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Getty Images Pauline Quirke’s husband said she now “just wants to spend time with her family” Pauline Quirke, famous for starring in TV sitcom Birds of a Feather, has retired from acting following a dementia diagnosis, her husband has said. “It is with a heavy heart that I announce my wife Pauline’s decision to step back from all professional and commercial duties due to her diagnosis of dementia in 2021,” Steve Sheen said. Her diagnosis was not made public at the time. “Pauline has been an inspiration through her work in the film and TV industry, her charity endeavours and as the founder of the very successful Pauline Quirke Academy of Performing Arts (PQA),” Mr Sheen added. Birds of a Feather: Pauline Quirke as Sharon Theodopolopodous, Lesley Joseph as Dorien Green and Linda Robson as Tracey Stubbs Mr Sheen praised his wife’s “talent, dedication, and vision”. He said her drama academy had “touched countless lives and will continue to do so through the legacy of her work and through PQA where her vision and guidance has facilitated many young peoples’ progression and interest in the arts and enhanced their self-confidence”. Quirke was best-known as an actress for her role as Sharon Theodopolopodous on the long-running sitcom Birds of a Feather, winning a British Comedy Award in 1990 for the role. It ran from 1989 to 1998 on BBC One, and then on ITV from 2014 to 2020. The series followed the lives of sisters Tracey and Sharon, played by Linda Robson and Quirke, who have to fend for themselves after their husbands are arrested for armed robbery. Quirke and Robson met as children at drama school in north London. The pair first worked together in BBC comedy drama Shine On Harvey Moon, set in London’s post-war East End, from 1982 to 1985. In 1997, Quirke was nominated for a Bafta award for playing convicted murderer Olive Martin in BBC drama The Sculptress, based on Minette Walters’ psychological thriller novel. She also received four National Television Awards nominations – three for Birds of a Feather and one for BBC drama series Down to Earth in 2002. Quirke also starred in BBC detective drama Maisie Raine from 1998 to 1999, appeared in ITV’s Broadchurch, and played Hazel Rhodes in Emmerdale from 2010 to 2012. PA Media Quirke received her MBE from the Prince of Wales at Windsor Castle in 2023 In 2022, Quirke was made an MBE for services to the entertainment industry, young people, and charities. PQA has about 250 academies and more than 15,000 students across the UK, and will “continue to operate as normal in accordance with Pauline’s ideology”, Mr Sheen said. He requested privacy and understanding for his wife and her family, saying they would not be making further statements. “Pauline just wants to spend time with her family, children and grandchildren,” he added. Alzheimer’s Research UK/PA Media Pauline Quirke with her husband Steve Sheen have pledged future support for Alzheimer’s Research UK Quirke and Mr Sheen married in 1996, and they have “pledged future support” for Alzheimer’s Research UK to help raise funds for research and awareness, the charity said. Hilary Evans-Newton, chief executive of Alzheimer’s Research UK, said they were “saddened” to hear about the actress’s diagnosis. “The family should be praised for making the brave decision to make her diagnosis public, which will not only provide more freedom for them, but also raise such vital awareness of the condition,” she said. Dementia UK CEO and Chief Admiral Nurse Dr Hilda Hayo added: “By choosing to speak publicly about her condition, Pauline will raise vital awareness for young onset dementia. “We hope this will encourage others to seek support if they are concerned about their brain health.” Mr Sheen also praised late actress Dame Barbara Windsor’s husband Scott Mitchell for his work with the charity following her dementia diagnosis. Source link

By KIM BELLARD Gosh, who knew that Jan 13 would be an AI day, with at least three major announcements about “blueprints” for its development going forward? Of course, these days every day is an AI day; trying to take in all AI-related news can be overwhelming. But before some other AI news drowns them out, I wanted to at least outline today’s announcements. The three I’m referring to are the Biden Administration’s Interim Final Rule on Artificial Intelligence Diffusion, OpenAI’s Economic Blueprint, and the UK’s AI-driven Plan for Change.   The Biden Administration’s rules aim to preserve America’s lead in AI, stating: “it is essential that we do not offshore this critical technology and that the world’s AI runs on American rails.” It establishes who advanced chips can be sold to and how they can be used in other countries, with no restrictions on 18 key allies and partners. It also sets limits on model weights for AI models, seeking to constrain non-preferred entities’ ability to train advanced AI models. “The U.S. leads the world in AI now, both AI development and AI chip design, and it’s critical that we keep it that way,” Commerce Secretary Gina Raimondo said in a briefing with reporters ahead of Monday’s announcement Not everyone is happy. The Information Technology & Innovation Foundation blasted the rule, claiming it would hamper America’s competitiveness.  Vice President Daniel Castro warned: “By pressuring other nations to choose between the United States and China, the administration risks alienating key partners and inadvertently strengthening China’s position in the global AI ecosystem.” Similarly, Nvidia, which makes most of those advanced AI chips, expressed its opposition in a statement from Ned Finkle, vice president of government affairs, claiming the rule “threatens to derail innovation and economic growth worldwide.” He explicitly contrasts how the first Trump Administration (and, one assumes, the next Trump Administration) sought to foster “an environment where U.S. industry could compete and win on merit without compromising national security.”   Not to be outdone, Ken Glueck, Executive Vice President, Oracle, says the rule “will go down as one of the most destructive to ever hit the U.S. technology industry,” and “we are likely handing most of the global AI and GPU market to our Chinese competitors.” It will be interesting to see what the Trump Administration does with the Rule. Meanwhile, OpenAI’s economic blueprint believes “America needs to act now to maximize the technology’s possibilities while minimizing its harms…to ensure that AI’s benefits are shared responsibly and equitably.” Its goals are to: Continue the country’s global leadership in innovation while protecting national security Make sure we get it right in AI access and benefits from the start Maximize the economic opportunity of AI for communities across the country. It sees “infrastructure as destiny,” with investment in AI infrastructure “an unmissable opportunity to catalyze a reindustrialization of the US.” It wants to ensure that “an estimated $175 billion sitting in global funds awaiting investment in AI projects” get invested here rather than in China. OpenAI does want “common-sense rules” that promote “free and fair competition” while allowing “developers and users to work with and direct our tools as they see fit” under those rules. And, of course, all this while “Preventing government use of AI tools to amass power and control their citizens, or to threaten or coerce other states.” It particularly wants to avoid a “patchwork of state-by-state regulations” The company is planning an event in Washington D.C. on January 30 with CEO Sam Altman “to preview the state of AI advancement and how it can drive economic growth.”  I’ll bet Mr. Altman is hoping he gets plenty of Trump Administration officials, although probably not Elon Musk. Last but not least, UK Prime Minister Keir Starmer has endorsed an ambitious set of AI recommendations, wanting to turbocharge the economy by turning the UK into an AI superpower. Mr. Starmer vowed: But the AI industry needs a government that is on their side, one that won’t sit back and let opportunities slip through its fingers. And in a world of fierce competition, we cannot stand by. We must move fast and take action to win the global race. Our plan will make Britain the world leader. It will give the industry the foundation it needs and will turbocharge the Plan for Change. That means more jobs and investment in the UK, more money in people’s pockets, and transformed public services. There are three key elements: First, “laying the foundations for AI to flourish in the UK,” including AI Economic Growth Zones and  a new supercomputer. Second, “boosting adoption across public and private sectors,” such as through a new digital government center that “will revolutionise how AI is used in the public sector to improve citizens lives and make government more efficient.” Third, “keeping us ahead of the pack,” with a new team that “will use the heft of the state to make the UK the best place for business.” It will do so while also charting its own course on regulation. “I know there are different approaches (to AI regulation) around the world but we are now in control of our regulatory regime so we will go our own way on this,” the PM said. “We will test and understand AI before we regulate it to make sure that when we do it, it’s proportionate and grounded.” Chris Lehane, Chief Global Affairs Officer at OpenAI, praised the plan: “The government’s AI action plan – led by the Prime Minister and Secretary Peter Kyle – recognises where AI development is headed and sets the UK on the right path to benefit from its growth:” All nice words, but lots left unsaid. As Gaia Marcus of the Ada Lovelace Institute pointed out: “Just as the government is investing heavily in realising the opportunities presented by AI, it must also invest in responding to AI’s negative impacts now and in the future.” ———– These things are true: AI is going to play a major role

“The greater part of human pain is unnecessary. It is self-created as long as the unobserved mind runs your life.” ~Eckhart Tolle “Holy shirtballs!” I yelped and leapt out of the ice-cold water stream, gasping for air. There I was in an Argentina hotel at 5:30 a.m., bleary-eyed and sleep-deprived, with no chances of hot water and a back that felt like the surface of the sun. I had gotten the worst sunburn of my LIFE the day before from laying on my belly, deeply absorbed in my first self-help book. I couldn’t believe that other people out there were like me, had huge ambitions, and wanted to develop themselves beyond societal boxes, too. I was so absorbed, in fact, that I forgot to put on ANY sunscreen. (Lesson learned!) When I packed my bags and left Argentina with a newfound sense of confidence and thrill—plus a killer tan—I vowed that I would use what I learned from that first book to change my life into exactly what I wanted. An epic relationship with a man who cherished me, freedom to start my own business, and finally getting in shape. And then, I touched down in my hometown, Buffalo. I was in college at the time, studying to be a Spanish teacher. Giving my family a squeeze, answering the good-natured questions they peppered, and looking out at the cold winter scene, I thought, “What was I thinking? Only uber-successful people can live that kind of life and set those kinds of goals. I’m just a girl from a small town with a successful future as a Spanish teacher. I already have so much. I can’t ask for more.” And thus began my years of self-torment, in which I lived a good life on paper but sabotaged the crap out of myself when I dared to dream bigger. When brave action was required to get in shape, push forward my career, or meet someone new, I found myself watching endless TV, shying away from the job posting, or saying no to a second date with a perfectly reasonable guy—all while my confidence and self-trust swirled down the drain. If you’ve also been there, shopping more after setting a goal to spend less money or ordering a pizza in week two of your new fitness plan, then you know that self-sabotage can be a frustrating habit that we may feel we’ll never kick. But there’s good news! Self-sabotage is actually the last action in a chain of predictable events. And these events happen to everyone. We can easily catch these precursors to self-sabotage ahead of time and deepen the richness of our pursuit towards our goals with the following three steps. 1. See imposter syndrome as EXCITING! Before we begin to dive into self-sabotage, we need to change our mindset around its precursors—the predictable events that lead up to self-sabotage. These precursors include: imposter syndrome overwhelm self-doubt analysis paralysis worry believing we’re not good enough These precursory experiences drive the behavior we take when we are acting from a place of “I can’t.” The new fitness plan, the next step in the relationship, or the promotion seem outside of our realm of control, and our brains immediately default to “I can’t handle this, so I can’t do this.” When we’re on the precipice of taking inspired action to lead our most fulfilling lives, we are taking a huge step outside of our comfort zones. Our brains, which have no evidence of success in this new arena and thus can’t adjust their blueprint to encompass it, will purposefully create these precursory thought patterns in order to get us to stop moving ahead. It sees anything outside of the comfort zone—including growth and fulfillment beyond where we are—as a psychological danger that it can’t account for. While we can’t stop our brains from trying to implement these safety measures, we can stop ourselves from buying into them. The change in mindset comes when we stop seeing the presence of these precursors as a bad sign or something to fix and instead see them as something EXCITING. I know you may be thinking, I HATE feeling overwhelmed or like I’m not good enough. It sucks! I don’t disagree that these are uncomfortable experiences. But I will say that these feelings are also evidence that you’re moving in the right direction. If you’re experiencing overwhelm, imposter syndrome, or self-doubt, it’s because the thing you’re considering doing is outside of your brain’s comfort zone. And because our purpose in life is to grow and evolve, and all growth and evolution takes place outside of our comfort zone… These behaviors only crop up when you’re about to do something BRAVE! Feeling like you’re not good enough is no longer evidence that you’re not good enough. It’s just evidence that you’re making a bold decision for yourself to truly live and grow instead of letting your brain stop you. You will likely always feel some precursor like overwhelm, self-doubt, feelings of not being good enough, comparisonitis, or imposter syndrome when you’re about to make a brave decision. When you can detach from the volatility of these precursors and come to understand that they are natural markers of exciting progress—not the end of the road but just a stop sign along the way—you can pivot from nervous self-sabotage to determined advancement. 2. Feel your feelings. All of us are guilty of modulating our emotions in ways we know don’t serve us. Maybe for you it’s scrolling through social media or going out with friends. It could be a glass of wine or an extra piece of chocolate cake. I always find myself drawn toward a Netflix comedy special when I’m overwhelmed. Or I just watch TV in general to take my mind off of what’s coming up. I want to stress that there’s nothing wrong with these behaviors in moderation. In fact, these pleasures are meant for us to enjoy in our time here on earth. But if we’re

By MIKE MAGEE In case you’ve missed it, sleep is all the rage in neurosciences these days. They are fast at work rebranding it “the brain’s rinse cycle.”  The brain, protectively encased in an unyielding bony casing, lacks the delicate lymphatic system that transports used body metabolites to breakdown and extraction sites in all other parts of the body. But in 2012, neuroscientist Maiken Nedergaard, identified a unique network of delicate channels (“tiny passages alongside blood vessels”) inside the brain that collect and discharge brain metabolites and waste materials including amyloid. This system, or “ultimate brainwasher” as some labeled it, was formally titled the “glymphatic system.” That same study also suggested that flow through the glymphatic system is enhanced during portions of the sleep cycle. Now 12 years after the original research, the same team, in a study in mice published in the Proceedings of the National Academy of Sciences USA journal, found that regular contractions or oscillations of tiny blood vessels in the brain, stimulated by adrenaline cousin, norepinephrine, generated the brain scrubbing liquid flow through the channel system. The focal contractions, normally occurring ever 50 seconds, speed up the pump to every 10 seconds, in sync with peaks of norepinephrine release during sleep. Sleep deprivation appears to not only interrupt this cycle, and allow harmful wastes to accumulate, but also disrupts other mental health functions that scientists are just beginning to understand. For example, researchers in 2021 established that “sleep deprivation impairs people’s ability to suppress unwanted thoughts.” They were able to identify a special location on the brain cortex responsible for storing away memories, and  suppressing and delaying their future retrieval. They further demonstrated enhanced activity at the site during REM sleep. As the lead investigator noted, “That’s interesting because many disorders associated with debilitating intrusive thoughts, such as depression and PTSD, are also associated with disturbances in REM.” The new work may help explain destructive recycling of historic conflicts among and between Silicon Valley AI uber-competitors. They may not be getting enough sleep, recycling historic grudges and grievances. As the sleep scientists reported in the December, 2024 publication, “The functional impairments arising from sleep deprivation are linked to a behavioral deficit in the ability to downregulate unwanted memories, and coincide with a deterioration of deliberate patterns of self-generated thought. We conclude that sleep deprivation gives rise to intrusive memories via the disruption of neural circuits governing mnemonic inhibitory control, which may rely on REM sleep.” Mike Magee MD is a Medical Historian and regular contributor to THCB. He is the author of CODE BLUE: Inside America’s Medical Industrial Complex. (Grove/2020) 2025-01-17 17:09:15

“Life is what happens while we’re busy worrying about everything we need to change or accomplish. Slow down, get mindful, and try to enjoy the moment. This moment is your life.” ~Lori Deschene Are you living life in a constant pursuit—chasing happiness, freedom, comfort, or success? What if the thing you’re so desperately looking for isn’t at the finish line? What if life isn’t a race to be won? These were the questions I asked myself not long ago. I won’t lie; answering them didn’t completely change my life overnight. I didn’t have any major breakthrough when realizing what I’m about to tell you, but it was a starting point. The starting point was realizing I had spent most of my life waiting. Chasing the things I believed I lacked. In the pursuit of happiness, I was waiting for that moment in which all my dreams coming true would finally bring me everlasting joy. Aspiring to be a free spirit—as free as the wind—I created mental cages and rules that made me feel stuck and hopeless, like a bird that knows how liberating it is to fly but cannot spread its wings. Chasing comfort, I let possibilities for growth slip through my fingers and run away from me. Trying to reach success, I forgot to take care of what truly deserved my attention: my health, my relationships, and my spark. The major problem? When you chase something, you’re placing it far away from you. You’re increasing the distance between what you desire and what you believe you lack. But what you desire is already at your fingertips. I didn’t have to wait for happiness because happiness wasn’t a destination to reach. Achieving my goals and making my dreams come true wouldn’t have made me any happier unless I was ready to fully embrace happiness in the here and now. Happiness was already inside of me and all around. I just wasn’t looking. The freedom I was so desperately chasing could have never touched me if I first didn’t get rid of the mental blocks I’d created myself. If I first didn’t destroy the walls my own mind had built. I quickly realized that comfort wasn’t my friend—it just wanted to keep me safe, but not necessarily feeling alive. Chasing success had me run, run, and run without actually going anywhere, like a hamster on a wheel. If life isn’t a race, why are we always running? We jump from one goal to another, from one’s arms to another’s, from one dream to another. We’re always running, chasing something that ends up turning into nothing. If we allowed ourselves to take a moment, slow down, and hit the brake pedal, we’d soon realize that the chasing is what’s making us unhappy. It’s pushing all we ever wanted far away from us—within our eyesight, but out of our reach. How do you stop chasing the next big thing when you’ve spent your whole life in pursuit of something—anything? All You Want Is Already Within You The major change you must make is shifting your perspective about what you want. I wanted freedom, but I wasn’t allowing myself to feel it because I had created unbreakable rules for my life. Then, it hit me: How could I expect to experience freedom in other areas of my life (career, money, etc.) if I wasn’t even free from my own mind? Whether you want love, connection, happiness, or purpose, are you sure you’re not the one standing in your way? If you want love and connection, are you loving yourself and genuinely getting interested in others? If you want to be happier, are you filling your days with small things that can bring you more joy? If you want purpose, are you actively seeking and engaging in activities that can bring you a greater sense of purpose? Shift your perspective and start believing that everything you seek is already within you. Because it is. Live in the Here and Now Being more mindful means learning to be where your feet are. Embracing the here and now can put an end to what feels like an endless race. Because there can be no race if you learn not to place any expectations or hopes in the future. There’s just this moment—right here, right now. Nothing else matters. Nothing else really exists. If this moment is all that’s true and all that exists, it means you already hold in your hands what you’re chasing. Becoming more mindful means giving yourself the space to be, to exist—still, frozen, standing. Mindfulness is not an end state but a way of living. You don’t have to meditate for one hour every day to start being more mindful. There are practices other than meditation you can adopt to bring more mindfulness into your day. For example, you could start by changing how you do mundane tasks. It could be as simple as sipping your coffee slowly, noticing its warmth and flavor instead of chugging it down. Or listening to what your friend has to say instead of thinking how you’re going to respond. Or, why don’t you start doing one thing at a time instead of falling for the trap of multitasking? If your body is here, why do you let your mind be anywhere else? Celebrate the Journey Finally, if you want to stop chasing the next goal, mental state, or fleeting desire, you must recognize how far you’ve gone before you start looking at what’s ahead. Instead of not giving yourself the time to reflect and look at the progress you’ve made, why don’t you try to slow down for once? Celebrate your achievements, big or small. Praise yourself for the path you’ve walked before you start searching for the next finish line. Your results deserve recognition. What’s the purpose of setting big goals and milestones to reach if, once you get there, you don’t even allow yourself to feel it, to enjoy the experience? The pursuit of

“Expectations are premeditated resentments.” ~Unknown Yesterday, I found myself sitting across from my boss, fighting back tears as I voiced something that had been eating away at me for three years: “I don’t feel valued enough.” The words felt heavy in my throat. As a law professor, I’d always prided myself on being composed and professional. But in that moment, all my carefully constructed walls came crumbling down. “I put in extra hours. I mentor people. I’m always available when someone needs help,” I continued, my voice barely above a whisper. “But it feels like nobody really appreciates it. Like all this effort goes unnoticed.” Anyone who’s ever poured their heart into their work might recognize this feeling. Maybe you’re the colleague who always stays late to help others meet deadlines. Perhaps you’re the team member who takes on extra projects without being asked. Or the person who remembers everyone’s birthdays and organizes office celebrations. You give and give, hoping that somehow, this dedication will translate into the recognition and respect you crave. My boss listened quietly, his expression thoughtful. Then he shared two insights that shook my understanding of professional relationships. “First,” he said, leaning forward, “mastery in any field takes time. But here’s what most people miss—it’s not just about mastering your technical skills. It’s about mastering your relationship with the work itself.” I sat with that for a moment, letting it sink in. How much of my frustration came from actually doing my job versus my expectations of how others should respond to my efforts? “Second,” he continued, “when we tie our confidence to others’ reactions, we’re building our professional house on shifting sand.” That hit home hard. I realized I had created an elaborate scorecard in my head: Each extra hour should equal a certain amount of appreciation; each additional task should translate to a specific level of respect. When reality didn’t match these expectations, my confidence crumbled. It’s a trap many of us fall into. We believe that if we just work hard enough, stay late enough, and help enough people, recognition will naturally follow. When it doesn’t, we feel betrayed and undervalued and begin to question our worth. Ultimately, we need to learn to validate ourselves, but here’s where things get nuanced—and important. This doesn’t mean we should accept environments that consistently undervalue or exploit our dedication. There’s a delicate balance between developing intrinsic motivation and recognizing when a situation is genuinely unhealthy. Let me share what this balance looks like in practice. A few months ago, I noticed I was staying three hours late every day, answering work messages at midnight, and constantly taking on others’ responsibilities. At first, I told myself I was just being dedicated. But then I asked myself three crucial questions: 1. Is this a pattern of working hard without any recognition, or am I overextending myself because I’m seeking validation? 2. Are my extra efforts occasionally acknowledged, even if not always? 3. Do I feel safe expressing concerns about workload and boundaries? The answers helped me distinguish between my desire for constant validation and my legitimate need for basic professional respect. I realized that while I needed to work on my own relationship with external validation, I also needed to set clearer boundaries about my time and energy. That evening, I opened my laptop and started a different kind of work journal. Instead of tracking others’ reactions, I wrote down what I felt proud of that day: explaining a complex concept clearly, helping someone understand a difficult topic, and making progress on a challenging project. But I also noted when my boundaries were crossed and when additional effort went beyond reasonable expectations. This dual awareness—of both internal validation and external respect—changed everything. I learned to appreciate my own efforts while also advocating for myself when necessary. I started leaving work at a reasonable hour most days, saving those extra hours for truly important projects. I began setting boundaries around my availability, and surprisingly, this earned me more respect, not less. Here’s what I’ve learned about finding this balance: 1. Question your expectations. Distinguish between needing constant praise and deserving basic respect. 2. Look for impact, not appreciation. When I did this, I noticed small moments I’d previously overlooked: a quiet nod of understanding during a presentation and a subtle shift in someone’s confidence after our interaction. 3. Build internal metrics. Define success on your own terms, but don’t ignore red flags in your environment. 4. Set healthy boundaries. Your dedication shouldn’t come at the cost of your well-being. 5. Recognize the difference. Know when you’re seeking validation versus when you’re being undervalued. Most importantly, I’ve learned that true professional satisfaction comes from a combination of internal confidence and external respect. It’s about knowing your worth while ensuring you’re in an environment that, at least fundamentally, recognizes it too. Now, when I catch myself slipping into old patterns—checking for signs of appreciation or feeling resentful about unacknowledged efforts—I pause and ask two questions: “Am I doing this because it matters to me, or am I doing it for recognition?” And equally important: “Is this a reasonable expectation of my time and energy?” Some days are still challenging. There are still moments when I wish for more recognition. But I’ve found peace in knowing that while I don’t need constant validation, it’s okay to expect basic respect and appreciation in my professional life. The key is building enough self-worth to know when you’re seeking excess validation and when you’re simply asking to be valued appropriately. This morning, I walked into my workplace with a different energy. I felt confident in my worth, clear about my boundaries, and secure in knowing that while I don’t need endless praise, I deserve to be in an environment that recognizes my contributions. Because true professional growth isn’t about learning to accept less than you deserve—it’s about finding that sweet spot between internal validation and healthy external recognition. About Kalyani Abhyankar Kalyani Abhyankar is

By TAYLOR J. CHRISTENSEN When I attended the Institute for Healthcare Improvement’s 2024 annual forum in Orlando, Florida, one of the best parts of the conference, as always, was talking to the other attendees. Every time I would sit down to eat a meal or sit down in a session, I would talk to the people around me. And I heard about so many different quality improvement (QI) projects! After several conversations, I started to notice a pattern: Many of the projects were fighting an uphill battle because they were going against financial incentives. Or, at a minimum, they were not supported by financial incentives. All of this got me thinking about a new exhaustive, mutually exclusive categorization . . . All QI projects can be divided into three categories: Category 1: Supported by financial incentives Category 2: Neutral to financial incentives Category 3: Opposed by financial incentives Determining which category a potential project will fall into is important for predicting how much support from hospital leadership a QI project will have. So how do you determine which category a potential project is in? Remember that seeking profit (or “surplus” if you’re a non-profit organization) is what drives most behavior in all organizations, even in healthcare. And whatever is profitable is what organizations have a financial incentive to do. Here’s a simple formula for profit: Profit = Revenues – Costs In most industries, providing a higher-value product or service (Value = Quality / Price) compared to competitors will earn that organization greater market power, which they can use to extract greater profits either by keeping prices the same and winning more market share or increasing prices while maintaining the same market share. Either way, that greater market power turns into greater profit. In healthcare, however, higher value does not lead to greater market power. The reasons for this have been explained elsewhere, but it really comes down to patients not making value-sensitive decisions when they are choosing where they will receive care. Thus, quality improvement efforts that result in a healthcare provider delivering higher-value care are not automatically financially incentivized. Instead, the only factor that matters from a financial incentives standpoint is whether the QI project increases revenue or decreases costs. So, if a project will increase revenue and/or decrease costs, it’s in Category 1; if it will not have any net impact on profit because either it doesn’t change revenues or costs or it increases or decreases both of them equally, then it’s in Category 2; and if it increases costs or decreases revenues, it’s in Category 3. This all probably seems heartless–we’re talking about quality improvements that can save lives and quality of life here, and all I’m focusing on is money? Yes–it’s a simple financial reality that an organization can only survive and continue to serve the community if, on average, it earns more money than it spends. And since hospital margins are typically pretty tight these days, there isn’t a lot of executive support for quality improvement projects that decrease profit. I’ve talked about this elsewhere, but the problem isn’t the “financialization” of healthcare; the problem is that financial incentives are not aligned with what we want the healthcare system to do for us. And that is the major barrier to quality improvements. So until we can align our financial incentives with what we want the system to do for us, we’re stuck having to evaluate QI projects from a cold profitability perspective rather than a “does this improve the value we are delivering to patients?” perspective. Now let’s look at some examples I heard about from the other conference attendees and see if we can figure out which category they are in: Fascia iliaca nerve blocks: An emergency department in Saskatchewan, Canada, has been trying to increase the utilization of these nerve blocks for patients who come in with hip fractures because it improves pain control and decreases the amount of narcotics they need, both of which decrease delirium in these usually elderly patients. The uptake of the procedure has been positive but lackluster, mostly because it’s more effort for emergency medicine doctors to do the nerve block and because it’s asking them to change their practice habits, which is always difficult. The difference in cost of doing a nerve block versus giving more narcotics is small enough to be negligible, although it takes a few more minutes for the physician to do the procedure compared to simply ordering narcotics to be administered. This project probably falls into Category 2 (neutral to financial incentives) because it has no significant impact on either revenues or costs. Thus, you can’t expect any great push from hospital administration to support this project unless they are generally very quality conscious; otherwise, the focus of their time and effort is on trying to stay within their budgets while avoiding the worst quality errors. Inflammatory bowel disease (IBD) care improvement collaborative: This collaborative facilitates the sharing of QI frameworks, evidence, and best practices to help various provider teams across the country improve their care of IBD patients, which generally leads to an improvement in IBD control with fewer flares, fewer emergency department visits, and fewer hospitalizations. Notably, some of the providers involved in the collaborative have said that their hospitals don’t like that they’ve been decreasing emergency department visits and hospitalizations because it hurts the hospital’s finances. Clearly, from a hospital standpoint, this is in Category 3 (opposed by financial incentives). If the clinic is not part of the same organization as the hospital, then it’s probably Category 2 (neutral to financial incentives) for the clinic, or possibly also Category 3 if there is a significant amount of resources (costs) being dedicated to the improvement work without an associated increase in clinic revenues. This project will probably not get the interest and uptake it deserves because financial incentives are working against it. Some kind of shared savings arrangement with the insurers could help make this a win for everyone. Improving

By MATTHEW HOLT It’s JPM week. That means a ton of startup bros wandering around San Francisco wondering who all the biotech guys and investment banker greyhairs are and why they’re still wearing suits. Unlikely to be wearing suits are the digital health kids and the VCs they are trying to hunt down. The glory days are long gone. Athenahealth and Venrock are no longer having competing parties (or parties at all) and most of the starving startup kids looking for free booze and food are trying to scrounge invites to law firms who are still charging $1500 an hour for associate time before their clients notice that ChatGPT will do the same for $20 a month. But venture in digital health continues on, even if much of it is subtexting cramdown M&A, such as last week’s General Catalyst deal funding Transcarent’s takeover of Accolade. But I’m not really here to talk about the digital health VC market per se.  What I do want to talk about is who is getting VC. This was prompted (to my slow Small Language Model) by a female friend who has been a CEO and was once a star at a fast growing digital health company. She told me that being female was now an active hindrance to raising money. Every time some tech bro on LinkedIn says how they raised $XXm in 12 minutes with no pitch deck, you’ll see lots of female CEOs explode in anger. You don’t need me to repeat the numbers. Women & minorities find it hard to raise money. First time founders get a massive run around. Even when things were crazy in 2020-2022 the survey of startups I ran showed that it was very hard for early stage companies to raise money. Now it’s the apocalypse. That’s not to say some female CEOs aren’t raising. Just last week Nema Health run by former Health 2.0 star intern (and now practicing Psychiatrist–which may be more relevant!) Sofia Noori raised $14m Series A to expand its amazing PTSD cure program. Maven’s Kate Ryder raised another $125m late last year to keep expanding their women’s health program, and must be viewing that elusive IPO sooner or later. And at a JPM party I ran into some of Joanna Strober’s team, reminding me that I thought Midi Health had perhaps raised too much money when it pulled down another $60m last year–but apparently it is going gangbusters. There’s also Equip for eating disorders with Kristina Saffran & Erin Parks at the helm (over $95m in so far) and doubtless a few more I’m forgetting. But in general they are the exceptions. What’s not the exception is the tech bros raising for AI. Obviously the big players here are OpenAI, Anthropic et al pulling down billions to build their AI infrastructure. Anyone with a 401K is probably hoping that all works out given how much of the value of Nvidia, Tesla, Google, Meta, Microsoft & Apple seems to be based on a perhaps mythical AI abundant future. But there’s plenty in health care. Just this week Innovaccer ($275m), Qventus ($105m) & Truveta ($320m) all backed up the truck, all to combine data, AI and hope it will solve some of health care’s troubles.Those CEOs are men. But that’s not what I am complaining about. You can also be a man and get away with a lot more. Hippocratic AI’s CEO Manjul Shah ran his last company HealthIQ into the ground. He screwed over suppliers, employees and customers to at least the tune of $17m in unpaid bills according to Katie Jennings at Forbes, then took another $170k personally out of the bankrupt company after he’d left. Was he a pariah to the investors who’s lost over $200m? Not in the least. The same investors A16Z and General Catalyst gave him another $50m right away to build an AI nurse chatbot company, and apparently health systems are lining up to buy it according to a podcast he was on with Julie Yoo of A16Z last week. This week Kleiner Perkins (and more) kicked in another $141m. You might also have noticed that Ali Parsa who went through over $1 billion and crucified all his public market investors too when Babylon Health cratered is also back. His new company – an AI assistant launched with some famous doctors including Shafi Ahmed – is called Quadrivia AI. Funding isn’t clear but Sifted found some filings that indicate a Swedish VC is behind it.There’s also more than a little controversy about whether Babylon’s demise was just a series of bad business decisions or Parsa was lying about the tech. (I had Parsa on a couple of panels and always found him deferential and charming, but you can google Sergei Polevikov’s opinion!) Look, unlike Lisa Bari at The Health Tech Talk Show, I love the idea of getting AI to answer patients’ questions, call them with information and generally use bots to add “abundance” to the health care workforce. I mean it’s just an extension of what Alex Drane and Eliza (and Silverlink & others) were doing 15 years ago. And there is huge possibility in using AI to actually diagnose and treat. I’m sure Parsa’s new AI bot also has the potential to improve physician care.  But should it be that easy for guys like Shah and Parsa to immediately get back in the game given the chaos they left in their wake? Shouldn’t VCs have some qualms about anointing as saviours the very people who just screwed over their previous customers, partners, employees and investors? But I guess we have our answer already. Adrian Aoun took a big swing with Forward and closed it after losing $650m and leaving patients in the lurch with no notice and 200 people unemployed. He was back on a podcast days later saying his investors wanted to give him more to start again. And the biggest loser, chaos agent and conman of recent years, Adam Nuemann of WeWork

“The only way to make sense out of change is to plunge into it, move with it, and join the dance.” ~Alan Watts I used to think that stability was the key to happiness. Stay in one place, build a career, nurture long-term relationships—these were the pillars of a successful life, or so I believed. My life was a carefully constructed fortress of routine and familiarity. Wake up at 6 a.m., commute to the same office I’d worked at for a decade, come home to the same apartment I’d lived in since college, rinse and repeat. It was safe. It was predictable. It was slowly suffocating me. As I approached my fortieth birthday, I found myself increasingly restless. The walls of my comfortable life felt more like a prison than a sanctuary. I’d scroll through social media, seeing friends and acquaintances embarking on new adventures, changing careers, and moving to new cities, and I’d feel a pang of envy mixed with fear. “I wish I could do that,” I’d think, quickly followed by, “But what if it all goes wrong?” It was during one of these late-night scrolling sessions that I came across a quote from Alan Watts that would change everything: “The only way to make sense out of change is to plunge into it, move with it, and join the dance.” I stared at those words, feeling as if they were speaking directly to my soul. What if, instead of fearing change, I embraced it? The next morning, I woke up with a sense of purpose I hadn’t felt in years. I decided to make a change—not a small one, but a seismic shift that would challenge everything I thought I knew about myself and my life. I was going to quit my job, sell most of my possessions, and travel the world for a year. The moment I made this decision, I felt a mix of exhilaration and sheer terror. What about my career? My apartment? My relationships? The questions swirled in my mind, threatening to overwhelm me. But beneath the fear, there was a spark of excitement that I couldn’t ignore. I gave myself six months to prepare. Those months were a whirlwind of planning, saving, and facing the reactions of friends and family. Some were supportive; others thought I was having a midlife crisis. My parents were particularly worried. “But what about your future?” they asked, echoing the same concerns they’d had when I switched majors in college. As the departure date drew closer, my anxiety grew. There were moments when I seriously considered calling the whole thing off. What if I was making a horrible mistake? What if I couldn’t handle the uncertainty? It was during one of these moments of doubt that I realized something important: The fear I was feeling wasn’t just about this trip. It was the same fear that had kept me trapped in a life that no longer fulfilled me. If I gave in to it now, I might never break free. So, I pushed forward. I boarded that plane with a backpack, a one-way ticket, and a heart full of both terror and hope. The first few weeks were challenging. I felt lost, not just geographically but existentially. Who was I without my job title, my routine, my familiar surroundings? But slowly, something magical began to happen. As I navigated new cities, tried new foods, and met people from all walks of life, I felt layers of my old self peeling away. I discovered a resilience I never knew I had. Problems that would have sent me into a tailspin back home became adventures and challenges to solve. I learned to trust my instincts, to find joy in the unexpected, and to embrace the unknown. One particularly transformative moment came three months into my journey. I was hiking in the mountains of Peru, struggling with altitude sickness and questioning my decision to attempt this trek. As I sat on a rock, catching my breath and fighting back tears, an elderly local woman passed by. She smiled at me and said something in Quechua that I didn’t understand. But her smile and the gentle pat she gave my shoulder spoke volumes. In that moment, I realized that kindness and human connection transcend language and culture. I also realized that I was stronger than I ever gave myself credit for. As the months passed, I found myself changing in ways I never expected. I became more open, more curious, more willing to try new things. I learned to live with less and appreciate more. The constant movement and change became not just tolerable but exhilarating. I was, as Alan Watts had said, joining the dance of change. But it wasn’t all smooth sailing. There were days of loneliness, moments of doubt, and times when I missed the comfort of my old life. I learned that embracing change doesn’t mean you never feel fear or uncertainty. It means you feel those things and move forward anyway. As my year of travel neared its end, I faced a new challenge: what next? The thought of returning to my old life felt impossible. I was no longer the person who had left a year ago. But the idea of continuing to travel indefinitely didn’t feel right either. I realized I was craving a new kind of stability—one built on the foundation of flexibility and growth I’d cultivated during my travels. I decided to move to a new city, one I’d fallen in love with during my travels. I found a job that allowed me to use my old skills in new ways, with the flexibility to continue exploring the world. I made new friends who shared my love of adventure and personal growth. I created a life that embraced change rather than feared it. Looking back on this journey, I’m amazed at how far I’ve come. The person who was once paralyzed by the idea of change now seeks it out as

Hi friend! As you might recall, last fall I shared an empowering five-day meditation and writing challenge from Tiny Buddha contributor Nadia Colburn. This month, she’s back with another free meditation and writing challenge, designed for the new year, focused on transformation, and I can’t recommend it enough! Founder of the online creative writing school Align Your Story, Nadia is a poet, memoirist, and yogi who has a talent for helping people create inner calm and access their most authentic voice. That’s what I love about her challenges—they allow us to turn down the mental noise that creates stress and confusion and tune into the gold of our intuition and creative genius. Each day’s fifteen-minute recording includes a short meditation, an evocative poem, and a prompt-based writing exercise inspired by that day’s piece. Though the meditation practices all vary, they all gave me quick access to increased calm and focus. And the poems and prompts are all perfect for this season of transformation, when so many of us are looking to get unstuck and create positive change. Like last time, I recognized common themes in my writing—blocks I need to address, fears I need to face, beliefs I need to challenge, and truths I need to accept. Life has been particularly overwhelming in recent months, due to significant challenges in every area of my life, and I’ve often felt lost in the haze of my own mind. Each day’s challenge elicited a new aha moment for me, giving me hope that greater clarity is coming. You don’t need to even think of yourself as a writer to enjoy and get something out of this challenge. It’s for anyone who wants to connect with themselves more deeply and perhaps find some of the answers they’ve been seeking externally within the quiet of their own mind. Some of Nadia’s past participants have noted how easily their writing flowed after meditation and how the prompts brought them unexpected insights. If you decide to give this challenge a try, I have a feeling it could do the same for you. You can access it for free here. Happy writing! About Lori Deschene Lori Deschene is the founder of Tiny Buddha. She started the site after struggling with depression, bulimia, c-PTSD, and toxic shame so she could recycle her former pain into something useful and inspire others do the same. She recently created the Breaking Barriers to Self-Care eCourse to help people overcome internal blocks to meeting their needs—so they can feel their best, be their best, and live their best possible life. If you’re ready to start thriving instead of merely surviving, you can learn more and get instant access here. See a typo or inaccuracy? Please contact us so we can fix it! https://cdn.tinybuddha.com/wp-content/uploads/2025/01/Tiny-Buddha-Graphic-Nadia-Colburn-640-x-427-px-1.png 2025-01-14 03:36:43