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…?