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    Science & Medicine

    PeerSpectrum | Journeys in Medicine

    Welcome to PeerSpectrum, where we dive deep with uncommon conversations in and around medicine. Expand your practice by exploring the world and ideas beyond it and get ready to make your downtime count. Get ready for PeerSpectrum with Dr. Keith Mankin and Colin Miller.

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    Latest Episodes:
    Nullius in verba. Understanding uncertainty with statistician, Sir David Speigelhalter, PhD Dec 05, 2019
    Show notes

    Nullius in verba. Understanding uncertainty with statistician, Sir David Speigelhalter, PhD by Keith Mankin, MD & Colin Miller


    True Grit at Lost Rivers. Saving a hospital from the brink with CEO, Brad Huerta. Oct 14, 2019
    Show notes

    We've all heard the bad news about rural hospitals in the U.S. 60 million of our fellow citizens rely on these small hospitals, often known by their designation as critical access facilities. According to a recent analysis conducted by the consulting firm, Navigant, 21% of rural hospitals today are at a severe risk of closure. That includes 430 hospitals across 43 states, representing 21,000 staffed beds, 150,000 employees and $21 billion in revenue. When one of these hospitals closes (and 95 have so far since 2010) critical access to care isn't the only casualty. These hospitals are often largest employers and drivers of economic activity in their communities. The ripple effects are felt wide and deep every time a hospital shuts its doors. OK, that's the bad news. How about some good news? Today we're making the trip to a remote town in Idaho, known as Arco. With a population of only 900, Arco is small. You won't find many restaurants, you won't even find a Walmart but you will find a hospital. A small 14 bed hospital called Lost Rivers (by the way, what a cool name for a hospital, right). Its existence and survival in the face of overwhelming odds is the story of today's episode. When our guest, CEO Brad Huerta, took over in 2013, he wasn't there to save Lost Rivers, he was there to shut it down. With over three million dollars in debt, pending bankruptcy, and only seven thousand dollars of cash in the bank, the situation was beyond grim. Today this same hospital is cash positive, free of every dime of debt, running six years with a yearly profit, and getting ready to open a new surgery center. How is this possible and what happened after Brad arrived? Well, it's one heck of a ride and one hell of a story. So buckle in and get ready. With that said, let's get started.


    Crossing Medicine's Last Perimeter. Aging & Longevity with Harvard Geneticist, David Sinclair, PhD. Sep 20, 2019
    Show notes

    Today we're heading to the front-lines of research testing and challenging one of the most basic truths of the human experience...we all get older and we all eventually die. Today's guest doesn't buy this. In fact, he actually views aging as a diagnosable disease, a disease that can be managed today, and one day fully treated. Now, before you start rolling your eyes, let's meet today' guest. David Sinclair is a professor of genetics at Harvard Medical School and co-director of the Paul Glenn Center Biological Mechanisms of Aging. He is widely considered one the world's foremost experts on longevity research. A co-founder of the journal Aging and several biotech companies, he also holds 35 patents. A recipient of more than 25 awards and honors, including being knighted in the Order of Australia, and Time Magazine's top 100 most influential people. Besides his peer-reviewed research, his work is featured in five books, two documentary movies, 60 Minutes, Morgan Freeman’s, “Through the Wormhole,” and other media. David's newest book, “Lifespan, Why We Age and Why We Don't Have To,” is to quote the blurb on the cover, “an elegant and exciting book that deserves to be read broadly and deeply." That comes from Siddhartha Mukherjee, the famous Columbia University oncologist, and winner of the Pulitzer prize. Not bad! It was a rare treat to have David with us today. Our conversation is also a great reminder that these really are incredible and exciting times we're living in. With that said, let's get started.


    Lockdown. Inside Prison Medicine with ER Physician, Dr. Jeffrey Keller. Sep 12, 2019
    Show notes

    All right welcome back. Here's a quick trivia question, which group of US patients are constitutionally guaranteed access to free medical care? And no this is not a trick question. The answer...prisoners. Today we're jumping into an area of medicine few, if any of us, know much about. Let's be honest, how many of you out there have even seen the inside of a prison of jail? Not many, we guess. Criminal records and professional medical licensing don't mix well. For those of you who've been with us for awhile, you know this isn't a political program. I say this because I'm going to read a few stats here. Don't worry, we're not gearing up for a policy discussion on prison reform. It is an important issue, but outside the scope of our conversation today. As of 2016, there were 2.1 million people incarcerated in the US. That makes us the world leader both in the total number incarcerated and a per-capita incarceration rate (655 per 100,000). That rate beats everyone, even places like China, North Korea, Russia, Kazakhstan and Saudi Arabia. As of 2015, the US population represented only 4.4% of the global population, while we held a whopping 21% of the global prison population. We're reading these stats to show just how big US prison medicine is. That's over two million people who are constitutionally guaranteed free medical care. Just imagine how many doctors, nurses and other medical professionals it takes to deliver that amount of care. Today's guest is one of them. [Read more…] Dr. Jeffery Keller is emergency medicine physician. After 23 years working in a busy trauma center, Keller got a call from the local jail. They needed help. Working in prison didn't sound very appealing, so he politely declined. Six months later they called again. This time he reluctantly agreed, but only temporarily. Then a funny thing happened, Keller actually started to enjoy his work seeing and treating inmates. So began a new path in Keller's career. A path through a largely unknown area of medicine that we're going to explore today. With that said, let's get started.


    Trading Places. Do Doctors Make Better Patients? MIT Economist, Jonathan Gruber, PhD. Aug 30, 2019
    Show notes

    All right welcome back. If you could pick the ideal patient population, armed with the best knowledge, fluent in medical jargon, generally healthy and willing to comply with recommended treatments, who would you pick? How about doctors? Doctors may not be perfect patients but at least they should outperform similar non-clinicians, right? Surprisingly, little to no research has actually been done comparing the care, compliance and outcomes of doctors to comparable groups of non- physicians. For reasons we'll soon see, this is actually a difficult question to tackle, but it's a very important question with broader implications. Today's guest is MIT economist, Jonathan Gruber. He recently co-authored a study using a unique data source to examine just how good doctors and their family members are when they find themselves in the patient seat. Spoiler alert, obviously if the results aren't surprising, we probably would not be here talking about it. That's for the first part of this episode. In the second, we'll explore some of Jonathan's other work. Besides his 160 researcher papers, seven books, numerous awards and prestigious appointments, there's also something else Jonathan is known for. He was one of key advisors (come have even called architects) of Romney-care and Obamacare. Perhaps you've forgotten so let's see if this jogs your memory: www.youtube.com/watch?v=tLOV4oUXawg So if you've been listening to us long enough, you know PeerSpectrum, unlike CNN, is not your home for politics. There are plenty of other places to go for that. Not that Keith and I don't have our opinions, we just recognize our limitations. We aren't journalists and we don't pretend to be. We'll leave the politics to them. Did we bring up Gruber's history and talk about it? You bet. There was no way we could skip it completely. In his own words, Gruber became a virtual proxy for the intense debates taking place during the lead up the passage of the ACA. Whatever you think about Obamacare, or Gruber personally, he's important figure and someone worth talking with. With that said, let's get started.


    The American Doctor at Chernobyl, Part II: Dr. Robert Gale Jul 23, 2019
    Show notes

    As you heard last time, Dr. Gale (a bone marrow transplant specialist from UCLA) rose to international prominence after being the first American physician invited by the Soviet Union to treat patients suffering acute radiation trauma, only days after the horrific incident at Chernobyl. Our journey continues as Dr. Gale is flown in by helicopter to personally survey the Chernobyl nuclear power-plant. This only weeks after the meltdown of reactor number four. We'll see what it was like walking through the eerily empty streets of Pripyat. This was literally one of the most dangerous and heavily restricted areas on the planet. For an outsider, especially an American, to be personally inspecting this area, actually treating patients, all during the height of the cold war, was simply unthinkable... until it actually happened. For those of you who enjoyed the recent hit HBO series on Chernobyl, we'll spend a little more time there. Then we'll move on to subsequent nuclear incidents such as Tokiamura and Fukushima, and Dr. Gale's first hand experience with those. We'll discuss his lessons learned and his thoughts on the future of nuclear energy. We'll also see what he's up to today. It's an incredible part II for this rare series. With that said, let's get started.


    The American Doctor at Chernobyl, Part I: Dr. Robert Gale Jun 05, 2019
    Show notes

    Thirty three years after the worst nuclear disaster in human history, the name Chernobyl rings ominously, and continues to inspire fear, outrage, debate and grim curiously. It's a captivating story now being re-told dramatically, though not completely accurately, through HBO's new and very popular mini-series. We've had some pretty unique people on this program but perhaps today's guest is more unique than most. Dr. Robert Gale is an academic physician who's spent his career researching and treating patients with Leukemia and other bone marrow disorders. He's published over 800 research articles and books, he's an international expert on nuclear disaster response, and get this...he's even written for, and appeared in several Hollywood movies. Oh, he's also the shared recipient of an Emmy award for his work in a, "60 Minutes" piece. As you heard in the opening news clip, Dr. Gale rose to international prominence after being the first American physician invited by the Soviet Union to treat patients suffering from acute radiation trauma after Chernobyl. It's where our journey begins on this special two part episode. With that said, let's get started.


    Treating Mother Teresa & Model-T Medicine: Cardiac Surgeon, Dr. Devi Shetty May 07, 2019
    Show notes

    Today's guest is Dr. Devi Shetty, a cardiac surgeon, entrepreneur and one of the most famous physicians in India. What's he famous for? Well, he performed the very first neonatal heart surgery in India, and actually served as Mother Teresa's personal physician after operating on her following a heart attack. Obviously, we weren't missing the opportunity to explore these unusual stories, but they are far from the main focus of our conversation. Dr. Shetty is best known for the unique and innovative health system he created. A system so revolutionary, the Wall Street Journal has nicknamed him the "Henry Ford of Medicine." We'll uncover what it takes to perform an advanced cardiac procedure, with western trained doctors, state of the art equipment, comparably lower complication rates than most US hospitals, for only $2,000 with a profit. The same procedure that would cost over $100,000 in the US with higher complication rates and additional OR time. Make no mistake, their model isn't simply about cheaper overseas labor and this isn't a story about medical tourism. We'll see how Naryana Health functions as a working laboratory for testing and implementing new techniques, technologies, models, and training allowing them to be more agile, efficient and safer than any hospital you have likely yet encountered. We'll see how Naryana Health has become a profitable publicly traded company while adhering to a policy of never refusing care to a patient regardless of their ability to pay. Yes, you heard that right! A profitable private hospital system that also provides free medical care. An hour just wasn't enough here. It was incredible conversation that only just scratches the surface of what's going on. It's also a forward look at what's coming whether we like it or not. With that said let's get started.


    Meditation Head-On: Neurosurgeon and Buddhist Priest, Dr. Patrick Codd Mar 19, 2019
    Show notes

    Keith and I have long considered doing an episode on meditation. What held us back was our goal (as it is with every episode) to answer these two questions: how would the episode specifically benefit you, the physicians and medical professionals in our audience, and how would we avoid simply rehashing a well worn topic explored elsewhere? As you know, we're not big on chasing trends here. So we tabled it, until just recently, when we came across today's guest. Dr. Patrick Codd earned his M.D. in the Harvard Medical School/MIT Health Science & Technology Program. He then completed his residency in Neurosurgery at the Massachusetts General Hospital/Harvard Medical School. Patrick then served as the Director of the North Neurosurgical Service at Massachusetts General Hospital, and an Instructor in Surgery at Harvard Medical School before joining the neurosurgery staff at Duke University Medical Center where we find him today. [Read more…] Not only is Patrick a solidly credentialed neurosurgeon at a world class institution, he's also, get ready for this, an ordained Buddhist priest. Not a combination you find everyday but just the kind of person we knew we had to invite on the program. We'll explore Patrick's uncommon path and his unique perspective on meditation. After-all, the brain isn't just the focal point of Patrick's meditative practice, it's also something he actually operates on every week. We'll learn how meditation initially helped him manage the daily encounters with stress and patient suffering he experienced as a resident. Then we'll see how a busy neurosurgeon fits meditation into his daily workflow, becoming a critical element of his life and practice. Maybe you already have a meditation routine, maybe you've tried it but found little benefit, or maybe you're still highly skeptical of the whole thing. Wherever you're coming from, this episode will have something for you. With that said, let's get started...


    Mismeasuring Medicine. "The Tyranny of Metrics," with Jerry Z. Muller, PhD Mar 07, 2019
    Show notes

    Most of you know the quote, “If you cannot measure it, you cannot improve it.” It's often attributed, incorrectly, to the famous nineteenth century physicist, Lord Kelvin. Wherever it came from, it's sounds about right. Same goes for this familiar quote from a popular business book author, “What gets measured gets done.” Well, in today's episode were going to talk about what's getting measured and what's actually getting done. What's getting measured are thousands of performance and quality indicators. What's getting done is docking our medical system billions of dollars every year in costs and lost productivity. Nothing new to all of you out there. But what if this “metric fixation,” is doing more than just wasting time and money? Used correctly, metrics and big data analysis offer incredible promise for research, visibility and improvement. Used incorrectly, they can steer us off course, devalue professional judgment, manipulate, encourage fraud, and possibly cause real harm to physicians, hospitals and patients. As you know, every so often we like to venture outside the medical tent for unique perspectives. That's certainly true of today's guest, historian Jerry Muller. Author of many books and a regular contributor to The New York Times, The Wall Street Journal and Foreign Affairs. His recent book, “The Tyranny of Metrics,” arose from his initial frustrations with metric fixation in higher education. As he dug deeper, he soon realized these fixations weren't' limited to universities, and they weren't new. They were already prevalent in business, law enforcement, the military, philanthropy, and of course medicine. What he found was a growing obsession with rankings, scores and a belief that all aspects of human performance and judgment can ultimately be deconstructed, demystified and quantified. This was a fascinating discussion with a rare thinker and scholar, we hope you'll enjoy. With that said let's get started.


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