ll report back if I find that the results are not working very well…




Consulo Indicium - 12/4/23

Information for your Consideration…

The Continuing Coffee Health Saga – I know, I know – it’s another Kevy story about the continuing saga of coffee. But, it’s exciting! A new study at the University of Tsukuba in Japan has identified a naturally occurring compound found in coffee that seems to improve age-related cognitive decline, memory and spatial learning. The compound is trigonelline. It’s a substance that is found in multiple neurologic pathways throughout the nervous system. It’s also a substance that increases neurotransmitter levels while simultaneously decreasing inflammation. The only problem is that the studies – so far – have been on mice. So, the next step is to determine their application to the human brain but all human brain studies seem to start with mouse brains so the resulting studies will be important.

But, that’s not all. I learned something new this past week. There is “natural” caffeine and then, there’s also “synthetic” caffeine. The coffee giants and the energy drink resources that have become ubiquitous purchases for many of us on our way to work (e.g. Starbucks, Aroma Joes, etc.) as well as the caffeinated drinks (e.g. Red Bull, Coke, etc.) are mostly saturated with “synthetic” caffeine. The interesting finding is that research is now becoming available that shows the not all caffeine is created equal. Emerging research is demonstrating that synthetic caffeine may actually accelerate aging while naturally occurring caffeine slows the age-related decline. With more than 60% of the caffeine we consume coming from the synthetic side, the issue of which type we are consuming becomes quite important. The ongoing research is important for understanding the difference. In a study reported in Nutrition and Metabolism, high caffeine content was associated with shorter telomeres – a marker for cellular aging in adults versus an increase in coffee consumption associated with longer telomeres. That finding would suggest that something other than caffeine is at work… Since this report, there have been a number of studies reporting the same essential findings. Hmmm? What to do? One analysis suggests that because coffee and tea contain not only caffeine but also any number of polyphenols with anti-oxidative properties, it’s likely that the telomere effect is multi-factoral. So, for the moment, I would hang in there and continue with my favorite caffeinated drink as long as it's a natural occurring compound or, chocolate, of course – the other natural source 😊.

Speaking Of Dementia – There is a growing body of evidence revealing that generalized Covid-19 infections can cause neurogenerative decline, especially among the elderly. Based on a review in the Journal of Neurochemistry the problem seems to stem from neuro-inflammation.  For example, in one study there was a 69% increase in onset of Alzheimer’s type dementia for those over the age of 65 who experienced a Covid-19 infection. And, increasingly a number of viruses are showing up associating infections of varying intensity with onset of early dementia. So, to prevent the problem keep up the vaccinations and keep your ear to the ground. When warnings are issued, stay alert, wear your masks and be prudent. The long-term effects could be more of a bummer than the short-term.

Making Travel Safer – The CDC recently announced that it is partnering with Gingko Bioworks to expand the Traveler-based Genomic Surveillance Program which will be testing for more than 30 priority pathogens in airports across the USA. The testing program will include voluntary nasal swabs, sampling of wastewater both in airports and from planes, testing of international travelers from high infection rate nations, and other testing functions. We should not be surprised if testing for flu, RSV and other fall-related pathogens were to begin over the holiday season. Just remember, it’s good for the nation and helps everyone. You’re not being singled out if asked for a swab…you’re part of a group… The major international airports will be the primary targets = JFK, SFO, IAD and others. 

What Are We Doing? – The rate of vaccinations among kindergarteners is declining!! In fact, the rate of vaccine exemptions for children reached the highest level ever reported in the USA according to the CDC. That means kids are not receiving their measles, mumps, rubella (MMR) vaccine, diphtheria, tetanus and pertussis vaccines as well as their poliovirus and chickenpox vaccines. Ay Yi Yi!!! In many cases, parents are seemingly less concerned about these infections because there are no reported cases in their communities. The reason? Because kids have gotten vaccines!! I believe the medical community needs to become more aggressive about advocating the need for vaccinations. The reason these diseases have declined is because of “safe” vaccines. The diseases are still around and lurking in the background only to arise again when a sufficient number of the community lack the vaccines. Take note…

Cyberthreats Abound In Healthcare – The healthcare community is experiencing a plethora of cyberthreats across the board from business email compromise (BEC), to supply chain problems, to cloud compromise, to ransomware. A recent study by the Ponemon Institute found that 88% of the 653 health care organizations surveyed had experience a cyberattack in the last 12 months!! The average cost of each of those cyberattacks was $4.99 million dollars which represented a 13% increase over 2022. At the top of the list according to the security analysts who participated in the study was cloud compromise with 74% of respondents indicating their organization was “at risk”. In many respects that’s not unexpected since “the cloud” is where most organizations now host their healthcare information rather than on server farms within their own organizations. But, while ransomware attacks are still a concern, the degree of concern has decreased somewhat from 2022 by 12%. Long story short, diligence on the part of the IT teams at healthcare organizations across the board is essential in today’s world of digital care delivery.

Healthcare Consultants

    ...Inspiring creative change to benefit the human condition