Subject: News from Dr. Kevin Fickenscher
From: "The Fickenscher Files" <[email-masked]>
To: <[email-masked]>
Date: Mon, 31 Dec 2018 10:54:52 -0500 (EST)

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The Fickenscher Files [http://r20.rs6.net/tn.jsp?f=001KkmzD8QVW4nFDmZdH9mgFzM5AjdCMPsCn7uJfGQHUL3cHW3Uqg2vyMCDfdNiMXZI0vR47sgcB2_QeB0cRoyI8Bm866KYbeZ4wwu8J3p-nEtJbA6flq-qLfpJe6dohpUCfssXmlDLgOmPb0cRxaXw-WTc7PykT-r6GzIZb9BXvntY63B13yakO2FVKi2_9Y3G&c=Q4_uGnupr9fPi0pV0zF8i9q42fWLZyg7xiMuwNkbSduoquB1_jv-Sw==&ch=4VKqG7Omh9FCBh_VVT2vzJmT00lNyNTPVv0Gc-CD0zvwAJPMhfVXMQ==]
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The Fickenscher Files, Vol. 6, Issue 16
Kevin M. Fickenscher [http://r20.rs6.net/tn.jsp?f=001KkmzD8QVW4nFDmZdH9mgFzM5AjdCMPsCn7uJfGQHUL3cHW3Uqg2vyE_eDkGyF0Fe0zWPoF_F7oAc1Gkk4iBmdHp-T6O9-_hr9243IAtXfU3ToiJflxAQVTU3ns-ThfxjNdHMGu5tlDSQbxrP2Cg3rcPyLBhDl2XrjUQgscCXUHi7q2wq0grl0TRoeO9T0myww7WKm1INFBUiNsNcFLyYGQ==&c=Q4_uGnupr9fPi0pV0zF8i9q42fWLZyg7xiMuwNkbSduoquB1_jv-Sw==&ch=4VKqG7Omh9FCBh_VVT2vzJmT00lNyNTPVv0Gc-CD0zvwAJPMhfVXMQ==],
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.
Watch for my Top 10 or so list for the coming year in the next edition of The Fickenscher
Files
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Quote(s) Of The Week
"AI is currently very, very stupid. It is really good at doing certain things which
our brains can't handle, but it's not something we could press to do general-purpose
reasoning involving things like analogies or creative thinking or jumping outside
the box."
Andrew Moore, Google vice president - in comments on whether or not AI will replace
humans anytime soon
"The ethics of the experimenter can charitably be described as substandard: the 
experiment was wildly premature, focused on a medical condition which already has
both treatment and prevention methods; was done in secret, and without either peer
review or adequate consent; and was done without any credible plan to protect the
resulting children (and their children, and their children's children) from harm."
George Annas, MD, Director of the Center for Health Law, Ethics & Human Rights at
the Boston University School of Public Health on the announcement of secret research
by a Chinese scientist using CRISPR technology to splice the genes of twins.
"Our societal silence over the last several years has been deafening. As we enter
the holiday season and a time of reflection, it seems to me that now is the time
 for a cacophony of compassion to rise up and overwhelm the people of our nation
 with the spirit of our founding mothers and fathers."
Kevin Fickenscher, MD - in a moment of reflection on his own forefathers and foremothers
who came by many routes "yearning to breathe free..."
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Random - But, Focused - Thoughts
Thoughts needing your feedback...
Considering For A Moment The Realities Of Our Time - Sometimes as we deal with the
daily burdens of our lives - both professional and personal - we tend to neglect
 the changes that are percolating across societies throughout the world. I was really
struck by an animated depiction of the GDPs of various countries throughout the 
world. In particular, China has continued its rise as a major economic force throughout
the world. In fact, when I was selected as a Kellogg Fellow in 1985, one of my points
of study was to learn more about China because I noted for the Kellogg Foundation
that "China will most likely become the dominant economic force of the next century."
Well - the next century is here and the prediction has become a reality. Take a 
few minutes to watch this video [http://r20.rs6.net/tn.jsp?f=001KkmzD8QVW4nFDmZdH9mgFzM5AjdCMPsCn7uJfGQHUL3cHW3Uqg2vyFLuurV_v1em87jo6hMLigw6CgWe0rkfYp1doPBOmZkRpSLh56oAQTF-iJfzu_cwpP8I4qsKEIj6UobHMlEUN9hBLsMXMeJlYBtBEqLB2Sg9A1aHEVqhaAtPWUhZFYLr8qCGMAZmASX2DEuHwR7rE_RqZltluFPiFQ==&c=Q4_uGnupr9fPi0pV0zF8i9q42fWLZyg7xiMuwNkbSduoquB1_jv-Sw==&ch=4VKqG7Omh9FCBh_VVT2vzJmT00lNyNTPVv0Gc-CD0zvwAJPMhfVXMQ==].
It becomes clear that the economic changes are a marker for political and social
 changes as well. We need to take note because even though the changes are outside
of health care they will both directly and indirectly impact on health care. Resources
are what makes societies hum. Embracing nations is how we've done it historically.
We should get back that approach.
Chasing Squirrels - About a week ago, I was upstairs in my office when I suddenly
heard this horrible choking sound coming from the first floor. It sounded as if 
my dog - Toto - was choking on something, although I've never heard him choking 
J . He loves to chew on tennis balls so the fleeting thought was well deserved. 
In a flash, I ran downstairs only to find Toto staring intently at the kitchen. 
But, the sound continued. I couldn't figure it out but is was obvious that Toto 
was focused on something. Then, I saw it. Toto had cornered a squirrel that was 
screaming its head off atop a large painting hung on the wall. He had cornered a
 squirrel!! From simple observation around the squirrels outside the home, I knew
that there was no way I was going to capture that squirrel by myself. So, I calmly
went downstairs and gathered up my son and his friend to assist me. The next screen
is directly from the Keystone Cops! The three of us with coats and towels to protect
us from the squirrel along with Toto gave hot pursuit to the wily little creature.
He gave us a run for the money. We chased it back and forth and around the house.
He would occasionally stop and simply stare at us as if to say, "Are you kidding?
You think you're going to catch me?" But, then we thought wiser by opening the windows
and the doors before restarting our hot pursuit. Within a minute, he was out the
 door and we were staring at one another with laughter at how easy that had been
 - at the end. So, what's this got to do with health care?
As I was thinking about the squirrel incident when it came to me that much of activity
in health care today is like chasing squirrels. We've got the various parts of the
system going in different directions. Some are chasing the proverbial squirrel with
large leather coats, others with towels and still others with open jaws in sheer
 intuitive instinct like Toto! We're not coordinated. One part of the industry is
trying to go in one direction, and another part is going in a different direction.
Meanwhile, the squirrel of health care costs and inefficiency is getting away with
dart here and a dash there. It is only by getting all of the parts to work in a 
coordinated fashion that we'll solve the problem. Fee-for-service providers working
in isolation from public health programs who are not connected to social support
 initiatives that use emergency rooms as fail-safe support systems during off hours
only results in more costs. Then, there is the drug and medical device industry 
toddling along to their own drummer quite apart from the insurance industry to say
nothing about the confusing role government now seems to play in the health care
 community of today. We're chasing squirrels!! It's time to stop and take thoughtful
consideration of the situation before continuing the chase. It seems to me that 
if we actually worked together - across the boundaries of the industry - we'd solve
this squirrel problem that has captured the attention of the health care community.
What do you think?
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Readings To Consider
Books and Articles worth a Review...
Become Disconnected - I was just about to start on my latest Fickenscher Files when
yet one more email came flying through the ethernet to capture my attention. It 
was from a colleague who was beside themselves because of a relatively minor disconnect.
Such disconnects seem to be happening more and more in the new world of "connectivity".
It brought to mind an article I had recently read by Atul Gwande, MD - the new head
of Amazon's yet-to-be-described health care initiative. He recently posted an article
in The New Yorker [http://r20.rs6.net/tn.jsp?f=001KkmzD8QVW4nFDmZdH9mgFzM5AjdCMPsCn7uJfGQHUL3cHW3Uqg2vyFLuurV_v1em4v_n7NQ5X4S4ScH1iKphGwY4-hfWvpo8ZGstRXhGn3xrCtgtzj3N5EH8U-6f3CPPSppfJNzd47AVAx-V82mDL4UpYmf_J6Kcxn4aF5yzGwnAYMWnG_gXbaa3To27ULAGzIcufH3Zje-VUBPTgpa8cKty0fF_O-46Jc-oxb5bJTlG_uSeSP4wOo-w_kfOl8Q1&c=Q4_uGnupr9fPi0pV0zF8i9q42fWLZyg7xiMuwNkbSduoquB1_jv-Sw==&ch=4VKqG7Omh9FCBh_VVT2vzJmT00lNyNTPVv0Gc-CD0zvwAJPMhfVXMQ==]
magazine on a related topic - the use of clinical information systems by physicians.
He captured an issue that is all too increasingly common among physicians and others
in the health care industry who spend intensive amounts of time in front of computer
screens - disconnection and burnout. The tedious nature of clicks and data requirements
while offering value on one side of the equation often result in more labor investments
on the other side of the equation. The burnout rate among physicians is increasing
and some of it stems from the intrusion of computers into the process without adequate
revision of the process. Just like the miscommunication with my colleague, the intrusion
of the computer screen between the patient and the clinician is becoming an obstacle
to conclusion and connection. We should take note. While there are no quick answers,
the issue of "connectivity" deserves our special attention. It is what makes for
 a good clinician...
The Gender Gap Considered - Women comprise about 80% of the health care workforce
in the US according to a recent  [http://r20.rs6.net/tn.jsp?f=001KkmzD8QVW4nFDmZdH9mgFzM5AjdCMPsCn7uJfGQHUL3cHW3Uqg2vyFLuurV_v1emxLeL47JIVTjghDMEq6mnoiIBwkcCSztMQkVChnXdwR7URAELPkHdFoeq-0TdxQy8IdMf_iomLx9WoktScT4_f1aVyUYAVFGD7xVZsrxVOlFfkZI2pjIRiflrvidI0LNHr31lt2ZE0oMwAHnhfAvGutYFm7d8ENM7sJMnxzfadoMgECsSKpSNXjYNRdf78ZVGWAho2THc8xmvmBprmJ8E1mqJrA_iQg3c3Rr8f2XDbRc=&c=Q4_uGnupr9fPi0pV0zF8i9q42fWLZyg7xiMuwNkbSduoquB1_jv-Sw==&ch=4VKqG7Omh9FCBh_VVT2vzJmT00lNyNTPVv0Gc-CD0zvwAJPMhfVXMQ==]report
[http://r20.rs6.net/tn.jsp?f=001KkmzD8QVW4nFDmZdH9mgFzM5AjdCMPsCn7uJfGQHUL3cHW3Uqg2vyFLuurV_v1emxLeL47JIVTjghDMEq6mnoiIBwkcCSztMQkVChnXdwR7URAELPkHdFoeq-0TdxQy8IdMf_iomLx9WoktScT4_f1aVyUYAVFGD7xVZsrxVOlFfkZI2pjIRiflrvidI0LNHr31lt2ZE0oMwAHnhfAvGutYFm7d8ENM7sJMnxzfadoMgECsSKpSNXjYNRdf78ZVGWAho2THc8xmvmBprmJ8E1mqJrA_iQg3c3Rr8f2XDbRc=&c=Q4_uGnupr9fPi0pV0zF8i9q42fWLZyg7xiMuwNkbSduoquB1_jv-Sw==&ch=4VKqG7Omh9FCBh_VVT2vzJmT00lNyNTPVv0Gc-CD0zvwAJPMhfVXMQ==]
by The Advisory Board [http://r20.rs6.net/tn.jsp?f=001KkmzD8QVW4nFDmZdH9mgFzM5AjdCMPsCn7uJfGQHUL3cHW3Uqg2vyFLuurV_v1emxLeL47JIVTjghDMEq6mnoiIBwkcCSztMQkVChnXdwR7URAELPkHdFoeq-0TdxQy8IdMf_iomLx9WoktScT4_f1aVyUYAVFGD7xVZsrxVOlFfkZI2pjIRiflrvidI0LNHr31lt2ZE0oMwAHnhfAvGutYFm7d8ENM7sJMnxzfadoMgECsSKpSNXjYNRdf78ZVGWAho2THc8xmvmBprmJ8E1mqJrA_iQg3c3Rr8f2XDbRc=&c=Q4_uGnupr9fPi0pV0zF8i9q42fWLZyg7xiMuwNkbSduoquB1_jv-Sw==&ch=4VKqG7Omh9FCBh_VVT2vzJmT00lNyNTPVv0Gc-CD0zvwAJPMhfVXMQ==].
But, they only represent between 3 - 9% of the leadership workforce for the industry.
It's one of the reasons I became involved in helping to develop the Carol Emmott
 Fellowship [http://r20.rs6.net/tn.jsp?f=001KkmzD8QVW4nFDmZdH9mgFzM5AjdCMPsCn7uJfGQHUL3cHW3Uqg2vyFLuurV_v1emSQPsi-uEqEswc-VVXTIh_bJ-1PRWStX2clCx0S7ZkyX61FAYr0gmnQgP0gIopPAl2lXiODVsml-GSdiYn4JUcjLennPimpa9zPCJI5RD3wyfnXVHG7K-9Q==&c=Q4_uGnupr9fPi0pV0zF8i9q42fWLZyg7xiMuwNkbSduoquB1_jv-Sw==&ch=4VKqG7Omh9FCBh_VVT2vzJmT00lNyNTPVv0Gc-CD0zvwAJPMhfVXMQ==]
(CEF) Program. The intent of the program is to accelerate leadership capacity for
women in health. Individuals selected for participation in the program complete 
a 14 month long program which includes experiential, didactic, and cohort experiences
along with coaching and mentoring from senior health care executives from across
 the entire industry. It's a program worthy of your organization's commitment. If
you're a leader in health care consider contacting the CEF and providing support
 for an emerging woman leader in your organization. It will pay off in dividends
 over the longer term for the greater good of the health care community.
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Consulo Indicium
Information for your Consideration...
The Disintermediation Is Coming - Disintermediation [http://r20.rs6.net/tn.jsp?f=001KkmzD8QVW4nFDmZdH9mgFzM5AjdCMPsCn7uJfGQHUL3cHW3Uqg2vyFLuurV_v1emKU4hwrsSeZ1fqx35GYqSv6u_uvg2E_BV8IRWgrPbDRO0eLWljeK5AlkSgiOxQY8tW6ZHfE1CGbqvdKNl9wvlenvwygqrdGTR5Eoa0IM3gEVMH0k-WCFOnGDGM7xMFthyHjmRbVPqxPJq_QC1UL1q9JSfhxhrv2El&c=Q4_uGnupr9fPi0pV0zF8i9q42fWLZyg7xiMuwNkbSduoquB1_jv-Sw==&ch=4VKqG7Omh9FCBh_VVT2vzJmT00lNyNTPVv0Gc-CD0zvwAJPMhfVXMQ==]
is the process of taking apart and putting back together in new, more consumer-centric
ways. It is the process of giving the user or the consumer direct access to information
that otherwise would require a mediator, such as a salesperson, a librarian, a lawyer
- or, even a doctor. Whereas in the past "intermediaries" were required for interpreting
the information - like priests reading the Bible - through the use of technology
 users hold direct access to medical, legal information, travel, or comparative 
data and information directly. The "disintermediation" comes by way of removing 
the doctor, lawyer, salesperson or other individual from the process.Before the 
coming together there is the tearing apart. Some examples include:

* Walgreens      (LabCorp) and CVS (Aetna) are building clinics and mobile apps 
to provide immediate, 24x7 access to their services - and, that does not      include
the efforts by Walmart and others.  Sears should have listened to me 30 years ago
when I suggested that      they tear out the carpet section and install clinics 
instead.
* At last      count over 900 Direct Primary Care or Concierge Medicine practices
have      been established or, a 230+%      increase from 2015.
* Amazon,      Berkshire Hathaway & JPMorgan Chase [http://r20.rs6.net/tn.jsp?f=001KkmzD8QVW4nFDmZdH9mgFzM5AjdCMPsCn7uJfGQHUL3cHW3Uqg2vyFLuurV_v1emgCXrvM_8lmfbOFboaK0S4bQIfBgXwIwYPgb68rEueLpWn-5GGgqPlmKudWC76niWaztX1IEO9pqMS7lu7b4DhUk4xdCLBIiBkFIXcTz_ig6H4ub_Ta6xAkI6Px8iko7lJ6R6Xc8oDs-SzLW19-4iPiqWxfKRRZpya2j1bPFB_RP0jDAtFVFc45LPoaeIA6YzxtVnVAZGSjgP7SpionHcKgmDQIkY_KXJNE2khVCgPz26yel2hPnbyRL1_W7j7EzjPBSpO_Lg_q7uc3QX-lKox0u0fXk1GXasy8nxwfPsAA_GF7t2WauxofOYf_Ndb949P7wxO2xqI7PDQ5yB4f2kuQjHzpl8rBzpHNfpJ7aKecN_TTyU6LCXxnmWvMcA7SnU3AXgQYNQDcDMjw5BtXDAZw==&c=Q4_uGnupr9fPi0pV0zF8i9q42fWLZyg7xiMuwNkbSduoquB1_jv-Sw==&ch=4VKqG7Omh9FCBh_VVT2vzJmT00lNyNTPVv0Gc-CD0zvwAJPMhfVXMQ==]
have teamed up to form an independent healthcare company and hired Atul Gwande, 
MD - an      innovator and thought leader of the first order - as their new CEO.
* And, not to      be left behind - Google, Apple, Microsoft, Express Scripts Holding
or,      GAME, among others - are eyeing the healthcare industry for opportunities
     to participate in the disintermediation party. Their insights      and analysis
into how and where "health" happens and is delivered will      change the way we
 think about "health care" on into the future.
Actually, the disintermediation is not coming - it has arrived!
Trump Administration Recommends More Consumer Responsibility - The Congressional
 Quarterly [http://r20.rs6.net/tn.jsp?f=001KkmzD8QVW4nFDmZdH9mgFzM5AjdCMPsCn7uJfGQHUL3cHW3Uqg2vyFLuurV_v1emWyLxSEJLoP4IATWPPDOlApTtaf6G7YSSQqJn9XhscXdP84HYds_vICe9QKLJhBdEnCPVWmRTW-nkzO4V31rOtXHX0yY5YDCIdbdtI9r9bbfU4MsFBQbmwdIigh9T6BXXUJ6qi5QJKP4Rk960ie0AdLaLXEdRKuFc2X-c1vhn85zwpJV7DSkZj4laHJBsFiUvSE45Y_4hlqC0vUtJBPuDn2rYgoTlpoqRcwhvCsH54OgLLjNTkoCv5RgjKr8xLf4po2kuIvPH5VXWLvDyGjsy_zaWsRUx-rF81cOm_8Kpm-RiKFJf1oTVuZ_Wd3xv0RZ9_pVG7o6JoHO6UJdcomAmWar_CcB-gVF1KfcZs5CTSj3qKkRoTD9-y9RIKnQ0Od51kvMFeGy_Am4DVfPZXS9anKGIYh0GblGJxgU3b3CB0jNxCcq1TDqe8mFMRLEZi1Am9XfVYp1D-T57J_M98tcvd3oz7eRhAAv9Jop1XdVB9xjFLz6icrlaPcuiegqSoxBruUvyW6ZS-na0xK_jpe3c5b46ydvj_bsr04X-hmcmW1SAeeC4t0CzVvUkRESceipPiuA_rzcSkaOdtTj30RQKlQ==&c=Q4_uGnupr9fPi0pV0zF8i9q42fWLZyg7xiMuwNkbSduoquB1_jv-Sw==&ch=4VKqG7Omh9FCBh_VVT2vzJmT00lNyNTPVv0Gc-CD0zvwAJPMhfVXMQ==]
recently noted that the Trump Administration in a report on how to increase competition
in health care recommended that Congress and the states could take steps to decrease
health care spending by lowering "...spending is to expose consumers to more costs
and allow them to 'pay directly' for health care." The posit that consumers are 
in a better position to avoid unnecessary and expensive care rather than the insurance
companies which they argue are incentivized to prioritize more expensive services.
Hmmm. One of the ways to foster such consumer attentiveness is through expansion
 of health savings accounts. With more than 50 other recommendations, the Administration's
plan entitled "Reforming America's Healthcare System Through Choice and Competition
[http://r20.rs6.net/tn.jsp?f=001KkmzD8QVW4nFDmZdH9mgFzM5AjdCMPsCn7uJfGQHUL3cHW3Uqg2vyFLuurV_v1emvEBXHTRDzLnqkXImqCg1pbcM8N3Oq_2D9f_Q_E7n6mg3G6_iwbota8K9GKf83HmjrIfaAon7ffFUtJH00NyrZWSCq3Khyp1TC6xT8H0Qi0PeKOM_mdLtRuzfa4tbUh_M_0rt0TvAWSnVV_n9RbA6qWEmLrS--rg_vmXiVIRSsd0-aTF8AejzkBKyggG03OUwR8zMJPEkEEAyxpfvqEsWrBGnDwX3AY0fZKLri_SFhg-99d753XVQlA==&c=Q4_uGnupr9fPi0pV0zF8i9q42fWLZyg7xiMuwNkbSduoquB1_jv-Sw==&ch=4VKqG7Omh9FCBh_VVT2vzJmT00lNyNTPVv0Gc-CD0zvwAJPMhfVXMQ==]"
provides a lens on the thinking of the leaders currently occupying the HHS offices.
At 120 pages, the full report is worthy of a download if you're into the nits and
nats of where US health policy might be headed. No doubt, implementation of the 
recommendations will be yet another story.
But, on the telehealth front, we have not seen the type of adoption that could truly
reduce costs and drive efficiency (my perspective). According to the Centers for
 Medicare and Medicaid Services (CMS), only one quarter of one percent (0.0025%)
 of the Medicare beneficiaries took advantage of telehealth services in 2016. To
 bring it back full circle to the Trump Administration's report; however, their 
recommendations were woefully weak. Of the entire 120 pages, only four short recommendations
were noted and they are mini-steps forward. They include

1. States should consider adopting licensure compacts or model laws that improve
 license portability by allowing healthcare providers to more easily practice in
 multiple states, thereby creating additional opportunities for telehealth practice.
Interstate licensure compacts and model laws should foster the harmonization of 
state licensure standards and approaches to telehealth.
2. States and the federal government should explore legislative and administrative
proposals modifying reimbursement policies that prohibit or impede alternatives 
to in-person services, including covering telehealth services when they are an appropriate
form of care delivery [emphasis added]. In particular, Congress should consider 
proposals modifying geographic location and originating site requirements in Medicare
fee-for-service that restrict the availability of telehealth services to Medicare
beneficiaries in their homes and in most geographic areas.
3. States generally should consider allowing individual healthcare providers and
 payers to mutually determine whether and when it is safe and appropriate to provide
telehealth services, including when there has not been a prior in-person visit.
4. Congress and other policymakers should increase opportunities for license portability
through policies that maintain accountability and disciplinary mechanisms, including
permitting.
These are obvious minor steps. To solve the problem requires a much more aggressive
- if not assertive - approach toward solving the problem. The technology is available.
The resources can be mobilized. The impediments remain. Relatively empty recommendations
won't get us there although hope is on the horizon. The Bipartisan Budget Act of
 2018 will allow MA plans, starting in 2020, to provide additional telehealth benefits.
The proposed rule would allow for telehealth services from a patient's home [http://r20.rs6.net/tn.jsp?f=001KkmzD8QVW4nFDmZdH9mgFzM5AjdCMPsCn7uJfGQHUL3cHW3Uqg2vyFLuurV_v1emZ-CgpjVm90nzzf6u1Mu1AKahpe9vBYLXJ95TS6GGglwdmNSVXGmencr-7g2SmqhvphUSbBG1er64o2vzb61_EQLM2kKBywOg_emPIPwRg3693vtoKfB83qtCrBbgGMvb1M7XhEJW1n3tZ9lDzOGVKYPUDpaGnYDWQPnXeIPJ8Eka7qJTZboBKY73vlVo4jAhUOBTLzsn3ECkkzwSy1z_478-fUv24V2y4dd7DduIbmI=&c=Q4_uGnupr9fPi0pV0zF8i9q42fWLZyg7xiMuwNkbSduoquB1_jv-Sw==&ch=4VKqG7Omh9FCBh_VVT2vzJmT00lNyNTPVv0Gc-CD0zvwAJPMhfVXMQ==]
for Medicare Advantage patients only. So, at least we are moving in the right direction
- if ever so slowly...
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Future Health
Delivering care in the new virtual world...
The Dawn Of A New CRISPR Horizon - It was only a matter of time before it would 
finally happen. And, I have to pile on!! A Chinese scientist - He Jiankui, Ph.D.
 from Southern University of Science and Technology of Shenzhen - claimed just before
the holidays that he had edited the DNA of twin embryos with the work being completed
in secrecy and outside the realm of a peer-reviewed journal. Specifically, he announced
that he had disabled the gene that allows HIV to infect cells. The stated reason
 for conducting the procedure was the fact that the father of the two twins - Lulu
and Nana - is HIV positive. While there were initially some who questioned whether
or not the claims were real...it was finally announced that they apparently were!
As you can imagine, the ethernet was alight with reactions - many, if not most, 
of which called into question whether or not this had breached the ethical constraints
the scientific community had previously placed on CRISPR research. But, as I note
rather cynically, did we really think this wouldn't happen at some point.
Now just for the record, I'm VERY concerned about the announcement. I believe it
 calls into question all sorts of issues which have not been fully debated, accounted
and accepted not just by scientists but all of society. The announcement has clearly
breached the "God point" in human creation. Now that the cat is clearly out of the
bag, we need to define it, deal with it and manage it rather than simply surmising
and talking about it. What will that take? It's clear that the theoretical has now
moved into the realm of the real. Therefore, a much more concerted effort by the
 entire international community needs to be convened to address the potential of
 CRISPR technology as well as the threats - and, how we as a human society will 
manage it. For the lay reader, this is crucial since the focus of the International
Summit on Human Gene Editing which met in 2015 was focused on CRISPR editing on 
disease-causing DNA by the human body's somatic cells. These are the cells that 
are not involved in reproduction which means that any changes cannot be passed along
beyond the individual. By venturing into the realm of reproductive cells, changes
made by scientists will clearly be passed along to subsequent generations into perpetuity
if reproduction is allowed to occur - which is only inevitable.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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The Weekly Whisk
Musings from a foodie...
I recently had the opportunity to visit San Francisco and on the last evening ended
up alone in the Mission District. So, I decided to do a search of restaurants in
 the area and found this little bistro - Brenda's French Soul Food [http://r20.rs6.net/tn.jsp?f=001KkmzD8QVW4nFDmZdH9mgFzM5AjdCMPsCn7uJfGQHUL3cHW3Uqg2vyFLuurV_v1emW-poLyfHnREnCZ07LcxokyOb3uztZbv7cUOybgS0OeYksqb7Vqrpg26Dw91x9qpZZknBRqu-YNitUL5KdDScHv2GkvWW7qCqXvipXerMjSrsoxBF-mXiFA==&c=Q4_uGnupr9fPi0pV0zF8i9q42fWLZyg7xiMuwNkbSduoquB1_jv-Sw==&ch=4VKqG7Omh9FCBh_VVT2vzJmT00lNyNTPVv0Gc-CD0zvwAJPMhfVXMQ==]
[* * * * *] over on Polk Street. It was a charmer of a restaurant. First and foremost,
it had the ambiance and feel of a bistro in New Orleans. When you enter, you write
your name on a chalk board near the maître's table and sit down on a bench to await
your turn. It didn't take long once I figured out what to do. Chef Brenda is the
 Proprietor and grew up in the small town of Harvey, Louisiana on the West bank 
of New Orleans. It's near another town I absolutely love - Lafitte, Louisiana which
is known for its fishin' boats and crawfish trapping. She picked up the cooking 
bug that incorporated the wild blackberries, pecans and local fish ("rad fish" -
 red fish) and the cuisine styles imbued with her Sicilian, French and Filipino 
ascendants. She eventually landed in San Francisco and earned three stars from the
SF Examiner, the SF Magazine, and was listed as among the Top Five Bold Newcomers
in the New York Times. She's also been invited to cook at the James Beard House 
in New York City - an honor I'm still looking for to add to my repertoire J. But,
I digress - as usual.
The food was true comfort. It was indeed French Soul Food. I adorned my plate with
Crawfish Beignets and French Onion Soup for starters and went to heaven. I then 
went for the Crawfish Etouffee but instead of the pilaf - asked (actually begged)
them to serve me a half portion of red beans and rice. It was at this point that
 I went back to heaven for the second time in the same evening. Perhaps it's because
I'm such an easy mark when it comes to Southern French cookin' but Brenda's is on
my list of "go-again-as-soon-as-possible" places. You will not be disappointed. 
It's casual. It's fun. And the food is fabulous. And, the wait staff were very accommodating.
Brenda's French Soul Food - 652 Polk Street - San Francisco, CA 94102 -www.frenchsoulfood.com
[http://r20.rs6.net/tn.jsp?f=001KkmzD8QVW4nFDmZdH9mgFzM5AjdCMPsCn7uJfGQHUL3cHW3Uqg2vyFLuurV_v1emW-poLyfHnREnCZ07LcxokyOb3uztZbv7cUOybgS0OeYksqb7Vqrpg26Dw91x9qpZZknBRqu-YNitUL5KdDScHv2GkvWW7qCqXvipXerMjSrsoxBF-mXiFA==&c=Q4_uGnupr9fPi0pV0zF8i9q42fWLZyg7xiMuwNkbSduoquB1_jv-Sw==&ch=4VKqG7Omh9FCBh_VVT2vzJmT00lNyNTPVv0Gc-CD0zvwAJPMhfVXMQ==]-
(415) 345-8100
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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The Good, The Bad, And The Ugly
The ongoing saga...
The Great - Being with family over the holidays...
The Good - The Trump Administration released its 50 point recommendation list on
 what to do in health care but, for those of us who are policy nerds - it was a 
bit short on detail and action. But, at least there is a list out there to facilitate
discussion...
The Anxiety Provoking - The gyrations of the stock market are enough to give you
 the willies!! I keep listening to the advisors; however, who tell us to sit tight.
Turning off the news helps too...
The Bad - The government shut down - to what purpose besides demonstrating total
 impasse?
The Ugly - The continuing animosity derived from tribalism - on both sides of the
aisle - that seems to have a stranglehold on open discussions and debates at tables
all across America.
The statements in The Fickenscher Files [http://r20.rs6.net/tn.jsp?f=001KkmzD8QVW4nFDmZdH9mgFzM5AjdCMPsCn7uJfGQHUL3cHW3Uqg2vyMCDfdNiMXZI0vR47sgcB2_QeB0cRoyI8Bm866KYbeZ4wwu8J3p-nEtJbA6flq-qLfpJe6dohpUCfssXmlDLgOmPb0cRxaXw-WTc7PykT-r6GzIZb9BXvntY63B13yakO2FVKi2_9Y3G&c=Q4_uGnupr9fPi0pV0zF8i9q42fWLZyg7xiMuwNkbSduoquB1_jv-Sw==&ch=4VKqG7Omh9FCBh_VVT2vzJmT00lNyNTPVv0Gc-CD0zvwAJPMhfVXMQ==]
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=001KkmzD8QVW4nFDmZdH9mgFzM5AjdCMPsCn7uJfGQHUL3cHW3Uqg2vyMCDfdNiMXZI0vR47sgcB2_QeB0cRoyI8Bm866KYbeZ4wwu8J3p-nEtJbA6flq-qLfpJe6dohpUCfssXmlDLgOmPb0cRxaXw-WTc7PykT-r6GzIZb9BXvntY63B13yakO2FVKi2_9Y3G&c=Q4_uGnupr9fPi0pV0zF8i9q42fWLZyg7xiMuwNkbSduoquB1_jv-Sw==&ch=4VKqG7Omh9FCBh_VVT2vzJmT00lNyNTPVv0Gc-CD0zvwAJPMhfVXMQ==]
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The Fickenscher Files | PO Box 840 | Kittery | ME | 039