Subject: News from Dr. Kevin Fickenscher
From: "Dr. Kevin Fickenscher" <[email-masked]>
To: <[email-masked]>
Date: Mon, 9 Feb 2015 09:06:36 -0500 (EST)

The Fickenscher Files [http://r20.rs6.net/tn.jsp?f=001FmgnrNVJlgf93OI98RqVqwe6xlce6r0F3dVPc_4eM2Mug2q9BCB5xw-VeqVrSDur9G4-ryyYb1qM7BkMlSInE-Ooo23BuwijrICUsOMMBrARun__dj-UAevo0CZMjSALbq2_UEBT76bcGi8PKxlh6VHapyJQKspOVgZL2oAkGJ4oQpqLbMx1JQ==&c=foBmOKA1-UnqRCPsjOEjltu5uo5i2m9V-Ab0mfuYHMm3UfXloqDJGQ==&ch=lZbEUgSjrPBUuYtjtCf1Qx_SPJ3HuJxl2xVnQllQiSMstNibEa8p2g==]
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

The Fickenscher Files, Vol. 3, Issue 25
Kevin M. Fickenscher [http://r20.rs6.net/tn.jsp?f=001FmgnrNVJlgf93OI98RqVqwe6xlce6r0F3dVPc_4eM2Mug2q9BCB5xxE9tTdDQQ4zQjY0afhpHJZpltz5VHArhl5tqaMQd5CJrO80W-zkeJmG1uDjVv1841cyuh5DUk3dPKS8WMBnQqgHeUUNRQvzgaign9wxbodWxt1dy3zAG13WCxa6-G73ezDTVsqZnUytbgr3Mw4FGYfGjEmdEqcGawVSvmQ7BtGpFA5uIT3inyMTjCifY81z_wxmbPeK8bOtm7HrvXpSzUk=&c=foBmOKA1-UnqRCPsjOEjltu5uo5i2m9V-Ab0mfuYHMm3UfXloqDJGQ==&ch=lZbEUgSjrPBUuYtjtCf1Qx_SPJ3HuJxl2xVnQllQiSMstNibEa8p2g==],
MD, CPE, FACPE, FAAFP
@MDKev

A compilation of information, thoughts, and perspectives on the issues of the day
related to healthcare, technology, and beyond - including the latest culinary explorations.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Quote(s) of the Week

Notable thoughts for your consideration...

"I did not say vaccines caused disorders, just that they were temporally related,"
Paul said in a statement. "I did not allege causation."

Senator Rand Paul (R-KY) - a physician by training - in follow-up comments to his
initial suggestion that there have been reports of a temporal relationship between
vaccines and other disorders.

"When you see educated people or elected officials giving credence to things that
have been completely debunked, an idea that's been shown to be responsible for multiple
measles and pertussis outbreaks in recent years, it's very concerning."

Amesh Adalja, MD - an infectious-disease physician from the University of Pittsburgh
Center for Health Security in response to Rand Paul's assertions on the relationship
between vaccines and disorders.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Consulo Indicium

Information for your consideration and reflection...

From The "Oy Vey" Category - Senator Thom Tillis (R-NC) recently appeared before
 the Bipartisan Policy Center in a discussion on the regulation of businesses. While
many of us would agree that business tends to be too heavily regulated, he went 
a road too far from my perspective on the notion of over-regulation.  The Republicans
like to focus on occupational licensing [http://r20.rs6.net/tn.jsp?f=001FmgnrNVJlgf93OI98RqVqwe6xlce6r0F3dVPc_4eM2Mug2q9BCB5x78N5raQcseSj642gEcKaHVMbbtRn29K1FAlU5vL6q7qPc1EPDFQejUP03e_aQ4FjeML3e0TePFeR2y4wNWXkuNxtR29HDpAZ9U-ShGIkJdk7At9v3QGoi2S7kWescEKgsIfktw5IkAYfRHEMzQzsXvRmwNrJBgvOhxeUVCdOzeYzaSdZHHIepjkXdlsizpGjvCBvuf8hOxA&c=foBmOKA1-UnqRCPsjOEjltu5uo5i2m9V-Ab0mfuYHMm3UfXloqDJGQ==&ch=lZbEUgSjrPBUuYtjtCf1Qx_SPJ3HuJxl2xVnQllQiSMstNibEa8p2g==]
as an example of over-regulation.  For example, many states require a "license" 
to draw blood [http://r20.rs6.net/tn.jsp?f=001FmgnrNVJlgf93OI98RqVqwe6xlce6r0F3dVPc_4eM2Mug2q9BCB5x78N5raQcseSBxkpnyWAkGJG4vSDqVkzfEXoUfbcycxdm48TJBD7si8FwlnJU7AvYXbLmlXirZyhOvqgOkd8PK9jvAI--dNqBkpSlaQ1UBW9P-1Xrng69prbVaLy6dMeU547uJFAXtfbwsfCggy4aY_vGt_Vqs_aU3O_7JMHU61Qyl5LdW9W0xqWEcWYo2HNCjoj6knePNtP&c=foBmOKA1-UnqRCPsjOEjltu5uo5i2m9V-Ab0mfuYHMm3UfXloqDJGQ==&ch=lZbEUgSjrPBUuYtjtCf1Qx_SPJ3HuJxl2xVnQllQiSMstNibEa8p2g==].
 We have professionalized far too many aspects of business operations.  The question
is - where is the line?  In the case of Tillis' suggestion - the line needs to be
redrawn.  He stated that rules requiring restaurant workers to wash their hands 
before leaving the restroom were unnecessary. My response?  "Oy vey!"  So, the question
is does free market thinking extend to areas where we know the "rules" make a difference.
 Perhaps we should allow people to stop at stop signs only when they want to?  Some
do for sure but for many of us, stopping - like washing your hands - is part of 
our process.  The regulation actually requires the posting of the sign - just like
a stop sign - but, it does not actually monitor the individual.  But, perhaps we
 should.  Hand washing is a de facto accepted methodology for reducing the transmission
of disease.  It's kind of like stop signs - another de facto methodology which has
been shown to reduce car accidents at intersections.  Hmmm?

The American Board of Internal Medicine (ABIM) Cries Uncle! - The ABIM made a dramatic
about face - or, at least sideways march J - on the implementation of the Maintenance
of Certification (MOC) process last week.  The shift in course came as the newly
 founded National Board of Physicians and Surgeons under the leadership of Paul 
Teirstein, MD - a cardiologist at Scripps Clinic - has put pressure on ABIM by proposing
an alternative certification program.  The biggest change in the ABIM stance comes
from the suspension for two years of requirements for physicians to complete the
 Practice Assessment, Patient Voice, and Patient Safety modules. These particular
modules have raised the ire of many physicians who felt they were not a useful component
for evaluating physician competence.  The other big change was the shift of language
from "meeting"/"not meeting" MOC requirements to "participating"/"non-participating"
in MOC requirements.  The controversy is not over but there is a definite groundswell
of opposition to the MOC requirements as they stand.  We should anticipate further
debate on the topic in the coming year since ABIM has stipulated that they are not
abandoning the MOC program.

Practicing Medicine Through Television - The measles outbreak was front and center
on virtually every news television news outlet over the past couple of weeks, on
 the dangers created by failing to vaccinate children.  The cause of the sudden 
discussion was the Disneyland outbreak followed by media fears of a continuation
 of the problem through exposure of children from crowds gathered at the Super Bowl
in Arizona where multiple cases were reported.  The good part was the media exposure
on the need for vaccinations, especially when NBC featured Charles Goodman, MD, 
a pediatrician who informed parents that if they do not have their children vaccinated,
they need to find another pediatrician. The other stations quickly caught on and
 the coverage expanded.  We - in the healthcare community - have been loath to use
the public media as a resource for fostering good practices.  It's clear that with
the ubiquitous nature of information coming to the public via television, the Internet,
Tweets, SnapChats and the like that we have entered a new age of public discourse.
 It is a discourse that does not necessarily occur behind closed doors.  It does
 not necessarily occur one-on-one between a professional and a person.  We are in
a many-to-many world - and, need to adapt.  Good medicine - from my perspective 
- requires good practice through all sorts of media in a more concerted and focused
fashion.  There's a reason that the immunization rate in the USA has fallen to about
90% (below "herd immunity" requirements).  People are getting skewed information
 and there is no effective counter campaign on the part of the medical and public
health community which shares the real story.  We should consider the lessons from
the measles outbreak and how that will affect our approach toward population and
 community health in the years to come.  The media is not going away.  In fact, 
it is swarming around us...

Unnecessary Antibiotic Use A Problem - According to the Centers for Disease Control
(CDC) about one-half of all USA prescriptions for antibiotics are unnecessary.  
The CDC recently released a report stating that while 80% of American are issued
 prescription antibiotics every year, "up to half of the estimated 258 million prescriptions
are unnecessary." In response to the report, the Obama Administration announced 
that they will be doubling the amount of federal funding dedicated to fighting antibiotic-resistant
bacteria, which are responsible for an estimated two million illnesses and 23,000
deaths each year.  But, that does not solve the problem of overuse.  Overuse is 
a two-sided coin.  On one side are the physicians who make up the vast majority 
of the prescriptions.  On the other side are the public who make demands for antibiotics
because of little understanding of the underlying problem and the desire to get 
a fix for their illness.  Any successful effort at curbing the overuse of antibiotics
will require attention to both sides of the coin.

Ongoing Success On The Secondhand Smoke Front - In yet another report form the CDC,
it was announced that the exposure of Americans to secondhand smoke "declined by
 half over the past decade".  Why?  It was, in large measure, due to local governments
banning smoking in bars, restaurants and offices in addition to the fact that there
are many fewer smokers at homes. The decline in secondhand smoke exposure has gone
from 53% in 2000 to 25% in 2012 - a remarkable drop. However, it was not an even
 drop among all Americans.  African-Americans still had a very high rate with over
2/3 of these children exposed to secondhand cigarette smoke in 2012.  Although the
bars, the restaurants and the worksites are doing well - we need to redouble our
 efforts in the home, particularly for young, disadvantaged children.

Failing To Insure - Health insurers may be finding new ways to discriminate against
patients. The Washington Post reported last month that health insurance companies
are finding ways to discriminate against patients with pre-existing problems.  Although
the Affordable Care Act was intentional in calling out this problem, a recent report
[http://r20.rs6.net/tn.jsp?f=001FmgnrNVJlgf93OI98RqVqwe6xlce6r0F3dVPc_4eM2Mug2q9BCB5x78N5raQcseSgwnrIvoQGMj6Vl8vjSYCsg-4d6qPi2AKDzK8bQQTPORuSdiysNs4EzkVT3af_9xH5xUL4XLH1zxzOUF8-6JJusQhgQo5rQ6sSiVRq5QWPJw6YuIZXhPgPKzV5gKipbyG0zrk2wC6u30IN9bBwBEFnHSI-e9tdzWe5VJDV7KxoBQZJdBsPEzreu7U8ACDHWcs0H-e7Uh68Pi6e5F-Qx8dSIfqmS4xYjYI4YFiSoEwHGhgT2mAp09BKujlhLXv7ZgSMmmdWDn9rel0ilYx8esqbQ==&c=foBmOKA1-UnqRCPsjOEjltu5uo5i2m9V-Ab0mfuYHMm3UfXloqDJGQ==&ch=lZbEUgSjrPBUuYtjtCf1Qx_SPJ3HuJxl2xVnQllQiSMstNibEa8p2g==]
by Benjamin Sommers, MD, Ph.D. of the Harvard School of Public Health noted an alarming
trend whereby insurers use drug benefit designs to purposefully keep out sicker,
 costlier patients from insurance plans. It is a worrisome trend and one that deserves
attention.  It's also the subject of a federal complaint so we should anticipate
 that there will be further work on the problem.

Future Health

Delivering care in the new virtual world...

New Interoperability Deadline Set - The bane of value creation from our investments
in health information technology is the lack of interoperability standards.  For
 the last decade, I've been talking about the need for national standards that require
interoperability.  It's the same lesson we learned from the trains in the past where
the rail widths were different for all of the train companies.  The end result was
that the trains did not have interoperability.  Imagine that?  We have essentially
the same problem with health IT interoperability.

In a new report [http://r20.rs6.net/tn.jsp?f=001FmgnrNVJlgf93OI98RqVqwe6xlce6r0F3dVPc_4eM2Mug2q9BCB5x78N5raQcseSGSxOQ8VdhD32pWKN_NYl9OKa1sUrjLn6Z6jV89pimv3dDxc3uCkkPGrLfO7AX9YZKreYcbWPSc1radg4QFSbOc2CNu2wlieEL2rObceD-RRUlX6qbKFFApuMXB7a_itobvjQi1sTVDYSg0IdDiiaYfbWYniTReQ-mRvz3IY2syAXNPj2LxEkWNH8mv4I9QzyEhf7tpA4Ui9e01PhZLhwHt5YSF3-o9Xq&c=foBmOKA1-UnqRCPsjOEjltu5uo5i2m9V-Ab0mfuYHMm3UfXloqDJGQ==&ch=lZbEUgSjrPBUuYtjtCf1Qx_SPJ3HuJxl2xVnQllQiSMstNibEa8p2g==],
"Connecting Health and Care for the Nation, A Shared Nationwide Interoperability
 Roadmap," the federal Office of the National Coordinator calls on the health IT
 community to deploy "a common set of electronic clinical information. . . at the
nationwide level by the end of 2017" that will allow providers to send information
in a ubiquitous fashion across multiple systems.  They have proposed a common data
set of 20 basic elements (e.g. patient demographics, lab results, provider identifiers,
etc.) in the plan which is open for public comment through April 3, 2015.  One of
the big issues preventing the move toward interoperability has been the lack of 
consensus on which information exchange standards to use, the configuration standards
for computer systems; and, business rules and practices for using the systems.  
The call for interoperability comes in the wake of the move by CMS toward having
 50% of Medicare services provided under value-based programs over the next several
years.  These are companion initiatives.  The move toward value-based care absolutely
requires interoperability.  So, it is not surprising that ONC is attempting to move
the ball forward.

In making the announcement, Karen DeSalvo, RN, the federal ONC National Coordinator
noted that the agency is not attempting to become a national network regulator. 
Rather, the ONC effort is an attempt at a "non-governmental governance" model.  
The skeptic in me wonders if a non-regulatory approach will work.  The realist in
me recognizes that ONC probably has to go down this road before moving toward regulatory
functions - which, at the end of the day, is the most likely course.
3-D Printing Comes To Medicine - Boston Children's Hospital is one of the demonstration
sites for a new initiative to integrate 3-D  [http://r20.rs6.net/tn.jsp?f=001FmgnrNVJlgf93OI98RqVqwe6xlce6r0F3dVPc_4eM2Mug2q9BCB5x78N5raQcseSLJdZ0KH5CtJKtKBkdVtgb7OAwdm7qSBI2mTd6KiXp_mesAUiViOFxzuRmcZsZT4VlqqrClpMJDDNBqr-YPUxBuupZpIqmWa_a80YXUnCyoedJafMyvLml3CvZWQiZ5ret4PH7dadXnzFdLzk3pOlUsouUdFg98Ff1fDHcb6uGyIH-D_eKUfUObq_4GfQfv8w4DhcQOE1LD_korGWdxG7WJu8D-ao7dfiMhEyYTsGz3vDLjgGu3Ner-Iau3nzy5Kxp3jyFoAEHvDWO2hW4T2gyQ==&c=foBmOKA1-UnqRCPsjOEjltu5uo5i2m9V-Ab0mfuYHMm3UfXloqDJGQ==&ch=lZbEUgSjrPBUuYtjtCf1Qx_SPJ3HuJxl2xVnQllQiSMstNibEa8p2g==]printing
[http://r20.rs6.net/tn.jsp?f=001FmgnrNVJlgf93OI98RqVqwe6xlce6r0F3dVPc_4eM2Mug2q9BCB5x78N5raQcseSLJdZ0KH5CtJKtKBkdVtgb7OAwdm7qSBI2mTd6KiXp_mesAUiViOFxzuRmcZsZT4VlqqrClpMJDDNBqr-YPUxBuupZpIqmWa_a80YXUnCyoedJafMyvLml3CvZWQiZ5ret4PH7dadXnzFdLzk3pOlUsouUdFg98Ff1fDHcb6uGyIH-D_eKUfUObq_4GfQfv8w4DhcQOE1LD_korGWdxG7WJu8D-ao7dfiMhEyYTsGz3vDLjgGu3Ner-Iau3nzy5Kxp3jyFoAEHvDWO2hW4T2gyQ==&c=foBmOKA1-UnqRCPsjOEjltu5uo5i2m9V-Ab0mfuYHMm3UfXloqDJGQ==&ch=lZbEUgSjrPBUuYtjtCf1Qx_SPJ3HuJxl2xVnQllQiSMstNibEa8p2g==]
technology into medical care [http://r20.rs6.net/tn.jsp?f=001FmgnrNVJlgf93OI98RqVqwe6xlce6r0F3dVPc_4eM2Mug2q9BCB5x78N5raQcseSLJdZ0KH5CtJKtKBkdVtgb7OAwdm7qSBI2mTd6KiXp_mesAUiViOFxzuRmcZsZT4VlqqrClpMJDDNBqr-YPUxBuupZpIqmWa_a80YXUnCyoedJafMyvLml3CvZWQiZ5ret4PH7dadXnzFdLzk3pOlUsouUdFg98Ff1fDHcb6uGyIH-D_eKUfUObq_4GfQfv8w4DhcQOE1LD_korGWdxG7WJu8D-ao7dfiMhEyYTsGz3vDLjgGu3Ner-Iau3nzy5Kxp3jyFoAEHvDWO2hW4T2gyQ==&c=foBmOKA1-UnqRCPsjOEjltu5uo5i2m9V-Ab0mfuYHMm3UfXloqDJGQ==&ch=lZbEUgSjrPBUuYtjtCf1Qx_SPJ3HuJxl2xVnQllQiSMstNibEa8p2g==].
 The goal is to avoid surgical complications, reduce the length of operations, and
cut costs. The hospital has already installed one printer and will be adding two
 more - at the cost of $400,000 each - over the coming year. These 3-D-printers 
create models - for example - of the human skull based on computerized magnetic 
resonance images that allow surgeons to transform the way they provide medical care;
and, educate patients and families on complex procedures. We're not quite there 
but the idea is to someday use the 3-D printers for printing replacement parts. 
 Now, that is "future health"...

Virtual Care Costs Lower Than Traditional In-Office Visit Costs - The Alliance for
Connected Care recently released a report [http://r20.rs6.net/tn.jsp?f=001FmgnrNVJlgf93OI98RqVqwe6xlce6r0F3dVPc_4eM2Mug2q9BCB5x78N5raQcseSjdRwMAcHpA9Ef9vj5AucCfDHXqBJHGLyqKGm2jDaut2jB2byNsm43hjeqmHQJfKXXCgiEuTLxIqMNgkkQ7Gp3yNeTgvgBmbpfReohvKQnj6yklVldaZdQN26c3bvKN6CpZvgeOx50LI1cXEuE0zWgJ8bgICzpFz5FDA4qw2IEWU=&c=foBmOKA1-UnqRCPsjOEjltu5uo5i2m9V-Ab0mfuYHMm3UfXloqDJGQ==&ch=lZbEUgSjrPBUuYtjtCf1Qx_SPJ3HuJxl2xVnQllQiSMstNibEa8p2g==]
comparing data from traditional care settings to the results of five telehealth 
companies.  The study found that telehealth visits cost between $40 - $50 on average
compared to a cost of $136 - $176 for traditional in-office visits. In addition,
 the study found that 83% of health conditions can be resolved with a virtual visit
and of those patients who did not get resolution of their problems, 10% ended up
 in the emergency room and 50% went on to have a repeat, traditional in-office visit.
Other highlights from the study indicated that: 1) 45.8% would have gone to an urgent
care facility if a virtual visit was not available; 2) 30.9%, to a physician's office;
3) nearly 12% would have done nothing; and, 4) 5.6%, to an emergency room for care.
 The move toward telehealth or "telecare" is taking off.  In a separate announcement,
Anthem announced that it will provide telehealth services to Medicare Advantage 
beneficiaries starting on January 1st.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Approaches In Alternative Care Delivery

Ideas and thoughts on how care delivery can be transformed...

Mixed Results From ACA Primary-Care Initiative - The anticipation has been great.
 The "patient-centered medical home" (PCMH) was touted as a way for the healthcare
system to save substantial amounts of money through better coordination of care 
by primary care providers.  But, the results [http://r20.rs6.net/tn.jsp?f=001FmgnrNVJlgf93OI98RqVqwe6xlce6r0F3dVPc_4eM2Mug2q9BCB5x78N5raQcseSOn4VXyWIXI0wCoX7en0pHFbVMrMRLa_RIm6N4JFsr8_ZMEnrHfRjJeE4ppbt2whP4AklVejFFY_Fi5IonB6jeDrC2fKdDjX8UhWcPRWpsxIkDnqRooX4IZy5DpibqlwgTlZ-74KgzowVLsxQx4m5UX7UZMW5WvxJ&c=foBmOKA1-UnqRCPsjOEjltu5uo5i2m9V-Ab0mfuYHMm3UfXloqDJGQ==&ch=lZbEUgSjrPBUuYtjtCf1Qx_SPJ3HuJxl2xVnQllQiSMstNibEa8p2g==]
of a report by the Mathematica Policy Research are less than compelling.  The first
year evaluation of the Comprehensive Primary Care Initiative [http://r20.rs6.net/tn.jsp?f=001FmgnrNVJlgf93OI98RqVqwe6xlce6r0F3dVPc_4eM2Mug2q9BCB5x78N5raQcseS33BXfN3GVAwn_GoEEGNTrNhP1A1baEFht4MXyUNLKGrKEsqYyyQbILkcuLEv57GqcG8zb5ole79aN0udFcVYYQd-_DNI19ZUW_6titkZgjQFNO16LbzmLzWKMJwyuejN-x8fD8FivDwKZEpUR8MoT92e6HWUg0We1doChjwOgJYG8Dx3LsY9MA==&c=foBmOKA1-UnqRCPsjOEjltu5uo5i2m9V-Ab0mfuYHMm3UfXloqDJGQ==&ch=lZbEUgSjrPBUuYtjtCf1Qx_SPJ3HuJxl2xVnQllQiSMstNibEa8p2g==]
- a four-year program in Colorado, New Jersey, and several other states; and, the
Multi-Payer Advanced Primary Care Practice Demonstration [http://r20.rs6.net/tn.jsp?f=001FmgnrNVJlgf93OI98RqVqwe6xlce6r0F3dVPc_4eM2Mug2q9BCB5x78N5raQcseSfnlkV-NJtJjrYICbmbmGnHQph3QFeM5XVPa-Yst1xkr8w2dgxc4G2NETxA2szwbNkPAc0vPBrLneTqDbW3drg1dMqqRIsnPiaAZGJ1Yh_9H382CCGBiZiJfmkkEW-H43_UscRCkWl4HZy12kzb-tmr1nzGMRor-63_c2Kb-GAd6O1k9Zve76syf_WHqg76Hp&c=foBmOKA1-UnqRCPsjOEjltu5uo5i2m9V-Ab0mfuYHMm3UfXloqDJGQ==&ch=lZbEUgSjrPBUuYtjtCf1Qx_SPJ3HuJxl2xVnQllQiSMstNibEa8p2g==],
a 3-year test in eight states - showed that costs were reduced by $168 for each 
participating Medicare beneficiary.  The cost reductions were primarily due to reductions
in hospital admissions and emergency visits.  The problem is that the savings did
not cover the extra $240 per patient that HHS paid practices for the extra nurses,
enhanced electronic records, 24x7 call lines and other support services required
 to make the PCMH operable. As David Nash, MD, Ph.D. and Dean of the Thomas Jefferson
University School of Population Health pointed out, "As a taxpayer -- are we really
making a difference?  I can't tell from this report."  That's the critical question.
 On top of the cost question is the question of quality.  The report wavered on 
that front as well noting that there was not a substantial difference in the quality
indicators.  But, the results are early and there are lessons learned.  The most
 promising part of the work is that the notion of "Laboratories of Democracy", where
experimentation at the state and local level eventually drives federal policy, is
working.  We should all be encouraged by that notion...
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

The Weekly Whisk

Musings from a foodie...

Rather than the usual restaurant review, I thought I would report out on a senior
thesis completed by a student at Harvard this past year.  Emily Groopman did a study
where she prepared four diets of peanuts to be fed to mice over the course of several
weeks. She tracked the weight, the consumption, and the amount of exercise for each
of the little critters.  Her results?  Cooked peanuts provided more energy to the
mice than the raw peanuts.  Why is this important?  Well, from an evolutionary standpoint,
we've been genetically programmed to crave fatty goods - like my nightly craving
 for Haagen Dazs ice cream!  Fats give humans the most nutrition for the amount 
consumed, with about two times the amount of calories from fat that we can get from
proteins and starches.  But, the study by Groopman showed that the mice fed with
 a diet of cooked fat-rich foods weighed - on average - significantly more than 
those that ate the same amount of a raw diet. The lesson learned is that "cooking"
gives us more calories that consuming raw foods.  Nuts are a good example.  Raw 
nuts are covered in a protein, oleosin, which hinders the digestive process.  Cooking
breaks down the oleosin and makes the fat of nuts more available.  Therefore, cooked
nuts deliver more fat than raw nuts.  According to the study, most cooked foods 
deliver fat in far greater amounts than raw foods. So, if you want to lose weight
- eat the raw stuff.  I'm switching to raw Haagen Dazs J!!  We should expect to 
hear more from Emily.  She's now an MD-PhD student at Columbia University.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

The Good, The Bad, And The Ugly

The ongoing saga...

The Good - The recent reimbursement shifts by the Centers for Medicare and Medicaid
Services (CMS) along with the announcements by major healthcare systems in support
of "value-based" care have gotten the conversation moving in the direction needed
for improving quality, enhancing service and reducing costs.  Now, the conversation
needs to be embodied in programs...

The Bad - Forgetting what you learn in medical school is not good for patient health.
 Dr. Rand Paul has let his knowledge (we assume he has it...) on the appropriate
 use of vaccinations to be overshadowed by politics.  He should remember the Hippocratic
adage, "First, do no harm."

The (Anticipated) Ugly - In just over a month, The Supremes will announce their 
decision on whether or not an agency can make a reasonable interpretation of a law
passed by Congress.  The Court has ruled over 13,000 times in favor of agencies'
 authority to "interpret" the law.  If The Supremes counter that history, it will
be ugly because the healthcare community will be fraught with lack of direction.
  If they support their history, it will be ugly on the legislative front because
of the commitment by Republicans to undo the Affordable Care Act.  Either way - 
it will be ugly!

The statements in The Fickenscher Files are the personal views of Kevin Fickenscher,
MD and do not reflect the views or policies of any organization with which he is
 affiliated.
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