Does your Surgeon Count his Cases? Why ?

 Your surgeon has a number.

They may not tell you what it is.

But it exists.

It is the number of surgeries they need to do each month to hit their productivity target. The number that keeps their administrator happy. The number that justifies their salary or their partnership share or their bonus.

When you walk into their office with knee pain, you are not just a patient. You are a potential case. A potential number.

If your surgeon is three cases short this month, the recommendation might tilt toward surgery. If they are ahead, maybe they mention physical therapy first. You will never know which version of the conversation you got.

This is not because surgeons are bad people. Most are not. It is because the system creates pressure. And pressure shapes decisions in ways people do not even realize.

The surgeon who needs to hit 20 cases this month is not thinking "I should operate on this person to make my quota." They are thinking "this patient probably needs surgery." The bias is unconscious. The incentive is invisible. But it is there.

I do not have a number.

Nobody is tracking my cases. Nobody is comparing my productivity to a benchmark. Nobody is pressuring me to operate more.

When I tell you that you do not need surgery, it is because you do not need surgery. When I tell you that you do, it is because you do. The recommendation comes from the exam and the imaging and your goals. Not from a spreadsheet.

That is what independence gives you.

A surgeon who is not keeping score. 

https://www.linkedin.com/posts/thomas-myers-md-b962a451_your-surgeon-has-a-number-they-may-not-activity-7440725085826646017-c006?utm_source=social_share_send&utm_medium=member_desktop_web&rcm=ACoAAAAqTbwBl7WHwBdULQ1iB1ThcCkr32EMVjE

3 D printed Middle Ear Ossicles

A little known African Otolaryngologist. Professor Mashudu Tshifularo, Head of Otorhinolaryngology at the University of Pretoria, performed the world's first middle ear transplant using 3D-printed titanium bones. March 2019. Steve Biko Academic Hospital.

He hadn't heard his daughter's voice in years. Then a South African surgeon did what no one had done before. Professor Mashudu Tshifularo, Head of Otorhinolaryngology at the University of Pretoria, performed the world's first middle ear transplant using 3D-printed titanium bones. March 2019. Steve Biko Academic Hospital. The patient was a 40-year-old man. A car accident had destroyed the three tiny bones that transmit sound — the hammer, anvil, and stirrup. For years, silence. After surgery, Thabo Moshiliwa heard immediately. Think about that. Not weeks of recovery. Not gradual improvement. Instant sound transmission. His first words: he could hear clearly again. The innovation that made it possible: ↳ Custom 3D-printed titanium ossicles — sized precisely for each patient ↳ Endoscopic surgery — minimally invasive, 90 minutes ↳ Reduced risk of facial nerve damage compared to traditional methods ↳ Faster recovery, less trauma A second patient that same week: born without fully formed middle ear bones. Congenital. Had never heard normally. The same implants worked. What stopped me: This wasn't developed in a billion-dollar lab in Boston or Zurich. It happened at a public hospital in Pretoria. Hundreds of inquiries have come from around the world since. Patients who had been told nothing could be done. The Multiplication Effect: 1 successful transplant = proof the method works 10 hospitals adopting 3D-printed ossicles = regional access to hearing restoration 100 countries with this capability = conductive hearing loss becomes treatable everywhere At scale = we stop asking who can afford to hear and start asking how we missed this for so long The shift isn't just surgical. It's about where innovation comes from — and who it reaches. What's one medical innovation you've seen come from a place no one expected, and why do you think geography still dictates who gets access to breakthrough care? Sources: University of Pretoria, Steve Biko Academic Hospital This is not a sponsored post. Please note: This is not intended as medical advice, diagnosis or treatment. Always check with a healthcare professional.

Periodic Therapeutic Phlebotomy Mitigates Systemic Aging Phenotypes by Promoting Bone Marrow Function - Cai - 2026 - Aging Cell - Wiley Online Library

Leach's may have worked...

Aging is the primary risk factor for numerous chronic diseases, making the identification of safe and effective anti-aging strategies a critical focus in biomedical research. Heterochronic parabiosis by blood exchange shows that the exchange interaction between young and old plasma can exert anti-aging effects through exchange of bloodborne factors. However, the limited plasma source greatly affects clinical translation. Here, we demonstrate that periodic therapeutic phlebotomy in D-galactose-induced aging models exerts significant and comprehensive anti-aging effects, which is reflected by a notable improvement in aging-associated behavioral deficits and neurogenesis, a significant decrease in the level of circulating senescence-associated secretory phenotypes, and an obvious mitigation of aging-associated structural degradation and molecular alterations within the muscle, bone, liver, kidney, and nervous systems. Mechanistically, periodic therapeutic phlebotomy induces bone marrow microenvironment restoration through functional rescue of mesenchymal stem cells and endothelial cells, thereby reestablishing balanced hematopoietic homeostasis. This hematopoietic revitalization subsequently drives systemic improvements in peripheral blood composition and function. In conclusion, our work provides preliminary evidence suggesting that periodic therapeutic phlebotomy exerts anti-aging effects by restoring bone marrow function and mitigating aging phenotypes, subsequently driving peripheral blood functional restoration. Given its technical simplicity and safety profile, this periodic therapeutic phlebotomy strategy will hold potential to pave the way for clinical translation.

Periodic Therapeutic Phlebotomy Mitigates Systemic Aging Phenotypes by Promoting Bone Marrow Function - Cai - 2026 - Aging Cell - Wiley Online Library

Health care is on hold for some older adults as they wait for Medicare

Waiting for Medicare: Steeper costs push some adults to delay care

AI Generated by USA TODAY

The end of expanded ACA subsidies has caused many adults in their 50s and early 60s to face sharply higher premiums, prompting them to delay essential medical procedures until they qualify for Medicare, which experts warn could increase health risks and future public costs.

Key points:

John Galvin, 64, delayed a colonoscopy until turning 65 because his monthly Obamacare premium rose to $2,460 and his deductible was $2,700.

People with incomes above 400% of the federal poverty level (about $86,560 for a two‑person family) lost the pandemic‑era subsidies at the end of December 2025.

Adults ages 50‑64 make up roughly half of ACA enrollees, and many are seeing premium increases of up to threefold, sometimes amounting to a quarter of their income.

AARP reports that the ACA cut the uninsured rate for the 50‑64 age group in half and provided a safety net for those without employer coverage.

Jessica Schubel warned that delayed care will create pent‑up demand, forcing Medicare to spend significantly more when these individuals enroll at 65.

Health care is on hold for some older adults as they wait for Medicare

Cyberattack against Stryker highlights potential impacts of Iran war on healthcare industry

HEALTHCARE IS ON A WAR SETTING WITH IRAN

The cyberattack against medtech company Stryker isn’t quite like other major cybersecurity events we’ve seen in the healthcare industry in recent years. This attack is part of Iran’s response against the US to the war in the Middle East.

On March 11, an Iran-linked threat actor called Handala (suspected by Israeli cybersecurity experts to be tied to the Iranian Ministry of Intelligence and Security) disrupted Stryker’s internal Microsoft network, the company shared in a statement, prompting the company to initiate a cybersecurity “response plan” and an internal investigation, per a Securities and Exchange Commission filing.

But crucially, this could be also a sign of more to come within this war, cybersecurity experts have said.

“You can’t look at this cyberattack in a vacuum. It’s direct retaliation tied to the broader conflict with Iran,” Erik Pupo, director of commercial health IT advisory at tech consultancy Guidehouse, told us via email.

Stryker has maintained since the attack that its medical and surgical devices have not been impacted and there has been no sign of malware or ransomware that could impact USB flash drives for related products. Its 56,000 global employees were encouraged to keep company-issued devices turned off and disconnected from networks.

“Incidents like the recent attack on Stryker are a reminder that cyber conflict increasingly mirrors geopolitical tensions, where disruption is used as a signal of reach and capability, not just immediate impact,” Michael Smith, field chief technology officer at digital security company DigiCert, told Healthcare Brew via email.

Cyberattack against Stryker highlights potential impacts of Iran war on healthcare industry

Cost Concerns and Coverage Changes: A Follow-Up Survey of ACA Marketplace Enrollees | KFF

A little more than half of Affordable Care Act (ACA) marketplace enrollees reported cutting back on spending for food, clothing and other basic household items to afford health care, which has become more expensive.  

In a new KFF poll released Thursday, 55 percent of returning ACA marketplace enrollees said they are already or are planning to cut back on food or basic household items so they can afford health care-related costs, with half of those surveyed saying their health care costs are “a lot” higher in 2026.

Roughly 4 in 10 survey participants said they have already or are planning to find an extra job or work additional hours because of higher health care spending. About the same amount of participants reported that their deductibles had gone up this year.

Among surveyed 2026 ACA marketplace enrollees, the vast majority — 78 percent — said they thought Congress did the wrong thing by letting the subsidies expire. Ninety-four percent of Democratic enrollees said it was wrong, while 58 percent of Republicans said the same.

About the Survey

At the end of 2025, despite a government shutdown over the policy, the enhanced premium tax credits expired, decreasing financial assistance for subsidized Marketplace enrollees and contributing to significant increases in the Affordable Care Act (ACA) Marketplace costs for most enrollees overall. Amid the debates leading up to the expiration, KFF conducted a probability-based survey of 1,350 adults covered by ACA Marketplace plans in late 2025 to better understand their worries about potential cost increases for their health coverage. Now—without the enhanced tax credits in place—KFF re-interviewed 1,117 individuals (more than 80% of the original sample) to learn how they are navigating these changes to the ACA Marketplace. 

This report is based on all 2025 Marketplace enrollees who took the follow-up survey, including returning Marketplace enrollees1, those who have left the Marketplace entirely for another type of coverage, and those who are now uninsured.

About the Survey

At the end of 2025, despite a government shutdown over the policy, the enhanced premium tax credits expired, decreasing financial assistance for subsidized Marketplace enrollees and contributing to significant increases in the Affordable Care Act (ACA) Marketplace costs for most enrollees overall. Amid the debates leading up to the expiration, KFF conducted a probability-based survey of 1,350 adults covered by ACA Marketplace plans in late 2025 to better understand their worries about potential cost increases for their health coverage. Now—without the enhanced tax credits in place—KFF re-interviewed 1,117 individuals (more than 80% of the original sample) to learn how they are navigating these changes to the ACA Marketplace. 

This report is based on all 2025 Marketplace enrollees who took the follow-up survey, including returning Marketplace enrollees1, those who have left the Marketplace entirely for another type of coverage, and those who are now uninsured.

Returning Marketplace Enrollees Are Paying More for Their 2026 ACA Coverage and Will Cut Back on Spending; Many Not Confident They Can Afford Premiums All Year

Percent of returning Marketplace enrollees who report each of the following:

Bar chart showing health care cost concerns among 2025 ACA Marketplace enrollees who still have Most 2025 Marketplace Enrollees Still Have Marketplace Coverage, Though One in Ten Are Now Uninsured

Current health insurance coverage for 2025 Marketplace enrollees:

Bar chart showing health insurance coverage type among 2025 Marketplace enrollees.

Marketplace coverage

69%

    Same Marketplace plan

39%

    Switched Marketplace plans

28%

Other type of coverage

22%

    Medicaid

7%

    Non-Marketplace, purchased plan

5%

    Employer-sponsored insurance

5%

    Medicare

4%

    Insurance through parents

 coverage.

Higher health care costs

Total who report higher health care costs

80%

   Their costs are "a lot" higher

51%

Affordability concerns

Worried about affording costs for emergency care or hospitalizations

73%

Worried about affording costs for routine medical care

49%

Worried about affording costs for prescription drugs

45%

They are, or will be, cutting back on household spending to afford health care costs

55%

They are not confident they can afford their premium all year

17%

Note: Among 2025 Marketplace enrollees who still have Marketplace coverage. See topline for full question wording.

 

Some previous ACA Marketplace enrollees are now uninsured or have changed to a different Marketplace plan, citing costs as the major reason for that decision. One in ten (9%) 2025 Marketplace enrollees say they are now currently uninsured and three in ten (28%) say they switched to a different Marketplace plan. When asked the reasoning behind their change, a larger share say costs were the driver rather than changes to their health care needs. A 34-year-old man living in Texas put it this way, “The prices are simply too high. $800/month for the absolute cheapest plan for two people. Our income is $120k, so we don’t qualify for subsidies in Texas. I don’t think we could afford our mortgage if I had to pay for health insurance.”

Health care costs may be a deciding factor for ACA Marketplace enrollees in the 2026 midterm elections. With health care costs front and center for 2025 Marketplace enrollees, many who are registered to vote say that the cost of health care will have a major impact on their decision to vote (48%) and which party’s candidate they will support (49%) in the midterm elections. The issue currently resonates more with Democrats, who are more than twice as likely as Republicans to say health costs will play a major impact on their decision to vote in the 2026 midterms (67% vs. 27%) and on which candidate they decide to vote for (70% vs. 30%).

Cost Concerns and Coverage Changes: A Follow-Up Survey of ACA Marketplace Enrollees | KFF

Ue It or Lose IT

The brain is continuously producing new brain cells. If they are not used, they undergo atrophy.

Artificial Intelligence use decreases the use of many brain cells. This will reduce your capacity to think about problems.

Brain Cell Regeneration

Gregg Braden: We produce new brain cells until the day we die. However, you have 7-10 days to use them before the brain thinks you don’t need them and atrophy sets in.