Physician Turnover in the United States

Medical groups, health systems, and professional associations are concerned about potential increases in physician turnover, which may affect patient access and quality of care. 

To address this concern, they are working together to develop innovative strategies to retain physicians. These include providing financial incentives, such as loan repayment programs and signing bonuses; offering flexible work schedules; increasing administrative support staff; creating career development opportunities for physicians; and improving the overall work environment. Additionally, physician organizations are exploring how technology can be leveraged to help retain doctors, such as through telemedicine and remote patient monitoring. 

The hope is that these measures will enable physicians to better manage their workloads, allowing them to spend more time providing quality care and less time dealing with administrative tasks. A strong emphasis on physician retention could help ensure the continued availability of reliable medical care for patients across the country.

A study from the Annals of Internal Medicine by Amelia M. Bond, PhD, Lawrence P. Casalino, MD, PhD, Ming Tai-Seale, PhD indicates there was little change in physician turnover.  The study, however, was based upon billing practices for Medicare patients. 

To examine whether turnover has changed over time and whether it is higher for certain types of physicians or practice settings.

Design:

The authors developed a novel method using 100% of traditional Medicare billing to create national estimates of turnover. Standardized turnover rates were compared by physician, practice, and patient characteristics.

Setting:  Traditional Medicare, 2010 to 2020.

Participants: Physicians billing traditional Medicare.

Measurements:  Indicators of physician turnover—physicians who stopped practicing and those who moved from one practice to another—and their sum.

Results:

The annual rate of turnover increased from 5.3% to 7.2% between 2010 and 2014, was stable through 2017, and increased modestly in 2018 to 7.6%. Most of the increase from 2010 to 2014 came from physicians who stopped practicing increasing from 1.6% to 3.1%; physicians moving increased modestly from 3.7% to 4.2%. Modest but statistically significant (P < 0.001) differences existed across rurality, physician sex, specialty, and patient characteristics. In the second and third quarters of 2020, quarterly turnover was slightly lower than in the corresponding quarters of 2019.

Implications:

The data suggest that physician turnover is an ongoing challenge for healthcare organizations, particularly in rural areas. It also suggests that healthcare organizations may be more successful in recruiting and retaining physicians if they can identify the factors associated with increased turnover, anticipate changes in the local or larger healthcare market, and design strategies to retain existing staff. The findings from this study add

Conclusion:

Over the past decade, physician turnover rates have had periods of increase and stability. These early data, covering the first 3 quarters of 2020, give no indication yet of the COVID-19 pandemic increasing turnover, although continued tracking of turnover is warranted. This novel method will enable future monitoring and further investigations into turnover. It also indicates that healthcare organizations should remain engaged in identifying the factors associated with increased turnover and developing strategies to retain existing staff. With this information, healthcare organizations can create better working environments and more efficient health service delivery for their patients. ~~~~~~~~~END~~~~~~~~~~~

This study flies in the face of frequent statements and beliefs about physician burnout, depression, suicide, and career change.

There are no national estimates of physician turnover, so it is not known whether turnover has increased, as is sometimes assumed (2). If changes in turnover over time exist, they could be driven by the large shift in the composition of physicians and their practices as the number of female physicians and the size of practices have grown in recent years. Even if turnover rates have not changed, they may vary by physician and practice characteristics, geographic location, or the composition of a practice’s patient population. The degree to which turnover merits additional or targeted organizational and policy intervention and investment requires information on these questions.1. Shanafelt T, Goh J, Sinsky C. The business case for investing in physician well-being. JAMA Intern Med. 2017;177:1826-1832. [PMID: 28973070] doi:10.1001/jamainternmed.2017.4340

Measuring Physician Turnover

We defined 2 types of physician turnover, physicians who moved from one practice to another and those who stopped practicing (that is, left practice), henceforth “movers” and “leavers.”

When identifying movers, our goal was to determine whether a physician who was working with one practice ended the relationship and joined a second practice. In billing data, it is possible to identify the month a physician begins billing a new practice or TIN. However, billing a new practice does not necessarily indicate movement; it could, for example, indicate that a medical group is using more than 1 TIN, that a medical group was acquired by another practice, or that a physician worked part-time in 2 practices. We developed 3 preconditions to determine whether the billing of a new practice constituted a physician moving: A physician had to have a relationship with both the first and new practices through sufficient months of billing—we used 4 months as the primary specification, with 3 and 6 months in sensitivity analyses; the relationships with the first and second practices had to be temporally independent (that is, a physician must bill at least 4 months with their old practice and new practice in different months); and the potential move should not represent a medical group reorganizing its financial structure. Specifically, the old practice had to continue to exist after a physician moved, and a physician could not continue to bill with many of their former peers. Section II of the Supplement provides full details on methods and sample flow charts

The goal in identifying physician leavers was to identify physicians who fully retired from practice or stopped practicing for an extended period. This method considered an extended period to be 2 years and identified physician leavers as those who stopped billing for 2 years (Section II of the Supplement). In sensitivity analyses, we applied periods of 3 months, 1 year, and 3 years.

Primary measures of moving and leaving were reported on a July-to-June basis because measurement of moving required up to 6 months of billing data before and after a potential month of moving. Rates of moving were reported for years 2010 to 2020. Rates of leaving were reported for years 2010 to 2018 because measurement of leaving required 2 years of billing data after a potential month of leaving.

In a supplementary analysis examining turnover during the beginning of the COVID-19 pandemic, we used modified quarterly measures that could be constructed through the third quarter of 2020. Moving required a physician to have a 3-month rather than a 4-month relationship with both the first and new practices. Leaving required a physician to stop billing for 3 months rather than 2 years.

CROSSREF

MEDLINE

GOOGLE SCHOLAR

2. Wallace JE, Lemaire JB, Ghali WA. Physician wellness: a missing quality indicator. Lancet. 2009;374:1714-1721. [PMID: 19914516] doi:10.1016/S0140-6736(09)61424-0

CROSSREF

MEDLINE

GOOGLE SCHOLAR

3. Willard-Grace R, Knox M, Huang B, et al. Burnout and health care workforce turnover. Ann Fam Med. 2019;17:36-41. [PMID: 30670393] doi:10.1370/afm.2338

CROSSREF

MEDLINE

GOOGLE SCHOLAR

4. Reddy A, Pollack CE, Asch DA, et al. The effect of primary care provider turnover on patient experience of care and ambulatory quality of care. JAMA Intern Med. 2015;175:1157-62. [PMID: 25985320] doi:10.1001/jamainternmed.2015.1853

CROSSREF

MEDLINE

GOOGLE SCHOLAR

5. Chanfreau-Coffinier C, Washington DL, Chuang E, et al. Exploring the association of care fragmentation and patient ratings of care quality: a mediation analysis of women veterans' experience with VA care. Health Serv Res. 2019;54:816-826. [PMID: 30989651] doi:10.1111/1475-6773.13153

CROSSREF

MEDLINE

GOOGLE SCHOLAR

6. Rodriguez HP, Rogers WH, Marshall RE, et al. The effects of primary care physician visit continuity on patients' experiences with care. J Gen Intern Med. 2007;22:787-793. [PMID: 17431698] doi:10.1007/s11606-007-0182-8

CROSSREF

MEDLINE

GOOGLE SCHOLAR

7. Haggerty JL, Reid RJ, Freeman GK, et al. Continuity of care: a multidisciplinary review. BMJ. 2003;327:1219-1221. [PMID: 14630762] doi:10.1136/bmj.327.7425.1219

CROSSREF

MEDLINE

GOOGLE SCHOLAR

8. Nyweide DJ, Anthony DL, Bynum JP, et al. Continuity of care and the risk of preventable hospitalization in older adults. JAMA Intern Med. 2013;173:1879-1885. [PMID: 24043127] doi:10.1001/jamainternmed.2013.10059

CROSSREF

MEDLINE

GOOGLE SCHOLAR

9. Hussey PS, Schneider EC, Rudin RS, et al. Continuity and the costs of care for chronic disease. JAMA Intern Med. 2014;174:742-748. [PMID: 24638880] doi:10.1001/jamainternmed.2014.245

CROSSREF

MEDLINE

GOOGLE SCHOLAR

10. Wasson JH, Sauvigne AE, Mogielnicki RP, et al. Continuity of outpatient medical care in elderly men. A randomized trial. JAMA. 1984;252:2413-2417.

CROSSREF

MEDLINE

GOOGLE SCHOLAR

11. Pourat N, Davis AC, Chen X, et al. In California, primary care continuity was associated with reduced emergency department use and fewer hospitalizations. Health Aff (Millwood). 2015;34:1113-1120. [PMID: 26153305] doi:10.1377/hlthaff.2014.1165

CROSSREF

MEDLINE

GOOGLE SCHOLAR

12. Nyweide DJ, Bynum JPW. Relationship between continuity of ambulatory care and risk of emergency department episodes among older adults. Ann Emerg Med. 2017;69:407-415.e3. [PMID: 27520592] doi:10.1016/j.annemergmed.2016.06.027

CROSSREF

MEDLINE

GOOGLE SCHOLAR

13. Sabety AH, Jena AB, Barnett ML. Changes in health care use and outcomes after turnover in primary care. JAMA Intern Med. 2021;181:186-194. [PMID: 33196767] doi:10.1001/jamainternmed.2020.6288

CROSSREF

MEDLINE

GOOGLE SCHOLAR

14. 2017 National Healthcare Quality and Disparities Report. Agency for Healthcare Research and Quality. July 2018. Accessed at www.ahrq.gov/research/findings/nhqrdr/nhqdr17/index.html on 5 April 2022.

GOOGLE SCHOLAR

15. Han S, Shanafelt TD, Sinsky CA, et al. Estimating the attributable cost of physician burnout in the United States. Ann Intern Med. 2019;170:784-790. [PMID: 31132791] doi:10.7326/M18-1422

LINK

GOOGLE SCHOLAR

16. Pappas MA, Stoller JK, Shaker V, et al. Estimating the costs of physician turnover in hospital medicine. J Hosp Med. 2022;17:803-808. [PMID: 35977052] doi:10.1002/jhm.12942

CROSSREF

MEDLINE

GOOGLE SCHOLAR

17. Hamidi MS, Bohman B, Sandborg C, et al. Estimating institutional physician turnover attributable to self-reported burnout and associated financial burden: a case study. BMC Health Serv Res. 2018;18:851. [PMID: 30477483] doi:10.1186/s12913-018-3663-z

CROSSREF

MEDLINE

GOOGLE SCHOLAR

18. Centers for Medicare & Medicaid Services. Medicare Data on Provider Practice and Specialty (MD-PPAS) user guide, version 2.4. March 2022. Accessed at https://resdac.org/sites/datadocumentation.resdac.org/files/MD-PPAS%20User%20Guide%20-%20Version%202.4.pdf on 23 January 2023.

GOOGLE SCHOLAR

19. 2020 standards for delineating core based statistical areas. Fed Regist. 2021;86:37770-37778. Accessed at www.federalregister.gov/documents/2021/07/16/2021-15159/2020-standards-for-delineating-core-based-statistical-areas on 6 April 2022.

GOOGLE SCHOLAR

20. Jarrín OF, Nyandege AN, Grafova IB, et al. Validity of race and ethnicity codes in Medicare administrative data compared with gold-standard self-reported race collected during routine home health care visits. Med Care. 2020;58:e1-e8. [PMID: 31688554] doi:10.1097/MLR.0000000000001216

CROSSREF

MEDLINE

GOOGLE SCHOLAR

21. Goda GS, Shoven JB, Slavov SN. What explains changes in retirement plans during the Great Recession? Am Econ Rev. 2011;101:29-34.

CROSSREF

GOOGLE SCHOLAR

22. McFall BH. Crash and wait? The impact of the Great Recession on retirement planning of older Americans. Am Econ Rev. 2011;101:40-44. [PMID: 23413315] doi:10.1257/aer.101.3.40

CROSSREF

MEDLINE

GOOGLE SCHOLAR

23. Blumenthal D, Tavenner M. The "meaningful use" regulation for electronic health records. N Engl J Med. 2010;363:501-504. [PMID: 20647183] doi:10.1056/NEJMp1006114

CROSSREF

MEDLINE

GOOGLE SCHOLAR

24. Tai-Seale M, Olson CW, Li J, et al. Electronic health record logs indicate that physicians split time evenly between seeing patients and desktop medicine. Health Aff (Millwood). 2017;36:655-662. [PMID: 28373331] doi:10.1377/hlthaff.2016.0811

CROSSREF

MEDLINE

GOOGLE SCHOLAR

25. Tai-Seale M, Dillon EC, Yang Y, et al. Physicians' well-being linked to in-basket messages generated by algorithms in electronic health records. Health Aff (Millwood). 2019;38:1073-1078. [PMID: 31260371] doi:10.1377/hlthaff.2018.05509

CROSSREF

MEDLINE

GOOGLE SCHOLAR

26. Meit M, Knudson A, Gilbert T, et al. The 2014 Update of the Rural-Urban Chartbook. Rural Health Reform Policy Research Center; 2014. Accessed at https://ruralhealth.und.edu/projects/health-reform-policy-research-center/pdf/2014-rural-urban-chartbook-update.pdf on 2 June 2023.

GOOGLE SCHOLAR

27. Auerbach DI, Buerhaus PI, Staiger DO. Implications of the rapid growth of the nurse practitioner workforce in the US. Health Aff (Millwood). 2020;39:273-279. [PMID: 32011941] doi:10.1377/hlthaff.2019.00686

CROSSREF

MEDLINE

GOOGLE SCHOLAR

28. Association of American Medical Colleges. 2021 FACTS: applicants and matriculants data. Accessed at www.aamc.org/data-reports/students-residents/interactive-data/2021-facts-applicants-and-matriculants-data on 10 March 2022.

GOOGLE SCHOLAR

29. Bertrand M, Kamenica E, Pan J. Gender identity and relative income within households. Q J Econ. 2015;130:571-614.

CROSSREF

GOOGLE SCHOLAR

30. Van Niel MS, Bhatia R, Riano NS, et al. The impact of paid maternity leave on the mental and physical health of mothers and children: a review of the literature and policy implications. Harv Rev Psychiatry. 2020;28:113-126. [PMID: 32134836] doi:10.1097/HRP.0000000000000246

CROSSREF

MEDLINE

GOOGLE SCHOLAR

31. Scully RE, Davids JS, Melnitchouk N. Impact of procedural specialty on maternity leave and career satisfaction among female physicians. Ann Surg. 2017;266:210-217. [PMID: 28272103] doi:10.1097/SLA.0000000000002196

CROSSREF

MEDLINE

GOOGLE SCHOLAR

32. Neprash HT, Zink A, Gray J, et al. Physicians' participation in Medicaid increased only slightly following expansion. Health Aff (Millwood). 2018;37:1087-1091. [PMID: 29985702] doi:10.1377/hlthaff.2017.1085

CROSSREF

MEDLINE

GOOGLE SCHOLAR

33. Zheng NT, Haber S, Hoover S, et al. Access to care for Medicare-Medicaid dually eligible beneficiaries: the role of state Medicaid payment policies. Health Serv Res. 2017;52:2219-2236. [PMID: 27767203] doi:10.1111/1475-6773.12591

CROSSREF

MEDLINE

GOOGLE SCHOLAR

34. Sinsky CA, Shanafelt TD, Dyrbye LN, et al. Health care expenditures attributable to primary care physician overall and burnout-related turnover: a cross-sectional analysis. Mayo Clin Proc. 2022;97:693-702. [PMID: 35227508] doi:10.1016/j.mayocp.2021.09.013

CROSSREF

MEDLINE

GOOGLE SCHOLAR

35. Rittenhouse DR, Mertz E, Keane D, et al. No exit: an evaluation of measures of physician attrition. Health Serv Res. 2004;39:1571-1588. [PMID: 15333123] doi:10.1111/j.1475-6773.2004.00304.x

CROSSREF

MEDLINE

GOOGLE SCHOLAR

36. Byers J. AMGA: physician turnover rate mirrors economy. HealthExec. 19 April 2011. Accessed at https://healthexec.com/topics/healthcare-economics/amga-physician-turnover-rate-mirrors-economy on 7 March 2022.

GOOGLE SCHOLAR

37. Irving F. Physician turnover rate hits all-time high. Healthcare Finance. 19 March 2013. Accessed at www.healthcarefinancenews.com/news/physician-turnover-rate-hits-all-time-high on 7 March 2022.

GOOGLE SCHOLAR

38. American Medical Group Association. Physician turnover remains high as more physicians retire. ScienceDaily. 21 August 2014. Accessed at www.sciencedaily.com/releases/2014/08/140821115632.htm on 3 May 2021.

GOOGLE SCHOLAR

39. Windover AK, Martinez K, Mercer MB, et al. Correlates and outcomes of physician burnout within a large academic medical center. JAMA Intern Med. 2018;178:856-858. [PMID: 29459945] doi:10.1001/jamainternmed.2018.0019

CROSSREF

MEDLINE

GOOGLE SCHOLAR

40. Neprash HT, McWilliams JM, Chernew ME. Physician organization and the role of workforce turnover [Letter]. Ann Intern Med. 2020;172:568-570. [PMID: 31931524] doi:10.7326/M19-2838

LINK

GOOGLE SCHOLAR

What is 'long vax'? Symptoms linked to COVID-19 shot baffle docs

You’ve heard of “long COVID,” the cases of people who can’t shake the lingering symptoms of COVID-19.

Now comes “long vax” — a rare, but baffling set of symptoms that follow a small number of people for months after receiving the COVID-19 vaccine.

“You see one or two patients and you wonder if it’s a coincidence,” Dr. Anne Louise Oaklander, a neurologist and researcher at Harvard Medical School, told Science Magazine. “But then you see 10 or 20, and you think, ‘Oh my gosh, this could be real.'”

Dr. Oaklander is one of a handful of researchers trying to figure out what’s happening with these patients. While most reported side effects from the COVID-19 vaccines are temporary and mild – such as sore arms, fatigue, and fever – some people are experiencing an array of symptoms that last for weeks or months. These include exhaustion, joint pain, nerve pain, headaches, cognitive problems, and heart palpitations.

It’s still unclear exactly how common long vax is in the general population and whether it’s directly linked to the vaccines. Scientists believe it may be related to the body’s immune response to the virus or to inflammation caused by the vaccine. While a few studies have looked at people who received the mRNA vaccines, there is still much that remains unknown.

The question of how long these symptoms will last and whether they can be treated with existing medications has been on many people’s minds since the beginning of the pandemic. In some cases, symptoms may improve over time as the body recovers from its immune response. Doctors are also looking at ways to treat long vax with medications and therapies that target inflammation or other underlying causes. 

Ultimately, more research is needed to fully understand this condition and provide treatments for those who experience it. 

Long Covid or Long Vax may be attributed to spike proteins remaining in the circulation causing inflammation in the heart, central nervous system, and immune system.  This can lead to symptoms such as fatigue, difficulty breathing, and other physical limitations. In some cases, long Covid sufferers may experience mental health issues such as depression or anxiety. 

Medical professionals are currently working on ways to diagnose Long Covid/Long Vax through tests that measure biomarkers of inflammation and oxidative stress in the body. Additionally, doctors are researching treatments to help mitigate the symptoms of this condition. So far, these have included various forms of physical therapy and lifestyle modifications such as yoga or meditation to reduce stress levels. More research is still needed in order to develop effective treatment strategies for those with Long Covid/Long Vax. 

With more knowledge about Long Covid/Long Vax, healthcare professionals are also looking into providing care for those suffering from mental health issues such as depression and anxiety related to the condition. This could involve therapies like cognitive-behavioral therapy or mindfulness-based interventions that help people better understand their experiences, cope with their thoughts and emotions, and manage their daily lives in a healthy way. 

The Covid vaccine was manufactured using a new process.. By introducing mRNA spike proteins are manufactured. Spike proteins reside on the viral capsid and are immunogenic, as well as providing entrance to the cell. 

The concern with these vaccines is that they appear to be causing some adverse effects, but it is too early to tell if Long Covid/Long Vax will become a persistent medical issue. There have been reports of side effects such as headaches, fatigue, muscle aches, and fever that can last for weeks after receiving the vaccine. 

To help manage these long-term effects, mental health professionals recommend a number of interventions. Cognitive behavioral therapy (CBT) can help people better understand their experiences and cope with their thoughts and emotions. Stress management techniques such as mindfulness practice, breathing exercises, and journaling can also be beneficial for those dealing with the after-effects of Covid vaccinations. Additionally, exercise and activity can help to improve overall well-being and boost energy levels. Finally, connecting with family, friends, and peers is a great way to stay grounded and share your experiences. 

Although it may be difficult to manage these lingering effects, understanding the cause of them is key in helping people recover from Long Covid/Long Vax. As vaccine research continues and more people are vaccinated, it is important to recognize the emotional and physical tolls that may come with this process. With proper self-care techniques and support from loved ones, it is possible to manage these post-vaccination effects. 

Myocardial inflammation caused by spike proteins in the Covid-19 vaccine has also been identified as a potential long-term effect. Studies have found that this inflammation can lead to an increased risk of heart disease and other cardiovascular issues for some individuals. Although more research is needed, it is important to be aware of the potential risks of receiving the vaccine and speak with your doctor if you experience any cardiac symptoms such as chest

It’s also important to seek medical help if symptoms persist for an extended period of time or become unmanageable.

Neurologic symptoms may also occur after receiving the vaccine, including headaches, dizziness, confusion, and difficulty sleeping. Many individuals have also reported feeling weak or tired for a period of time after vaccination. While these symptoms usually decline over time, it is important to seek medical help if they persist or become severe.

It can be difficult to determine whether post-vaccination effects are related to the vaccine itself.

In addition to the symptoms outlined above, individuals may experience fever, chills, joint pain, and rash. These are usually mild and go away after a few days. If they persist or become severe it is essential to receive medical attention.  The length of long covid is yet to be determined, however, it is important to seek medical help if any symptoms persist for more than a few days.

I 

 

What is 'long vax'? Symptoms linked to COVID-19 shot baffle docs

5 Simple Ways to Get Healthy and Fit on a Budget

Are you looking for ways to get fit and healthy without breaking the bank? Health Train Express is here to show you how! With a few simple tips and tricks, you can learn how to take control of your health and fitness goals on a budget. So don't let financial constraints hold you back - set yourself up for success with these 5 cost-effective methods to stay healthy and fit.

1. Shop Smarter - Eating healthy doesn't have to cost you a fortune. Take the time to research which stores offer discounts on organic and natural foods, and try shopping at local farmer's markets for fresh produce that won't leave your wallet feeling empty. Additionally, look for deals like BOGO (Buy One Get One) or bulk buying options at grocery stores to help you save money.

2. Get Moving - Exercise doesn't have to involve expensive gym memberships or fancy equipment. You can get just as much benefit from activities like walking, jogging, biking, and swimming that don't require any extra costs after the initial investment of a pair of shoes or swimsuit. Plus, these activities are free and easily accessible, so you can get your workouts in without having to worry about the price tag.

3. Try At-Home Workouts - If you prefer more structured workout sessions, there are plenty of free and affordable options available online. From yoga and Pilates to HIIT and strength training programs, the internet is full of resources that will help keep your fitness goals on track.

4. Get Creative with Meal Prep - It's easy to get into a meal prep rut but don't let that deter you from eating healthy on a budget. Instead of buying pre-packaged meals or ingredients, create your own recipes using pantry staples like dry beans and grains. This way, you'll save money while still enjoying nutritious meals.

5. Find Support - Having a support system is crucial when it comes to staying motivated and on track with your fitness goals. Ask friends or family members to join you in healthy activities like walks, hikes, cooking classes, or even just meal prepping together. Not only will this help keep you accountable and motivated, but it can also be a great way to bond and have fun. With a few simple changes, staying fit on a budget is easy!

By taking advantage of the free and low-cost options available, you can still achieve your fitness goals without breaking the bank. Remember to plan ahead, get creative with your meals and workouts, and don’t forget to find a support system that will help keep you on track. With these tips in mind, you’ll have no problem staying fit without spending too much. Good luck!

Happy fitness journey! :-)

Moving Away From the Medical Control Grid | Childrens Health Defense

Moving Away From the Medical Control Grid | Childrens Health Defense

References:

Citizens' Council For Health Freedom

CCHF Coalition Letter To Stop The National Patient ID

Navigating Healthcare: Like A Mom | Jennifer Walters BSN-RN, PHN, MFA

Association Of American Physicians And Surgeons | A Voice For Private Physicians

Chiropractic - Mission Of The World Chiropractic Alliance

The Impact Of Technology On The Future Of Healthcare

CDC Panel Recommends Pfizer Pneumococcal Vaccines For Infants, RSV Vaccines For Adults

Merck Knew Its Popular Asthma Drug Could Lead Kids To Commit Suicide, Lawsuits Allege

Join The Wedge

American Association Of Naturopathic Physicians

Surgery Center Of Oklahoma

Scriptco Pharmacy

My Med Lab

Protocolkills | Home

American Frontline Nurses

IPAK-EDU

Dr. Sherri Tenpenny's Educational Site | Learning4You

Congress Must Reject PFAS Polluter Holiday | EWG

The Solari Report

How To Make Your Own Perfect First Aid Kit | Dr. Sam Bailey

Military Guide To Building A First Aid Kit

Homeopathy For Mommies

Getting Started With Oxygen In Metal Tanks

Importance Of A Fever - Dr. Sherri Tenpenny

The HIPAA Deception - Why HIPAA Is Not A Privacy Law

Patient Tools | Association Of American Physicians And Surgeons

Holistic Dental Association | Find A Holistic Dentist

What Is Concierge Medicine And Is It Worth The Price Tag?

"Nursing Drug Handbook"

The Best Family Homeopathy Acute Care Manual: A Pictorial Guide To First Aid And Acute Therapeutics

The School Of Natural Healing | Dr. Christopher

Dr. Tenpenny’s “The Importance Of Fever” Digital Book

"A Holistic Approach To Viruses "By Dr. Brownstein

"Iodine: Why You Need It. Why You Can't Live Without It. 5th Edition" By Dr. Brownstein

"The Grow System" By Marjory Wildcraft

Moving Away From the Medical Control Grid | Childrens Health Defense

New forms of Oral Polio Virus

“We’ve designed these new vaccines using lessons learned from many years of fighting polio and believe they will help eliminate the disease once and for all,” Andino says. “If there’s polio anywhere, it will come back where there are gaps in vaccination. The perception that polio is gone is a dangerous one.”

‘Reckless in the Extreme’: FDA Panel Recommends New RSV Shot for Use in Healthy Infants • Children's Health Defense Fund

Treatment options continue to expand

To create the new vaccines, the researchers used the molecular backbone of their earlier vaccine for the type 2 virus. They retained the genetic components that help keep the weakened virus from becoming pathogenic. But they replaced coding regions for the virus capsid (shell) unique to the type 2 virus with sequences from the other two polio types.

Time has shown critics were wrong.  This is only the beginning of a tug of war as others pursue gains from Pfizer-Moderna.

The oral polio vaccine is often used in resource-poor regions, due to its lower cost and easy delivery. The oral vaccine is also more effective in many ways, but it has a significant drawback: It is based on a live weakened poliovirus that can mutate and evolve. In rare cases, it can become infectious. This can lead to a vaccine-derived outbreak in communities with many unvaccinated people. There are three poliovirus types, with only type one still spreading in the wild. But episodes of all three types can still occur because of the vaccines.

Studies in mice showed that both novel vaccines triggered strong immune responses similar to those seen with the current oral vaccines. Each effectively prevented infection after exposure to the poliovirus. 

Since then, more than 600 million doses of the vaccine have been used to treat polio outbreaks in 28 countries. In their latest study, the researchers created modified oral vaccines that target the other two polioviruses, types 1 and 3. Research to develop the vaccines was supported in part by NIH. Results appeared in Nature on June 14, 2023.

Polio – a disease many have prematurely consigned to history – made headlines around the world in recent months when the virus was detected in relatively high-income country settings from New York, London, Montreal, and Jerusalem. This apparent comeback in polio-free countries has left many questioning the feasibility of eradication. On the contrary, we have never been closer to achieving our goal of a polio-free world: this resurgence only underscores the urgent need for eradication.

When the Global Polio Eradication Initiative (GPEI) was launched in 1988, nearly 1,000 children were being paralyzed with wild poliovirus (WPV) infection across 125 countries every single day. Since then, a concerted effort of health workers, communities, local governments, and global partners such as Rotary International has helped eradicate two of the three serotypes of wild poliovirus (WPV2 and WPV3) and cornered the remaining strain of WPV – type 1 (WPV1) – to small areas of Pakistan and Afghanistan – the last wild polio-endemic countries. The genetic diversity of the remaining chains of WPV1 is also on the decline, indicating the virus might very well be on the verge of being wiped out.  

However, this incredible progress is in jeopardy. Due in part to the COVID-19 pandemic, the world has seen a worrying drop in immunization rates over the past few years, creating pockets of under-immunized communities at heightened risk of polio infection and paralysis. Children missing polio vaccinations create opportunities for polio to re-emerge and spread – as seen in 2022 when WPV1 originating in Pakistan was detected in paralyzed children in Malawi and Mozambique. This episode served as a poignant reminder that as long as polio exists anywhere in the world, it remains a threat to people everywhere.

Persistently under-vaccinated communities are also at risk of outbreaks of vaccine-derived poliovirus (VDPVs). These polio variants evolve from oral polio vaccines (OPVs), which use a weakened form of the virus to protect children from infection and act as a key tool for many countries to stop the spread of polio. When a vaccinated child sheds that weakened virus into the environment, it can help provide indirect protection for the entire community. However, in areas with persistently low immunization coverage, the weakened vaccine virus can circulate over a prolonged period, ultimately regaining the ability to cause paralytic outbreaks that can spread across geographies. 

What do we do about it?

One technological solution to the VDPV situation is the development of OPV strains that are more genetically stable and therefore less likely to evolve into VDPVs. In 2011, a scientific consortium was formed to explore the development of a next-generation vaccine while still maintaining the advantages of existing OPV, such as ease of delivery and intestinal mucosal immunogenicity. As poliovirus serotype 2 strain has been associated with most of the paralytic polio outbreaks of cVDPVs, a new, type 2 OPV was selected as the initial focus of the consortium.

In November 2020, the novel oral polio vaccine type 2 (nOPV2) was authorized under the Emergency Use Listing (EUL) pathway by the World Health Organization (WHO) following positive findings from phase I and phase II studies of safety, reactogenicity, immunogenicity, and the desired genetic stability. The rollout of nOPV2 for outbreak response began in March 2021 and since then, more than 580 million doses of nOPV2 have been delivered in 28 countries, with surveillance data from initial field use indicating a high likelihood of success at closing outbreaks with a lower risk of seeding the emergence of new ones.

Regardless of which polio vaccine is used to stop an outbreak, there must be high immunization coverage for all children to be protected against paralysis. Following the detection of an environmental sample or confirmation of a case of paralytic polio, outbreak response campaigns must be launched in a timely manner to reach all at-risk communities with vaccines. Coordination transcending geographic borders is also key, which is why countries currently at a high risk of polio spread – such as Pakistan and Afghanistan as well as Malawi, Mozambique, Tanzania, Zambia, and Zimbabwe – are synchronizing campaigns to help ensure that underserved and migrant communities are not missed. Readiness on the regulatory front to use a vaccine under EUL provisions as in the case of nOPV2 and maintaining adequate global supplies of such vaccines will be important in minimizing the risk of the spread of polio.

https://pubmed.ncbi.nlm.nih.gov/25824845/

https://pubmed.ncbi.nlm.nih.gov/32330425/

https://pubmed.ncbi.nlm.nih.gov/37317297/

https://pubmed.ncbi.nlm.nih.gov/24175215/

Novel vaccines may help quell polio outbreaks | National Institutes of Health (NIH)

In the mid-1900s, the highly contagious disease poliomyelitis, or polio, was responsible for about a half-million cases of paralysis or death worldwide each year. Polio outbreaks began to drop dramatically beginning in the 1950s, after the development of two effective vaccines—one given orally, the other by injection. But despite worldwide efforts to eliminate polio, a few pockets of infection still remain, especially in developing countries.

The oral polio vaccine is often used in resource-poor regions, due to its lower cost and easy delivery. The oral vaccine is also more effective in many ways, but it has a significant drawback: It is based on a live weakened poliovirus that can mutate and evolve. In rare cases, it can become infectious. This can lead to a vaccine-derived outbreak in communities with many unvaccinated people. There are three types of poliovirus, with only type one still spreading in the wild. But outbreaks of all three types can still occur because of the vaccines.

An international research team has been seeking ways to improve the safety of the oral polio vaccine. The team is led by Drs. Raul Andino of the University of California, San Francisco, and Andrew Macadam of the U.K.’s National Institute for Biological Standards and Control. In 2020, they reported on modifications to the oral vaccine for type 2 poliovirus that made it genetically more stable. That means it was less likely to mutate, evolve, and become infectious. That same year, the World Health Organization approved the vaccine for emergency use.

Since then, more than 600 million doses of the vaccine have been used to treat polio outbreaks in 28 countries. In their latest study, the researchers created modified oral vaccines that target the other two polioviruses, types 1 and 3. Research to develop the vaccines was supported in part by NIH. Results appeared in Nature on June 14, 2023.

To create the new vaccines, the researchers used the molecular backbone of their earlier vaccine for the type 2 virus. They retained the genetic components that help keep the weakened virus from becoming pathogenic. But they replaced coding regions for the virus capsid (shell) that are unique to the type 2 virus with sequences from the other two polio types.

Studies in mice showed that both novel vaccines triggered strong immune responses similar to those seen with the current oral vaccines. Each effectively prevented infection after exposure to the poliovirus.

Further study showed that the new vaccines were genetically stable and so unlikely to evolve. The vaccines prevented infection even when packaged together to target two or all three types of poliovirus at once. The finding suggests that a combination vaccine could target all three strains and enable broad protection from poliovirus via an oral vaccine.

“We’ve designed these new vaccines using lessons learned from many years of fighting polio and believe they will help eliminate the disease once and for all,” Andino says. “If there’s polio anywhere, it will come back where there are gaps in vaccination. The perception that polio is gone is a dangerous one.”

Novel vaccines may help quell polio outbreaks | National Institutes of Health (NIH)

Rabbinical Wisdom and Covid

 

The Truth about COVID Vaccines

Advanced Treatments for Refractory Treatment of Epilepsy

Advances in epilepsy diagnostics, and treatment return man to quality of life

For years, Eric Walthall of Woodville, Wisconsin, experienced more than 100 debilitating epileptic seizures a month. For more than 20 years, he couldn’t drive. He stopped attending many of his sons' activities because he feared a seizure would cause him to lose consciousness. He separated his shoulder twice and hit his head because seizures caused him to fall.

"I couldn't get through life much more," says Eric, now 53, who was diagnosed with epilepsy at 16. He had tried several medications and procedures, seeking care in five different states, with limited success over more than 30 years.

Still, when Eric came to Mayo Clinic in 2021, he had hope. "I knew Mayo was going to knock it out of the park," says Eric, who is seizure-free after extensive evaluation and eventual surgery.

Eric's complicated case was reported in Epilepsy & Behavior Reports. His treatment included radiofrequency ablation with high electrical current guided by stereoelectroencephalography (SEEG), which uses electrodes placed directly into Eric's brain to find where seizures originate.

Treatment options continue to expand

"Mr. Walthall's case was extraordinarily complex and required close teamwork from a multidisciplinary team," says Brian Lundstrom, M.D., Ph.D., Mayo Clinic neurologist and senior researcher on the report. "Fortunately, combined with recent advanced approaches, we were able to find and treat a specific area of Mr. Walthall's brain and control his seizures.”

Epilepsy affects about 50 million people worldwide, according to the World Health Organization. For about a third of people with epilepsy, seizures persist despite use of medication. For some people, surgery to remove brain tissue where their seizures originate is not an option because of the potential risk to brain areas that control speech and movement.

Before coming to Mayo, Eric had tried various epilepsy treatments. He tried two neurostimulation devices that were implanted and ultimately removed — a vagus nerve stimulation (VNS) device and a responsive neurostimulation (RNS) device. While many patients have had success controlling seizures with neurostimulation devices, Eric did not.

He also had undergone extensive evaluations at other medical institutions. Eric's Mayo team incorporated a wide array of data from these previous tests. "It was critical for us to fully incorporate previous data into our current approaches to optimize seizure control for Mr. Walthall and minimize risk to his speech and motor functions from surgery," Dr. Lundstrom says.

Complicated epilepsy case

Kai Miller, M.D., Ph.D., Mayo Clinic neurosurgeon, used SEEG — temporarily putting small electrodes directly into Eric's brain to find the origin of Eric's seizures and help plan personalized treatment options. The Mayo Epilepsy team read the electrical changes in Eric's brain while he was being monitored in the hospital, narrowing the seizures' origin to a specific region of the brain.

Brain mapping of seizure activity

Then, using the same temporary electrodes, Dr. Miller used a high electrical current called radiofrequency ablation to treat the brain area that the team identified. For some people, radiofrequency ablation will stop the seizures. But if it doesn’t, surgery still may be performed with no additional risk.

For Eric, the radiofrequency ablation treatment helped temporarily, and this was crucial in confirming the location in his brain for further surgery. He did go on to have surgery to remove part of his brain tissue where seizures were originating.

"Radiofrequency ablation allowed us to test the effect of disrupting the brain region where we believed the seizures were starting from, using electrodes that were already in place," Dr. Miller says. "The ablation gave us information to help weigh the benefits and risks of removing brain tissue in an open surgery; we always must balance the likelihood of a cure against possible risks of surgery. I'm thrilled that Eric's seizures have stopped and he's back to enjoying an active life."

Brain mapping

New technology has improved even traditional surgery for epilepsy. During the operation, Eric was awake, which allowed innovative brain mapping — using a Mayo-developed software tool — to ensure the surgery was as precise as could be to help preserve important brain functions, including language and movement.

In the operating room, Dr. Miller stimulated Eric's brain directly. Eric could speak with Dr. Miller and Eva Alden, Ph.D., a Mayo Clinic neuropsychologist, who administered tests to Eric and compared Eric’s presurgery responses to his abilities during the surgery.

"By assessing and monitoring Eric's responses during surgery, I could provide real-time feedback about his cognitive performance," Dr. Alden says. "This helped Dr. Miller gauge whether it was safe to continue operating in that part of the brain, or whether removing it could potentially result in a functional deficit of language or movement."

Eric recovered in the hospital for a week and had speech and occupational therapy.

'This is a blessing now

Today, Eric is back to driving. He and his wife, Melissa — Eric's chauffeur for years — are figuring out their new normal. Eric was able to take a trip to Canada last fall with his hunting buddies. He returned to downhill skiing, a hobby he had given up. Most importantly, he's able to enjoy family time, in the stands at his younger son's high school basketball games or visiting his older son in college.

"There was a lot of emotional pain and suffering, missing out over the years," says Eric, adding, "This is a blessing now. I give all the credit for my healing to my faith in God and the support of my family and friends and doctors."

For Eric, seeing someone else experience a seizure inspired him to share his story. Once, in a patient reception area, he saw a young girl convulse with a seizure. "Boom, she had one. My eyes welled up. I thought, 'If I ever get better, I want to be an ambassador to show what's possible.'"

The realm of what's possible for patients with epilepsy continues to expand, notes Dr. Lundstrom. Including RNS and VNS, there are other forms of stimulation including noninvasive stimulation and deep brain stimulation for epilepsy. In addition to radiofrequency ablation, there are minimally invasive lasers and guided ultrasound treatment. New research includes studies to predict seizures using wearables, like a smartwatch.

"From a research perspective, it is very exciting to see new diagnostic and therapeutic approaches developed every year," Dr. Lundstrom says. "Even better, though, is to see the difference they can make in a patient's life."

How Artificial Intelligence such as ChatGPT will aid in Cancer Treatments

This content was generated by ChatGPT4

The use of artificial intelligence (AI) in the prognosis for cancer has shown great promise in improving the management of cancer patients. AI techniques, such as machine learning and deep learning, have the potential to analyze large amounts of data derived from multi-omics analyses and assist in decision-making processes related to cancer diagnosis, prognosis, and treatment [[1](https://www.nature.com/articles/s41416-021-01633-1)][[3](https://pubmed.ncbi.nlm.nih.gov/31830558/)].

AI in precision oncology is transforming the current approach by integrating data from various sources, including genomics, imaging, and clinical information. These techniques enable the identification of patterns and interactions that may be difficult to detect through traditional methods [[1](https://www.nature.com/articles/s41416-021-01633-1)]. Radiomics, a field within AI, focuses on extracting quantitative features from medical images, such as CT scans and MRI, to create predictive models for cancer diagnosis and prognosis. Radiomics-based AI models have shown promise in predicting cancer outcomes and guiding treatment decisions [[2](https://www.nature.com/articles/s41571-021-00560-7)].

By leveraging AI algorithms, researchers and clinicians can develop predictive models that consider multiple factors and biomarkers, providing a more accurate prognosis for cancer patients. These models can help in assessing disease progression, determining the risk of recurrence, and guiding personalized treatment plans [[3](https://pubmed.ncbi.nlm.nih.gov/31830558/)].

Some specific applications of AI in cancer prognosis include:

1. Cancer Detection and Screening: AI algorithms can assist in the detection of cancer by analyzing medical imaging data. Deep learning models have demonstrated high accuracy in detecting lung nodules in chest radiographs [[2](https://www.nature.com/articles/s41571-021-00560-7)]. AI-based screening systems have also been evaluated for breast cancer screening, showing potential in improving detection rates [[2](https://www.nature.com/articles/s41571-021-00560-7)].

2. Prognostic Prediction: AI models can help predict the prognosis of cancer patients by analyzing various clinical and molecular features. These models take into account factors such as tumor characteristics, genomic profiles, and clinical data to estimate the likelihood of disease progression and overall survival [[1](https://www.nature.com/articles/s41416-021-01633-1)][[3](https://pubmed.ncbi.nlm.nih.gov/31830558/)].

3. Treatment Response Assessment: AI techniques can aid in assessing treatment response and distinguishing between true disease progression and pseudoprogression (an imaging phenomenon that mimics tumor growth). This information can guide treatment decisions and prevent unnecessary interventions [[2](https://www.nature.com/articles/s41571-021-00560-7)].

While AI shows great potential in improving cancer prognosis, there are challenges to be addressed. The development and validation of robust AI models require large and diverse datasets, access to high-quality data, and careful consideration of ethical and regulatory aspects. Integration of AI into clinical practice also requires careful validation, standardization, and ongoing refinement to ensure its reliability and effectiveness [[3](https://pubmed.ncbi.nlm.nih.gov/31830558/)].

In conclusion, the use of AI in prognosis for cancer holds promise for improving patient outcomes. AI techniques, such as machine learning and deep learning, can analyze complex data sets and provide valuable insights for personalized treatment strategies. Continued research and development in this field have the potential to revolutionize cancer care and enhance the accuracy of prognosis prediction in the future.

Medical Freedom Panel 2023 - Senator Mastriano- State of Pennsylvania

The. legislature of the Commonwealth of Pennsylvania wants to pass a "Medical Freedom Act". Currently, eleven states have passed “safe harbor” practitioner exemption laws in some form, including Minnesota, Rhode Island, California, Louisiana, Idaho, Oklahoma, Arizona (for homeopaths), New Mexico, Colorado, Nevada, and, most recently, Maine.

The committee had a hearing which included several patients and medical experts to testify about Covid19 and the Federal and employer mandates regarding COVID vaccination in regard to work, airline travel, and in public spaces.

The testimony is documented in the video HERE.

On June 9, 2023,  Senator Mastriano of the Pennsylvania House of Representatives sponsored a hearing in which Peter McCullough, MD MPH testified with compelling information before the committee.  At the outset (2021) of the pandemic, Dr. McCullough was widely criticized as a right-wing anti-vaxxer. Despite his legitimate medical and academic career, he was lumped in with all other COVID non-experts.

Time has shown critics were wrong.

The topic of the hearing was the illegal mandate for vaccinations using an unproven and non-approved vaccine. Testimony from several patients who were victims of the adverse events from mRNA vaccines.  Citizens were denied employment, refused entry into public spaces, and forced to wear masks (which has been shown not to decrease the spread of viral particles.

Readers of my substack should watch this video

Dr. McCullough’s testimony is clear and concise and deconstructs the enormous amounts of unproven data regarding COVID.

There is a clear paper trail for support by the NIH in a gain of function research for SARS-COVID dating back to the 1970s.  The virus was studied at the Wuhan Viral Laboratory in a level 4 biohazard facility. Their study was clearly funded by the NIH, Francis Collins, and Anthony Fauci.  In essence, COVID-19 was produced by the United States and you, the taxpayer.  IT WAS NOT A CHINESE VIRUS.  The Federal government knew that developing biomedical weapons was outlawed by international law and sought to disguise it by offshoring the project yet underwriting its activities.

During a state of crisis, largely induced by media coverage and support by the CDC, vaccines were rushed into production using a technique named mRNA to produce a ‘spike protein’.  mRNA protein production was developed over a decade ago. However, it had never undergone controlled clinical trials (RCT). The metabolic pathway was poorly understood, nor was the biochemistry of its byproducts or detoxification path in humans. Protein spikes remain in the bloodstream for an unknown period. 

The Spike Protein of SARS-CoV-2 Impairs Lipid Metabolism ...   Spike Proteins of SARS-CoV-2 Induce Pathological ... - MDPI.    Adverse effects of COVID-19 mRNA vaccines

In addition to the immunogenic effect allowing viral particles entry into cells, the spike protein has intracellular effects and also persists for a lengthy period in circulation.  This effect is now demonstrated by the syndrome colloquially known as ‘Long Haul Covid’.

The United States has the highest death rate despite being a wealthy nation. Developing nations where vaccination rates were low or non-existent had low death rates from vaccination.  (This may be a statistical anomaly due to poor or nonexistent reporting.). 

Numerous experts have reported these outcomes but were suppressed until recently. Unfortunately, this has not been reported by major media sources that ignore new information.  My readers can find these sources through any internet search for “VAERS” The raw data about COVID vaccination  adverse reactions can be accessed HERE

Medical Freedom Panel 2023 - Senator Mastriano