Subject: News from Dr. Kevin Fickenscher
From: "The Fickenscher Files" <[email-masked]>
To: <[email-masked]>
Date: Fri, 17 Aug 2018 14:19:56 -0400 (EDT)

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The Fickenscher Files [http://r20.rs6.net/tn.jsp?f=001bAinQa4DiUCpS7kJE-ND858CWfY2K_94dratqIgNy0DatliHaM2SEZcbQsnKpfs5FdiwjvZUoRCJN1b2xySsSIryxTdAgW3mL2yEQwuRieWQ75ig-jShM6AXC2bKZ0Xhi5bEdL6pMZc7uRNu4yaBiENnvs3WfsLOlsJM5HcV7DVG2cj7hlkUIFuoatKYHoyA&c=RdR3xIqc_3dWD9uJMERIH6obChnEZKBJ_t1Wm5abNggnkByqHFMAhQ==&ch=-Uuwmaj3g2uaxV-qO4PtcfPsNRNe32U08-NKzjUDtsKJLyLD8QsODw==]
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The Fickenscher Files, Vol. 6, Issue 11
Kevin M. Fickenscher [http://r20.rs6.net/tn.jsp?f=001bAinQa4DiUCpS7kJE-ND858CWfY2K_94dratqIgNy0DatliHaM2SEf4Up1ShkIlqtNfFKI9jarS73p_2b8fiE8xY8DPCV_VKrtws2wcgTonBVGD9LrWeZGA-POZMvCkjE94berWF3_atgYtwLhhe3eLF1ovdGYaMqFyxTqp7uPXfvlBEE1MoAgHFLe71byneCbN_E82qpsuDxkygM5qtUg==&c=RdR3xIqc_3dWD9uJMERIH6obChnEZKBJ_t1Wm5abNggnkByqHFMAhQ==&ch=-Uuwmaj3g2uaxV-qO4PtcfPsNRNe32U08-NKzjUDtsKJLyLD8QsODw==],
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
"Pope Francis often says, 'This economy kills.' (1)  The divide between the wealthy
and the poor in the United States continues to grow. A handful of billionaires are
literally 'making a killing,' while millions who live below the poverty line are
 'making a dying,' and very few make a fair living. Just one tangible example: without
access to affordable health care, roughly '40 percent of Americans [take] on debt
because of medical issues.' (2)
Father Richard Rohr, leader of the Center for Action and Contemplation in his daily
reflection [http://r20.rs6.net/tn.jsp?f=001bAinQa4DiUCpS7kJE-ND858CWfY2K_94dratqIgNy0DatliHaM2SEZc574RGBLzjCTeJkXMDlHcvQtZ8-VLnOF3P1njnhKDpMvQF1Y1BbWaKYgxMpctbTjrUzs616RvmZgHqMmQzIY7bBkPBmh2VqKYkAsOZkyr3&c=RdR3xIqc_3dWD9uJMERIH6obChnEZKBJ_t1Wm5abNggnkByqHFMAhQ==&ch=-Uuwmaj3g2uaxV-qO4PtcfPsNRNe32U08-NKzjUDtsKJLyLD8QsODw==].
This past week, Father Rohr has been focused on the growing disparity between the
"haves" and "have nots" in the USA and how this is contributing to the abyss in 
our dialogue as a nation.
"The Queen is dead - long live the Queen."
'Everyone' from headlines to bylines to comments on the elevator, on August 16
th with the passing of Aretha Franklin, the Queen of Soul.
(1)Pope Francis outlines key economic struggles in Evangelii Gaudium (The Joy of
 the Gospel), his first Apostolic Exhortation (November 24, 2013), http://w2.vatican.va/content/francesco/en/apost_exhortations/documents/papa-francesco_esortazione-ap_20131124_evangelii-gaudium.html
[http://r20.rs6.net/tn.jsp?f=001bAinQa4DiUCpS7kJE-ND858CWfY2K_94dratqIgNy0DatliHaM2SEZc574RGBLzj31Iq5_TxW8gKBKKmTwNu1d-7VrQ3KvFS7iqmnAQQ7Xb_JbOeeY-A9SUPW-MjLj5mLZKUBM7VW9K-6pdAVkcXb85ujslUvyOIF56X0OBG2JDMB-5z6UkTjU2R1MRxvlOyo5Ef1jHACs7KQ_y0Wdw6vlKR8fSyw-JWBo3KuOuFD2mymMxdZCfzpjtJ5NEAJzSjihpgADAT4_FeScPvJWUJAsvQ6EM-JcADS_DAgBUbUYrwTrSHk3ck6BU5zJVqONyoNcXtNYh3jCs=&c=RdR3xIqc_3dWD9uJMERIH6obChnEZKBJ_t1Wm5abNggnkByqHFMAhQ==&ch=-Uuwmaj3g2uaxV-qO4PtcfPsNRNe32U08-NKzjUDtsKJLyLD8QsODw==]
, 53-60.
(2)The Souls of Poor Folk: Auditing America 50 Years After thePoor People's Campaign
Challenged Racism, Poverty, the War Economy/Militarism and Our National Morality,
https://www.poorpeoplescampaign.org/audit/ [http://r20.rs6.net/tn.jsp?f=001bAinQa4DiUCpS7kJE-ND858CWfY2K_94dratqIgNy0DatliHaM2SEZc574RGBLzjg4f-ai-nTmYmctqpP3zYF2Gel2vAadV-mrUbkA3M_rUdvf5BuCSigw7JkdZI-b9pDNBpif-O77qVuxPUnJbRSeGTzcQ0Xw6zwI6RGXYhE__QvyOKiWtANky1xlEj9hv4XaPtobRag8c=&c=RdR3xIqc_3dWD9uJMERIH6obChnEZKBJ_t1Wm5abNggnkByqHFMAhQ==&ch=-Uuwmaj3g2uaxV-qO4PtcfPsNRNe32U08-NKzjUDtsKJLyLD8QsODw==]
,10.
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A Shameless Advertisement Or, Two...
A Mom and Adopted Dad Made Proud...
Cookie Is Her Real Name - Our youngest, Cookie Harrist - is a "post-modern dancer".
She made the big leap by moving to San Francisco this past year which is one of 
two epicenters for the movement. The other is Berlin which we are anticipating is
next in line for places to visit. Cookie recently was hosted as one of the centerpiece
dancers in "Standing Still" - an experiential dance show at the Haas-Lilienthal 
House in San Francisco. Here [http://r20.rs6.net/tn.jsp?f=001bAinQa4DiUCpS7kJE-ND858CWfY2K_94dratqIgNy0DatliHaM2SEZc574RGBLzjmpZWje8XUcWJuGDnystO_-lsDKkysVl2HBLyRRKURU2arNzE6muL3WqCcUVUFGmly5qhSqw9q7mfJiGIwGsnKGkrzrChYfh2wyewv-Xsw_iMrZM2sAA_mLKA7rBfMjp-suDB89q9Fw4eyu9A2jtrZ_Fn-3LiWz-es8W-OSbf7EGd3g5KWlxWBxcxlhoZ2a2y&c=RdR3xIqc_3dWD9uJMERIH6obChnEZKBJ_t1Wm5abNggnkByqHFMAhQ==&ch=-Uuwmaj3g2uaxV-qO4PtcfPsNRNe32U08-NKzjUDtsKJLyLD8QsODw==]
is one of featured songs and some selected pieces [http://r20.rs6.net/tn.jsp?f=001bAinQa4DiUCpS7kJE-ND858CWfY2K_94dratqIgNy0DatliHaM2SEZc574RGBLzjkHdWmNUGz76fiwfZntEAby2slhLIkrQy2Xq5N9brp9D4xl5fU_0xkyBhfyIc1S1c7Gl_1k7TuofIeKRxk1CNNTo1xlHj3Lkd3j61TUHnAjZNui4QZyfuYZwj_XWlufzs&c=RdR3xIqc_3dWD9uJMERIH6obChnEZKBJ_t1Wm5abNggnkByqHFMAhQ==&ch=-Uuwmaj3g2uaxV-qO4PtcfPsNRNe32U08-NKzjUDtsKJLyLD8QsODw==]
from the show. Enjoy!
But, There's More - Michael is a musician. In addition to his career as a modal 
musician (music from the Middle East), he's also part of Amerinouche [http://r20.rs6.net/tn.jsp?f=001bAinQa4DiUCpS7kJE-ND858CWfY2K_94dratqIgNy0DatliHaM2SEZc574RGBLzjbs9P2xq4bTZ08gPB75johYc4T_3qNT6BdvKnUr0qz_e4zKAKvpqTf5eREqm5sVG-e2rd9GPoNuh_IqujfWxKOoRTUHN_NCcel8QnkI65E7yWYjnbxVCKxQ==&c=RdR3xIqc_3dWD9uJMERIH6obChnEZKBJ_t1Wm5abNggnkByqHFMAhQ==&ch=-Uuwmaj3g2uaxV-qO4PtcfPsNRNe32U08-NKzjUDtsKJLyLD8QsODw==].
He's the bassist with a fabulous beat. Watch him play. His mind and body become 
one with the music. It's fun to watch - and, hear.
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Media To Consider
Books and Articles worth a Review...
OyVey - If you haven't heard the Terri Gross interview on NPR's Fresh Air from July
19, 2018 - it's worth the time of listening.  Terri is one of the best interviewers
on either television or radio - from my perspective and, she's extremely fair, always
trying to get to the real information.  Check it out!  The interview [http://r20.rs6.net/tn.jsp?f=001bAinQa4DiUCpS7kJE-ND858CWfY2K_94dratqIgNy0DatliHaM2SEZc574RGBLzjtpdf8_xiNnuJ63ywijXOe0Z4owXHjlak1JzaZLIjRNog6W5TDjnFmsGuY-C4CvBOV0YBHQtUrVEcPGN2EUz7UJ1AnqnOfNCuofBY8ZrzbMZjzC9AUPtANhjVRRnoUcGjWCPWIPYiNvlHufOOMbVHZnUVKLWMEAfu-5sxtyCYfmk0NqxtTAA4xwy70DrT4eyW8w9yXww4qnjuSnhm6v0lUj-Ad4iIqGjRlaqf3HtdwgyPZ4Gv6BihzA==&c=RdR3xIqc_3dWD9uJMERIH6obChnEZKBJ_t1Wm5abNggnkByqHFMAhQ==&ch=-Uuwmaj3g2uaxV-qO4PtcfPsNRNe32U08-NKzjUDtsKJLyLD8QsODw==]
will make your hair stand on end.
The Ongoing Aging Issues - One of the challenges many of us face is the slow moving
implications of aging.  Unlike the younger years when we were seemingly invincible,
quick and agile - there are times as we age when we begin to feel a bit vulnerable,
slower than normal and even a bit clumsy.  While others may not see it, the decline
is self-evident.  But, it's not as bad as it seems AND, we can do something about
it. Forgetfulness [http://r20.rs6.net/tn.jsp?f=001bAinQa4DiUCpS7kJE-ND858CWfY2K_94dratqIgNy0DatliHaM2SEZc574RGBLzj5J7hbFvSprnz4TC1G2cSuh0jEmBmskoEDSHKW2OWD4Fex3IlUJd7vmlq4Y2aWy319aGv92VDHEwlouExGMbW1i-g5cvpJW6Au7RZ6z8heBc4mP221MVCswrChBDD06VqOpyhJs_SABt-Ba90Jda5K1kJ-0zsJzxo_waMI_BTBGt7mjh1_TF6lseKrwg52avZtlHy8P8XML2ghw_WRmEusMsuz6r6GhAVC8gIRR2silTxOmvlyohsYBu7fkMkPADhhecN8BPRrTLUJgH94uy0UKf4ANehYvISg773fFF3fGeDqO56PQW7cye3l1bcTu7WLOZ_pPJJ8X8=&c=RdR3xIqc_3dWD9uJMERIH6obChnEZKBJ_t1Wm5abNggnkByqHFMAhQ==&ch=-Uuwmaj3g2uaxV-qO4PtcfPsNRNe32U08-NKzjUDtsKJLyLD8QsODw==]
is one of the big issues.  Check out the information on WebMD if this is one of 
your bugaboos.
Curiosity and Medicine - Atul Gwande, MD recently gave the UCLA commencement address
[http://r20.rs6.net/tn.jsp?f=001bAinQa4DiUCpS7kJE-ND858CWfY2K_94dratqIgNy0DatliHaM2SEZc574RGBLzjUk6uLz0bMnJYfbD4M4VmCaoJKlHtNf6VqFZK37gy-WOMhSxPMPnDStTQ4dEeSxpvBT0H32LVGA1fbBGe70kle9rLjmL07dy5cze8ork95sAOLIlFCyiDVvqwxwzxg0as3bxdCYWX85guMg1K9Rry6sIC7Hsi4L25l0xSb4rV1m4=&c=RdR3xIqc_3dWD9uJMERIH6obChnEZKBJ_t1Wm5abNggnkByqHFMAhQ==&ch=-Uuwmaj3g2uaxV-qO4PtcfPsNRNe32U08-NKzjUDtsKJLyLD8QsODw==]
for the School of Medicine graduate in June, 2018.  The address was titled: "Curiosity
and What Equality Really Means".  It is an excellent reflection on the "why?" that
many of us learned in medical school and too often let fall by the wayside.  It's
an excellent reminder that as health care professionals, one of the most important
elements we bring to the bedside in caring for people is our curiosity.  At least
for the moment, no technology, learning machine or protocol will replace that capability.
 Consider it...
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Consulo Indicium
Information for your Consideration...
Drug Overdose Deaths: Moving From Shrugging Shoulders To Action - The death toll
 from drug overdose [http://r20.rs6.net/tn.jsp?f=001bAinQa4DiUCpS7kJE-ND858CWfY2K_94dratqIgNy0DatliHaM2SEZc574RGBLzjgywk-UHG7lLoboEs9YVetI93koXw-yukY5t7VJbSCrYui3Q80g3ZABEsJPrgSqgYJprlZLJpQbd4hUFsg5Wc1_-aOzWA0VcvSptu30NnrHwws2EKB13EHm2uWZSgQz1qPb_3gplHOrJVtwkN7ajYDh47CQT7EOTfK_CCb_ZSNiXGgNNSeQuWMxWfAhh66TzTGdxPcFx7P-c=&c=RdR3xIqc_3dWD9uJMERIH6obChnEZKBJ_t1Wm5abNggnkByqHFMAhQ==&ch=-Uuwmaj3g2uaxV-qO4PtcfPsNRNe32U08-NKzjUDtsKJLyLD8QsODw==]-
in particular, opioids - continues to climb, increasing to more than 72,000 Americans
in 2017 or, about a 10% over the prior year. The deaths from drug overdoses even
 exceeds the highest recorded levels for car accidents and gun-related deaths and
outpacing influenza, pneumonia and suicide - which makes the tragedy all that much
worse. So, the question is Why? According to the CDC, the cause is because "...overdose
deaths involving synthetic opioids rose sharply, while deaths from heroin, prescription
opioid pills and methadone fell." Furthermore, certain areas of the country have
 been hit harder than others. The New England states and Appalachia have been particularly
hard hit with West Virginia at the top - tipping the scale at nearly 59 overdose
 deaths per 100,000 residents. But, something can be done that's not being done.
 As Patrice A. Harris, M.D., chair of the AMA Opioid Task Force, noted, "We know
 what works. We can point to states where making access to medication assisted treatment
(MAT) has been a priority, and the mortality rates are doing down." Such programs
need to be uniformly available across the entire country. The hold up is primarily
with state legislatures making the investments. Now is the time for the medical 
community to step forward and aggressively push for programs at the state level.
Meanwhile, at the state level, one example of state action is the lawsuit by New
 York state [http://r20.rs6.net/tn.jsp?f=001bAinQa4DiUCpS7kJE-ND858CWfY2K_94dratqIgNy0DatliHaM2SEZc574RGBLzjS3i5uo6y2bvQU3kDqoqY5s7cP-SB5YR6f76AxMhZMkl22TJEzHhzIzM-OaIXM-6wxkl9lRLvYXZmcCaTMClYpYM_Mve0yJWiUa-ESDrV1Fzx3WtkSt-ovqQ6WugN1BbkoYcu-q47_1K3EOjRKZKNk4AcGBNnY7-QoRoleppzPvm93q9JJVH6Ampgw6KNsfJ8fHlZ6lIhVF2a86h_7m5NchUFNmo2NHMF&c=RdR3xIqc_3dWD9uJMERIH6obChnEZKBJ_t1Wm5abNggnkByqHFMAhQ==&ch=-Uuwmaj3g2uaxV-qO4PtcfPsNRNe32U08-NKzjUDtsKJLyLD8QsODw==]
which was filed against Purdue Pharma. The reason? The state alleges that the pharma
manufacturer of fentanyl misled physicians on the safety of the drug which has been
linked to the addiction, overdose and deaths of many people throughout the nation.
In announcing the lawsuit, Governor Andrew Cuomo stated: "The opioid epidemic was
manufactured by unscrupulous distributors who developed a $400 billion industry 
pumping human misery into our communities."
In The Nick Of Time Or, So We Hope - The Alzheimer's research world was abuzz recently
when Eisai, a Japan-based drug company, and Biogen announced the results of BAN2401.
The drug was used in a trial involving 856 patients from across the USA, Europe 
and Japan who exhibited early signs and symptoms of cognitive decline with a diagnosis
of either mild cognitive impairment or mild Alzheimer's dementia. The key issue 
is that all of the patients had significant accumulations of the amyloid protein,
the clumps or plaques which are present in brain for those people with the disease.
The essence of their finding was that for the first time in a large clinical trial,
a drug was able to both reduce the presence of plaques and slow the progression 
of dementia in patients with the disease. In prior research with other drugs, amyloid
levels have been reduced but the memory decline and other cognitive difficulties
 continued so there was, in essence, no relief. However, for this study - at the
 high dose given - both amyloid levels and cognitive loss declined compared to patients
who had received the placebo. Now, to be cautious, this was a Phase 2 study and 
other drugs have shown promise at this stage only to fail at Phase 3 trials. So,
 we shall wait and see - but, with anticipation!! For those of us with Alzheimer's
in our family history (the cause is unknown), we are continuously vigilant and anxious
about what comes next...
Believe It Or Not - A new study by the Brookings Institute [http://r20.rs6.net/tn.jsp?f=001bAinQa4DiUCpS7kJE-ND858CWfY2K_94dratqIgNy0DatliHaM2SEZc574RGBLzjCWf9tpMPJeI-wc6MElDDjettJ199yCeSqizh2QIgG6XwrJ8IvJXXblJ6LOXHjgh9vkMGgvYMtwHXBBFgPjcIcSIN9sBOVoXN6L8DIm9TNkF-CzZO3zQwPASsA8LxAgNByeRYVjCrKhXGHdP09aHd6SU_1m4NNt_eop-6_kVKjZkX6J-gjmwPZ2WmB_1ib3YX_7AO9vwvPPdDUKkUQaTVvnb9SteRVzhe&c=RdR3xIqc_3dWD9uJMERIH6obChnEZKBJ_t1Wm5abNggnkByqHFMAhQ==&ch=-Uuwmaj3g2uaxV-qO4PtcfPsNRNe32U08-NKzjUDtsKJLyLD8QsODw==]
revealed that ACA (= ObamaCare) "premiums would likely be decreasing next year if
the Trump administration and congressional Republicans had left the law alone". 
The data from the study showed that the premiums would be 4.3% lower. Why? Because
the healthier people leave the individual market which raises premiums for those
 who stay and keep their insurance in place because they are most likely at higher
risk. For those of us who are cynics - these are the "intended consequences" of 
dismantling the program. But, I'm taking the long view. My prediction: we will be
back to something like ObamaCare in the not-too-distant future. Remind me that I
 predicted this in case I forget (SEE prior note).
Shulkin's Legacy Lives On At The VA - In a long awaited decision, the Department
 of Veterans Affairs finalized a new rule that will allow providers to treat patients
across state lines using tele-technologies. It's part of the ongoing movement toward
the use of virtual technologies for enhancing and delivering care. The big obstacle
to the advancement in use of virtual technologies has been state licensure laws 
which have required that anyone being treated at an in-state entity be licensed 
in the state. The new rule [http://r20.rs6.net/tn.jsp?f=001bAinQa4DiUCpS7kJE-ND858CWfY2K_94dratqIgNy0DatliHaM2SEZc574RGBLzjLXkWefH-4fVGLk4I4R2OYw2R1T2wKHy0btowZH9VH-Uqrzf0eWNP2ly5x_aYyqhF01nqKAz8lezDEkUsWKLMzq1dQ0Cq7Q4XepgdOCsn_Ke_X3QcLWW1CMZmZ0yQxF0urV2objEDTm-E0Mt74gRp5G1d_pklcewBIbTE2yzKe9WZGfeYTdcUZFP3C79AEsB1KD8Clnto_ILW8o6x9qJ191Ju3WJIhrWMQ9GNXH5M9C-BLhCiKl0a4lZLl6o1IGm7VvTzUXz-vYdmWMwfDzngLG-IVzxufUzyuIjLJBevRwgA8jfgyKuSuN5XtGdFU-lSDGxsIvTMVTE=&c=RdR3xIqc_3dWD9uJMERIH6obChnEZKBJ_t1Wm5abNggnkByqHFMAhQ==&ch=-Uuwmaj3g2uaxV-qO4PtcfPsNRNe32U08-NKzjUDtsKJLyLD8QsODw==]
finalizes a proposal from last year which laid out the approach for the VA to override
state licensing restrictions [http://r20.rs6.net/tn.jsp?f=001bAinQa4DiUCpS7kJE-ND858CWfY2K_94dratqIgNy0DatliHaM2SEZc574RGBLzjAtp1g10ZDp2-rVmqpZ46d-cEC4UkiOZxFXq9N43WOsnuuxsfY4wKR9gKn-aZd4Kd2G6vkvKxriah0BhGHisidCHGyw3OU9RiAj6_SLaC-4ENzztorVzUQewZ9i0bWEX7GTTiwCKpWBKL4OTE_O5OUL4k6yD3-euH3HyFlSRhfOkihkChRuq_BWBX0OcEAfeEBWJVBlUzeErncnMG5h2_2Q==&c=RdR3xIqc_3dWD9uJMERIH6obChnEZKBJ_t1Wm5abNggnkByqHFMAhQ==&ch=-Uuwmaj3g2uaxV-qO4PtcfPsNRNe32U08-NKzjUDtsKJLyLD8QsODw==]
so clinicians can treat veterans from anywhere in the country. It's a legacy of 
David Shulkin, MD's leadership when he announced about one year ago the VA's Anywhere
to Anywhere [http://r20.rs6.net/tn.jsp?f=001bAinQa4DiUCpS7kJE-ND858CWfY2K_94dratqIgNy0DatliHaM2SEZc574RGBLzjcJMuRIeUHUnDfktvDcyFnY9DsqKMXfTWiDOHmJXntPK4ZpJXkBKONVqrvTFqICqKreNkSF-NbnIjFTXI-c4RCedf-u-4FxTyn0udqdCwv0QXYQTcv4oQMZIJuh2o0HHXU5YxhxDixSF0xdr-tx2vNgSVBL8EOVHkZQj2dm_Q4-ohz5D41wfALU2_CkAL2MHvbDahJ4cPvQfBXnQY5cckX-Ainua0IzdS&c=RdR3xIqc_3dWD9uJMERIH6obChnEZKBJ_t1Wm5abNggnkByqHFMAhQ==&ch=-Uuwmaj3g2uaxV-qO4PtcfPsNRNe32U08-NKzjUDtsKJLyLD8QsODw==],
telecare initiative. The VA's leadership is a harbinger of what's to come.
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Future Health
Delivering care in the new virtual world...
Keeping Up Or, Not -The explosion in medical knowledge is daunting. Last year, more
than 2.5 million clinical studies were published, and the rate of increase is accelerating.
For example, in 1950, it took 50 years for medical knowledge to double. By 1980,
 that had reached just 7 years. In 2020, the projection for the doubling of knowledge
in medicine is 2.5 months. Imagine that!! I think it is amazing how much has changed
since I graduated (a ways back J) but those changes pale in comparison to what the
future physicians will be managing. It's all happening because of artificial intelligence,
machine learning and the like. AND, it's one of the reasons that we need to reconsider
the medical school curriculum to integrate the use of information technologies as
a core component of medical school training. I don't believe doctors will be replaced
anytime soon - unless they don't learn how to use these new and evolving tools which
provided "clinically augmented intelligence." Those skills are as important - if
 not more important - than the biochemistry, physiology and anatomy of yore.
GAFABAT - Have Your Heard About It? - There's a new term that's beginning to float
around the ethernet = "GAFABAT". If you have not heard about it, you should know
 about it because GAFABAT is working to change your life in both direct and indirect
ways - at home, in the office while working, while sleeping and even while simply
contemplating. So, what is it? It is short for "Google, Apple, Facebook, Amazon,
 Baidu, Alibaba and Tencent or, GAFABAT. This small group of seven companies is 
all about artificial intelligence and changing the way work, life, living is done.
These companies have attracted the very best talent in the world to help them make
changes across the board in our lives. Their data sets are massive - so massive 
that you are most likely not even able to comprehend their increasingly ability 
to not only understand any number of work-related activities but, also to understand
you. While I am a big believer in artificial intelligence and machine learning, 
I'm also increasingly of the opinion that we need to keep a watchful eye on the 
developments of this field. For example, in China there are all sorts of reports
 on the use of government surveillance to manage the populace that are powered by
computer vision and face recognition technologies. In that nation, you can be followed
anywhere. But, it's not just China. The same applies to London and increasingly 
in many urban areas throughout the world. And, it's not just our faces. It's what
we buy, what sites we visit on the Internet, what programs and songs we download
 from Apple, what items we buy at the grocery store. In essence, what we do every
minute of every day in our life. While there is incredible good that will no doubt
come of this knowledge there is also the potential for "not so good". We should 
consider those issues. We should debate them. We should deal with them rather than
brushing them aside. I offer these thoughts after two cups of coffee on a Saturday
morning. Imagine what my thoughts will be by this afternoon...
The Reality Of Our Reality - There is an evolving technology that is likely to change
health care in some very substantial ways. It's been primarily a focus of the gaming
industry but all of that is about to change. Specifically,Virtual Reality (VR) and
Augmented Reality (AR) are coming of age. These two technologies are increasingly
being used in various industrial sectors and only now coming to health care. While
it's clear that the technology has a bit of further development and is only at the
very formative stages of development, it's also clear that it could very easily 
alter our whole notion of how, where, who and when care is delivered. Let's consider
just two examples:

* Training - The process for educating health professions students and for orienting
our staff to the workflow of our organizations hasn't changed much until recently.
We're clearly at the formative stages of a disruption in how training [http://r20.rs6.net/tn.jsp?f=001bAinQa4DiUCpS7kJE-ND858CWfY2K_94dratqIgNy0DatliHaM2SEZc574RGBLzjvVmbkxAf01by1gO_qI-Ay_abQfqsgUHrw7RF5RHdNfWuDmD7txtEOJx6CfP_7dNsMj1RQ26d3Y0sp8Q7W5xDxjP2Uu4waoOTvbiRODB73cHcXseTQ7h7WVk9P_iQ2oExWbmMkFSjD2nrXAE2j9dUVxpuxSEJ-Cpl&c=RdR3xIqc_3dWD9uJMERIH6obChnEZKBJ_t1Wm5abNggnkByqHFMAhQ==&ch=-Uuwmaj3g2uaxV-qO4PtcfPsNRNe32U08-NKzjUDtsKJLyLD8QsODw==]
will occur through the use of VR/AR technologies. Some non-health care examples 
include Walmart's introduction of Strivr [http://r20.rs6.net/tn.jsp?f=001bAinQa4DiUCpS7kJE-ND858CWfY2K_94dratqIgNy0DatliHaM2SEZc574RGBLzjMK5oQjXwO7lAx7ZJW-UGyrLGj7XpdxzLnXkWgOqPSwjpdMQyMwaRKHgzpR2L493imxFmv2GBiPdiK0x0qPmOXY7tuXDuj8Hl9I8ssBJVZfs=&c=RdR3xIqc_3dWD9uJMERIH6obChnEZKBJ_t1Wm5abNggnkByqHFMAhQ==&ch=-Uuwmaj3g2uaxV-qO4PtcfPsNRNe32U08-NKzjUDtsKJLyLD8QsODw==]
- a VR tool that helped to prepare employees for its Black Friday sales in 2017.
 It created an alternative, lifelike environment that immersed the new sales associates
in experiences with long queues and crowds in order to prepare them for all sorts
of happenings that occur on Black Friday at Walmart stores throughout the nation.
Or, consider another VR training tool, Oculus VirtualSpeech [http://r20.rs6.net/tn.jsp?f=001bAinQa4DiUCpS7kJE-ND858CWfY2K_94dratqIgNy0DatliHaM2SEZc574RGBLzjCHYMu92L242E5xG6ExBwObJQdVAS7MbS5_yX93d1Zbk2aoST7aFQJ-Is71Bs1vDkafzXXaQ9wdr6tg8JdxioFHS9E9uuu8dAgukyo-elSSpmJkLgR8SzIrP9pkT8XsawVtxFgqASPiPpzqpjDR6i7fVPUb6t1qko64jY1gY-CgY=&c=RdR3xIqc_3dWD9uJMERIH6obChnEZKBJ_t1Wm5abNggnkByqHFMAhQ==&ch=-Uuwmaj3g2uaxV-qO4PtcfPsNRNe32U08-NKzjUDtsKJLyLD8QsODw==]
which helps users hone their public speaking skills in a simulated environment. 
Distractions and other occurrences that are part of engaging with people are built
into the Oculus experience. Imagine how these two tools could be used in health 
care to help workers learn how to manage busy emergency rooms and to engage with
 patients who are experiencing health problems in the acute care setting. In particular,
the VR/AR tools will enable healthcare professionals to practice in a risk free 
environment. Think it's not possible? Think again. Children's Hospital of Los Angeles
(CHLA) is already using Oculus to train staff [http://r20.rs6.net/tn.jsp?f=001bAinQa4DiUCpS7kJE-ND858CWfY2K_94dratqIgNy0DatliHaM2SEZc574RGBLzj4vrfBaUCXVpOStjlxN6Gy1X9Krs6KB8AeBAp0lLmYZE6GF2P1kGfSreLKzoN6Ob5fijd2epoBpjvU1xVBtYR_Wqou0l9ECMrHzjTqXAhNcBgHOPU2ZUFa0iwscL42FbdhfVCODg2JN6YbsWLu6rCYoWBwsCjOiltUiCgrZh8IkCuwOQBCHRCbEz1cRnrzOzI&c=RdR3xIqc_3dWD9uJMERIH6obChnEZKBJ_t1Wm5abNggnkByqHFMAhQ==&ch=-Uuwmaj3g2uaxV-qO4PtcfPsNRNe32U08-NKzjUDtsKJLyLD8QsODw==]
for pediatric trauma cases. And, there are more opportunities on the horizon. Beyond
these ideas, we are now seeing VR/AR used for training surgeons in the OR, technicians
for all types of procedures, and administrative/clinical personnel for enhancing
 their interactions with patients.
* Building Care Delivery Facilities - The construction of health care facilities
 continues to be one of the most expensive efforts in the building business. The
 use of VR/AR offers a host of benefits for reducing costs, creating efficiencies,
avoiding construction mistakes and enhancing the end-user experiences once the facility
is opened. The technology actually lets the future patient and clinician walk through
the environment [http://r20.rs6.net/tn.jsp?f=001bAinQa4DiUCpS7kJE-ND858CWfY2K_94dratqIgNy0DatliHaM2SEZc574RGBLzj-ejeUkewq89P5PnL47Wej0Fk75hj69FDAbb1c9O6opBvOjaHHVpAD7hv6IjAGijsXXr5DxHuFNmQCS9xe3TXskj3gj0cFd0zDrGRe5aRIH0=&c=RdR3xIqc_3dWD9uJMERIH6obChnEZKBJ_t1Wm5abNggnkByqHFMAhQ==&ch=-Uuwmaj3g2uaxV-qO4PtcfPsNRNe32U08-NKzjUDtsKJLyLD8QsODw==]
so that the architects can finalize their designs before construction starts. It
 provides the bridge between the imagination of the architect and the reality of
 end users who will live in these facilities.
It's a new day in health care. Keep your eye on the VR/AR world. It's going to change
how we prepare everyone for doing everything in health care. The imaginary worlds
are becoming reality and, if you can imagine it, you can create it and, prepare 
for it!
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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The Weekly Whisk
Musings from a foodie...
Now, I'm from North Dakota and, while I love the state, I don't expect to find over-the-top,
fabulous restaurants - except my favorite greasy spoons in little towns littered
 across the state. That being said, I was flummoxed when I traveled to Salt Lake
 City for a visit to Valter's Osteria [* * * *]. The food was great but the service
was outstanding!! It's an Austrio-Italiano-Americano type of place hosted by none
other than Valter Nassi - the host of Salt Lake City cuisine par excellence!! He's
Italian so that flavor dominates. The antipasti was a Caprese Salad of sliced tomatoes,
mozzarella, olive oil (of course) and fresh basil. The primi was a ravioli pomodoro
with a homemade spinach and ricotta stuffing followed by our choice of scaloppini
al funghi, pollo alla peperonata (a chicken with a mozzarella and red bell pepper
reduction sauce), or salmone al pomodoro. I got my signed menu for my collection
 and surprise gift of Valter's special olive oil that is grown on his vineyard back
in Italy. It was special!! I'd go again - and, will!!! Check him out: Valter's Osteria
[http://r20.rs6.net/tn.jsp?f=001bAinQa4DiUCpS7kJE-ND858CWfY2K_94dratqIgNy0DatliHaM2SEZc574RGBLzjiTngxKgydpncSvAH5O0XEzi1yxZAc10_BUUCtG7kzY4wArfs1XxrkNkwe7vC2YrsPDkzVg97ETdsxHy_n6df__VJo1o9hzA3OqC7TRfTKAGAmLK76hu4UivhTrEum8wERQOIA96sYuM=&c=RdR3xIqc_3dWD9uJMERIH6obChnEZKBJ_t1Wm5abNggnkByqHFMAhQ==&ch=-Uuwmaj3g2uaxV-qO4PtcfPsNRNe32U08-NKzjUDtsKJLyLD8QsODw==]-
173 Broadway, Salt Lake City, UT 84101 - (801) 521-4563
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

The Good, The Bad, And The Ugly
The ongoing saga...
The Good - Presidents in the USA must be re-elected every four years for a maximum
of two terms. We're at the half-way point on the first term. I'm taking the long
 view: we will survive...
The Bad - First it was "covfefe" - which was confusing, at best. Now, it is "dog"
- which is disgusting, at best. It's lower than low and nothing more need be said.
The Ugly - Watching the news and seeing our government slowly devolve into an irrelevant
presence among the nations of the world. It's time for some of our Republican colleagues
to step out of the shadows first, by saying something then, debating whether to 
do something...
The Sad - The passing of The Queen of Soul, Aretha Franklin, was a sad day for all
of us. She captured our soul and we all offer blessings for her soul. She will be
missed!!
The statements in The Fickenscher Files [http://r20.rs6.net/tn.jsp?f=001bAinQa4DiUCpS7kJE-ND858CWfY2K_94dratqIgNy0DatliHaM2SEZcbQsnKpfs5FdiwjvZUoRCJN1b2xySsSIryxTdAgW3mL2yEQwuRieWQ75ig-jShM6AXC2bKZ0Xhi5bEdL6pMZc7uRNu4yaBiENnvs3WfsLOlsJM5HcV7DVG2cj7hlkUIFuoatKYHoyA&c=RdR3xIqc_3dWD9uJMERIH6obChnEZKBJ_t1Wm5abNggnkByqHFMAhQ==&ch=-Uuwmaj3g2uaxV-qO4PtcfPsNRNe32U08-NKzjUDtsKJLyLD8QsODw==]
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=001bAinQa4DiUCpS7kJE-ND858CWfY2K_94dratqIgNy0DatliHaM2SEZcbQsnKpfs5FdiwjvZUoRCJN1b2xySsSIryxTdAgW3mL2yEQwuRieWQ75ig-jShM6AXC2bKZ0Xhi5bEdL6pMZc7uRNu4yaBiENnvs3WfsLOlsJM5HcV7DVG2cj7hlkUIFuoatKYHoyA&c=RdR3xIqc_3dWD9uJMERIH6obChnEZKBJ_t1Wm5abNggnkByqHFMAhQ==&ch=-Uuwmaj3g2uaxV-qO4PtcfPsNRNe32U08-NKzjUDtsKJLyLD8QsODw==]
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The Fickenscher Files | PO Box 840 | Kittery | ME | 039