Information for your Consideration…

The Slippery Slope – A recent 2024 Gallup poll offered a somber outline on the perspective of Americans towards the medical and health system. Specifically, only 34% of Americans still trust the medical system! If only 34% TRUST the MEDICAL SYSTEM, the collective WE have our work cut out for us!!

Aging And Friendly Care Delivery – A new report released by the John A Hartford Foundation and completed in collaboration with Age Wave revealed a striking misstep in the USA health care system - widespread dissatisfaction among older adults with care delivery. The researchers combined information from a Harris Poll, focus group analysis, and recent research reports. The report deserves your attention and I would recommend downloading a copy of the report entitled Meeting the Growing Demand for Age-Friendly Care: Health Care at the Crossroads. For all of us who are leaders in health care and/or deliverers of care…an important read.

Oh No – Don’t Tell Me It’s True! – Sorry, but it does seem to be true. According to a recent article in the journal Nature, the Large Language Models (LLMs) used in AI products are beginning to get the drift of how to lie. Yes, lie!! There is logic to everything from structured information that gives answers to complete questions to how best to lie about some issue or topic. As a result – according to the article – the LLMs are becoming less reliable because they are increasingly recognizing that it is more important to “make things up” rather than to not provide an answer. “Millions of people are using general-purpose artificial intelligence (AI) systems based on large language models (LLMs), which have become commonplace in areas such as education⁶, medicine⁷, science^8,9 and administration^10,11” [NOTE: citations copied directly from the article]. Although the LLMs are increasing their reliability, they are also getting better at lying!

At the same time – as a proponent of learning how to effectively integrate AI/ML learning derived from LLMs into medical and healthcare delivery – there is reason to be positive. In a recent post, Azeem Azhar argued that humanity needs to embrace AI as a source for accelerating our knowledge development capabilities. I agree! Rather than rejecting AI/ML or putting it in a box, we need to determine how best to use it, what policies are required to assure its value to society, how to prevent misuse of the technology, and a host of other thoughts. It’s very clear that the path of Generative AI/ML development is on a much more accelerated pathway of development than either the use of personal computers or the Internet. I remember introducing the use of computers to office work in the early 1980s. Then, I was on the horn in the early 1990s learning about this new resource called “the web”. And, where we’ve come from those early days is incredible! And, the acceleration is even accelerating with the advent of OpenAI – the beginning tool of down-the-road tools that we will need to integrate into the medical and health system. AND, we are not educating or training our young health and medical graduates across the board in the effective use of AI/ML – let alone those who are in practice today.

Alzheimer’s Disease, Dementia, And Falls – In a new report from JAMA Network Open researchers found that when controlled study parameters were put in place death and falling were associated with a 21% increased risk of a subsequent dementia diagnosis. The metanalysis examined almost 2.5 million Medicare claims to derive the assessment. The claims were for older adults who had a traumatic injury leading to an emergency room visit as a result of a fall. The researchers found that within one year of the incident “new dementia diagnoses were more common in people with falls than other injuries.” They didn’t say anything about falling out of your office chair when you swivel around quickly – like I did yesterday. However, I was able to jump up right away and luckily no one was around to see the incident. Now about those stairs, I walk up and down from the kitchen at least 10x per day…hmmm…

Step It Up A Notch – Of late, I’ve become a lot more interested in the use of physical exercise as a mode for sustaining health. I guess that getting older has something to do with my enhanced interest. Nonetheless, the data shows very clearly that physical exercise is a proven modality of not only managing but also preventing chronic disease. This is especially apropos for any adults 65 and older such as an increased number of independent living years, reduced risk of falling – one of the major contributors to decline among the elderly – and improved brain health in the form of reduced dementia, including Alzheimer’s disease. If you’re looking for more immediate results consider the value of sleep quality, reduction in blood pressure, weight loss (a good thing unless you’re ill), bone health derived from exercise, and less anxiety. You should start early and go often. It makes a difference. I’m finding that it’s made life a lot better for me and increased my sense of well-being. So, step it up a notch to better in the end… 

Ubiquitous Microplastics Found In Brain Tissue – In another study from JAMA Network Open by Brazilian researchers, they found that microplastics were prevalent in brain tissue derived from human cadavers. The sampling was small where the olfactory bulb was sampled in 15 patients between the ages of 15 and 100. Samples from eight of the cadavers contained microplastics — tiny bits of plastic that ranged from 5.5 micrometers to 26.4 micrometers in size consisting of plastic fibers and particles. The composition of the plastics were polyethylene vinyl acetate, polypropylene, and polyamide – all common materials used in coverings for commercial products. Yikes!! It’s unclear what the presence of plastics means but foreign bodies inside the body for any reason are cause for concern. And, it’s clear that microplastics are a ubiquitous problem for the world. It’s another “world health” problem we need to be thinking about – and, more importantly – doing something about…

The Vaccination Dilemma – It was very disturbing to read an Associated Press release noting that: “…U.S. kindergarten vaccination rates dipped last year and the proportion of children with exemptions rose to an all-time high, according to federal data...where the percent “of kids exempted from vaccine requirements rose to 3.3%, up from 3% the year before.” Although a large percentage of kindergartners got their shots (=92.7%), the fact that we’re seeing a gradual increase in non-vaccinated kids over the last several years is a disturbing trend. In fact, vaccine exemptions increased in 40 of the states according to CDC data. And, it’s occurring across the board for measles, mumps, rubella, diphtheria, tetanus, and pertussis – diseases that we’ve been working to wipe out BUT that will no doubt recur without attention to effective vaccination programs. As a result of the vaccination decline, there were 13 measles outbreaks this past year compared to four in 2023. And, more generally the states with the greatest number of outbreaks have been in California, Florida, Illinois, Minnesota, New York, and Oregon. I’m of the age where I remember having playmates with sequelae from a number of these diseases. Let’s not let them come back. Once again, it seems that we need to counter the misinformation.

Information for your Consideration… 

Ficky Errors – I got a message that some of my hyperlinks did not work in the last edition of The Fickenscher Files. I apologize for the inconvenience and hope it did not present a problem with the readers. BTW – feedback is always appreciated… BTW, The Fickenscher Files are prepared by me not ChatGPT although I do use Grammarly for checking the grammar in my blog. However, the content is determined by me – so you can hold me accountable there…

On The Medicare Roller Coaster – The Medicare program has become over the years an “essential” asset for those who are Medicare eligible and those with disabilities. As a consumer of the program, I take note of any changes. Most people may not be aware but President Biden recently signed bipartisan legislation that passed both the Senate and House for implementing the Inflation Reduction Act. The new legislation will affect access and make financial relief available for the 49 million older adults and those with disabilities who rely upon Medicare for drug services. For the very first time, there will be an annual limit on what Medicare beneficiaries pay out-of-pocket for their prescription medications!! That’s big news. There are six elements to the Act which affect Medicare:

• Starting in 2023: 1) Vaccines can be obtained without copays; and, 2) Insulin co-pays are limited to a max of $35/month;
• Starting in 2024: 1) More people will become eligible for the “Extra Help” program which offsets out-to-pocket costs for those who fall under certain income limits; and, 2) the 5% co-insurance requirement for catastrophic coverage is eliminated; and,
• Starting in 2025: 1) the annual cap on prescription medications costs will be $2000; and, 2) recipients can opt for monthly payments to “smooth” out the yearly out-of-pocket costs for their prescription medications, if desired.

The only problem with the new system is that the payments for advisors who went through all of the options to provide recommendations for Medicare recipients are going away! So, it will be more difficult to obtain unbiased advice on which of the Medicare Advantage or regular Medicare programs to select. Those of us who are Medicare-eligible will have to do a lot more homework to prepare for the October 15 – 30 sign-up period. The problem I foresee is for those individuals who have disabilities and/or medical problems (e.g. Alzheimer’s) that prevent them from making good decisions on the fly. Whoever created the rules on this front seemed to miss the mark in my estimation. While I can make good decisions on which direction to take I have some colleagues and friends that will be baffled if they have to figure out the options on their own. If anyone thinks I’m overstating it – let me know. So, it is a bit of a roller coaster… 

Paul Keckley’s Thoughts And Considerations – If you don’t get the “Keckley Report”, it is definitely one to read regularly. Paul (a good friend) regularly offers up his thoughts on all things health care. I was struck by his recent post on: “ Are Employers Ready to Move from the Back Bench in U.S. Healthcare?” from August 26, 2024. Here are a few highlights that he noted that are important for all of us in the healthcare industry to consider as we look to the future:

• For 2024, the USA population was 342 million citizens. Of that population, 92.3% (= 316M) have health insurance of which just over half of this group (51.9%) are through employment-based coverage, 17.8% (61M) hold Medicare coverage; and, 23.1% (79M) have Medicaid/CHIP coverage and 164 million through employment-based coverage.
• The Congressional Budget Office (CBO) is predicting that Medicare coverage will increase by an estimated 18% through 2032 with Medicaid/CHIP remaining about the same and employer-based coverage increasing by about 3.0% Needless to say, this puts the focus on the federal level on the state of Medicare – something America’s seniors care a lot about!! It’s an area that is ripe for further evolution and change.
• The cost of health care has risen more than 50% since 2017. Such unmitigated cost increases are clearly a front-burner issue for government, employers, self-pay individuals, or anyone taking a hard look at the healthcare world over the next several years.

Staying abreast of all these changes within the industry as well as policy analysis is a part of The Keckley Report, a period analysis on all things healthcare. If you don’t already subscribe, I highly, HIGHLY recommend it as a resource for staying abreast of policy and developments within the healthcare arena. Paul is methodical in his assessments and a trusted advisor. You will not go wrong in signing up for his regular reports. The level of increases across the board is the biggest reason that I believe we are headed toward a “value-based” financing approach to healthcare in the not-too-distant future. Too many people are affected for change not to occur!!

Private Equity Takes a Hit – The California legislature recently passed Assembly Bill (AB) 3129 on August 31, 2024. Governor Newsom (D-CA) has until September 30^th to decide on whether or not to sign it into law or to veto the legislation. In essence, effective January 1, 2024, the new law will require healthcare investors – of any type – to notify and obtain written consent from the California Attorney General before finalizing the investment in certain healthcare facilities or with healthcare providers. The bill essentially raises the bar on the corporate practice of medicine by creating a protective oversight responsibility in the AG’s office to guard against commercial exploitation of the industry by private equity groups or hedge funds. While a majority of states ban corporations from practicing medicine, there are loopholes in many of those state bans. The private equity groups have become quite good at taking advantage of those loopholes by manipulating the financial levers to create mechanisms for controlling physician behavior and services.

So, why is there an evolving outrage in the healthcare community toward private equity? It’s because the only focus of these investments is on profitability – not outcomes. Most analysts within the industry – including me – have concluded that an outright ban on private equity ownership of doctors’ practices is the only way to mitigate the risks of a focus on profitability over outcomes and value. This, in essence, is the reason the California bill received such strong support in the legislature. But, the California bill goes one step further. It also includes hospitals and nursing homes in the mix. Why? Because – if you follow the money – the American taxpayer ends up with the brunt of the cost shift as these equity expenditures are folded into pricing increases by private insurance, Medicare, and Medicaid reimbursement. We – the taxpayers – end up paying the piper!!

And, to add fuel to the fire, a new report was recently released by the industry watchdog group Private Equity Stakeholder Project (PESP) on the continuing trend of bankruptcies among private equity-owned healthcare companies. In fact, private equity bankruptcies represent nearly a fourth of all bankruptcies in the healthcare space for 2024. In some respects, such levels are not surprising since many of these investments are made in high-risk ventures at the start. Eileen O’Grady, the Director of Programs at PESP observed in a statement of Health Exec on the topics: “Private equity’s aggressive financial strategies increase the risk of bankruptcy and threaten the delivery of critical healthcare services. The use of excessive debt by these firms can have significant ripple effects on the broader healthcare industry. This year might see a grim scenario of more healthcare bankruptcies if current trends persist.” In further analysis by PESP, the increase in private equity bankruptcies over the last five years has escalated by 112% with these firms holding responsibility for 1/5 of all healthcare bankruptcies. 

CDC Recommends Watercress – A recent announcement by the Centers for Disease Control and Prevention (CDC) caught my attention. It was an analysis of the “nutrient density” of various foods or, in lay terms – the “healthiest” foods which were all vegetables in the top tier. And, the winner? Watercress which came in with a density score of 100 out of 100!! The runners-up included: Chinese cabbage (91.99 points), Swiss chard (89.27 points), Beetroot (87.08 points); and, Spinach (86.43 points). I thanked my lucky stars that Spinach was on the list. It’s become one of my favs among the vegetables – more so than Watercress. Which is a cruciferous vegetable that is part of the same family as kale, broccoli, Chinese cabbage, arugula, and Brussels sprouts (the underlined veggies are my other go-to's). So, the CDC findings were in line with my wife’s (almost) daily admonition that I need to eat “6 cups of fruits or vegetables” per day; and, she also reminds me that “Burger King does not serve them!” Take note and enjoy the Watercress or, Spinach – if you’re like me…but, Broccoli and Brussels Sprouts are also scrumdiliumptious! 

Incidence Of Male Cancer Expected To Increase By 2050 – In a new report coming out of Australia in the journal, Cancer. the incident of “…cancer cases and deaths among men are expected to surge by 2050.” The investigators analyzed cancer cases and deaths for 30 different types of cancer across 185 territories and countries in 2022. The increase in cancer cases goes from 10.3M to 19M over the 28 years or, an 84% increase! And, more importantly, the death rate also increases from 5.4M to 10.5M or, a 117% increase. Now, this applies to men over the age of 65 years. The question is “Why?” Most likely, it’s because the number of men moving into the age cohort will also be increasing AND, globally, cancer care/treatment on an international level is not equivalent to US standards. The result is a global increase in male cancer incidence and death rates.

Information for your Consideration…

Concerns Of “We The People” – The Kaiser Family Foundation completed a health tracking poll last February 2024 to ascertain the public’s perspective on the state of the Accountable Care Act (ACA) and health care costs. To put it mildly – health care is a BIG CONCERN! The surveyed about 1,300 adult voters across the political spectrum. And, across that spectrum, several key points of pain were identified:

• 74% were “somewhat” or “very” worried about their ability to afford unplanned medical bills (NOTE: Count me in as well!!)
• 73% were “somewhat” or “very” concerned about the overall cost of healthcare services.
• Of those with health insurance, 48% were concerned about the cost of their monthly premiums.
• And, of those who are lacking insurance – 25% have delayed or postponed accessing healthcare services but 61% of the uninsured simply skip needed medical care.
• Where the two sides differed was on the issues related to the ACA with 59% of Democrats noting a favorable view of the plan; and, 23% of Republicans wanting to limit the plan and 39% being favorable toward outright repeal.
• And, not to be forgotten, 36% of Republicans versus 71% of Democrats viewed the future of ACA as “very important”

Shuffling The Chairs At DHHS  - There seems to be a fair amount of movement in the US Department of Health and Human Services (DHHS) of late with the recent announcement on the creation of an Assistant Secretary for Technology Policy – which in reality represents an expansion of the Office of the National Coordinator. But, it’s a noteworthy advancement because it not only includes an upper level oversight appointment but also the creation of a Chief Technology Officer, Chief Data Officer and a Chief AI Officer. Yowser!! Or, perhaps I should say – Finally!! In making the announcement, Andrea Palm, DHHS Deputy Secretary said: “These organizational changes will ensure that HHS is best suited to serve the American people during this incredibly dynamic time in the technology space.” All of this recent activity and response stems from the 2023 Biden Executive Order on AI that charged DHHS with responsibility for implementing a plan to deal with the evolving avalanche of all things AI/ML affecting health care. So, we are likely to see even more down the road…for example, like the following…

But, There’s More: Kudos To ONC – For those of us who follow the information technology space, the Office of the National Coordinator (ONC) recently issued a new proposed rule for all healthcare providers and health plans receiving Health and Human Service funding of any type. It would require use of “certified” health information tech tools and adherence to ONC standards by all health care providers and plans. The implications are significant. Why? Because the new requirements related to the acquisition, implementation, and upgrading of all health information and the systems used for sharing the information. In essence, it moves the idea of “interoperability” objectives previously described in the Health Information Technology for Economic and Clinical Health Act (HITECH Act) into reality.

In essence, the new rule is designed to ensure that all health IT systems procured by HHS or that connect to the agency in any form such as healthcare providers, health plans, or insurance issuers who contract for payments be fully compliant with the standards and implementation specifications set by regulation. The penalties are not inconsequential. For example, there are penalties for those vendors that prevent the “unreasonable” access, exchange or sharing of electronic health information (EHI) of up to $1 million. And, furthermore, “unreasonableness” is not just a technical connectivity issue. It also applies to the fees charged by IT vendors for providing the connectivity. It’s a good measure. The feds through Medicare, Medicaid, FQHCs, the VA and other funding operations are the biggest game in town when it comes to health care finance. It creates quite a strong incentive by the vendors and payors to move forward on something that should have been accomplished (my perspective) several decades ago!! In sum, the good news is that all of the major Health Info Tech (HIT) organizations have been working on the interoperability issues and while there will no doubt be some hiccups, the industry is finally moving forward in this most important area for enhancing care delivery across the board. If you have any comments on the proposed rule, they must be submitted by October 8, 2024. Shortly after that point, the rule will be finalized.’’

The Summer COVID-19 Surge Is Upon Us – Throughout early August and as we move into the Fall, the US Centers for Disease Control and Prevention is issuing warnings that COVID-19 is once again running rampant. The coastal areas of the USA seem to be the hardest hit. Furthermore, through my information “friends survey,” it seems that travelers coming from Europe and the Far East are bringing the virus home 😊. So, taking some precautions by those travelers coming home after wonderful trips abroad should definitely be considered. The Family Physician Newsletter does a good job of tracking the pandemic and includes information on “long COVID”, treatment options, testing and testing options. Check it out for good, reliable, and readable information.

And, Don’t Forget The Other Virus – In addition to the covert COVID-19 virus that passes human-to-human, it’s now summertime. The West Nile Virus is still out there and increasingly being identified by health departments across the USA. The rate of infections is far, far less than but can be just as problematic. And, like COVID-19, the spread is a function of community. So, lather up with mosquito repellent and keep those mosquito growth areas (e.g. stagnant water pools) cleaned up.

More Dementia News – Some might wonder why I’m reporting more information on dementia these days. It’s for two reasons. First, I’ve reached an inflection point where I’m now beyond the 70 year mark when dementia seems to reach an accelerating velocity among friends and neighbors. And, second, the research on preventive and treatment options for managing the problem area is also accelerating. For example, there’s a new study recently published in JAMA Network Open on the dietary patterns of dementia patients. The report noted that eating an anti-inflammatory diet of whole grains, fruits and vegetables instead of an inflammatory diet consisting primarily of red or processed meats and ultra-processed foods (e.g. sodas, sugar-coated cereals, fries and ice cream) resulted in lowering of the risk of dementia risk by 31%! Furthermore, the researchers noted that the benefits were also present for those patients with a history of stroke, heart disease and type-2 diabetes. This speaks to my wife’s daily mantra of: “Six cups of fruits and vegetables per day”. BTW, I do miss the mark but not as frequently as I once did AND, I do like ice cream 😊.

Now – About The Caffeine – As my long-time readers will know, I’m obsessed with ongoing studies, trials and reports on caffeine consumption. Why? Because for many years now, I’m one of the top consumers (my suggestion) of caffeine – in the form of strong coffee. I love it. I rarely get the signs and symptoms of too much consumption (e.g. headaches, jitteriness, etc.) and find the flavors of the various grinds to be wonderful. But, yet another report has come out reporting that individuals who drink more than 400 milligrams of caffeine a day appear more likely to develop heart disease. In fact, the investigators discovered that individuals consuming the highest amounts of caffeine (e.g. 600 milligrams/day or more) had significantly elevated heart rate and blood pressure even after five minutes of rest following a three-minute step test. Whew!! I’ll just be safe 😊. My BP runs in the “just over the 100s over 60s” and my pulse is a solid 82 (there’s nothing like reliable pacemakers). So, perhaps I’m an outlier. Actually, several people have mentioned that but I don’t think it related to caffeine…

Information for your Consideration… 

Access To Care In Rural Areas – One of the multi-decade issues faced in the USA – but, also in rural areas throughout the world – is access to health care services. As a long-time rural health proponent, I’ve followed many different initiatives for solving the problem – which often comes down to a lack of people resources for delivering appropriate care. It’s been 35+ years since I served as President of the National Rural Health Association, and I’ve continued to be a proponent of solutions and trials for solving the ongoing rural health care delivery problems. More recently, several Members of the Rural Health Caucus in the U.S. House of Representatives introduced a bill to allow for the ownership and operation of new hospitals in rural areas.

The bipartisan Physician Led and Rural Access to Quality Care Act (NOTE: a full text is here) would amend Title XVIII of the Social Security Act, which specifically bans the opening of new physician-owned hospitals. The ban intends to prevent a conflict of interest by the provision of unnecessary care by physician owners of rural hospitals. Specifically, the SSA amendments would allow “certain exemptions to rules for physician-owned hospitals in rural areas and remove a ban that prevents existing physician-owned hospitals from expanding.” The bill even includes specific parameters for determining eligibility such as a “new” hospital must be at least 35 miles or more away, or 15 miles if the new hospital is only accessible through secondary roads (e.g. in mountainous areas).

To be honest, I’m not sure this addresses the rural health problem. I can think of other initiatives that might be more successful at enhancing access to care in rural areas such as:

• Establishing ubiquitous internet access across the entire nation,
• Increasing training programs across the board for all the healthcare professions in rural areas,
• Enhancing EMS services,
• Funding public health programs,
• Addressing the many social determinants of health that prevent adequate access to follow-up care by patients,
• Re-investment in the National Health Service Corps; and,
• Any number of other initiatives that might provide equivalent or even better care delivery for rural areas.

While the intent is good, training the next generation on the use of technologies, enhancing their ability to provide quality care, refocusing – once again – on the need for adequate “primary care” training and other considerations will more likely yield better long-term results than more institutions. I’m not opposed to the idea but, think the investment should be weighed against all of the other options that are clearly on the table. The Congressional delegation has already received support from the American Medical Association, the American Association of Orthopedic Surgeons, Physician-Led Healthcare For America, and a few others. Notably absent in the press release was the support of the National Rural Health Association.

Finally, the other looming issue is the notion of private equity in longitudinal problems like access to care in rural areas. In recent years, I’ve become increasingly skeptical about the use of the private equity model as a resource for all types of health care. First and foremost, private equity at the end of the day is about enhancing financial return. It is not necessarily about “equity”. In fact, while the above rural coalition of Congressional representatives introduced their efforts to expand “private equity” by allowing physicians to own and operate rural hospitals, another group of bipartisan Congressional representatives advocated and passed the bipartisan Lower Costs, More Transparency Act. 

While there are several provisions in the legislation, it essentially attempts to enhance private equity ownership transparency in the area of vertical integration by insurers. It did not address the other elements of private equity. But, the issue is getting attention. In the US Senate, Senators Grassley (R-IA) and Whitehouse )D-RI) introduced legislation related to private equity backing among hospitals; and, Senator Peters (D-MI) introduced measures to obtain information on private equity backing of emergency departments. In a more sweeping legislative effort, Senator Markey (D-MA) released a draft legislative proposal as the “Health over Wealth Act” that would establish oversight programs to improve transparency related to hospital ownership by private-equity or corporate-owned institutions, physician practices, hospices, behavioral health providers, and other similar provider services outside of rural health. So, the issue is getting attention. 

Then, just as I had finished the final draft of The Fickenscher Files, I received a report from an industry watchdog group, the Private Equity Stakeholder Project (PESP). They follow the private equity marketplace and among healthcare companies and reported that 23% of all bankruptcies (so far) in 2024 for the healthcare market were for private equity owned organizations. In large measure, it’s because of the amount of debt incurred by the PE firms in purchasing these entities. Furthermore, the latest report expands upon a prior PESP report in April which noted that PE bankruptcies have increased 112% over the last five years in healthcare. Your thoughts? 

USA Screening For Five Cancers Costs $43B – A recent article in the Annals of Internal Medicine reported on an analysis of healthcare expenditures in 2021 on the costs of preventive cancer screening programs for five different cancers in the USA. The five cancers of focus were lung, colorectal, breast, cervical, and prostate cancers. While $43B seems like a lot – and, it is – in the scope of investments it represents only about 2.53% of USA national expenditures for health care (based on an estimated $1.7T overall investment). The investigators also determined that 88% of the expenditures were paid by private insurance with the remainder covered by government programs (i.e. Medicare, Medicaid, etc.). I may be wrong on this front – but, given the number of patients on government programs versus private insurance, the investment in screening by these government programs seems low…

A Stark Statistic – Have you heard any discussions among the politicos on the future of Social Security? Most likely, the answer would be “Nada!” It’s an issue that affects about 68 million Americans who have been paying into “the system” for all these decades and are now entering their retirement years. It’s an issue that requires debate and discernment on how to manage – AND, the solution (from my perspective) will be a “bipartisan” solution. It will not be solved through name-calling. It will not be solved by placing Senatorial and Congressional heads in the sand. It will only be resolved by all our leaders working together to address an issue that affects every American citizen, eventually. Why is it so important? In large measure, because the vast majority of citizens underestimate the cost to society. In preparing this short “call to action” I asked three colleagues who are with me what they thought the cost of Social Security is on an annual basis. The guesses were: “$500M”, “$250M”; and, “$100M”. All were off by a significant measure. The actual cost in 2024 will be about $1.5T (= “trillion”) from a fund that has been tapped for “loans” by the federal government. So, where will the money come from? Hmmm? Now, that’s a policy issue I’d like to hear discussed rather than the size of crowds, the “weirdness” of one side or the other or, other such machinations. 

Don’t Swat The Honeybees – First, if you’ve ever hung around the garden and taken notice of the honeybees, you’ll know that they are fairly innocuous. They glide around the flowers sniffing out the honey they gather for the honeycombs back home. But, there’s something science has only recently figured out about the innocent honeybee. According to research conducted at Michigan State University, neural engineers have determined that honeybees are excellent spotters of lung cancer victims by virtue of very sensitive sensors in their antennae. How did they figure this out? Well, that’s the interesting part. They hooked up the honeybees to electrodes, then they passed various scents under their antennae. By monitoring the honeybee’s recorded brain activity, the researchers were able to discern when various scents were recognized. A researcher from the French National Research Institute noted that for honeybees, recognizing “scents” is their lingua franca. In fact, the use of various animals – and, now insects – for recognizing scents in humans has been recognized for some time. I just wonder how they got those little helmets on the honeybees for capturing the neural notes (sic).

The Exploding Incident Of Syphilis – I’ve just returned from Norway where we visited the Leprosarium where Hansen’s Disease was first described. Upon my return when I was catching up on my readings, I learned that the incidence of syphilis in the USA has gone from less than 32,000 cases back in 2000 to more than 207,000 in 2022 according to the U.S. Centers for Disease Control and Prevention. It translates to 62 cases per 100,000 people and has particularly become a problem among pregnant women and babies. The problem is that in many cases syphilis is asymptomatic coupled with the overall decrease in funding for standard public health programs funding has been frequently pulled from the “low incident” disease prevention programs – syphilis being one of them! There are many social determinant issues at play as well that need to be managed more effectively. In too many cases, the tests are done but the conversations do not occur related to prevention and sources of infection.

The Ignored Pandemic – The US Centers for Disease Control and Prevention recently announced that for the 12 months ending in November 2023, the number of USA overdose deaths approached 110,000 or – to put it in context – a 54.2% increase over the 12 months ending in November 2019. Furthermore, almost 70% of the deaths were related to fentanyl and other synthetic opioids. In addition, the overdose death rate was highest among the 35 – 64 year-old age group with Black and Native American men holding the highest level of deaths with 60 per 100,000. Among teens (years 14 – 18), opioid deaths were the third leading cause of death behind firearm deaths and vehicle collisions. Again, it’s fentanyl!! AND, furthermore, the problem is far worse in the rural areas of the country. Plus, the above data does not include the associated secondary effects of the drug pandemic related to crime. Not only does our nation need “preventive” intervention, but it also needs effective “treatment” and “outreach” programs to solve the problem.

 

The Era Of Loneliness – Last year, the US Surgeon General declared that the nation was suffering from a loneliness health epidemic. According to a recent poll by Cigna, the number of US adults who described call themselves as lonely increased from 46% (2017) to 58% (2018). So, why is this happening? It appears to be related to the recent changes we’ve had in work environments since the global pandemic started in 2020. For example, more than 40% of fully remote workers polled by Bright Horizons indicated that they often go days without leaving the house. Furthermore, for those working in in-office environments, the workers indicated they spend only 8% of their time in face-to-face meetings. For example, Axios reported that in 2023, the share of workers who stayed muted for the entirety of a virtual meeting was 7.2%, up from 4.8% in 2022. In fact, I frequently tell people that I’ve become a “Zoomaholic” – which when I’m home is absolutely true!! In another survey by Cushman & Wakefield (a consulting firm), virtual work time has tripled since 2020. We have all become a nation of isolated workers in cubicles across virtually all industries – and, it seems to be associated with burnout, isolation, and loneliness.

It’s also evident in environments that customarily in the past were ablaze with energy. Think of subways where interactions were more common, lobbies where people often interacted, cafeterias where workers congregated and caught up with one another, and, a host of other examples. Now, those options for human interaction most often do not exist. Instead, we all (including me) pull our “devices” to check emails, news (argh ☹), and other sources of information or, even to simply play games. Wordle or such. So, what to do about it?