Subject: News from Dr. Kevin Fickenscher
From: "The Fickenscher Files" <[email-masked]>
To: <[email-masked]>
Date: Fri, 26 Aug 2016 17:25:36 -0400 (EDT)

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The Fickenscher Files [http://r20.rs6.net/tn.jsp?f=001xynDyc1Pg6m2t3__uPI7Xlg2u-vd3TC32vLtcDlC993qx-1wLS09ihklP47ExcObMdx3dgVi_dFT3BXDOfF40xnsGpYJ-G6FQbUnDe8dVZofI5Y9aDA3oZ9cSoTCpLF2OQqkEKDwPv1p0bmJGAnlGdH38yeNpUUXthogJZGbqPixZCxuDAnaE-IouUy9tVQB&c=rVm-HH2GQhw3_bSNU4Lw0eveOs43BSRnpoZUrCphRRHyO0T8ywd9aQ==&ch=tdrV0eCaBWVQ2wBrM887baYTDyEmqS-8BvT46qkvw3OJWmJkrRlDeA==]
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The Fickenscher Files, Vol. 4, Issue 11
Kevin M. Fickenscher [http://r20.rs6.net/tn.jsp?f=001xynDyc1Pg6m2t3__uPI7Xlg2u-vd3TC32vLtcDlC993qx-1wLS09iuXtkW924v6MtkugEe7ZO2iLCNCi4VU9vkVRgbWXa2e01XA-jdY_VbIFZZgtGzvrsNg1vDW7leCxGC9_wl4De8txp6nEoWklxAFoZPO1Sg8umyVO8AUdbjAZUJTVXmqmQdlNpNa1FW-ukut-WCTcA2u7M8A9qv-JXuqblEUzWPiu5FPPwoga4mBEycCr9Qf4vVUBROoc1mCwVQRjMlySYrY=&c=rVm-HH2GQhw3_bSNU4Lw0eveOs43BSRnpoZUrCphRRHyO0T8ywd9aQ==&ch=tdrV0eCaBWVQ2wBrM887baYTDyEmqS-8BvT46qkvw3OJWmJkrRlDeA==],
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.
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Quote(s) Of The Week
Perspectives from around the world...
"This system needs to be fixed. No one knows what anything costs.  Our health care
system is in a crisis...This bubble is going to burst."
Heather Bersch, CEO of Mylan Pharmaceuticals in comments during a CNBC interview
 [http://r20.rs6.net/tn.jsp?f=001xynDyc1Pg6m2t3__uPI7Xlg2u-vd3TC32vLtcDlC993qx-1wLS09ih0FnTwqgnw-D5snnqrnIM8kj0vw-NqQnnBaN50Dx7ITTqHQEN-wDmMjQZgDcOe7E5KNTW7H8EmsJXDoLegqZtSDSX06oQ39lkVyIMCLJKatkOoJ00lbQ9y5egGp9vyh_aVMU7plLvpQcvQFcwQi_nx1F_cfkGb4PyyGhXtjh1X-mTyM7RF9liK2tKrfWsY_-w86_KL6hfkFbR6r8eRq038GlFYyLyVbC8nt22rrAOM6zd6vYWBftFY=&c=rVm-HH2GQhw3_bSNU4Lw0eveOs43BSRnpoZUrCphRRHyO0T8ywd9aQ==&ch=tdrV0eCaBWVQ2wBrM887baYTDyEmqS-8BvT46qkvw3OJWmJkrRlDeA==]
where she compared the state of the health care industry to the real estate mortgage
crisis of 2008.  She was responding to queries on why Mylan increased the price 
of its Epipen - a device used by many people with highly allergic reactions - from
under $100 in 2009 to $600 this year.
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Consulo Indicium
Information for your Consideration...
Money And Election Time Politics - There is a piece of legislation - which for the
moment appears to be stalled - in the US Senate that would allow companies to sell
stem-cell therapies [http://r20.rs6.net/tn.jsp?f=001xynDyc1Pg6m2t3__uPI7Xlg2u-vd3TC32vLtcDlC993qx-1wLS09ih0FnTwqgnw-KGlGOCzbZtbZGwr87y00-TL3wRBUpOMVgDyfTO0UuVWT7q50PiRUty6P-vE3JpVxR2oLHbOQ1DEA0_Rh62Ova-fBAdqfkWdQDdtLI1VZsvpf7KR3vt7f71EL0oJEyCZXxl90KqQf3Y5lO0y5BjwXFXN4VJwp1FvgvmVGTiC4MTkCXwBIMzvAa2J_vcNFLkWGzWbBiQvgd6136WRES7g6b5W12jFvSf2vE5sy-n5ueac=&c=rVm-HH2GQhw3_bSNU4Lw0eveOs43BSRnpoZUrCphRRHyO0T8ywd9aQ==&ch=tdrV0eCaBWVQ2wBrM887baYTDyEmqS-8BvT46qkvw3OJWmJkrRlDeA==]
that have been shown to be safe but haven't yet been proven effective.  The bill
 was introduced as the REGROW Act by Senator Mark Kirk [http://r20.rs6.net/tn.jsp?f=001xynDyc1Pg6m2t3__uPI7Xlg2u-vd3TC32vLtcDlC993qx-1wLS09ih0FnTwqgnw-8KPKGtGytOnubLI80e-DIL02bCLlqs8xs-Zdz5a2Bq5zhCZW_ifcos_1nIMZS_ipzgX1e56iS0tVUAnbUW7AM3mzCJGoRADerfNtTZrRZK0vmI5ojVPb40m717VE71t0&c=rVm-HH2GQhw3_bSNU4Lw0eveOs43BSRnpoZUrCphRRHyO0T8ywd9aQ==&ch=tdrV0eCaBWVQ2wBrM887baYTDyEmqS-8BvT46qkvw3OJWmJkrRlDeA==](R-Ill.)
at the behest of Ed Bosarge, an ultra-wealthy Texan whose donation of $2 million
 to the Mitch McConnell [http://r20.rs6.net/tn.jsp?f=001xynDyc1Pg6m2t3__uPI7Xlg2u-vd3TC32vLtcDlC993qx-1wLS09ih0FnTwqgnw-oFBbQSiYlvKcx8xZjDWbujyGJy_173ZpYGhbJ7lhOEb-Vz5S4qGFZUrYHlTVJHoJlykmcqAg1HkStP62HHu0Xl0IIUkR6GiegBOq6bBe4Xu4mwgmMwbysPgg6nwfYAo7&c=rVm-HH2GQhw3_bSNU4Lw0eveOs43BSRnpoZUrCphRRHyO0T8ywd9aQ==&ch=tdrV0eCaBWVQ2wBrM887baYTDyEmqS-8BvT46qkvw3OJWmJkrRlDeA==](R-KY
and Senator Majority Leader) super PAC according to POLITICO coincided with the 
introduction of the legislation.  Bosarge, a regenerative medicine investor, has
 been lobbying the FDA for the last year in an effort to open the door for "safe
 but unproven" therapies.  It seems that the Bipartisan Policy Center has taken 
a lead role in developing and promoting the bill, which evolved from one of their
reports last year on policy priorities for biomedicine.  However, two of the largest
advocacy organizations in the field - the Alliance for Regenerative Medicine and
 the International Society for Stem Cell Research - have expressed opposition to
 the bill. The major question is does this open the door for other products that
 are deemed "safe but unproven".  The answer would be, "Yes!"  And, the corollary
question is - "Do we want to allow products to be marketed/sold (i.e. take your 
favorite word and insert) to the public where the value is "unproven".  If we do,
I've got some products I'd like to sell from my refrigerator that would save a lot
of money rather than investing in a Cancer Moonshot...
Medical Schools Take Up A Difficult Challenge - As we get older (yes...that was 
a "we" I inserted into the sentence), the number of chronic conditions "we" have
 grows.  I frequently tell audiences where I speak that in the last several years
I have spent more money on my health care than I spent in the previous 63 years 
of life - and, it's true!!  The issue is that physicians were trained for one-on-one
approaches toward care.  Yet, chronic diseases do not come in isolation.  They evolve
in multiples which requires a different approach toward care delivery.  In recognition
of this fact, the physician educators from nearly two dozen medical schools recently
worked together at an American Medical Association (AMA) Accelerating Change in 
Medical Education Consortium [http://r20.rs6.net/tn.jsp?f=001xynDyc1Pg6m2t3__uPI7Xlg2u-vd3TC32vLtcDlC993qx-1wLS09ih0FnTwqgnw-ffnsSDQiNVqoNoGM73vi0yWcjJDTOfjPh7Kfq6b5mwc5lMIdMNQ2-hXCDzpFl7USxtt_1Q2ttcaRqBO8VjUQRZ96MziYLpHL6twgiVbMu6JHYyqZQO_7o27HjzcoXHS2yjJ2zFIV3q7VGE6y1sgxoTPN1AHZCTLPmV7WhxPP_buVUcszS6N_pu8iPk69QyZu7OGZ4pBfQ979JZCIR2sre3SlgzLj98jp3xDYXjU8wabGg--dp6O-xQ==&c=rVm-HH2GQhw3_bSNU4Lw0eveOs43BSRnpoZUrCphRRHyO0T8ywd9aQ==&ch=tdrV0eCaBWVQ2wBrM887baYTDyEmqS-8BvT46qkvw3OJWmJkrRlDeA==]
meeting to address the issue.  The educators heard from population health experts
and started the discussions among the various specialties on how best to care for
chronic diseases [http://r20.rs6.net/tn.jsp?f=001xynDyc1Pg6m2t3__uPI7Xlg2u-vd3TC32vLtcDlC993qx-1wLS09ih0FnTwqgnw-_3WtZ5N_QXAc6teouhxQJAiH2hX9xCR5uhWmrdYqBJndkTgW35y_ES9dkbv1Da_pjGa84tzE-8FAWRhvJbXwZMIMHFDbTqVG5ZMhtQO-CIvuGkXjvnECpVVqWEmzJLgSqh2Bi46dt2jSMUj_xjNNfzG3MUIZa3upnS1UpwA-lLYyIZmybbkZSKWeG7vlqLQWxjA9h4eTlp_Ebv-vP9gph_8JDfco_Wqtp-5YnUI8nqFkViVwfzOZmiZbcq10figIVHqos0yJXwy21tTjC0SNktSstZoql6sxyDiG-foqMdDYLl3BJ7DweYc5Qqx6v8E56RF5NgThgFKI9BVz_ynjGDqiE2sDKd_OkkLw1gvpYiY7Mhl2rtXeWSdhSy8fifclLJT_saX405_g-ePK-5LiYEoM6efou4N1MHhdE77ACqc=&c=rVm-HH2GQhw3_bSNU4Lw0eveOs43BSRnpoZUrCphRRHyO0T8ywd9aQ==&ch=tdrV0eCaBWVQ2wBrM887baYTDyEmqS-8BvT46qkvw3OJWmJkrRlDeA==]
and how the curricula should be altered to better prepare students such practice.
 In presenting to the group, Omar Hasan, MD, Vice President for Improving Health
 Outcomes [http://r20.rs6.net/tn.jsp?f=001xynDyc1Pg6m2t3__uPI7Xlg2u-vd3TC32vLtcDlC993qx-1wLS09ih0FnTwqgnw-BjMUoNtaHohcwLamahmWSbiuqiHMLl32jFjgOUW0-tTZJN2KBteOSOPrnvnnPN49Dv300R0VWnsx_oYB9Tc0uxCiB17lULmKxj4_3TL0h3Efx7zn2t_1vjR0pVpmExBHDXkPze_1MzQmC6Vko5foVlPyUwFxuLrC5yXUb-tHJYaeqC3PTlA8ZZQ2GD7d-8cMnqQ8qX__UHc=&c=rVm-HH2GQhw3_bSNU4Lw0eveOs43BSRnpoZUrCphRRHyO0T8ywd9aQ==&ch=tdrV0eCaBWVQ2wBrM887baYTDyEmqS-8BvT46qkvw3OJWmJkrRlDeA==]
at the AMA noted, "Almost half of all Americans have at least one chronic disease,
and 13 percent have more than three." He went on to note that the number of people
in the 25 - 44 age range with more than one chronic condition has doubled over the
last couple of decades.  So, the problem is only getting worse.  In another presentation,
Christine Sinsky, MD, the AMA Vice President of Professional Satisfaction [http://r20.rs6.net/tn.jsp?f=001xynDyc1Pg6m2t3__uPI7Xlg2u-vd3TC32vLtcDlC993qx-1wLS09ih0FnTwqgnw--Tm1hWLPfXYbuoA9FMef7N1u-rH3NhoKhDdN2RobPS-zMUQywxQ3U62GYyAEHu9gN1qbgudogj1wJ3SswwBP40qJ3LGbQS_zEyove5hGLf724y1hfegHCzaWMN7lHsuyGE9kqq4s8vL3OqOtX7AFhkqYTuEI700Oncw_YoZ4aJlIcc-r42Rco8KeK1BgNkHU_8qlitLf7BvcwNECeq1nKBpW-rT9lXpd&c=rVm-HH2GQhw3_bSNU4Lw0eveOs43BSRnpoZUrCphRRHyO0T8ywd9aQ==&ch=tdrV0eCaBWVQ2wBrM887baYTDyEmqS-8BvT46qkvw3OJWmJkrRlDeA==],
noted that the five main challenges to effective chronic care delivery are: 1) Chaotic
office visits with overfull agendas; 2) Inadequate support for patient care; 3) 
Poorly functioning health care teams; 4) Increased requirements for documentation
and administrative management; and, 5) Work on electronic health record (EHRs) which
is left to the physician rather than the whole health care team.  At the heart of
these issues - it seems to me - is the notion that we need a different model for
 care delivery.  Rather than a focus on an "individual" care provider (i.e. the 
physician), we need to focus on a group of providers working together (i.e. the 
health care team).  To accomplish that objective, we need to align the incentives
which means that as we move toward value-based care from volume-based care delivery
models - considering how we incentivize and pay "the team" seems to be a prudent
 course of action.  So far, there's been a paltry amount of discussion on this idea.
 However, in my experience, without alignment of the objective with the money - 
the end result will not be changed.  As a good friend of mine once said to me about
healthcare incentives, "Kevin, it's NOT the money. It's the money."  Some things
 don't change.  Let's begin to consider models for team-based reimbursement...now!!
Presidential Candidate Policy Positions - Or, Lack Thereof - As you can imagine,
 I am attempting to follow the various policy issues in the current USA Presidential
campaign.  Unfortunately, we seem to have a dearth of discussions on important policy
issues.  For example, the Zika epidemic is in the news.  It's a crisis that desperately
needs attention and, unfortunately, has been swept under the rug by leaders so that
now it's becoming an epidemic.  So, I did a little digging and here's what I found
on the Zika problem from our USA Presidential candidates:

* Trump - This last month as Mr. Trump traveled to Florida but did not really address
the public health issues surrounding the outbreak of Zika infections in the state
when asked directly.  He responded [http://r20.rs6.net/tn.jsp?f=001xynDyc1Pg6m2t3__uPI7Xlg2u-vd3TC32vLtcDlC993qx-1wLS09ih0FnTwqgnw-Li0oKqoo0dFXc3RYNujk91x_7xzR9VpVfecBtvucn4qPHp2RbPg2wlsqTB7IRKON_vs63mgKXml8Nf6neCaTBoM1NhZhXHy04VqKHeJ9uLpqN9HRT2YpmlgTGAk_1N-jcdaUUvE7My0EOqniDW-UaCgiVbHITyuuOW0EhVhybss=&c=rVm-HH2GQhw3_bSNU4Lw0eveOs43BSRnpoZUrCphRRHyO0T8ywd9aQ==&ch=tdrV0eCaBWVQ2wBrM887baYTDyEmqS-8BvT46qkvw3OJWmJkrRlDeA==]
with the following statement: "You have a great governor who's doing a fantastic
 job - Rick Scott - on the Zika. And it's a problem. It's a big problem. But I watch
and I see. And I see what they're doing with the spraying and everything else. And
I think he's doing a fantastic job and he's letting everyone know exactly what the
problem is and how to get rid of it. He's going to have it under control, he probably
already does."  When pressed on the issue he did not offer whether or not Congress
should pass emergency legislation authorizing federal funding to combat the disease.
If someone finds a policy statement that I could not find - please forward it.

* Clinton - The Clinton campaign, on the other hand, released a fairly comprehensive
statement where she advocated that Congress should create a Public Health Rapid 
Response Fund to better respond to public health emergencies - much like the Federal
Emergency Management Agency (FEMA) responds to disasters. She's addressed the topic
several times in various presentations [http://r20.rs6.net/tn.jsp?f=001xynDyc1Pg6m2t3__uPI7Xlg2u-vd3TC32vLtcDlC993qx-1wLS09ih0FnTwqgnw-J8ak3EOBOIhsQzbecXHXztBJmCJMWsE47Jx2WiE6L7_fcMg-qlWBw0abXCuqOVYEJZcz4t5rdU-E1Qa6oQXlbLfB09kyX8cwbTp5QVwPW3O5DYG_znrJ7aHsNoAUV8nutkxzbSl0kdh_wRU1C_k6mB4Mw-gr9Yhzh9uxjCNvhEUj3eyCSXXLwu7NrRRREb4a4gaBGARRTGGfrwY-FgkH7fw6a1UybhCioFBz3pI2pbg=&c=rVm-HH2GQhw3_bSNU4Lw0eveOs43BSRnpoZUrCphRRHyO0T8ywd9aQ==&ch=tdrV0eCaBWVQ2wBrM887baYTDyEmqS-8BvT46qkvw3OJWmJkrRlDeA==]
around the country. In addition, her campaign released a two page summary [http://r20.rs6.net/tn.jsp?f=001xynDyc1Pg6m2t3__uPI7Xlg2u-vd3TC32vLtcDlC993qx-1wLS09ih0FnTwqgnw-wyKdJsseGynOgm91wNy1IkHilkQ0NnXkz02KuTsnqvVQ3eV1z_Lxy7PHE3zK0HGrUiWg7kF9mXWWOsKQeAmrEMDh0YgYHy4_H62Ya62rQkDvbIobsd34gig6q2AIdUNTEmykyqDamvfDN5JSvnEapGUsZ86XDsR0zf2evNZLY_ondW0YAl9B4uTfucP8I_jP&c=rVm-HH2GQhw3_bSNU4Lw0eveOs43BSRnpoZUrCphRRHyO0T8ywd9aQ==&ch=tdrV0eCaBWVQ2wBrM887baYTDyEmqS-8BvT46qkvw3OJWmJkrRlDeA==]
of their policy plan for addressing the issue.  She states, "The United States faces
new threats to public health, from pandemic diseases like those caused by the Ebola
and the Zika viruses, to the risk of biological weapons and bioterrorism, to long-term
challenges like more extreme weather and expanding ranges for Lyme disease and water-borne
illnesses as a result of climate change. And in a global economy, diseases like 
SARS, MERS, and avian influenza cannot be contained in their countries of origin."
 She goes on to point out that public health spending has declined by more than 
9% [http://r20.rs6.net/tn.jsp?f=001xynDyc1Pg6m2t3__uPI7Xlg2u-vd3TC32vLtcDlC993qx-1wLS09ih0FnTwqgnw-UyQ9TArKLPuB5g9g93U4Z-BIyf3KQNhA59dqF62Oqwb2T1jjGiGokhs3jLZvqBsMSBRcaYYibdq-sodCiOTAtSrHgWIhfJ8hWaX2BEiAFHF60rGT21S9JaHscrNydDJRL42c3r8pklug2dV8cBQ1a6tOmpzW6sxqtm7Fm9iXRdv8D5eSH-AXHsZmx7yyA1zUvRmz0ta-EYaIQ-MkZCn4-eI_b0-U5LPzLOzv7mbB0FWEnmvEP_MfANT5AlkhGVRaMe1RelkSTzw=&c=rVm-HH2GQhw3_bSNU4Lw0eveOs43BSRnpoZUrCphRRHyO0T8ywd9aQ==&ch=tdrV0eCaBWVQ2wBrM887baYTDyEmqS-8BvT46qkvw3OJWmJkrRlDeA==]
since 2008.
Another example that I decided to check out is Alzheimer's - one of my personal 
hot topics because of the impact of the illness on my family.  Both candidates favor
a national initiative to work toward tackling the problem.  However, only one plan
has been put forward - by Clinton.  Trump's father had Alzheimer's and it's clearly
an issue but, there's no plan or proposal.  The differences are stark. Check it 
out [http://r20.rs6.net/tn.jsp?f=001xynDyc1Pg6m2t3__uPI7Xlg2u-vd3TC32vLtcDlC993qx-1wLS09ih0FnTwqgnw-YPzn2YAsYqOhdhTiw43F0JTi4TIIP-d6QQKIfWrSAIILmUUYnR6Wyljcs6TGIutUkha0QvMwyOcMuC_7IYub0DIkLNE_vgE0mPqZRrR5hKufnNG3YUb0me9uPXh6N-zpIQIQlQJBCtLNyzXVjHkzdG1VRB-ZjzCW&c=rVm-HH2GQhw3_bSNU4Lw0eveOs43BSRnpoZUrCphRRHyO0T8ywd9aQ==&ch=tdrV0eCaBWVQ2wBrM887baYTDyEmqS-8BvT46qkvw3OJWmJkrRlDeA==].
If I'm wrong, let me know.  But, the health care debate - or, lack thereof - is 
because we really only seem to have the position of one candidate at this point.
  I'll keep checking...
The Obesity Problem Is Bigger Than We Thought - The New England Journal of Medicine
recently published a review of the literature [http://r20.rs6.net/tn.jsp?f=001xynDyc1Pg6m2t3__uPI7Xlg2u-vd3TC32vLtcDlC993qx-1wLS09ih0FnTwqgnw-EHCoTwJEuSJJFUyKwvWoWpOe966fGQG_AXVQBP6YStzz4EZuNcjyXD4N40tyTKRRcqtJ1GCNVnlCYKgX7R9ggl6aqnJo5-3bAqbHPS7WwSj5LahgSa1W5z8o3TAX132WdzhjXKe3Kd6FVdMrQ9kOqTsC0_3CEavrzhnFgu8eBEfDypWlcbfOxnIZRBe_wUuHA-49H6Zxc4Okeq5Whss6XsWlsj4CLs8P5nMlt_OjzrQQw96ZT9lBzAaqQ6g6BHk7VQaetZZoWSI7BtMPEmQo-qXVx3-CrFNjWaMCuXhmDL7m5x3T1KmzMSSQ6lqIfQ21Py22j4Wyg_b8JQAdgjQqEEUmBMAaZcNOUG822AGeysNd1kQam5o1V7HzEckjqZPGYK6JDhcv8ybUiEGrThKz_DtcTUktdxKQ5I6hHveCBs9mtyCh-kyIbI4IwZircNn09Yow18BAvRp9bBC2-puzTFjvQpCm71yBNBc41Z_0Csams9gLka-oytrgJ3ZgobMP1v_bLVHVwVOkIpnmXUbZyqvpjraMfcmt1cSyqymTUPfMRDhwe2zcr-UIs4hPMMiFtKHiHM4q9cSiwreUPcVM_A==&c=rVm-HH2GQhw3_bSNU4Lw0eveOs43BSRnpoZUrCphRRHyO0T8ywd9aQ==&ch=tdrV0eCaBWVQ2wBrM887baYTDyEmqS-8BvT46qkvw3OJWmJkrRlDeA==]
that "found solid evidence that being overweight or obese increases the risk for
 at least 13 types of cancer."  In particular, five cancers were tied to being overweight
or obesity: adenocarcinoma of the esophagus; colorectal cancer; breast cancer in
 postmenopausal women; and uterine and kidney cancers.  In addition, there were 
"links" to another eight cancers: gastric, liver; gallbladder, pancreatic, thyroid,
ovarian; and, meningioma cancers as well as multiple myeloma.
The Stuff That's Hurting Us That We Don't Know Is Hurting Us! - Sometimes the issues
that are harming us the most get the least coverage.  Or, so that seems to be the
case with the nearly 6.5 million premature deaths each year which can be attributed
to air pollution.  The scale of the problem is such that it is a full-blown public
health crisis but is rarely noted in the media.  So, it's of interest that the International
Energy Agency (IEA) recently published a report [http://r20.rs6.net/tn.jsp?f=001xynDyc1Pg6m2t3__uPI7Xlg2u-vd3TC32vLtcDlC993qx-1wLS09ih0FnTwqgnw-oOyyUH5E3Af99UMtm8JZWJE0Xta2DRswEtBrgbyyE4TRNrRe3mZyNrmqVjzEODB6VQ0g_nHLjnimdAsGE3Q9WqqugUwvhLg15QvIyqLPp0Ui7FH6RNSsIHupy9U_prvqGhZeNUpYOMg=&c=rVm-HH2GQhw3_bSNU4Lw0eveOs43BSRnpoZUrCphRRHyO0T8ywd9aQ==&ch=tdrV0eCaBWVQ2wBrM887baYTDyEmqS-8BvT46qkvw3OJWmJkrRlDeA==]
on the causes of air pollution and the importance of the energy sector in helping
to resolve the problem.  In particular, the report highlights the impact of the 
problem for the United States, Mexico, the European Union, China, India, Southeast
Asia, and Africa.  The report also proposes a practical, attainable strategy for
 reconciling the world's need for energy with the requirement that we also sustain
the environment with cleaner air. Consider the implications.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Future Health
Delivering care in the new virtual world...
The New mHealth Care Delivery Models - For some time, I've been advocating that 
we need to take up the challenge on how we are educating our practitioners of the
future.  The model we currently use embodies much of what was developed by Sir William
Osler over a century ago.  However, the growth of the "mHealth" industry is precipitating
a demand for clinicians which have a new set of requisite skills, knowledge and 
understanding that embraces the use of new and evolving technologies as a foundational
element of care delivery.  The part of mHealth that has not yet been fully appreciated
is that it incorporates a new model of care delivery requiring a systems approach
rather than simply deploying technology on a piecemeal basis.  It seems to me that
the latter approach is the dominate mode at the present time.  A systems approach
requires the involvement of multiple stakeholders, consideration of organizational
dynamics, implementation of policy changes as well as deployment of the appropriate
foundational infrastructure.  At the international level, the University of Edinburgh
recently announced an offering to prepare clinicians with a Masters in Global eHealth
[http://r20.rs6.net/tn.jsp?f=001xynDyc1Pg6m2t3__uPI7Xlg2u-vd3TC32vLtcDlC993qx-1wLS09ih0FnTwqgnw-9E24bGyFpggFpGJjA0W0yxL2NOYOoHu-UTGWnduZIUB1BuN4fT80vvC2BREzCCUKBwB2d4NoR1kVmRDvfyBrDBGXQ5Mxw3dT_XGWPlfny9n3UDG_zZmv7UYK_7BNUdvgs_MaOnRtypshdZtGpvSaoem3ZKVxcVOU59oVui-vN5lAyYKsjLbiyZ028kbvlcxf6QOi0ECORswJghprbv6nTjn01Kn9Eupxkx3UIThnts1exfCuoSMb2yxSUu_KoTaHBOoCXMlExLdW9EDA7IxqdOdK2tM21fOChu-QpcJiT-I=&c=rVm-HH2GQhw3_bSNU4Lw0eveOs43BSRnpoZUrCphRRHyO0T8ywd9aQ==&ch=tdrV0eCaBWVQ2wBrM887baYTDyEmqS-8BvT46qkvw3OJWmJkrRlDeA==].
 We should anticipate that there will more such initiatives in the coming years 
as the recognition on the new and evolving requirements for effective use of mHealth
strategies becomes apparent with health care delivery organizations.
About That Trip To Mars - Researchers from Florida State University recently released
a NASA-funded study [http://r20.rs6.net/tn.jsp?f=001xynDyc1Pg6m2t3__uPI7Xlg2u-vd3TC32vLtcDlC993qx-1wLS09ih0FnTwqgnw-mELDW8svD-fwwgCS3M8KLHB9neAtZlDToMARjSHRUf8raklJ8z0FPRYwWUQZBt-BOmIEnp_e6PEBtHimq9plUgCQy7E4q4eSadeYdfabopfTv3ly3d-MBND9j46e7zqd4yJ1lCapSPP2043OvuegF1be7b4LW_mG2P0a175ebv6OjmgUsgkfWKjHKlpEO8Q_AuqovQTyJmjkACgr7-meUDU_aSfrJncKB3vKA_C6A6zs-83GP4hJW6yGOH0nwEnerhUwm9FJcdg=&c=rVm-HH2GQhw3_bSNU4Lw0eveOs43BSRnpoZUrCphRRHyO0T8ywd9aQ==&ch=tdrV0eCaBWVQ2wBrM887baYTDyEmqS-8BvT46qkvw3OJWmJkrRlDeA==]
comparing the death rate of astronauts who had never traveled into space with those
who had spent time in the heavens above.  In comparing the 42 astronauts who had
 traveled into space with the 35 who had not, they made a rather astounding discovery.
 The space-bound astronauts had a rate of death from cardiovascular incidents at
 43% (high by any measure) compared to the earth-bound astronauts with a rate of
 merely 9%.  The researchers then studied mice and exposed some to radiation and
 others to the normal atmosphere of earth.  The interesting finding was that the
 exposed mice exhibited changes in the lining of their blood vessels associated 
with atherosclerosis.  So, a trip to Mars could be a much bigger deal than just 
the length of time it takes to get there.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Suggestion(s) Of The Week
Information for your Consideration...
The Net Comes Alive - The Internet has become a ubiquitous part of our lives.  It
seems that increasingly we cannot do anything without everything that is available
on "The Net".  Because of its ubiquitous availability, I frequently find myself 
in conversations with both professional colleagues and personal friends where an
 issue will come up where we don't have the answer.  Our approach?  To reach out
 for our handheld and call up "Dr. Google" to find the answer.  Now, comes a documentary
on the formation of the Internet [http://r20.rs6.net/tn.jsp?f=001xynDyc1Pg6m2t3__uPI7Xlg2u-vd3TC32vLtcDlC993qx-1wLS09ih0FnTwqgnw-SMFnbnfUO-36yini9jsHovOvf6LK5Nrc2vnVjmyZpfZb_KbGlqHIkPKWM0lEb4owJtD-uo-3aTxQuTK86fKofBFikZGh3jyDa7JnTdDGuh6mLGsDEWHw5j0wt-usMlxYfaYBNHUCKDS1UmPqcDWjI7NkaWSw1jh8uaoQIiPkCxoJ6xat6jFoiFxG_bucaCzO&c=rVm-HH2GQhw3_bSNU4Lw0eveOs43BSRnpoZUrCphRRHyO0T8ywd9aQ==&ch=tdrV0eCaBWVQ2wBrM887baYTDyEmqS-8BvT46qkvw3OJWmJkrRlDeA==]
by Werner Herzog - "The Internet Lo & Behold".  Over the years, Herzog has completed
a large body of documentary work that has received multiple awards.  While I have
not seen the final product, I've seen trailers and the evaluations of the film. 
 It seems like it would definitely be worth your time.  Consider downloading - of
course - off the web and watching it on NetFlix.  Enjoy and consider the implications.
A Retro Review - If you want a blast-from-the-past, check out The Rolling Stone 
 [http://r20.rs6.net/tn.jsp?f=001xynDyc1Pg6m2t3__uPI7Xlg2u-vd3TC32vLtcDlC993qx-1wLS09ih0FnTwqgnw-w6vnAAExmVeoVW2jl6UnjzEhwWgWiUzoWObcqjEZW6eKGAcoTdkWyW4ixo6DqPbdWjsrMcG95cfjpxtu4I0xhzl1M_nCP6ERUXCMkYm6PZnGBnXWDx51THV9znjhwo4G46SiFlQEUNx9FJM1rethCTjoikIIHlJyeGUehWpaXCb3CIn4bCjwsjvFuAzxbNxdNxznr1Y8kgQ=&c=rVm-HH2GQhw3_bSNU4Lw0eveOs43BSRnpoZUrCphRRHyO0T8ywd9aQ==&ch=tdrV0eCaBWVQ2wBrM887baYTDyEmqS-8BvT46qkvw3OJWmJkrRlDeA==]website
[http://r20.rs6.net/tn.jsp?f=001xynDyc1Pg6m2t3__uPI7Xlg2u-vd3TC32vLtcDlC993qx-1wLS09ih0FnTwqgnw-w6vnAAExmVeoVW2jl6UnjzEhwWgWiUzoWObcqjEZW6eKGAcoTdkWyW4ixo6DqPbdWjsrMcG95cfjpxtu4I0xhzl1M_nCP6ERUXCMkYm6PZnGBnXWDx51THV9znjhwo4G46SiFlQEUNx9FJM1rethCTjoikIIHlJyeGUehWpaXCb3CIn4bCjwsjvFuAzxbNxdNxznr1Y8kgQ=&c=rVm-HH2GQhw3_bSNU4Lw0eveOs43BSRnpoZUrCphRRHyO0T8ywd9aQ==&ch=tdrV0eCaBWVQ2wBrM887baYTDyEmqS-8BvT46qkvw3OJWmJkrRlDeA==]
which highlights the top 10 best solo songs by Paul Simon.  If you're even close
 to the 1960s these songs will resonate and bring back a flood of memories.  It 
was passed along by a friend who thought you all would enjoy.  Check it out.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

The Weekly Whisk
Musings from a foodie...
Every once in a while (almost weekly :-) ), I get a hankering for diner food.  So
a couple of weeks ago, I met my Step-Son at his favorite diner for lunch.  TheDeluxe
Town Diner [http://r20.rs6.net/tn.jsp?f=001xynDyc1Pg6m2t3__uPI7Xlg2u-vd3TC32vLtcDlC993qx-1wLS09ih0FnTwqgnw-xwDfx2DVAj9g9jsKN0lJjEgOffP_O3tDz1CdT_x9RnR0g7zekCl2L6reo0joTfpEAF41v5_3-wLOyfkVx_oyK7bK32CNuOrQYKDpdybr_oOfAwz0pq7XkRvIu_pLV3ocsZN8eAX2mXKNqoURVUStOA==&c=rVm-HH2GQhw3_bSNU4Lw0eveOs43BSRnpoZUrCphRRHyO0T8ywd9aQ==&ch=tdrV0eCaBWVQ2wBrM887baYTDyEmqS-8BvT46qkvw3OJWmJkrRlDeA==]
[* * *] is just such a place.  It is pure comfort food in a comfort environment 
- a diner classic.  I started with the chicken soup which was homemade just like
 Grandma made for me when I was a kid.  Large chunks of chicken with big noodles
 and the occasional vegetable :-).  The starter was followed by a fried chicken 
sandwich with swiss cheese and traditional onion rings.  These were not pre-made
 onion rings but rather the type that are made at the diner.  It was all overlaid
with background music ranging from Al Green to Somba to create an ambiance of a 
classic diner.  If you're in the mood and in Boston (the western edge), consider
 Deluxe Town Diner - 627 Mt. Auburn Street - Watertown, MA - (617) 926-8400 - www.deluxetowndiner.com
[http://r20.rs6.net/tn.jsp?f=001xynDyc1Pg6m2t3__uPI7Xlg2u-vd3TC32vLtcDlC993qx-1wLS09ih0FnTwqgnw-s4yCbTCWtCHMXx584hDKoDGL-3HQuWeHDHdZ5LJF9HgPNttWZMwAbajm0xRrJYouCHblkT1dBHqHPx_N_xpwNYW-1p91paVq6Hldb3fuRr-j_DNLHbXKRQ==&c=rVm-HH2GQhw3_bSNU4Lw0eveOs43BSRnpoZUrCphRRHyO0T8ywd9aQ==&ch=tdrV0eCaBWVQ2wBrM887baYTDyEmqS-8BvT46qkvw3OJWmJkrRlDeA==]
Now, if you want a bit more upscale and you travel north of Boston to Kennebunkport,
you should definitely check out The White Barn Inn [http://r20.rs6.net/tn.jsp?f=001xynDyc1Pg6m2t3__uPI7Xlg2u-vd3TC32vLtcDlC993qx-1wLS09ih0FnTwqgnw-PwrcNE8o7p5Xwr5QCFuguJxlltYtlQnbw56GlCqysk_R4A_9t3aUSFoOC0zawyguPG83ve5X1qCNSpb7YssOnbL5tss5pkp_pIg3friiDjgtCWvzVpX85_5h4-JKpEKpQase1YxT9g2YBxbC7bx7B2_AUzW9Au8w3DcY6kWgKC1FEytnRsJDwcoIfLafImHDTgpeoekaAxBh8v02J82_9ev6lXUpkWbK&c=rVm-HH2GQhw3_bSNU4Lw0eveOs43BSRnpoZUrCphRRHyO0T8ywd9aQ==&ch=tdrV0eCaBWVQ2wBrM887baYTDyEmqS-8BvT46qkvw3OJWmJkrRlDeA==]
[ * * * * *]  Executive Chef Derek Bissonnette and Sous Chef Gabrielle Coté continue
to offer an outstanding array of menu items that are some of the best in the Northeast.
 I reported on it several years ago and decided to check it out for a family celebration.
 The menu was over the top wonderful and every item was spectacular.  Rather than
go through each item and the particulars, let me simply list them and say "OooLaLa":

* Pan Seared Quebec Foie Gras en Croute,
* Creamsicle Torchon with Fennel Seed Powder and Citrus
* Compressed Watermelon with Goat Cheese
* Fontina Cheese Soup in a Miniature Sourdough Boule
* Pan Seared Loin of Veal with Sweet and Sour Sweetbreads, Grilled Peaches, Charred
Onions, Corn Purée and Champagne Froth
* Foie Gras Crusted Tenderloin of Beef, Zucchini and Garlic Puree, Summer Potatoes
and Madeira Sauce
The cost of the meal is a bit on the pricey side at $109.00 per person sans wine.
 We didn't try the wine but you can get a pairing for $85.00 from the Reserve Wine
List, if desired.  So, if you have a special event and/or are visiting the northeast
- just down the street from Former President George H.W. Bush - you can stop by 
the White Barn.  Call ahead.  They take reservations beginning exactly 30 days prior
to the date you want.  Call in the morning.  By noon many of the slots are taken.
 Enjoy!!
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

The Good, The Bad, And The Ugly
The ongoing saga...
The Good - There are just over 75 days left before the USA Presidential elections.
 To paraphrase President Gerald Ford from August 9, 1974 - after the November 8th
election "My fellow Americans, our long national nightmare [will be] over."
The Bad - The tenor of the ongoing debate, dialogue and discussion about the future
of our country.
The Ugly - The lack of an ongoing debate, dialogue and discussion on the future 
of our country.
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.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Name | Company | Phone | Email [mailto:[email-masked]] | Website
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~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

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