Subject: News from Dr. Kevin Fickenscher
From: "The Fickenscher Files" <[email-masked]>
To: <[email-masked]>
Date: Wed, 7 Mar 2018 07:35:13 -0500 (EST)

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The Fickenscher Files [http://r20.rs6.net/tn.jsp?f=001Ie1js218vUS6pgQAD-X8tvaJBW0biBt3b0olGQxyIkv1rdYuL1egmE_ePjZcMyCVahGEMiXLQ5sBbM8rUp_AyCRsEzyrwm2dZ8y4fMUG5tj0rk7LBeFyPYksMZAY8V1bsNGeVJ0EnEhUz0j5X7AVyNMdJprArqsfFnS2zp5NT5DU1ShdCC7o3yHWR_AfPDTw&c=a1QPbx_6kWOXWTn1bn--7Y-L3mf_QWqVO2ViLMdr7aMOkz3n2d8-Uw==&ch=kkv78Wp_rLcV7YsgWC2N857kyQdUgPlZwPr_yNna4CXW8CkE81-xug==]
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The Fickenscher Files, Vol. 6, Issue 4
Kevin M. Fickenscher [http://r20.rs6.net/tn.jsp?f=001Ie1js218vUS6pgQAD-X8tvaJBW0biBt3b0olGQxyIkv1rdYuL1egmJyxCXbWBmkTqMk4JiQkabhRZslckaUpPLQDD0QixtJr8IX_UGeLEmPeCYdBrsz5I7AC16_zNtnmZb8UNAyD2N3ZO0zhloMs7r2Q95WVCMM1-xWedSvB4rxi4pLjXWCu0z_OKx7vRYcn1h8nqkAuOWDOQx0CkhbVgg==&c=a1QPbx_6kWOXWTn1bn--7Y-L3mf_QWqVO2ViLMdr7aMOkz3n2d8-Uw==&ch=kkv78Wp_rLcV7YsgWC2N857kyQdUgPlZwPr_yNna4CXW8CkE81-xug==],
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
"When I talk about technology and the internet, people normally pine for them and
look forward to a future that will promote liberalization. But people neglect the
fact that modern authoritarianism also rises with the development of technology,
 which makes wider and deeper control possible."
Sui Muqing, the lawyer for Zhang Guanghong - a human rights activist - who is under
scrutiny by the Chinese government for his postings on WhatsApp
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Media To Consider
Books, Articles or Videos worth a Review...
Download Utopia! - The National Institute for Health Research (NIHR) at King's College
in London issued a report several weeks ago on "Using Telecare for Older People 
in Adult Social Care". The Brits are, in general, far ahead of the USA when it comes
to social care as a dynamic in sustaining a viable environment for people of all
 ages to stay in the home rather than seek institutionalized services. There is 
lots to learn from this seminal piece of work. Download [http://r20.rs6.net/tn.jsp?f=001Ie1js218vUS6pgQAD-X8tvaJBW0biBt3b0olGQxyIkv1rdYuL1egmF8VSNMoWPoVNbFxhX-Z4WiR53btGLSUrkIVZOdwJi6a_Zt-xH-6HuaU0yguNxOfq9dBYCf4j8aY_mXWbABCt0vn6rpSWz9uCyq24df3K5ZHblLhc8m6ZLXrz_ILSDfvln0-SMoGoJp-kKDltxWMVGg3XpteKixAMvtl0lOwMH0CJYhtCOFwHWPNoaf1Hw_zlbodhnUbAiGu&c=a1QPbx_6kWOXWTn1bn--7Y-L3mf_QWqVO2ViLMdr7aMOkz3n2d8-Uw==&ch=kkv78Wp_rLcV7YsgWC2N857kyQdUgPlZwPr_yNna4CXW8CkE81-xug==]
it, share with your colleagues and then consider how to move forward with implementation.
You'll be ahead of the curve - unless you are already deep into a value-based reimbursement
environment.
Be Ahead Of The Disruption Curve - There is lots of information available on the
 web and elsewhere on disruptive technology trends. Disruption Hub [http://r20.rs6.net/tn.jsp?f=001Ie1js218vUS6pgQAD-X8tvaJBW0biBt3b0olGQxyIkv1rdYuL1egmF8VSNMoWPoVOUwZt8BK3t_uaiqjyLMScBpSgMSzJBTaQnk_7posT2UxxArkIdaHFA7ILIp2KvxjwoepFyijPvfHyaEHvURWFUc1AMGvs5OStb6Fhr1L16vTzUQBtDU_iQ==&c=a1QPbx_6kWOXWTn1bn--7Y-L3mf_QWqVO2ViLMdr7aMOkz3n2d8-Uw==&ch=kkv78Wp_rLcV7YsgWC2N857kyQdUgPlZwPr_yNna4CXW8CkE81-xug==]
is a "go to" website if you want to keep ahead of the curve. In particular, you 
should check out the 18 Disruptive Technology Trends for 2018 [http://r20.rs6.net/tn.jsp?f=001Ie1js218vUS6pgQAD-X8tvaJBW0biBt3b0olGQxyIkv1rdYuL1egmF8VSNMoWPoVqTtHHRIkHgSopYW1gsS6kEi6lfqxBRcEvDYN2Jmypy5RP-xhVwRJL5sCAJ6AX29nb0-6mqQ30Phcoz72ZWHDGpsa_Et2pBA0UcURz8LhciTiWyXYzifmV_O2o7pMKYt-d0-hvRQbV1vww78IGtFu1g==&c=a1QPbx_6kWOXWTn1bn--7Y-L3mf_QWqVO2ViLMdr7aMOkz3n2d8-Uw==&ch=kkv78Wp_rLcV7YsgWC2N857kyQdUgPlZwPr_yNna4CXW8CkE81-xug==].
Now you know where I get some of my information...
What Do You Practice? - I recently was shown the video - What Do You Practice? [http://r20.rs6.net/tn.jsp?f=001Ie1js218vUS6pgQAD-X8tvaJBW0biBt3b0olGQxyIkv1rdYuL1egmF8VSNMoWPoV_Bmn2L0nBmTo09eu8gNBr8awMsGmmYwL5uooEb3W2hISACc8u668dvs1Lfma1mfOI27H-fR5S_B-ROk0Ta5QbBXAkshAUzUjHrAstbNqqRS98GQss9p7gFeFvzIrfQqee6F3OBOVVgA=&c=a1QPbx_6kWOXWTn1bn--7Y-L3mf_QWqVO2ViLMdr7aMOkz3n2d8-Uw==&ch=kkv78Wp_rLcV7YsgWC2N857kyQdUgPlZwPr_yNna4CXW8CkE81-xug==]
- at church and I thought the message is something that is critically important 
for all of us who are involved in caring for people. What we "practice" comes across
in our demeanor, our approach, our mode of communicating, our approach to caring.
Not only is the message important but, the messenger is someone we are likely to
 hear from again in the future...
Comparing Health Care And Higher Education - I was recently interviewed by Southern
New Hampshire University on the comparisons between health care and higher education.
There are some very interesting comparisons. My opinion is these two industries 
are some of the last to be transformed by technology but, the pace is quickening.
You can check it out [http://r20.rs6.net/tn.jsp?f=001Ie1js218vUS6pgQAD-X8tvaJBW0biBt3b0olGQxyIkv1rdYuL1egmF4qidP61BMhbbF5pIr1dbsK-qifl60xM-qr_6ICeL4NVTtmmHiYinEolevaxcFNmA66TTLPFT9DwXg6EwexhfbLxP9Tg-dpI1oslV4rDSE6D9BwhtT0bRm3Vs0G6xSACZrriELv7Yw0wpeuyA35Whu5MgWGZUagt1JBgBh_-aSoinYwnbfxBGGD2ks2_LcVD4FrMdPA_Ak3B8_5MpAb9iM=&c=a1QPbx_6kWOXWTn1bn--7Y-L3mf_QWqVO2ViLMdr7aMOkz3n2d8-Uw==&ch=kkv78Wp_rLcV7YsgWC2N857kyQdUgPlZwPr_yNna4CXW8CkE81-xug==]
and get back to me with your thoughts...
Lamenting Lame Legislation - In 1996, the US Congress inserted a rider into the 
omnibus spending bill which stipulated that "none of the funds made available for
injury prevention and control at the Centers for Disease Control and Prevention 
[http://r20.rs6.net/tn.jsp?f=001Ie1js218vUS6pgQAD-X8tvaJBW0biBt3b0olGQxyIkv1rdYuL1egmF8VSNMoWPoVeR17NwWBvQo2ZDPHSnLSgx_ckZogttWaaIXs700yBIU6bXj0MFVBX49GW7FtCb3d4PvrClk_VL5WCE6m4-9y9HPmRg16to4Tgep-418BI_Ed-tZobOHMGWakOhtrvt_GmDNRDzIJYBU8S-Fi9LGcwDpmP_ZQ5QJj4jfLb5FOnG8iXbukNkikKA==&c=a1QPbx_6kWOXWTn1bn--7Y-L3mf_QWqVO2ViLMdr7aMOkz3n2d8-Uw==&ch=kkv78Wp_rLcV7YsgWC2N857kyQdUgPlZwPr_yNna4CXW8CkE81-xug==]
(CDC) may be used to advocate or promote gun control." Known as the Dickey Amendment
[http://r20.rs6.net/tn.jsp?f=001Ie1js218vUS6pgQAD-X8tvaJBW0biBt3b0olGQxyIkv1rdYuL1egmF8VSNMoWPoVObxUjNjDEc6UtbTpNJpL05UJrQ3b9LR7No6PRZeuy83SEyBtJLiE3_Duaa7ZTVAKDCA-LjnvjQsYFTin5oawgE6rQ6FsWKwFcxv-MEUsq6yl-zFgr_qwK6oSD5QotKbAQlNf8xjvzPSfX5V-g2ZowyDnnc4Jp6lz&c=a1QPbx_6kWOXWTn1bn--7Y-L3mf_QWqVO2ViLMdr7aMOkz3n2d8-Uw==&ch=kkv78Wp_rLcV7YsgWC2N857kyQdUgPlZwPr_yNna4CXW8CkE81-xug==]and
introduced by Rep. Jay Dickey (R-AK), Congress went even further by earmarking the
$2.6 million which had been allocated for gun control research for traumatic brain
injury research. Who's going to fight TBI? So, why did Congress do that? It seems
that the National Rifle Association (NRA) felt that there was a bias in a 1993 study
funded by the CDC which had found that guns in the home were associated with an 
increased risk of homicide in the home. In essence, the amendment put a stop to 
any gun-related research by the CDC. In fact, the author of the amendment in a 2012
op-ed piece, reversed course and regrets the role he played in dismantling the CDC's
nascent efforts to begin gun violence research. President Obama tried to get the
 CDC back on track by calling for research on gun violence in 2013. When nothing
 happened, the Democrats sent a letter to their colleagues in Congress asking to
 rescind the amendment. However, despite their best efforts, the rescission did 
not pass and the Amendment was upheld for the 2016 federal budget. Did Congress 
listen to the tobacco industry when it wanted to push aside research on smoking?
 Or, how about the car industry and crash prevention? How about coal miners and 
occupational diseases? Isn't this just plain stupid? A lot of medical and health
 care associations have called for removal of the amendment but so far, they have
not been successful. Shouldn't we at least consider the science in our policy deliberations
or, is science now out the window? After all, there really isn't any global warming...
Did You Know? - In the wake of the Parkland shootings, some startling statistics
 are only now starting to be discussed. Did you know that the USA has the distinction
of holding the highest rates of substance abuse, suicide, and gun violence in the
world?  So, what does the data show? There will be 175 deaths from drug overdoses
today and every day this year! There will be 123 suicides and 43 gun violence deaths
today, and every day this year! The question then remains: Why hasn't the health
 care community stepped up to declare a public health crisis? There are segments
 of health care - like mental health, psychiatry, psychology and other similar areas
- that seem to be calling for action. But, where are the hospital systems? The emergency
room physicians? The family physicians? And, all the rest?
From Sandy Hook To Parkland With No Action - In 2012, 20 first graders and 6 adults
were killed by a gunman at Sandy Hook School [http://r20.rs6.net/tn.jsp?f=001Ie1js218vUS6pgQAD-X8tvaJBW0biBt3b0olGQxyIkv1rdYuL1egmF8VSNMoWPoVu_PKoBbGZNfbNoW6Ylx2Qa_Zq_xB59gzDxXu4sw_LPDmcWtnyJDOyemp6HX53tiIsCH77szSof8eq9Utja_S4-aJ1BljssbRNQnvw99VoSEdIuJgbclxQJsAXhXkp-TMNycqAgXk1GZaN2zLDWj91O4YMYS4iLxg3w6mfW-cl1x2DvFI7ZZFT31RVMRQN7iMLr1Wwb62vNw6P_2oSx3Q9nEOHY-WvbV2&c=a1QPbx_6kWOXWTn1bn--7Y-L3mf_QWqVO2ViLMdr7aMOkz3n2d8-Uw==&ch=kkv78Wp_rLcV7YsgWC2N857kyQdUgPlZwPr_yNna4CXW8CkE81-xug==]
in Newtown, Connecticut with an assault rifle and it caught our attention - for 
about 10 seconds! Since that fateful day, there have been nearly 250 school shootings
nationwide with more than 450 people shot and at least 138 killed! Here is some 
pictorial data from the Gun Violence Archive that describes the situation better
 than words. The dark dots are deaths and the light dots are injuries:

Note the last one. It's the Marjory Stoneman Douglas High School in Parkland, Florida.
What's more troubling is the number of mass shootings. They have apparently gone
 up in recent years. Why? It's the availability of assault weapons of all sorts.
 For a complete analysis of the data, you need to read the February 15, 2018 article
in The New York Times [http://r20.rs6.net/tn.jsp?f=001Ie1js218vUS6pgQAD-X8tvaJBW0biBt3b0olGQxyIkv1rdYuL1egmF8VSNMoWPoVgYPUkNuzka1youxKA2_G4_NJiOih1gpG5p77MjcWF7ZQOrOQXbYAz-Ih6P_HRgSUnJzf7O36KwOoM_ppWDTPgWL9F5RUNUT4__laB6KO6FMBByLItlSEXZXVu02vZ1QTxlx3mz9CBtPd_uTk-xAikvvcPcZBfB6aJVFIEILX4JH-jt5ngHwNOSSVQKQF2j0_bPGnvLeT4HTsTgUc9Ozo7A==&c=a1QPbx_6kWOXWTn1bn--7Y-L3mf_QWqVO2ViLMdr7aMOkz3n2d8-Uw==&ch=kkv78Wp_rLcV7YsgWC2N857kyQdUgPlZwPr_yNna4CXW8CkE81-xug==]
by Jugal Patel. The health care community needs to be at the forefront of this debate
but, we are not!  Why? Let's use our moral authority...
HUGE Increase in ACA Health Insurance Rates - "HUGE" is a new word that keeps getting
bandied about so I thought I would apply it to the problem of health insurance rates.
The Urban Institute is now projecting an 18% increase in premiums for Affordable
 Care Act (ACA) plans. Why? The researchers noted that "the Trump administration's
efforts to loosen health insurance rules" is the primary cause - which is no surprise
to those of us who have any knowledge of how health insurance works. If you take
 the healthy people out of the risk pools by offering less-comprehensive plans, 
the sicker ones are left in the risk pool and the overall cost for the more fully
insured group goes up. It's fairly basic. Furthermore, the Urban Institute projects
that another 2.5 million people will simply drop out of the insurance plans because
the individual mandate is now dropped. In essence, by creating an unsustainable 
plan the Administration has guaranteed the "massive failure" of ACA program unless
something is done. Now, one could argue that the Urban Institute is very liberal
 and left - and, would be expected to offer up such an analysis. But, it's also 
been predicted by another analytical shop - Fox News. However, I could not find 
their research online - only their analysis J
In other news on the ACA front, 20 states filed suit against the federal government
claiming the ACA is "no longer constitutional after the repeal last year of its 
requirement that people have health insurance or pay a fine." Texas and Wisconsin
led the effort by a coalition of conservative states. So, there are several fronts
in the war on ACA. Keep your eye on all of them...
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Consulo Indicium
Information for your Consideration...
Consolidation Continues - I've been predicting it for at least a decade - if not
 longer - and, the Catholics seem to be at the head of the consolidation movement
among health care systems. In case you have not been watching, Ascension Health 
(St. Louis, MO) and Providence St. Joseph Health (Seattle, WA) are moving forward
with their mega-merger to create the largest not-for-profit health system in the
 nation. The combined entity will reach over 27 states creating a chain of 191 hospitals
and over $45 billion in annual revenue. While it does not quite reach the $61+ billion
of Kaiser Permanente, the reach is further. And, then there is the $28+ billion 
merger of Dignity Health and Catholic Health Initiatives extending over 28 states
with 139 hospitals. Hmmmm. What or Who is next? And, will we have 10 systems in 
10 years? We're moving in that direction...
Technology Disrupting Health Care Delivery - Don't Bet On It Just Yet! - Perhaps
 I'm getting a cynical or perhaps a bit more realistic. I think it's more the latter
than the former J. A recent article in The Washington Post [http://r20.rs6.net/tn.jsp?f=001Ie1js218vUS6pgQAD-X8tvaJBW0biBt3b0olGQxyIkv1rdYuL1egmF8VSNMoWPoVk9ymJPn9iPYVdIJA5Iiz-SZMMoEbuYPM4KJCrRgxyD57ZldzGe2B-0T7tboUN8K7AYNxzjMH2oqhWETYCaMHBENREGeh2bog93hV10sBSV7JNAN7l_DE-upYZk9QDeFSrADl_m5CVelArb0D_TwDIOP7n9KzXRJ8R1dls5CI1ilUdKoP6bXY5DXA_QQ0Ip3P_E12C38k1JFDxfLPyROf23ZeW99PQMBE7KnXftk0M1IvtkoOGNgdx2unAMms6a3hq54oH5B1iaxDinrO9s0T_3zzgPia-YMmAWO0L-odRIgBLGDNODH_EX5wpH7h7CS57GTbUPOm-h5fRMiCKrBqYfAlT-XqMufXsBxCrURq7B51svHaXjwgFm53UFR3A-Nw7c-6wHmfAAoa8ERMA48dZQ==&c=a1QPbx_6kWOXWTn1bn--7Y-L3mf_QWqVO2ViLMdr7aMOkz3n2d8-Uw==&ch=kkv78Wp_rLcV7YsgWC2N857kyQdUgPlZwPr_yNna4CXW8CkE81-xug==]
caught my interest on the topic of technology disrupting health by summing up the
current state of affairs with the headline - "...Don't count on it". The article
 surveyed a number of interesting approaches and ideas related to the use of technology
for fostering greater efficiency and effectiveness in care delivery using virtual
support and delivery. For example, a symptom checker was developed by IBM and offered
to its employees but the use rate was abysmally low - less than 10%. Why?
In essence, it's not the technology - it's the approach we take to paying for services.
My perspective is that as long as we have a "fee-for-service" or piecemeal payment
model we will get piecemeal services and continuation of the existing system - which
is costing far too much. It is only if health care moves towards a "value-based"
 payment model that real change will begin to occur. Health care is moving toward
high deductible plans and that is causing some consumer shift. But, my perspective
- for what it's worth - is that without the move toward value-based care delivery
we will only be managing costs at the margin or around the edges of health care.
 No big dent will be made in shifting or transforming health care. We are beginning
to see such moves in selected geographies around the nation where value-based care
or accountable care organizations are beginning to take hold such as Oregon, Washington
and North California; the Upper Midwest; and, the Northeast and Central Atlantic
 areas. But, the rest of the country continues to be firmly planted in the FFS model.
But, is it important?
On the whole, it's incredibly important. Just the growth in the Medicare eligible
population must drive the change if nothing else. The current trajectory is not 
sustainable and so policy change which encourages efficiency, effectiveness, quality
outcomes and customer satisfaction should be at the forefront of our thinking as
 we consider redesign of health care. It those elements happen, the shift will be
dramatic and swift. It's not a matter of if. It's a matter of when! Are you getting
ready? By the way, when "when" occurs, technology will be a core facilitator of 
change... And, "when" is knocking on the door...
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The Weekly Whisk
Musings from a foodie...
Having spent some time living in London, I became an aficionado of Fish & Chips!
 There is nothing quite like haddock cooked to perfection. So, I was delighted to
have the opportunity to visit one of the better seafood restaurants on the coastal
Massachusetts area as part of a recent birthday surprise. Turner's Seafood [http://r20.rs6.net/tn.jsp?f=001Ie1js218vUS6pgQAD-X8tvaJBW0biBt3b0olGQxyIkv1rdYuL1egmF8VSNMoWPoVPIqkwhT0XnhVl0HZtNpMCBaVzPHpbAj1tPRQZg_yVELzAJVKN7IiwyOCQcSfhxGOb0UP-PzD0sCO41yN4AdtQ2JKjf3KRECby2XdsvbqjS345bsch2oAfQ==&c=a1QPbx_6kWOXWTn1bn--7Y-L3mf_QWqVO2ViLMdr7aMOkz3n2d8-Uw==&ch=kkv78Wp_rLcV7YsgWC2N857kyQdUgPlZwPr_yNna4CXW8CkE81-xug==]
[* * * *] is nestled among the many early New England buildings in downtown Salem,
Massachusetts - yes!! Where the witches lived. In fact, the nickname for the city
is "Witch City" and there's even a costume shop devoted entirely to witch's costumes.
But, I digress - as usual.
I must say that the Fish & Chips were cooked to perfection. In fact, they were some
of the best Fish & Chips I've had - cooked in the traditional English way - on the
East Coast. Definitely worthy of a stop if you're an aficionado! But, as part of
 the luncheon surprise, we also indulged in a number of other items on the menu 
- after all, it was my birthday J. First, there was the obligatory Lobster Mac and
Cheese, a New England requirement! It was great. Then, there were the Nantucket 
Scallops with breadcrumbs. They were incredible. These scallops were not the big
 boys you find in most of the stores. Rather, they were the small little thimble
 size scallops that were absolutely sweet and succulent. The season ends in March
and has to do with the warmth of the ocean. Evidently, the colder the water - the
more sweet and succulent the scallop. What a treat. This was all accompanied by 
wonderful cole slaw of cabbage, scallions, carrots, and chives. What a taste treat.
But the piece de resistance was the continuous overhead 60's music extending from
Simon and Garfunkel to the Mamas and Papas to Joni Mitchell - just to name a few.
And, they didn't know it was my birthday until I sat down.  Check 'em out: Turner's
Seafood at Lyceum Hall - 43 Church Street - Salem, MA 01970 - (978) 745-7665 - www.turners-seafood.com
[http://r20.rs6.net/tn.jsp?f=001Ie1js218vUS6pgQAD-X8tvaJBW0biBt3b0olGQxyIkv1rdYuL1egmF8VSNMoWPoVPIqkwhT0XnhVl0HZtNpMCBaVzPHpbAj1tPRQZg_yVELzAJVKN7IiwyOCQcSfhxGOb0UP-PzD0sCO41yN4AdtQ2JKjf3KRECby2XdsvbqjS345bsch2oAfQ==&c=a1QPbx_6kWOXWTn1bn--7Y-L3mf_QWqVO2ViLMdr7aMOkz3n2d8-Uw==&ch=kkv78Wp_rLcV7YsgWC2N857kyQdUgPlZwPr_yNna4CXW8CkE81-xug==]
But, the day was not over!! One of my favorite restaurants in Kittery, where we 
call home (other than Marriott, of course), lost its chef about 16 months ago. I
 did not know where he had moved until about six months ago when I discovered he
 has moved to Exeter, New Hampshire just a short 30-minute ride away. Chef Lee Frank
started a new place - Otis Restaurant [http://r20.rs6.net/tn.jsp?f=001Ie1js218vUS6pgQAD-X8tvaJBW0biBt3b0olGQxyIkv1rdYuL1egmF8VSNMoWPoVl5dPsxv9BPcfrOwcaT-hxGrH3C0kcbg1i3jx-stZYISFyhr_ZER9VGIbDqUwOoWUW96TH4B1ie5n9pzECgA6OXferlmg7BMJmftxK3D_qkYOFbPnUPf0ig==&c=a1QPbx_6kWOXWTn1bn--7Y-L3mf_QWqVO2ViLMdr7aMOkz3n2d8-Uw==&ch=kkv78Wp_rLcV7YsgWC2N857kyQdUgPlZwPr_yNna4CXW8CkE81-xug==][*
* * * *] - that has been getting rave reviews and was selected as Best New Restaurant"
in New Hampshire for 2017. It was a culinary delight and a fantastic way to end 
a wonderful day. Since the Fish & Chips had been such a feast, we decided to do 
a "share" meal. We started with a salad of fresh beets and whipped feta accompanied
with dehydrated yoghurt (that is yoghurt that is dried as a thin veneer and served
as almost transparent pieces of the sheet) along with small pieces of dried bread
cut into animal shapes (I got the elephant). This was followed by a wonderful fresh
pasta with Oyster and Blue Mushrooms along with chicken and parsley in a mushroom
reduction sauce. Incredible. Finally, we ended the main course with Duck Breast 
accompanied with Braised Cabbage, Sweet Potato and a silky Onion Puree - all drizzled
with a honey coriander sauce and dehydrated cabbage dust on the side. Not only was
the food fantastic but the presentation was outstanding as well!! Finally, we came
to dessert which was a traditional English Sticky Toffee - and, it was traditional,
it was English and, it was Great!! Lee has done an outstanding job in creating his
mark with Otis Restaurant. It's about one hour north of Boston in Exeter in the 
downtown area. It's worth the drive. But, you need to call 30 days in advance to
 get your reservation. Enjoy. Otis Restaurant - 4 Front Street - Exeter, NH 03833
- (603) 580-1705 - https://www.otisrestaurant.com/ [http://r20.rs6.net/tn.jsp?f=001Ie1js218vUS6pgQAD-X8tvaJBW0biBt3b0olGQxyIkv1rdYuL1egmF8VSNMoWPoVl5dPsxv9BPcfrOwcaT-hxGrH3C0kcbg1i3jx-stZYISFyhr_ZER9VGIbDqUwOoWUW96TH4B1ie5n9pzECgA6OXferlmg7BMJmftxK3D_qkYOFbPnUPf0ig==&c=a1QPbx_6kWOXWTn1bn--7Y-L3mf_QWqVO2ViLMdr7aMOkz3n2d8-Uw==&ch=kkv78Wp_rLcV7YsgWC2N857kyQdUgPlZwPr_yNna4CXW8CkE81-xug==]
- It's already one of my favorites for 2018. If you're near Boston, it's worth the
effort...
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The Good, The Bad, And The Ugly
The ongoing saga...
The Great - Thank God for young people. Whether it's Vietnam, climate or gun control
- it seems that we don't do much until the young people get involved.
The Good - Kudos to Gary Oldman from the Darkest Hour. Great story. Great acting.
The Bad - The incoherence of shifting policy positions emanating from The White 
House.
The Ugly - An environmental researcher I recently met told me that researchers have
"known for about a decade" that the "oceans will be sterile of their current life
forms by the end of the century" - a mere 40 to 50 years away. It's because of the
oceans' absorption of carbon. But, there is no climate change...right?
The statements in The Fickenscher Files [http://r20.rs6.net/tn.jsp?f=001Ie1js218vUS6pgQAD-X8tvaJBW0biBt3b0olGQxyIkv1rdYuL1egmE_ePjZcMyCVahGEMiXLQ5sBbM8rUp_AyCRsEzyrwm2dZ8y4fMUG5tj0rk7LBeFyPYksMZAY8V1bsNGeVJ0EnEhUz0j5X7AVyNMdJprArqsfFnS2zp5NT5DU1ShdCC7o3yHWR_AfPDTw&c=a1QPbx_6kWOXWTn1bn--7Y-L3mf_QWqVO2ViLMdr7aMOkz3n2d8-Uw==&ch=kkv78Wp_rLcV7YsgWC2N857kyQdUgPlZwPr_yNna4CXW8CkE81-xug==]
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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The Fickenscher Files | PO Box 840 | Kittery | ME | 039