Subject: News from Dr. Kevin Fickenscher
From: "The Fickenscher Files" <[email-masked]>
To: <[email-masked]>
Date: Fri, 11 May 2018 17:29:01 -0400 (EDT)

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The Fickenscher Files [http://r20.rs6.net/tn.jsp?f=001eAeftIxjbEQJHDYhcFcHACbCNH6zLSSV846nUmw_zNzVlhuZ4CZqqoLqwwSjLSA5PpkiGUewQLdNpKjWJ_caSpiL6lM-6CZ4E34Xx8EApkObjI8PTRF5kbtZC8-dqq8FJinnmIsKU2ggwdNmgTCOzr-EGQZ6owLHdvAt-mEFxgMkJToGFxyaH10-l12yEwly&c=jlecrwKeang21aP7d-FltSLtYFoMyMeSOz3d4eytwFaoMR4yKk13ag==&ch=Kz7FKJhduGvWtSA0Qbh1s6rfK6IWdMtj7VusWQe83x_7spp1rasKRQ==]
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The Fickenscher Files, Vol. 6, Issue 8
Kevin M. Fickenscher [http://r20.rs6.net/tn.jsp?f=001eAeftIxjbEQJHDYhcFcHACbCNH6zLSSV846nUmw_zNzVlhuZ4CZqqu1yQgGdyHHEhTkyhJVkmxJGQOhEimheut0Cu5y64wyYCjAE1kCPYV5De3YgYvNBBM35Y30AQWsRjkuznQ-RIPhzeT2pMaS3G-HuqPQ5Ds7QWUHtF2HxhPAtt5ooV5KxF20vnbOIALzplA0FLIoiuCtjvE4-XAGWKw==&c=jlecrwKeang21aP7d-FltSLtYFoMyMeSOz3d4eytwFaoMR4yKk13ag==&ch=Kz7FKJhduGvWtSA0Qbh1s6rfK6IWdMtj7VusWQe83x_7spp1rasKRQ==],
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
"Change is possible. Change is necessary. And change is coming. This administration,
and this President, are not interested in incremental steps. ... We are unafraid
 of disrupting existing arrangements simply because they're backed by powerful special
interests."
Alex Azar, Secretary of the US Department of Health and Human Services in comments
before health care executives from the Federation of American Hospitals
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Media To Consider
Books and Articles worth a Review...
What Are You Reading? - I came across a statistic in the last week that was shocking
at best. The statement that drew my attention is that One third (1/3) of high school
graduates and 42% of college graduates never read another book after completing 
their degree!  I actually couldn't believe it. So, I did some further research and
the results come from a study done in 2003 by the Jenkins Group, Inc. [http://r20.rs6.net/tn.jsp?f=001eAeftIxjbEQJHDYhcFcHACbCNH6zLSSV846nUmw_zNzVlhuZ4CZqqsJI6KUkigJ-bH17VFdBQ9uQQmLR0raYnJzvXztTGb6L_Jl772Hx3Md4PFtJKVPjfty2NYyOE6_3ZIeY35Nfd4FAqNXSqbGuwZ3xiuN8B953F_DDAZnTiGKg9tf3372dt4A34Qh4OAbe&c=jlecrwKeang21aP7d-FltSLtYFoMyMeSOz3d4eytwFaoMR4yKk13ag==&ch=Kz7FKJhduGvWtSA0Qbh1s6rfK6IWdMtj7VusWQe83x_7spp1rasKRQ==]
- an independent publishing company. So, what's wrong with that? In a period where
transformational change is all around us - where are people getting their new information?
So, I did some research. Here's what I found:

* According to the National Library Board [http://r20.rs6.net/tn.jsp?f=001eAeftIxjbEQJHDYhcFcHACbCNH6zLSSV846nUmw_zNzVlhuZ4CZqqsJI6KUkigJ-guJ2q9LFhavzxDD1wsRUB9zxxLfxiWWaWUf7fUPa204sBT5fd5kY3s6fI6YRm3EX5TeejtMqwysjTUBVk_Yx_x-EQUlvjLCIPna3i8SHmQVsQLMOstJ8iqd72uLTYiYRzFVUO7seu3-OO75oR5bR4FE4JvMi_tQx-yWol78rB5acyUjrOn5-F-N8PoCfkVPxsz6SIhyrJ1sxt1YO0gXqxw==&c=jlecrwKeang21aP7d-FltSLtYFoMyMeSOz3d4eytwFaoMR4yKk13ag==&ch=Kz7FKJhduGvWtSA0Qbh1s6rfK6IWdMtj7VusWQe83x_7spp1rasKRQ==],
68% of Americans get their news and information via print or digital sources; 41%
via social media sources; and, 19% via books and e-books.
* The Pew Research Center [http://r20.rs6.net/tn.jsp?f=001eAeftIxjbEQJHDYhcFcHACbCNH6zLSSV846nUmw_zNzVlhuZ4CZqqsJI6KUkigJ-7wVmJzIJ6b5alven0LZ1XC-TFN5G81vKSyRGjraj1BFLZ24AS32pGA0Jd878lVpoiPNboS50j9FgHHKRGUT-o52f63B-ICszOa7RUIvOu1sK6RGP83fBeiWMGqs9ZDmX8_wb4ro-NAjpm2tPduYf-rFMXdDJqhaL&c=jlecrwKeang21aP7d-FltSLtYFoMyMeSOz3d4eytwFaoMR4yKk13ag==&ch=Kz7FKJhduGvWtSA0Qbh1s6rfK6IWdMtj7VusWQe83x_7spp1rasKRQ==]
basically did a similar study in 2016 with the same results.
* A Reuters Institute study discovered that only 16% of the U.S. population paid
 for digital news last year with only half of those paying for a recurring subscription.
In other words, only about 52 million Americans are getting their news this way.
 The remaining 274 million Americans are simply using Facebook, free news services
and websites they like to supply them with "news".
* The Millennials and GenZ are more likely to pay for news subscriptions than any
other generation although it's still relatively low.
* So, where do people get their news? Historically, it's been via television, but
that source is on the decline as well. The upsurge in take home news for the clear
majority of Americans is via social media.
Now - do these statistics cause you heartburn or, is it just me? The era of Walter
Cronkite or Huntley and Brinkley sourced, reliable and consistent information is
 over! Anyone can throw "news" out on the web. Folks - the combination of these 
data points is of major concern or am I becoming my father?
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Consulo Indicium
Information for your Consideration...
Technology Reading Your Mind - And, you thought it was way out into the future...
Researchers at MIT Media Lab have been working on a wearable device that can read
your mind - literally. The device is like an extended ear piece for a mobile device
except that it has an elongated attachment that follows your jawline and attaches
to the skin just under the lower lip. It picks up neuromuscular activity in the 
face and jaw which are activated by verbalizations. The result is that this activity
has been translated into the specific words, thereby allowing verbalization of your
thoughts. Dubbed the AlterEgo [http://r20.rs6.net/tn.jsp?f=001eAeftIxjbEQJHDYhcFcHACbCNH6zLSSV846nUmw_zNzVlhuZ4CZqqsJI6KUkigJ-20pbI4Key5xY7RGvLI-NFuNZrUXxpEXrKhHD0cOCt-ss_e1_JhejCBevtnoTI22WFKa0pkdssPAM_vluBxD_gj9ag3K2sl_8KFgnYeO6A7xmO1B3C_lhuZQ1wXTi-mZ1GX3jsOauGODpE6lbxq9O2kyynfzX6vs-&c=jlecrwKeang21aP7d-FltSLtYFoMyMeSOz3d4eytwFaoMR4yKk13ag==&ch=Kz7FKJhduGvWtSA0Qbh1s6rfK6IWdMtj7VusWQe83x_7spp1rasKRQ==],
the device is now at 92% when trained with a limited vocabulary of 20 words. But,
after all - it is only May 2018. Just think what it will be able to do by Christmas!!
Cost Of Health Care Continues To Increase -It's not too surprising but a recently
released study reveals that the major drivers of high healthcare costs [http://r20.rs6.net/tn.jsp?f=001eAeftIxjbEQJHDYhcFcHACbCNH6zLSSV846nUmw_zNzVlhuZ4CZqqsJI6KUkigJ-Ad4bxvgpQokR2JF03j3CtV0lw5vT3n0Ak-Y2ea2FGviXQnZkg_honBuWBJA312tzjnF9A7TmF3kD4inSuOmXpFXRvL48d13YR_k7P_OQyBBQ6Y0yjxrCrHpYNtuyg8SIbSMtEVgMppseMZT2s8kACGE3xE9VSj_q&c=jlecrwKeang21aP7d-FltSLtYFoMyMeSOz3d4eytwFaoMR4yKk13ag==&ch=Kz7FKJhduGvWtSA0Qbh1s6rfK6IWdMtj7VusWQe83x_7spp1rasKRQ==]
in the USA are essentially higher prices for nearly everything-from physician care
to hospital services to diagnostic tests and on to pharmaceuticals to say nothing
of the costs associated with administrative complexity. The study was completed 
by researchers from the Harvard Global Health Institute [http://r20.rs6.net/tn.jsp?f=001eAeftIxjbEQJHDYhcFcHACbCNH6zLSSV846nUmw_zNzVlhuZ4CZqqsJI6KUkigJ-WrryHOcSPJapInWzG49wjsAuazynwTbslozXuBdOar9PXVAhOkzr27PuS5NZit3nzhQyN3VTMwe_4-6uheQ6gasm8HdA7oYMFFc71L0U6it9c2m688eaiA==&c=jlecrwKeang21aP7d-FltSLtYFoMyMeSOz3d4eytwFaoMR4yKk13ag==&ch=Kz7FKJhduGvWtSA0Qbh1s6rfK6IWdMtj7VusWQe83x_7spp1rasKRQ==]
and the London School of Economics [http://r20.rs6.net/tn.jsp?f=001eAeftIxjbEQJHDYhcFcHACbCNH6zLSSV846nUmw_zNzVlhuZ4CZqqsJI6KUkigJ-8s0F8VwV3GREYiNumqUXGMgjBRhwzVyN5JP6zWKJmOKe1cKuePti17EbvGj_q5CvUm4fuSw-6X3Y8bKOarjr7mikUMt-1mZft8QCgo2dHkQ=&c=jlecrwKeang21aP7d-FltSLtYFoMyMeSOz3d4eytwFaoMR4yKk13ag==&ch=Kz7FKJhduGvWtSA0Qbh1s6rfK6IWdMtj7VusWQe83x_7spp1rasKRQ==]
and published [http://r20.rs6.net/tn.jsp?f=001eAeftIxjbEQJHDYhcFcHACbCNH6zLSSV846nUmw_zNzVlhuZ4CZqqsJI6KUkigJ-tT0EIMdrtGq5PyuJJZZRwABBNhvx6lofCLl-GZNVS0I7PE3CW5LgQVQSaL4UA0mp7MP-qa9CYxGl9mJSjYCn5jxDCoDkVf-vyk2D2u4Adh4N_tKme-9KzgOuKcKdxqj18uSnV26PcTe4Lwm8Zk3SUz4EggiIXdxf&c=jlecrwKeang21aP7d-FltSLtYFoMyMeSOz3d4eytwFaoMR4yKk13ag==&ch=Kz7FKJhduGvWtSA0Qbh1s6rfK6IWdMtj7VusWQe83x_7spp1rasKRQ==]
in the March 13, 2018 issue of JAMA (Journal of the American Medical Association).
The researchers compared USA health care cost data with 10 other comparable countries
(i.e. Australia, Canada, Denmark, France, Germany, Japan, the Netherlands, Sweden,
Switzerland, and the United Kingdom) on nearly 100 data points.
And, the findings [http://r20.rs6.net/tn.jsp?f=001eAeftIxjbEQJHDYhcFcHACbCNH6zLSSV846nUmw_zNzVlhuZ4CZqqsJI6KUkigJ-DBrVhsgpi4Vci3IVC1GcVr6apLvmL8xJYpgD29p9gx0L1UECSn6-gBDqnBdeuJB8oUE5XOiglv2GGxf1vgBzPWTiaJlglREoWhOkkVWYk-w0fwTcwCPpjC_m-EJnl_pXWxWRMpNqrrJQqDzDJ_fiHEZVXdf9T5J7VYwBVEfQaGRCjjDfX1wiRSlpVWi1bfvZdUTgauizdmfucT0nY9CfEgaE05a6hmBp&c=jlecrwKeang21aP7d-FltSLtYFoMyMeSOz3d4eytwFaoMR4yKk13ag==&ch=Kz7FKJhduGvWtSA0Qbh1s6rfK6IWdMtj7VusWQe83x_7spp1rasKRQ==]?
In no surprise to many of us, the study confirmed that USA health care costs are
 way higher with worse population health outcomes and less access to care than all
of the other wealthy countries. For example, the USA percent of GDP for health care
in 2016 was 17.8% and growing. The next highest was Switzerland at 12.4% to a low
of 9.6% for Australia. In a point of further humiliation, our USA life expectancy
was the lowest of the entire group at 78.8 years (range = 80.7-83.9 years); and,
 the percent of the USA population with health insurance coverage was 90% - again
lower than all of the other nations (range: 99%-100% for the remaining 11 nations).
I recommend that you read the study. It blows away a lot of myths about USA health
care. Folks...I keep saying it: "We've got a problem". If we continue the current
course with the current demographic trends, the entire system is unsustainable. 
Health care is Job #1 in America but: 1) not well understood, 2) complex, 3) system-centric
rather than consumer-centric; and, 4) disconnected from the average person because
of the way health insurance is structured. Change will happen one way or the other.
Either we lead the change or change will happen to health care. Either way - it's
moving forward...
Not That I'm A Bearer Of Bad News, But - Since I'm on a downer today, I thought 
you should also be aware of that the well-being of USA citizens took a hit in 2017,
according to the annual Gallup-Sharecare Well-Being Index [http://r20.rs6.net/tn.jsp?f=001eAeftIxjbEQJHDYhcFcHACbCNH6zLSSV846nUmw_zNzVlhuZ4CZqqsJI6KUkigJ-SXLfEksduvrk-QZ6txyeeZyFlAuyx74DzNal8_dYu60Z4N8lHc5KseNv__Idb8E1IoFlXzfztBCLeGFJl082ZBE7feZizk4O0gcOw6PQYhYBu8uMfxtbmYUk1N5vf3IQnywQ0l4Sg6FuuAF381uiug==&c=jlecrwKeang21aP7d-FltSLtYFoMyMeSOz3d4eytwFaoMR4yKk13ag==&ch=Kz7FKJhduGvWtSA0Qbh1s6rfK6IWdMtj7VusWQe83x_7spp1rasKRQ==]
results released last month. In fact, 2017 saw the worst decline in well-being in
the 10-year history of the survey, marking the worst results since the Great Recession.
The top five states in well-being included:

1. South Dakota (64.10)
2. Vermont (64.09)
3. Hawaii (63.39)
4. Minnesota (63.12)
5. North Dakota (63.06) - we'll stop right here J
Something is going right in the Upper Midwest. Perhaps it's the winter storms? Or,
the prairie mentality? Any ideas on why?
"It's Not The Money, It's The Money!" - I've used this moniker before which I learned
from a close friend and colleague nearly 30 years ago in referencing the problems
with the health care system. So, it wasn't surprising to learn that 71% of the Medicare
Shared Savings Program ACOs recently indicated that were likely to leave the program
if forced to take on risk. The results came from a survey [http://r20.rs6.net/tn.jsp?f=001eAeftIxjbEQJHDYhcFcHACbCNH6zLSSV846nUmw_zNzVlhuZ4CZqqsJI6KUkigJ-_SRwBYtUmeZxertKz0tbfelnmY_zLHV-_b06j3LyLvCilDVMwq8R-83qMABo9QGOVrAZhQE0YHUxdjmvts_hADWkdsy9u7G_SLTkIGQST0aa5URYzoTyrfh4uSL9ZQkH2BUrIn9rcTc=&c=jlecrwKeang21aP7d-FltSLtYFoMyMeSOz3d4eytwFaoMR4yKk13ag==&ch=Kz7FKJhduGvWtSA0Qbh1s6rfK6IWdMtj7VusWQe83x_7spp1rasKRQ==]
conducted by the National Association of ACOs (NAACOS). In responding to the survey,
the ACOs noted that the three biggest reasons for their decisions were: 1) the risk
is too great, 2) ACO and CMS rules are too unpredictable; and, 3) the financial 
projections are often unreliable. As Clif Gaus, President/CEO of NAACOS, in responding
to the results of the survey noted, "It's naïve to think ACOs that aren't ready 
will be forced into risk in what is ultimately a voluntary program. The more likely
outcome will be that many ACOs quit the program, divest their care coordination 
resources and return to payment models that emphasize volume over value." Such a
 result would be a wrong turn at the busy intersection of health care...
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Future Health
Delivering care in the new virtual world...
Dr. Mom & Dr. Dad As Second Assists - It's only a matter of time before the baton
is passed and we get consumers more involved as "partners" in care delivery. In 
a study recently report in JAMA Dermatology, pictures taken by parents of a child's
skin conditions via a smartphone camera and forwarded to a dermatologist for diagnosis
were of high enough quality to allow for reliable pediatric dermatology care. The
result is that teledermatology involving parents as partners makes for better access
at lower cost with comparable results. The study was completed at Children's Hospital
of Pennsylvania (CHOP). The study involved 20 families who were given photography
instructions and 20 families who were not given instructions. The researchers then
compared diagnoses made during in-person visits with photograph-based diagnoses 
made by a separate clinician.  The photograph-based diagnosis matched the in-person
diagnosis 83% of the time with only three of the 87 images not allowing for a conclusive
remote diagnosis due to poor photographic quality. In a similar study released in
January from researchers at Stanford University, a computer assisted model had an
accuracy level of 95+%. So, the advent of Dr. Mom and Dr. Dad is on the horizon.
 It's an important shift especially in shortage specialties like pediatric dermatology.
Artificial Intelligence On The Rise - For those of you who are trying to keep up
 with all of the changes in technology and the implications for health care, it's
rather difficult given the plethora of studies and information. If you're trying
 to understand the implications of artificial intelligence, check out the 2017 Artificial
Intelligence Index [http://r20.rs6.net/tn.jsp?f=001eAeftIxjbEQJHDYhcFcHACbCNH6zLSSV846nUmw_zNzVlhuZ4CZqqtgr0W3L6rQ43DSZn_U0i03SrjQPx8fDp8bILY9jnGEYgbhLoMmfZ4Dh6fdOQXSXq1FyEw8EBxZpHxBXOZdKdWXQs8ZTZNC2NPg3_ZV6B5afgvou7IqXtCOxkxa_-I14XHyVZrOHWy6C&c=jlecrwKeang21aP7d-FltSLtYFoMyMeSOz3d4eytwFaoMR4yKk13ag==&ch=Kz7FKJhduGvWtSA0Qbh1s6rfK6IWdMtj7VusWQe83x_7spp1rasKRQ==]
completed by a multi-institutional, multi-disciplinary group of experts. At 101 
pages, it is ripe with information on the future of AI. Check it out! The reason
 this is important relates to another survey study [http://r20.rs6.net/tn.jsp?f=001eAeftIxjbEQJHDYhcFcHACbCNH6zLSSV846nUmw_zNzVlhuZ4CZqqsJI6KUkigJ-KLsq9WV321vAjTdJVBQ9K2NUtPd8pHmYZb_hIcd7-WbZUi-qqF5XDKM3rsUFVY1VYmCJWrB_1xk-aQ3a1B6FkBhMqK3oEueQ8W9pJUVuSg-FcWN_ScAEva-GSVb2tkTErdNwGWHnE8HUAmmDolJ_PGBQidBW4d2iBEySlt5NQJJlvjTyGvGp7yVcz0FdRLGtsk-EtlIPdpM=&c=jlecrwKeang21aP7d-FltSLtYFoMyMeSOz3d4eytwFaoMR4yKk13ag==&ch=Kz7FKJhduGvWtSA0Qbh1s6rfK6IWdMtj7VusWQe83x_7spp1rasKRQ==]
of 20+ healthcare organizations released in December 2017 by the Center for Connected
Medicine. That survey found that the healthcare organizations were marking artificial
intelligence deployments as a "low" or "very low" priority in 2018. Rather than 
focusing on AI, the systems are leaning towards initiatives in cybersecurity defenses,
consumer-facing technologies, and leveraging predictive analytics for precision 
medicine. While these areas are very important and there are only so many resources
available - AI should be moving further up the technology list. From my perspective,
leaders in the use of AI as an "adjunct to care delivery" will be the successful
 health systems of the future. Just watch in the coming years as the nimble AI adjudicated
care delivery systems outpace the traditional care delivery organizations. It's 
going to happen - and, happen quickly. Stay tuned!!
Then, Consider The Impact Of Artificial Intelligence On Work - As if you don't have
enough to do already, you may want to consider reading (browsing) the 20 most insightful
books [http://r20.rs6.net/tn.jsp?f=001eAeftIxjbEQJHDYhcFcHACbCNH6zLSSV846nUmw_zNzVlhuZ4CZqqsJI6KUkigJ-kjdexw-iMtiSkddeeMmNI3NP8h7dIefbOk173hCdp7PN2l2MLqRK9_fr7BN7doHrhOx74ZsRKheoZzu5HxOWhfgOQ0nfV6OTSWxeSNpoNKn8nQuMV6m9QP04G8t4kOF--q-xHlNfy10E9HNRstXt9vWtYMDknqgmYwG3C62Ig65YMIhwUW7f2g==&c=jlecrwKeang21aP7d-FltSLtYFoMyMeSOz3d4eytwFaoMR4yKk13ag==&ch=Kz7FKJhduGvWtSA0Qbh1s6rfK6IWdMtj7VusWQe83x_7spp1rasKRQ==]
recommended by Upwork - an organization that monitors the impact of technology on
work. It's very clear that technology is changing the way work gets done from manufacturing
cars to mining coal. And, if we think it will not impact healthcare we will be wrong,
wrong, wrong. In fact, the industry is at the forefront of change. Why - because
 historically we've solved our delivery problems by throwing people at the problem.
But, that's costly and part of the underlying problem with costs in healthcare delivery.
Couple that problem with the fact that over the next decade large numbers of our
 workforce will be retiring, becoming disabled or dying as the Boomers move into
 their last quarter - and, the industry is set for dramatic, rapid change in how
 work gets done!! Here are some thoughts from Stephane Kasriel, CEO of Upwork as
 recently presented at the 2018 World Economic Forum [http://r20.rs6.net/tn.jsp?f=001eAeftIxjbEQJHDYhcFcHACbCNH6zLSSV846nUmw_zNzVlhuZ4CZqqsJI6KUkigJ-kbQ8Ut1hnMEZpoCmhpE80mJ9qTVNlQBl9F6D83HVSbOs4b2T7Pe6B5MBBNNzZt35sljJxpsOGGEJDwqvY85iqSjhtTDBxZpsVyPFovpu6ie_AL09G-0Hv28BkQVwXHHuIqkZLlZENWLFhnhxQKmNYUeU7VD8fH-Fcy4VDgwQazsLAzGRXoTCHaqlC1QLjsRp&c=jlecrwKeang21aP7d-FltSLtYFoMyMeSOz3d4eytwFaoMR4yKk13ag==&ch=Kz7FKJhduGvWtSA0Qbh1s6rfK6IWdMtj7VusWQe83x_7spp1rasKRQ==]:

1. AI and robotics will create more jobs, not mass unemployment - as long as we 
responsibly guide innovation - There have been several doomsday scenarios presented
including Entrepreneur Elon Musk's notation that artificial intelligence is "our
 biggest existential threat" to mankind. I'm not sure that's going to happen. In
 fact, it may be the biggest leap forward for mankind - depending on how it is used!
As Kasriel noted in his WEF presentation, society needs to "guide innovation responsibly
[by] opening up new windows of opportunity, not eliminating them." AI requires new
skills and capabilities. Simply doing work the way we've done work for the last 
150+ years will create job loss. However, adaptation of the professions to these
 new capabilities will actually enhance our capability rather than diminish our 
presence and opportunities.
2. Cities will compete against other cities in the war for top talent - we are seeing
this one play out real-time as Amazon strings many cities across the USA along with
the opportunity to be the "second Amazon headquarters city". The Metropoles across
the US cities are competing aggressively [http://r20.rs6.net/tn.jsp?f=001eAeftIxjbEQJHDYhcFcHACbCNH6zLSSV846nUmw_zNzVlhuZ4CZqqsJI6KUkigJ-HUDWV3v4eg69k57Sa6jFIap7YOO2J708hwU2YBq4tv9D5SQjUI6-JpyPQvkl9VzNVWgmgajLg83446wZ4HyRQMVHa24ZFn1zI5-6ktSsW97AZgmK4od39CTSRFesXbdyXI2NiWyb77rOd5Tlt7kdHdhiVKZDVuEiyQYLVgurqzBVFt6CxLtekAH3z_4XoSnbTRTYnAJjv6g=&c=jlecrwKeang21aP7d-FltSLtYFoMyMeSOz3d4eytwFaoMR4yKk13ag==&ch=Kz7FKJhduGvWtSA0Qbh1s6rfK6IWdMtj7VusWQe83x_7spp1rasKRQ==]for
Amazon's attention which will invest over $5 billion in building a second headquarter.
3. The majority of the US workforce will freelance by 2027 - In today's world, about
36% of the US workforce (= 57 million workers) work in freelance situations. It 
is projected that over the next decade, the majority of USA workers will become 
freelancers according to the report Freelancing in America: 2017 [http://r20.rs6.net/tn.jsp?f=001eAeftIxjbEQJHDYhcFcHACbCNH6zLSSV846nUmw_zNzVlhuZ4CZqqtgr0W3L6rQ4pFaOFedZpa8VHe-rG8HVQ-f_9uuftuWh7n-_Qtkja7oBR5gFarCe8ChDpDWR01h-ebsdKNEbx9qIzrQEt_qv0Q90SvW7VvBxfESAu62yjHlskQ2rFLmxkWniAvxc_yGfvzdJNZOGbMHTTWs4owP7vQpD2UGL0PHc&c=jlecrwKeang21aP7d-FltSLtYFoMyMeSOz3d4eytwFaoMR4yKk13ag==&ch=Kz7FKJhduGvWtSA0Qbh1s6rfK6IWdMtj7VusWQe83x_7spp1rasKRQ==].
4.  Education breaks out of the silo - I sit on the board of a major distributed
 graduate university and it is safe to say that we are reassessing the future of
 higher education. We are coming to the recognition that the approach we've taken
toward education is no long sufficient in preparing the workforce for the challenges
they will face. Something needs to be done. I personally believe that education 
will no longer be an "dedicated, time-focused experience" but rather will require
that the workforce engage in an "ongoing, continuous learning environment". The 
approach to such a situation requires vastly different models, processes and business
models from the tradition of higher education.
Managing 23, Me, Myself and I - Several weeks ago, the genetic testing company, 
23andMe [http://r20.rs6.net/tn.jsp?f=001eAeftIxjbEQJHDYhcFcHACbCNH6zLSSV846nUmw_zNzVlhuZ4CZqqsJI6KUkigJ-_JjnVLfWmL2uveHAl2W9CMG2lGbolYpusTMNVXuDPpW7r69nC3_Ogg202nW2RC1zNo2EbnUo0z93ZWhaP3ny-FS5ocdFJBTktJ9h59SAOE61JYq2BrfwPw==&c=jlecrwKeang21aP7d-FltSLtYFoMyMeSOz3d4eytwFaoMR4yKk13ag==&ch=Kz7FKJhduGvWtSA0Qbh1s6rfK6IWdMtj7VusWQe83x_7spp1rasKRQ==],
announced that the FDA had finally given the go-ahead for launching a direct-to-consumer
(D2C) testing kit for cancer. Consumers will be able to pick up the kit without 
a prescription for tests like BRCA1 and BRCA2, which have been genetically linked
to a higher risk of ovarian, break and prostate cancer. The only problem is that
 the results of the test will provide data and the value of the data is in the interpretation.
Managing that piece of the equation is where the challenges will no doubt arise.
 Keep your eyes on this one for it is the future but the path is unclear...
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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The Weekly Whisk
Musings from a foodie...
I don't usually go beyond Page 6 for my blog but I'm making an exception for this
one because the dinner in Spain was over-the-top wonderful. Dinners in Spain are
 a festive occasion that is marked with lots of hugging, smiling, laughing and general
conviviality. So, it was with excitement that we were invited to a "special" invitational
dinner for the international guests at a Spanish Dermatology conference on Mallorca.
For starters, there is Mallorca. What an island! It's like Kauai, the Big Island
 and Maui all wrapped into one convenient package. We were then just days after 
the Mallorca 312 finished which is one of "the" cycling events in the world where
the cyclist circumnavigates all 312 miles of the island. But, I digress. Back to
 food... Off we went to Flanigan [* * * * *] or, what we were told was King Juan
 Carlos' favorite restaurant. I can believe it. First, if I were King Juan Carlos,
I would travel to Mallorca as much as I could to get away from the stress of leading
the country. And, second, I'd stop in at Flanigan on every visit. They would be 
my hideaway on the island.
The dinner started with Jamon Pata Negra. The term refers to the color of the pigs'
nails, which are white in most traditional pork breeds, but black for the Black 
Iberian breed. I got a short lesson in the differences between all of the "jamon's"
and they are definitely not the same. The term pata negra is often used to refer
 to jamón ibérico in general, which generally refers to any one of three types of
jamon. The finest is called jamón ibérico de bellota (acorn). This ham is from free-range
pigs that roam oak forests (called dehesas) along the border between Spain and Portugal,
eating only acorns. The ham is cured for 36 months with the meat divided into two
types: 1) Black label - which identifies the jamón as derived 100% from pure-bred
Iberian pigs; or, 2) Red label - which identifies the jamón as derived from free-range
pigs that are not pure-bred. Since 2014, the percentage of Iberian ancestry in the
animal must be specified on the label. The next grade is called jamón ibérico cebo
de campo or Green labelwhere thepigs are pastured and fed a combination of acorns
and grain. Finally, the third type is called jamón ibérico de cebo or White label
which is ham derived from pigs that are only fed grain. These latter two types of
ham are cured for 24 months.
Following the obligatory Black label Jamon, we moved on to the Tostadas Tomate or,
diced tomato on toast with olive oil. It was fabulous. They then served a salad 
of Malloca tomatoes, which are much more solid than other tomatoes bought in the
 US with less fluid and a much more tart flavor.  The tomatoes were served with 
Ventresca de Bonito or white tuna in olive oil. Then, came the "Spanish tortilla"
or a diced potato and olive oil combination lightly cooked inside of an egg omelet
where onions can be added as an option. This was followed by a very small fish (I
didn't get the name) cooked in olive oil.
After this amazing start, we moved on the main course where we had the option of
 Hake, pan seared in olive oil or a classic seared beef filet with both options 
served with French Fries.  The fries were quite like McDonalds except made from 
real potatoes and they were crispy with slightly less salt. And, if that were not
enough, they served a small salad of cut lettuce and sliced white onions topped 
lightly with a sweet vinaigrette dressing. But, the piece de resistance was the 
ultra-thin apple tart served with a creamy vanilla ice cream. It was to die for 
and, at the end of the meal I figured out why King Juan Carlos liked the place so
much.
It was a classic upscale Spanish restaurant with dinner starting at 10:00 PM and
 ending around 12:30 AM for an "early" evening. Consider it if you get to La Palma,
Mallorca. It's about a 20-minute cab ride from the downtown/beach area. The cabbies
will know how to find it. And, the VERY BEST part was their business card which 
is a wooden clothes pin with the name, address, phone number and web address marked
on the pin. It's quite a reminder. I'm thinking about handing out baby whisks with
my contact information. They're remember me then... Enjoy!!! Flanigan - Puerto Portals,
Local 16 - 07181 Calvia Illes Balears, Mallorca, Spain +34 (971) 67 91 91 - www.flanigan.es
[http://r20.rs6.net/tn.jsp?f=001eAeftIxjbEQJHDYhcFcHACbCNH6zLSSV846nUmw_zNzVlhuZ4CZqqsJI6KUkigJ-kmIc3F0UVATaOVAbHvpsO6NioUDvezCjUS-QDhG1X-6xf-e0kIdUhqipO-C52U07CPggDBAKDKtWFFdLoSwVoVzrUAk8bxL4-Qp0hqJ5H94=&c=jlecrwKeang21aP7d-FltSLtYFoMyMeSOz3d4eytwFaoMR4yKk13ag==&ch=Kz7FKJhduGvWtSA0Qbh1s6rfK6IWdMtj7VusWQe83x_7spp1rasKRQ==]
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

The Good, The Bad, And The Ugly
The ongoing saga...
The Great - The food on Mallorca is Spanish cuisine at its best!
The Good - Traveling overseas and being absent from the daily bombardment of Trumpisms
emanating from Washington except for dismantling of the Iran nuclear deal - which
is a big, big deal in Europe where I was visiting.
The Bad - The anticipated slam the British economy is going to take as the financial
community picks up and moves to mainland Europe with the coming implementation of
Brexit.
The Ugly - The shaking of heads overseas in amazement at the seeming dismantling
 of the American leadership role in international affairs.
The statements in The Fickenscher Files [http://r20.rs6.net/tn.jsp?f=001eAeftIxjbEQJHDYhcFcHACbCNH6zLSSV846nUmw_zNzVlhuZ4CZqqoLqwwSjLSA5PpkiGUewQLdNpKjWJ_caSpiL6lM-6CZ4E34Xx8EApkObjI8PTRF5kbtZC8-dqq8FJinnmIsKU2ggwdNmgTCOzr-EGQZ6owLHdvAt-mEFxgMkJToGFxyaH10-l12yEwly&c=jlecrwKeang21aP7d-FltSLtYFoMyMeSOz3d4eytwFaoMR4yKk13ag==&ch=Kz7FKJhduGvWtSA0Qbh1s6rfK6IWdMtj7VusWQe83x_7spp1rasKRQ==]
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
[http://r20.rs6.net/tn.jsp?f=001eAeftIxjbEQJHDYhcFcHACbCNH6zLSSV846nUmw_zNzVlhuZ4CZqqoLqwwSjLSA5PpkiGUewQLdNpKjWJ_caSpiL6lM-6CZ4E34Xx8EApkObjI8PTRF5kbtZC8-dqq8FJinnmIsKU2ggwdNmgTCOzr-EGQZ6owLHdvAt-mEFxgMkJToGFxyaH10-l12yEwly&c=jlecrwKeang21aP7d-FltSLtYFoMyMeSOz3d4eytwFaoMR4yKk13ag==&ch=Kz7FKJhduGvWtSA0Qbh1s6rfK6IWdMtj7VusWQe83x_7spp1rasKRQ==]
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