Subject: News from Dr. Kevin Fickenscher
From: "The Fickenscher Files" <[email-masked]>
To: <[email-masked]>
Date: Tue, 1 May 2018 11:33:35 -0400 (EDT)

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The Fickenscher Files [http://r20.rs6.net/tn.jsp?f=001HtQBXGufDgaO9JBHJi5rrwVy_54RX8bkA3qC71Zvp4dXieQISLurjcCrWjGHvZltNHXM_hisbK9KOGWJ3Fsbv8byI3iI0HbsJeCRh1PFL2eimExfgfXxlIoVzPtKpA_5XlMd-HCQOPUcNZ6vlqN1LCKOam4137Ze1EjOFTwcbF22GtPqLQMNX9BsxGkCcMoN&c=mLF6E8BErrx3NuWr66WJ-VB0mDc-RU47UygG94omYsLyof59EQ2oXw==&ch=TNmOGJykrAS4a0-Bsi7YO26Ol8O4vYzTzJyDCMd3i-elmc--pQg_kw==]
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The Fickenscher Files, Vol. 6, Issue 7
Kevin M. Fickenscher [http://r20.rs6.net/tn.jsp?f=001HtQBXGufDgaO9JBHJi5rrwVy_54RX8bkA3qC71Zvp4dXieQISLurjaXs30oynSFy3mjZrc18kBZzLJuibBuuYZW664uIofZawvCUIzRNdBIYeL4-KH8QVRY7CDen19KA5hz743xm5YdCNKC25E2u4GpeLB9IsJYSPCTcuB9gTeV-deN5iijhkus-l4Qp_qVNp-2LcEPPf3JSMlKAI8hOsQ==&c=mLF6E8BErrx3NuWr66WJ-VB0mDc-RU47UygG94omYsLyof59EQ2oXw==&ch=TNmOGJykrAS4a0-Bsi7YO26Ol8O4vYzTzJyDCMd3i-elmc--pQg_kw==],
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
"Probably in healthcare-where you have this personalized and preventive medicine
 and treatment. We had some innovations that I saw several times in medicine to 
predict, via better analysis, the diseases you may have in the future and prevent
them or better treat you."
Emmanuel Macron, President of France - in a wide-ranging interview with the Editor
of WIRED magazine [http://r20.rs6.net/tn.jsp?f=001HtQBXGufDgaO9JBHJi5rrwVy_54RX8bkA3qC71Zvp4dXieQISLurjVMwYsXHXmZwoC9X2qxbOK7vPQs_C0_yWWNxM8x8MBjmaLmOxSBDgdFm80_Xq37hFrK5Z1rOPWfnhElX0hRlnlSKfhh9Ou7VHjgd_vXwE8o0MKsYPdsyb7EgBkOdePIW3xqIqL4ytqhLregwDh7XbMWlt58VrlNod9UCdaU3g2a_72T5rcFL13hw_dS0JEcd4W8X5rgRBxsf&c=mLF6E8BErrx3NuWr66WJ-VB0mDc-RU47UygG94omYsLyof59EQ2oXw==&ch=TNmOGJykrAS4a0-Bsi7YO26Ol8O4vYzTzJyDCMd3i-elmc--pQg_kw==]
on the announcement by France that it will be investing ?1.5 billion ($1.85 billion)
to develop the "artificial intelligence" community in France to compete directly
 with the US and China. "Healthcare" was only one of the areas mentioned for possible
focus. Anyone up for living in Paris? Hmm.....
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Random Considerations
Observations, Books or Articles worth a Thought or Two...
A Buzz To Remember - The brewing controversy over the response of Facebook to a 
number of issues but primarily related to its position on the use of personal information
by the more than 2 billion users is not an incident but a growing cacophony. It 
wasn't helped this past week by a piece in Buzz Feed on the role of Vice President
Andrew Bosworth - a provocative Vice President for consumer hardware - when it was
revealed that in an internal post back in 2016 he wrote the following: "The ugly
 truth is that we believe in connecting people so deeply that anything that allows
us to connect more people more often is *de facto* good. It is perhaps the only 
area where the metrics do tell the true story as far as we are concerned...That 
isn't something we are doing for ourselves. Or for our stock price (ha!). It is 
literally just what we do. We connect people. Period." You must read the whole article
[http://r20.rs6.net/tn.jsp?f=001HtQBXGufDgaO9JBHJi5rrwVy_54RX8bkA3qC71Zvp4dXieQISLurjVMwYsXHXmZwgcA3jjUPA5Q4nSvVh2oEWAR530hBAC7Fin8oLw0Cz25Q41n4G-MBgO5NNyp6O8a7Ck4HbI2bRl6hcY5WB9DjuX4IWpxiEGwNpuAA9YnUyrQDyaFQnpCP2VF9W-vaTgtbA5VfY7GeHUljVOANQiYGO7ZvI12cFF58pNMPmrtSLvf9Q7Gex5hI7Yh7_RrTlCNuU1BMh4WiBdXEqzEXYEywWvYh-jVoad4Bn58FgjMwtg13OPqQaMxyXQ==&c=mLF6E8BErrx3NuWr66WJ-VB0mDc-RU47UygG94omYsLyof59EQ2oXw==&ch=TNmOGJykrAS4a0-Bsi7YO26Ol8O4vYzTzJyDCMd3i-elmc--pQg_kw==]
to get a sense of the issue and how the use of data and information by Facebook 
has not only created wealth but also now consternation among many on their team.
Change Happens When You're Not Looking - I feel like I've been hiding under a rock
or something. This past week, I attended the American Telemedicine Association conference
- one of my favorite annual treks. This year the meeting was held in Chicago at 
McCormick Place but the important point is that the other ongoing event at the same
venue was America's Beauty Show! Yes, America's Beauty Show [http://r20.rs6.net/tn.jsp?f=001HtQBXGufDgaO9JBHJi5rrwVy_54RX8bkA3qC71Zvp4dXieQISLurjVMwYsXHXmZw_sLsGDslbsKsnItTSBDYwg9dYWwOB40TPQIEzu5FagSnXEZfsDiEifINrdkWGMA6T6W7YBZgZPY9kVD7Gsu2RZbf02GUcAQtwaC7lQc13AuTABhBks8gPNJxriQZMIzb&c=mLF6E8BErrx3NuWr66WJ-VB0mDc-RU47UygG94omYsLyof59EQ2oXw==&ch=TNmOGJykrAS4a0-Bsi7YO26Ol8O4vYzTzJyDCMd3i-elmc--pQg_kw==].
It was a lesson in "change" or, "what happens when you're not paying attention".
 I have never seen so much blue (I mean really blue), green, pink, red, yellow, 
fuchsia and other assorted colors of hair!! Not only that, but many of the people
(mostly women - not a statement, just an observation) were wearing jeans with frayed
fronts and/or holes - something we would have patched over in the 1960s with an 
upside down flag or something. I felt like what was normal had been turned upside
down.  Shouldn't colored hair be natural and subdued rather than bold, if not outrageous,
and iridescent?
Now...........imagine how the medical and health care community feels when we tell
them that a lot of their thinking will be replaced by artificial intelligence, that
robots are coming which can actually interact with people, that the way to increased
productivity is through the use of remote care management monitoring devices and
 on and on. Imagine you grew up when the Beatles and Rolling Stones were popular
 and now there is some weird kind of music you can't figure out. That's called "change"
and, it happens. If you think you've seen a lot of change in health care over the
last decade think blue (I mean really blue), green, pink, red, yellow, fuchsia and
other assorted colors as the metaphor for what's happening. It will help you to 
understand how much change is coming. And, it won't take five decades...
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Consulo Indicium
Information for your Consideration...
Ominous Clouds On The Horizon - As I grew up on the Great Plains, one of the lessons
I learned is that when you see a really dark storm on the horizon - it's important
to pay attention. So, we have one of those metaphorical storms brewing on the American
horizon in my estimation. So, what is it? In 2020, according to the Congressional
Budget Office, the federal deficit will exceed $1 trillion (yes, that's "T" as in
terrible). The new tax law advanced the increase by a couple of years and over the
years 2021 to 2028, the rate of increase in the annual deficit will be 4.9% of GDP
or, higher than at any point since World War II. Even more troubling, the total 
national debt will reach $33 trillion or 96% of GDP over the next decade. What are
we doing? What kind of legacy are we leaving our children? Congress and our elected
officials (all of them) are simply kicking the can down the road. In my experience,
ominous clouds on the horizon generally cause major - in some cases disastrous -
 damage and destruction. Are we headed in that direction? I think so...
Statistics Worth Noting And, Checking - In 2016, the USA witnessed the highest share
of homicides attributable to guns in the last century at 74.5%. In fact, we've seen
more gun-related deaths since 1968 (1.58 million) than all of the USA wars combined
(1.48 million) according to the according to data compiled from various sources 
by Snopes - the Fact Checker [http://r20.rs6.net/tn.jsp?f=001HtQBXGufDgaO9JBHJi5rrwVy_54RX8bkA3qC71Zvp4dXieQISLurjVMwYsXHXmZw6VDbdilgyNHxHewWEQitHdyaeXDl_t_jN6q2DeMxNZ140UcfqTGorsdtTocZh9DY11Dwak_mFy01QgHHjEf4FCDq-GdX4Vr1fFninJzrLrK0PcZZWTuCkN1OffVYjEZYQ0tpfUD5BTRrcQIY_-LYoA==&c=mLF6E8BErrx3NuWr66WJ-VB0mDc-RU47UygG94omYsLyof59EQ2oXw==&ch=TNmOGJykrAS4a0-Bsi7YO26Ol8O4vYzTzJyDCMd3i-elmc--pQg_kw==].
Furthermore, the rate of homicide by guns is higher than we have seen at any time
since the 1920s at the height of Prohibition - the next highest time period. It 
was a time when mobsters were carrying around machine guns and other automatic weapons.
It's also a time when the National Rifle Association (NRA) became an advocate for
stricter gun control. Hmmmm!!
Alright, Alright - Let's Exercise - For many of us, getting our bodies moving with
exercise is a challenging daily task or, should I say "chore". Well, get the lead
out. There's a new studythat ties your marbles to your muscles. In a long-term study
started in 1968, investigators found that high levels of cardiovascular exercise
 resulted in a dramatic reduction in dementia for middle-aged women at a level of
88% LESS than those participants who did not exercise regularly!! The dementia examinations
occurred in six separate evaluations over time. In fact, the study showed that the
highly fit women who did develop dementia did so an average of 11 years later than
the moderately fit women. So, while the researchers follow-up with further studies,
I recommend that everyone continue to exercise - and, we'll start with me...
And, in a related consideration, researchers have for many years questioned why 
our cognitive abilities decline over time. The consensus has been that part of the
reason is that the brain did not create new cells as older cells died off. Such 
a model would ultimately result in the loss of nerve connections leading to memory
and reasoning loss along with declines in language skills. But, the researchers 
at Columbia University have reported that the brain, in fact, makes new nerve cells
[http://r20.rs6.net/tn.jsp?f=001HtQBXGufDgaO9JBHJi5rrwVy_54RX8bkA3qC71Zvp4dXieQISLurjVMwYsXHXmZwziYYVv1Pm7nMLW16XuW4ZQBTApb0ekUVUm27rGIomBmZHluVezBtgAIEGI_4QUwPz6coGMh0xnbMkoyN1EMVqSFuG4jSddB6ea0xfSl9vb4ywAmD0Lc-p_X-JRGqXSaP2WjeUHlcpvhwHjFtjjO4SofW3dvOKOhhgMWX_9JV5IP3h_dI8eUkLQ==&c=mLF6E8BErrx3NuWr66WJ-VB0mDc-RU47UygG94omYsLyof59EQ2oXw==&ch=TNmOGJykrAS4a0-Bsi7YO26Ol8O4vYzTzJyDCMd3i-elmc--pQg_kw==],
especially in the parts of the brain involved in memory. Specifically, the researchers
found that cellular replacement occurred in older and younger people. However, in
the aged brain, the reduction in blood flow for nourishing the new cells was far
 less than among the younger subjects. This takes us back full circle to the other
study mentioned immediately above. So, the mantra (coming from multiple studies)
 is exercise, exercise, exercise [http://r20.rs6.net/tn.jsp?f=001HtQBXGufDgaO9JBHJi5rrwVy_54RX8bkA3qC71Zvp4dXieQISLurjVMwYsXHXmZw7qNFtaM0azhIx9wkY6q5wcZC-hoAihm3VHQaKZCXfjPBgUl5Y5FF2XNScNca03tb3ZsRq6gV1gGpeq8jP-FymcGc2w0ELDLNuw-DiXdzex4WyFiMajO1gJy2Y1noRdA1lCxGTvB7YiQuIPoX__WesA==&c=mLF6E8BErrx3NuWr66WJ-VB0mDc-RU47UygG94omYsLyof59EQ2oXw==&ch=TNmOGJykrAS4a0-Bsi7YO26Ol8O4vYzTzJyDCMd3i-elmc--pQg_kw==]...
Congressional Opioid Inaction - There seems to be a lot of inaction, action among
the four US House and Senate committees that are considering legislation to address
the ongoing opioid epidemic. The good part is that what some are describing as "the
most sweeping proposal" is a draft bipartisan bill winding through the US Senate
 Education, Labor, and Pensions Committee. It includes provisions such as accelerating
the development of non-addictive alternatives, enhancing existing enforcement efforts
of current opioid controls; and, increasing the grant programs to the states that
have been hit the hardest by the opioid epidemic. But, some of these provisions 
will take time. For example, Francis Collins, MD, the Director of the National Institutes
of Health (NIH) has noted that it will likely take at least five years for a non-addictive
for pain medication to become available.
On the research front, a new study was recently reported in JAMA Psychiatry [http://r20.rs6.net/tn.jsp?f=001HtQBXGufDgaO9JBHJi5rrwVy_54RX8bkA3qC71Zvp4dXieQISLurjVMwYsXHXmZw-34Hq41oxDnuKacNiqr9BXEa_KXdM3MQoBbVnhWY_Skqllu3d_26yfChgklo0M0aj0wXstaUw-448Foj3gKdhcgzKfRmXBUzWxHQJ1nX2yAAK7wUYbO016qGwVrqoZzUD5B09UHgLwGSc3H1Wz10WbIolBYADeiRvWPUoClwVWQ=&c=mLF6E8BErrx3NuWr66WJ-VB0mDc-RU47UygG94omYsLyof59EQ2oXw==&ch=TNmOGJykrAS4a0-Bsi7YO26Ol8O4vYzTzJyDCMd3i-elmc--pQg_kw==]
that treating people in jails and prisons for opioid addiction show some promising
results for reducing the incidence of deaths after discharge. Specifically, the 
report discussed a program instituted by the Rhode Island Department of Corrections
in 2016 and resulted in a 61% decrease in post-incarceration deaths.   In discussing
the results of the study, one of the researchers from the Boston Medical Center 
Grayken Center for Addition and an Adjunct Associate Professor at Brown University
- Traci Green, MD offered the following assessment: "This program reaches an extremely
vulnerable population at an extremely vulnerable time with the best treatment available
for opioid use disorder...Here we have a program that's shown to work, and it's 
absolutely replicable in other places. Not only do we see that a statewide program
treating people using medications for addiction treatment is possible and reduces
deaths, but also this approach intervenes on the opioid epidemic at its most lethal
and socially disrupting point - incarceration - to give hope and heal communities."
So, onward with the replication
Obscurity Vs. Transparency - If you have ever tried to traverse the pathways of 
health insurance or pharmacy benefits managers (PBMs), you know that it is a treacherous
course. The out-of-pocket costs seem (to me, at least) to shift every year. One 
of the little known requirements imposed by those health insurance providers and
 PBMs is that pharmacists are often restricted from informing patients that a certain
drug is cheaper if paid for out-of-pocket rather than paying for the drug through
their insurance program. Senators Susan Collins (R-ME) and Claire McCaskill (D-MO)
introduced S. 2554 or, the Patient Right to Know Drug Prices Act which removes the
"gag clause" imposed by the insurers and PBMs. The increase in transparency is CRITICAL
as we move forward towards value-based care delivery. Without it, consumers will
 not be empowered and the whole notion of fostering "value" will be crippled. Kudos
to the Senators for taking the lead. Let's get behind them and support the legislation.
Let's Get On Board! - Two of my colleagues - John Halamka, M.D., CIO at Beth Israel
Deaconess Medical Center (the "other doc who wears all black") and David Bates, 
M.D., Senior Vice President for Innovation at Brigham and Women's Hospital - along
with some other colleagues from the British National Health Service and Scotland
 have called on Congress to allow for the creation of a uniform health identifier.
The ability to move in this direction was banned by Congress due to privacy concerns.
However, as the advocates noted, the ban has fostered an environment that has allowed
misidentification and medical errors which could be easily correctable to continue.
We need to get ahead of the curve here (finally) and move in this direction. The
 article from the NEJM Catalyst [http://r20.rs6.net/tn.jsp?f=001HtQBXGufDgaO9JBHJi5rrwVy_54RX8bkA3qC71Zvp4dXieQISLurjVMwYsXHXmZwFAhlVHmfJEuR7NqMLOH6RX1K9-r_76PuzLXhYs0NnEwjCpCodTLSu2HN891jspos5PlHrJi9a5D7byDrfekjprqpxngto3eU9UdhEDKUOpi4bTcUgffSmdZLSbVaonj3lSymUxjUziy7IsHV2akM-2Lh6eTzrqqy&c=mLF6E8BErrx3NuWr66WJ-VB0mDc-RU47UygG94omYsLyof59EQ2oXw==&ch=TNmOGJykrAS4a0-Bsi7YO26Ol8O4vYzTzJyDCMd3i-elmc--pQg_kw==]
made the following point: "When accurate information is attached to the right patient,
data access is timelier for clinical, administrative, quality improvement and research
purposes; inappropriate care, redundant tests and medical errors are reduced; and
health information exchange becomes easier-within organizations as well as between.
Identifiers are also beneficial for patient mobility, allowing information to be
 linked to patients and following them as they move." Let's get behind them. There
is growing and strong support in the medical community [http://r20.rs6.net/tn.jsp?f=001HtQBXGufDgaO9JBHJi5rrwVy_54RX8bkA3qC71Zvp4dXieQISLurjVMwYsXHXmZwX4HRn9AUNv57elg_UZI8P1s7bwa26XU-BDAGC546SVSW604XujzJcVMxZyIfujh5aOzDvcsZpHl3nT8v438l0n1RqE7m_urQn3hRZIJJDSAgKAK4lpPYezzctaEpQ7dqVV7odGXEvA4FezszyE78LkKL0D9EcNOtysj61kkAt_M=&c=mLF6E8BErrx3NuWr66WJ-VB0mDc-RU47UygG94omYsLyof59EQ2oXw==&ch=TNmOGJykrAS4a0-Bsi7YO26Ol8O4vYzTzJyDCMd3i-elmc--pQg_kw==]
for moving in this direction. Write your Congressional delegation!
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The Weekly Whisk
Musings from a foodie...
I realized this week that my newer lifestyle of not traveling as much is getting
 in the way of finding new restaurants for my readers to consider. And, since "The
Weekly Whisk" is the most popular part of my blog - I'd better focus on it. However,
that will have to wait until the next blog when I return from Spain. For this one,
I travel three blocks from the hotel a short distance from McCormick Place (the 
convention center) to Ricobene's [http://r20.rs6.net/tn.jsp?f=001HtQBXGufDgaO9JBHJi5rrwVy_54RX8bkA3qC71Zvp4dXieQISLurjVMwYsXHXmZwzdbe8ufPrJpYnjtHaShwIuKPgrpOS1ry9OLintptHth9Zmz9Jq0r1WAOEQnCRbVqtez_qXwxGlM0PkR1wGOERigOAUGaRD72rfppEeSBWcac9gjuDLHILA==&c=mLF6E8BErrx3NuWr66WJ-VB0mDc-RU47UygG94omYsLyof59EQ2oXw==&ch=TNmOGJykrAS4a0-Bsi7YO26Ol8O4vYzTzJyDCMd3i-elmc--pQg_kw==]
- a pizza and sandwich joint on the South Side [* * *]. What can I say, it satiated
me. It was filled with calories - enough to fill a day - more than ample. It was
 also swarming with people - families of all strips and colors - a truly American
scene! And, while I loved it, Charlie Trotter would likely be disappointed in me.
What's a person to do when it's getting late, you've got early morning meetings,
 no local transportation except your well-worn shoes, and hunger that's biting. 
Head to Ricobene's - if you're on the South Side of Chicago and, if you're on the
Northwest side head someplace else J. Ricobene's - 252 W. 26th Street - Chicago,
 IL. 60616 - (312) 225-5555 and, other locations in the Chicago metro area.
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The Good, The Bad, And The Ugly
The ongoing saga...
The Great - President Macron taking it directly to Congress with his concerns...
The Good - The potential for Peace on the Peninsula is extraordinary after all of
these years. The leaders of both North and South Korea deserve a lot of credit for
moving the ball forward although the quiet hand of China is no doubt contributing
substantially to the movement of various pieces on the Korean chess board.
The Bad - Bright Blue (45%) and Bright Green (45%) with frontal streaks of Brilliant
Red intermingled with tangles of Sunshine Yellow (10%) [NOTE: See "Random Considerations"
above]
The Ugly - The number of Trumpees that have come and gone since the start of the
 current Administration. - we are losing the world community's "trust" and "credibility"
in the USA. Read Sapiens by Yuval Noah Harari, pages 328 - 333. It will all make
 sense...
The statements in The Fickenscher Files [http://r20.rs6.net/tn.jsp?f=001HtQBXGufDgaO9JBHJi5rrwVy_54RX8bkA3qC71Zvp4dXieQISLurjcCrWjGHvZltNHXM_hisbK9KOGWJ3Fsbv8byI3iI0HbsJeCRh1PFL2eimExfgfXxlIoVzPtKpA_5XlMd-HCQOPUcNZ6vlqN1LCKOam4137Ze1EjOFTwcbF22GtPqLQMNX9BsxGkCcMoN&c=mLF6E8BErrx3NuWr66WJ-VB0mDc-RU47UygG94omYsLyof59EQ2oXw==&ch=TNmOGJykrAS4a0-Bsi7YO26Ol8O4vYzTzJyDCMd3i-elmc--pQg_kw==]
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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Name | Company | Phone | Email [mailto:[email-masked]] | Website
[http://r20.rs6.net/tn.jsp?f=001HtQBXGufDgaO9JBHJi5rrwVy_54RX8bkA3qC71Zvp4dXieQISLurjcCrWjGHvZltNHXM_hisbK9KOGWJ3Fsbv8byI3iI0HbsJeCRh1PFL2eimExfgfXxlIoVzPtKpA_5XlMd-HCQOPUcNZ6vlqN1LCKOam4137Ze1EjOFTwcbF22GtPqLQMNX9BsxGkCcMoN&c=mLF6E8BErrx3NuWr66WJ-VB0mDc-RU47UygG94omYsLyof59EQ2oXw==&ch=TNmOGJykrAS4a0-Bsi7YO26Ol8O4vYzTzJyDCMd3i-elmc--pQg_kw==]
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