The Silent, Under-The-Covers USA War

Thoughts and Perceptions

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

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

In case you missed it, my book – The Persistence Factor – is now available on Bookshop.org or Amazon.com. It’s not a healthcare book. Rather, it’s a book about leadership and the need for persistence in solving life’s most challenging and demanding problems!!

Books and Articles worth a Review…

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

• Ending Wars and Increasing Security:

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

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

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

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

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

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

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

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

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

AND FINALLY…on the healthcare front…

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Information for your Consideration…

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

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

Opinions and Reflections

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

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

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

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

Musings from a foodie…

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

The ongoing saga…

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

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

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

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

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