Recent Notable Quote(s)

“Hope is like a road in the country; there was never a road, but when many people walk on it, the road comes into existence.”

LIN YUTANG (1895–1976) - a famous Chinese writer, translator, and linguist who bridged Eastern and Western cultures

“The practice of democracy is not passed down through the gene pool. It must be taught and learned anew by each generation.”

SANDRA DAY O’CONNOR, Former Supreme Court Justice – 2018-2006

The Occasional Perspective

Opinions and Reflections

In Case You Missed It – On the occasion of our 250^th Anniversary of the USA Declaration of Independence, our local newspaper here in Kittery, Maine, published a copy of the document for all of us to read and consider. While I was quite familiar with the first part of the declaration, I was not nearly so familiar with the remainder of the document. It’s definitely worth a read – and it reminds us in these seemingly trying times that we live in one of the most unique and wonderful nations of the world at perhaps the zenith of our attraction to the rest of the world.

Real Leadership Help – I recently joined a group of individuals who provide guidance, assistance, and support related to “leadership” for individuals who are on the frontlines. Their approach is to offer active guidance and assistance to “leaders” who are working through issues, problems, projects, and ideas within their organizations, as well as leading people to make those areas reach resolution. They have organized a day-long summit focused on helping leaders with the issues they are facing within their organizations. If you have the time, consider joining us. Use the attached QR code for more details…

Responding In Kind

Responses and comments from my readers…I do receive periodic information from the many readers of the blog. While I have often responded individually, I decided that I should share more transparently. Hopefully, this contributes to an ongoing dialogue…

Readings and Listening To Consider

Books and Articles worth a Review…

A New Book To Consider – And, It’s Not Mine 😊 – There’s a new book just out that I have not read yet but is on my “to do” list. It’s by Samual Moyn and entitled “Gerontocracy in America: How the Old Are Hoarding Power and Wealth”. It takes on the over-65 crowd by pointing out that for the first time in American history, there will now be as many over-65 members of society as there are under-18! The book is intended as a stimulus for society to more effectively address the many issues of how we allocate resources. In the current period of a major social change precipitated by the digital revolution, the evolving conflicts between the various segments of society need attention. The book appears to be that source of stimulus. So, it’s on my soon-to-read list. Consider it…

The Occasional Perspective

When I feel I must share my thoughts and perspectives on a burning issue…

I Promise To Be Brief – From the information noted below under “Consulo Indicium”, you’ll find me close to a rant. I am very fearful that the current Administration is “undoing” many good features and services of government to simply make a political point. What concerns me even more is the reconstruction of government services (let alone reputation) that will require decades of work by subsequent Administrations. Congress needs to step in! The time has come. It’s not a question that some things do not work so well. But, rather than simply dismantling oversight and services, well-considered modifications are always open for discussion and debate. That’s part of an open society responsibility!!

Consulo Indicium

Information for your Consideration…

First, The Good News – As my long-time readers know, I frequently talk about the issue of coffee intake and its effect on the health of consumers. As a confirmed “Coffee-holic,” I’m quite the imbiber, especially the robust “dark roast” style of coffee. So, I was quite excited about several scientific reports that came out in the last month. The first statement was from the American Heart Association (AHA) in an article that appeared in the journal Circulation, noting that the consumption of up to five cups of coffee a day is safe for most adults. Furthermore, the cited study revealed that regular coffee consumption may be linked to a lower risk of stroke, diabetes, and heart failure!! Previous guidelines on coffee consumption were based on less reliable quality outcomes studies. The AHA panel that provided the comprehensive review of clinical trials identified the following results:

• Patients who have previously had a procedure to address an irregular heart rhythm (i.e. “me”) can reduce the risk of the condition returning by 39% through daily coffee consumption.

• Regular, robust coffee consumption was also associated with a 20 - 30%

But, please note that these heart-healthy links apply strictly to paper-filtered or instant coffee – which are my “go-to” forms of coffee. Unfiltered options such as French press, espresso, or Turkish coffee evidently retain a natural compound called cafestol (= a natural compound in coffee) that raises low-density lipoprotein, or LDL, the “bad” cholesterol that can clog arteries over time. And, one other caveat mentioned in the study was that the positive heart results do not translate to highly concentrated synthetic caffeine products like energy drinks, shots, or pills. The reason these products are problematic is that they are associated with sudden spikes in blood pressure and acute episodes of irregular heart rhythms, even in healthy adults. However, in my case, my blood pressure is so low – that coffee consumption keeps me alive…or, so I think 😊.

AND, the equally important news comes from researchers at Cedars-Sinai Medical Center in Los Angeles who reviewed data on 355,000 individuals in the UK Biobank. They discovered that those consumers who drank five or more cups a day were 32% less likely to be diagnosed with cirrhosis than non-coffee drinkers and had a 47% reduction in their risk of liver cancer. So, healthy liver biology means lower levels of liver fat, liver iron, fibrosis, and liver inflammation. But while the researchers made the finding, they also did not recommend drinking that much. However, you be the judge!!

Now, The Bad News – But Not As Bad As It Could Be News – As of July 22^nd, the number of cases of cyclosporiasis infiltrations in lettuce confirmed by the USA Centers for Disease Control (CDC) was at 4,173, resulting in 308 hospitalizations in 41 states and no deaths. However, this was simply the “laboratory-confirmed” cases. At that time, there were also another 7,400 cases “in the wings” that had not yet been laboratory confirmed and required further investigation. But, so far – no deaths! Let’s keep our fingers crossed…

Ah Come On – For Crying Out Loud!!! – Recently, the Centers for Medicare and Medicaid Services (CMS) released a CMS proposal that would prevent Medicare payments to health care providers for services related to “remote patient monitoring” if delivered by third-party vendors. As a result, the health care community is up in arms about the proposal. The information I received came from Becker’s Health IT Newsletter by Giles Bruce. In the article, Bruce points out several important implications that will have major ramifications if the policy is implemented, including:

1. Vendors are the major source of RPM throughout the nation at the present time by providing 60 – 70% of such services.

2. Rural providers – in particular – are ill-equipped to provide services through internal resources so the dependency upon external vendors is much higher. And, as a long-time rural health advocate – this is a major problem!!

3. The Medical Group Management Association (MGMA) has indicated that many smaller practices also rely on outside vendors for remote monitoring because – once again – they lack the resources to bring those functions in-house

4. The proposal is exactly the opposite of a new Congressional bipartisan telehealth initiative in Congress. Two days after CMS released the rule, the House Ways and Means Committee approved legislation to expand and protect rural RPM access.

While it would not be inappropriate to have better guidelines in place for the use of vendor-provided RPM services, to blatantly call for discontinuation is unjust. In fact, it emanates from the desire of the current Administration (do I need to name them) to correct their “fraud concerns”. As an advocate for embracing technologies and applying them appropriately for the purposes of enhancing care delivery, CMS could be applying leadership rather than a blatant, misleading effort to suggest that the care delivery system is rampant with fraud.

Rural Health Transformation Plans Submitted – The Kaiser Family Foundation has been tracking the submission of plans for the states for participation in the Rural Health Transformation Act. The tracking of plans relates to the proposed use of the funds provided under the auspices of the BBB Act. The report provides an abstract on how the funds will be used in each of the states over the course of their projected timelines. The total expenditures vary in three tiers: >$233M (=4), $202 - $233M (= 22), $180 - $201M (=17); and <$180M (= 6). The actual projects are denoted by the states, so there is a fair amount of detail. For those who are interested in the issue, it’s a definite resource to be reviewed.

A Sad Commentary – In a recent Associated Press report, there was a very sad note (my perspective), stating: “The number of measles cases in the U.S. has surpassed the record-breaking tally for all of 2025, with five more months of 2026 still to come.” On that note, the CDC had logged 2,318 cases of measles. Check the update here. There have no doubt been more cases since I first checked the notice, but at that time, there had been 2,289 cases reported for the USA in 2025. It was the worst year for measles in more than three decades. It’s a sad commentary because in the 1980s when I was in active medical practice, the number of cases was nil and we considered the disease “wiped out” – although it obviously was not. But it was not prevalent either. AND, THE REASON? Because kids were getting their immunizations. Unfortunately, the lack of scientific understanding and the distribution of disinformation by our current Secretary of DHHS has caused the dramatic increase by disparaging the need for immunizations. I find it disheartening – especially since, as a Resident in Family Medicine (1977-80), I took care of several kids in NYC who had severe neurological sequelae from contracting the disease. It’s a disease that should be gone! We have the capability to make it rarer than rare. But we are failing. This is what happens when we don’t listen to science…

National Blood Shortage At Critical Stage!!! - The Washington Post recently reported that the American Red Cross has issued a statement declaring that: “…a national blood supply crisis for only the second time in its history as blood donations fell to a four-year summer low [with only] less than a one-day national supply of O-positive blood, the most commonly transfused blood type.” As a result of the shortage, the ARC is now limiting the distribution of all blood types to hospitals across the nation. The decrease in blood supply has been attributed to a variety of issues across the country, including the spread of foodborne illnesses, poor air quality from various fires, and extreme heat in the Central USA. It’s a very important issue, and all of us healthcare types should be encouraging eligible patients to consider donating!!

The Tragic Dismantling of AHRQ – One of the more important programs in the USA federal government over the last several decades has been the agency responsible for supporting health services research. However, due to unprecedented funding as well as executive impoundments of funds for the purposes of delaying funding, the Agency has been devastated. As an example, AHRQ recently canceled virtually all previously awarded grants involved in training the next generation of scientists on topics including: hospital-acquired infections, cancer screening, asthma care, provider care for child abuse, and other important areas related to care delivery. It’s that upwards of 80% of AHRQ staff are no longer employed by the Agency under the leadership of the Trump Administration. As a result, all of the oversight functions have been decimated, making it impossible to fulfill the responsibilities of the agency. I’m not usually so vocal, but this is a stupid – yes, “stupid” – move by the Administration that will not only have ramifications for the USA but also throughout the international health research community.

The March Of The Humanoid Robots Continues To Move Forward – A recent report in Nature reported on the use of humanoid robots performing the first successful minimally invasive laparoscopic surgical procedure using standard surgical instruments on pigs. The robots were successful in completing laparoscopic gallbladder removal procedures in pigs. The intent of the researchers was to determine if it was feasible to consider the use of such robots as a source of lower-cost alternatives to common procedures performed through robotic capability. These “humanoid” robots are controlled by human surgeons using remote teleoperation platforms from remote locations. If such tools became available, it would potentially make available services in remote and underserved areas where travel is now required for the service.

Coffee Consumption Promotes “Good” Bacteria – In a new study from the University College Cork (Ireland) reported on regular consumption of coffee – both caffeinated and decaffeinated – affects the gut microbiome. Specifically, the presence of “good bacteria” (e.g., Eggertella sp and Cryptobacterium curtum) was increased among coffee drinkers. Both bacteria are thought to play a role in eliminating unhealthy bacteria that cause stomach infections. On the decaffeinated side, there were also improvements in learning and memory, most probably due to the presence of polyphenols, which have been shown to provide cognitive benefits.

The Weekly Whisk

Musings from a foodie…

Good Place On A Massachusetts Bay [⭐⭐⭐⭐⭐ ] – I frequently talk about restaurants from around the world, but in the past year or so, I’ve been here at home in the old USA. And, as a “quasi-retired” healthcare person, I’m just not traveling as much. So, my culinary attention has shifted to more of the “local” places in the region surrounding Kittery, Maine, where I live. One restaurant that I’ve visited several times now is C.K. Pearl located in Essex, MA. It’s a “diner-like” environment with the quality of an upscale restaurant. Given that it is located directly on the bay outside of Essex, Massachusetts, you would expect that seafood is highlighted – and it is!! At the same time, there are other staples as well. If you get over to that part of Massachusetts, east of Boston, in Essex – definitely consider the “Pearl”. You will not be disappointed!! [112 Main St, Essex, MA 01929 – (978) 890-7378

The Good, The Bad, And The Ugly

The ongoing saga…

The Great – Not sure…

The Good – Congress (both the U.S. Senate and House) seems to be stepping up a bit more to their role as the “legislators” of policy and funding for programs rather than demurring to the machinations derived from the internal workings of the current Administration.

The Bad – The polls are returning numbers showing the percent of respondents in both American and international polls who believe that the USA is losing its status as the leader of the democratic, free world.

The Ugly – The devastation of federal healthcare programs is a travesty, and I predict it will take a couple of decades to recover – if it actually does, in fact – recover.

“Everything in Medicine seems under attack now, and we bring you yet another big one, probably the biggest. – Lani Graham, MD, Family Medicine physician and Former Chief Public Health Officer, State of Maine

The Occasional Perspective

When I feel I must share my thoughts and perspectives on a burning issue…

AND, IT NEEDS AN IMMEDIATE RESPONSE…BY YOU!!

First, I rarely – if ever – ask my readers to respond in an immediate fashion. However, due to the urgency of the following message, I’m asking you to consider sending your thoughts ASAP – not to me but, to the Federal Office of Management and Budget (OMB). This “Special FickFiles” blog is the result of an email I retrieved from my incoming on a very important issue related to the funding of federal research under proposed rules by the Office of Management and Budget (OMB). The following is a “verbatim” copy of the letter from a colleague here in Maine, Lani Graham, MD, MPH, a Family Medicine physician and a Past Chief Public Health Officer for the State of Maine. She stays abreast of the federal funding issues, and her note is VERY IMPORTANT. So, rather than adapting her thoughts, I’m simply copying the note regarding the OMB Comment Period (= July 1 – July 13, 2026). As you can see, the timeline is short!! I’m asking all of my readers to consider sharing your thoughts on these new OMB regulations related to federal funding. Here is Lani’s note:

“The Office of Management and Budget (OMB) has proposed new rules to regulate all federal grants, not just science (think NIH and CDC), but housing, education, defense, NASA and everything in between. These rules would strip away the independence that has kept science from becoming a political tool. I believe that this action is potentially more destructive than the vaccine debacle, more destructive than the firings at CDC and NIH, more destructive than appointing RFK as Secretary of HHS, and even more destructive than the “big, beautiful bill”. It is hard to overestimate how destructive this could be if it moves forward as proposed. It could set back progress in multiple health areas by years or even decades. And if passed, it will set a precedent that will be hard to undo. Others who watch these things more closely than I do have pointed out three very serious elements in these rules:

1. Political appointees would decide which science gets funded, and peer review would be explicitly sidelined or ignored.

2. Grants could be canceled at any point, without warning, in the middle of ongoing work.

3. Researchers would have a harder time communicating their findings without pre-approval from the federal government.

The deadline for submitting comments is July 13^th. COMMENT, as soon as possible. Below is a guide for submitting comments, and here is the link to submit your comments.

• Ideally, use a personal comment. OMB will likely disregard numerous identical comments. OMB must respond to each comment specifically so we need to make it hard for AI. Form responses are easier for us, but much easier for them.

• Example Comment: “A colleague of mine is in charge of a research grant studying the effects of PFAS on children. She is concerned that a lack of understanding of these chemicals could cause her research funding to be withdrawn. Please explain why these rules would not specifically undermine our progress on understanding how chemicals affect human health.” (Not everyone does research, but we know people who do. They still have to answer).

• Identify yourself, but **Note: ** You can also submit an anonymous comment.

• Explain the impact of losing stable, merit-based federal grants or the cancellation of a local program you value.

• Urge action by requesting OMB to eliminate the discretionary termination provisions (§200.340) and the political appointee review requirements (§200.205), and not to finalize the rules.

Each of us who are concerned about our nation’s leadership in medical and health sciences research need to weigh in. Thanks to all of you who take the time to offer your thoughts to OMB…AND, thanks for Lani for sharing this very important development with all of us!!

The Good, The Bad, And The Ugly

The ongoing saga…

The Good – Thanks to Lani for letting us know!!!

The Bad – The short timeline for responding

The Ugly – The obvious politicization of ongoing healthcare research!!!

“U.S. health care is likely to continue to underperform until policymakers and health care leaders address the rising cost of health services.”

The Commonwealth Fund, in a May 2026 report related to the affordability of USA healthcare, which is defined as one of the most pressing challenges for the nation.

Responding In Kind

Responses and comments from my readers…I do receive periodic information from the many readers of the blog. While I have often responded individually, I decided that I should share more transparently. Hopefully, this contributes to an ongoing dialogue…

“Make America Health Again”

Donald Trump, President of the United States – in multiple presentations over the past month…

“While making us healthy again is important – remember the 1960s when we were told to exercise at recess – there are multiple critics of the revised statement. While improving nutrition is valuable, it does not address affordability, insurance coverage, Medicaid, prescription drug costs, the issue of immunization availability, or access to physician services. In fact, healthcare costs remain the number one healthcare issue for Americans these days.”

Kevin Fickenscher, MD – in a conversation with a group of colleagues related to the major healthcare issues facing American citizens.

Consulo Indicium

Information for your Consideration…

A Colleague’s Post – I recently received a Facebook post from 2026-0702 from one of my long-time colleagues, John Glaser. Evidently, he did some research using his research companion – ChatGPT – by asking the question: Where does the USA stand in relation to other nations throughout the world on a variety of areas? As he points out in his note: While there are many areas where the US is the best in the world, there are also areas where it is something other than the best. Specifically, I was appalled at where we stood on “healthcare” and “longevity” – the former being my professional focus throughout my career; and, the latter being my focus as I enter the twilight years. Consider the information…What should we do about it?

Here are John’s thoughts, which I also wanted to share since they are right on point: “The US excels in creating wealth, innovation, scientific research, entrepreneurship, and global cultural influence. At the same time, many peer nations achieve better average health outcomes, longer life expectancy, lower inequality, and higher reported life satisfaction.” So, where are we at today? And, John asked the key question: “…What [would] the “Founding Fathers” think of the US today?” It’s something we should quite muttering about and, instead – do something about…

Seeking Health Information – The Kaiser Family Foundation (KFF) recently reported on a new tracking poll of the American public on how and where they seek “health information” and “trust” when questions or support are needed for issues they are facing. The poll revealed that 3 in 10 adults turn to social media (31%) or AI chatbots (29%) for their health information. The primary reasons for turning to the web were that they were seeking thoughts and perspectives from others with similar experiences, or they needed immediate information to address a particular concern.

The Downside of Self-Sought Information – A recent report in The Washington Post noted that TikTok videos are “pushing misinformation about sunscreen” and are receiving a “disproportionately high share of likes, shares and comments”. The reason for the concern? It’s because people accessing the platform are receiving a disproportionately high number of anti-sunscreen postings. The trend is of concern to dermatologists (NOTE: Among them, my wife is a Mohs Cancer Specialist and Past President of the Am Acad of Derm) because the postings discourage the use of sunscreens, which protect against skin cancer. The misinformation, however, touts information like the increase in melanomas as “caused” by sunscreens. It’s total hocus pocus misinformation. But it’s not just the dermatologists who are concerned. In a separate PLOS Digital Health report shared on NBC News, data shows that information distributed on TikTok videos had some of “the highest views across the five most popular sunscreen-related hashtags.” The report went on to note that while 87% of the nearly 1,000 videos promoted sunscreen use, the content that had the highest levels of engagement included the sites containing misinformation.

But, It’s Not Just the Laity – In another report on the professional use of AI, the percent of use by the legal profession increased from 69% (2025) to 92% (2026)!! Why? It seems that 88% of the legal professionals responding indicated that the use of AI allowed them to “increased workloads” as reported by 88% of the legal professionals. Hmmm? Does this mean I might be seeking advice from “Legal AI” down the road instead of setting appointments for face-to-face discussions?

Oh Oh!! – Back in June 2025, 21 States and the District of Columbia filed suit against the Department of Health and Human Services to prevent the release of Medicaid data on recipients to Immigration and Customs Enforcement (ICE) for purposes of enforcement. However, the Justice Department recently admitted to the judge that a Medicaid data file from the states had been “inadvertently” sent by HHS to ICE. The mistake came to light in a recent federal court filing. It’s been a continuing battle between the states and the federal government over control of whether or not Medicaid data can be used to aid immigration arrests. It’s an important issue since such data could be used for other purposes should the feds win their case against the states.

Healthcare Tops The List Of American Concerns – The Kaiser Family Foundation conducted yet another survey revealing that “healthcare” ranks as the #1 issue of concern to the American public. The most recent tracking poll found that about 64% of adults are worried about their ability to afford and pay for healthcare services with fully a third noting that they were “very worried”!! And, only 13% noted no worries about their ability to afford healthcare costs. Other issues highlighted as part of the survey include:

• Challenges related to “affordability” among both those with and without insurance is a major concern.

• Nearly one-half (46%) of the insured note that lower out-of-pocket costs are the most important change they’d like to see made to their insurance, with 22% opting for the elimination of prior authorization as their most important concern.

These two issues outranked by far those who felt that they needed to get more value for the care they received (13%) or, wanted more choice in which specialists and physicians they could see under their insurance plan (12%)

Across the political spectrum, “healthcare” was described as an issue that would have a “major impact” on who they vote for in the coming elections (55% overall), with Democrats leaning more heavily on the issues (64%) versus Independents (52%) and Republicans (48%). However, it was close. It’s clear that a “top of mind” issue in all of the upcoming campaigns will no doubt be access and financing of healthcare. So, the question is: What promises will be made? And what promises will be kept in the coming couple of years?

A Slightly Shorter Daily Obligation – For the last several years, in an effort to keep the “senility lion” at bay, I’ve tried to walk about 10,000 steps a day. It’s just short of a mile around my block, and my two dogs like to go for walks at least twice a day. So, reaching the 10K mark is possible – but, due to other obligations, not every day! So, I was a bit heartened when a report appeared in HealthDay noting that: “About 8,500 steps a day may be the sweet spot for keeping weight off after dieting, new research shows.” However, the study only reported on “maintaining weight loss” – which is not my problem. So, despite those findings, I’m going to continue my efforts to maintain the 10,000 steps mark (at least 3 – 4x/week 😊). You can check out the details on the findings that were published in the International Journal of Environmental Research and Public Health.

The Weekly Whisk

Musings from a foodie…

As some of my long-time readers know, I lived in London for a number of years during my Perot Systems days. My tenure as the leader for International Health was one of the most exciting and satisfying experiences of my entire career. In addition, I became a fan of the London culinary scene. As a result, when I returned to London for a meeting recently, I sought out some of my old haunts. In particular, I wanted to highlight one of my favorites of the favorites, Benares [ ⭐⭐⭐⭐⭐⭐ ]. But I discovered they were also using another name = “1947 London” (NOTE: the year of India’s independence). Despite the name change, it is still one of the very best Indian restaurants from the bevy of restaurants listed in my Outlook file. While the name has changed from “Benares” to “1947 London”, they have maintained their Michelin Star Rating. So, I highly recommend it if you have the opportunity to visit London anytime over the next couple of years. They pay homage to the rich and diverse culinary heritage of India with absolutely inspired culinary preparations. Benares Restaurant & Bar (located in Mayfair) = 12a Berkeley Square, Mayfair, London W1J 6BS – Phone: +44 (0)20 7629 8886 – Website: Benares Restaurant – book a table

The Good, The Bad, And The Ugly

The ongoing saga…

The Great – At the local level in towns throughout the nation, there were celebrations for the 250^th anniversary of independence for the United States of America on July 4^th. Despite everything else going on in the nation, we could step aside, come together, and celebrate “life, liberty and the pursuit of happiness” for at least a couple of hours…

The Good – Healthcare is ranked as the “number one” issue for the majority of Americans. Perhaps it will stimulate some positive change among the politicians for solving the problems we face as a nation and solving the many elements of the existing American healthcare crisis.

The Bad – Hmmm? Where to start. There are such a growing number of “bad” things happening right now. Let’s start with the resumption of the Iran war…arch!!! I continue to wear my peace symbol.

The Ugly – The “deserved” withdrawal of Graham Platner as the Democrat nominee for Senator in the upcoming Maine elections. While there was great hope among the Dems on his potential for unseating Sen. Susan Collins – a last-minute across-the-board Trump supporter – his undoings emanated from the personal side.

Chronic underinvestment in the education and training of health workers in some countries, and the mismatch between education and employment strategies in relation to health systems and population needs, are contributing to ongoing shortages. These are compounded by difficulties in deploying health workers to rural, remote, and underserved areas. Moreover, the increasing international migration of health workers may exacerbate health workforce shortfalls, particularly in low- and lower-middle-income countries. Human resources for health information systems are often weak in tracking selected health workers from the public sector. So, here are some quotes for introducing some thoughts on the topic:

“In 2030, all Baby Boomers will be age 65 or older, accounting for 1 out of every 5 Americans. This group will be an increasingly large part of the U.S. population in the future. They will need a robust, well-trained long-term services and support (LTSS) workforce to meet their needs.”

National Center for Health Workforce Analysis, U.S. Department of Health and Human Services, December 2025

“A severe, growing shortage of healthcare workers is driven by an aging population requiring more care, while a large portion of the experienced workforce retires. This imbalance is worsened by intense staff burnout, high stress, and demanding working conditions—intensified by COVID-19—leading to many leaving the field.”

Kaiser Permanente

“To do what nobody else will do, in a way that nobody else can do, in spite of all we go through…that is what it is to be a nurse.”

Rawsi Williams, RN – a BSN who also holds a Law Degree and describes her skill set as a change-agent and proven Turn-Around Specialist

“10 million. That is the projected global shortage of healthcare workers by 2030. Behind that number aren’t just vacancy rates or spreadsheets—they are people. They are the doctors, nurses, and support staff who hold our health systems together, often while facing burnout, exhaustion, and a feeling that they are pouring from an empty cup.”

Kelsey Fuller, MS, Director, System Value Performance and Transformation Communications @ University Hospitals, Value-Based Healthcare Operations, Cleveland, Ohio

Now, read the next page, where I have included an article I wrote in 1976 on “Lacidem”

The Occasional Diversion

Opinions and Reflections

An Interesting Diversion On A Rolling Tortoise – The following story comes from Popular Science on a tortoise who adapted to his predicament through unconventional means. A group of Philippine veterinarians provided the creative intervention for solving the problem where he had lost the function of his hind legs. So, they created a “scooter” for the Aldabra tortoise (the large type that are found in only a few places in the world). As a result, the tortoise has become “…quite the mover and shaker in his homeland area.

Here’s what the article reported: “According to Popular Science, a private zoo brought the injured tortoise to Nielsen Donato, the chief surgeon at Vets in Practice. After finding no dislocations or fractures, the team suspected the leg weakness might be neurological or the result of interactions with larger companions at the zoo. In addition to anti-inflammatory therapy, they decided to install four wheels onto the bottom of its shell for an extra mobility boost — as you can watch here (highly recommend). The tortoise was eventually sent home after showing mobility improvements, and we’re happy to share that the reptile is walking normally again without wheels.”
​
​I thought of this diversion because we’ve just come through “turtle season” here in Maine, where we are encouraged to “help the turtles” cross the road when we see them during our commutes or drive-abouts! That way, surgery will not be needed…😊

Consulo Indicium

Information for your Consideration…

A Personal Note – One aspect of The Fickenscher Files is that I try to share perspectives from all sides. However, a number of my more conservative readers seem to have abandoned me. I’m disappointed. I’ve always tried to present those perspectives when those with alternative thoughts share their viewpoints, and I have done so anonymously. Given the tenor of the times, however, I’ve found that we seem to be facing a deconstruction of the healthcare marketplace of the norms we’ve developed over many years. I’m clearly not a fan of RFK, Jr. I predict that his tenure as Secretary of DHHS will go down in history as one of the worst – if not the worst – in USA history. And, as importantly, the leadership of the USA on the healthcare front is now being seriously debated across the continents. But, if you disagree – let me know!!

FROM Rohan Solgarkar – The global Artificial Intelligence Market (AIM) valued at US$14.92 billion in 2024, stood at US$21.66 billion in 2025 and is projected to advance at a resilient CAGR of 38.6% from 2025 to 2030, culminating in a forecasted valuation of US$110.61 billion by the end of the period. The growing incidence of chronic diseases, linked with an increasing geriatric population, puts substantial financial pressure on healthcare providers. There is a rising need for the early detection of conditions such as dementia and cardiovascular disorders. This can be done by analyzing imaging data to recognize patterns, which helps create personalized treatment plans.

The Medical Perspective on “Healthy Diets” – Much has been in the news of late on the question of “healthy diets”, especially with RFK, Jr.’s focus on “highly processed foods”. While there is some perspectives on these foodstuffs, the emphasis should be on “some”! In essence, we do have a problem in the USA. It’s particularly evident when one looks around because 28+% of the USA population is obese (NOTE @ 100M obese Americans versus 349M total USA population). That’s particularly stark when one travels around the world. You really begin to notice how evident the problem is in the USA. And, obesity is caused primarily due to consumption of “highly processed foods, sugar-sweetened beverages, and excess sodium”. However, that is not the total problem. It’s also over-consumption of foods in general, lack of exercise (remember JRK’s fitness program from the 1960’s (I do 😊) that was aimed at bolstering youth health under the auspices of the President’s Council on Physical Fitness? It became a national obsession for the under-18 crowd (at least for a while…)

In an effort to counteract the amount of misinformation that has been disseminated in the last year related to dietary modification (among any number of other health issues), the AMA has developed a set of webinars to assist physicians by providing “evidence-based education” that the physicians can use as guides for use by their patients. You can check out the free AMA dietary webinars. Now, just so everyone believes the above, please note that one of my close colleagues always reads the FickFiles with a focus on dietary missives. She’s a noted dietician and fact checks me regularly. If I’m wrong, I will hear from her and let you know her thoughts as well!!

Acetaminophen (= Tylenol) Exposure During Pregnancy NOT Linked To Offspring Autism – a new study was recently published in JAMA Pediatrics by Danish researchers who reported that the use of acetaminophen “by women during pregnancy was not associated with autism in their children.” Specifically, they examined the records of “more than 1.5 million children ‌born between 1997 and 2022, including 31,098 exposed to Tylenol in the womb. Autism was later diagnosed in 1.8% of exposed children and 3% of the unexposed group.” Furthermore, the data examined was not restricted to consumption only, but also accounted for the dose of the drug and in which trimester the Tylenol was used. Furthermore, the study echoes the results of a 2024 Swedish study that also “found no link between autism and pregnancy use of Tylenol.” No doubt, further studies are in the works. If reports become available, I’ll try to make sure you hear the results. We need to remember that science is built on data analyzed to find the truth, not on selectively inaccurate information that does not adhere to scientific analytic principles!!

MAHA Disappointments – Many of you are no doubt inundated with unrequested emails of one political persuasion or another. Erica Schwartz, MD, the former Deputy Surgeon General is now the CDC Surgeon General nominee. She is the 4^th (I believe that is correct) person to be selected for the role over the last two years. Not only does she have extensive experience in public health but she’s also had a lot of experience in government work both in the military and with the DHHS. The Friday Pulse is a compilation of observers including:

• “She hasn’t earned a reputation for pushing back on Covid-19-era vaccine requirements and prolonged school closures…”

• “During the pandemic, Schwartz took on a role as the official physician ordering Covid tests for drive-through testing sites nationwide…”

• “…She doesn’t have a history of publicly questioning the safety of routine vaccinations.”

• “Aaron Siri…Kennedy’s personal attorney…criticized Schwartz for her role in writing smallpox and anthrax vaccine mandates for some Coast Guard members during her time overseeing its health system.”

• And, a final counterpoint from Friday Pulse: “…This agency does not need another cheerleader for industry; it needs a regulator over industry,”

But, the major issue seems to be that even though she is clearly qualified for the role given her background and experiences, RFK, Jr. – as DHHS Secretary – can overrule the guidance that she and her team develop. So, the question becomes – how to manage RFK, Jr.

Ruminations On Aging – It appears, based on some new research described in WebMD.com, that aging and happiness often follow a U-shaped curve in life. As a trial of 1, I can concur with the findings of this new study. When we are young and on into our middle years, the line slowly dips. As an example, it was in those middle years that I started bike riding on the prairies of North Dakota, and I quit smoking abruptly due to worries about my health. The evolution continues on into the 40s – 50s, where our “happiness” index starts to rise again. When we reach the 60s, about 1/3 of people in those years are contented – which is a tish more than those under the age of 35. And as a member of the golden decades group, we are presented with new challenges appearing on the horizon. It’s not uncommon that we start to perseverate about our health, our economic capacity for weathering those years, the increasing number of death among our loved ones as well as the iconic public figures in our lives from prior decades. In fact, the “top of mind” list of concerns for those in 60+ era includes the following: 1) cancer risk, 2) hearing loss, 3) weight creep (in both directions), 4) skin changes (dry, scaly, wound healing problems), 5) heart troubles (oy vey), 6) brain power (double oy vey), 7) vision problems, 8) bone and joint issues, 9) sleep quality or lack thereof, 10) increased blood pressure, 11) bladder control (my assessment is “frequency”), 12) immunity to diseases and circulating “bugs”, 13) dental issues, and 14) add your own areas of focus to the list. These issues compound to the point of perseveration at times. So, to manage these issues, I’ve taken to (attempting) to walk 10,000 steps a day and modifying my dietary intake towards the Mediterranean style diet (except for chocolates and a few other goodies). Consider the alternative!! It’s a real motivator!!

Notes From The Keri Report – Given my interest in all things culinary, I recently joined a semi-regular podcast by Keri Gans, a Registered Dietitian (RDN) and host of The Keri Report podcast. Shortly after joining, I noticed a podcast on “What to Eat Before Bed for Better Sleep”. You should check out the longer version. Here is the essence of her suggestions. First, she noted that our sleep cycle is affected by the hormone melatonin, which has a major influence on the sleep-wake cycle. However, I was not aware of the fact that certain nutrients affect and support the brain chemicals involved in sleep. It makes sense on the face of it. So, here are some suggested pre-sleep ingestible foods to consider for enhancing your sleep:

• Kiwi – A fruit that has grown in the USA in recent years is marked as a good source of magnesium. The pill form is part of my daily routine for mitigating my peripheral neuropathy, it also supports the production of melatonin as well as mitigating the neuropathy.

• Turkey – For the meat-eater types, turkey offers up tryptophan, an essential amino acid that facilitates the production of melatonin and serotonin - hormones that regulate our mood and the sleep-wake cycle.

• Eggs – another option to consider that affects tryptophan because of the fact that eggs contain the essential substance. Also, eggs contain Vitamin B6, which according to dietary research, also contributes to the conversion of tryptophan to serotonin.

• Tart Cherries – imagine that!!! Evidently, an article in a 2025 article in the journal Food Science & Nutrition reported that consuming an ounce of tart cherry juice for seven days increased the total amount of sleep that people were able to achieve. Their sleep was also more efficient in that time in bed devoted to sleep increased as well. So, definitely switch from red wine to Tart Cherries. I’m on it

• Milk – serves as a great source of protein, plus it offers tryptophan and calcium – an essential vitamin that provides support to signaling by nerve cells. Calcium is another one of my daily consumptive elements, although in place of milk, I use a nightly dish of ice cream. I just hope the transfer is just as complete. My informal report is that ice cream before bedtime is a must, plus my two dogs appreciate the bowl licks following my consumption.

• Bananas – are high in magnesium and potassium, which facilitate muscle relaxation and, like eggs, contain Vitamin B6.

I could go on with the list that includes bananas, avocados, sweet potatoes, walnuts (I like the honey-coated type), But, in addition to the dietary intake to facilitate sleeping, my suggestion is to stay away from alcohol, too much coffee (although for a coffeeholic like me, it does not seem to be a problem), tea, colas and other such offerings. But, check out the full article as noted above. It’s worth the read!!!

The Weekly Whisk

Musings from a foodie…

Almost Ready To Move – We’re just returning from a wonderful six-day trip to Sicily, where the adventures were quite incredible – but I’m not about to start a travelogue. Rather, it’s simply a report on two of my favorite culinary experiences over the last several weeks. In years past, when I traveled extensively overseas, I was able to offer up a large variety of experiences. In recent years, my observations have been primarily USA-based. However, with our trip, we were able to go out every night. So, my two suggestions are: Don Camillo in Siracuza [⭐⭐⭐⭐ ] and Tratoria Malvasia [⭐⭐⭐⭐ ]– both in Taormina on the Sicily coast.

I must admit that Don Camillo had an extensive antipasto, pasta, and main menu with a fixed price for x2 and x3 options. However, there were two major critiques of the whole experience that resulted in a downgrade on the non-food front. The first was the fact that the four of us (we were with friends) were seated at a rather large round table capable of seating upwards of eight quite easily, which made the conversation somewhat repetitive since I kept saying “what did you say” – politely, of course. The second was that there was a “pretentious” atmosphere underlying the whole experience. On the food front, the menu offered an interesting culinary tour:

• Tomato ice cream with spiced celery

• Mussel in a canapé shell with the appearance of a mussel shell

• Sliced bread (= 1/8 of an inch thick) dried with butter and garlic – loved it!!

• Carpaccio of bacalao topped with caviar and citrus jellies plus seaweed

• Smoked local shrimp with onion cream

• Multiple Salted breadsticks between courses

• THE BEST beef ravioli with cheese sauce

• Pasta shell stuffed with swordfish & eggs with an outstanding tomato sauce

• Rabbit with tomato sauce

• Lamb loin, which was the weakest link during the entire culinary experience, not because of taste but because I have an aversion to eating lots of fat…😊

Don Camillo was established in 1985 and received a Michelin rating in 2025. I could go on, but I was wondering if they kept it in 2026? And, while the foods were tasty, the other elements of the experience reduced their star rating. It was a once-in-a-lifetime experience. AND, regardless of foody experiences, I fell in love with Sicily.

The second experience was with Trattoria Malvasia [ ⭐⭐⭐⭐⭐], also located in Taormina. The antipasto was simple but wonderful with Prosciutto and Mozzarella Cheese. We opted for their “House Specialty” of Ravioli with Shrimp. The sauce and ravioli were exquisite with small shrimp. It was a treat. They also surprised us with sea urchin, and our table conversation drifted toward the fact that Maine is one of the largest Sea Urchin producers in the world, although most of them are evidently shipped to Japan. However, the best part of the dinner was the Branzino with a simple but exquisite olive, caper, and tomato dressing. The chef (I did not catch her name) was also present and welcoming of folks following dinner. It was a delightful, open-air trattoria that you need to consider if you travel to Taormina. If I get back, I’ll give them a try again.

While I’ve traveled to Italy many times and had lots of experiences on the mainland, Sicily is a treasure unto itself and should be experienced at some during life. If you like pasta, you’ll fall in love like me!!

The Good, The Bad, And The Ugly

The ongoing saga…

The Great – When gasoline prices drop back down to the $2.00+ range, we will all be very happy. Hmmmm…

The Good – The snow has melted in most of Maine and around the nation, with the daffodils reaching full bloom. It’s created a sense of energy.

The Bad – When I asked my wife for advice on “What is Bad right now?” her response was: “What isn’t bad?”

The Ugly – The failure of leadership by the legislative, executive, and administrative branches of the USA government due to the abyss of ideological infighting at multiple levels that is not solving real issues of concern to the American – and international – community!

“At least 12 of the pardoned rioters have since been charged with other serious crimes, including child molestation, assault, harassment, murder plots, and charges related to a vicious dog attack. The outcome was predictable. Critics, including this board, had warned that Mr. Trump’s pardons would embolden the rioters by signaling that crime has no consequences.”

The Editorial Board, The New York Times – Read full commentary here

“Scientists once thought illness was caused by ‘miasmas’, foul vapors that drifted through the air. For centuries, they were certain that the sun rotated around the Earth. Until the 1950s, they believed that lobotomies were the best way to treat mental illness. Why did we stop believing these things? In each case, skeptics used the scientific method to produce data that disproved the incumbent theory.”

Noubar Afeyan – a Lebanese-Armenian American entrepreneur, venture capitalist, and biotechnology innovator best known for co-founding Moderna.

“In 2026, medical AI will move from the ‘Peak of Inflated Expectations’ to the early ‘Slope of Enlightenment’ on the Gartner Hype Cycle—a sign that hype is giving way to reality.”

Hugo Aerts, Ph.D., Investigator – Mass General Brigham, from a report: Looking Ahead: Predictions for Science and Medicine in 2026.

And, so many more quotes in the last month that I had to stop…😊

The Occasional Perspective

Opinions and Reflections

Kudos To Sen. Angela Alsobrooks (D) Maryland – There are an increasing number of legislative leaders in the US Congress with some backbone! I have been a consistent critic of Secretary Robert F. Kennedy, Jr. for his many unfounded and unscientific views. Over the course of the last year, that perspective has solidified considerably. For my detractors, please note that I have always believed that our nation’s problems are generally solved through debate, discussion, compromise, and joint decision-making, in the final analysis, from perspectives on all sides of the table. But when ideas or perspectives are fringe at best, it is time for leadership to step up to the plate rather than step aside in deference to position. Such is the case for the U.S. Congress versus Robert F. Kennedy, Jr.

So, kudos to Sen. Angela Alsobrooks of Maryland, a fierce critic of the Senator for his unhinged, unscientific views and perspectives. At Kennedy’s confirmation hearings, she asked Kennedy to explain why the vaccine schedule for blacks should be different from that of whites. Kennedy defended himself, saying that was what a peer-reviewed study had concluded, but Alsobrooks wasn’t convinced. While I agree that understanding the basics of “nutrition” is important, I happen to believe that educating physicians (and other health care professionals) on the evolution and integration of AI/ML is more important at this point. And, it’s been my experience that getting medical and health science schools to adopt such education is difficult due to a “full” curriculum on other topics. Perhaps we should reassess those topics, BUT I digress. It’s now extended to other topics. This is not a topical issue – it’s a global issue throughout DHHS. From the placement of individuals with little or no experience into leadership roles, to advocacy for non-peer-reviewed studies, to absolute disregard for the scientific approach – which has created the “health” of modern societies – the leadership within DHHS has been stupefied. We need more than Alsobrooks to step up to the plate. While a few ideas are worth pushing, they do not outweigh the bad ideas emanating from DHHS at the moment – and leadership is responsible.

7:07 PM CST Splashdown of Artemis II – Like many people across the spectrum, both globally and politically, it was amazing to watch the Artemis II splashdown on April 10^th at 7:07 PM CST. The discussion from atmospheric entry to final splashdown was quite detailed in describing the hows, whens, and whats of the re-entry process. In particular, I was struck by the comment that splashdown would occur at 7:07 PM CST. That announcement was made just a couple of minutes after re-entry in the upper atmosphere. When they splashed down, I looked at my watch and – it was 8:07 PM EST or, 7:07 PM CST. Isn’t science amazing? It would be great if Secretary Kennedy and his minions actually “listened” to science on the health care front. If that were the case, we would be improving health rather than dismantling it!!

Readings and Listening To Consider

Books and Articles worth a Review…

Let me offer a GIANT SHOUT OUT to the University of North Dakota (UND) Fighting Hawks Hockey Team (in case you did not know it, their jerseys are “green”) – because of their move to the FINAL FROZEN FOUR of intercollegiate hockey. Despite the loss to Wisconsin, the team did a great job of showing up with pure hockey fever. As both an undergraduate and medical school graduate of UND, I remember the days when hockey was played at the Ice House on campus, a large, covered hockey rink without heat. There were many a weekend night spent there yelling, whistling, and cheering on the “then” Dakota Sioux (the name changed about a decade ago from “Sioux” to “Hawks”). So, while I was disappointed in their loss to Wisconsin (my other state of residency for a long period of time), I was proud of their efforts. Perhaps next year they can go on to win the trophy and bring it home for the friends and family back at my homestead state.

The Occasional Perspective

When I feel I must share my thoughts and perspectives on a burning issue…

A Revised Hippocratic Oath? Over the last several years, I’ve noticed an interesting sidebar discussion that seems to be ongoing and evolving. It relates to the Hippocratic Oath, where the first order of commitment is to “…first do no harm.” The evolving discussion relates to the use of AI as part of the armamentarium of clinical providers. In recent years, there have been a number of articles by various writers and scholars related to ethical frameworks for artificial intelligence. For example, Oren Etzioni wrote “A Hippocratic Oath for Artificial Intelligence Practitioners” (2018), proposing an ethical pledge for AI developers. Others have included: Li Felländer-Tsai (AI ethics editorial), Peter Shen (STAT article on medical AI ethics), and Chinmayi Sharma (academic paper on AI oath frameworks), as well as the National Library of Medicine! My sense is that this is an increasingly important issue as AI becomes more and more an integral component of the health care delivery process. But we need to move beyond the ethicists and get the clinicians involved in the discussion and debate. Now is the time…

A Short Commentary On Religion – In recent weeks, we’ve seen Defense Secretary Pete Hegseth urging the citizenry to “take a knee…on bended knee” as they pray to Jesus for success in the Iran War. Then, just a few days later, he read out a sermon praying that “wicked souls” be “delivered to the eternal damnation” in the fight against Iran. As a kid, I attended Wednesday evening Luther League, Saturday School for learning about the Bible, and Sunday School for good measure – all followed by close attention during the sermon on Sunday. But I switched to Methodist a number of years ago because of their acceptance of all people, come what may! In all of those years as both a Lutheran and a Methodist indoctrinated person, I never experienced a call for mass killings. And, I was never encouraged to call upon Jesus as a “warrior” for saving me or the world. His calls are disturbing at best and disgusting as a representation of Christianity.

An Interesting Graph!! – I thought everyone would be interested in this graph put out by the Bureau of Labor Statistics. Even though I was trained as a physician and practiced both formally and informally for a decade plus, I’ve actually spent a major part of my career as an executive, Chief Medical Officer. Hmmm… It would be interesting to see what percent of the “administrators” are “clinicians” (i.e., physicians, nurses, etc.). I suspect it would change the graph somewhat.

Future Health

Delivering care in the new virtual world…

Johns Hopkins Medicine and the American Telemedicine Association recently announced a major three-year push to develop and deploy new legislation that would reduce state licensure barriers to allow for the expansion of telehealth access. Referred to as the LIFTT Initiative (Licensure Innovation for Telehealth Transformation), it intends to educate the public on the urgent need for federal reforms to improve telehealth access nationwide.

The initiative aims to integrate proposed federal solutions with state-based licensure protocols. The rationale for the project is that it offers a potential solution for the vast majority of states that have not addressed the issue of “telehealth” and, as a result, hold restrictive telehealth licensure rules. During the COVID-19 pandemic, many states adopted more flexible rules related to telehealth visits, many of which have now been rescinded. Advocates for the change believe that certain populations are at the highest risk, including patients with cancers and rare diseases.

During the COVID-19 pandemic, temporary rules made it easier for patients to have video visits with doctors in other states. Those rules have since ended. Many states have gone back to their old, stricter rules about which doctors can treat patients, Johns Hopkins said. This means patients often can’t get care through telehealth from doctors who live in a different state, students who reside in a state that is different than the one in which they are enrolled, people residing in rural underserved or remote areas, patients enrolled in palliative care, travelers who experience problems in states where they do not live and other similar problem areas.

The LIFTT Licensure team believes that the current variety of licensure requirements at the state level is inhibiting access to effective care delivery services. It seems that many of our existing laws and regulations will be increasingly challenged as we move toward more globalization – across the board. From banks to products of all types to healthcare, the shift is occurring. We are beginning to live in a new world, and old-world solutions and requirements are clearly at the forefront of potential change in the new era of globalization.

On The AI Front – A New Ongoing Section

Perspectives and realities emerging in the transformational AI space….

Technology Replacing Clinicians? Is it any surprise that the leaders of information technology have come out indicating that AI will replace doctors? We should not have been surprised that Bill Gates and Apple have joined the list of influential voices predicting AI will replace doctors. So, is the future bleak? Do we need to put away our stethoscopes and consider another profession (BTW, it’s too late for some of us)? I present what might be the most comprehensive case yet for why that future is nearer than we think. Should doctors start packing? It depends on how attached they are to stethoscopes. 😉 Bill Gates has given us a decade to prepare for the inevitable. And, for their part, Apple announced the release of their approach, referred to as the “AI Doctor” this past month.

However, I don’t believe we should look at the future through such bleak glasses. Will AI become an instrumental component of the care delivery process? YES. Will AI be able to touch someone? Hold their hand? Examine that pain for which they are seeking care? Address all of the patient’s questions? No, I doubt it. In fact, “futurists” have been making such predictions about medicine since at least the mid-part of the last century.

Now, will AI be able to “augment” our abilities as providers of care? ABSOLUTELY!!! In fact, I’ve been referring to the use of technology in the care delivery process as providing “clinically augmented intelligence”. And, the technologies will augment our capabilities in very significant ways. But, machines – at least the ones on the horizon now – will not be able to touch the patient, hold their hand, lower their voice, reassure the family, and on and on… There is something to be said for “human interaction” as a critical component of the care delivery process.

Consulo Indicium

Information for your Consideration…

Health Systems And Plans Pursue Performance-Based Contracts – One of the interesting phenomena occurring across the healthcare community is the pursuit of performance-based contracts with digital health vendors. In a recent survey conducted by the Peterson Health Technology Institute, Modern Healthcare reported: “75% of health plans and 61% of health systems implemented performance-based contracts with digital health vendors.” For those organizations that have not yet adopted such an approach, it was further reported that “…the majority of the organizations that didn’t use performance-based contracts last year expressed interest in doing them.” Assuming that such a model is successful, we should anticipate further use of “performance-based contracting” in other areas of the healthcare arena.

The Increasing USA Nurse Shortages – Long story short, the nursing shortage is going from bad to worse across the country. Data from the DHHS Health Resources and Services Administration is projecting an 8% shortfall in the number of needed nursing staff for the health care community in 2028. Some of the data points include:

§ The overall combined deficit of registered and licensed practical nurses will top 355,000 by 2028.

• Over the next decade the situation worsens with at least nine states will have unfilled nursing job rates in the double digits—California (22%), North Carolina (20%), Georgia (20%), Michigan (18%), Washington (17%), Maryland (16%), Oklahoma (13%), South Carolina (12%) and Louisiana (11%).

The problem is indicative of other areas in the healthcare community as well. As a rural health advocate, I should add that the rural areas of the country are in an even worse situation related to staffing shortages. Also, as I observe staffing patterns in both long-term care programs and outpatient settings, the use of temporary staff is increasing as well. The difficulty with such a staffing approach – while filling the acute shortage – too often results in gaps in actual care delivery – especially for those patients requiring longitudinal care.

Finally, it appears that the problem is only going to worsen over the coming decade if certain proposed policies of the Trump Administration are implemented. Specifically, the US Department of Education is proposing the exclusion of nursing from the “professional degree” category of education. Why is that important? It’s a factor in why individuals pursue nursing careers as Jennifer Mensik Kennedy, Ph.D., RN, President of the American Nurses Association, has clearly stated in a recent interview: “We’re going to have less staffing. We’re going to have fewer nurses throughout the continuum of [the patient] experience in healthcare, and nurses are the backbones of the healthcare system.”

Health Care Financial Stress Increasing – In its proposed budget for fiscal year 2027, the Trump Administration is proposing an across-the-board 10% cut in federal government spending, except for the support going to the military for the Iran War, where it is seeking a 44% increase. I’m wearing my peace sign from my 1960s high school and college days; you know where I stand on that one… The end result is that the health care community is on pins and needles due to rising costs. Those costs stem from high inflation (which is happening to everyone), increasingly tight operating margins, and rising pharmacy and overhead costs. Cost of care is a major issue of primary concern among administrative and clinical leaders in the healthcare industry, with 84% citing it as the “greatest threat” in a recent Becker’s Healthcare survey. As a result, operational efficiency, cost reduction (where possible), and outpatient services growth have become the watchwords among healthcare leadership. The survey also included an analysis of the challenges facing the health care community, including the following major points:

• Outpatient care is a major growth sector for the healthcare delivery sector with a projected 18% increase over 2025 – 2035. Ambulatory surgery is another area of increased services in outpatient surgical units, representing a 51% increase in eligible surgeries over the period of 2024 – 2028.

• Fitch Ratings – one of the world’s major credit rating agencies – recently issued a “deteriorating” outlook for the healthcare sector due to cost issues, increased uncertainty on regulatory issues, and expiration of the Accountable Care Act subsidies.

• Ongoing labor and technology costs continue to increase, with cybersecurity leading the cost increase in IT budgets by 31%.

• Decreased government spending with a project 7.9% reduction in Medicaid spending in 2026!

In sum, health care is facing a “cautious at best” outlook for 2026, which is forcing budget tightening. From my perspective, it suggests (strongly) that in the USA, we need to get more serious about a shift toward “value-based care delivery” reimbursement. Under such a system, the outcomes and value of service delivery would be major parameters for payments. It’s an ongoing discussion…

The Cost Of Care By Family – The Public Policy Institute recently issued a report assessing the contribution of care provided by friends, neighbors, and relatives for the aged community. It’s clear that the economic contribution of family and friends toward sustaining the aged is worth significant dollars. The Public Policy Institute used data from 2024, noting that 59 million Americans provided care for their adult relatives, neighbors, or friends. By adding up to the estimated 49.5 billion hours of care (a probable undercount), the economic contribution of labor comes to $1.01 trillion, which exceeds both Medicaid and out-of-pocket health spending. “A Place for Mom” may in fact be your living room or your friend next door that reach out to help those still living at home. Kudos to those who provide such support. BUT – as a society – we should not underestimate the cost nor the value of such services provided by neighbors, friends, and family.

The Weekly Whisk

Musings from a foodie…

In recent travels, I’ve had the opportunity to visit a number of places around the country. When arriving in Denver, Colorado recently, I had a hankering for some good Italian cooking and found a good place in the downtown area called Tavernetta [ ⭐⭐⭐⭐⭐⭐]. At first, I was quite taken by the menu because there were a number of “Mainer” foods on the menu (e.g. lobster, diver scallops, and the like). However, as you will see, I did succumb. However, for starters, I decided to stick with more traditional foods and was not disappointed. The Rigatoni with Lamb Ragu was exceptional as a “primi” dish. However, for the “secondi” I acquiesced to the Black Cod with white Asparagus, spinach, and hazelnut sauce. Again, it was great. It’s definitely worth a visit if you’re in the Denver area. In fact, it’s one of the best Italian restaurants I’ve experienced this year. But, standby!! I’m off to Sicily in 3 days. I’ll report back following the trip. Tavernetta – 1889 16^th Street – Denver, CO 80202 – (720) 605-1889 - www.tavernettadenver.com/

The Good, The Bad, And The Ugly

The ongoing saga…

The Great – Hmmm…not sure.

The Good – Winter is over and Spring is started to blossom!

The Bad – The tit-for-tat engagement of the President with the Pontiff seemingly does little to resolve any of the issues affecting the Presidency

The Really Bad – The increasing staffing shortages evidently across the healthcare spectrum. It needs the attention of all of us…

The Ugly – The “obliterated” have already started on their “reconstruction” efforts.

Recent Notable Quote(s)

“The United States…is like a golden retriever bounding through the forest, wagging it’s tail and knocking things over.”

Adm. James Starvidis, Former Supreme Allied Commander (Ret.) – in comments on CNN Live, February 16, 2026, related to the current approach of the United States in managing its European relationships…

“Let us not seek the Republican answer or the Democratic answer, but the right answer. Let us

not seek to fix the blame for the past. Let us accept our own responsibility for the future.”

John F. Kennedy, 35th President – United States of America

The Occasional Perspective

Opinions and Reflections

It’s Time To Come Together – On March 15^th, Heather Cox Richardson offered up her daily Substack post with a commentary on Maine Joining the Union in 1860. I was not aware of the historical significance of Maine becoming a state and the political machinations that occurred over the state joining the Union. The southern states were in opposition to Maine joining the Union because it was a “free” state. It would have created a majority of federal legislators in the Senate with that perspective. We seem to be at a similar point in our legislature today although focused on a different set of issues. There are lessons to be learned in considering history for all of the lessons that could be applied today. When, “we the people” come together, we can make a difference.

Resonating Considerations - Project 1776 – I recently received an email from two financial analysts – Porter Stansberry and Luke Lango. I wanted to share it because their thesis truly resonated with all my readings and considerations over the last year. In essence, we are facing a dramatic, self-sustaining transformation of the way our nations, governments, companies, communities, and even our social relationships. The focus of the white paper was on how wealth was going to be created. And, while that’s an important consideration, the societal considerations are even more important. Specifically, I believe the greater issue is how the life we lead – as individuals and family – is going to be led!! And, by “life…created” I mean how we work, live, interact, and cooperate (or not) with our compadres, community, colleagues, friends, and even family. The message of the analysts is that we are moving very fast. These dynamics are creating a revolution in how society works. So, if we look at these changes in the context of revolutions, what we find is the following:

• The rise and spread of Christianity took 3 centuries (1^st – 3^rd)

• The Islamic Cultural and Economic Revolution^, an additional 3 centuries (7^th – 10^th)

• The Printing Revolution, 100 years (in the 15^th century), which then fostered the Protestant Revolution and Scientific Revolutions (16^th and 17^th centuries)

• The Industrial Revolution (18^th and 19^th centuries)

• The Democratic Revolution (18^th – 20^th centuries) that fostered the evolution of human rights and served as the foundation for the Declaration of Independence in the USA

AND NOW…

• The Digital Revolution is upon us!! And, the pace of change is accelerating. Consider these facts:

• The radio took 38 years to reach 50 million users.

• Television took 13 years.

• The internet, 4 years.

• ChatGPT hit 100 million users in 2 months.

We’ve come through revolutions before but the magnitude and pace were just a tad bit less dramatic. It’s clear that the current digital revolution is much more than provocative! In fact, the “pace” and “depth” of change have accelerated to the point where it has become exceptionally hard to “keep up” with the changes. Furthermore, the changes are altering the inner workings of life as we have known them over the centuries. Why?

• Communication has shifted from local to global, anytime, all the time.

• The intelligence of how we accomplish “work by workers” is being decoupled from the process of “completing work”.

• Knowledge is distributed and disseminated through technology rather than people.

We’ve been through revolutions before – and, we’ve adapted. The challenge is before us! The question is whether we can pick up the pace and be flexible in our responses to this worldwide challenge. My advice? Let’s embrace and let’s adapt!

Readings and Listening To Consider

Books and Articles worth a Review…

American Heart Assn, American College of Cardiology, Plus 9 Others Issue New Guidance – In a joint release, the leading organizations involved in identifying ways for all of us to stay “heart healthy” released a new report in the past month in an effort to reduce the toll of cardiovascular disease, which is responsible for about one in three USA deaths. In releasing the guidance, Roger Blumenthal, MD, Chairman of the guideline group and a cardiologist at Johns Hopkins Medical School, opined that: “Eighty percent or more of cardiovascular disease is preventable.” So, the emphasis was on younger folks as well as us older (more gentile 😊) folks.

The new guideline starts with a focus on getting younger people to start with making sure they have a lifetime of lower LDL levels which would have a major effect on their health. He noted that: “Heart disease would go down markedly. We think we could cut heart attack and stroke rates down by half.” The new recommendations include starting by testing LDL cholesterol levels (i.e. “bad” cholesterol) even in childhood at around age 10. The recommendation, if followed, would identify one in 250 people with a genetic condition that leads to extremely high cholesterol levels. Treatment could then start immediately rather than happenstance identification of the problem down the road. The report also recommends that physicians start testing all other patients around ages 18 – 20 with repeat screenings every 5 years. It should be done more often for those with high LDL levels or other risk factors like diabetes. The intent is to have all individuals striving to have an LDL level below 100. And, if other risk factors are at play, below 70. And, if per chance, someone has had a heart attack or stroke, or is diagnosed with peripheral artery disease, the LDL needs to be even lower, below 55.

The Occasional Perspective

When I feel I must share my thoughts and perspectives on a burning issue…

Disgusting! – In a recent newsletter by Heather Cox Richardson, she noted that the Trump family has been enriched by about $4 billion since the onset of President Trump’s most recent term. And, he just applied for “copyright” of his name and accoutrements associated with his name so that airports (several name changes in process), merch, and the like will provide payments to him and his family. The use of his position as President to enrich himself and his family is disgusting. It speaks to the totally narcissistic behavior that seems to have become the daily norm for this current White House. It’s sad when there are so many issues that need attention in our nation and in the world…

Consulo Indicium

Information for your Consideration…

Hallelujah!!! US Cigarette Smoking Hits All-Time Low –The USA has finally hit an all-time (well, perhaps not “all-time”) low in cigarette smoking. When I was a kid growing up, I found my Dad’s smoking appalling. He cut our hair on a regular basis in the basement and always had a cigarette hanging out of his mouth. I found it disgusting. Then, in 1969 – when I started college – I tried a pipe but quickly moved to cigarettes. But I wasn’t alone! In fact, it was just over 40% of the American public that smoked – and there were no rules about when or where. However, my consumption grew over time, and I became an outlier. By 1983, I was puffing away on four packs of Marlboro Lights a day! Yes, 4 a day!!!

But then in the early 1980s, I developed some health problems (how stupid of me as a young physician). And, when walking with my best friend after dinner and talking about the problems (he was a physician as well, actually a pathologist – yikes!), I threw my pack into the garbage can on the street. As a result, I’ve become an ardent non-smoker now for 40+ years and wince every time I see a smoker. I share the story because I became very excited when I read about a newly published research study revealing that the number of smokers had dropped to less than 10% in 2024. It marks the first time the rate has dipped into nearly single digits. Again, hallelujah!!!
​
So, why the drop? It’s because of a decades-long public campaign by the government that started in 1964 when the surgeon general reported on the dangers of smoking. Since that time, a whole series of lifesaving initiatives have been started in addition to the public campaigns, including cigarette and tobacco taxes, smoking bans, and regular physician admonishments. Those efforts have prevented almost 4 million lung cancer deaths and chronic obstructive pulmonary disease among Americans. But, we still have a ways to go. The public health community has targeted a 6.1% adult smoking rate by 2030. Now, about those questions on vaccinations…

Trust The Healthcare Professionals…Spread The Word – The medical profession, via the American Medical Association and an increasing number of medical specialty societies, has developed the “Vaccine Integrity Project” to provide quality outcomes information on the use of vaccines. It’s been led by Michael Osterhoff, Ph.D., MPH, leader of the University of Minnesota Center for Infectious Disease Research and Policy. The work of the Center will include:

The Vaccine Integrity Project delivers transparent, science-based vaccine information by rapidly countering inaccurate or misleading information, synthesizing evidence, and translating research for decision-making.

The effort was put together through the collaborative organizing efforts of Osterhoff and the AMA as a response to the irresponsible information currently being promulgated by the US Department of Health and Human Services under the leadership of Secretary Robert F. Kennedy, Jr. Special thanks are extended to the folks in Minnesota, the AMA and the various specialty societies who are stepping up with ACCURATE information on vaccinations!!

Changing Behavior Of Consumers Due To Health Care Costs – In a recent report from

Academy Health, the behaviors we exhibit as a result of increasing health care costs is becoming an issue. Specifically, a recent Gallup poll revealed that the increasing cost of USA health care is creating a situation where citizens are making trade-offs on how, what and where they make ongoing life expenditures. In essence, about 1/3 of Americans are cutting back on basics like food, transportation, and utilities. And, where is the money headed? Of course, to pay for health care services by skipping meals (11%) and borrowing money (15%) or delaying prescriptions (15%). In fact, nearly 50% of the middle-income households and a significant portion of higher-income households noted that they have postponed big ticket items such as buying a home or having children – due to health care costs. Yikes! The worst situation is with uninsured individuals where 62% of such individuals report at least one financial sacrifice to cover medical costs.

Furthermore, the findings clearly point out that the affordability of health care is not purely a financial issue. It holds social, familial, and personal behavioral considerations as well by shaping how people live, plan, and prioritize their futures. For health services researchers, this highlights the need to better understand on how cost pressures influence health-seeking behavior, foregoing or delaying care, reducing medication adherence, and trade-offs between health and other essential needs. It also underscores the importance of studying financial strain beyond clinical settings, including its connections to mental health, stress, and worsening physical health outcomes.

At the same time, rising costs and reductions in public coverage – such as Medicaid cuts – are opportunities that deserve further study how policy changes affect affordability and access across different populations. It’s also clear that research to examine variation across income groups, insurance status, and states to better understand those who are most impacted and why is also another important area of research. More broadly, these trends raise critical questions about downstream effects on the health system, including increased emergency care use, higher long-term costs, and widening inequities, all of which position affordability as a central issue for both research and policy moving forward.

RFK, Jr. Dismissing Important And Valued DHHS Capabilities!! – Everyone with an interest in health care must read the following information, which was prepared and released by Academy Health, a very reliable academically-oriented organization:

The U.S. Preventive Services Task Force (USPSTF) is an independent, volunteer group made up of 16 national experts across behavioral health, internal medicine, pediatrics, nursing, family medicine, geriatrics, obstetrics and gynecology. These experts serve to advance the task force’s mission to “improve the health of people nationwide by making evidence-based recommendations about clinical preventive services and health promotion.” In addition to this, the members’ recommendations also influence insurance coverage. The task force has been an instrumental component of our preventative care system since 1984. Now, doctors fear having been abandoned by the U.S. Department of Health and Human Services (HHS).

The USPSTF meets three times a year in March, July, and November; however, the group has not met since March 2025. Without convening, there are potential threats to the Affordable Care Act’s (ACA) no-cost prevention care mandate, as the task force offers recommendations to services with a Grade A or B that insurance plans cover. Without up-to-date, evidence-based guidance from the task force, there is a potential for health disparities to worsen. The meetings have not been directly cancelled, but instead, members have been told that the meetings will be rescheduled without a tentative date. This group of experts offer recommendations around STI testing, cancer screenings, mental health concerns in primary care, medications, and more, to help reduce disease and to ensure coverage for preventative care services.

Postponing the meetings without following up with tentative meeting dates could hinder updates to preventative care recommendations that doctors rely on to assist in guiding patient care. Additionally, since the task force has not been able to meet in a year, they were not able to submit their annual report to Congress. This yearly report is used to help grant decision making for the National Institutes of Health and to outline gaps in research. Doctors have expressed concern about postponement being a larger warning that the HHS plans to erode and restructure the task force, like other federal advisory groups.

In addition, as of March 2026, the U.S. Supreme Court issued a 6-3 decision upholding the constitutionality of the U.S. Preventive Services Task Force (USPSTF) appointment process, protecting no-cost coverage for recommended preventive services (e.g., cancer screenings, HIV PrEP) under the Affordable Care Act (ACA), per SCOTUS Blog and American Medical Association. While the legal structure is secured, the task force will likely face potential logistical, staffing, and political challenges to its operations, according to CNN. This is very important, since experts warn that changes in the composition of the task force as well as its operational support will have the ability to impact millions of Americans.

Trust The Healthcare Professionals…Spread The Word – The medical profession via the American Medical Association and an increasing number of medical specialty societies have developed the “Vaccine Integrity Project” to provide quality outcomes information on the use of vaccines. It’s been led by Michael Osterhoff, Ph.D., MPH, leader of the University of Minnesota Center for Infectious Disease Research and Policy. The work of the Center will include: The Vaccine Integrity Project delivers transparent, science-based vaccine information by rapidly countering inaccurate or misleading information, synthesizing evidence, and translating research for decision-making. The effort was put together through the collaborative organizing efforts of Osterhoff and the AMA as a response to the irresponsible information currently being promulgated by the US Department of Health and Human Services under the leadership of Secretary Robert F. Kennedy, Jr. Special thanks are extended to the folks in Minnesota, the AMA and the various specialty societies who are stepping up with ACCURATE information on vaccinations!!

On The AI Front – A New Ongoing Section

Perspectives and realities emerging in the transformational AI space….

Consumer Focused Copilot Health Unveiled By Microsoft & Amazon – Amazon’s first major step into the health care world was the purchase of One Medical, a one-stop primary care-oriented medical service. It was the first major step and it was a face-to-face model of care delivery. Now, it’s moving toward virtual consultations with the launch of Health AI on a broad scale. Under the new program, eligible USA-based Amazon Prime members who use Health AI will gain access to five free direct-message care consultations with a One Medical provider for more than 30 common conditions. These consultations are initially focused on the “basics” in primary care, such as allergies, cold and flu, acid reflux, straight-forward infections such as pink eye and urinary, anti-aging skin care, and hair loss, among others. Individuals who seek the care will be eligible to receive 5 free virtual consultations as part of an introductory offer from Amazon.

As you can imagine, once they gain experience with the basics, the intent is to offer broader, expanded coverage for virtual consultations. It’s not surprising, and it’s just the first step… But wait!! There’s more. For non-Prime individuals who want a care offering, there’s an introductory offer of out-of-pocket, pay-per-visit of $29 for a virtual visit with an Amazon One Medical provider – both virtual and real. In the near-term, expect “add-on” services such as dietary advice, exercise recommendations, and other “healthy” support advice. And, how does this interact with the existing primary care providers? I couldn’t get a clear answer…

ChatGPT – The New GoTo Health Care Information Consumer Resource – As of early January, 2026, roughly 1.5 – 2.0 million questions each week are sent as queries to ChatGPT related to health insurance. But, that’s not all folks!! It’s also becoming the go-to for health information on all sorts of problems. If you thought insurance was a big issue, consider this:

§ More than 40 million people query ChatGPT with healthcare questions every day. It’s a message from consumers! Consumers are clearly shifting many of their questions away from traditional sources to the chatbot.

§ Furthermore, nearly 7 of 10 health-related conversations with ChatGPT occur outside of typical clinical hours (much better than the local hospital emergency waiting room). So, it’s clear that consumers are seeking information outside of access to their providers.

§ If you consider the data across the globe, more than 5% of ChatGPT messages are about healthcare = “billions of messages” according to OpenAI.

Approaches To Alternative Care Delivery

Ideas and thoughts on how care delivery can be transformed…

The Weekly Whisk

Musings from a foodie…

Sometimes I feel like I’ve become a member of the local Rotary Club and one of my jobs is to support local business! And, I do with friends and colleagues who don’t live in Maine. But, for my blog, I’ve always had listings of various places around the nation and the world. But, I’ve been home for a while now. So, I decided to – once again – share a note with my readers on a local gem that is located right here in Kittery, Maine – my adopted hometown. It’s…

Robert’s Maine Grill [⭐⭐⭐⭐⭐⭐]. It’s not a white tablecloth, fancy silverware, poofy-do kind of place, but the preparation on their seafood is among the best I’ve ever had – and the oyster bar at the entrance is always a delight. The oysters come from various farms located up and down the coast of Maine – each with a discernible taste that is uh-la-la.

The restaurant is just off of Route 1 on “Mall Road” in the midst of the outlet malls that bring shoppers from all over the Northeast to Kittery every week. You can’t miss it since it’s located near a bay that extends up to the highway, is an iconic blue-grey building, and there are always lots of cars located in the parking lot!! It’s clearly a sign of quality.

You’ll have your choice of multiple fish as well as lobster rolls. I personally prefer the haddock (YES!!), another local fish, and sometimes the cod (Also, a YES!!). Their prep by the cooks in the kitchen is always perfect! The batter is light, not heavy. And, don’t forget, fish is a healthy source of protein. Plus, it’s always “fresh” at Robert’s. They’ve never disappointed me on this count. I would also definitely recommend oysters as a starter, and the haddock chowder is very worthy of a taste as well. Or, at minimum – perhaps a dip into your partner’s bowl 😊.

And, finally, for dessert, you MUST have the blueberry pie made with Maine blueberries. They are not those “big blue jobs” from places down south (like New Jersey and others) but, instead, those small, pea-sized berries that exude tastiness served with some local vanilla ice cream and it’s to die for… Need I say more? If you get close to Kittery, make your reservations and head to Robert’s. It’s worth the visit.

By the way, there are lots of other options on the menu. You can check it out by going to the Robert’s Maine Grill website or Facebook page. And, if you don’t have Google Maps or Waze, check out this map as a resource for finding this culinary jewel that we treasure here in Maine, which also serves up the very best authentic New England seafood.

The Good, The Bad, And The Ugly

The ongoing saga…

The Great – This too shall pass if “WE THE PEOPLE” keep calm and carry on (= a British phrase adopted during WWII) that we should adopt as well during these turbulent times.

The Good – Finally, the U.S. Supreme Court is appropriately stepping up to the Trump Administration.

The Bad – I pulled out my “peace necklace” as a quiet sign of protest for yet another senseless war that will go nowhere when we have so many other resources by engaging the world community in working with the USA to solve global problems…

The Ugly – Robert F. Kennedy, Jr.’s attempt to de-science the incredible abilities we’ve developed at the U.S. Department of Health and Human Services during my lifetime. It was – and will again at some point post-Kennedy’s tenure – be the world’s best resource of solid information on immunizations and other notable healthcare information.

“The United States…is like a golden retriever bounding through the forest, wagging it’s tail and knocking things over.”

Adm. James Starvidis, Former Supreme Allied Commander (Ret.) – in comments on CNN Live, February 16, 2026, regarding the current U.S. approach to managing its European relationships…

“We tend to think massive protest is all that is valid today. But the massive is also manipulated and doctored. It is false. The genuine dissent remains individual.”

Thomas Merton (1915–1968), an American Trappist monk, writer, theologian, mystic, poet, and social critic, as well as one of the most influential Catholic spiritual thinkers of the 20th century.

“Political life will always involve disagreement, but it is less likely to fracture when people know they have to keep showing up together.”

Brandon Taylor, Assistant Professor of English at Mount Marty University in South Dakota, from “The Politics of Presence”, Sojourners, March 2026.

“Trust isn’t only built through clinical competence. It’s built through humanity. Small choices in language, tone, and attention can make an enormous difference.”

Kristin Flanary – in an online post by “Lady Glaucomflecken,” who is married to “Dr. Glaucomflecken,” aka ophthalmologist and internet comedian Dr Will Flanary.

The Occasional Perspective

Opinions and Reflections

Remembering February 24, 2020 – It was four years ago – on the day after my 71^st birthday – that I dug into the drawer in my bedroom to look for a medallion I wore throughout the Vietnam War. It was a “peace” sign. I couldn’t find it, so I ordered a new one. I did it because “war”, “incursions” and the like often affect the health of people caught in the middle of conflicts. When we – in the care delivery community – speak of “health”, it seems to me that too often we are really talking about “medical” issues. Health is broader, and it’s more inclusive, which is why I raise a thought today.

A second factor in my note here is that we are also “connected” – not just to one another but to people, organizations, nations, and the evolving artificial intelligence modalities. So, I raise the issue of Ukraine as a “health” consideration. We were told it would be solved in a day. NPR reported on the anniversary of the war that nearly 600,000 Ukrainians and 1.2 million Russians have been senselessly killed due to the ongoing war between the two states. At the present time, negotiations to end the conflict have been led – virtually unilaterally – by the USA. Remember, we were promised it would “…end in a day” just over one year ago. However, world leadership was set aside in the process. It seems to me that rather than disengaging the other nations, we should be involving other nations of the world (or, a significant part of them) to step in and work as a force “together” to foster, support, and demand a resolution!. While there is an opportunity role for the USA by helping to organize and lead the requisite nations who need to be involved, the energy of the world to stop the death and destruction must not be allowed to simply sit on the sidelines. Why? For the health and well-being of the people in both countries - something needs to be done.

The ongoing war is a travesty that demands action. Furthermore, we now live in a very connected world. It is also a travesty that the nations of the world don’t align to resolve the conflict. And, finally, it is a travesty that the USA is not providing leadership, but rather unilateral discussions. It seems to me that – as a “world community” – we must begin to start thinking and act together. We have major problems facing us as a species. The world needs to come together to solve big world problems. “Health” is just as important as doctors, nurses, and others on the “medical” team who provide the care to the people. After all, the focus of good medicine is to help people have good, healthy lives...

Responding In Kind

Responses and comments from my readers…I do receive periodic information from the many readers of the blog. While I have often responded individually, I decided that I should share more transparently. Hopefully, this contributes to an ongoing dialogue…

From Guy.W: Great comment about immunizations. I agree we need to continue the measles vaccination program. It has been effective. Some refinements to the points you make:

1. In your 2025 #: 1,798 is not the CDC full-year total. CDC reports 2,281 confirmed measles cases in the U.S. for the full year of 2025. The 1,798 figure appears to be a partial-year snapshot. CDC also reports 982 confirmed U.S. cases already in 2026 as of Feb 19, 2026. Not a good trend! “Measles was officially eliminated from the United States in 2000, meaning there is no measles spreading within the country and new cases are only found when someone contracts measles abroad and returns to [or immigrates to] the country. Achieving measles elimination status in the United States was a historic public health achievement. The below figure illustrates how common measles was before vaccines and how vaccine policy enabled elimination.” And you have the first-hand experience of that full era!

2. The decline has not been exactly steady from 1963. ”From January 1 to December 31, 2019, 1,274 individual cases of measles were confirmed in 31 states . This was the greatest number of cases reported in the United States since 1992.

3. The uptick in 2025 occurred before the January 2026 CDC recommendations, so policy changes could not have been “THE REASON” for a massive increase in incidence. And in any case, the CDC continues to “recommend that all children are vaccinated against . . . measles, mumps, rubella, . . . for which there is international consensus . . .”

This may sound wild, but a bipartisan bill to trumpet the efficacy of the vaccines would be welcome. RFK Jr is big on the “healthy-eating” message. I think we owe our population both – keep healthful foods in AND keep preventable diseases out!

Kevin Responding In Kind – Thanks for the updates. Much appreciated!! Agree that “…we owe our population both…”, but let’s do it based on science. Much of what is being promulgated by Kennedy and other minions has no foundation in science and is speculative, at best. It’s the old “show me the data” message that has dramatically improved the health of Americans and the world community over the last century. Again, thanks for sending your thoughts!!

The Occasional Perspective

When I feel I must share my thoughts and perspectives on a burning issue…

Disgusting! – In a recent newsletter by Heather Cox Richardson, she noted that the Trump family has been enriched by about $4 billion since the onset of President Trump’s most recent term. And, he just applied for “copyright” of his name and accouterments associated with his name so that airports (several name changes in process), merch, and the like will provide payments to him and his family. The use of his position as President to self-enrich him and his family is disgusting. It speaks to the totally narcissistic behavior that seems to have become the daily norm for this current White House. It’s sad when there are so many issues that need attention in our nation and in the world…

Consulo Indicium

Information for your Consideration…

Trust The Healthcare Professionals…Spread The Word – The medical profession, via the American Medical Association and an increasing number of medical specialty societies, has developed the “Vaccine Integrity Project” to provide quality outcomes information on the use of vaccines. It’s been led by Michael Osterhoff, Ph.D., MPH, leader of the University of Minnesota Center for Infectious Disease Research and Policy. The work of the Center will include: The Vaccine Integrity Project delivers transparent, science-based vaccine information by rapidly countering inaccurate or misleading information, synthesizing evidence, and translating research for decision-making. The effort was put together through the collaborative organizing efforts of Osterhoff and the AMA as a response to the irresponsible information currently being promulgated by the US Department of Health and Human Services under the leadership of Secretary Robert F. Kennedy, Jr. Special thanks are extended to the folks in Minnesota, the AMA and the various specialty societies who are stepping up with ACCURATE information on vaccinations!!

But, What About Lack Of Trust? – One of the issues the health professions are facing relates to the explosion of dis- and mis-information on a whole spectrum of health care problems that people face. Not only is it difficult to reach our favorite clinician when the need arises for their assistance, but too often the use of algorithms, protocols, and such can feel manipulative to the individuals who experience their guidance through the complexities of a problem. On the other hand, information from social media is much easier to obtain, often at low or no cost. The downside, however, is that the mis- and dis-information can be easily spread with no accountability for outcomes. One online physician,

Mikhail Varshavski, DO (aka “Doctor Mike”) has 30 million followers on YouTube and Instagram. He refers to the current online health care information environment as “…a perfect storm of events” with disinformation now “coming from all sides.” It’s a serious challenge to medical and health care. We all need to take this challenge to “the way things are done” and consider the changes needed within the existing healthcare world to accommodate the external challenges that are disrupting traditional care delivery patterns. For more information, check out the full Medscape article: How These Doctors Fight the Social Media Trust War

An Example Of The Consumer Protection Demise? – Since the inception of the Consumer Protection Agency with passage of the Dodd-Frank Act in July 2010, the American public has become much more reliant upon the agency related to financial regulation, corporate accountability, and reduction in risks of products and services. In fact, we now trust the products and services offered to the pubic. However, due to some very significant changes brought about under the Trump Administration, problems are arising. Specifically, the Acting Director Russell Vought (one of the co-authors of Project 2025) instituted staffing reductions that made the compliance program that protects consumers against the excessive compliance patterns of major credit bureaus and banks as well as implementing the funding reductions that could force the agency to close up shop sometime in the next couple of months of 2026. So, where will Mr. Vought turn next as an “Acting Director”?

Pathological Lying – I received an interesting email from WebMD the other day as an “update” on pathological lying. It was interesting. I did not realize that there is actually a diagnostic term for habitual lying. It’s referred to as “pseudologia fantastica” or “mythomania”. It’s evidently not an “official diagnosis,” but it’s a real issue and part of a pattern for individuals with antisocial behaviors, narcissistic personality disorder, and patients diagnosed as histrionic. Furthermore, the key characteristics of lying are the presence of contradictory stories – where the details often conflict with one another, unverifiable details; and, overly dramatic stories with anecdotes that describe intense situations. Hmmm…

So, what are the signs that someone is lying to you? For starters, it’s important to note that people who lie frequently often exhibit “tells” that are consistently noticeable, if you’re observant. Here are a couple of areas that the article outlined that we all need to be aware of for uncovering the lie – which may sound like the truth. Here are some areas to be considered as they spin their tales over the fibs they are spewing:

Unverifiable Details – The “lie” is often associated with the presence of a lot of “details” and “data” in support of their lie. However, if you then go out in an effort to verify the data, you’ll find that either it does not exist or has been distorted beyond belief.

Story Contradictions – When the lie is presented or made public, disparities are often a prominent feature. Why? Because the person and/or group that is disseminating the lie can’t get their story right and sends conflicting information in support of the lie. It often happens because the lie is coming from too many quarters who are sending different messages that will conflict with one another.

Dramatic Overlay – The louder, the longer, the looser a lie gets – the more it falls apart. The anecdotes don’t jive or go in different directions through a long, circuitous description that overplays the problem considerably.

So what’s the suggestion for managing lies when they are spewed in your direction? First, don’t over-react. It’s important to remain calm and not turn yourself inside out because of the lies you are hearing. Second, arguments don’t work. The person who lies habitually actually believes the material they make up on the fly or even the data that’s been twisted to meet their objective. Third, don’t over-engage in the lie. Take action on “real” data and information that can be verified, bring it forward, and – if it’s disregarded – find allies who will support you and your cause to countermand the lies so that verified truths and data can be disseminated widely in support of your arguments!

Another Data Point For Coffee – I won’t belabor the point since I’ve done that in prior iterations of The Fickenscher Files. But, when a study comes out that again supports the idea on approach toward solving a problem, it’s worth extolling. So, the study highlighted above is from JAMA – a very respected, peer-reviewed publication of the American Medical Association. The study “provides evidence of cognitive benefits from coffee and tea – if it’s caffeinated and consumed in moderation: two to three cups of coffee or one to two cups of tea daily.” It’s important to note that the researchers specifically highlighted the fact that “people who drank…[coffee or tea]…for decades had lower chances of developing dementia than people who drank little or no caffeine.” Yahoo!!! Said the Mainer who imbibes his favorite “dark roast” on a daily basis. Furthermore, the findings of the research were reviewed by other independent experts who verified that the adjustments in the study related to body mass, smoking, socioeconomic status, education, diet, medications, concomitant medication intake, and the like were all appropriate. The supposition is that caffeine acts in some fashion on the neuroinflammation and/or vascular function, which is a finding in other studies as well.

Meanwhile – Mix It Up!! – A new report from researchers at Harvard University provides some compelling evidence on how to engage in an exercise program. For those who are doing the same thing every day, every week, all month long – the advice is mix it up just a bit!! The study looked at the exercise approach of 111,000 health professionals and nurses over the course of 30 years. The project monitored everything from gardening to yoga to strength training, walking and the like, onward to Pickleball and other assorted exercise programs. The interesting finding from the study was that those individuals with the most varied routines had the best results by a big margin. They had a 19% lower risk of premature death. So, the study would suggest that “mixing it up” would be a good strategy rather than doing the samo-samo exercise routine. The message from the study was clear. You can do the exercise routine – just don’t do the same one every time you go to the gym! Mix it up a bit.

Think about the workout you never skip — the Pilates class locked into your calendar or the daily walk that happens no matter what. That kind of consistency feels like a win, but a new study suggests repeating the same type of movement may not give your body the full payoff. Researchers at Harvard University followed nearly 111,000 nurses and health professionals for 30 years and tracked their time spent doing exercises like walking, strength training, gardening, stair climbing, tennis, and yoga. The continuous use of that variety of exercises resulted in a 19% lower risk of premature death than the individuals with the least variety, even when total exercise time was about the same.

What it means: You don’t need to abandon what already works. Keep the elliptical and go-to ’90s pop playlist or the yoga class where you already have a favorite mat spot. The point is not to reduce your overall routine — rather, just increase the variety! A little variety helps pull the body out of autopilot. Take the stairs. Spend time in the garden (yes, it counts), Take a casual walk with your favorite friend or spouse (yes, it counts too!!). Try a new class now and then, whether at your gym or through a service like ClassPass. And the best part? You don’t have to work out longer. Simply cut five minutes from your usual workout and add something different. Variety is the spice of life…so to speak 😊

The Stress Of Drug Shortages In Primary Care – A recent study in JAMA Network Open highlighted the effect of drug shortages on about 900 primary care clinicians and their patients over a two-month period in 2024. The final analysis included clinicians from family medicine (42%), ambulatory care (75%), urban practices (78%), and private practices (71%). Of the total participants, 795 reported a perceived drug shortage during the 6 months prior to the survey. Why were there shortages? It appears multiple factors were the cause, including: supply chain disruptions, regulatory burdens, small profit margins, a limited number of manufacturers, in addition to external factors such as natural disasters and unforeseen surges in demand for certain drugs. The end result was that 87% of surveyed clinicians made changes in their practice patterns. The implications on care delivery have yet to be reported…

The Weekly Whisk

Musings from a foodie…

I had the opportunity to visit one of the iconic eateries in Manhattan, a couple of weeks ago, Dock’s Oyster Bar ( ⭐⭐⭐⭐⭐1/2), which is a well-known seafood restaurant in Midtown Manhattan recognized for its extensive raw bar and classic New York ambiance (i.e., noisy and friendly), plus located in the heart of the business district. The restaurant is well-known for reliable quality and fresh oysters combined with a lively after-work scene. Established in 1987, it serves up oysters from both the East and West coasts to satisfy the tastes of a diverse crowd, along with Littleneck and cherrystone clams, crab, shrimp, baby lobster rolls, and the like. They also have a strong seasonal selection, such as Nantucket bay scallops, Florida stone crab claws, Maryland soft-shell crabs, and wild Alaskan king salmon, to name a few. Although voices had to be raised to be heard, it was an enjoyable evening, and the food was quite tasty. If you’re into a “New York experience”, I would recommend the place. It’s located near Grand Central Terminal in Manhattan at 633 3rd Avenue (between 40th & 41st Streets), New York, NY. Also, the wait staff was quite good. Check it out if you happen to be in NYC. So…why the half? = It had to do with the noise level. When the noise gets beyond the capacity of my ears to hear, I feel compelled to reduce the rating 😊.

The Good, The Bad, And The Ugly

The ongoing saga…

The Good – The snow is melting in Maine. It would be nice if the cold would melt in America!

The Bad – I’m a peacenik at heart. I wore a peace symbol around my neck throughout the Vietnam War and started wearing one again at the start of the Israeli-Palestinian Conflict. And, now? I have good friends whose family is being pounded by war in Iran – a war that was unilaterally started without Congressional involvement – and, to what end?

The Ugly – The emerging disengagement of the USA from global accords…

The Really Ugly – The lack of Congressional involvement, engagement or oversight in pretty much everything…

Thoughts and Perceptions

“In a free society, all are involved in what some are doing. Some are guilty. All are responsible.”

Rabbi Abraham Joshua Heschel (1907–1972), a Polish-American rabbi, theologian, philosopher, and civil-rights activist from his writings on social ethics and collective responsibility in The Prophets (1962).

Shameless Marketing

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Readings and Listening To Consider

Books and Articles worth a Review…

The Silent, Under-The-Covers USA War – First, let me declare that I am not an economist. So, I may be off-base on some of my thoughts. If so, correct me. Second, my thoughts on what has been described as a “silent war” derived from the inaction by both Democrats and Republicans are as follows. Second, I’m not a politician, so I may be off-base on the second count as well. If so, correct me. Regardless, I have concluded that the collective “we” have a problem!! So, what is it? We are not listening to one another. We are not engaging one another. We are not considering the data and information so readily available to the folks in leadership positions – as well as to us followers. It’s a war of political attrition that is undermining the fabric of America. Compromise is not a dirty word! In fact, it is how things get done. Enough said…

Let’s Get Back to Health: Easy Steps For Maintaining Health – Aging well is an important element of getting older. The New York Times recently had a piece on the topic outlining four areas of assessment that are predictive of getting older in a healthy way, including outlines of the:

1. Sitting-Rising Test (= 5 points for standing from sitting position and 5 points for sitting from standing with one point lost for each time you use a hand, arm, or any other objective to help you do either standing or sitting),

2. Walking Speed Assessment (= walking 13 feet in about 3 seconds),

3. Grip Strength Test (= walking for 60 seconds while carrying a heavy object, aka the farmer’s carry); and,

4. Single Leg Stand (= standing on one leg for a minimum of 10 seconds)!! Yikes!!!

You can check out the details here. And, you can practice these four simple tests every day to gain the strength and capability to meet the standards outlined above. All it takes is about 10+ minutes every morning when you get up and at ‘em!! Consider it – no matter what your age. I’m getting really good at the “Sitting-Rising Test” but that “Single Leg Stand” can be problematic at times…so, I keep working on it. Stay well…Be safe…

The Occasional Perspective

When I feel I must share my thoughts and perspectives on a burning issue…

The Transition – Perhaps it’s an age thing! Perhaps it’s the result of all that’s happening throughout the world? Perhaps it is the disruptions that are upending the regularities we’ve come to expect or accept. Whatever it is, the transitions occurring throughout the world are more disruptive – in my experience – than the stock market crashes, the Vietnam War, the birth of children who will replace us down the road, the death of family members, and all the many other transitions that come about as a part of life. At some point, we come face-to-face with the need to “go deeper” as admonished by the philosophy shared above. It is the type of admonishment that we need and should embrace at present by all of us to not only “form” but also to sustain “…a more perfect union.” of the people across the globe.

First, Congrats To Republican Governors – Gov. Kevin Stitt of Oklahoma recently notified President Trump that an invitation of only Republican Governors to the annual visit of the Governors with the President was inappropriate – and would not occur. After a conversation with the Governor, the President changed his mind. KUDOS to Governor Stitt!! We must have leaders across the board who are willing to engage in bipartisan dialogue, debate, and solutions to solve the problems we face and maintain the nation “of the people” – all of them!

Second, Friendship Before Politics – I am a firm believer that true friendships extend far beyond the realm of political perspectives. Friends nurture us – sometimes in unwanted but useful ways. It’s been my philosophy throughout my life. It is because of this philosophy that I have several friends who hold opposite points of view related to my thoughts on the future of American society. To that end, I received the following message from my good friend Tim.M in response to my castigation of the Trump Administration when I lamented many of the problems emanating from his tenure. He provided the following thoughts on the “successes” of the Administration in the short one-year (so far) experience of MAGA leadership:

Trump has “…Closed the border and is making meaningful progress on removing those that are not legally here; check, check! Lowering inflation; check! Reduce gas prices; Check! End wars and increase security; check, check! Remove government red tape; check! Growth of USA-based industries; check! Identify and begin actual removal of fraud, waste, and abuse; check, check, check! Started a process for the meaningful remodeling of the healthcare disaster known as the ACA; Check! There are negatives too...but”…

I did some research because I tend to lean on facts and data. Here is what I found…

• Inflation: Prices are ~2 – 2.7% higher now than in 2024. If the trend continues, we will see an ~8 – 10.8% increase over the course of the MAGA experience.

• Gas Prices: The average price of regular gasoline is $2.97/gal, down about 13 cents from the 2025 average of roughly $3.10/gal. or, about a 4% decrease. That’s good news!

• Ending Wars and Increasing Security:

• Israeli-Palestinian War – an agreement to stop the war was secured in late October 2025, but…continuing violations of the ceasefire occur a daily basis; and, equally important - Israel has instituted a blockade to prevent assistance to the Palestinians, related to housing, public health, and general healthcare, among other similar efforts.

• Cambodian-Thailand Conflict – The Administration has had no involvement.

• India-Kashmir Flareups – The same, no Administration involvement.

• Ukraine-Russia Conflict – Efforts to end the war initiated by Russia to overtake Ukraine are at a stalemate, and the Administration has withdrawn from active negotiations. Ukraine has turned to Europe for assistance.

• Remove Government Red Tape – The “Department of Government Efficiency” (DOGE) has – in many examples from across government – actually decimated staffing and diminished government agency capability and responsiveness via:

• 322,000 departures out of ~2,300,000 non-military employees ~13% in 2025 and figures not yet available for 2026,

• The equivalent of another ~140,000 is projected in the 2026 budget for a total of a ~20+% staffing reduction over the course of 2025-26.

Such “downsizings” in the corporate world would clearly hamper any organization’s ability to function properly – especially given the exceptionally short timeline for the departures. It is, therefore, essentially an open question on whether “efficiency” has been integrated into the USA government!!!

• Stock Market Is Up! – Yes, the stock market is up. But who and what is responsible? It’s a question that is on the minds of many Americans as well as our international friends. The short answer to the question when I did my research was that no single person or even the President is in “control” of the stock market. While we (and our financial advisors) often make the final decisions, it is generally based on a combination of considerations related to a mix of economic data, corporate performance, technology trends, and the psychological state of investors at the time. Those four cornerstones all seem to be moving in different directions.

AND FINALLY…on the healthcare front…

Let’s Start With The US Centers for Disease Control and Prevention, as reported in USA Today as of December 23, 2025: the USA recorded 2,012 measles cases, the highest total in more than 30 years – and, the incidence is expected to grow as immunizations continue to fall. Don’t get me started on the incompetence and destruction (NOTE: I use these two words quite intentionally) within the Department of Health and Human Services that exemplify the ongoing dismantling of essential services and capabilities.

The whole issue of recurrence of measles is actually very personal for me. The last case of measles I saw was during residency in 1977. It was a young child on the pediatric ward in The Bronx. One of the complications of a measles infection is the onset of Acute Encephalitis (brain swelling), which can turn into Subacute Sclerosing Panencephalitis (SSPE). It’s a complication that leads to permanent brain damage, intellectual disability, deafness, seizures, coma, and even death. The case I cared for was the latter problem – not just a simple case of measles. I often think of that child, and what life is like given the clear advanced disabilities he was suffering when we finally discharged him to his home. The long-term impact of measles can be massive, and it significantly impacted my practice patterns. I made sure that everyone of the kids cared for in my practice was up-to-date on their immunizations – across the board!!

We are going to see more children – needlessly – affected by SSPE. It’s horrible. The complications are ruthless on the lives of children!!! And, in all the years as a practicing Family Physician (NOTE: My wife refers to me as a “Suit” now that I am a consultant), I never saw a complication derived from administering the measles vaccine. My SSPE case involved one physician, but misinformation and DHHS policy changes will cause that “one” to become many across my specialty.

I could go on and on about the debacle that has occurred at DHHS and the broad short- AND long-term impact of decisions emanating through the errant philosophies of Robert F. Kennedy, Jr., who serves as Secretary and his minions. I cannot say enough about the ineptitude and lack of scientific application to decisions made under his term as Secretary (NOTE: I’m not using the word “leadership” and I explicitly used the word “ineptitude”) and by the other associated leaders who have been appointed.

So, Kevin – what’s the data show about measles in today’s environment? In short, over the last two years, there’s been an exponential increase in baseline measles infections occurring while over the previous 40+ years, the incidence of measles had steadily decreased. And, in large measure, the current spiking of the disease is due to a major decrease in the immunization rate for measles as well as other diseases through the combination of misinformation AND, more recently, reduced vaccine recommendations made by DHHS. As a result, we are now seeing a MAJOR increase in this awful disease. For all intents and purposes, we were on the verge of wiping out the disease. Now, we face the consequences of bad leadership…

Misinformation started the upward tick but policy changes have been THE REASON for a massive increase in incidence. Here’s the data (Source: CDC Database) on the number of cases:

2020: 13 2021: 49 2022: 121 2023:59 2024: 285 2025: 1798

The data speaks for itself…And, furthermore, the number of cases in 2026 (as of February 1st) was 733 (= i.e., 2 months of data). We’re on our way to a major crisis. Why is this important? The dismantling of what was accomplished in fostering health improvements during the 20th and early part of the 21st century is truly a sad commentary. It is precipitating a very significant ripple impact around the world. I fear that recovery will take far more time than the dismantling undertaken by the Trump Administration. In fact, I predict a recovery period of at least several decades, although I hope I am wrong!!

So, to all my friends who think I’ve become a “lefty” (and others of similar perspectives): Is my data wrong?

I’m not arguing that there are no inefficiencies and/or potential areas for improvement in the administration and/or management of government or even the healthcare industry. (NOTE: I frequently take the healthcare industry to task for lack of attention to quality, outcomes, and performance improvement programs that improve care delivery).

Clearly, a continuous quality improvement (CQI) approach is an essential foundation for any industry, and healthcare is no exception. We can do better!!! And, under the right leadership, we will do better, just as we have continuously improved care delivery and outcomes over the last century and become a leader in healthcare, which is recognized throughout the world. It is our responsibility to do better… The approach of RFK, Jr., et.al. is not the pathway to success!!

An Ominous Report by the Washington Post – “…among 275 respiratory viruses collected since September 28, 2025, which underwent additional genetic characterization at the CDC, 89.5% belonged to subclade K, a variant of the influenza A(H3N2) virus.” So, the severity indicators are not as high as during the COVID era. However, the incidence of ER and outpatient visits as well as hospitalizations is up. The current CDC estimate is: “…at least 4.6 million flu-related illnesses…49,000 hospitalizations and 1,900 deaths this season, which (will run) through March or April…” – all because of insufficient efforts to distribute and immunize the American public!!

But, Good News From The Pediatric & Family Physicians On Childhood Vaccinations – As reported in the Wall Street Journal (1/26), the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) both reaffirmed their recommendation that children be vaccinated against 18 diseases, along with 10 other medical and healthcare groups. The recommendations were published in the AAP Journal, Pediatrics.

1 Quote of the USA Founders at the 1787 Constitutional Convention and later re-quoted by Abraham Lincoln in his First Inaugural Address and many other leaders of the nation over the last several centuries

Consulo Indicium

Information for your Consideration…

The AMA Weighs In On ICE – In a recent statement, the American Medical Association – a relatively conservative, slow-to-respond organization – as the representative of physicians throughout the nation, issued the following on January 26, 2025: “The AMA is deeply concerned by reports of immigration enforcement activity in and around hospitals and emergency rooms – a tactic fueling fear among patients and hospital staff alike. When people are afraid to seek medical attention for themselves or their families, it threatens their health, impedes the ability of physicians to render care, and ultimately undermines basic trust in our health care institutions.“ Kudos…

CDC Reports: The Flu Season Has Sprung! – First, another sad note from the CDC on immunizations. Of the 52 children who have died this flu season, 90% of the children had not received their annual flu shot and, so far, it’s been “the highest rate of children hospitalized with the flu in 15 years”, or the 2010-2011 flu season. Also, the specific strain of influenza is shifting as well. The recently released CDC data reports showed that influenza B strains had increased with the “flu A activity…holding steady.” Overall, flu activity was described as “brisk” driven by [the] influenza A strain from the H3N2 lineage. Years when H3N2 strains dominate tend to be more severe. Among results reported to the CDC ending January 24, 87% involved A strains of the flu, while about 13% were from B strains.” The CDC also reported that a “high burden of influenza” was reported in 29 states…[with] 10 states are reporting moderate activity.”

The Occasional Perspective 2

Opinions and Reflections

A Lesson Learned – About three years ago, I happened to be traveling via my favorite airline – United – when I arrived at O’Hara Airport. My usual pattern as I traverse the airport was to simply walk to the nearest United Lounge, say “Hi” to the attendants, scan my entry card, find the nearest table where I can sit to work on my computer, and (most importantly) grab a cup of coffee. On this particular day, the table I found was adjacent to a group of six young people (i.e. late teens, I think) who were sitting in a circle next to my table. They each had a mobile device and were intently looking at their personal device with deep focus. I didn’t give it much attention until suddenly, they all started laughing simultaneously. I found it curious. The laughing suddenly stopped and they resumed their serious attention to their devices. Then, there was a second laughing spree after several minutes that became more animated with slaps on the backs and knees as well as all manner of banter. It became clear to me that they were engaged in some activity (e.g., a game??) that was “virtual” and in which they were all participating.

Ratchet forward three years and I’m walking around the markets in downtown Santiago, Chile following our recent trip to Antarctica with my baby backpack on my back and my cellphone on my right belt. We are ambling through the market when suddenly, a lady approaches my wife telling her that the zippers on my backpack are open. I immediately pulled my backpack off and we started re-zipping it with all of our energy focused on the task. Then, we resumed our walk. My wife then asked me a question (I forget what it was) so I reached for my mobile device only to discover that it was missing from my holster. It had been lifted in the foray of fidgeting with the backpack. I knew this because I had checked its presence in my holster not even a minute prior to the discovery. I had been pickpocketed!!

So, what’s the point or the lesson learned? It’s the fact that my life has become totally dependent upon the presence of my iPhone or “device” in my holster!! Without it, I am unable to tell time, to find my location in a foreign city, to travel to places, to receive messages, to do pretty much anything that requires others to connect with me or receive information in any fashion. Just like the youth who were playing a game, I’ve become hostage to the presence of my device as “part of my life”. In fact, I use it for purposes of retaining “memory” via pictures, notes to myself, lists of things to do, phone numbers, addresses, etc. I’ve become totally dependent. It’s a lesson learned that we only realize when something – or, the device in this case – goes missing in our lives – whether it’s technology, connectivity, people, friends, loved ones, or…

Kudos For Ross Perot, Sr. – The Dallas Morning News posted a notice of personal significance to me and my career. The Plano City Council (a suburb of Dallas) recently announced that two monuments to H. Ross Perot, Sr., will be deployed in honor of the founder of both Electronic Data Systems and, later, Perot Systems. He started working as a salesman at IBM and built these two major, leading corporations as state of the art providers of technology and consultative services. It was my pleasure to be a part of Perot Systems, where I helped to lead the development of our healthcare consulting and international practices, which over time became one of the leading such programs throughout the nation. Kudos to Mr. Perot and all he did for making health care better and developing services to accelerate that mission within the health care community.

The Weekly Whisk

Musings from a foodie…

My apologies to the regular readers of The Weekly Whisk – the MOST frequently read portion of my regular blog [✯✯✯✯✯✯] Hmmm! However, I was traveling this past month – in Antarctica – and the culinary options were quite limited. We only had buffets, so I’m making a “pass” on culinary commentary this week (NOTE: The first time in nearly 10 years!!).

The Good, The Bad, And The Ugly

The ongoing saga…

The Great – I’ve made it (so far) through two very significant (i.e., one 12” and one 8”) snowstorms that covered only a portion of my very long driveway (i.e., my plow-guy did the long part from the road down the lower portion) AND, I did the work of shoveling the snow without getting chest pain or some other debilitating ice-borne problem (e.g., falling, fractures, etc.). Whew!!

The Good – The announcements of 12 (so far) national health care professional groups on the need to retain the prior immunization schedules AND decision-making process for setting national recommendations.

The Bad – The apparent, ongoing dissolution of inter-governmental collaboration on the healthcare front as the USA loses its pole position as the leader in developing and deploying frameworks related to care delivery.

The Ugly – The bad – no, despicable – approach of the U.S. Department of Health and Human Services in extending advice to the American (and, I might add “international”) community that is based on non-science, anecdote, and flawed opinion!!

The statements in The Fickenscher Files are the personal views of Kevin Fickenscher, MD and do not reflect the views or policies of any organization with which he is affiliated.

Thoughts and Perceptions

“…the world is all messed up. The nation is sick. Trouble is in the land; confusion all around…But, I know, somehow, that only when it is dark enough, can you see the stars…I don’t know what will happen now. We’ve got some difficult days ahead. But it doesn’t matter because I have been to the mountaintop…Like anybody, I would like to live a long life…And, I’ve looked over. And I’ve seen the promised land. I may not get there with you. But I want you to know tonight, that we – as a people – will get to the promised land.”

Reverend Dr. Martin Luther King, Jr. – in a speech on April 3, 1968 (the night before his assassination), before the Memphis, Tennessee sanitation workers, as part of his effort to integrate civil rights with economic justice.

“As we mark 250 years since the dawn of American freedom: What will our children, grandchildren, and their descendants write about this time in our Commonwealth’s history – this chapter – 50, 100 and 250 years from now?”

Abigail Spanberger (D-VA) – following her oath of office as the Virginia Commonwealth’s 75^th Governor and as the first woman to hold the position in the state’s history.

NOTE: The above quotes were derived from the January 17^th and January 18^th, 2026 blogs by Heather Cox Richardson – notable historian and Maine resident. Also, a “must-read” on a daily basis. Check her out!! I must admit that when I read the MLK quote, I got tears of remembrance and commitment in my eyes! Then, when I read Spanberger’s quote, it totally resonated with my thoughts coming out of Antarctica into the realities of all that we are facing throughout the world!!

A Reflection

Thoughts that evolve after the pause of time away from reality…

Over the last several weeks following the December holidays, I had the opportunity to step away from my daily responsibilities and “go on holiday”. I won’t bore you with the details except that we visited Antarctica, Patagonia, and other sites in Chile. And, to sweeten the opportunity, I was totally disconnected from the day-to-day of goings on throughout the world. It’s the kind of holiday that encourages one to “step back” and consider life…

In Antarctica, the penguins rule! There is a lot of squawking, but they stand in “community” as if Antarctica were the only place that existed in the universe. They have created “penguin highways” for getting around the island, which are communal and used by all of them together. But even though they are a dominant species in the cold environment, various birds also fly and flit around at will. And the seals occasionally engage the penguins for control of the waterways. However, it does not seem to impair the penguins’ ability to navigate freely throughout the various bays that mark the shoreline of Antarctica. It seems to me that we could learn much about how to get along in the world. The remarkable part of the experience is the degree to which they all get along in their existing environment. We – as a species – could learn much about “getting along” with our fellows throughout the world in ways that allow for mutual support and collaboration – despite our differences. It requires the “give and take” that I observed in the community of species that inhabit Antarctica.

And, then, beyond the species interactions, there are the thoughts that evolved as we considered the environment not only in Antarctica but also in Chile. The layers upon layers of sediment that dominate the landscape in both places reveal an environment that has been evolving for millions upon millions of years. In fact, it extends back to the time prior to the dinosaurs, when Gowanda dominated Planet Earth. It consisted of a portion of North America (i.e., Laurentia) combined with pieces of the South American, Antarctica, and Australian landmasses, as the dominant continent on Planet Earth. Or at least that is my understanding. I’m sure my friends who are geological experts will correct me if I am wrong when they read this piece. In essence, I had the chance to look at landscapes beyond hundreds of millions of years in the making.

Such an experience pulls you up short about what we (i.e., the human species) are doing at present. What is all of the intergovernmental control about when the world is increasingly connected across all such barriers? Who wants to follow individuals who are maniacal about their control of states around the world – whether it’s North Korea, China, Russia, Venezuela, Belarus, Iran, Syria, OR even the USA. Do “We The People” really want such an environment?

In fact, if we look at the reaction of the populace in those countries I mentioned, there is intimidation, disparate wealth, unequal health, incongruent access to education, and the list goes on… Why do we allow such an environment? When do we speak up? From my perspective, the value of a construction worker who builds office buildings is as important as the doctor who is an excellent diagnostician. There is a difference in pay due to level of education and impact, but both sides should be able to make a living wage.

It occurred to me while I was pondering the future of Planet Earth that my friends in the Far East, in the Southeast, in India, in Africa, in Europe – essentially in places all around the world would probably mostly agree that a civil society is in the best interest of everyone!! So, it seems to me that rather than pursuing the objectives of leaders – whether here or abroad – who are averse to the needs of the people:

We should all be working diligently to accomplish that objective rather than engaging in rhetorical or even real dismissal of populations pursuing betterment of their lives.

We should all be working to ensure that healthcare is available to everyone in society.

We should listen to one another across the world.

We should be providing baseline education to everyone in all societies.

The “We should” list goes on…

Readings and Listening To Consider

Books and Articles worth a Review…

An Important Analysis – Larry Levitt, MPP, is a prominent American health policy expert and senior executive serving as Executive Vice President for Health Policy at the KFF (Kaiser Family Foundation). He provides regular health policy commentary on issues related to healthcare. He has a recent article that appeared in the JAMA Forum entitled “How Unaffordable Is Health Care?” I wanted to provide a synopsis of the major points of his article. Why? Because I believe that health care costs are the looming crisis facing the USA and many nations throughout the world due to the aging of our populace, of which I am a leading member at the age of 75!! It is a specific policy issue in the upcoming mid-term elections where the issue of affordability has become a major issue for the electorate. Levitt provided an excellent overview, and I thought it was worthy of your consideration as we move forward toward those elections in the coming year. So, what are his thoughts? Here is a summary:

• The core issue we are facing as a nation related to health care is: “What is an affordable level of health care costs that people should be expected to bear?” This is the reason that there is an ongoing debate related to the extension of the Affordable Care Act (ACA) enhanced premium tax credits, which impacts the ability of some 22 million people to obtain affordable insurance.

• The costs of health care in the USA compared to the rest of the world are significantly more!! As a comparison, the USA spent $13,432 per person in 2023, or about 80% more than $7393 average per person in other high-income countries (NOTE: the comparison does not include moderate- or low-income nations).

• When President Richard Nixon warned of a “crisis” related to health care costs, our percentage of GDP devoted to health care spending was approximately 7%. The latest USA health care spend is at 17.6% of GDP, growing to an estimated 25% by 2030 if nothing is done to mitigate costs. If we spend more on health care – as a nation – we have less to spend on other national requirements. Furthermore, high health care expenditure affects the competitiveness of USA products and stagnates worker wages. Plus, are we any healthier? No, is the short answer.

• While health care costs have not necessarily become more significantly “affordable” under the Affordable Care Act (ACA), the increase in national spend has slowed significantly since passage in 2010.

• For individuals who do not qualify for Medicaid or Medicare or do not have access to employer-sponsored coverage (NOTE: a sizeable number of the USA populace), the ACA offers the opportunity to use refundable tax credits for making health care insurance coverage. The affordability threshold requirements for participating were lowered in 2021 but expired in 2025 because the US Congress did not act! In essence, without the tax credits, the 22 million subsidized ACA enrollees will see an increase in the out-of-pocket expenditure by 114%, or $1016 per person. In particular, the “older, middle-income ACA enrollees” will experience the greatest increase in cost. Levitt provides an example of a 60-year-old woman making $64,000/year in North Carolina whose out-of-pocket expenses go from $5440 per year (8.5% of income) to $14,853 (23.2% of income). It’s clearly an unsustainable situation – in my estimation – for the vast majority of such individuals.

The article is EXCELLENT, and I encourage all of my readers to review it (See citation above). It outlines quite clearly what inaction on the part of the US Congress does to impact the ability of people to pay for the increasing escalation of health care costs. The cost of health care is why I have been so adamant over the last bunch of years that the primary objective we need to address in health care – aside from sustaining quality – is that:

The USA must begin to manage the ongoing escalation

of health care costs!!

Otherwise, our ability to sustain the other needs

of the nation will be jeopardized!!

Source: January 8, 2026 – doi:10.1001/jamahealthforum.2025.6929. An open-access article distributed under the terms of the CC-BY License. Levitt L. JAMA Health Forum; and, Corresponding Author: Larry Levitt, MPP, KFF, 185 Berry St, Ste 2000, San Francisco, CA 94107 (larryl@kff.org) – in case you want to reach him directly on the commentary of the original article.

The Occasional Perspective

Opinions and Reflections

Progress Or Not? Let’s Be Clear – As I returned home, I was overwhelmed with the number of emails and “policy” updates that populate my in-box. As I plowed through the incoming, it became increasingly clear that here in the USA, we are “undoing” decades of progress on the healthcare front. That DOES NOT mean that I am opposed to doing a better job by fostering efficiencies, reducing waste, decreasing waste, and the like. But the slash-and-burn approach of the Administration, coupled with the policy decisions of the U.S. Congress, will have lasting and important implications for care delivery. As a result, I thought it might be helpful to provide an overview of the impact of policy changes occurring during the last quarter of 2025 that are having the most profound implications across the board. AND, BTW – IF ANY OF MY READERS DISAGREE WITH MY DATA POINTS OR ASSESSMENTS, PLEASE FEEL FREE TO SEND ME A NOTE OF CORRECTION WHICH I WILL DILIGENTLY CONSIDER. My assessment, however, includes the following:

1. Federal Legislation & Policy Shifts – The On Big Beautiful Bill Act (OBBBA) – the 2025 budget reconciliation bill – moved forward with some significant effects, including:

a. Medicaid Reforms – new work requirements for adults on Medicaid are imposed that will allow low-income enrollees to be charged modest copays as well as cuts in some of the provider tax rules – all of which are projected to reduce eligibility and coverage over time.

b. Reduced Medicaid Funding & Coverage Loss – long-term Medicaid cuts are projected to increase the uninsured population and worsen access, with analyses showing potential millions losing coverage and higher preventable hospitalizations.

c. Cuts to Navigator Funding and Increased Eligibility Requirements – while some rules have been adopted to streamline Medicaid and CHIP enrollment (e.g., reducing frequent renewals and administrative hurdles), other federal policy choices are threatening access.

d. Rural Health Funding – the rural health community got a potential boost through a dramatic increase in funds to be provided as part of a federal rural health transformation fund (= $50 billion over five years) to support struggling rural providers, a response to many recent hospital closures (YEA!!).

e. Access Gaps & Rural Strain – despite the transformation funding, rural hospital closures are accelerating at a disturbing pace, which is leading to an erosion of access to care, especially in more remote communities. It appears that the new federal policy shifts are contributing to the problem by tightening fiscal support of care delivery, with costs continuing to increase at an accelerated rate. New federal grants and pilot programs aiming to support rural hospitals and speed up Medicare Advantage payments are being implemented in some states – but these efforts are early, state-focused, and may not offset the broader cost pressures that are accelerating at a more rapid pace.

2. Affordable Care Act (ACA) Marketplace Subsidies – Modifications in the approach toward providing subsidies were included in the legislation, including:

a. ACA Premium Spikes – with the expiration of ACA premium subsidies that made coverage more affordable, coupled with enrollment changes, will likely result in about 800,000 fewer people signed up for 2026 plans compared with last year.

b. Debate On Extending Subsidies – Congressional debate continues on this topic with important implications, especially for the underserved. If the subsidies are not extended, even more people are likely to be pushed into either uninsured status or into high out-of-pocket plans.

3. Medicare & Federal Program Adjustments – The previously sacrosanct Medicare program is also facing modifications to reduce overall costs, including:

a. Premiums & Deductibles – Part B premiums and Part D deductibles are rising in 2026, resulting in increased costs for seniors – a topic that is increasingly animated among my friends and colleagues on Medicare.

b. Drug Price Negotiation – on a positive note, the Inflation Reduction Act’s drug price negotiation authority (begun through earlier legislation) continues to yield savings on select drugs for Medicare beneficiaries.

c. Access Limits – certain cost-saving eligibility expansions for Medicare Savings Programs have been delayed until 2034, resulting in a reduction of support for low-income enrollees.

d. Price Transparency Initiatives – again, on a positive note (so far), The Centers for Medicare and Medicaid Services under the Trump Administration has proposed new rules to improve healthcare price transparency, helping consumers compare prices and potentially shop for lower-cost care.

4. Impact on Costs for Individuals & Employers – In general, it can be stated that the “cost” of care delivery seems be accelerating at a rate faster than any of the proposed changes can accommodate, including:

a. Rising Insurance Costs – employer-sponsored health insurance costs are projected to exceed ~$18,500 per employee in 2026, which will put mounting pressure on workers and businesses.

b. Out-of-Pocket Premiums and Costs Increase – premiums in the ACA marketplace have risen sharply, making basic coverage less affordable for many who still have insurance. But the issue has not been addressed in the GBBB.

c. Targeted Expansion of Behavioral & Mental Health Services – federal policy developments have generally targeted expansion of mental health and substance use disorder services. However, despite these efforts, access gaps continue – especially in underserved communities.

5. Companion Trump Administration Decisions – decimation of government capability for managing the changes is a “real” problem, especially given the way the reductions were made through an arbitrary process, resulting in a yet to be finalized diminished workforce of between 8.7% (i.e., @ 200,000 departures) to 13% (i.e., @ 300,000 departures). It’s an open question on whether or not “efficiency” will be the outcome…

6. Summary Thoughts — the following table puts all of the various issues described above into a synopsis of the 2026 policy impact for your consideration: See Below Table

Again, if any of my readers disagree or have alternative thoughts on the descriptions I’ve outlined above, please feel free to send me a note at drkevin@creostrategicsolutions.com. Include documentation that I can review. Thanks…

Consulo Indicium

Information for your Consideration…

Impact On A Place I Know All Too Well – I recently received a notice about a story that ran on CBS News related to a small town in North Dakota – my home state, where I grew up (although some would say that I need to continue “growing up” 😊). The story relates to West River Health Services in Hettinger, ND, a town of about 1,000 residents in southwest North Dakota nestled near the northern portion of the South Dakota border. I became very familiar with the health care services at West River when I served as the Founding Director of the Center for Rural Health at the University of North Dakota in the 1980s. West River was one of the iconic rural (some would say “remote”) care programs in the nation – and continues with progressive capabilities and services in a frontier region of the state.

The CBS report related to the Trump Administration’s new H-1B visa fee requirement if a USA-based organization hires an individual from a foreign country. The issue is that “rural” or “remote” areas of the country are very underserved in terms of available healthcare professionals. As a result, many health systems are turning to foreign-based physicians and health care personnel to fill the increasingly large gap in staffing for these rural areas. Waivers are possible, but approval for these providers to join U.S.-based health care organizations increasingly takes months, despite vetting, review, and validation of their capabilities by existing local providers. In the case of West River, they had 30 applicants to review, but coming up with the fee for waiving the entry of foreign graduates was not feasible. It takes what little funds are available for side activities away from providing “care” to the rural underserved populace. For example, a $100,000 was established as part of a September proclamation by President Donald Trump, which applies to any foreign worker living outside the USA who does not already hold a visa. However, the fee is equivalent to the compensation provided to two lab technicians over the course of a year.

Prior to the new policy, the fee was $5,000. It’s obvious that the difference is not viable in virtually all rural health environments. So, in the presence of significant shortages in nursing, technical, and clinical personnel, costs escalate rapidly and surpass the resources available to rural communities. CHECK OUT the website as noted above for the details. From my perspective, it’s yet another failure of the DHHS oversight of proclamations emanating from the Trump Administration that are ill-conceived and a failure in sustaining the workforce capabilities of USA-based healthcare services – let alone the impact on many other areas as well (e.g., technology, production, farming, etc.).

The First Wave Arrives – Anthropic – an AI/ML company based in San Francisco recently announced the deployment of a new tool designed specifically for launch artificial intelligence capabilities for health care providers and payers – aka, “Claude for Healthcare” which is a first cousin derivative of “Claude for Life Sciences” (I’m not sure why it was name Claude but there’s not doubt a reason behind the name). It uses the CMS Coverage Database, PubMed, and the ICD-10 codes as part of its technical framework. The derivative capabilities are built

around Anthropic’s existing AI models but include connectivity to various medical databases and coding systems. The intent is to enhance the workflow of the organization. However, down the road, we should anticipate that offering the ability to provide “clinical augmented capability” is no doubt on the horizon. So, while it will likely be useful for fostering and supporting improved workflow and coding, we should anticipate that this represents the first wave of multiple efforts to [“move into”] the health care space.

I’m not opposed, but I’m a VERY FIRM BELIEVER that these “tools” should be viewed as sources of “clinical augmentation” rather than “clinical replacement” – which is a philosophy that may be at odds with some of the technology initiatives. Anthropic, for its part, has stated that it is committed to building a responsible and safe AI system specifically for hospitals, systems, payers, and organizations.

The company asserts that its commitment to building safe, responsible AI makes it uniquely suited to work with health systems, hospitals, payers, and other healthcare organizations. In a statement on behalf of the company, Eric Kauderer-Abrams, head of biology and life sciences at Anthropic, stated at the recent health IT conference in San Francisco that, “Anthropic is a very natural fit for the healthcare and life sciences world because our identity as an AI company is built around safety and responsibility and rigor and reproducibility, and these are all the central tenants of the healthcare and life sciences industries.” So, we shall see…and, at the same time, we should remain open but diligent as these tools are developed and deployed…

BUT – it’s obvious to me that I have been away too long since my blog has gone longer than the traditional 6 – 7 pages. I apologize!! However, there is a lot to present, and we are in the proverbial “rapids” in terms of the flow of healthcare changes. We will need to paddle harder and remain focused to make it through the rapids while continuing to provide the very best for the patients and people we care for… Stay tuned. I’ll try to stay on top of the changes…

Approaches To Alternative Care Delivery

Ideas and thoughts on how care delivery can be transformed…

Friendship: The Neglected Elixir of Health – As I was preparing to depart for our bucket list trip to Antarctica, I had the opportunity to hear a “day after the 1^st” discussion on NPR related to the importance of friendship. In essence, it was stressed that “friendships” are a key factor in boosting physical health. So, how? Basically, lowering the stress level of our daily lives improves heart health (e.g., lower blood pressure, reduced heart disease risk) and strengthens the immune system by encouraging healthier behaviors (like regular exercise). It has even been shown to assist in managing chronic conditions, acting as a protective “bubble wrap” against loneliness, which is as harmful as smoking for health. Close ties with friends, indeed, seem to protect the body from stress and reduce inflammation. Furthermore, friendships are linked to longer lifespans and better overall wellness, sometimes more than diet or exercise alone.

In essence, the answer to the common medical problems can be as simple as having friends with whom one has regular and open contact. And, as I considered the research findings, it was supported by my own experience. While I have friends all over the world, I now live in Kittery, Maine – and, for the first time since grade school and high school – I have “local” friends. We have regular informal and formal contact. And, they are not only companions but confidants, colleagues, energizers, and “buddies for life”. Over the last 10 years of having these friends, it’s become apparent to me that they often serve as the “energizer bunnies” in my life for helping to keep me going. So, when I discovered the research being conducted by the UCLA Center for Friendship, I thought it was something that we need to highlight more. It’s not just the medical interventions in life that keep us going. It’s also the friends who help us with life daily that can be equally important, if not more important, at certain times in our lives. As identified by the UCLA Center, the following are the key benefits derived from friendship:

Stress Reduction: Supportive friends lower blood pressure reactivity and heart rate during stressful tasks, protecting your cardiovascular system.

• Heart Health: Strong social connections are linked to lower blood pressure, healthier cholesterol, and a reduced risk of heart attack and stroke. Ah, the health reasons for my book club become more obvious…

• Stronger Immunity: People with robust social ties are less likely to get sick and recover faster, as social connections help regulate immune function and inflammation. Same observation…

• Longevity: Having close friends is associated with a lower risk of premature death from all causes, with some studies suggesting it’s more impactful than diet or exercise. But, this does not mean foregoing the regular exercise required for making longevity a reality!

• Better Health Habits: Friends encourage physical activity, which helps maintain a healthy weight, blood pressure, and cholesterol.

• Improved Illness Management: Friends help with doctor visits, meals, and overall self-care, improving control of conditions like diabetes. Especially as we get older…

• Reduced Inflammation: Loneliness is linked to inflammation, which can lead to serious illnesses; friendships combat this. This is a new one for me. 😊.

The Weekly Whisk

Musings from a foodie…

✯Due to the plethora of eats consumed over the last couple of weeks of our trip to Antarctica, the choices are still being evaluated… Apologies in advance to those who only read The Fickenscher Files for a chance to review the tastes of the moment…

The Good, The Bad, And The Ugly

The ongoing saga…

The Great – I realize the economics are not feasible for everyone, but for those with resources that can be used for such items, I more than highly recommend a trip to Antarctica. We just returned. It not only helps one appreciate the environment, but also embrace the contemplative energies also stimulated as part of the experience. Furthermore, all of the species living on Antarctica get along with one another – a lesson we have seemingly lost among the human species in recent years…

The Good – The release of several new AI/ML products at the recent technology conference is both exciting and predictive of the changes we should anticipate in healthcare. It will be positive if we remain diligent, resulting in “good”.

The Bad – The ongoing decimation of health care policy, services, and oversight developed by the DHHS over the last 50 years under the leadership of Robert F. Kennedy, Jr.’s leadership. I predict that in a few years, “when this too shall pass”, we will look back in significant dismay at the resulting chaos and setbacks to health care, in general, initiated by the current Administration.

The Ugly – Look around…

Recent Notable Quote(s)

“If you want to go fast, go alone. If you want to go far, go together.”

-African Proverb

“The world changes according to the way people see it, and if you alter, even by a millimeter, the way a person looks, or people look at reality, then you can change it.”

-James Baldwin (1924–1987), an American writer who was one of the most powerful voices on race, identity, and morality in the 20th century

“In a real sense all life is interrelated. All…are caught in an inescapable network of mutuality, tied in a single garment of destiny.”

-Rev. Dr. Martin Luther King, Jr.

The Occasional Perspective:

Observations On Societal Direction In The Coming Decade…

NOTE: This is not my usual “Fickenscher Files”. Instead, I’m sharing thoughts that have been rolling through my head for the last couple of months. I wanted to share these thoughts with you as well as encourage you to provide your feedback, whether positive or negative. In essence, I believe we are on the cusp of very significant societal changes. And, we – especially those of you who are of younger generations – have the opportunity to influence the direction of those changes…

The Simultaneity of Change

The Global Digital Revolution Coupled With The Requisite Societal Evolution

WAIT A Minute!!! There seems to be a lot happenin’ lately on the “change” front. We’ve got this ongoing war where Russia is failing to take over Ukraine in an apparent effort to distract the Russian people from all of their internal woes and misfortunes. However, Ukraine – under the leadership of Volodymyr Zelensky (the television star turned President-of-a-country) is doing an admirable job of keeping the Russians at bay. Then, there is the turnover of Prime Minister leadership roles in the United Kingdom that just happened, with a populist from Manchester taking over the role. And, let’s not forget Xi Jinping, erstwhile leader of China who is doing everything he can think of to fill the global leadership void with all-things-Chinese. And, let’s not forget. Then, there is the on-again, off-again – or, should I say evolving – “forever” war precipitated by our own President Trump on behalf of the USA against Iran in a run-up to the 250^th Anniversary of our founding as a nation. Boy, what a birthday present that’s been.

But, I’m not going to get started down that sidetrack because I don’t want to turn me off a bunch of you yet before I’ve had a chance to introduce my ongoing thoughts. Besides, these thoughts are not about President T. anyway. Instead, this note is about “leadership” at the global level and the evolving relationship of peoples throughout the world. So, let me get on with it…

An Overview of Societal Change Through the Millennia – My original thoughts started when I read an article in New Scientist about the evolution of mankind. The essence of the series of articles was that our humanitarian social structure has evolved over the millennia from small, egalitarian hunter-gatherer bands into the highly complex, stratified, and globalized societies we experience today. This trajectory was propelled by environmental pressures, the development of pair-bonded households, the mastery of agriculture, the transition to urban living, and the introduction of mechanical devices to replace human endeavors – all culminating in a series of cultural and social revolutions. While there are many academic overviews on the various societal approaches and impacts that caused those revolutions, a brief review is warranted as a precursor to my thesis: We are now at the formative stages of yet another, dramatic revolution that will evolve at a global level rather than as isolated activities in certain sectors of the globe. In fact, it is a different revolution because it is a revolution of society rather than simply genomics. And, it is a revolution that is occurring far faster, reaching much further, and affecting all of us more directly and more deeply than past earthly revolutions, in my estimation. But, before I explore my projections on the future of mankind and society, a brief overview of prior social structural and societal changes is in order, including the following:

1. Genomic Evolution of Homo Sapiens – Based on the Jebel Irhoud fossils, Homo Sapiens first appeared about 300 – 315,000 years ago – a relatively short time ago in the geologic stretch. Even more recent, the fossils we’ve discovered (so far) of modern Homo Sapiens date back to around 160,000 years ago. For us contemporary humans who live on average to about 80 years, even that latter date seems like a long time ago. Furthermore, the “human” revolution really started moving about 70 – 100,000 years ago when the bred moved out of Africa and started populating the world. And, that’s about the extent of species development period for Homo Sapiens evolution. We then moved into some other realms…or, how we related to one another…

2. Egalitarian Hunter-Gatherer Bands – For many thousands of years, modern Homo Sapiens lived in small, mobile, kin-based groups with the following characteristics:

• Social Structure: Small bands of extended families (20 to 50 people) were the norm. Decisions were made collectively, and leadership – if present – was often based on skill, experience, or influence rather than inherited power. Cooperation was the norm. Resources were shared to ensure group survival in harsh, often unpredictable environments.

• Kinship: To build broader alliances and prevent inbreeding, groups practiced direct-exchange kinship, where the trading of partners across neighboring bands was often practiced. These “trades” also created inter-community bonds where mutual support was normative.

Then, things started to accelerate a bit…

3. The Agricultural (Neolithic) Revolution - Beginning about 10,000 years ago, the invention of agriculture and animal domestication fundamentally changed human social organization, resulting in:

• Social Structure: Over time, there was a transition to larger, sedentary communities and villages. In addition, because land and stored food could be hoarded by groups that worked together, social hierarchies and resource inequalities emerged for the first time.

• Kinship: Direct exchange was replaced with generalized exchange (i.e., creating partnerships – both economic and social – across multiple communities). The solidification of larger tribal territories allowed for the dispersion of the populace over larger geographic areas. As a result, a variety of governance models evolved during this period, but all were generally focused on large local or regional affairs.

4. The Age of Exploration – From the 1500s to the beginnings of the 1800s, commerce around the world exploded. Ships sailed hither and yon as part of commerce but also as part of discovery. Exchanges between the continents were initiated and expanded during this time period. The “Americas” were discovered by the Europeans – even though they had been “discovered” and “populated” by Natives for centuries preceding the arrival of their cousins from across the ocean. The cold of Antarctica and the Arctic were explored. Africa and Asia became “go-to” places for food. And, the connectivity brought about conflict between the traditions of prior settlers and the invaders from across the seas. Nonetheless, the world was “mapped” and charted with increasing accuracy, and the isolation that had existed on the various continents was disarmed forevermore.

5. The First and Second Industrial Revolutions – Urbanization and Evolution of the State – Throughout the late 1800s and into the 1900s, a dramatic shift toward urbanization began, in part, the result of improved farming techniques requiring fewer workers on the land as well as simultaneous specialization of the work functions beginning to occur across various occupational groups. The specialization cut across all forms of community work, resulting in food production surpluses, specialized skills, and distant travel to a greater extent. This allowed populations to concentrate in cities beyond the confines of river valleys and agricultural settings. Social structures evolved as well, creating hierarchies that managed the affairs of the various evolving professional groups:

• Social Structure: Complex, stratified societies emerged which concurrently developed the formation of new political structures for managing the affairs of states or other geographic areas. This era markedly expanded the role of governments at all levels, standing armies, and management of specialized labor (e.g., artisans, priests, merchants, professionals, etc.).

• Shift from Kinship to Power Dynamics: Power transitioned from kinship-based networks to more centralized authority, often defined by class systems, laws, and inherited rulership (e.g., monarchies and empires) at one extreme as a governance solution and elected representative governments at the other end of the spectrum.

6. Evolution of the Post-Industrial Societies – In the early decades of the 20^th century, a dramatic shift evolved that has extended the societal changes far beyond those changes emanating from the agrarian social structures transitioning to urbanized societies. While significant change has occurred through the adoption of mass production and technology-driven industrial development, it pales in comparison to the evolving transformations in the new, evolving digital age, including:

• Social Structure: The pre-existing social relationships and structures of society based on economic class, educational attainment, location, national affiliation, and global markets are disaggregating. Furthermore, it appears that the dissolution of traditional relationships has been particularly acute among those entering the marketplace over the last decade. Many relationships among this generation are of a virtual nature. Community is “online” rather than “local” or “face-to-face,” which by its very nature alters the way we interact and relate to one another.

• Institutionalized Connectivity: Over time, the prior iterations of social structure during the last centuries resulted in the rise of formal institutions such as governments, markets, public schooling, production of goods and services, healthcare systems, and other social institutions. These capabilities have been formalized through the provision of essential social services rather than being simply managed solely by family or small social units. However, under the new virtual evolution, modern social institutions are no longer strictly bound by physical geography. Advanced transportation and global communication networks have fostered the decentralization of these requisite social resources.

Lessons Learned Over Time – First and foremost, it’s clear when we look back on societal change over time that each successive social revolution was not simply a linear progression. In fact, if we step back from the specifics of each social revolution, eleven overarching changes have affected the peoples of the world, including:

1. Each successive social revolution integrated the experiences of prior revolutions as they redefined the promises of further societal change.

2. There have been periods of dramatic change coupled with more incremental change resulting from the various revolutionary changes derived from the societies of the world.

3. Successive social revolutions have generally not been linear but more often build upon the lessons of prior movements.

4. Very importantly, the pace of change over time has been accelerating during each of the eras described above to the point that we are most likely on the verge of experiencing a revolution that will occur over decades rather than centuries.

5. The breadth of change affecting the populations of the world has shifted revolutions from local and/or regional influence toward worldwide impact.

6. Each successive revolution has brought us closer together by extending our relationships from families to communities to regional connections to global connectivity.

7. Inclusion of disaffected groups over time has expanded by integrating successive groups into the mainstream of societies.

8. Lasting change has been supported through the dissemination of laws, education, economic incentives, and evolving cultural norms, with these factors supported through ongoing leadership.

9. Societal changes have most often been driven through economic imperatives, which then evolve toward political imperatives that establish the changes as more permanent requirements of the movement.

10. Technology and innovation have served as core components of the infrastructure supporting change in each successive social revolution. As an example, we’ve gone from clay tablets, to papyrus and paper, to the printing press, to radio and television, to the internet and social media, to the new world of artificial intelligence and machine learning. Each successive technology has increased the rapidity, breadth, and magnitude of change across the world.

11. And, finally, one overarching pattern is clearly evident. Successful revolutions increasingly move beyond altering relationships and changing laws to reshaping institutions, norms, and shared values. Over time, societies have learned that enduring progress depends not only on a consideration of expanded rights, but also on building systems capable of sustaining those rights across generations.

Top of Form

Bottom of Form

So…Where is Society Headed Now?

The thesis I am putting forward is that the social structure and dependencies we will experience in the coming decade as a result of our connectivity will fundamentally alter how we organize, communicate, shape, and collaborate as societies. In addition, the change will – and is – happening at rates with far more rapidity than past societal shifts. What occurred over hundreds of thousands of years, multiple centuries, or multiple decades is now occurring over the course of years, at most, through the impact of successive digital and artificial intelligence revolutions.

In particular, the last two successive revolutions – over the course of a couple of decades, at most - will increasingly require societal attention toward defining the value derived from balancing the incredibly rapid evolution of innovations related to ethical governance and ensuring that advances in artificial intelligence, biotechnology, and digital systems benefit society broadly rather than concentrating power or opportunity. We appear to be at the formative stages of this debate as it begins to alter the entire economic and social foundation of societies across Mother Earth!

In essence, I am suggesting that we are in the formative stages of a rapid global revolution brought about by the deployment of digital technologies that will be affecting all aspects of our lives. The concurrent global digital and artificial intelligence revolutions are precipitating changes in how we live, who we work with, how those changes will affect our relationships and lives, where and how existing social constructs will respond, and what our relationships will be across multiple geographic, political, and social boundaries.

Historically, we’ve experienced very significant changes over time, but the time was measured in millennia, multi-century, century, or multi-decade periods. The pace of change happening in the moment is far more rapid. Furthermore, aside from the comet that destroyed the dinosaurs when it hit Mother Earth, there has never been anything that has evolved across the globe at such a rapid pace. The changes we are experiencing are dramatic. So, the questions arise…

• Beyond the anxiety of human replacement in work, what does it all mean?

• What is the impact of global connectivity?

• Does it change how we are organized at all levels of society?

• How will the digital revolution affect…me?

…my family?

…my compadres?

…my country?

…the world?

• Is the sky falling? Or are we seeing a new day with a new approach to life

…to community

…to work

…to international interactions

…to the essence of our relationships with one another at all levels?

The path of change is clearly breathtaking. In fact, our current media seems filled with apocalyptic stories on how the new evolving technologies will replace humans with machine capabilities in the not-too-distant future. No longer are devices “helping” us (e.g., consider the ox-drawn plow, the tractor, the printing press, etc.). Rather, the evolving revolution is dramatically altering the need for human participation as digital and artificial intelligence technologies assume greater responsibilities. However, I am a firm believer that the need for “human” interaction will continue to be a major resource, albeit providing us with more time for contemplation, reflection, and deliberation that – if applied appropriately – could benefit society at large!

Furthermore, it is increasingly clear that global connectivity is driving dramatic change across all societies across Planet Earth in a fashion we’ve never seen or experienced before! The increasing interconnectedness of people, businesses, governments, and cultures is affecting transportation, trade, communication systems, healthcare, economics, and international institutions through evolving global connections. The impact is all-inclusive and exceptionally broad, with simultaneously evolving benefits and challenges. It’s increasingly clear that societies across the globe will be forced to face multiple challenges across a spectrum of their embedded cultural, economic, and social requirements in the coming decade. Notice I used the word “decade”. Why? It is due to the rapidity of the changes we are experiencing throughout the world. While definitive changes may take somewhat longer, the pathway forward consisting of dramatic social, economic, and cultural change will be set in the short term. So, what are the implications?

Let me be clear: I’m not suggesting that we are facing an apocalyptic social disintegration on the horizon. However, life will not be a bowl of cherries and whipped cream either. The collective “we” across the entire globe will face many challenges in the coming decade; however, there are also positive elements that need to be considered, which are directly accelerating the digital revolution. As a foundation for change, we need to realize that recent studies have shown that 74% of the global population now has access to digital connectivity. A short ten years ago, it was 40%, and twenty years ago, it was 16%. The degree of change is at a pace far more rapid than all of the societal changes we’ve experienced throughout the history of mankind – except for the comet that hit Planet Earth and killed off those dinosaurs.

On a more positive note, there are a number of very positive societal benefits we are all experiencing as a direct result of the digital revolution. Those benefits include:

• Economic Growth – It’s increasingly obvious that the world is developing a global interdependency derived from expanded international trade and investment. Ideas and products evolve and become dispersed much more quickly in markets today than in the past, reaching beyond the local community to the nation and even globally. Furthermore, new industries and jobs are created – as well as dissolved – through the application of digital technologies and e-commerce, thereby changing the labor marketplace in very dramatic ways. And, finally, if it’s not already clear, the marketplace for virtually all products and services is becoming increasingly global rather than simply local.

• Faster Communication – It’s apparent to almost everyone who owns a computer or mobile device that communications, connectivity, and exchange are instantaneous. Colleagues, friends, and associates increasingly expect to have immediate access to your thoughts via email, video conferencing, and social media. And it’s 24x7! Furthermore, work is no longer an 8 – 5 process. Depending on one’s role, it can mean 24x7 access. In addition, the responsibilities of work and teams are shifting toward more remote and virtual approaches to solve common problems. As such, work is no longer a sequestered process, occurring in a controlled office setting with social rules on how work is accomplished within particular environments. Furthermore, at the end of the day, work has increasingly become an integrated part of daily life rather than a separate function that occurs someplace else.

• Information Contamination – Given the rapidity of information dissemination, the expectation of “truthiness” derived from the information we receive is also becoming less trusted. The decontamination of information which we previously relied upon through trusted outlets is being subsumed by the distribution of anything…anytime…by anyone…on any topic. Therefore, the vetting of information by trusted sources is now diminished, resulting in the loss of information reliability, with the erosion of the reliability occurring at an accelerated pace as it barges into our devices. It’s a sad commentary, but all information is increasingly suspect.

• Diffusion of Innovation and Scientific Exploration – Society is experiencing an explosion of technology, scientific discovery, and innovation on all fronts, in part, due to global connectivity and the application of the very technologies that are disrupting societies across the board. In the past, science and innovation were sequestered in workshops throughout the world. Sharing of information, ideas, projects, and initiatives occurred at intervals in structured environments. Now, it is not uncommon for scientists and companies to collaborate globally in real-time. New, effective technologies spread rapidly like wildfire through a dry forest. The shared knowledge that is evolving from these collaborative initiatives has accelerated discoveries across fields such as healthcare, artificial intelligence, renewable energy, telecommunications, education, and the like. In my own field of healthcare, the use of telemedicine for connecting patients has increasingly made it possible to provide patients with state-of-the-art care regardless of location – if they have connectivity! However, we still have pockets of inaccessibility in rural and remote areas throughout the world that hamper such access. At the same time, medical research, drug discovery, and vaccine development are experiencing marked acceleration through global collaboration. The list of benefits in all fields is literally growing on a daily basis.

• Enhanced Access to Knowledge and Education – At the same time we are experiencing a diffusion of knowledge, we are also accelerating the actual use of the information at all levels of society. Information that was in academic journals or professional chronicles is now at our fingertips. The previously hidden, obscured, or simply unavailable can now be unveiled by anyone. As a result, our knowledge portfolio is enhanced – if we take advantage of the information appropriately. One of the positive outcomes is that university education, research, and knowledge dispersion are increasingly moving toward collaborative models that are more expansive and internationally focused. Such efforts represent the forerunner of changes we will see throughout society in the coming decades.

• Enriched Cultural Exchange – While enhanced cultural exchange began during the 20^th century through increased connectivity derived from ocean, air, and telephone technologies, it has accelerated appreciably in the new era of ubiquitous connectivity. Cultural exchange is no longer confined to “being there” in the physical sense. The positive result is that our exposure to different cultures has promoted greater understanding, appreciation, and, in some cases, anxiety related to different customs, perspectives, and societal expectations. We’ve increasingly learned to appreciate different viewpoints in music, literature, food, ideas, and even politics through the easy spread of information.

And, while there are many benefits that society has experienced through the flow of technology across the globe, we are also facing the onset of new challenges that heretofore have never been experienced by the peoples of the world. Those challenges and risks associated with these new, evolving capabilities include:

• Economic Inequality – Despite the economic explosion, we are simultaneously experiencing the unequal distribution of benefits derived from inadequate or insufficient access to technology and infrastructure; a “digital divide” is increasingly evident among societies of the world. Also, the loss of jobs in certain industries that previously relied upon human labor, where shifts to automation and globalization have occurred, is accelerating. In essence, the divide between the haves and have-nots is widening. The question before us is how to manage the situation. Are we our brother’s keeper? How do we parse the resources of society in fair and equitable ways? And what is equitable?

• Ease of Misinformation Distribution – As already noted, it is apparent to the frequent user of the web that misinformation is much more easily dispersed through the internet than in the past, which relied upon print and oral formats. Where is Walter Cronkite when we need him? As a result, individual preconceived ideas or perspectives can be either reinforced or challenged, resulting in amplification of rumors, polarization, and manipulation through social media. Any opinion on any issue can be amplified through the web!

• Increased Cybersecurity Threats – Due to the connectivity of the populace, there is increased vulnerability to cyberattacks, fraud, and data breaches. Staying ahead of cyberattacks has become a full-time effort. In addition, critical infrastructure can be more easily affected due to digital disruptions at the local, national, and international levels.

• Environmental Impact – While we are still at the formative stages of understanding the potential implications of the technology revolution on the environment, it seems increasingly clear that the production and storage of information will be affecting our global supply chains as well as placing pressure on natural resources. Will the dissemination and infrastructure support required for the diffusion of technology include an increase in global warming derived from the deployment of server farms spread across the world? It’s a legitimate question that is moving to the forefront.

• Cultural Homogenization – As the world’s connectivity increases, it is very likely that local traditions and languages may be overshadowed by dominant global cultures, resulting in the potential loss of cultural identity. For example, English has evolved as the intercontinental language of business. It is increasingly a mandatory component for key workers within a variety of industries. Such evolution will ultimately lead to homogenization…

• Scientific Advancement – We are also clearly at the forefront of major advances across all of the sciences. From particle physics to genomics to astronomy to climate science and beyond – our understanding of the world from a scientific basis is remarkably accelerated!! The learnings that will evolve from our increased knowledge will affect our impact on Mother Earth, space travel, healthcare, everything we touch and beyond! You get the idea. We’re on a fast track to somewhere…

• Geopolitical Evolution – Global connectivity is reshaping international relations among the nation-states of the world. There is clearly an increased economic interdependence fostered, in part, by expanded multinational corporations and governmental interests. The evolving capabilities of artificial intelligence and machine learning are also accelerating technology competition, which leads to intensified cyber conflict and increased influence of global, non-state actors.

• Governance Evolution – The individual nation-states throughout the world will be increasingly challenged both internally and externally. As businesses evolve across traditional political boundaries, as intercommunication among people continues to expand, and as the connectivity of people throughout the world accelerates – the potential for evolving political, administrative, and governance structures will move to the forefront as a foundation for societal decision-making. Economic unions of varying structure will no doubt evolve during the formative years of the evolving century. In many respects, the experimentation on this front has already started with the formation of security alliances such as the North Atlantic Treaty Organization (1949), ANZUS (1951), Collective Treaty Security Organization (2002), among other evolving alliances.. Such groupings will no doubt support the ongoing integration and homogenization process inherent in diverse groups working together to solve common problems. My prediction is that, much like the tribes of yesteryear, we will no doubt see new structures emerge for addressing the evolving challenges of the times we have yet to experience!!

Global connectivity is clearly reshaping economies, social services, education, politics, and everyday life. While the dispersion of information technologies has increased prosperity and opportunities for billions of people, it has also created new and evolving vulnerabilities that will clearly require international cooperation and collaboration. In fact, it seems clear that global connectivity has made the world more interdependent, with events in one country increasingly influencing people and institutions in other countries. Our connected societies are becoming larger units of people rather than smaller through the coming together of the world. In sum, all of us throughout the world are facing a new revolution that will be more rapid, have a greater impact, and reach across the entire world at a much faster pace than prior revolutions.

Our personal connectivity is increasing with people throughout the world, not simply with the people down the street, in our community, or who are members of our state or even nation. As an example, in the past week I’ve been in contact with colleagues from India, Jordan, and the United Kingdom related to various topics. Such interaction is increasingly not an unusual occurrence. In essence, I am suggesting that we are in the midst of a rapid transition toward more decentralized, globally intertwined, and technologically mediated relationships among the peoples of the world. An example of a move in this direction is the European Union, where individual nations of physical Europe in 1993 moved from individual nation-states that defined their policies and approaches toward other states to a regional “union”, now composed of twenty-seven (27) nations. While certain responsibilities were retained by each of the countries, the union has increasingly become a central force in several areas such as defense, economic development, social policy, and the like.

It would appear that other such groupings in the world are also at the formative stages of moving from independent economic and social unions toward global connectivity and reliance. From a political, social, and economic standpoint – the world is getting much smaller! As the trends continue, such an evolution will no doubt require further refinement of global, multilateral governance structures as well as the emergence of borderless digital communities through global connectivity.

These ideas are not unique to my analysis. They have been posited by several academics in recent years. However, regardless of the origin of this type of thinking, it seems clear that in addition to the elements noted previously, we are also at the door of a new world order. Not all parts of the world will be willing to move in this direction immediately. However, the economic requirements and global connectivity of the world order will most likely bring about compliance over time. How it will shake out exactly is not clear. What is clear is that we are rapidly moving toward one global community.

So, Why Am I Writing About This Subject?

The imperative before us is that we – the peoples of the world – must begin the hard work of learning how to work together, cooperate, collaborate, and provide mutual support to one another. The evolution of technology will require it, and the transition will not be easy. National boundaries will likely become less relevant. There will no doubt be acrimony and dismay at the degree of change. Change initially will be modest. Initially, cooperation and coordination will perhaps be geographically based, but the move toward more global cooperation and coordination is clearly before us. Change will inevitably occur.

For my part, I sincerely wish I were going to be around for the coming changes. However, my age will likely prevent that possibility…unless my being can be transplanted into another form – which I doubt! If only I were a couple of decades younger, I would commit to helping make the change happen… After all, change and persistence have been my modus operandi for many years! Good luck to those of you who will help make the revolution successful… It will be an interesting journey, but ultimately collaboration and coordination will evolve as connection becomes more ubiquitous.

Good luck!! In many respects, I’m jealous and wish I could be part of the evolution… Don’t get the wrong idea. I’m a healthy 75+ year-old gent who exercises regularly – and, except for my nightly ice cream habit – I lead a relatively healthy life. I’m not about to disappear, but I’m also real enough to know that beyond another 20+ years at best, it’s unlikely I’ll be able to go much further. But, then again, I did mention advances in healthcare as one of the projected positives we could experience in the near term…Hmmmm!

The Good, The Bad, And The Ugly

The ongoing saga…

The Great – Taking the long view allows all of us to realize that we are inextricably traveling on a new road, with different guidelines, going in a new direction together as the human race.

The Good – We are generally confined to Mother Earth, so we are stuck working together, which should encourage us to work together toward common interests and needs.

The Bad – As with any change, there will be fits and starts on the road to somewhere, requiring perseverance and persistence…to fulfill the potential positive outcomes of the evolution.

The Ugly – The resistance that will no doubt arise from those who do not like change, want to maintain control, and want society to revert to “the good ole’ days”.

The Really Ugly – Societal transitions have almost always been accompanied by inter-community strife leading to international strife in more recent years. It is highly likely that such strife will extend itself to global strife until we settle into a new, new way of getting along in the world.