Consulo Indicium - 8/6/25
Information for your Consideration…
Kudos to the Alice Walton School of Medicine (or, as it is affectionately known as “AWSOM”) – I totally get the idea that we cannot get everything into the curriculum designed for training doctors. But, at the same time, we cannot ignore the fact that the world is changing – rather dramatically and rather fast!! So, it’s a welcome addition to welcome the new accredited Alice L. Walton School of Medicine, located in Bentonville, Arkansas, to the 155 accredited medical schools. With a name like AWSOM, it’s named after the world’s richest woman of Walmart's originating family (PS – “thanks for giving back”). So, why the kudos? It’s because the focus of the school is somewhat different than almost all the others. In creating the school, Ms. Walton stipulated that she wanted a school that focused not only on sick care but also “…wanted to create a school that gives doctors the ability to focus on how to keep their patients healthy.” Their newly accredited curriculum prioritizes preventive health by adopting the “whole-patient principles” as part of their inclusive curriculum. With such a philosophy, perhaps I’ll be able to convince them to adopt “digital health” education as part of the curriculum in the future…😊
Coffee…Coffee…Coffee!!! – As my regular readers know, I keep up on the latest related to coffee consumption. As an out-and-out “coffeeholic,” I monitor the literature for all of the health benefits I can identify through coffee consumption. In addition to the clear pick-me-up capabilities derived from a cup-a-joe, research is continuing to identify longer-term health benefits. Some of the best are its effect on Type 2 diabetes, heart failure, and a decreased risk of cancer. Even death reduction has been noted in some studies. But, there are some downsides. Evidently, dementia and stroke and acute death from cardiovascular disease among coffee drinkers with hypertension is a problem. But, even with those caveats, the data base is fairly clear that moderate coffee consumption is beneficial. So, like anything, that means we all need to moderate our intake to a reasonable level. The former FDA has previously noted that 4 or 5 8 oz. cups of coffee are an OK intake level. I’m not sure what the newly reformed FDA will recommend in the future or even if they will consider the issue… But, if not – I’ll try to keep up on the literature…
Consumer Feedback On B3 Health Care Is Negative – CBS and YouGov recently completed a poll of over 2,000 respondents on the new B3 bill related to its impact on them and their families. Only a quarter (25%) felt that the changes would help them and another quarter (28%) indicated it would have little to no impact. Furthermore, 61% of respondents in the YouGov poll poll noted that the B3 or, “Big, Beautiful Bill “would ultimately benefit the wealthy most versus a similar proportion (60%) that indicated the poor would be harmed by its enactment. I clearly tend to fall on the latter category. I’m actually VERY concerned about the health care impact of the legislation although there are “pieces” that are good news.
Healthcare Consolidation Continues – The consolidation on the hospital side of health care has been a notable change occurring for the last couple of decades. However, the number of physician practices becoming tightly integrated with hospitals has received less attention until recently. However, a recent review by the National Bureau of Economic Research (NBER) over the period of 2008 – 2016 has raised the flag showing a steady increase in acquisitions along with an associated increase in the price of services. Specifically, the percentage of physician employed by hospital systems has increased from 27.5% (2008) to 47.2% (2016) – and, most likely, has gone beyond that mark during the ensuing years. Further analysis in the NBER study shows that the cost of physician care increased by 15+% and hospital care by 3.3% - however, it was a bit unclear because I did not see inflation figures over the same period. Regardless of my analysis, the NBER concluded: “Our estimates suggest that the costs of these mergers of hospitals and physicians have been substantial, and our mechanism tests offer guidance in predicting where the anticompetitive effects of non-horizontal mergers are likely to be strongest.” More recent studies indicate that the trend is continuing. For example, a JAMA article published in January 2025 that includes more recent data revealed that the trend seems to be continuing. In particular, I noted - as a Family Physician – that over 50% of primary care physician practices are now affiliated with hospitals as of 2022 – so the trend continues. This is an issue that the medical community needs to follow since consolidation has implications not only from a cost perspective but also service delivery, availability, and susceptibility perspective as well.
Further Analysis re: B3 – Many readers are no doubt interested in learning more about the potential impact of B3. For a more complete analysis related to the “Big Beautiful Bill” (B3), I did some work to identify the “best” analysis that’s available to date. It appears that the Kaiser Family Foundation (KFF) has done the best job of providing a comprehensive analysis of the bill. I’ve started reading it but, you should be the judge yourself. Check it out: Health Provisions in the 2025 Federal Budget Reconciliation Bill. It is an excellent overview and definitely worth the time and effort to taking a read…
Repurposing Drugs – Researchers at UC San Francisco and the Gladstone Institutes recently announced that initial research on mice has shown that two FDA-approved drugs used in cancer treatment appears to also treat Alzheimer’s! The first is irinotecan used for colon and lung cancers and the second is letrozole used for breast cancer. The findings came through research on mice showing the reversal of protein clumps and brain degeneration. Using the drugs in combination reduced the changes significantly. They then examined the many medical records for patients receiving the drugs for cancer treatment and discovered that those patients treated also exhibited improvements in memory and reversal of Alzheimer’s. Further research is clearly needed but it’s a very interesting phenomenon that is being pursued on a number of fronts whereby the use of existing drugs – either solely or in combination – are being explored for potential use on other problems like Alzheimer’s. Stay tuned…
Other Important Brain Research – Perhaps it’s because I’m getting older but I am increasingly interested in the whole field of brain research. Another study coming out of the UK and published in Nature Communications examined in a review the brain scans of 1000 individuals from before and after the Covid-19 pandemic and compared the results to a similar cadre of individuals who had brain scans in “normal” (whatever that means 😊) times. Long story short, the pandemic brains aged about 5.5 months faster through the loss of both white (neurotransmission) and gray (memory, emotions, movement) matter compared to the non-pandemic brain scans. Other prior studies have shown that as a result of the pandemic brain damage has been documented in those who experience various forms of dementia. However, the decline of non-infected persons was an unexpected finding from the research. The reasons for the changes in uninfected individuals are unclear. Furthermore, the decline was more evident in the elderly and those with lower education status and income. Why these groups were affected disproportionately is unclear but further examination of the data will no doubt be forthcoming.
