Issue 115.4 - Oz Sultan by topdoctormagazine

Special Issue

Oz Sultan A New HOPE for Underserved Urban Communities for 21st Century Healthcare

October 2020 Issue 115.4

Medicare Annual Enrollment Period: What You Need To Know Pg 26

Medicare Scam Attacking Seniors Amidst Trying Times Pg 14

contents

PRESIDENTIAL CANDIDATES' CONTRASTING VISIONS FOR THE FUTURE OF HEALTHCARE

OZ SULTAN SPOTLIGHT:A NEW HOPE FOR UNDERSERVED URBAN COMMUNITIES FOR 21ST CENTURY HEALTHCARE

2020 ELECTION: WHAT A TRUMP WIN VS A BIDEN WIN WILL MEAN FOR HEALTHCARE/MEDIC ARE ... EITHER WAY RPM IS HERE TO STAY!

MEDICARE SCAM ATTACKING SENIORS AMIDST TRYING TIMES

FIRST SUSPECTED DEATH FROM RUSHED VACCINE

19 TELEHEALTH IN MEDICARE & MEDICAID:

HALLOWEEN FICTION SPECIAL

WHAT JUDGE AMY CONEY BARRETT'S NOMINATION TO THE SUPREME COURT MIGHT MEAN FOR HEALTHCARE

MEDICARE ANNUAL ENROLLMENT PERIOD: WHAT YOU NEED TO KNOW

THE COVID-19 VACCINE - WILL IT GET HERE IN TIME AND CAN WE TRUST IT?

OBAMACARE: THE ACA AND BIRTH CONTROL

MEDICAID, IMMIGRATION AND THE DHS

BE AWARE OF THESE SIDE EFFECTS WHEN WEARING A MASK…

5 BENEFITS OF DRINKING LEMON WATER YOU NEED TO KNOW ABOUT

DON’T LET KNEE PAIN KEEP YOU FROM BECOMING THE BEST VERSION OF YOU

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PRESIDENTIAL CANDIDATES' CONTRASTING VISIONS FOR THE FUTURE OF HEALTHCARE As the presidential election approaches, the topic of healthcare is front and center once more. Both candidates hold contrasting views and the American people are again at odds. So, what do these men believe, and how will it affect the future of healthcare? Healthcare is a complicated topic that covers many areas that impact civilian life, government policy, business, and innovation. How these men treat healthcare policy will have drastic effects on the rest of the nation. Voting is essential to ensure that your voice is heard and that you are doing your part to see your healthcare needs' proper resolution. 01

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But what exactly do these men believe when it comes to fair and proper healthcare? Well, President Trump has a firm conservative view on how healthcare should operate. First and foremost, Trump plans to repeal the Affordable Care Act and replace it with a free-market plan. Through this, he wants to give authority to the states, permitting consumers to purchase across state lines. This would break insurance company monopolies. Trump's plan would provide individual tax relief for insurance and help keep plans affordable. As well as wants to maintain and further improve Social Security, Medicaid, and Medicare. The large theme around Trump's views on healthcare is the removal of government control over them. He believes the only involvement the government should have, is to make sure that institutions are financially strong in catastrophic happenings. In the end, medical care should remain private. Socialized medicine is not an attractive idea to the President. Another great plan Trump has is to create deals with local hospitals to increase care for impoverished communities. Low-income Americans deserve the same healthcare as everyone else, and Trump wants to make sure that there is a plan in place to make that happen. As for abortion, Trump has always been pro-life and remains to be so. His vaccination stances are pro-vaccine, but not pro "all in one" vaccinations for children. He believes that vaccines are beneficial and help curb serious illness. Still, he also believes that super dosing with vaccines can lead to aging children's physical and cognitive disabilities. Biden, on the other hand, has polar opposite views. Candidate Biden has always been pro ACA and wants to push to protect further and expand it, removing any congressional talks about its repeal.

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To go along with this, Biden wants to expand premium subsidies with the ACA. This would include those who make 400% more than the national poverty level. He also would like to reinstate funding for the ACA. As for Medicare, Biden does not want it to be universal and will push people to receive similar care through the ACA. Biden would like to increase the government's presence in the medical arena, having individuals rely on the government for medical assistance. He would also like the government's ability to help negotiate prices for healthcare with individuals on a personal basis. He would permit the importation of prescription drugs, rather than the U.S. made generic. Biden says that because of his Catholic background, he is not pro-abortion; however, he will not stop abortions.

He believes abortions are every woman's right to choose and that he should not get in the way of that kind of personal decision. This includes lateterm abortions and federal funding. Other stances Biden holds include his wanting to establish an LGBTQ+ mental health task force, a Racial and Ethnic Disparity task force, and increase opioid crisis treatment. As evidenced above, both candidates share drastically different views on how the healthcare system should work. Their choices will have lasting effects on the nation for many years to come. As a voter, now is the time for your voice to be heard. Will you heed the call?

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OZ SULTAN SPOTLIGHT A New HOPE For Underserved Urban Communities For 21st Century Healthcare With 21 years of experience working in technology and a decade of experience in technology marketing, Oz Sultan is making it a part of his #HarlemForward mission to help bring 21st-century medicine to the forefront of the medical industry. His background spans the gamut of multi-million dollar and startup tech systems to building, operating, and consulting on such projects as Blockchain, Big Data, and select political ones. Additionally, he is a part of initiatives that focus on building interfaith bridges in NYC, anti-trafficking; job development; entrepreneurship; and developing young leaders in Harlem. Lately, his work has focused on Blockchain risk scenarios and using them to secure both business and governmental systems. His goal in running for New York Senate is to develop policies that serve the community.

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Some of the key issues Oz is tackling in Harlem include improving reasonable access to jobs, healthcare, housing, training, and banking.

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Speaking to Top Doctor Magazine, Oz related his personal concerns and vision for healthcare in urban communities.

"The institutions around us, from the legislative institutions to the regulators, they're not prepared for the cybersecurity risks, they're not prepared for the data risk, and they're not prepared to provide advanced level services to communities that are less affluent." RPM AND TELEHEALTH Healthcare in the United States, particularly in urban and rural areas, has not advanced to the full extent of its utility. According to Oz, the technology available behind Telehealth and Remote Patient Monitoring (RPM) is 21st-century medicine. Not only does it bring about the best care for patient outcomes, but it is a tremendous overlay of technology and systems that sits upon the surface of Medicare and Medicaid Services. According to Oz, there are three specific benefits that RPM provides: Live engagement Prevention Quality of life "What if I could give you 21st-century medicine? What if I could give you the technology that would basically give you access to everything you would have if you were full time in the hospital? That's what [RPM] is," says Oz. 05 | TOPDOCTORMAGAZINE

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Through RPM, it is possible to have 24/7 live engagement between patients and clinicians. This is incredibly important for situations like the one Oz found himself in as he cared for his uncle, who was waiting for a heart valve transplant and recovering from radiological treatments for colon cancer. During caregiving, the two biggest issues that Oz recognized were first, interaction and cooperation between various doctors, and second, having efficient data monitoring. The simple fact is both problems could have been resolved through RPM, specifically RPM's Activities of Daily Life (ADL) tags. ADL tags are Bluetooth low-energy monitors that can be easily placed in a patient's home to monitor key aspects of that person's life. For example, with a colon cancer patient, an ADL tag can monitor and track frequent restroom visits or lack thereof. This is used to determine a change or deterioration in a current condition and then be relayed to the correct healthcare professional. Also, the data collected by RPM services can be viewed by whatever clinician is needed, cutting out the hassle of passing information between various offices. With devices such as ADL tags, blood pressure, and glucose monitors, the continuous data collection for RPM patients makes preventative medicine not only a possibility but a reality. Clinicians can easily establish baselines for each patient and recognize or diagnose potential problems or future illnesses they may not catch otherwise. In many cases, this can be life-saving and certainly improve quality of life.

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BLOCKCHAIN AND HEALTHCARE "The future of healthcare is intertwined with data privacy, healthcare privacy, and it needs people who understand how this works." As RPM and Telehealth become more established in the medical industry, a common concern is emerging - privacy protection. Consequently, many of the current policies and procedures being used in patient information and privacy protection are being examined with a fine-tooth comb and are found to be lacking. This is where Oz, who has worked for years with Blockchain and Big Data, predicts and advocates for the efficiency and assurance of Blockchains within healthcare. A blockchain is a guaranteed immutable public ledger that records transactions and tracks assets, all of which can be distributed. It is drawing the healthcare sector's attention as this technology is expected to improve systems like medical record management and the insurance claims process. Besides, it is expected to accelerate clinical and biomedical research. According to Oz and his experience, Blockchains are valuable to the healthcare and medical industry for two specific reasons: Ease of sharing patients' records Complete privacy and protection of records and data With the boom of Electronic Health Record (EHR) systems being used to share patients' records among various clinicians or hospitals, there is a challenge arising. 07

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It is still a challenge for entities to access patient data that is scattered through multiple EHRs. This is where Blockchain steps in. Acting as a ledger for data, Blockchain technology allows access rules to be assigned for patients' medical information and permissions for specific clinicians to access parts of the information for a period of time. Through Blockchain technology, the ease of sharing medical data is greatly increased. The development of Blockchain comes from the basis of sharing high-value information and data between people who don't trust each other. As a result, the way it works as an immutable ledger meaning, what goes in doesn't come out - secures patient data. "We need to eliminate the need for multiple people to pass around paperwork, we need to eliminate the middlemen, and at the same time increase security, increased currently limited patient access, increase cybersecurity, and increase the opportunity for data to be utilized in a more meaning fashion," said Oz about his vision for Blockchain and healthcare.

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BLOCKCHAIN AND HEALTHCARE In his #HarlemForward initiative, Oz has a simple vision: make lasting change in Harlem. One such change is going to be found in healthcare as the current system is outdated and lacking. With men and women like Oz and their combined experience, the medical industry and communities throughout the United States can expect to be ushered into 21st-century medicine and all the benefits it offers. Find out more about Oz here.

REFERENCES: Yoon H. J. (2019). Blockchain Technology and Healthcare. Healthcare informatics research, 25(2), 59–60. https://doi.org/10.4258/hir.2019.25.2.59 Tith, D., Lee, J. S., Suzuki, H., Wijesundara, W., Taira, N., Obi, T., & Ohyama, N. (2020). Application of Blockchain to Maintaining Patient Records in Electronic Health Record for Enhanced Privacy, Scalability, and Availability. Healthcare informatics research, 26(1), 3–12. https://doi.org/10.4258/hir.2020.26.1.3

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2020 ELECTION: What a Trump Win vs A Biden Win Will Mean For Healthcare/Medicare ... Either way RPM is here to stay!

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One of the key points that concerns Americans everywhere when comparing the two potential presidential candidates is their stance on healthcare. Both President Trump and former Vice President Biden have made their plans for altering the current state of affairs fairly clear, and the tacts they both plan to take could not be more different. Since President Trump’s inauguration in 2017, he has been attacking the Affordable Care Act (Obamacare) and working to “repeal and replace” what he declared to be an unconstitutional approach to healthcare. His initial attempt to dramatically do away with Obamacare was thwarted, and he and his administration have since chosen to dismantle the Affordable Care Act bit by bit, rather than all at once.

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Another big change made by President Trump removed the ban on Medicaid adding work requirements to their plan, effectively giving Medicaid the ability to kick people off of Medicaid for being unemployed or not working a certain amount of hours. This is another controversial move that is likely going to be decided in the Supreme Court. Several other changes have been made to the ACA, and this some claim that this has made American citizens who rely on Medicaid and

other forms of government healthcare uneasy, as the changes to policy result in a level of uncertainty. If President Trump continues to hold office in 2021, he has declared his intention to reduce the costs of prescription drugs and insurance premiums, as well as creating more coverage for American citizens that have preexisting conditions. He has been unclear about the exact method he plans to use to dismantle the Affordable Care Act, but what has been extremely evident is that he intends to do away with it, as he has reiterated that it is, in his opinion, “unconstitutional” and “too expensive”. President Trump has pledged to issue every American on Medicare essentially a $200 gift card for prescription drugs while policies for prescription drug reform are being put into place. 11

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According to Trump’s campaign site, he also is envisaging a future in which the individual, whether patient or doctor, is in charge of their healthcare, “surprise billing” is banned, and veterans are protected and provided with “world-class” healthcare and services. Surprisingly, the plans both candidates have shared have at least one shared goal. Former Vice President Joe Biden has also made clear his intention to reduce prescription drug costs, by creating an independent commission to regulate drug costs and simultaneously removing tax breaks being given to pharmaceutical companies. The similarities end there, as Biden plans not on removing and repealing the Affordable Care Act, but rather reinforcing and enlarging it. He plans to add a public option plan that would allow all Americans to have premium-free healthcare that is similar to Medicare, regardless of any other insurance options available to the individual. Biden has mentioned that undocumented immigrants will be given access to this public option plan as well. His administration would also be removing the income cap that determines eligibility for a tax credit that assists in paying for insurance premiums. While Trump has taken steps to separate government funding and abortion, Biden plans to resume financial support of Planned Parenthood, and allow federally funded abortions.

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Biden has shared a 775 billion dollar plan for child and elder care that will shorten waitlists for patients requiring home care, and allocating tax breaks for caregivers of elderly family members. Finally, Biden intends to create a public health jobs corps that would employ hundreds of thousands of American healthcare workers to serve in prevention of diseases in communities that are currently understaffed, care for veterans, and combat addictions. No matter which man finds themselves seating in the Oval Office come January, we can expect big changes in the healthcare world. But something that will be around no matter the man in the office is Remote Patient Monitoring. With the advent of Covid-19, huge advances have been made in the world of telehealth. RPM uses digital technology to collect health information from patients and electronically transfer that data to their health care providers, who are then able to assess needs and make prescriptions for care. This ability to care for and monitor patients remotely has been an amazing asset in reducing the amount of in-person doctors appointments and ongoing visits required by doctors.

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MEDICARE SCAM ATTACKING SENIORS AMIDST TRYING TIMES Senior citizens are more at risk from scam calls than any other age group. These criminals target those who are most susceptible to their tricks, potching vital information out of our elderly. Now, as medicare enrollment opens up again, it is scamcall season once more. Phone scammers have grown crafty over the years, perfecting their craft to emulate simple calls. Because of this, the medicare enrollment season is a difficult time for those who are unable to discern phone calls.

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The scammers call the elderly, posing as government employees, where they inquire about personal information. Such information may include social security numbers, personal care physicians, and more vital info. If scammers gain hold of this information, the victim is at risk of total identity theft and monetary assets loss. But how can you discern between real and scam callers? The first thing to remember is that officials will never ask for your social security number over the phone. They also will not ask for your bank account number or credit card information. Secondly, most formal matters will not occur over the phone but on official websites.

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Genuine callers may instruct you to access certain websites but never ask to hand over private information on the phone. Although most individuals targeted are elderly, there are a few demographics that fall through the cracks. Persons between 25 and 59 face half as much attention as those 60 and up. So, it is imperative to cautious of numbers you do not recognize and what information you share with strangers over the phone. Especially when it comes to medical information, mishandling information can mean the difference between security and total privacy loss.

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First Suspected Death from Rushed Vaccine Unexplained Illness Breaks Out Among Test Groups On Wednesday, October 21st, the announcement from Brazil’s O Globo newspaper and CNN Brasil of the first COVID-19 vaccine-related death rocked the country of Brazil, causing a ripple effect of concern in other countries battling the current coronavirus pandemic. The participant, a 28-year-old man from Rio de Janeiro, Brazil, is reported to have died from COVID-19 complications. His death marks the first occurrence of such in a COVID-19 vaccine trial. The young man, yet to be identified by the group, was a volunteer taking part in AstraZeneca’s clinical trials for its vaccine, which is being developed with the Oxford Vaccine Group. The official statement from O Globo is that the man was in the trial’s control group and was given a placebo instead of the experimental vaccine. However, this may be hard to confirm, considering legal and privacy limitations. As of now, the vaccine trial will continue. Joanna Bagniewska, the spokeswoman from Oxford Vaccine Group, told Business Insider that: “...there have been no concerns about safety of the clinical trial and the independent review in addition to the Brazilian regulator have recommended that the trial should continue.” The trial’s continuance would have been suspended if the volunteer had been confirmed as a part of the group getting the experimental vaccine injection.

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This news comes after the Food and Drug Administration put a latestage clinical trial from AstraZeneca on hold in the United States in early September. The cause? A patient in the company’s United Kingdom trial fell ill with an unexplained illness suspected to be a rare spinal inflammatory disorder called transverse myelitis.

SYMPTOMS OF TRANSVERSE MYELITIS ARE: Weakness of the arms and legs - This weakness can progress rapidly, developing into partial or complete paralysis. Pain - While initial indications typically include lower back pain, it can become sharp, shooting sensations that radiate down the arms, legs, or torso. Sensory alterations - These alterations can cause paresthesias (abnormal sensations such as numbness, burning, or tingling) as well as the loss of sensation in the torso and genital region. Bowel and bladder dysfunction - It is common for this illness to cause increased frequency, constipation, and lack of control in urination or defecation. Additionally, individuals suffering from transverse myelitis can experience muscle spasms, loss of appetite, depression, fever, sexual dysfunction, and respiratory problems.

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The FDA is now requiring researchers conducting the trial to add information about this incident into consent forms to be signed by study participants. Regulatory officials in the UK have reviewed the illness and determined that there was “insufficient evidence to say for certain” whether or not the development of transverse myelitis was related to the vaccine or not. Forbes reports that there have been two patients to date who have contracted transverse myelitis. Pausing a vaccine trial is a common precaution, as seen in the AstraZeneca UK trial, and the Johnson & Johnson trial paused on October 12th. In both cases, the cause of the halt was patients experiencing unexplained illnesses.

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Telehealth in Medicare & Medicaid: The Hidden Hero Keeping Us Connected to Our Doctors even in a Pandemic

“The genie is not going back in the bottle!” In recent months, the Centers for Medicare and Medicaid Services (CMS) has expanded access to telehealth services under President Trump’s emergency declaration. This allows beneficiaries to receive a broader range of services from their doctors without going to a healthcare facility. These benefits are part of the larger effort put forth by CMS and the White House Task Force to ensure that all Americans particularly those at high-risk are aware and able to access systems that can keep them healthy. Under the 1135 waiver, Medicare can now pay for office and hospital visits - among other types of visits - furnished via telehealth across the country. This is a drastic change from before the waiver when Medicare could only pay for telehealth services on a limited basis.

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As of October 14th, the CMS added eleven new services to the growing list of telehealth services that Medicare will reimburse during the COVID-19 public health emergency. Since March 2020, Medicare has added more than 135 services via telehealth that it will pay for, including emergency department visits and nursing facility visits. Seema Verma, the administrator of CMS, said of the additions: “Responding to President Trump’s Executive Order, CMS is taking action to increase telehealth adoption across the country… This revolutionary method of improving access to care is transforming healthcare delivery in America. President Trump will not let the genie go back into the bottle (CMS.gov, 2020).”

In the past three years, CMS has been working to modernize Medicare as part of the Fostering Innovation and Rethinking Rural Health strategic initiatives. It has unleashed innovation in the private sector, improving access to telecommunication technologies and services to beneficiaries. Starting in 2019, Medicare began paying for virtual check-ins where a patient can connect with doctors via phone or video chat. These check-ins were done as a preliminary way to assess whether the patient needed to come in for an in-person visit. However, in response to the COVID-19 pandemic, CMS rapidly expanded its payment for telehealth services. This allowed Medicare beneficiaries living in all parts of the country access to high-quality care from the comfort of their own home where they could avoid unnecessary exposure to the virus or other illnesses. 20

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“Before the COVID-19 pandemic, only 14,000 beneficiaries received a Medicare telehealth service in a week while over 10.1 million beneficiaries have received a Medicare telehealth service during the public health emergency from mid-March through early-July” reports CMS.gov.

TELEHEALTH IN MEDICARE: WHAT DOES IT LOOK LIKE? As the healthcare industry has had to rush to fill the gaps in coverage during the COVID-19 pandemic, CMS has made keeping people safe and avoiding unnecessary exposure to the virus a priority. Providing a fact sheet on the various telehealth services now allowed through Medicare, patients, and healthcare providers alike can seek guidance on the best options for personalized care. This historic effort has been made possible by new policies implemented in both 2019 and 2020. For a beneficiary, these services can look like an inquiry call to their doctor if they are experiencing symptoms. During this call, it can be assessed whether a physical exam is needed or merely remote monitoring to see if symptoms worsen. If the beneficiary worsens, a virtual check-in allows the doctor a chance to make recommendations without making a patient step into the office or hospital. 21 | TOPDOCTORMAGAZINE

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TELEHEALTH IN MEDICARE: HERE TO STAY? Telehealth services and the technologies needed for such procedures are nothing new. They were already in progress and en route to being widely accepted before the start of this year and the COVID-19 public health emergency. However, due to the PHE, telehealth became the premier source of care - being widely accepted and, in many cases, the only avenue through which medical attention could be accessed. As we have no real way of knowing the PHE’s end, there is no approaching end date for telehealth and its services. Not to mention, with its proven track record thus far, it may very well become the preferred method of care for many patients. Medicare and Medicaid beneficiaries, especially. While telehealth will never replace the gold-standard of an in-person doctor’s visit, it serves as an important addition of access. Its rapid explosion in recent months has raised the question of whether returning to the status quo will turn back the clock on innovation and a new level of care. Remote patient monitoring (RPM) is one such innovation under question should Medicare revert to pre-pandemic telehealth service limitations.

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TELEHEALTH IN MEDICARE: WHAT IS RPM, AND WHY IS IT THE BACKBONE OF TELEHEALTH? Remote patient monitoring (RPM) is a delivery method for healthcare that uses the most advanced technologies to gather and analyze patient data, which is then used to develop and manage a treatment plan tailormade or related to a chronic illness or health condition. RPM is about moving conventional healthcare delivery outside of the box for better patient care and outcomes. These technologies are the latest and greatest, emphasizing today’s consumer-friendly personal tech items. Leveraging Bluetooth and smartphones or tablets, these data collection devices are used specifically to make patients comfortable monitoring and aiding in their own care. As a result of this comfort, engagement levels between patients, their monitoring devices, and ultimately the doctor are increased. Naturally, higher engagement levels correlate to improving the overall quality of care. Not only is the patient incentivized to be involved in his or her own health due to the comfort of quality RPM devices, but clinicians are equally better equipped to understand and manage their patients’ health situations. This is extremely important in the prevention of deteriorating health or worsening conditions. RPM is the backbone of Telehealth because it enables clinicians to actually see what their patients are doing daily. Never before has this level of care been accessible to the public. 23

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As witnessed in recent months, without Telehealth - without RPM the mode of most healthcare delivery systems would have been cut off for weeks on end. With Telehealth services and RPM, where a patient can interact with their doctor via technology and have their situations monitored 24/7, it is possible to diagnose, treat, assess, and prevent. It is more convenient than conventional doctor or hospital visits. It is more accessible to demographics of the public. And it is an essential part of limiting unnecessary exposure to the more vulnerable. In conclusion, without the advances of technology, especially in the medical field, the COVID-19 virus would be able to spread much faster and further like the H1N1 Influenza Pandemic of 1918 where social distancing wasn’t a thing between doctors and their patients nor even in medical wards. 50 Million people are estimated to have perished just a hundred years ago from a similar virus compared to the 1.14 million people who have died from COVID-19. No one should ever die from a horrible disease and our hearts go out to all those suffering from COVID-19 (it has touched our own office as well). It is our dream at Top Doctor Magazine and among the doctors we serve to continue the exponential growth in medical advances over the past century so that mankind can be much closer to realizing a world virtually free from lifeending diseases in the not-to-distant future.

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Citations:

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Gilman, M., & Stensland, J. (2013). Telehealth and Medicare: payment policy, current use, and prospects for growth. Medicare & medicaid research review, 3(4), mmrr.003.04.a04. https://doi.org/10.5600/mmrr.003.04.a04 CareInnovations. (2020). What Is Telehealth? What Is Remote Patient Monitoring? How Are They Different? Retrieved from https://news.careinnovations.com/blog/what-istelehealth-what-is-remote-patient-monitoring-how-are-they-different CMS. (2020). President Trump Expands Telehealth Benefits for Medicare Beneficiaries During COVID-19 Outbreak. Retrieved from https://www.cms.gov/newsroom/pressreleases/president-trump-expands-telehealth-benefits-medicare-beneficiaries-duringcovid-19-outbreak CMS. (2020). Proposed Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2021. Retrieved from https://www.cms.gov/newsroom/fact-sheets/proposed-policy-payment-and-qualityprovisions-changes-medicare-physician-fee-schedule-calendar-year-4 CMS. (2020). List of Telehealth Services. Retrieved from https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/TelehealthCodes Foley & Lardner, LLP. (2020). Top Ten Medicare Remote Patient Monitoring FAQs for 2021. Retrieved from https://www.foley.com/en/insights/publications/2020/08/ten-medicareremote-patient-monitoring-faqs-2021 CMS. (2020). Trump Administration Announces Historically Low Premiums and New Insulin Benefit as Medicare Open Enrollment Begins. Retrieved from https://www.cms.gov/newsroom/press-releases/trump-administration-announceshistorically-low-premiums-and-new-insulin-benefit-medicare-open CMS. (2020). Telehealth Benefits in Medicare are a Lifeline for Patients During Coronavirus Outbreak. Retrieved from https://www.cms.gov/newsroom/pressreleases/telehealth-benefits-medicare-are-lifeline-patients-during-coronavirus-outbreak

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Medicare Annual Enrollment Period: What You Need To Know

Medical emergencies are always unwanted and often surprising. So it is important to be prepared for whatever situations may lay ahead. Medicare is one such tool that you should consider when evaluating your options for health care. If you qualify, Medicare could save you hundreds of thousands in professional medical care and prescription fulfillment.

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What is Medicare? Medicare is for those 65+, younger with disabilities, and ESRD. It works with your existing insurance to figure out who pays for your medical bills first. Medicare grants qualifying individuals access to affordable medical insurance. Almost everyone gets part A for free, but access to parts B and C premiums must be paid. So, what exactly does it cover?

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"Medicare provides benefit payments for three broad categories of medical treatment: hospital (emergencies and surgeries), medical (doctors and treatments), and pharmaceutical (medicines)."

MEDICARE PLAN A: Plan A covers hospital insurance. This includes expenses such as room and board, inpatient services, limited stays in nursing facilities, and helps cover hospice expenses. Even though Plan A covers hospital expenses, it should be noted that it does not cover all facets, and there may be a deductible in the end.

MEDICARE PLAN B: Plan B covers doctor services, outpatient services, and particular medical supplies. It can also help cover certain occupational and physical therapies, as well as at-home care. On average, the amount that you pay for Plan B comes from your social security benefits.

MEDICARE PLAN C: Plan C is known as the Medicare advantage and covers both A and B benefits plus plan D's prescription drug coverage. Through this plan, you are choosing to receive benefits from a private healthcare company.

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MEDICARE PLAN D: Plan D is primarily focused on your prescription drug coverage. To help manage these medications' costs, usually, Plan D needs to be added on with the others.

ENROLLMENT PERIODS Three months before you turn 65, you become eligible to enroll in Plans A and B, and it ends 3 months after you turn 65. If you are already enrolled in social security benefits, you may not need to do anything. However, if you are not, you will have to sign up for Medicare online. One important thing to remember is that you do not want to be late when singing up for Plan B. Doing so will incur a lifetime penalty, and your premium will increase each time you miss the deadline. If you miss your enrollment period, you can sign up for the general enrollment period. This period exists between January 1st and March 31st. Also, after your initial enrollment period ends, you may qualify for special enrollment. You may sign up for both Plan A and B if you are under special circumstances. When signing up for Medicare's A and B plans, if you are interested in prescription help, you should also enroll in D before the deadline is up. Otherwise, if the deadline is missed, you will have to wait until the fall enrollment time, which takes place between October 15th and December 7th.

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Lastly, a good thing to do before joining medicare is to evaluate your options. It's imperative that the medical help you receive lines up well with what you desire. You don't want to be caught in a situation where you can't get your preferred doctor because you didn't read the fine print. Like all things, there are limitations, and knowing these limitations will save you much hurt down the road. Check your eligibility and see if you qualify before the coming deadline this season. 29

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Medicare helps many people, and it could help you. Before worrying about where your next medical bill will come from, enroll in Medicare, and remove the unknown's stress. In the end, only you know what you need. The right tools have been put into place if you choose to take advantage of them. So, what will you choose today?

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The COVID-19 Vaccine - Will It Get Here in Time and Can We Trust It? The governments of the world are in a race of both strategy and time, to deliver a safe vaccine for the coronavirus. It’s a complex scenario amidst a global pandemic, where the political landscape motivates how trials are conducted, as does the economic catalyst. Most will agree that we don’t want a repeat of 2020, and with Winter around the corner, a viable vaccine is seen as the best defense entering 2021. The question then becomes whether the vaccine(s) will be available in time to prevent another year of lockdowns and 30

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fear? Equally important, when they arrive, will they be safe?

WHAT EXACTLY IS A CORONAVIRUS VACCINE? Before we get into the who, when, where and why, let’s take a quick look at the “what”. It’s safe to lean back on a familiar saying: it takes one to know one. Vaccines allow the body to become familiar with the make-up of a virus before the person becomes infected, forcing the immune

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system to develop a resistance to the virus, almost like it remembers what to look for. The coronavirus vaccines being developed are designed to attach to the protein of the virus, but some also involve a few steps that have never been implemented before. Coronavirus vaccines are “designed to sharpen the immune system by introducing inactivated viruses, viral proteins, or genetic instructions (RNA or DNA) that tell the recipient’s cells to produce viral proteins for the immune system’s training.”

DON’T GET PHASED BY THE PROCESS

but considering the multiple methods of design involved, we don’t know what broad decisions will be required. For the U.S. alone, we may not have a clear picture of a timeline until after elections when we know what approaches an administration would use for testing and distribution. Moderna, AstraZeneca and others are already producing and contracting out mass quantities of vaccines with an assumed, yet uncertain approval. The USA alone has purchased 100 million doses of Moderna's mRNA vaccine candidate and 300 million doses of Astrazeneca's adenovirus vector vaccine.

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Vaccines like those in development for the coronavirus are usually tested in multiple phases. In their first phase, the safety of the vaccine is tested with dozens of patients at most. A phase 2 trial tests hundreds of patients, and phase 3 involves thousands of patients. Due to FDA fast-tracking and similar from other countries, most vaccinations are going to already have occurred before 2nd and 3rd phase tests are even complete. It historically takes years to process such data.

WHO’S MAKING THEM, WHEN AND WHERE? It sounds like high expectations mean the first vaccines could be ready for mass distribution in the first quarter of 2021,

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Russia’s vaccine “was developed by the Gamaleya National Center of Epidemiology and Microbiology (Moscow, Russia)” with a medical seal of approval from President Putin himself, so it must be safe. A nod to the race for space, Russia’s vaccine is called the Sputnik V, with Putin’s own daughter rumored to take part in the test group. Phase 3 trials are now underway, including tens of thousands of individuals from the United Arab Emirates, Saudi Arabia, the Philippines, India and Brazil, and more than 2 million doses of Sputnik V are already scheduled to serve Kazakhstan. Bill Gates, who’s Bill Melinda Gates foundation cites the need to test the entire world’s population, is placing India at the forefront of testing. While their globalscale philanthropy has gotten more exposure due to the pandemic, it still gives many a pause for concern when reading their efforts in “new approaches for integrating molecular surveillance into malaria control programmes”. According to Prime Minister Narendra Modi, India is leading the race to a COVID-19 vaccine and is also implementing a “well-established vaccine delivery system...this digitised network along with digital health IDs will be used to ensure immunisation of our citizens”. Australia presents an example of how several countries are preparing to handle COVID-19 vaccines. Their option is made by the UK drug firm AstraZeneca. While they state they are not considering making the vaccine mandatory, they’re voicing the likelihood of banned travel, refusal to recognize passports of their citizens, and

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“enforcing policies like 'no jab, no pay'”, meaning those who refuse vaccination will not be permitted into the workforce. Early trials have shown the vaccine to be effective, and it is currently in phase 3. “AstraZeneca has already agreed to share the vaccine with the UK, the European Union and international organisations including the Coalition for Epidemic Preparedness Innovations and Gavi, the Vaccine Alliance.“ They have supply agreements already lined up with the UK, Japan, India, Indonesia, Argentina, Brazil and South Korea. Pfizer and Biopharmaceutical New Technologies (BioNTech) are using the FDA’s fast track to speed past phase 3 trials, under the U.S.’s apt title Project Lightspeed, a “proprietary mRNA-based vaccine.”

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The joint effort plans to produce “100 million doses by the end of 2020 and potentially more than 1.2 billion doses by the end of 2021.” While Russia claimed they were first on the world stage to approve a vaccine in August, it was actually China who didn’t waste any time to start trials, testing their own military with their CanSino Biologics vaccine as early as March, 2020.

IMMUNITY OR EQUITY? THE WORLD HEALTH ORGANIZATION ISN’T JUST TRACKING DATA The World Health Organization has placed themselves in the position of global governance for the distribution of COVID-19 cures with their COVAX project.

The WHO’s COVAX Facility is committed to “vaccinating some people in all countries, rather than all people in some countries.” According to WHO, as of Aug 28, 2020, nine vaccine candidates were in late-stage trials..

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A unified initiative, COVAX has been formed “to ensure any eventual vaccine is distributed fairly and equitably” between 92 low-to-middle income countries. Included in their initiative is the UN NCD (noncommunicable disease) Inter-Agency Task Force to lead the public health decisions regarding the world’s supply of vaccines. In case you’re like most people who probably had no idea the United Nations even had an NCD task force, you’ll be glad to hear that their “Coalition for Epidemic Innovations and Preparedness – CEPI – is supporting nine candidate vaccines that will be made available to the Facility if successful, seven of which are in clinical trials.”

SAFETY IS OUR NUMBER ONE….OUR NUMBER TWO CONCERN. SERIOUSLY, ARE THEY SAFE? While it’s true that the “1986 National Childhood Vaccine Injury Act requires that vaccines be both ‘safe and effective’”, consumer lawsuits are no longer possible as a means to hold manufacturers and healthcare providers responsible. We’re promised these vaccines are/will be extremely safe, but we also hear a great deal from Bill Gates that vaccines reside in their own medical classification, protecting parties from any liability ‘in case of a zombie apocalypse’... okay, rather, against any unintended health consequences. The danger lies in the short time frame these vaccines are being developed. A truly safe, thoroughly tested vaccine generally takes 10 years, and at least 3-5 years to create tens of millions of doses. So, let’s shoot for something entirely reasonable like 7 billion doses in 7 months; sounds about right. Either most, or all of the vaccine options available will require a booster shot as well.

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The promise of safety is resounding, but technically not a promise anyone can make. Phase 2 and 3 trials are going to continue for months and years after most of the world’s population has already been vaccinated due to fasttracking. There should be genuine scrutiny over initial supplies from Russia and China, and one has to remain partly realistic, that the race to a partial cure is at least equally motivated by record-setting sales, as it is about health. The truth is, we won’t know how long people will remain immune to COVID-19, and the long-term standard for vaccines is at least 50% effectiveness. People in the trials are “reporting fever, headaches, muscle aches, and injection-site reactions.” People should be aware that beyond the pro/anti-vaccination position, there are in fact technologies at work that have not (to the best of our knowledge) ever been implemented. There is talk of a health ID implemented as part of the vaccine itself, allowing contact tracing to be built-in to the cure, and there are equal concerns tied to this, that along with a cure comes the exclusion of others who are unwilling to take it. The world could very quickly become a battlefield of “us against them” for those who value freedom, perhaps in trade for safety and the promise of a cure. Again, regarding the aforementioned zombie threat, there are circles of people in the medical community who take a reasonable step of caution

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in the “we’ve never done this before” direction, their concerns being that we don’t know the medical impact, and even more, we may not know it for years or even decades. The Dean of the Brown University School of Public Health, Ashish Jha, warns, regarding Russia’s rush to testing: “We have no idea whether this vaccine is safe or whether it works...it is really worrying when people start to bypass the standard process we have for vaccine development.” As we round the corner into Winter and an uncertain 2021 immediately to follow, we can be assured that the world is quickly becoming a much different place. One word of warning is simply this: remember to be kind and 36 | TOPDOCTORMAGAZINE

thoughtful to others when it comes to crucial decisions like taking a vaccine for the coronavirus. With legitimate reasons to desire rushing to the front of the line for protection or wishing to run in the opposite direction with concerns over a cure that may be too rushed to be safe, in reality none of us are certain what the impact of a vaccine will be, and that includes the world’s leaders and the very organizations self-appointed to see to a fair global distribution, the likes of which history has never witnessed. So, where do you stand? Are you anxious to get the first vaccine available, or do you think it is worth the risk to step back and wait for better data?

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Halloween Fiction Special

“On Tuesday, October 26th, Mary Ann Summers went in as a test-trial patient for a coronavirus vaccine produced by an unnamed pharmaceutical company. At 9:48 AM on Wednesday, October 27th, the hospital staff were unable to revive her due to unexplained complications. At 7:52 PM, she was seen wandering the hallways of the local hospital very much alive. By 11:13 PM, all the corpses from the hospital morgue had gone missing…” 37 | TOPDOCTORMAGAZINE

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Terrell pulled into an open parking spot in the garage adjacent to the community hospital, speakers thumping with the week’s top hits. He started humming the melody as he turned off the engine and popped open his door. It was a warm night for the season with a slight breeze bearing on it the stench of something rotten. Glancing around, he spotted the overflowing garbage bin several yards away next to the elevators. Terrell wrinkled his nose, suspecting he had located the cause of the stench and looked away. Walking around the back of his car, he spotted a woman dressed in a hospital gown, standing two cars away from him. She was facing the other direction as he opened the passenger door. His mom, a nurse at the hospital, was working the night shift, and despite a 10-page essay Terrell had to turn in at midnight, he’d agreed to bring her something to eat. Still humming, he bent down to scoop up the brown take-out bag from the passenger seat of his car. He didn’t see or hear the girl approach. Instead, one moment he was standing upright, and the next something slammed into his back, buckling his knees. Shouting in surprise, Terrell’s legs gave out and dropped him to the hard concrete so hard he felt the sharp, shooting sensation of pain ripple up his spine.

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Long fingers grappled around his face and neck as a loud, growling sound roared in his ears. The smell of rotting flesh overwhelmed his senses making his eyes burn. Panicked, he tried to shove the attacker off, but his attempt to fight back merely made the person latch onto him tighter. Pain lanced through his veins as he felt what must have been teeth clamp down on his left shoulder. He cried out again, unable to push to his feet. Instinct alone had him grabbing for the baseball bat he kept on his car’s floorboard for after school practice. His fingers missed the wooden handle by an inch as his attacker bit him again, this time on his neck. Twisting under the writhing mass assaulting him, he managed to grab the bat and swing it behind his head to where he imagined his attacker’s would be. There was a loud wail, and then the weight of his attacker dropped off him. He shot to his feet at once, noticing that his white shirt was quickly turning crimson with blood. His attacker - the woman who he had noticed a few moments before the attack - lay on the ground, grunting and struggling to rise. The hospital gown she wore was torn and hung haphazardly off of her shoulder, exposing an oozing sore. With growing alarm, Terrell observed that the majority of her skin was marred by blistering spots or places where the flesh had turned putrid. He couldn’t believe the first thought that popped into his head as the woman finally managed to drag herself upright. She’s a zombie. His next thought was more conceivable. But that’s impossible. Zombies don’t exist.

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As if to prove him wrong, the woman shuffled around to face him. Her eyes were glazed over with thick white films as she peered at him for several breathless seconds. Then she lunged. Terrell felt her fingertips brush his arm as he dodged to the side, swinging the bat at her. It connected with her arm, and he heard bones crunch. But the woman - no, the zombie didn’t seem fazed. She came after him again, broken arm hanging limply at her side. This time Terrell didn’t wait around. He took off at a dead run for the elevators and was mercifully inside before the creature could attack him again. The wounds to his shoulder and neck were still bleeding, his hands shaking as he fumbled to dial his mother’s number on his cell phone. As the elevator started to travel upward, he knew that he should have been dialing 911, but the adrenaline crashing through his veins singled out one concern: his mom’s safety. The elevator doors dinged open right as the phone started ringing. Terrell stepped out into the hospital hallway, phone to his ear, baseball bat tucked under one arm. His call went straight to voicemail. He hit redial, rounding the corner of the hallway. Again it went to voicemail. “Come on, come on…pick up, mom!” he muttered, approaching the nurses’ station where his mother usually worked. No one was there. In fact, as Terrell began to look around, he noticed that the hospital was eerily empty. Quiet. Still. Three things that could rarely be said of any hospital. 40 | TOPDOCTORMAGAZINE

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Pocketing his phone, Terrell moved past the deserted nurses’ station and peeked into the closest patient rooms. The bed was vacated, blankets, and monitors discarded in a tangled mess as if the occupant of the room had left in a hurry. Continuing down the line of rooms, he found the same scene in each. At the end of the hallway, Terrell stepped into another elevator and pushed the lobby button. He was no longer sure if he was awake or dreaming. The entire situation felt too...staged. Zombies weren’t supposed to be real. None of this is supposed to be happening. The elevator came to an abrupt stop at the lobby level. Its doors sliding open sluggishly as Terrell hesitantly peered out, still holding the baseball bat close. He was once more greeted with an unfamiliar silence in the hospital. Stepping into the lobby, he spotted the first person since the zombified girl in the parking garage. “Hey,” Terrell called out, not wanting to get too close in case the person turned out to be like the girl. “Where is everybody?” The man standing on the other side of the lobby glanced at Terrell, face ashen and eyes wide. He was wearing nurses’ scrubs. “They’re outside,” he said, barely above a whisper. “Wait, everyone’s outside?” Terrell frowned. He didn’t think anything but a fire would warrant a hospital-wide evacuation, and if there had been a fire, he was sure he’d hear alarms and sirens. The man shook his head, a finger held to his lips. “No, they’re outside.” Confused, Terrell walked across the lobby floor to where the man was standing. Together they looked out the large windows overlooking the front hospital parking lot. Terrell’s heart dropped in relief when he spotted his mother among the crowd of doctors, nurses, and patients gathered just beyond the front door. 41 | TOPDOCTORMAGAZINE

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“Mom!” Terrell shouted, lunging forward. The man at his side grabbed for Terrell, hand clenching around his arm like a vice, stopping him. “No,” he whispered when Terrell tried to struggle free, “You can’t go out there. They’ll eat you.” “What?” Terrell frowned, following the man’s gesture to the windows. What he saw stopped his heart cold. His mother stood in front of the nearest window looking inside at him. Her eyes were glossy with the same white film as the girl in the parking garage. In fact, to Terrell’s horror, he realized that every one of the doctors, nurses, and patients peering in at them through the window had the same glazed look. “They shouldn’t have taken the vaccine,” the man holding Terrell in place said, “It made them like this.”

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WHAT JUDGE AMY CONEY BARRETT'S NOMINATION TO THE SUPREME COURT MIGHT MEAN FOR HEALTHCARE 43 | TOPDOCTORMAGAZINE

It’s the week of October 12, 2020, and President Trump’s nominee to the Supreme Court, Amy Coney Barret, is experiencing what a select few will ever know or endure first hand; a juror’s highest level of confirmation hearings. No time in history could speak with more clarity to the reality that medical science is closely tied to politics. Like it or not, truth, facts, science, money, access and everything that involves one’s health all come down to the perspective of politically powerful people and their programs. So, one could say, it’s an important week for medical science. Let’s take a close look at what Judge Amy Coney Barrett’s nomination could mean for healthcare..

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GETTING TO KNOW YOU WHO IS JUDGE AMY CONEY BARRETT? A devout Catholic, Judge Barrett graduated from Rhodes College and gained her law degree from Notre Dame. Barrett was “appointed to the Chicago-based U.S. Court of Appeals for the Seventh Circuit by President Trump in 2017.” There is a lot that can be said about this devout wife and mother of 7, as a woman of faith, lawyer and judge. For a more in-depth look, her wikipedia page is extensive. Regarding Barrett’s approach to law, she makes a clear distinction between one’s individual opinion and the letter of the law, and even offers the transparency of where she draws the line for issues that come down to religious belief. When speaking to issues of her faith, in 2017 she stated that “personal church affiliation or my religious belief would not bear in the discharge of my duties as a judge”. Judge Barrett views herself as a textualist, “which basically means you read a statute and you strictly apply the text of that statute.” This is the neutrality one looks for in an objective jurist, but the concern from opposition typically is that people tend to edit their ideals into what is written in that text. One can grant, though, that if a person’s ideals are to remain objective solely based on the law, textuality would seem the purest way to approach each given case. Let’s take a look at how this projects onto her views and work, and how it could impact the future of America’s healthcare system.

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IT ALL COMES DOWN TO THE ACA Perhaps the most divisive and important impact on the U.S. healthcare system deals with the Affordable Care Act. Nearly everything that can be ruled for or against is connected to the ACA to some degree. Since the topic of the ACA has come up more than a few times in Barrett’s career, this gives us a clear window into who Judge Barrett is, and what ethics and legal guidelines she holds dear.

On the second day of confirmation hearings, Judge Barrett stated: “I’m not here on a mission to destroy the Affordable Care Act.” Barrett emphasizes that she has “no hostility to the ACA… I would approach it with no bias or hostility.”

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OBAMACARE The ACA and Birth control Judge Amy Coney Barrett signed a public statement of protest in 2012 against the birth control requirement of the ACA, citing its “assault on religious liberty and the rights of conscience.” In this letter, Barrett described the ACA's birth control benefit as a "grave infringement on religious liberty". The statement continued: “The simple fact is that the Obama administration is compelling religious people and institutions who are employers to purchase a healthinsurance contract that provides abortion-inducing drugs, contraception and sterilization... a grave violation of religious freedom and... an insult to the intelligence of Catholics, Protestants, Eastern Orthodox Christians, Jews, Muslims and other people of faith and conscience to imagine that they will accept an assault on their religious liberty if only it is covered up by a cheap accounting trick.”

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ABORTION/ROE V. WADE The two are synonymous to a degree, but nuance brings an entire spectrum to the issues that affect medicine. It isn’t so much the legality of abortion, but the lines drawn, method, and requirements tied to the ACA. Judge Barrett has been consistent in her position that Roe v. Wade has remained an established legal mainstay and is likely to remain, but the issues surrounding it may come into question. Judge Barrett has been a member of a right to life group for years, and has openly shared that she ascribed her views on the evils of abortion in an ad that stated: "In the 40 years since the Supreme Court's Roe v. Wade decision, over 55 million unborn children have been killed by abortions… we renew our call for the unborn to be protected in law and welcomed in life”. Support and opposition to Barrett’s views are both with merit, considering that during her career, Barrett has ruled against abortion rights in two cases, one which dealt with seeking an abortion based on reasons of sex or race. In 2013, Judge Barrett wrote an article in the Texas Law Review, stating that “the public response to... Roe (v. Wade) reflects public rejection of the proposition that (precedent) can declare a permanent victor in a divisive constitutional struggle rather than desire that precedent remain forever unchanging. Court watchers embrace the possibility of overruling”.

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In a lecture on the 40th anniversary of the Roe ruling, Barrett said: “I think it is very unlikely at this point that the court is going to overturn (Roe v. Wade)... the fundamental element, that the woman has a right to choose abortion, will probably stand.” In 2016 she remarked, in regards to a conservative Supreme Court: “I don’t think abortion or the right to abortion would change. I think some of the restrictions would change ... the question is how much freedom the court is willing to let states have in regulating abortion.”

THE SUPER-PRECEDENT Understanding the super-precedent is key to understanding Barrett’s impartiality that she tightly embraces. While she may hold personal beliefs, and is willing to honestly face her opposition to abortion itself, as a jurist it is her job to look at the current, text-based status of law, and offer judicial input only as it pertains to issues raised to the court. In her confirmation hearings, Barrett clarified that she did not consider Roe to be a “super-precedent” like Brown v. Board of Education, the landmark case that desegregated schools, because there remain challenges to Roe and efforts to overturn it. An assumption of the super-precedent would be something so set in stone, that the core of the topic would simply not continue to arise, both in politics and culture. The results surface in the heart of the medical community and how the nation chooses to support the law, financially and legally. Since abortion continues to be the ultimate hot-button issue, it is clear that its precedence can be assumed to continue to be called into question, as it also pertains to contraception and other sensitivities that are embedded. In a 2017 Senate hearing, Judge Barrett stated that she would “decide cases according to rule of law, beginning to end, and in the rare circumstance that might ever arise... where I felt that I had some conscientious objection to the law, I would recuse”. She added that a “judge may never subvert the law or twist it in any way to match the judge’s convictions from whatever source they derive.”

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MEDICAID, IMMIGRATION AND THE DHS

Numerous controversial issues are likely to fall to the Supreme Court over the coming months and years: from those that cross between vaccines and stem cell research, to issues with Medicare and Medicaid. Perhaps one of the more interesting points has already been visited by Judge Barrett in the Seventh Circuit. It was Barrett’s position that differed from the other two judges, regarding the issue of public charge and immigrants. Barrett posited that limited use of resources like Medicaid for illegal immigrants did not classify as overreach from the Department of Homeland Security. The subject brings up an incredibly important point. First, the issues of providing medical care cross many political zones, and some of them are interpreted completely by the world-view of majority politicians.

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National, local and state budgets all have to factor in the costs of emergency care versus government subsidized healthcare. Costs can be manipulated to an extreme in both directions, but no one would make the initial assumption that it would be an issue for the DHS instead of medical boards and legislators. Reining in these extremes may very well be left to the wisdom of the high court, where sometimes a clear right and wrong is the most difficult to discern at lower levels and between departments.

We are watching yet another layer of unrepeated history unfold in front of our eyes this year. No other time could be more pivotal to our country’s further direction, with a national election representing the widest divide in worldviews we have faced, a Supreme Court nominee that has shown a record of fairness and a lack of bias at the bench, who also is unashamed of very specific religious and moral views. The medical world is already at the center of controversies from COVID-19 remedies to mixed questions on preventative clarity, a rushed call to vaccines and the organizations that stand to benefit, and the mere fact that the disease leaves many citizens with a growing fear of interaction with the medical system on whole, including testing and contact tracing. Adding it all up, we will see everything from the Affordable Care Act to specifics about abortion grow in intensity as we enter 2021. The answer, then to this article’s headline, is that Judge Amy Coney Barrett stands to add quite a substantial bottom line to the state of healthcare in America.

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BE AWARE OF THESE SIDE EFFECTS WHEN WEARING A MASK… THE UNINTENDED CONSEQUENCES OF MASKWEARING

WHAT YOU CAN’T SEE CAN HURT YOU

We’ve all heard the saying about having to choose between the lesser of two evils. 2020 seems to be the breeding ground of perfect examples. Most of the world is navigating orders to socially distance and wash our hands after every single activity, which seems logical enough in the throws of a global pandemic, but there may be more than just caution hidden beneath the masks we’ve all been wearing. Some of the repercussions that come from wearing them may open the door to an entirely new list of problems. From new health issues to the social and psychological impact, problems are coming to light in ways we never could have anticipated.

Research hasn’t even begun to reveal the full implications of mask-wearing and the potential for spreading disease. Take just one vital example: Helicobacter pylori, or H. pylori for short, an extremely common bacterial infection. A huge portion of the population gets it, and most will likely never know. People can be carriers for a long time, often an entire lifetime, never to be affected, but for those who are harmed, the health ramifications can be deadly.

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FIRST, A LITTLE BACKGROUND H. pylori is sustained in stomach acid and can survive outside the body for hours, which is enough to infect others who come in contact. Health experts “believe the germs can be passed from person to person by mouth, such as by kissing”. Because it is often transmitted through saliva, and can live on surfaces for hours, the mask provides a new surface in close proximity, when touched, adjusted, removed and replaced, it can facilitate spreading H. pylori more widely to others. Researchers have found that approximately half of the people carrying H. pylori can infect others via their saliva directly through kissing, and indirectly with shared surface contact, which is where mask-wearing enters in. It is an extremely common “pathogen that is able to alter host physiology and subvert the host immune response, allowing it to persist for the life of the host.” What many do not know, is that H. pylori is the primary cause of peptic ulcers and gastric cancer, the latter which kills over 700,000 people every year. In fact, it’s the first bacterial species proven to cause cancer, “classified as a group I carcinogen by the International Agency for Research on Cancer”. Allowing that grim number to sink in, prior to the coronavirus, the numbers of people affected by H. pylori were shrinking, but for those harmed the greatest, antibiotic resistance has been a crisis that only intensifies the threat, and it’s doing so at an alarming rate. Ulcers and deadly cancer may be at the top of the list of concerns, but H. pylori is directly connected with damage to the liver and gallbladder, is linked to bronchiectasis and chronic obstructive pulmonary disease, ocular disease, Alzheimer’s and Parkinson’s, cardiovascular disease, autoimmune disorders, thyroid disease, and even multiple sclerosis.

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Since more than half of the people in the U.S. with the bacteria are over 50 years old, and considering the increased health risk for those infected with COVID-19 in this age group, the connected risk is not to be underestimated.

MASKNE? A less lethal, but growing health concern from mask-wearing is people who are experiencing acne, or “maskne” as the new vernacular permits. Skin issues resulting from heat and moisture while wearing masks are on the rise. It’s a problem dermatologists are seeing first-hand, adding maskne to a list of the most common issues they’re treating. Medical spas like the Wellness Jar are using light therapy to treat acne skin breakouts resulting from skin irritation that result from wearing masks.

JUST TAKE A DEEP BREATH; OR, DON’T? We need oxygen to survive, but there’s a growing controversy about the dangers of rebreathing our own carbon dioxide while wearing the most common face masks. While growing numbers are complaining about dizziness and lightheadedness, the experts claim the most common cloth masks, and even N95 masks won’t cause breathing issues. Those who deny the potential for breathing dangerous carbon dioxide levels open the discussion for an even deeper level of controversy. Since experts state that the seal around one’s face isn’t tight enough to cause carbon dioxide re-breathing side-effects, and cloth masks are supposedly porous enough to avoid the same, one has to wonder how they are effective against the tiny-sized coronavirus droplets from which they’re said to protect us? The scientific community has both ruled out the possibility of being harmed, while also stating there are no official tests providing data. There is medical recognition of a known rise in headache complaints from extended mask-wearing, but this is minimized by the medical community, suggesting that most people simply don’t wear masks long enough to experience the inconvenience. People who suffer from asthma and COPD have described a worsening of conditions and even used this as an exemption to wearing a mask, but there continues to be conflict from medical experts on whether to officially sign-off on these exemptions. The outspoken voice of science says there is no impairment, but one has to wonder if they are truly listening to their patients. 53 | TOPDOCTORMAGAZINE

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Professionals suggest repeating selfencouraging mantras and to search for a comfortable mask, even if it’s homemade, suggesting that even insufficient protection will reduce spreading the virus better than nothing at all. This appeals to our sense of logic, but again, does the science really support this reasoning? If the virus is tiny enough to pass directly through even some of the least porous materials, and openings to the side allow the safe passage of air, then are masks actually providing us any real safety, or just a surface perception of caution?

WHAT’S ON YOUR MIND? It isn’t hard to see how wearing face masks is inviting new possible risks to our health, potential infections, skin irritations and breathing patterns, but how are they affecting people’s psychological well-being? A study at Bielefeld University, Germany revealed that “observers mostly relied on the eye and mouth regions when successfully recognizing an emotion”. Much of new mental anxiety stems from how we fill in the visual cues that are now missing. There is a small exception, like those who suffer social phobias who take comfort in veiling their emotions from the public. For example, people who suffer erytrophobia, the fear of blushing in public may likely take it as a blessing that wearing masks in public greatly reduces their anxiety, but for the majority, there is a spike in discomfort and stress that comes from the expressiveness that is concealed. People are unable to distinguish important emotional cues that balance social interaction with emotional well-being.

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When Nicole Ellerbrock, a “hospice nurse from Minnesota” was told about their order to wear a mask at all hours at work, she was unable to sleep. She began to experience claustrophobia, which only worsened as the summer months got hotter and they added a requirement to also wear a face shield. Psychotherapists suggest that “nodding the head” or “giving a thumbs up” can help fill in for missing emotional facial cues, but for those who suffer anxiety, they tend to fill in a lack of visual information with more alarming data that is otherwise neutral. We’ve observed waves of citizens across the globe rising up to rebel against shelter-in-place and

mandatory mask orders, with the U.S. cited most often in the media.

The mask may in fact, be a partial deterrent against the deadly COVID-19 pandemic. History has taught us that often the very things meant to protect our lives, can open a door to new dangers we couldn’t see coming. With a microscopic disease added to the invisible air that we breath, the potential to spread deadly bacteria we were already battling to a higher degree, the mask represents a wide range of emotions, from safety to fear, anxiety to uncertainty. So, we’re curious what you think? Are masks making a huge difference in reducing the number of COVID-19 infections?

Do you think that the risk of passing on H. pylori has gone up because of increased surface contact with masks? Do you think that people who complain of suffering carbon dioxide poisoning are imagining their symptoms? Or, is there some truth to the logic that the very safety mentioned with masks, allowing air to pass from the sides and being porous enough to provide proper ventilation could mean they’re just as likely to allow the coronavirus to pass? We’d love to hear your feedback.

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The U.S. isn’t the only country to rebel against wearing masks on the basis of their rights to liberty, but it is notable that even in the great pandemic of 1918, Americans were widely reported for their strong reactions against wearing masks. Perhaps it is often the simple freedoms that are the most symbolic, and in the case of the year 2020, all of us have a lot of new restrictions to digest and ponder.

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All doctors are invited to attend & learn the latest strategies for maximizing practice revenue and profitability via Regenerative Medicine 10XYOURPRACTICE.COM

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5 Benefits of Drinking Lemon Water You Need To Know About The benefits of drinking lemon water is a common and highly recommended concept. Unlike other trends, drinking lemon water actually lives up to the hype it has caused. Doctors, fitness gurus, and nutritionists alike have all boasted on the positive effects it can have on one’s overall health - especially for weight loss and boosting the body’s immunity.

SIMPLE LEMON WATER RECIPE A glass (8 or more ounces) of warm water 1-2 tablespoons of freshly squeezed lemon juice A squeeze of honey (optional) If you are not a fan of lemons, lime can be a nice substitute.

NUTRITIONAL VALUES The lemon is an extremely rich source of Vitamin C. In fact, one lemon squeeze produces around 21% of a person’s daily value. As a citrus fruit, lemons contain many flavonoids - powerful antioxidant agents that help the body function more efficiently and protect it against toxins, stressors, and diseases. But, aside from this, there’s not much else special about the lemon. Containing only trace amounts of protein, fats, carbs, or sugars, the lemon is a relatively unremarkable fruit, and yet it has been proven to improve the body and its health. According to the United States Department for Agriculture database, the nutrient breakdown for lemon water containing one 48 gram (g) squeezed lemon is as follows: 56

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10.6 calories 18.6 milligrams (mg) of vitamin C, or 21% DV 9.6 micrograms (mcg) of folate, or 2% DV 49.4 mg of potassium, or 1% DV 0.01 mg of vitamin B-1, or 1% DV 0.01 mg of vitamin B-2, or 1% DV 0.06 mg of vitamin B-5, or 1% DV While it does not seem to provide a lot of nutrients, lemon water is a low calorie, low sugar beverage. In comparison, by replacing the lemon with the juice of half an orange, you would double the number of calories and triple the amount of sugar while only achieving 24% of a person’s daily value of vitamin C.

BENEFITS Helps Weight Loss The most common benefit people associate with drinking lemon water is losing weight. This is not entirely accurate. By simply drinking water with lemon juice in it, the body does not lose weight. However, there are several qualities about lemon juice and how it interacts with the body’s functions that can help maintain weight or even aid in dropping a few pounds. Naturally, staying properly hydrated helps the body achieve healthy weight loss. Not only does drinking water improve the digestive system by flushing out fats, but it also works to decrease appetite. With lemon juice, this process can be expedited. If you drink water before bed, it can promote diuretic properties and flush toxins out of the body throughout the night. With the excretion of toxins, overall metabolism can be boosted (a huge factor in weight loss). Additionally, lemon juice is a great substitute for high-sugar or high-calorie beverages. This reduces calorie intake, another big factor in overall weight loss. 57

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Boosts Immunity

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In the current era of concern over COVID-19, improving one’s immunity is a high priority. The lemon, which is full of Vitamin C, is one of the best and tastiest ways to boost your immune system. Containing both flavonoids and antioxidant agents, lemons help to boost your immunity in two ways. First, flavonoids are various compounds found naturally in most fruits and vegetables. Because of their anti-inflammatory, anti-oxidative, and anti-carcinogenic properties, flavonoids are now considered indispensable components in many nutraceutical, pharmaceutical, medicinal, and cosmetic applications. These amazing compounds may also work to aid in managing weight and cholesterol. Simply put, flavonoids help ward off everyday toxins and, in a few cases, decrease risks of some chronic health conditions. Second, the antioxidant agents found in both flavonoids and Vitamin C supports the immune system by helping to prevent infections. It does this by fighting free radicals - which can damage healthy cells - and bacteria. Additionally, research has shown that if you are already feeling under the weather, Vitamin C can shorten the length of a common cold.

Eases Cough and Cold Symptoms With the flu and cold season on the near horizon, people are looking toward simple ways to ease pain and discomfort. Lemon water, especially taken warm and with a little honey, is a great holistic approach to combating cold symptoms and easing coughs or sore throats. According to many, lemon juice is reported to decrease the strength of the cold and flu virus in the body and reduce phlegm. This clears up overall congestion. By drinking lemon juice in a

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glass of water, you can limit the amount of congestion and drainage you experience. And when added with honey, which has antibacterial properties, lemon juice can soothe a sore or scratchy throat.

Aids Digestion, Relieves Constipation No one likes to talk about it, but the truth is that constipation happens. Indigestion, constipation, and Irritable Bowel Syndrome can have vastly negative effects on a person’s life - even to the point of hindering the quality of life. In consideration of these issues, research has been done showing that consuming lemon water can help the above. This is because lemons (along with prunes and apples) contain dietary fiber. The body does not digest fiber; instead, it passes through the digestive system and helps keep the gut healthy. Diets rich in dietary fiber and plenty of water promote regular, healthy digestion and bowel movements. The United States Department of Agriculture suggests that men eat at least 34 grams and women eat 28 grams per day. That being said, people who have constipation may need to consume more grams of fiber daily. While some research suggests that the acids found in lemons can aid in digestion by supplementing the body’s natural stomach acids, the true benefits of lemon water and digestion are found in the fiber. Not only does this aid in the overall digesting process, but when combined with water, it also helps to keep stool soft, easing defecation. However, to truly reap the fiber benefits found in lemons, you may need to eat the pulp of it, not just consume the juice. This can create a simple remedy to get rid of constipation and lessen symptoms of Irritable Bowel Syndrome. 49

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Improves Skin Health The benefits that drinking lemon water produces in skill health are a controversial topic. There is not enough research to report an overall standard. However, we know that certain aspects or qualities of lemon juice have - and can - improve skin health. These qualities include many already discussed above. Because of the antioxidant agents and antioxidative properties found in lemons, consuming a regular dose of lemon water can result in antiaging effects and may even suppress wrinkles. The Vitamin C content in lemon water can also promote collagen formation - the main structural protein found in skin and connective tissue. While the benefits from drinking lemon water are not the same in all people, those who have tried consuming it regularly see results such as: Pores were less visible and felt less clogged Acne breakouts were less frequent and less severe Making the overall complexion more radiant Reducing the lines on the face

RISKS While lemon water is entirely safe to drink, there can be some negative side effects to be mindful of before implementing it into your daily routine.

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Can Harm Tooth Enamel Because of the acidity found in lemons, damage can be done to the enamel over time, causing the teeth to be more prone to cavities. To combat this, many recommend drinking acidic drinks through a straw or rinsing the mouth out afterward. Avoid brushing your teeth right after drinking lemon water as the enamel can be in an acid-softened state.

Rashes Dermatologists want to clarify that while drinking lemon water has helpful benefits for skin health, topically applying lemon juice or lemon water can have bad side effects. Applying lemon juice or lemon water to the skin as a toner can damage the epidermis, creating inflammation and possible scarring. Additionally, if applied to the skin topically, citrus juice can make the skin more sensitive to sunlight and result in burning.

CITATIONS: Panche, A. N., Diwan, A. D., & Chandra, S. R. (2016). Flavonoids: an overview. Journal of nutritional science, 5, e47. https://doi.org/10.1017/jns.2016.41 Mahmoud, A. M., Hernández Bautista, R. J., Sandhu, M. A., & Hussein, O. E. (2019). Beneficial Effects of Citrus Flavonoids on Cardiovascular and Metabolic Health. Oxidative medicine and cellular longevity, 2019, 5484138. https://doi.org/10.1155/2019/5484138 National Institutes of Health. (2019). Vitamin C. Retrieved from https://ods.od.nih.gov/factsheets/VitaminC-Consumer/

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Don’t Let Knee Pain Keep You From Becoming The Best Version of YOU Knee pain limits both function and mobility; oftentimes impairing the quality of life for those affected. And while knee pain is most common in men and women aged 50 or older, it can be a negative influence at any age as it comes from various causes. According to a study conducted for the Annals of Internal Medicine, knee pain has substantially increased over a 20-year period independent of age and body mass index. With this in mind, it is of the utmost importance to understand the causes, risk factors, and prevention techniques so that you can navigate current or potential knee pain.

CAUSES A variety of causes can lead to knee pain: injuries, mechanical problems, and types of arthritis, for example. To better understand the cause of your knee pain, first, you must understand your knee. 62

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With approximately 25% of adults in America suffering from frequent or chronic knee pain, you are not alone in your struggle to overcome this obstacle in the pursuit of overall wellness and health. New studies are continuously being published that bear the ill-tidings of increasing knee pain and joint replacement statistics especially in the older population. But this doesn’t have to be the case for YOU.

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THE KNEE Our knees are composed of four bones, with the femur at the top of the joint and the tibia and fibula making up the joint’s lower part. On the top of the knee, a fourth bone (the patella) slides in a shallow groove at the end of the femur. Likewise, to the four bones, four main connective tissue bands secure the femur to the tibia and create a hinge-like structure out of the joint, allowing it to rotate as it bends. This unique ability is why the knee is called a swivel joint. In addition, the knee includes fibrous bands of tissue known as tendons that connect the muscle to the bone. Our knees have two major tendons - the quadriceps tendon and the patellar tendon. You guessed it. The quadriceps tendon connects the long quadriceps muscle (found at the foundation of the thigh) to the patella, and the patellar tendon connects the patella to the tibia. These tendons are responsible for you being able to straighten and extend your leg while the hamstring muscles at the back of the leg help stabilize the knee joint. Finally, there is the meniscus and bursa - your knee’s cushioning system. The meniscus, a Cshaped cartilage, curves around the inside and outside of the knee while the bursae (fluid-filled sacs) help the many ligaments and tendons to slide smoothly across the knee joint. Altogether, the bones, tendons, ligaments, meniscus, and bursa construct one of the most dynamic and essential joints of the body. Since they support and stabilize, weakness in any of them greatly increases the likeliness of injury.

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Knee Pain with Injury Injuring the knee is a widespread occurrence. The National Library of Medicine presented a study that found that the knee is the most commonly injured joint by adolescent athletes, with an estimated 2.5 million sports-related injuries presented to emergency departments annually. Additionally, doctors often discover that meniscus tears, torn cartilage, or patellar fractures are among the top 30 injuries older patients suffer from. The following are the most prevalent knee-related injuries found in all ages:

ACL Tear The most common of the various knee injuries is the ACL tear or rupture. This occurs when the anterior cruciate ligament (ACL), one of the four ligaments that connect your shinbone to your thighbone, is overstretched, partially torn, or completely torn (in which case it is referred to as an ACL rupture). It is estimated that there are 100,000 to 200,000 ACL ruptures in the United States alone every year. This type of injury is most common among athletes of specific sports such as soccer, football, skiing, or tennis.

Fractures An unfortunate consequence of vehicular accidents or falls, typically the patella ( kneecap) that suffers a fracture or break. As it sits in front of the entire joint, acting like a shield, it is most vulnerable to direct falls onto the knee for impact, such as hitting the dashboard in a vehicle collision.

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PATELLAR TENDINITIS Found most often in runners, skiers, cyclists, and those involved in activities that contain lots of jumping, patellar tendinitis is the irritation and inflammation of the patellar tendon, which connects the quadriceps muscle to the shinbone.

TORN MENISCUS A torn meniscus is very similar to the ACL tearing, except the meniscus is a tough, rubbery cartilage, not a ligament. The meniscus is the knee’s shock absorber and can be torn if suddenly twisted while bearing weight.

KNEE BURSITIS Like patellar tendonitis, knee bursitis is a type of inflammation. It comes from three main causes: frequent or sustained pressure (such as kneeling), overuse, and a direct impact to the knee. If such an injury occurs, the bursae (small sacs of fluid that cushion the knee joint) become inflamed and painful.

KNEE PAIN WITHOUT INJURY The most common cause of knee pain that does not result from an injury is arthritis. More than a hundred different types of arthritis exist, but the varieties listed below are most likely to affect the knee.

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Osteoarthritis The most common type of arthritis, and the most common cause of disability in older adults, osteoarthritis is sometimes referred to as degenerative arthritis. It is a wear-andtear condition that occurs when the cartilage in the knee deteriorates with age and use.

Rheumatoid arthritis This type of arthritis can affect almost any joint in the body and is the most debilitating form of arthritis. It is an autoimmune condition and considered a chronic disease, although pain and severity can vary.

Septic arthritis If the knee joint becomes infected, septic arthritis may quickly cause extensive damage to the knee’s cartilage. There is usually no trauma before the onset of this knee pain, although it often occurs with a fever.

RISK FACTORS While there is no specific guarantee relating to the cause of knee pain, there are several factors that increase the risk of injury and problems. Such factors include:

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EXCESS WEIGHT While knee pain can be independent of a person’s body mass, it should be noted that the knee absorbs a huge amount of pressure with every step. This pressure equals one and a half times your body weight. Consequently, the pressure of excess weight takes a toll over time weakening muscles and ligaments or deteriorating the cartilage. One of the first treatment angles doctors take is to assess the patient’s weight and ascertain if it is contributing to the knee pain or injury.

LACK OF MUSCLE STRENGTH AND FLEXIBILITY As discussed above, the bones, muscles, and other dynamics of the knee all work together to stabilize and protect the joint. If there is a weakness in one or multiple areas, the risk of injury becomes far greater. Strong muscles are essential to stabilization, while muscle flexibility ensures that you can achieve a full range of motion protecting against injuries like ACL ruptures.

CERTAIN SPORTS OR OCCUPATIONS For those in sports that put greater stress on the joints than others, injuries are always at a higher risk. This is true concerning knee injuries as well. Basketball players, runners, and skiers all face the same conflict: do what they love and risk injury. Additionally, jobs such as farming or construction that require repetitive pressure or stress on the knees also increase the risk of injury.

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Previous injury This may sound repetitive, but it is worth reconsidering. There is a much higher risk of pain currently or in the future for those of us who have had previous knee injuries. Which is why the next segment of this article is so important. Preventative measures are a must in order to keep knee pain from impairing quality of life.

PREVENTION TACTICS As they say, the best defense is a good offense. While it is not always possible to prevent knee pain, the following suggestions can reduce or prevent injuries, pain, and joint deterioration altogether.

Get Strong, but Stay Flexible With weak muscles being a leading cause of knee injuries, you will benefit greatly from building up balance and stability. This comes from strengthening the hamstrings and quadriceps, but also other exercise routines and target areas. Many fitness industry professionals recommend that the best way to alleviate knee pain is to get moving. Swimming, yoga, walking, and cycling are all approved (and suggested) exercises associated with improving arthritic knee pain or general knee pain symptoms.

Be Smart About Exercise Exercising is a great way to stay fit and healthy and keep joint pain at bay, but it can also do more harm than good if done improperly. If you are already experiencing knee pain, or are in the categories for those potentially at risk, try switching your exercise routines to low-impact activities such as swimming or stationary biking. 68

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KEEP EXTRA POUNDS OFF As mentioned before, excess weight does not always cause knee pain. However, it has the potential to do so in many cases. Each extra pound puts additional strain on your joints (not just your knees), increasing the risk of injury and pain. This is why it is important to stay focused on protecting your joints from any unnecessary strain.

TREATMENTS Treatments for knee pain will vary depending upon the underlying cause of the knee pain. These treatments can include medication, therapy, and in severe cases surgery.

Medication The type of medication prescribed by a doctor fluctuates with the exact diagnosis. Typical medications for anti-inflammatory treatments (common for simple sprains and even arthritis) are over-the-counter drugs like acetaminophen (Tylenol), aspirin, or ibuprofen, and naproxen (Aleve). Injectable medications are also a rising choice of treatment, as discussed below.

Therapy In some cases, knee pain can be easily corrected through physical exercise (such as movements designed specifically to strengthen the weak areas causing pain). Additionally, certain types of corrective wedges worn in the shoes or even braces can lessen or eliminate your discomfort.

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Surgery If surgery is needed to treat your knee pain, the options you have may include: arthroscopic surgery, partial knee replacement surgery, and total knee replacement surgery. In the first procedure, the doctor can examine and repair your joint damage using fiber-optic cameras and small incisions around the knee. Arthroscopy can be used to remove or repair damaged cartilage, reconstruct torn ligaments, or remove loose bodies from the knee joint. In the second and third procedures, the doctor either replaces the most damaged parts of your knee with small parts of metal and plastic or replaces the entire joint with an artificial one made of metal alloys and high-grade plastics and polymers.

INJECTABLE TREATMENTS Injectable medications are a common treatment, and are usually the step between taking oral medication and surgery

Corticosteroids Injections of a corticosteroid drug into the joint may work to reduce symptoms of an arthritic flare-up and provide relief for weeks or months. However, these injections are not always successful and may lead to cortisone abuse in later years.

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Hyaluronic acid The human body naturally produces this thick, gooey substance. Found in large amounts in your skin, its main function is to retain water and keep the tissues lubricated and moist. When used to treat knee pain (particularly osteoarthritis), it can provide relief through one or a series of shots up to six months. A third possible treatment is the injection of stem cells and growth factors into the knee joint. Dr. Dana Churchill, an established Naturopath specializing in regenerative and fully integrated healthcare at his clinics in California, sees many patients suffering from knee pain. So much so that one of his areas of expertise in treating joint pain. In an interview with Top Doctor Magazine, he shared that his “gold standard” for treating knee pain is the injection of Wharton’s Jelly. This gelatine-like substance is found within the umbilical cord and contains hyaluronic acid and chondroitin sulfate. Both of which are already used widely as a dietary supplement to treat osteoarthritis. A regenerative agent, Wharton’s Jelly regenerates the tendons, ligaments, and cartilage in the knee. It can postpone and even stop deterioration. Dr. Churchill reports that with the injection of Wharton’s Jelly, he has seen an improvement of symptoms and pain in as soon as two weeks and as long as six weeks.

GET YOUR PERMANENT KNEE SOLUTION NOW CLICK HERE TO CONTACT US

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WHARTON’S JELLY Author: Justin Miller The world of holistic medicine has always been a unique space. New treatments, and experimental healing strategies are just another average day in this field. Still, one interesting medical discovery has begun to capture the interest of the public, Wharton’s Jelly.

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What is Wharton’s Jelly? Wharton’s Jelly is a gelatinous substance that provides insulation and protection within the human umbilical cord. It is composed largely of mucopolysaccharides and has a few key growth factors, including cytokines and stem cells that contain regenerative properties. Wharton’s jelly also has some strong characteristics, including compressibility, response to friction and shear, cushioning, and flexibility.

The FDA has ruled Wharton’s Jelly as a homologous derivative for tendon, ligament, joint, and musculoskeletal applications. This was done because Wharton’s Jelly provides tissue support within the cord blood of the umbilical cord. To obtain this substance in the United States written permission must be given from the family. Doing so grants experts access to mesenchymal stem cells from neonates. Wharton’s Jelly is considered a structural tissue, because it fits within the criteria of barrier, conduit, connects, covers, or cushions. Since it covers these areas, Wharton’s Jelly derived mucopolysaccharides will be used within regenerative and healing applications. It should be noted that these specific mucopolysaccharides do not produce teratogens or carcinogens.

Uses of Wharton’s Jelly The applications for Wharton’s Jelly are still mostly unknown, because of how new this form of medicine is. Although, there are a few possible applications. One such application can be found in therapeutic aid, through the use of _Mesenchymal_ stem cells for diabetics. Now, stem cell treatments are nothing new to the diabetic world.

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However, there is a substantial increase of interest regarding MSC treatments. It just so happens that Wharton’s Jelly and umbilical cord blood contain the highest amount of MSC’s. This is why Wharton’s Jelly is being considered as a major source for MSC treatments in diabetics. It should be noted that when treating patients, ethics is at the forefront of treatment and harvesting MSC’s can walk a blurry ethical line. That is why WJ-MSC’s are the main source of MSC’s for treatment. With the parent’s consent WJ-MSC’s are harvested from the UC and treated; They then can be used in various ways.

Diabetic Treatment To combat diabetes, WJ-MSC’s target insulin producing cells. Because of their regenerative properties, it is believed that these stem cells rejuvenate the insulin producing cells, increasing the natural output of insulin. As of now there is no evidence that these treatments produce teratoma risks.

Cardiac Applications The internet is circulating a few articles that state WJ-MSC’s effectively treat heart failure. Yet, the truth is, there is not enough empirical evidence to support this claim. What is known is that intracoronary infusion has bee safely done, but treatment efficacy was not validated.

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Tissue Engineering Another great use of Wharton’s Jelly is in cochlear tissue engineering. WJ stem cells work alongside biomaterials and growth factors to regrow and repair damaged tissue. Normally when these treatments are performed, embryonic stem cells and induced pluripotent stem cells are considered. The primary dilemma regarding ESC’s and ISP’s is that harvesting them is not always ethical. So, the best option is WJ stem cells for treatments.

Cardiac Applications The internet is circulating a few articles that state WJ-MSC’s effectively treat heart failure. Yet, the truth is, there is not enough empirical evidence to support this claim. What is known is that intra-coronary infusion has bee safely done, but treatment efficacy was not validated.

Autoimmune Diseases Autoimmune diseases may benefit the most from WJ-MSC treatment. They have been clinically tested, and have been shown to be effective in controlling the progression of diseases.

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This is due to MSC’S having immunomodulatory properties, making them effective in autoimmune disease cases.

Prospects Going Forward The future is bright for Wharton’s Jelly, especially now with the massive increase of births in the United States and beyond. Experts predict that there will be no shortage of the substance going forward and researchers are hard at work identifying all the uses for it. Regarding today, WJ-MSC’s will continue to be used in regenerative treatments and therapeutics. Hopefully, this substance will reduce the need for unethically sourced stem cells, paving the way for more socially appropriate harvesting techniques.

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Dr. Dana Churchill Spotlight

In his clinic, The Churchill Center, in Fullerton, California, Dr. Churchill focuses on practicing the art of medicine healing the body, mind, spirit, and soul.

Making Leaps and Bounds in

As a child and adult, Dr. Churchill

Regenerative Medicine

suffered from high blood pressure and other illnesses related to or caused by hypertension. His parents, both Ivy

Dr. Churchill is a Naturopathic doctor with over a decade of experience in Homeopathic, anti-aging, and regenerative medicine. He specializes in healing the whole body through holistic, natural treatments that address the root cause of illness and disease. 77 | TOPDOCTORMAGAZINE

League academics, were extremely proactive in the endeavor to find a cause for his illness - taking him to every expert they could find in New York where they lived. But no matter the doctor, the diagnosis and results remained the same.

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No one could figure out why he had hypertension and none of the traditional treatments or medications were working effectively. This led Churchill into a type of destructive lifestyle and depression which would plague him - and his illness - for the next fifteen years. After graduating from Princeton High, Dr. Churchill went to culinary school in New York to obtain a degree in that field. He was trained in French cuisine and upon completion worked first in New York and then in New Jersey in his mother’s restaurant. Finally, the hypertension and unhealthy lifestyle habits became too much. On the eve of his thirtieth birthday, Dr. Churchill made a selfevaluation that would begin to change his life. 78

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At a party with his friends, he was asked what he wanted in the future. His response - “I want something different.” And after fifteen years of symptoms and side effects, he decided to actively pursue something different. In the endeavor to find healing and answers for his high blood pressure, Dr. Churchill went first to Rutgers University. Already trained in the culinary arts, he sought to find further answers through a nutritional and physical point of view. Eventually, he graduated with a Bachelors of Science in Nutritional Biochemistry and Clinical Nutrition. But his search for answers did not stop there.

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Intrigued by topics such as traditional medicine and toxicology, he continued learning. While obtaining his Bachelor's degree, Dr. Churchill made a habit of reading through and memorizing the unabridged medical dictionary. “I would read and memorize the [medical] dictionary with a gallonsized coffee. If I didn’t have the coffee to drink, I didn’t care about what I was learning. But when I was drinking the coffee, I was able to fully focus and learn.” From Rutgers, Dr. Churchill went on to attend the National University of Natural Medicine (NUNM) to further his passion for treating the whole body while embracing natural treatments. And later, influenced by his time as a patient at the Princeton Bio Center, founded by Carl Pfeiffer MD Ph.D, a pioneer in orthomolecular medicine, Dr. Churchill also pursued advanced Aesthetic and AntiAging Curriculum with Roberta Foss Morgan DO and Thierry Hertoghe MD.

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What is Homeopathic Medicine? Created in the 1790s by the German physician Samuel Hahnemann, homeopathy is a form of alternative medicine. It is based on three theories: “Like cures like” - This is the idea that a disease or illness can be cured by a substance that produces similar symptoms in healthy people. You can read more about this principle here. “Law of minimum dose” - This notion is that the lower the dose of medication gives, the greater its effectiveness will be. You can read more about this principle here. “A single remedy” - Many homeopathic practitioners prescribe one remedy at a time, an idea that stems from the desire to observe results that are uncluttered by the effects that could be produced by multiple remedies at a time. You can read more about this principle here.

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Generally, Homeopathic products and treatments come from plants, minerals, and animals. These treatments are “individualized” or tailor-fit to each patient - so much so, that it is common for the same condition to be treated differently for different people.

What is Regenerative Medicine? Regenerative medicine seeks to replace or restore damaged tissue and organs that may have been affected by disease, trauma, or congenital issues. It is different in its approach as it wants to promote regeneration instead of traditional medicine strategies which focuses primarily on treating the symptoms. Tools used in regenerative medicine include tissue engineering, cellular therapies, medical devices, and artificial organs. Combinations of these approaches can amplify our natural healing process in the places it is needed most, or take over the function of a permanently damaged organ. While a relatively new field of expertise, regenerative medicine combines experts from professions such as biology, chemistry, computer science, engineering, genetics, medicine, and robotics to find solutions to the challenging medical problems facing mankind. It comes to the aid of our body's innate response to heal itself when confronted with injury or disease - harnessing the already established power of healing.

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The Churchill Approach At the Churchill Center, under Dr. Churchill’s compassionate practice, patients receive premier care that does not merely treat their symptoms but seeks to improve their entire life by discovering the true cause of their illness or disease. The focus is on revitalizing the body, mind, spirit, and energy.

Using a 17 page lab report, Dr. Churchill is able to see and measure a patient’s lipids, inflammatory markers, nitric oxide levels (ADMA and SDMA markers), and the myocardial structure stress functions. These markers and a patient’s symptoms can then be plugged into a complex, intuitive software which will piece together a remedy or treatment plan that is specifically designed for that patient. The specific treatments and programs that the Churchill Center offers are: Diagnostic Testing - Before a treatment plan can be created, Dr. Churchill requires a critical diagnostic test to be undertaken so as to confirm, rule out, or understand the cause of the symptoms in relation to the entire body.

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Detoxification - For Dr. Churchill, detoxification has a special and specific definition. “It is the process of reducing the body’s toxic load by lessening exposure to harmful chemicals”. From his personal battle overcoming hypertension, it has been a personal calling of Churchill’s to help transcend his patients past disease, discomfort, and wean them from harmful lifestyle habits. IV Therapies and Injections - Called the “gold standard” of treatments, the IV therapies and injections offered at the Churchill Center provide the body with a sense of comprehensive wellbeing. Infused with pure and organic vitamins, nutrients, fluids, electrolytes, and antioxidants these IVs are tailor made for each patient so they can work hard and play harder. 82 | TOPDOCTORMAGAZINE

Women’s Health - The illnesses and diseases women experience are unique and as such need a unique approach. Through the many anti-aging, IV therapies, and peptides at the Churchill Center there is a perfect solution for every woman.

Men’s Health - As specialists in male aesthetic injections including MSC Stem Cell Exosomes, Botox, and NonSurgical Rejuvenation, the Churchill Center knows how to get you to retain your youthful vitality, libido, and muscle tone.

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The Churchill Approach Making great strides into the beneficial arena of Stem Cell treatments, the Churchill Center under Dr. Churchill’s expert direction is now offering and excelling in PRP/Ozone Facials, joint regeneration, and Silver Nebulizer Treatments. PRP/Ozone Facials - This evolutionary, non-invasive age defying procedure is able to reduce or eliminate wrinkles, lines, uneven pigment, blemishes, and scarring. Joint Regeneration - With the regenerative nature of Stem Cells, it is possible to repair and restore damaged cells or other elements of the joints while also regenerating new cell growth.

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Silver Nebulizer Treatment - This treatment is a natural alternative for respiratory diseases or conditions.

Citations: Mao, A. S., & Mooney, D. J. (2015). Regenerative medicine: Current therapies and future directions. Proceedings of the National Academy of Sciences of the United States of America, 112(47), 14452–14459. https://doi.org/10.1073/pnas.15085 20112

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REMDESIVIR - DOES IT ACTUALLY WORK? AN IMPORTANT PATIENT NEEDS A CURE On October 2, the world took a brief, sobering pause as it was announced that President Donald Trump tested positive for COVID-19. Questions immediately turned to what his course of treatment would be. With the first promising signs of a vaccine months or years away, every option known was experimental at best.

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We soon learned that President Trump received “two antibodies directed against a key protein of the virus that causes COVID-19, SARS-CoV-2”. Regeneron, who created this cocktail, completed preliminary data that showed no side effects for those suffering similar conditions to the president’s, and “shortened symptomatic disease in patients who did not have SARS-CoV-2 antibodies at the trial’s start.”

WHAT IS REMDESIVIR?

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Regeneron wasn’t the only treatment administered to the president, though. In addition to the cocktail, the president was treated with remdesivir, an experimental medicine that came under particular scrutiny and curiosity. Known to be experimental, and with no official treatments approved by the FDA, questions arose regarding how the treatment course was approved. What exactly was remdesivir? Would it be effective, and perhaps most importantly, did it work on COVID-19? The brand name of remdesivir is Veklury, and while it was originally made “for hepatitis C and Ebola”, it is now branded as “an investigational antiviral medicine used for the treatment of certain people in the hospital with COVID19”. Remdesivir is administered intravenously once daily for up to 10 days.

FDA APPROVAL OF REMDESIVIR Many wondered how it could be safe for remdesivir to be used to treat COVID-19 when it hasn’t been officially, legally released for such use. The FDA approved the “use of Veklury for the treatment of COVID-19 under an Emergency Use Authorization (EUA)”. The U.S. Food and Drug Administration’s (FDA) regulation expanded access allows physicians to request “compassionate use” of experimental treatments through an “investigational new drug” pathway used for individual patients or for emergencies. The FDA has widened the emergency use order for patients of all ages, and not just those with severe cases, but even those who are just suspected of having COVID19.

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IS REMDESIVIR SAFE? Information is limited regarding the safety and effectiveness of using remdesivir for COVID-19.Gilead Science is the parent company responsible for Veklury, the brand name for remdesivir. Gilean initiated a study to test the effectiveness of remdesivir, and to learn of potential side effects. This study looked at the “first 12 U.S. cases of COVID-19...” where only 3 patients were given remdesivir, and all three “...experienced gastrointestinal issues and… elevated liver enzymes”. There are specific concerns about whether remdesivir can compromise a patient’s liver, but it is possible these concerns regarding liver function stem from COVID-19 and not from its treatment. This is among the data we will probably learn from over the months and years to come.

REMDESIVIR SIDE EFFECTS There are numerous potential side effects observed in clinical trials. These include allergic reactions like low blood pressure, changes in heartbeat, shortness of breath, wheezing, swelling of lips, face, or throat, rash, nausea, vomiting, sweating, or shivering. The greatest concern has been the increase in levels of liver enzymes, which have been seen in people who have received Veklury, which may be a sign of inflammation or damage to cells in the liver, but could also be a direct link to COVID-19 itself.

HOW MUCH DOES REMDESIVIR COST?

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For patients with private insurance, Gilead would charge “hospitals $520 per dose, which would come to $3,120 for a typical treatment of six doses over 5 days” and for those with “Medicare or other government-sponsored insurance, Gilead would charge $390 per dose, or $2,340 for six doses”.

DOES IT WORK? Clinical trials have shown promise in its ability “to shorten the time to recovery in some people”. It appears to be specifically effective with those who have mild COVID-19 symptoms, and are given treatment in its earliest stages.

Since the FDA is allowing consideration of use in patients of all ages and at all levels of severity, we should learn a great deal more in the months to come. Under pressure, and in unprecedented times, the medical community has had to make drastic decisions that can’t be easy. Every patient is a human life, and every case is likely to be unique. Are we already at a stage where there are some treatments that benefit an entire spectrum of patients? Or, will we find in the coming months, that some face a greater hardship than others with their treatment, just like we have seen with the virus itself? The future is uncertain, but remdesivir seems to have found a place of promise and relevance, in a post-COVID-19 world, and in a prevaccine window. What about you: would you take remdesivir if you were diagnosed with COVID-19? Would you go as far as aggressive treatment from a cocktail in addition to it, or would you want to hold out for as little experimental treatment as possible?

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A Word from the Editors Top Doctor Magazine is a magazine from doctors for doctors and patients. We cover everything from cutting edge medical techniques and procedures to enterprising doctors, dentists, surgeon, naturopaths, chiropaths, orthodontists and more who are thought leaders within their own medical practice and changing the way we all experience medicine for the better. We wish to be your one-stop digest for inspiration by other professionals in your field who are making waves and setting trends and if you too are a trend-setter, reach out to us so that we can interview you for your own spotlight within an upcoming Top Doctor Magazine issue!

Brianna Connors

Justin Miller

Derek Archer

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