Consulo Indicium - 1/18/21

Information for your Consideration… 

In Case You Missed It – There are three articles that I highly recommend. First, The Bottom of the Health Care Rationing Iceberg by Tim Lahey, MD from the University of Vermont appeared in the December 3, 2020 issue of the New England Journal of Medicine. It highlights the VERY IMPORTANT issues related to health care rationing in the USA. It should be a point of discussion by all clinicians in Grand Rounds and other forums across the nation.

Second, COVID-19 Conspiracies and Beyond: How Physicians Can Deal With Patients’ Misinformation – discusses the impact of a training program at Duke University for clinicians on how to deal with patient misinformation. We – the educators of the future generation of health care providers – need to proactively consider how we educate our clinicians to enhance their skills at recognizing and dealing with “mis-information”. The increasingly ubiquitous availability of information generally – some of it VERY good and some of it VERY bad is presenting all professionals with a challenge. Somehow, we need to enhance the “sniffer” capabilities of our clinicians so that they can detect and put to rest inaccurate, wrong or downright misleading information related to the care patients receive. It will be a challenge…but an important undertaking. I bequeath it to the next generation 😊.

Third, the MIT Technology Review had an article back in July (as you can see, I’m a bit behind on some of my readings) on a similar topic with an article entitled, How to Talk to Conspiracy Theorists – And Still Be Kind. The article evolved as a result of the author’s experience in responding to a video in May 2020 indicating that the coronavirus was a laboratory-manipulated virus deployed to wreak havoc across the globe so that the subsequent vaccine could be deployed and create massive profits to the company. Then, there was the conspiracy theory that actually Bill Gates was in charge of vaccination efforts worldwide by implanting microchips that could be activated by 5G cellular towers. Whoa, that’s over the edge and into the dumpster as well. What’s fascinating is that about 1/3 of the American public thought that these two conspiracy theories were either “probably” or “definitely” true. Yikes!! Now, for me, I can’t imagine who actually thinks these things up or, for that matter, what kind of mind lets these kinds of ideas in…

The broader issue; however, seems to be the social health implications of the digital revolution which is a broader topic – something I’ll be taking up as we move into February. So, stay with it and start considering the issues. It actually may be one of the more important issues facing health care as we continue to move from our digital revolution.

We Should All Take Note – Tom Frieden, MD, the past Director of the Centers for Disease Control, recently sent out a Tweet which was handed to me by my wife. She indicated that I should post it in my blog so…  The Tweet noted that there are six countries with the lowest death rate from COVID-19 across the globe compared to the US death rate of 1 in 990. They include:

  • Taiwan - 1 in 3.4 million
  • New Zealand  - 1 in 204,000
  • South Korea  - 1 in 63,000
  • Liberia - 1 in 55,000
  • Hong Kong - 1 in 55,000
  • Finland - 1 in 11,000
  • Denmark - 1 in 5,000

Now this is all notable but more importantly – as pointed out by Suzanne – these countries are all led by women. Hmmmm…just sayin’…  Personally, I vote New Zealand. I’ve always thought it would be a good place to live or even for retreat. Now I’m convinced!!

In Case You Missed It – Health Affairs released an article by Martin, et.al. entitled “Growth for the Fourth Consecutive Year” noting that health care spending continued its escalating climb with another 4.6% increase in 2019 to $3.8 trillion. The abstract reads: 

US health care spending increased 4.6 percent to reach $3.8 trillion in 2019, similar to the rate of growth of 4.7 percent in 2018. The share of the economy devoted to health care spending was 17.7 percent in 2019 compared with 17.6 percent in 2018. In 2019 faster growth in spending for hospital care, physician and clinical services, and retail purchases of prescription drugs—which together accounted for 61 percent of total national health spending—was offset mainly by expenditures for the net cost of health insurance, which were lower because of the suspension of the health insurance tax in 2019. 

Not A Second Longer For 2020 – The International Earth Rotation and Reference Systems Service (IERS) made a call that was welcomed by all of us who keep tabs of these kinds of events. The IERRSS is the group that sets the world’s atomic clocks. One of the issues is that the moon is very gradually slowing the spin of the Earth’s rotation due to gravitational forces. As a result, every couple of years, an extra second is added to the atomic clock. The IERS; however, made the good decision to wait until June 2021 to extend the time rather than making the change in 2020 – otherwise, we would have had to put with 2020 for another second. Whew!!

COVID-19 And Falling Off The Wagon – The global pandemic has had lots of consequences extending from societal disruptions to personal angst. As a coping response, a significant number of people have turned to or returned to drugs and alcohol as a coping mechanism. The results have shown up in the face of many restaurants and bars closed where at-home alcohol sales have increased by 22% with the biggest increases in wine (27%) and spirits (32%) since the onset of the pandemic. In fact, the largest increase has been through online sales. According to the CDC, drug overdose deaths between June 2019 and May 2020 increased to 81,000 USA citizens – or, the highest death 12 month death rate in history. In particular, the AA groups have been markedly affected because of the inability to use traditional locations for the in-person meetings – the hallmark of Alcoholics and Narcotics Anonymous effectiveness. There has been a major effort among the AA groups to work on adopting audio, video, and digital platforms for sharing information and connecting individuals. The whole issue is another of those unanticipated impacts from the pandemic.

It’s Not Either-Or…It’s BOTH-AND – The FDA recently released a statement that upon receiving either the Moderna or the Pfizer (coronavirus) vaccine, everyone needs to make sure that they also get the second dose. Therefore, the official declaration is that a successful immunization occurs when BOTH the first and the second dose are administered. I would add that there is also a big “AND” in addition to the “BOTH”. The AND is that people also need to continue wearing masks. So, “BOTH-AND” is the watchword for getting your immunizations completed properly. 

NEJM Offers An Editorial on “New Order, New Hope” – Andrew Tambryraja, MD (a vascular surgeon with the Royal Infirmary in Edinburgh, Scotland) penned an editorial in the December 24, 2020 issue of the New England Journal of Medicine that is a must read by all of us in health care. He describes a “game” that he often plays in the operating room with new medical students where offers up a series of questions. The first is: “There’s a giant flood coming that will devastate the earth and its inhabitants. You’ve got a big boat in which to preserve human civilization. There’s room for 100 citizens of the world and 5 doctors. Which doctors do you want to take on the boat?” Interesting question. After some discussion, he then asks: “You’ve got to ensure that your ship of pioneers can repopulate the new world once the flood subsides.” Then, asks the same question. Again, more discussion. Then: “What if there are new illnesses from infectious diseases that have never been encountered?” Imagine the discussion… His editorial is definitely worth a read. It provokes a major consideration on how we value the various specialties of medicine and where should be making investments in our training programs to meet the challenges of the future. Consider the questions. Read the editorial. Think about it…

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