The Accad and Koka Report

Ep. 214 Polio’s Eradication: At What Price? Nov 13, 2022

A round table discussion of a chapter from the book Dissolving Illusions by Suzanne Humphries, MD, and Roman Bystrianyk. Our guest is the anonymous internet personality and blogger who writes under the pen name of Medical Nemesis.

GUEST:

Medical Nemesis: Twitter and Substack

WATCH ON YOUTUBE:

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Ep. 213 Paul Thacker on Disinformation and Corruption Nov 09, 2022

Our guest is Paul Thacker, an investigative journalist who reports on science, medicine and the environment. He recently received the British Journalism Award in Specialist Journalism for a series of articles in the BMJ investigating undisclosed financial interests among medical experts advising the US and UK governments on vaccines.

GUEST:

Paul Thacker: Twitter and Substack

WATCH ON YOUTUBE:

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Ep. 212 Internet Rando vs. CDC Oct 22, 2022

Our guest is Kelley Krohnert, a mom from Georgia who has repeatedly taken to task public health so-called experts for their shoddy analysis of pandemic statistics. In doing so, Kelley has won a large following on Twitter and on her website COVID-19 in Georgia which is well-respected for its reporting on the pandemic.

One of Kelley's major fact-checking contribution was to discover that a pediatric COVID mortality statistics that was widely disseminated by the CDC, presented at the June 2021 ACIP meeting, and used to establish vaccine policy, was taken from a pre-print article that contained an egregious error and grossly over-estimated COVID deaths among children. This error was admitted by the authors who were forced to correct the paper.

GUEST:

Kelley Krohnert: Twitter and webpage

WATCH ON YOUTUBE:

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Ep. 211 The Doctor’s Office Time Crunch: A Historical Review Oct 18, 2022

Our guest is Michelle-Linh Nguyen, a research fellow in the National Clinician Scholars Program at UCSF. She is the first author of a recent article published in Annals of Internal Medicine examining the history of time organization in U.S. outpatient medicine.

GUEST:

Michelle-Linh Nguyen: Twitter and UCSF webpage

WATCH ON YOUTUBE:

Watch the episode on our YouTube channel

Ep. 210 The Florida Vaccine Study in Perspective, with Tracy Beth Hoeg Oct 14, 2022

Our guest is Tracy Høeg, MD, PhD, who returns to the show to share her perspective on the controversial study published by the Florida Department of Public Health analyzing a possible link between COVID mRNA vaccines and cardiac-related deaths. Dr. Høeg has made notable contributions to empirical research pertaining to SARS-COV2 transmission in schools and to vaccine-related myocarditis. She has published her findings in the CDC’s MMWR and has given oral testimony to Congress.

GUEST:

Tracy Høeg, MD, PhD: Twitter

WATCH ON YOUTUBE:

Watch the episode on our YouTube channel

Ep. 209 The Physics and Metaphysics of Fetal Heartbeats Oct 02, 2022

Drs. Anish Koka and Michel Accad discuss the controversy regarding the meaning of fetal heartbeats and Dr. Koka's latest Substack article on the subject.

LINKS:

Anish Koka's Newsletter
Michel Accad's Alert and Oriented blog

WATCH ON YOUTUBE:

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Ep. 208 Ben Recht on the Humble Side of Machine Learning Aug 10, 2022

Our guest is Ben Recht, Associate Professor of Electrical Engineering and Computer Science at UC Berkeley, and co-author with Moritz Hardt of Pattern, Prediction, and Action: A Story About Machine Learning soon to be published by Princeton University Press but already freely available as a pdf format pre-print here. We discuss his work and perspective on machine learning and artificial intelligence.

GUEST:

Ben Recht: Twitter and webpage

LINKS and RELATED EPISODES:

AI in medicine: What's hype and what's real (YouTube episode with Anish Koka and Ben Recht)
Ep. 187 That Bengladesh Mask Study! (with guest Ben Recht)
Ep. 5 Normal is Fuzzy (with guest Saurabh Jha)
Lecture by Peter Hacker on the claims of cognitive neuroscience (YouTube)

Ep. 207 A Conversation with Andrew Bostom Jul 26, 2022

Our guest is Dr. Andrew Bostom, an academic physician also known as “The Researcher Brown University Doesn’t Want You to Know About.” We discuss his life experience as an academic physician with politically conservative views, his opposition to the pandemic response, and his recent suspension from Twitter.

GUEST:

Andrew Bostom: Twitter

LINKS:

Andrew Bostom’s blog

RELATED EPISODES:

Ep. 192. A Conversation with Viral Myalgia

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Ep. 206 Mattias Desmet on the Psychology of Totalitarianism Jun 21, 2022

Our guest is Mattias Desmet, Professor of Psychology at the University and Ghent and author of The Psychology of Totalitarianism. He discusses with us the phenomenon of "mass formation" and its emergence from a background of a mechanistic ideology that has gripped the developed world over the last 300 years,

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Ep. 205 Stanley Goldfarb on Taking CRT Out of the Exam Room Apr 26, 2022

Our guest is Dr. Stanley Goldfarb, author of the recently-released Take Two Aspirins and Call Me By My Pronouns, a book that details the intrusion of critical race theory and identity politics into medical education and medical practice. He is a former Associate Dean for Curriculum at the University of Pennsylvania Perelman School of Medicine and returns to the show to discuss his book and the new organization that he is leading to push back against the new trend.

GUEST:

Stanley Goldfarb: Twitter

LINKS:

Do No Harm

RELATED EPISODES:

Ep. 102 Curriculum Subverted: An Academic Leader Pushes Back Against Woke Medicine (with Stanley Goldfarb)
Ep. 140 Amy Wax on Wokeness in Medicine
Ep. 149 James Lindsay: Critical Race Theory, Post-Modernism, and Medicine

WATCH ON YOUTUBE:

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Ep. 204 Maternal Mortality: Statistics and Realities, with Steven Calvin Apr 08, 2022

Our guest is Steven Calvin, a maternal-fetal medicine physician who is currently serving on the US HHS Secretary’s Advisory Committee on Infant Mortality (SACIM). Dr.Calvin has 40 years of experience in the field and is the founder and medical director of the Minnesota Birth Center. We have a wide-ranging conversation discussing trends in maternal mortality, COVID and pregnancy, and the role of midwives in the ecology of obstetric care.

GUEST:

Steven Calvin: Bio at the Charlotte Lozier Institute and Minnesota Birth Center

LINKS:

Studnicki et al. Improving the metrics and data reporting for maternal mortality: A challenge to public health surveillance and effective prevention (published in OJPHI)
Studnicki and Fisher. Recent increases in the US maternal mortality rates: Disentangling trends from measurement issues (published in Obstretrics & Gynecology)
Ameya Kulkarni. Maternal Mortality: Separating Signal from Noise (published in The Health Care Blog)

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Ep. 203 Why Non-Compete Clauses Turn Patients Into Property, with Amy Doherty Mar 31, 2022

Our guest is Dr. Amy Doherty who was issued a restraining order from her former employer for allegedly violating a non-compete clause. She received the order a week after opening her new practice in an underserved area.

GUEST:

Amy Doherty: Practice website, FaceBook page, and personal blog

LINKS:

"Divine Savior suit seeks to stop doctor from opening a Portage practice" (report in the Portage Daily Register)

RELATED EPISODES:

Ep. 80 How to Rollback Bad Healthcare Laws (with Marcelo Hochman)
Ep. 18 A Doctor Fights Against CON Laws (with Gajendra Sign)

WATCH ON YOUTUBE:

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Ep. 202 Ian Miller on the Global Failure of Mask Mandates Mar 15, 2022

Our guest is Ian Miller, author of Unmasked: The Global Failure of COVID Mask Mandates, a detailed chronicle of 24 months of arbitrary, wholly inconsistent, and grossly unscientific mask mandates.

GUEST:

Iam Miller: Twitter and Substack

LINKS:

Anish Koka “The COVID Pandemic: Who Dunnit?” (from The Health Care Blog)

RELATED EPISODES:

Ep. 187 That Bangladesh Mask Study! (with guest Ben Recht)
Ep. 188 Jason Abaluck on the Bangladesh Mask Trial

WATCH ON YOUTUBE:

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Ep. 201 Ali Mortazavi on RNA technology Mar 05, 2022

Our guest is Ali Mortazavi, CEO of eTherapeutics, a UK-based computational biology company focused on the development of RNA technology. He shares with us his perspective on mRNA vaccines and the application of RNA technology to medicine in general.

GUEST:

Ali Mortazavi Twitter and company website

WATCH ON YOUTUBE:

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Ep. 200 Public Health and Conservatives: Time for Affirmative Action? Feb 26, 2022

Our guests are University of Chicago Professor Harold Pollack and Robert Graboyes, Senior Fellow at the Mercatus Center discussing the place of conservatives in public health.

GUESTS:

Harold Pollack: Twitter and W ebsite

Robert Graboyes: Twitter and Website

LINKS:

Harold Pollack: “Why Public Health Experts Aren’t Reaching Conservatives on Covid” (from Politico)
Robert Graboyes: “Conservatives and Public Health: A Warm Welcome in a Cold Climate” (from Discourse Magazine)

RELATED EPISODES:

Ep. 179. Political Conservatism: Cure to a Failed Health Care Liberalism? (with guest Shawn Whatley)

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Ep. 199 David Cayley: How the Mythology of “Saving Lives” Is Tearing Us Apart Feb 19, 2022

David Cayley returns to the show to discuss the the social fractures and "divisions among friends" engendered by the pandemic response. Using the thought of Ivan Illich as a point of departure, we have a wide-ranging conversation on the myths and realities of the role of science in political life.

GUEST:

David Cayley Website

LINKS:

David Cayley "Concerning Life"
A conversation on Ivan Illich's Shadow Works (YouTube)

RELATED EPISODES:

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Ep. 198 Shamez Ladhani on COVID and Children: What the Science Shows Feb 12, 2022

Our guest is Dr. Shamez Ladhani, a pediatric infectious disease specialist with a focus on vaccine-preventable diseases. He also holds a position of epidemiologist at Public Health England and has been among the first to obtain real life data on the effects of the pandemic on children and schools. He joins us to discuss his perspective on what a public health policy based on data, rather than perception and fear, should look like.

GUEST:

Shamez Ladhani: Twitter and ResearchGate profile

LINK:

Shamez Ladhani. "Children and COVID-19 in Schools" Perspective article in Science Magazine, November 2021

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Ep. 197 Accad v. Koka on Brain Death Feb 09, 2022

Dr. Accad and Dr. Koka hash out their disagreements on the question of brain death.

RELATED EPISODES:

Ep. 35 Why Brain Dead Isn’t Dead: An Introduction to “Shewmon’s Challenge.” with Alan Shewmon, MD
Ep. 45 Brain Death at the Bedside with Fred Rincon, MD
Ep. 145 Diagnosing Brain Death: Clinical and Legal Quagmires with Doyen Nguyen, MD, and Alan Shewmon, MD
Ep. 196 Taking a Stand Against Brain Death with Paul Byrne, MD, and Christine Zainer, MD

WATCH ON YOUTUBE:

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Ep. 196 Taking a Stand Against Brain Death Feb 06, 2022

Our guests are Drs. Paul Byrne a pioneer neonatologist and Dr. Christine Zainer, an anesthesiologist from Wisconsin. Drs. Byrne and Zainer discuss their involvement in the care of patients with severe brain injury, particularly those given a diagnosis of "brain death."

GUEST:

Paul Byrne: Website

LINKS:

"Dr. Paul Byrne: From preemies to end-of-life issues, one man has made a difference." (article from Celebrate Life magazine by Rob Sample)
Doyen Nguyen: The New Definitions of Death for Organ Donation and Transplantation: A Multidisciplinary Analysis from the Perspective of Christian Ethics (Amazon link)
Michael Potts, Paul Byrne, Richard Nigels Beyond Brain Death: The Case Against Brain-Based Criteria for Death (Springer)

RELATED EPISODES:

Ep. 35 Why Brain Dead Isn't Dead: An Introduction to "Shewmon's Challenge." with Alan Shewmon, MD
Ep. 45 Brain Death at the Bedside with Fred Rincon, MD
Ep. 145 Diagnosing Brain Death: Clinical and Legal Quagmires with Doyen Nguyen, MD, and Alan Shewmon, MD

WATCH ON YOUTUBE:

Watch the episode on our YouTube channel

Ep. 195 Vaccine Myocarditis: A Personal Encounter Jan 27, 2022

Our guests are Aiden and Emily Jo Ekanayake. Aiden had vaccine-induced myocarditis last June and he and his mother relate the experience and the consequences—physical, emotional, and financial—that they are facing to this day. GUEST: Emily Jo Ekanayake: Twitter WATCH ON YOUTUBE: Watch the episode on our YouTube channel

Ep. 194 The Psychology of the Pandemic Response, with JD Haltigan Jan 09, 2022

Our guest is JD Haltigan, a developmental psychologist at the University of Toronto who joins us to discuss psychological factors that may explain the larger social phenomena in the pandemic response.

GUEST:

JD Haltigan, PhD: Twitter and Substack

LINKS:

JD Haltigan. "Understanding pandemic-emergent personality and behavioral psychopathology."
JD Haltigan. "Pittsburgh: A City Study in the Successor Ideology."

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Ep. 193 Tracy Høeg on the Anti-Science of School Closures Jan 01, 2022

Our guest is Tracy Høeg, MD, PhD, who has made remarkable research contributions pertaining to SARS-COV2 transmission in schools and to vaccine-related myocarditis. She has published her findings in the CDC's MMWR and has given oral testimony to Congress.

GUEST:

Tracy Høeg, MD, PhD: Twitter

WATCH ON YOUTUBE:

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Ep. 192 A Conversation with Viral Myalgia Dec 14, 2021

Our guest is the anonymous physician who provides very keen analyses of COVID-related issues on well-documented Twitter threads.

GUEST:

Viral Myalgia, MD, PhD: Twitter

WATCH ON YOUTUBE:

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Ep. 191 The Myth of Statistical Inference (Part 2): At the Heart of the Replication Crisis Dec 11, 2021

Our guest is Michael Acree author of The Myth of Statistical Inference, published by Springer earlier this year. Dr. Acree is a former statistician at the University of California San Francisco. This is the second episode in a 2-part series.

GUEST:

Michael Acree, PhD.

RELATED EPISODES:

Ep. 49 Many Statisticians, Many Answers: The Methodological Factor in the Replication Crisis (with Brian Nosek)

Ep. 57 Neither Fisher nor Bayes:The Limits of Statistical Inference

Ep. 190 The Myth of Statistical Inference (Part 1) Historical Background

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Note: The Accad and Koka Report participates in the Amazon Affiliate program and may earn a small commission from purchases completed from links on the website,

Ep. 190 The Myth of Statistical Inference (Part 1): Historical Background Dec 09, 2021

Our guest is Michael Acree author of The Myth of Statistical Inference, published by Springer earlier this year. Dr. Acree is a former statistician at the University of California San Francisco. This is the first episode in a 2-part series.

GUEST:

Michael Acree, PhD.

RELATED EPISODE:

Ep. 57 Neither Fisher nor Bayes:The Limits of Statistical Inference

WATCH ON YOUTUBE:

Watch the episode on our YouTube channel

Note: The Accad and Koka Report participates in the Amazon Affiliate program and may earn a small commission from purchases completed from links on the website,

Ep. 189 Paul Marik on Letting Doctors Be Doctors Dec 06, 2021

Our guest is Dr. Paul Marik, an acclaimed academic leader in critical care medicine who has also taken controversial positions over the years about the treatment of patients, most notably recently about using Ivermectin as part of a treatment protocol for COVID-19. We discuss his career and the tension between the knowledge that comes from clinical experience and that derived from formalized clinical studies.

GUEST:

Paul Marik, MD: Webpage and Curriculum Vitae

WATCH ON YOUTUBE:

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Ep. 188 Jason Abaluck on the Bangladesh Mask Trial Dec 03, 2021

Our guest is Jason Abaluck, Professor of Economics at the Yale School of Management and one of the principal investigators of the Bangladesh cluster randomized trial of community masking that was just published in Science.

GUEST:

Jason Abaluck, PhD: Twitter and faculty webpage

RELATED EPISODE:

Ep. 187. That Bangladesh Mask Study! with Ben Recht

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Ep. 187 That Bangladesh Mask Study! Nov 28, 2021

Our guest is Ben Recht, Associate Professor of Electrical Engineering and Computer Science at UC Berkeley, who recently got hold of and analyzed the raw data from the Bangladesh cluster randomized control trial of masking which made headlines in September.

GUEST:

Ben Recht: Twitter and webpage

LINKS:

Ben Recht's recent blog post: Revisiting the Bangladesh Mask RCT
Michel Accad Why N-of-1 is Enough
Ep. 97 with Peter Klein on "Evidence-Based Economics: What the Doctor Ordered?"

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Ep. 186 Jenin Younes on Legal Challenges to Vaccine Mandates Nov 26, 2021

Our guest is Jenin Younes, a Litigation Counsel for the New Civil Liberties Alliance. She joins us to discuss her involvement in advocacy and in legal challenges against vaccine mandates. She holds a B.A. degree from Cornell University and a J.D. from New York University School of Law. She has been featured on several national media outlets for her commentary and she recently penned an op-ed in the Wall Street Journal building the case against mandatory vaccination in children.

GUEST:

Jenin Younes: Twitter and webpage

WATCH ON YOUTUBE:

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Ep. 185 James Heathers on Ivermectin, Data Science, and Trust Nov 23, 2021

Our guest is James Heathers, physiologist, scientist, and part-time "data thug" who's developed the technique of sniffing out fraudulent or highly erroneous scientific publications into an art. He has recently published "The Real Scandal About Ivermectin," an article in The Atlantic featuring an analysis that he and his colleagues have performed identifying devastating flaws in some randomized control trials that purportedly showed Ivermectin to be effective against COVID-19. The article discusses the Ivermectin story in the broader context of the reliability of scientific publications. James is also Chief Scientific Officer at the technology company Cipher Skin.

GUEST:

James Heathers, PhD: Twitter, and podcast

PREVIOUS APPEARANCE ON THE PODCAST:

Ep. 65 James Heathers: Why Science Needs Data Thugs.

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Ep. 184 Vinay Prasad Nov 19, 2021

Our guest is Vinay Prasad, hematologist-oncologist and Associate Professor in the Department of Epidemiology and Biostatistics at the University of California San Francisco. He is the author of over 300 academic articles, and the books Ending Medical Reversal(2015), and Malignant(2020). We have a wide-ranging conversation covering public health, the politicization of science, and the future of the established institutions of knowledge.

GUEST:

Vinay Prasad: Twitter, YouTube, and Website

PRIOR APPEARANCE ON THE SHOW:

Ep. 153 Vinay Prasad: Making Conversations About Medicine Great Again.

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Make a small donation on our Patreon page

Ep. 183 Approving COVID Vaccines for Children: Part 2 with Cody Meissner Nov 15, 2021

Our guest in Dr. Cody Meissner, Chief of Pediatric Infectious Disease at Tufts University School of Medicine, and member of the FDA's Vaccine and Related Biological Products Advisory Committee (VRBPAC) who recently approved the EUA for Pfizer's COVID vaccine for children ages 5-11.

GUEST:

H. Cody Meissner, MD: Webpage

WATCH ON YOUTUBE:

Watch the episode on our YouTube channel.

Ep. 182 Approving COVID Vaccines for Children: Part 1 with Paul Offit Nov 14, 2021

Our guest is Dr. Paul Offit, an expert on vaccines, immunology, and virology. He is the Maurice R. Hilleman Professor of Vaccinology, Professor of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania and Director of the Vaccine Education Center at The Children’s Hospital of Philadelphia. He is also a member of the FDA's Vaccines and Related Biologic Products Advisory Committee (VRBPAC) which recently approved the EUA for the Pfizer's Covid-19 vaccine for children age 5-11.

This is part 1 of a 2-part series on this topic.

GUEST:

Paul Offit, MD: Twitter and Webpage

WATCH ON YOUTUBE:

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Ep. 181 Medicine, Capital Punishment, and the Troubling Reality of Death by Lethal Injection Nov 10, 2021

Our guest is Dr. Joel Zivot, Associate Professor of Anesthesiology at Emory University School of Medicine in Atlanta. Ho also holds a Masters degree in ethics and is a Senior Faculty Fellow at the Emory University Center for Ethics. He shares his personal experience with and perspective on the reality of death by lethal injection and discusses why the medical profession should not serve as an arm of the State.

GUEST:

Joel Zivot, MD: Twitter and Webpage

WATCH ON YOUTUBE:

Watch the episode on our YouTube channel.

Ep. 180 A New Yorker Speaks Truth to Power Nov 05, 2021

Our guest is Eli Klein, a gallery owner in Manhattan who became a scourge to governor Andrew Cuomo for his handling of the pandemic.

GUEST:

Eli Klein: Twitter and Website

WATCH ON YOUTUBE:

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Ep. 179 Political Conservatism: Cure to a Failing Health Care Liberalism? Nov 01, 2021

Our guest is Dr. Shawn Whatley, returning to the show to discuss a recent essay introducing conservative principles to a health care audience steeped in a liberal tradition.

GUEST:

Shawn Whatley, MD. Blog and Twitter

LINK:

Shawn Whatley. How to Get Canada off the Health Care Teeter-Totter (at The Hub)

BOOKS BY DR. WHATLEY:

Note: The Accad and Koka Report participates in the Amazon Affiliate program and may earn a small commission from purchases completed from links on the website.

PREVIOUS APPEARANCE ON THE SHOW:

Ep. 40 Practicing Medicine in Canada: Promises and Realities

Ep. 165 Deconstructing Medical Socialism

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Ep. 178 Doctors and Defibrillators Oct 29, 2021

Our guests are John Mandrola and Bogdan Enache, returning to the show to wrap up our series on "Adventures and Misadventures in Defibrillation."

GUESTS:

John Mandrola, MD: Twitter and Website

Bogdan Enache, MD: Twitter

LINKS:

Michel Accad. The case against shared decision-making part 1, part 2, and part 3.

RELATED EPISODES:

Ep. 172 Adventures in Defibrillation

Ep. 174 Misadventures in Fibrillation

WATCH ON YOUTUBE:

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Ep. 177 The Media and the Pandemic, with David Zweig Oct 25, 2021

Our guest is journalist and author David Zweig, one of the few voices in the media that dared to question the public health narrative and was able to scoop major stories about the pandemic that were ignored by the mainstream outlets.

GUEST:

David Zweig: Webpage and Twitter

WATCH ON YOUTUBE

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Ep. 176 The Case for Physician-Owned Hospitals, with Brian Miller Oct 22, 2021

Our guest is Brian Miller, Assistant Professor of Medicine and Business (courtesy) at the Johns Hopkins University. He is a practicing hospitalist, health policy researcher, and health policy analyst, working as a consultant to the FTC Bureau of Consumer Protection on health insurance. He is also a member of the Medicare Evidence Development & Coverage Advisory Committee, the UNC-NC State Biomedical Engineering Department Industrial Advisory Board, and the Keck Graduate Institute School of Medicine Dean's Advisory Council. GUEST: Brian J. Miller: Webpage and Twitter LINKS:

Cost and Quality of Care in Physician-Owned Hospitals: A Systematic Review (Mercatus Center)
Reversing Hospital Consolidation: The Promise of Physician-Owned Hospitals (in Health Affairs blog)
Health Affairs Article Misses the Mark on Physician-Owned Hospitals. (American Hospital Association website)
Testimony to Senate Judiciary Committee on Competition Policy, Antitrust, and Consumer Rights.

WATCH ON YOUTUBE Watch the episode on our YouTube channel.

Ep. 175 Jay Bhattacharya on Public Health Oct 10, 2021

Our guest is Jay Bhattacharya, Professor of Medicine and Health Policy at Stanford University. Professor Bhattacharya is also research associate at the National Bureau of Economics Research, a senior fellow at the Stanford Institute for Economic Policy Research, and director of the Stanford Center on the Demography of Health and Aging.

Dr. Bhattacharya gained international prominence during the COVID pandemic for his contributions to determining the infection fatality rate of the virus, and for his criticism on broad coercive lockdown policies and vaccine mandates. Along with colleagues Martin Kulldorff and Sunetra Gupta, he wrote the Great Barrington Declaration of focused protection which has garnered 860,000 signatures to date.

GUEST:

Jay Bhattacharya: Twitter and Stanford page

WATCH ON YOUTUBE:

Watch the episode on our YouTube channel

Ep. 174 Adventures in Fibrillation Sep 30, 2021

Our guests are John, a patient with an extraordinary story to tell, and Dr. John Mandrola, a cardiac electrophysiologist from Louisville, KY. Dr. Mandrola is cardiology editor on Medscape where he writes a regular column and produces a weekly podcast. He is also the co-author of The Haywire Heart: How Too Much Exercise Can Kill You and What You Can Do To Protect Your Heart.

GUEST:

John Mandrola, MD: Twitter and Website

LINKS:

The Haywire Heart (Amazon link)

Note: The Accad and Koka Report participates in the Amazon Affiliate program and may earn a small commission from purchases completed from links on the website,

WATCH ON YOUTUBE:

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Ep. 173 Pandemic Ethics: Is Public Health Out of Control? Sep 17, 2021

Our guest is Euzebiusz (Zeb) Jamrozik, MD, PhD, a practicing internal medicine physician and fellow in ethics and infectious diseases at the Wellcome Centre for Ethics and Humanities at the University of Oxford. He is head of the Monash-WHO Collaborating Centre for bioethics at the Monash Bioethics Centre. His academic work on infectious disease ethics is focused on vaccines, vector-borne disease, and drug resistance. Dr Jamrozik is lead author of the report of a Wellcome Trust funded project on ethical and regulatory issues related to human challenge studies in endemic settings.

GUEST:

Zeb Jamrozik, MD, PhD: Twitter and Webpage

LINKS:

Jamrozik E and Heriot G. "Imagination and remembrance: What rolw should historical epidemiology play in a world bewitched by mathematical modelling of COVID-19 and other epidemics." (In History and Philosophy of the Life Sciences free text available)
Jamrozik E and Heriot G. "Not in my backyard: COVID-19 vaccine development requires someone to be infected somewhere." (In The Medical Journal of Australia free text available)
Euzebiusz Jamrozik and Michael Seldeling. Human Challenge Studies in Endemic Settings: Ethical and Regulatory Issues (Springer, 2020, free text available)

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Ep. 172 Adventures in Defibrillation Sep 12, 2021

Our guests are Thomas Wingert, a patient, Bogdan Enache, an electrophysiologist at Centre Hospitalier Princesse Grace in Monaco, and Saurabh Jha, an Associate Professor of Radiology at the Perelman School of Medicine and the University of Pennsylvania.

LINK:

Point/Counterpoint on Halting the Implantation of Subcutaneous ICD. Editorial by B. Enache and J. Mandrola in JACC Electrophysiology.

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Ep. 171. The Policy and Politics of Cancer Care, with Ted Okon Jun 21, 2021

Our guest is Ted Okon, a nationally recognized expert on the policy and politics of cancer care. Mr. Okon has testified before Congress on cancer issues and is frequently on Capitol Hill discussing the nation’s cancer care delivery system.

GUEST:

Ted Okon: Twitter and Community Oncology Alliance website

WATCH ON YOUTUBE:

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Ep. 170 From Pandemic to Endemic: Living with COVID-19 Jun 07, 2021

Our guest is Professor David Heymann is an American physician and epidemiologist based at the London School of Hygiene and Tropical Medicine. He has held leading positions at the WHO for more than 20 years, coordinating global responses to epidemics such as Ebola, AIDS, polio, and SARS. He also served as Chairman of Public Health England from 2009 until 2017. He shares his perspectives on post-pandemic life and on opportunities for the public health sector.

GUEST:

David Heymann: Professional page and Wikipedia page

RELATED EPISODES:

Ep. 140. Gabriela Gomes: Why Herd Immunity May Be At Hand

Ep. 148. Herd Immunity Models and Realities, with David Heymann and Paul Fine.

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Ep. 169 COVID-19: Why Consequentialism Fails May 16, 2021

In the aftermath of the dramatic surge of COVID cases and deaths in India, Michel Accad and Anish Koka revisit the question of lockdowns and the principles that should inform the response to epidemics.

WATCH ON YOUTUBE:

Watch the episode on our YouTube channel

RELATED EPISODES:

Ep. 162 A Libertarian's Case for Lockdowns, with Chris Snowdon

Ep. 160 Elise Amez-Droz: Those Treacherous "Essential" and "Non-Essential" Labels

Ep. 158 Alycia "The Bomb" Baumardner: A Fighter's Life Under Lockdown

Ep. 150 David Cayley on Ivan Illich

Special episode Accad and Koka on Lockdowns (Aug 2020)

Ep. 168 The COVID Crisis in Delhi, with Anupam Singh May 09, 2021

Our guest is Dr. Anupam Singh, Assistant Professor of Medicine at SMC in Ghaziabad, who is in the thick of the COVID crisis in Delhi. He shares his perspective on the situation.

GUEST:

Dr. Anupam Singh’s Twitter and ResearchGate profile

WATCH ON YOUTUBE:

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Ep. 167 COVID in India: The View from Bangalore Apr 30, 2021

Our guest is Dr. Somalaram Venkatesh, interventional cardiologist In private practice in Bengaluru, India. He shares his thoughts on the current severe surge of COVID in India. Dr. Venkatesh obtained his medical degree and completed his cardiology training at PGI, Chandigarh. He is now director of cardiology at Aster Hospital, Bengaluru.

GUEST:

Somalaram Venkatesh, MD: Twitter and Professional website

WATCH ON YOUTUBE:

Watch the episode on our YouTube channel.

Ep. 166 Clinicians and Probabilistic Reasoning, with Dan Morgan Apr 23, 2021

Our guest is Dan Morgan, MD, MS, a physician and epidemiologist in Baltimore, Maryland. He is Associate Professor of Epidemiology and Medicine at the University of Maryland School of Medicine, Chief Hospital Epidemiologist at the Baltimore VAMC, and a fellow at the Center for Disease Dynamics, Economics and Policy (CDDEP). We discuss a recent paper he co-authored about probabilistic diagnostic reasoning among clinicians.

GUEST:

Dan Morgan Twitter and Website

LINKS:

Morgan D, et al. Accuracy of practitioners estimate of probability of diagnosis before and after testing. JAMA Internal Medicine. 2021.

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Ep. 165 Shawn Whatley on Deconstructing Medical Socialism Apr 11, 2021

Our guest is Shawn Whatley, a physician in Canada who is the author of the recently released book When Politics Comes Before Patients: Why and How Canadian Medicare Is Failing. Dr. Whatley is past-president of the Ontario Medical Association and is a senior fellow at the MacDonald-Laurier Institute for Public Policy in Toronto.

GUEST:

Shawn Whatley, MD. Blog and Twitter

BOOKS BY DR. WHATLEY:

Note: The Accad and Koka Report participates in the Amazon Affiliate program and may earn a small commission from purchases completed from links on the website.

PREVIOUS APPEARANCE ON THE SHOW:

Ep. 40 Practicing Medicine in Canada: Promises and Realities

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Ep. 164 What Has Beauty To Do With Health? Apr 07, 2021

Our guests are David Clayton and Charlie Deist, on the topic of the relationship between beauty and health

GUESTS:

David Clayton: Website and Twitter

Charlie Deist: Website and Twitter

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Ep. 163 Accad ❤ Koka Mar 11, 2021

Dr. Accad interviews Dr. Koka regarding his latest article entitled "Correlative Adventures with COVID"

LINKS:

Anish Koka: "Correlative Adventures with COVID"
Anish Koka: "In Defense of Small Data"
Anish Koka: "The Price of Progress"
Michel Accad: "The Devolution of Evidence-Based Medicine"
Michel Accad: "Why N-of-1 is Enough"

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Ep. 162 A Libertarian’s Case For Lockdowns, with Chris Snowdon Mar 02, 2021

Our guest is Christopher Snowdon, a freelance journalist with a focus on the intrusion of public health into the daily lives of ordinary people. He is the author of many books, including Velvet Glove; Iron Fist, A History of Anti-smoking, published in 2009, and more recently, Polemics, an anthology of articles on economics, politics, science, and culture. He is also Head of Lifestyle Economics at the Institute for Economic Affairs in London. We discuss his position on lockdowns which has surprised many and put him at odds with other libertarians.

GUEST:

Chris Snowdon Twitter and Website

LINKS:

"The Rise of the Coronavirus Cranks" (article in Quilette)
"The Great Lockdown Debate: Chris Snowdon v. Toby Young" (YouTube on talkRadio channel)

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Ep. 161 Hormetics: A Principle of Health and Fitness, with Charlie Deist Feb 24, 2021

Our guest is Charlie Deist, author of Hormetics: Physical Fitness for Free People. We have an engaging and somewhat philosophical conversation on principles of health. How do we identify good nutritional and exercise habits? Amongst the myriad of fads, what rules should guide one's health choices and behaviors?

GUEST:

Charlie Deist: Website and Twitter

LINK:

Note: The Accad and Koka Report participates in the Amazon Affiliate program and may earn a small commission from purchases completed from links on the website.

Charlie Deist. Hormetics:Physical Fitness for Free People (on Amazon)

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Ep. 160 Elise Amez-Droz: Those Treacherous “Essential” and “Non-essential” Labels Feb 14, 2021

Our guest is Elise Amez-Droz, program manager for the Open Health program at the Mercatus Center at George Mason University, where she also manages the health policy portfolio. Ms. Amez-Droz is a Public Policy Fellow with The Fund for American Studies and a member of the Millennial Cohort of American Enterprise Institute’s Leadership Network.

GUEST:

Elise Amez-Droz: LinkedIn

LINKS:

"Labeling Us 'Essential' or 'Non-Essential' Makes Us Less Human" (Discourse Magazine)
The Mercatus Center website

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EPISODE MENTIONED ON THE SHOW:

Ep. 21 Inside the Swiss Healthcare System (with guest Marc Fouradoulas, MD)

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Ep. 159 Terence Kealey on the Myths of Public Funding of Science Jan 30, 2021

Our guest today is Terence Kealey, Professor Emeritus of clinical biochemistry at the University of Buckingham in the United Kingdom, where he served as Vice Chancellor until 2014. He is also a Research Fellow at the Cato Institute. Professor Kealey trained in medicine at Bart’s Hospital in London and obtained his doctorate at Oxford University following which he pursued a career in clinical biochemistry research, before joining the faculty at Buckingham University.

He is the author of 3 books. The first, published in 1996 and titled The Economic Laws of Scientific Research is a sweeping exploration of the relationship between government and science and argues against public funding of scientific research. The second, Science, Sex, and Profits, published in 2008, continues the same theme and develops the notion that science is not a public good but is organized around what he terms “invisible colleges.” His third book, Breakfast is Your Most Dangerous Meal, was published in 2014 and links government intervention to very unhealthy nutritional advice.

Note: The Accad and Koka Report participates in the Amazon Affiliate program and may earn a small commission from purchases completed from links on the website.

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Ep. 158 Alycia “The Bomb” Baumgardner: A Fighter’s Life Under Lockdown Jan 27, 2021

Our guest is Alycia Baumgardner, a professional super feather boxer based in Michigan. She joins us to share her professional and personal experience with the lockdown measures instituted in response to the COVID-10 pandemic.

GUEST:

Alycia "The Bomb" Baumgardner: Twitter and Facebook

LINKS:

Video: "Baddest Woman in Boxing Alycia Baumgardner!"

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Ep. 157 Stephen Senn: N-of-1 Trials and Beyond Nov 29, 2020

Our guest is Professor Stephen Senn, a world renowned statistician whose career has spanned the gamut of activities that involves statistical analysis in medicine, from teaching to research to consultancy. Professor Senn obtained his PhD in Statistics from the University of Dundee and became a Chartered Statistician from the Royal Statistical Society in 1993. He has held professorships at University College London and at the University of Glasgow. He is the author of several books, notably Statistical Issues in Drug Development and Dicing with Death: Chance, Risk, and Health.

GUEST:

Stephen Senn, PhD: Twitter and Website

LINKS:

Note: The Accad and Koka Report participates in the Amazon Affiliate program and may earn a small commission from purchases completed from links on the website.

Wood FA, et al. N-of-1 Trial of a Statin, Placebo, or No Treatment to Assess Side-Effects (Open Access in New Engl J Med)
Araujo, A Julious S, Senn S. Understanding variation in sets of N-of-1 trials (Open Access in PLOS One)
Senn S. Statistical pitfalls of personalized medicine (Open Access in Nature)
Senn S. Mastering Variation: Variance components and personalized medicine (Open Access in Stat in Med)
Stephen Senn. Dicing with Death: Chance, Risk, and Health (Amazon link)

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Ep. 156 The Push for Nurse Practitioners on the Frontlines of Healthcare Nov 13, 2020

Our guests are Rebekah Bernard, MD and Niran Al-Agba, MD, authors of a soon-to-be-published book examining the rise of nurse practitioners and physician assistants in healthcare.

Dr. Bernard is a family physician from Fort Myers, Florida. She is board member of Physicians for Patient Protection, an organization calling for more transparency regarding the difference in training between physicians and non-physician providers.

Dr. Al-Agba is a board-certified pediatrician in private practice in Washington State. She is a prolific writer who speaks widely and openly on a variety of issues, including policy, ethics, and medical practice.

GUESTS:

Rebekah Bernard: Twitter and website

Niran Al-Agba: Twitter and website

LINKS:

Note: The Accad and Koka Report participates in the Amazon Affiliate program and may earn a small commission from purchases completed from links on the website.

Niran Al-Agba and Rebekah Bernard: Patients at Risk: The Rise of the Nurse Practitioner and Physician Assistant in Healthcare (Amazon link and book website)

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Ep. 155 Kevin McKernan on PCR testing for COVID-19 Nov 07, 2020

Our guest is Kevin McKernan, founder and chief scientific officer of Medicinal Genomics, a company specialized in genetic testing of medicinal plants, including cannabis for strains, traits, and pest infestation, including plant viruses. He is here to shed light on the process of PCR testing as applied to the COVID pandemic.

GUEST:

Kevin McKernan: Twitter

LINKS:

Note: The Accad and Koka Report participates in the Amazon Affiliate program and may earn a small commission from purchases completed from links on the website,

Jaafar R. et al. "Correlation Between 3790 Quantitative Polymerase Chain Reaction–Positives Samples and Positive Cell Cultures, Including 1941 Severe Acute Respiratory Syndrome Coronavirus 2 Isolates" (Open access in Clinical Infectious Diseases)

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Ep. 154 Outpatient COVID-19 Therapy: Why the Controversy? Nov 01, 2020

Our guest is Peter McCullough, MD, MPH, consultant cardiologist and Vice Chief of Medicine at Baylor University Medical Center in Dallas, Texas. He is an internationally recognized authority on the role of chronic kidney disease as a cardiovascular risk state with more than a thousand publications and more than five hundred citations in the National Library of Medicine. His works have appeared in the New England Journal of Medicine, Journal of the American Medical Association, Lancet and other top-tier journals worldwide.

However, he is not with us to discuss the cardiorenal syndrome nor his many illustrious achievements in cardiology. Rather, he joins us to tell us about an article on the outpatient treatment of COVID-19 of which he is first author. The paper is titled and was published in the American Journal of Medicine online on August 6, 2020.

GUEST:

Peter McCullough, MD, MPH: Twitter

LINKS:

McCullough P, et al. “Pathophysiological Basis and Rational for Early Outpatient Treatment of SARS-CoV-2 (COVID-19) Infection” (Open Access in Am J. Med)

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Ep. 153 Vinay Prasad: Making Conversations in Medicine Great Again Oct 28, 2020

Our guest is Vinayak K. Prasad, hematologist-oncologist. He was an associate professor of medicine at the Oregon Health & Science University School of Medicine and in the summer of 2020 moved to the University of California San Francisco.

He is a prolific researcher with a particular interest in the quality of medical evidence and trial design. He is also author of 2 best-selling books: Ending Medical Reversal (2015) co-authored with Dr. Adam Cifu and Malignant: How Bad Evidence and Bad Policy Harm People With Cancer, released earlier this year.

We have a broad ranging conversation about the tenor of medical discourse today and about his main ideas regarding the quality of medical evidence.

GUEST:

Vinay Prasad: Twitter, Website, and Podcast

LINKS:

Note: The Accad and Koka Report participates in the Amazon Affiliate program and may earn a small commission from purchases completed from links on the website,

Prasad, V et al. "A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices." Open Access in Mayo Clinic Proceedings with accompanying video of Dr. Prasad
Vinay Prasad and Adam Cifu. Ending Medical Reversal. Amazon link.
Vinay Prasad. Malignant. Amazon link.

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Ep. 152 Underrepresented Minorities in India: The Reservation System Oct 25, 2020

Our guest is Dr. Somalaram Venkatesh, interventional cardiologist In private practice in Bengaluru, India. He obtained his medical degree and completed his cardiology training at PGI, Chandigarh. He is now director of cardiology at Aster Hospital, Bengaluru. He discusses India's historical legacy of discrimination, and the solution built into the Indian constitution to rectify this : the reservation system.

GUEST:

Somalaram Venkatesh, MD: Professional website

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Ep. 151 Brain Death: Challenges and Responses Oct 21, 2020

Does it matter if we call irreversibly comatose patients "dead?" Our guest is Doyen Nguyen, OP, MD, STD. Dr. Nguyen was previously an academic hemato-pathologist and is currently a Catholic moralhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5749302/ theologian and bioethicist. She has authored books and articles both in medicine and in moral theology/bioethics and authored a 600-page monograph that takes a critical look at brain death from a variety of perspectives.

LINKS:

Nguyen D. The New Definition of Death for Organ Donation: A Multidisciplinary Analysis from the Perspective of Christian Ethics. (2018, Amazon link)
Nair-Collins, M and Miller, FG. "Do the 'Brain Dead' merely appear to be alive? (in J of Med Ethics, open access)

RELATED EPISODES:

Ep. 35 Why Brain Death Isn’t Death: An Introduction to “Shewmon’s Challenge” (with guest Alan Shewmon, MD)

Ep. 45 Brain Death at the Bedside (with guest Fred Rincon, MD)

Ep. 146 Diagnosing Brain Death: Clinical and Legal Quagmire (with guests Alan Shewmon and Doyen Nguyen)

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Ep. 150 David Cayley on Ivan Illich Oct 16, 2020

Our guest is David Cayley, author and broadcaster based in Toronto, Canada, whose career focused on the philosophies of major contemporary thinkers and on the history of intellectual thought. For 30 years, he made radio commentaries for the acclaimed Ideas radio series produced by the CBC. He is well known for his close collaboration and friendship with the philosopher and social critic Ivan Illich who is the subject of this episode.

GUEST:

David Cayley: Website

LINKS:

Note: The Accad and Koka Report participates in the Amazon Affiliate program and may earn a small commission from purchases completed from links on the website.

"David Cayley. "Questions about the current pandemic from the viewpoint of Ivan Illich." (blog post, April 8, 2020)
Ivan Illich. Limits to Medicine: Medical Nemesis; The Expropriation of Health (Amazon link)
David Cayley and Ivan Illich. Rivers North of the Future: The Testament of Ivan Illich (Amazon link)

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Ep. 149 James Lindsay: Critical Race Theory, Post-Modernism, and Medicine Oct 10, 2020

An American-born author, mathematician, and political commentator, Dr. James Lindsay has written books spanning a range of subjects including religion, the philosophy of science and postmodern theory. He is the co-founder of the website New Discourses and is currently promoting his new book "Cynical Theories". Enjoy a wide ranging discussion on the Post-Modern movement and how it impacts Medicine

GUEST:

James Lindsay: Twitter and New Discourses Web page

SHOW NOTES:

Amazon book link: Cynical Theories

John Stuart Mill Essay: On Liberty

Anish's article in Quilette on the Real Gender gap in Cardiology: https://quillette.com/2019/06/12/the-real-gender-gap-in-heart-disease/

New Discourses website: https://newdiscourses.com/

Podcast on race and estimated GFR: https://podcasts.apple.com/us/podcast/race-and-estimated-gfr/id1461664501?i=1000488650915

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Ep. 148 David Heymann and Paul Fine: Herd Immunity Models and Realities Oct 04, 2020

Our guests are Professors David L. Heymann and Paul Fine from the London School of Hygiene and Tropical Medicine. Professor Heymann is a physician who held leading positions at the WHO for more than 20 years, coordinating global responses to epidemics such as Ebola, AIDS, polio, and SARS. He also served as Chairman of Public Health England from 2009 until 2017. Professor Fine is also a leading academic figure in epidemiology and public health with broad interests in infectious diseases. Professor Heymann and Professor Fine, along with colleague Ken Eames, have co-authored an landmark review paper on the concept of herd immunity.

GUESTS:

David Heymann: Professional page and Wikipedia page

Paul Fine: Professional page

LINKS:

Paul Fine, Ken Eames, and David Heymann: "Herd Immunity": A "Rough Guide (Open Access in Clinical Infectious Diseases)
David Heymann: How SARS Was Contained (Opinion in New York Times)

RELATED EPISODES:

Ep. 140. Gabriela Gomes: Why Herd Immunity May Be At Hand

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Ep. 147 Sally Satel: Should Med Schools Teach Antiracism? Sep 29, 2020

Our guest is physician and author Sally Satel, MD. Dr. Satel is a resident scholar at the American Enterprise Institute and staff psychiatrist at a local methadone clinic in the Washington DC area. She earned a bachelor's degree from Cornell University, a master's degree from the University of Chicago, and an MD degree from Brown University.

She has written widely in academic journals on topics in psychiatry and medicine, and has published articles on cultural aspects of medicine and science in numerous magazines and journals. She has testified before Congress on veterans’ issues, mental health policy, drug courts, and health disparities. She is the author of numerous books including The Health Disparities Myth:Diagnosing the Treatment Gap with co-author Jonathan Klick and, most recently, Brainwashed: The Seductive Appeal of Mindless Neuroscience co-authored with Scott Lilienfeld.

GUEST:

Sally Satel, MD: Twitter and Website

LINKS:

"The Hypocritical Oath" (in Persuasion online community)
The Health Disparities Myth: Diagnosing the Treatment Gap(with co-author Jonathan Klick)

RELATED EPISODES:

Ep. 144 John Mandrola: Why Doctoring and Politics Shouldn't Mix

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Ep. 146 Diagnosing Brain Death: Clinical and Legal Quagmire Sep 19, 2020

Our guests are Doyen Nguyen, OP, MD, STD and D. Alan Shewmon, MD. They join us to discuss troubling development on the legal treatment of brain death.

Dr. Nguyen was previously an academic hematopathologist and is currently a Catholic moral theologian and bioethicist. She has authored books and articles both in medicine and in moral theology/bioethics and authored a 600-page monograph that takes a critical look at brain death from a variety of perspectives.

Dr. Shewmon is Professor Emeritus of Pediatric Neurology at UCLA. His work, comprising decades of well-documented clinical observations and reflections, is now known as “Shewmon’s challenge,” a compelling rebuke to the principal arguments put forth to defend the concept of brain death.

LINKS:

Shewmon DA. "Chronic “brain death”: Meta-analysis and conceptual consequences." (in Neurology, 1998)
Lewis A, et al. "Determination of Death by Neurologic Criteria in the United States: The Case for Revising the Uniform Determination of Death Act" (in J. of Law, Medicine, and Ethics, 2019)
President's Commission for the Study of Ethical Problems in Medicine, Biomedical and Behaviora Research. "Defining Death" (1981)
Nguyen D. The New Definition of Death for Organ Donation: A Multidisciplinary Analysis from the Perspective of Christian Ethics. (2018, Amazon link)
Nguyen, D. "Does the Uniform Determination of Death Act Need to Be Revised?" (2020, Linacre)

RELATED EPISODES:

Ep. 35 Why Brain Death Isn't Death: An Introduction to "Shewmon's Challenge" (with guest Alan Shewmon, MD)

Ep. 45 Brain Death at the Bedside (with guest Fred Rincon, MD)

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Ep. 145 Damian Carabello on Surprise Billing: Through the Looking Glass Sep 11, 2020

Dr. Damian Carabello discusses the depths insurance companies go to make sure they end up on top.

GUEST:

Damian Carabello, MD: Twitter

LINKS:

Anish Koka long read on surprise billing
Damian Carabello "Let's end surprise billing without a Trojan horse" blog on KevinMD about the problems with benchmarking.
Twitter thread on the history of Ingenix
Andy Slavitt's involvement with health insurance fraud case

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Ep. 144 John Mandrola: Why Doctoring and Politics Shouldn’t Mix Sep 05, 2020

Dr. John Mandrola returns to the show to discuss why doctoring and politics shouldn't mix and how he got into hot water on Twitter for holding that unacceptable view.

Dr. Mandrola is an electrophysiologist in Louisville, Kentucky. He is is cardiology editor on Medscape where he writes a regular column and produces a weekly podcast.

GUEST:

John Mandrola, MD: Twitter and Website

LINKS:

John Mandrola: "Doctoring and Activism"
Sally Satel: "The Hypocritical Oath"
Mandrola et al: The Case for Being a Medical Conservative (in the American Journal of Medicine)

PREVIOUS GUEST APPEARANCES:

Ep. 12 John Mandrola: The Case for "Less-Is-More"

Ep. 107 Independent Nurse Practitioners: Public Health Threat or Libertarian Step Forward?

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Ep. 143 Adam Mortara on Litigating Affirmative Action Sep 01, 2020

Our guest is Adam Mortara, lead trial counsel in the case of Students for Fair Admissions v. Harvard University.We discuss the legal aspects of affirmative action in light of the paper by Dr. Norman Wang which set off a storm of controversy in academic medicine.

GUEST:

Adam Mortara, JD: Professional page

LINK:

Norman Wang's paper: Diversity, Inclusion, and Equity: Evolution of Race and Ethnicity Considerations for the Cardiology Workforce in the United States of America from 1969 to 2019.

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Ep. 142 Robert Yeh on Harnessing Real World Evidence Aug 28, 2020

Our guest is Robert Yeh, Associate Professor of Medicine at Harvard Medical School and Director of the Smith Center for Outcomes Research in Cardiology at the Beth Israel Deaconess Medical Center in Boston. We discuss the challenges of outcomes research and his excellent work to improve the reliability of observational studies

GUEST:

Robert W. Yeh, MD: Twitter and professional web page

LINKS:

Strom JB, et al. Use of Administrative Claims Data to Assess Outcomes and Treatment Effects in Randomized Trials of Transcatheter Aortic Valve Replacement (in Circulation)
Faridi KM, et al. Use of Administrative Claims Data to Estimate Treatment Effects for 30 days versus 12 months of Dual Antiplatelet Therapy After Percutaneous Coronary Intervention (in Circulation)
Konstam M. Real World Data as trial End Points: Off and Running with a Long Way to Go (editorial in Circulation)

PREVIOUS GUEST APPEARANCE:

Ep. 19 Public Reporting: Necessary Evil or Harmful Fake News?

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Ep. 141 Amy Wax on Wokeness in Medicine Aug 21, 2020

Our guest is Amy Wax, Robert Mundheim Professor of Law at the University of Pennsylvania Law School. Before attending law school she obtained her undergraduate degree from Yale University in biophysics and biochemistry, graduating summa cum laude. She then attended Harvard Medical School and trained as a neurologist at New York Hospital - Cornell Medical Center before completing her law degree at Columbia University. She is the author of Race, Wrongs, and Remedies: Group Justice in the 21st Century. In 2017, she was the target of academic backlash after co-authoring an opinion piece in the Philadelphia Inquirer on the societal benefits of "bourgeois values."

GUEST:

Amy Wax: Faculty page and Wikipedia entry

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Ep. 140 Gabriela Gomes: Why Herd Immunity May Be at Hand Aug 16, 2020

Our guest is Gabriela Gomes, Professor of Mathematics at the University of Strathclyde. She specializes in population dynamics and the modeling of herd immunity and her recent work suggests COVID-19 herd immunity may be at hand. We discuss how herd immunity thresholds are estimated and why she thinks classic models are flawed and must incorporate a measure of variation in individual susceptibility.

GUEST:

Gabriela Gomes, PhD: Twitter and Website

LINKS:

Gomes et al. (May 2020 paper): Individual variation in susceptibility or exposure to SARS-CoV-2 lowers the herd immunity threshold in MedRxiv
Aguas et al. (July 2020 paper): Herd immunity thresholds for SARS-CoV-2 estimated from unfolding epidemics in Medrxiv
Britton et al. A mathematical model reveals the influence of population heterogeneity on herd immunity to SARS-CoV-2 in Science (Open Access)
Kevin Hartnett. The Tricky Math of COVID-19 Herd Immunity in Quanta Magazine
Fine et al. "Herd Immunity": A Rough Guide in Clinical Infectious Disease (Open Access)

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Ep. 139 Diversity in Cardiology, with Martha Gulati Aug 13, 2020

A recent article authored by Dr. Norman Wang on the history and current state of affirmative action programs in medical schools and cardiology departments has led to a storm of controversy and to Dr. Wang's demotion as fellowship program director. To discuss that article and the controversies we are joined by Dr. Martha Gulati, division Chief of Cardiology at the University of Arizona. She is also the best-selling author of Saving Women's Hearts and editor-in-chief of ACC's CardioSmart.

LINKS:

The now retracted Wang paper: https://www.ahajournals.org/doi/pdf/10.1161/JAHA.120.015959

Journal of the AHA comment on retraction: https://www.ahajournals.org/doi/10.1161/JAHA.119.014592

Regents of Univ. of California v. Bakke, SCOTUS decision: https://supreme.justia.com/cases/federal/us/438/265/

GUEST:

Martha Gulati: Twitter and Website

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Ep. 138 How Health Care Intermediaries Profit Aug 12, 2020

GUESTS:

Marion Mass is a pediatrician in the Philadelphia area where she has practiced in hospital, Emergency Room, delivery room, outpatient, and urgent care settings. She graduated from Duke University Medical School and trained in Pediatrics at Northwestern Memorial Hospital in Chicago. She has been writing about life inside medicine, published in the WSJ, Washington Times, and the Philly Inquirer. She is also co-founder of Practicing Physicians for America, a physician lead organization that advances the interests of practicing physicians. She has written extensively on the role of third party intermediaries in medicine.

Dr. Rupali Chadha is a Board Certified Psychiatric Physician who diagnoses and treats mental illness. She is also Board Certified Psychiatric Physician in the specialty area of forensics. She serves the LA Superior Courts in identifying inmates who are incompetent to stand trial and has also served as a forensic expert in criminal trials. She recently traveled to Washington DC to visit the White House and witness signing of a recent Presidential Executive Order on intermediaries in healthcare.

WATCH ON YOUTUBE:

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LINKS:E

White House Executive Order: https://www.whitehouse.gov/presidential-actions/executive-order-lowering-prices-patients-eliminating-kickbacks-middlemen/

Overview of third parties that suck up most of the health-care dollars: https://www.medpagetoday.com/publichealthpolicy/healthpolicy/84795

The rebates that may fuel higher drug prices: https://www.washingtontimes.com/news/2019/feb/10/a-bipartisan-opportunity-to-cut-drug-prices/

John Arnold in statnews discusses the role of Pharmacy benefit managers (PBM): https://www.statnews.com/2018/08/27/pharmacy-benefit-managers-good-or-bad/

A detailed look at Group Purchasing Organizations and PBMs: https://practicingphysician.org/scrubs-vs-suits-the-battle-inside-the-nations-hospitals-part-2/

Needle stick story referenced in the podcast: https://nebula.wsimg.com/9e87fe4c7de204baccc77a2bc373daf1?AccessKeyId=62BC662C928C06F7384C&disposition=0&alloworigin=1

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Make a small donation on our Patreon page on and join our discussion group or receive a free book.

Accad/Koka on Lockdowns Aug 11, 2020

Anish Koka and Michel Accad discuss lockdowns in light of the experience of the last few months.

GUESTS:

Anish Koka, MD: Twitter

Michel Accad, MD: Twitter

LINK:

Michel Accad: It's Not About Trade-Offs

YOUTUBE:

Watch the episode on our YouTube channel

Ep. 137 Joshua Gottlieb on Government Policy and Physician Income Aug 06, 2020

Joshua Gottlieb is an economist who co-authored a recent paper examining the effect of government policy and physician income. The paper was recently presented at a conference co-sponsored by the NBER and NIA and its pre-publication has generated significant controversy among doctors.

GUEST:

Joshua Gottlieb, PhD: Twitter and Website

LINK:

Paper: Who Values Human Capitalists’ Human Capital? Healthcare Spending and Physician Earnings

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Ep. 136. Manny Sethi. Trauma Surgeon & US Senate Candidate Jul 29, 2020

Manny Sethi is a trauma surgeon running to be the next senator from the state of Tennessee. He is the son of immigrants,and an unabashed conservative who discusses his journey from medicine to politics, as well as his views on healthcare.

GUEST:

Manny Sethi: Twitter and Bio

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Ep. 135. Avik Roy: The FREOPP plan for reopening schools Jul 27, 2020

Reopening schools in the midst of a pandemic is a controversial topic. FREOPP, a non-partisan think tank founded by Avik Roy recently released a plan for reopening schools. We discuss some of the data from around the globe, as well as practical considerations related to opening schools.

GUEST:

Avik Roy: Twitter and Bio

LINK:

Reopening America’s Schools and Colleges During COVID-19

Iceland Study (NEJM): https://www.nejm.org/doi/full/10.1056/NEJMoa2006100?query=featured_home

Dutch National Institute Study: https://www.ntvg.nl/artikelen/de-rol-van-kinderen-de-transmissie-van-sars-cov-2/volledig

Supreme Court Decision on school funding

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RELATED EPISODES:

Ep. 73 Conservative Means to Progressive Ends? Avik Roy on Healthcare

Ep. 119 Avik Roy: A Practical Plan to Bring People Back to Work

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Ep 134. Edward Leamer: Is Econometrics a con? Jul 23, 2020

Dr. Leamer is a Professor of Economics and Statistics at UCLA who comes on the show to discuss the recent arrival of econometric analyses in medicine. He is a longstanding skeptic of the robustness of conclusions derived from econometrics and has some advice for clinicians puzzling over what to do with these analyses.

GUEST:

Ed Leamer, PhD, Professor of Economics and Statistics

SHOW NOTES:

Let's take the Con out of Econometrics - Ed Leamer warns of the science of econometrics in 1983: https://www.international.ucla.edu/media/files/Leamer_article.pdf

The Credibility Revolution in Empirical Economics: How Better Research Design is Taking the Con out of Econometrics - Angrist and Pischke argue in 2010 that new econometric tools : pseudorandomization, instrumental variables, and natural experiments mark a credibility revolution for the field. https://pubs.aeaweb.org/doi/pdfplus/10.1257/jep.24.2.3

Tantalus on the Road to Asymptopia- Ed Leamer responds to Angrist/Pischke : https://pubs.aeaweb.org/doi/pdfplus/10.1257/jep.24.2.31

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Ep. 133. Rohin Francis: Britain, COVID, and Race in Medicine Jul 12, 2020

Our guest is Rohin Francis, MD. Dr. Francis is a Cardiologist in London, who also hosts a popular YouTube channel. He recently discussed what COVID may tell us about racism in science and medicine (Video in show notes), and comes on the show for a wide ranging discussion on racism in medicine, COVID in Britain, and how minority groups have fared in Britain.

GUEST:

Rohin Francis MD: Twitter

SHOW NOTES:

Watch Rohin's video on Racism in Science and Medicine

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Ep. 132 Marilyn Singleton on the Hidden Story of Black Physicians in America Jun 22, 2020

Our guest is Marilyn Singleton, MD, JD. Dr. Singleton comes from a long line of American physicians. She shares with us her fascinating family history and her insights into the rich history of Black physicians in America. We also discuss the deleterious effects of race victimization manifest today.

GUEST:

Marilyn Singleton, MD, JD: Twitter and article archive at the AAPS website

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Ep. 131 Sunil Rao: An Editor’s Thoughts on the NEJM/LancetGate Jun 15, 2020

Dr. Rao is an interventional cardiologist and researcher who has been at Duke University for over 10 years. He also works in the Veteran's hospital in Durhum, is a leader in the cardiology social media community with 16k followers on Twitter, and is also editor-in-chief of the journal Circulation Interventions. In this podcast he discusses his perspective on the recent retractions of papers involved in the Surgisphere scandal.

GUEST:

Sunil Rao, MD: twitter

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SHOW NOTES:

Article from the-scientist on Lancet/NEJM retractions

RELATED EPISODES:

https://accadandkoka.com/episodes/episode26/

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Ep. 130 David Howard MD, PhD. Race in America Jun 13, 2020

In the wake of the murder of George Floyd, Dr. David Howard comes on the show to discuss his experiences in America, and more broadly racism in America.

Dr. David Howard was originally born in Jamaica and immigrated to the U.S. at the age of eighteen. He received his Bachelor of Arts in Psychology from the Johns Hopkins University and then pursued his Md and PhD in Epidemiology through the Medical Scientist Training Program at the Johns Hopkins School of Medicine. He completed an internship at the New York Presbyterian Hospital followed by a residency in Obstetrics and Gynecology at the University of Missouri-Kansas City. He also completed a post-doctoral fellowship in Epidemiology at the University of North Carolina Chapel Hill. He is currently a Board Certified Obstetrics/Gynecology Specialist practicing in Las Vegas, Nevada, and is affiliated with several different hospitals in the area.

GUEST:

David Howard MD, PhD: twitter

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Ep. 129 Mary Davenport and George Delgado on Reversing Medical Abortion Jun 11, 2020

Our guests have developed a treatment protocol that can reverse the effects of the abortifacient mifepristone and be given to women who change their mind after a medical abortion. They tell us the story of their pioneering work and of the international network of physicians that is now in place to provide the therapy. We discuss the challenges that remain when the medical establishment is ideologically resistant to supporting women in their second choice.

GUESTS:

Mary Davenport, MD: Practice website

George Delgado, MD: Practice website and STENO Institute

LINKS:

Abortion Pill Rescue website
Delgado, G, et. al. A Case Series Detailing the Successful Reversal of Mefiprestone Using Progesterone (In Issues in Law and Medicine)
Creinin, M, et al. Mifepristone Antagonization with Progesterone to Prevent Medical Abortion: A Randomized Clinical Trial (free access in Obstetrics and Gynecology)
Graham, R. A New Front in the War Over Reproductive Rights: "Abortion-Pill Reversal" (in The New York Times)
Grossman D and White K. Abortion "Reversal": Legislating Without Evidence (in New England Journal of Medicine)

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Ep. 128 Chen Wu : A functional neurosurgeon discusses Elon Musk’s Neuralink Jun 05, 2020

Our guest is Neurosurgeon Chengyuan Wu. Dr. Wu specializes in functional neurosurgery, a field that focuses on using brain surgery to restore function to patients. He discusses Elon Musk's initiative to create a new brain-human interface using implants in the brain that communicate with the environment.

GUEST:

Chengyuan Wu, MD: Twitter

SHOW NOTES:

Scientific American article on Neuralink

Joe Rogan Elon Musk podcast transcript

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Ep. 127 A Florida Physician Runs for Congress May 25, 2020

What does it mean to promote a politically conservative vision for health care? Our guest is Dr. Leo Valentin, a radiologist running as a Republican candidate for US Congress in Florida's District 7.

GUEST:

Leo Valentin, MD: Twitter and Website

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Ep. 126. What a Retracted JAMA Paper Tells Us About the Research Enterprise May 12, 2020

Our guest is Eric Weinhandl, an epidemiologist whose investigation of a JAMA paper on dialysis patients lead to its retraction, and subsequent republication.

Eric discusses the steps leading to the paper's eventual retraction, and what this signals about the larger research enterprise. Eric also discusses the role of bias, conflicts of interest, big data and home dialysis, as well as some thoughts on the field of epidemiology during the COVID pandemic.

GUEST:

Eric is an epidemiologist with 14 years of research experience in kidney disease, mostly regarding dialysis and pharmaceuticals. Eric worked at the United States Renal Data System (USRDS) Coordinating Center between 2004 and 2015 and has conducted studies with Amgen, Baxter, DaVita, NxStage, Sigma Tau, and the Peer Kidney Care Initiative.

He recently worked for Fresenius Medical Care, one of the major dialysis companies in the United States, and currently works with the chronic disease research group as part of the Hennepin County Medical Center.

Twitter

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SHOW NOTES:

JAMA retracted and republished paper

JAMA research letter

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Ep. 125 Testing and Contact Tracing: The Challenges Ahead May 12, 2020

Our guest is Gregg Gonsalves, Assistant Professor of Epidemiology at Yale University Medical School as well as Associate (Adjunct) Professor of Law and Research Scholar in Law at Yale Law School. His research focuses on the use of quantitative models for improving the response to epidemic diseases and he will help us understand better what a strategy of testing and contract tracing might look like, and what the challenges ahead are.

GUEST:

Gregg Gonsalves, PhD: Twitter and professional website

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Ep. 124 Fevers, Flus, and Viruses: Adam Rodman on the Nosological Challenges of COVID-19 May 09, 2020

Our guest is Adam Rodman, host of the podcast Bedside Rounds, a great show on the history of medicine. With his deep knowledge of the vagaries of medical thought, Dr. Rodman sheds light on the COVID-related challenges that clinicians are now confronting.

GUEST:

Adam Rodman, MD: Twitter and Bedside Rounds

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Ep. 123 Andrew Althouse on Clinical Trial Design and Remdesivir May 03, 2020

Our guest is Andrew Althouse, statistician at the Center for Clinical Trials and Data coordination in Pittsburgh. He holds an undergraduate degree in Statistics and a PhD in Epidemiology from the University of Pittsburgh. His main area of interest is the design of randomized control trials. He discusses adaptive randomized control trials, and dissects the recent news of the positive Remdesivir trial.

GUEST:

Andrew Althouse: Twitter and professional page

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Ep. 122 Charged with Negligence? COVID-19 and the Law May 01, 2020

Our guest is Dorit Reiss, Professor at UC Hastings College of the Law in San Francisco, California. She holds an undergraduate degree in Law and Political Science from the Faculty of Law at Hebrew University in Jerusalem and a PhD in Jurisprudence and Social Policy from the University of California, Berkeley. She is a legal authority on the question of vaccines and vaccine mandates. She has published numerous articles on this topic in a variety of law review journals and her expertise is recognized around the world.

GUEST:

Dorit Reiss: Twitter and professional page

RELATED EPISODES:

Ep, 77 A Debate on Vaccine Mandates

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Ep. 121 What to Make of J.P.A. Ioannidis? Apr 28, 2020

Our guests are Dr. Swapnil Hiremath for the University of Ottawa and Saurabh Jha from the University of Pennsylvania. We discuss the controversies surrounding the COVID-related opinions and research findings of John. P.A. Ioannidis, the notorious Stanford data scientist and physician.

GUESTS:

Swapnil Hiremath, MD: Twitter and professional page

Saurabh Jha, MBBS: Twitter and professional page

LINKS:

"A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data" (STATNews)
"Why Most Published Research Findings Are False" (PLOS)
"Scientists who express different views on Covid-19 should be heard, not demonized" (STATNews)

RELATED EPISODES:

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Ep. 120 COVID in India: Relative Peace Amidst Ongoing Challenges Apr 24, 2020

Our guest is Dr. Anupam Singh, Assistant Professor of Medicine at Santosh Medical College and Hospital, one of the designated COVID hospitals in Ghaziabad, Utter Pradesh, India. He returns to the show for a great conversation about the surprising aspects of the pandemic in the Indian subcontinent.

GUEST:

Anupam Singh, MD; Twitter

LINKS:

Mortality Rates Drop Sharply in Parts of India, Bucking Coronavirus Trend (Reuters)
The Open Air Treatment of Pandemic Influenza (American Journal of Public Health, Open Access)

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PRIOR GUEST APPEARANCE:

Ep. 14 EBM India-Style, with Dr. Anupam Singh

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Ep. 119 Avik Roy: A Practical Plan to Bring People Back to Work Apr 21, 2020

Should we wait for COVID testing benchmarks to be met before we can reopen the economy? What if testing remains imperfect and uncertainty remains high? Our guest is Avik Roy, head of the Foundation for Research on Equal Opportunity. He returns to the show to discuss FREOPP's plan to bring people back to work.

GUEST:

Avik Roy: Twitter and Bio

LINK:

A New Strategy for Bringing People Back to Work During COVID-19

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Ep. 118 The Virus and the Money Printing Press: Socioeconomic Effects of the COVID Lockdowns Apr 18, 2020

Our guest is economist Ryan McMaken, senior editor at the Mises Institute. He was the economist for the Colorado Division of Housing from 2009 to 2014. He is also the author of Commie Cowboys: The Bourgeoisie and the Nation-State in the Western Genre a book that reveals his aptitude for analyzing economic events in their broader cultural context.

GUEST:

Ryan McMaken: Twitter and Mises.org website

LINKS:

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Ep. 117 Pandemic Trade-Offs, with Jeff Deist Apr 16, 2020

Our guest is Jeff Deist, President of the Mises Institute. We discuss the unprecedented governmental response to COVID, the trade-offs that are unaccounted for, and the inability of local communities to set their own course when, in fact, "all crises are local."

GUEST:

Jeff Deist: Twitter

LINKS:

"End the Shutdown" (Mises.org editorial board)
"What Governors Can Do"
"All Crises Are Local"

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Ep. 116 Nicole Saphier: Make America Healthy Again Apr 14, 2020

Our guest is Dr. Nicole Saphier. She is a radiologist and a breast imaging specialist at Memorial Sloan Kettering, Monmouth, New Jersey. She appears frequently as a medical contributor on Fox News, and comments on a variety of medical as well as health policy issues. She comes on today to discuss her new book - Make America Healthy Again.

GUEST:

Nicole Saphier, MD: Twitter and Website

LINKS:

Make America Healthy Again (Harper Collins)

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Ep. 115 Per Bylund on Regulations, COVID, and Sweden Apr 11, 2020

Our guest is Per Bylund, Assistant Professor of Entrepreneurship at Oklahoma State University where he holds the Records-Johnston Professorship of Free Enterprise in the School of Entrepreneurship. We talk about regulations in the age of COVID, and he also shares his perspective on Sweden's response to the pandemic.

GUEST:

Per Bylund, PhD: Twitter and Website

LINKS:

That Which Is Seen and That Which Is Unseen (Frederic Bastiat)
What Sweden Can Teach Us About Obamacare (WSJ, April 17, 2014)
Is Sweden a Good Model? (The Tom Woods Show)

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Ep. 114 Hospital Ethics in the Face of COVID-19 Apr 01, 2020

Our guest is Aaron Kheriaty, MD, Associate Clinical Professor of Psychiatry at the University of California, Irvine, where he is Director of the Bioethics Program. Dr. Kheriaty is the chair of his hospital's ethics committee and is presently working on a task force with the University of California Office of the President to prepare for the possibility that a surge in demand for intensive care due to the coronavirus pandemic will outstrip the supply of equipment and staff. He is the author of numerous articles in peer-reviewed journals and in the lay press, many of which are focused on end-of-life issues.

GUEST:

Aaron Kheriaty, MD: Twitter and Website

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Ep. 113 COVID-19: The Seattle Experience Mar 28, 2020

Our guest is intensive care specialist Mark Tonelli, Professor of Medicine at the University of Washington Medical Center in Seattle. He shares with us the encounter with the COVID-19 pandemic as it emerged from a nursing home in King County, Washington, and how the Seattle area medical community has responded to this first US cluster of cases.

GUEST:

Mark Tonelli, MD: Faculty Website

PREVIOUS GUEST APPEARANCE:

Ep. 30 Beyond EBM: Case-Based Reasoning and the Integration of Clinical Knowledge

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Ep. 112 Paul Offit: Striking a Balance in Our Response to COVID-19 Mar 26, 2020

Our guest is Dr. Paul Offit, an expert on vaccines, immunology, and virology. He is the Maurice R. Hilleman Professor of Vaccinology,Professor of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania and Director of the Vaccine Education Center at The Children's Hospital of Philadelphia. He shares with us his thoughts on the response to the COVID pandemic, a response that should take into account the health costs of a severe economic downturn.

GUEST:

Paul Offit, MD: Twitter and Webpage

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Ep. 111 Daniel Jafari : Life at the Center of the COVID Storm Mar 25, 2020

Anish discusses the COVID19 pandemic with Dr. Daniel Jafari, an emergency physician and surgical critical care specialist working at the North Shore University Hospital in New York. Dr. Jafari speaks to us about watching the pandemic unfold, the problems being wrestled with, the remarkable response, and what's needed in the coming weeks.

GUEST:

Daniel Jafari : @DanielJafari

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Ep. 110 Health Care, Free Markets, and Viruses Mar 23, 2020

Our guest is Russ Roberts, host of EconTalk, the award-winning weekly podcast about economics and daily life. Russ is the John and Jean Denault Research Fellow at the Hoover Institution at Stanford University. He wrote several books, including most recently Gambling with Other People’s Money: How Perverse Incentives Caused the Financial Crisis.

GUEST:

Russ Roberts: Twitter and Website

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Special Episode: The COVID19 Pandemic Mar 11, 2020

Anish discusses the COVID19 pandemic with Christos Argyropoulos, Chief Nephrologist at New Mexico. Dr. Argyropoulos has been warning all of us for some time about COVID19, and we discuss where his early concern emerged from, mis-steps of the US in handling this early on, and what to do now.

GUEST:

Christos Argyropoulos, MD PhD : @ChristosArgyrop

LINKS:

CDC COVID19 Website: https://www.cdc.gov/coronavirus/2019-ncov/index.html

Anthony Fauci MD, NIAID Director NEJM editorial : https://www.nejm.org/doi/full/10.1056/NEJMe2002387

"Flattening the curve" : https://www.statnews.com/2020/03/11/flattening-curve-coronavirus/

South Korea's success: https://nationalinterest.org/blog/korea-watch/no-panic-here-i-am-south-korea-watching-coronavirus-spread-128697

Johns Hopkins Global COVID19 tracker: https://systems.jhu.edu/research/public-health/ncov/

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Ep. 109 A Social Contract for Pharma? Feb 29, 2020

Our guest is Peter Kolchinsky, author of The Great American Drug Deal: A New Prescription for Innovative and Affordable Medicines. Peter holds a PhD in Virology from Harvard University and is co-founder and manager of the Boston-based investment firm RA Capital Management.

GUEST:

Peter Kolchinsky, PhD: Twitter and Website

RELATED EPISODES:

Ep. 15 Lethal Regulations: The 1962 FDA Amendments (with guest Mary Ruwart, PhD)
Ep. 92 Why is the Antibiotics Market Broken? (with guest Schlaes, MD, PhD)
Ep. 100 Can We Trust Generic Drugs? The Ranbaxy Whistleblower Narrates the Pharma Scandal of the Century (with guest Dinesh Thakur)

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Ep. 108 The Testing Cartel Retreats on Step 1: What Next for Medical Students? Feb 23, 2020

Under pressure from a grassroots campaign, the monopolistic National Board of Medical Examiners has made a significant concession in the way it administers Step 1 of the US Medical Licensing Examination. Our guest, Bryan Carmody, was among the most vocal participants in that campaign. He returns to the show to give us an update and to share his thoughts on what might happen next.

GUEST:

Bryan Carmody, MD: Twitter and Website

RELATED EPISODES:

Ep. 72 Taking the USMLE to Task (with guest Bryan Carmody)

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Ep. 107 Independent NPs: Public Health Threat or Libertarian Step Forward? Feb 07, 2020

Hordes of independent nurse practitioners are on the horizon. Many physicians are raising the alarm bell, but our guest views things differently.

GUEST:

John Mandrola, MD: Twitter and Website

LINKS:

Independent Nurse Practitioners and Physician Assistants: A Doc's View (Medscape)

RELATED EPISODES:

Ep. 69 MD vs. NP: Patient Protection or Turf War? (with guest Rebekah Bernard)

Ep. 72 Taking the USMLE to Task (with guest Bryan Carmody)

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Ep. 106 Geoffrey Rose’s Untenable Theory of Population Health Jan 28, 2020

Geoffrey Rose published The Strategy of Preventive Medicine in 1992 and thus gave birth to the "Population Health" movement. This podcast episode critically examines Rose's influential ideas.

LINKS:

Geoffrey Rose The Strategy of Preventive Medicine (Amazon)

Geoffrey Rose. Sick Individuals and Sick Population. Reprinted in the Bulletin of the World Health Organization (open access)

Michel Accad Moving Mountains: A Socratic Challenge to the Theory and Practice of Population Medicine(Book website)

Slide deck for the talk presented at the 2018 AAPS meeting. The talk is available on YouTube here.

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Ep. 105 Privatizing the NHS: Who Profits? Jan 10, 2020

Our guest is Dr. Bob Gill, producer of the documentary The Great NHS Heist. We discuss what life in the NHS is like, how it differs from practice in the United States, and most importantly, Dr. Gill's fears of what is undermining the mission of the NHS - a hostile takeover by American corporate interests.

GUEST:

Dr. Bob Gill: Twitter

LINKS:

WATCH ON Vimeo:

https://vimeo.com/ondemand/thegreatnhsheist

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Ep. 104 Physician-Assisted Suicide: Why and Why Not Jan 01, 2020

Many physicians feel ambivalent about assisted suicide and neither endorse the practice nor outright condemn it. As a result, they also avoid discussing the topic altogether. Our guest is Dr. Adam Cifu, who kindly agreed to engage in a conversation on this difficult question.

GUEST:

Adam Cifu, MD: University of Chicago website and Twitter

Books by Adam Cifu: Ending Medical Reversaland Symptom to Diagnosis

LINKS:

FREE e-Book: "A Deadly Choice for the Medical Profession"

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Ep. 103 Ok, dinosaur: Skeptical Scalpel on the State of Surgical Education Dec 25, 2019

Our guest is the highly successful and widely respected blogger who writes anonymously under the pen name “Skeptical Scalpel.” He is a former Chairman of Surgery at an academic institution and we conversed about the state of surgical education and its present-day challenges.

GUEST:

Twitter, blog, and author page at Physician's Weekly

LINKS:

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Ep. 102 Curriculum Subverted: An Academic Leader Pushes Back Against ‘Woke’ Medical Education Dec 12, 2019

Should the medical school curriculum include health inequity, climate change, and gun control? Our guest is Professor Stanley Goldfarb, author of a recent and controversial op-ed in the Wall Street Journal on the politicization of medical education.

GUEST:

Stanley Goldfarb, MD: Professional website

LINKS:

"Take Two Aspirins and Call Me by My Pronouns" (WSJ, Sep 12, 2019)

"An Open Letter to Our Former Dean, Stanley Goldfarb" (Medscape, Sep 20, 2019)

"Social Justice and Educating Our Physicians" (WSJ, Editorial Board, Sep 19, 2019)

RELATED EPISODES:

Ep. 43 Doctors and Guns: Where Is the Lane? (with guest Pradheep Shanker, MD)

Ep. 75 Bridging Health and Community (with guest Pritpal Tamber, MBChB)

Ep. 58 The Rise and Fall of the American Medical School (with guest Milton Packer, MD)

Ep. 46 Reforming Medical Education: Beyond the Usual Platitudes (with guest Adam Cifu, MD)

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**Ep. 101 A Tougher Pill to Swallow: Roundtable on Generic Drugs** Nov 29, 2019

Swapnil Hiremath, MD John Tucker, PhD
As a follow-up to our podcast on the Ranbaxy Scandal, we are joined by medicinal chemist John Tucker, PhD and hypertension specialist Swapnil Hiremath, MD. Our distinguished guests share with us their perspectives and impressions on the unsettling question of generic drugs.
**GUESTS:**
John Tucker, PhD: Twitter
Swapnil Hiremath, MD: Twitter and Professional website
**RELATED EPISODE:**
Ep. 100 Can We Trust Generic Drugs? The Ranbaxy Whistleblower Narrates the Pharma Scandal of the Century (with guest Dinesh Thakur)
**SUPPORT THE SHOW:**
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**WATCH THE SHOW:**
Watch the episode on our YouTube channel

Ep. 100 Can We Trust Generic Drugs? The Ranbaxy Whistleblower Narrates the Pharma Scandal of the Century Nov 20, 2019

Dinesh Thakur

Generic drugs represent 90% of the pharmaceutical market. Their use has been encouraged through decades of favorable legislation and subsidies, with authorities claiming they are as safe and effective as brand name drugs. Yet generic preparations tainted with impurities are being reported with increasing frequency. What should doctors and the public know about generic drug manufacture? Our guest is the chemist who was at the center of the most important scandal to rock the global pharmaceutical industry in decades.

GUEST:

Dinesh Thakur Twitter and Website

LINKS:

Bottles of Lies by Katherine Eban

RELATED EPISODES:

Ep. 15 Lethal Regulation: The 1962 FDA Amendments (with guest Mary Ruwart)

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WATCH THE SHOW:

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Ep. 99 Health Policy Should Focus on Choice Nov 15, 2019

David Balat

A health policy of choice—not of constraints—is what we need, says our guest David Balat. He is currently the Director of the Right on Healthcare initiative with Texas Public Policy Foundation. He has a broad base of experience throughout the healthcare spectrum with special expertise in healthcare finance. He is a former Congressional candidate in Texas’ 2nd Congressional District and a seasoned hospital executive with more than 20 years of healthcare industry leadership and executive management experience.

David is focused on education and advocacy in an effort to simplify coverage that is too expensive, complicated, and untrustworthy. He is an ardent advocate of Physicians and believes the restoration of the Physician/Patient relationship is critical to fixing our dysfunctional system. He often volunteers of his time to help families navigate their bills and how to understand their benefits.

GUEST:

David Balat: Twitter and Webpage at the Texas Public Policy Foundation

LINKS:

“Uninsured by Choice or by Circumstances?” (from The Hill, September 2019)

Free to Care Coalition

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Ep. 98 Psychiatry v. Antipsychiatry Nov 09, 2019

George Dawson, MD, DFAPA

As a medical discipline, psychiatry has often been the target of severe criticism, particularly in the last 50 to 60 years. Is the criticism valid or not? What is the outlook for the science of mental illness and the practice of psychiatry? Our guest today defends his chosen medical specialty.

George Dawson, MD, DFAPA, is a Staff Psychiatrist at the Hazelden Betty Ford Foundation and an Adjunct Professor at the Hazelden Betty Ford Graduate School of Addiction Studies. His clinical interests have been in acute care, geriatric psychiatry, neuropsychiatry, and addiction psychiatry. He currently practices addiction psychiatry, providing psychiatric consultation on patient care to the professional staff, and lectures on the neurobiology, epidemiology, and the clinical aspects of addiction psychiatry.

Dr. Dawson completed his training in psychiatry at the University of Wisconsin where he was a research fellow. Scholarly interests include biological psychiatry, consciousness studies, and the medical, philosophical, and political aspects of psychiatry. In his spare time, he writes a blog about some of these topics called Real Psychiatry.

GUEST:

George Dawson, MD, DFAPA: Twitter and website “Real Psychiatry”

LINKS:

Selected blog posts by Dr. Dawson:

RELATED EPISODE:

Ep. 71 Psychiatry: Past, Present, and Future (with guest Paul McHugh, MD)

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Ep. 97 Evidence-Based Economics: What the Doctor Ordered? Nov 06, 2019

Peter G. Klein, PhD

Will the randomized control trial bring more clarity and certainty to economic science? Is “evidence-based economics” something to be hailed as a welcome innovation or should it be appraised with a more sober attitude? To examine this topic and discuss the relative place of randomized trials in economics and medicine we have as our guest Peter G. Klein, W. W. Caruth Chair and Professor of Entrepreneurship at Baylor University’s Hankamer School of Business. Professor Klein is also the Carl Menger Research Fellow at the Ludwig von Mises Institute. He obtained his PhD in Economics from the University of California Berkeley, and his BA from the University of North Carolina Chapel Hill.

His field of interest is in the area of the economics of entrepreneurship and business organization. He taught previously at the University of California, Berkeley, the University of Georgia, the Copenhagen Business School, and the University of Missouri, and served as a Senior Economist with the Council of Economic Advisers. He is the author of 5 books and numerous peer-reviewed articles.

GUEST:

Peter G. Klein: Twitter and academic web page

LINKS:

Klein, P. “New Nobel Winners Are Latest Bad Science for Economic Theory” (Article on the Ludwig von Mises Institute website).

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Make a small donation on our Patreon page and join our discussion group or receive a free book.

WATCH THE SHOW:

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Ep. 96 Surprise Billing: What the Policy Wonks Don’t Get Nov 02, 2019

Amy Mecozzi Cho, MD

Do hospital-based physicians benefit from being out-of-network? Are policy wonks who attack “surprise billing” fully aware of the relevant factors? In this second episode on this topic, Dr. Koka leads a conversation with our guest, Dr. Amy Cho, an emergency physician from Minnesota.

Dr. Cho graduated from the University of Michigan with a joint MD/MBA and completed her residency in Emergency Medicine at Advocate Christ Medical Center in Chicago. Prior to medical school, she worked as a management consultant with Bain & Co. and as a product manager with Convio, a venture-funded software company.

GUEST:

Amy Mecozzi Cho, MD: Twitter

LINKS:

High Yield Script (website)

RELATED EPISODE:

Ep. 94. The Trojan Horse of Surprise Billing Legislation (with guest Daniel E. Choi, MD)

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**Ep. 95 Polygenic Risk Scoring: An Epidemiologist’s Perspective** Oct 30, 2019
A. Cecile Janssens, PhD
Has cardiovascular genetics come of age? Are “polygenic risk scores” ready to inform us in clinically meaningful ways? In the final analysis, who or what are epidemiological data informing? Our guest is A. Cecile Janssens, PhD, Professor of Translational Epidemiology at the Rollins school of Public Health at Emory university in Atlanta, GA.
Professor Janssens’ research concerns the translation of genomics research to applications in clinical and public health practice and focuses on the genetic prediction of common diseases such as diabetes, cardiovascular disease and cancer. She also studies how the predictive ability and utility of genetic testing can best be measured.
**GUEST:**
A. Cecile Janssens, PhD: Twitter and website
**LINKS:**
The following graphs referred to on the podcast are taken from the paper by Torkamani, Wineinger, and Topol: The personal and clinical utility of polygenic risk scores.

**SUPPORT THE SHOW:**
Make a small donation on our Patreon page and join our discussion group or receive a free book.

Ep. 94 The Trojan Horse of Surprise Billing Legislation Oct 27, 2019

Daniel E. Choi, MD

Are out-of-network physicians deliberately trying to price-gouge patients in need of emergency care? Will “surprise billing legislation” solve the problems of narrow networks in a socially responsible manner? In this episode, Dr. Koka leads a conversation with our guest, Dr. Daniel E. Choi, on the topic of surprise billing legislation.

Dr. Choi obtained his MD degree from Northwestern University Feinberg School of Medicine in Chicago, completed his residency training at Rutgers State Univeristy of New Jersey, and completed a combined neurosurgical and orthopedic fellowship in spine surgery at Harvard Medical School.

GUEST:

Daniel E. Choi MD: Twitter

LINKS:

Fix Surprise Billing (website)

Cho AM: Congress Is About to Give Health Insurance Companies the Nuclear Weapon. Available at: https://www.highyieldscript.com/take-action-against-the-benchmark-solution/. Accessed October 9, 2019.

Corlette S, Hoppe O: New York’s 2014 Law to Protect Consumers from Surprise Out-of-Network Bills Mostly Working as Intended: Results of a Case Study. Available at: https://georgetown.app.box.com/s/6onkj1jaiy3f1618iy7j0gpzdoew2zu9. Accessed October 9, 2019.

New York State: Governor Cuomo Announces Success of New York’s Landmark Out-of-Network Law Protecting Consumers from Surprise Medical Bills. Available at: https://www.governor.ny.gov/news/governor-cuomo-announces-success-new-yorks-landmark-out-network-law-protecting-consumers. Accessed October 9, 2019.

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Ep. 93 Neurosurgery, Health Policy, and the Free Market: A Conversation with Richard Menger Oct 14, 2019

Richard Menger, MD

Can a graduate of the Harvard Kennedy School hold on to free market principles? Evidently so! We talk health policy and economics with our guest Richard Menger, MD, MPA, a neurosurgeon serving as Chief of Complex Spine Surgery at the University of South Alabama.

Dr. Menger completed medical school with honors at Georgetown University School of Medicine where he was elected to the Alpha Omega Alpha Honor Society and received the Barbara Bregman PhD Award. He then trained at Louisiana State University Shreveport and at Columbia University for a fellowship in scoliosis treatment. At the Harvard Kennedy School of Government he completed a Master in Public Administration and was awarded the Hale Champion Public Service Fellowship.

Dr. Menger has authored numerous scientific papers in academic journals and is the lead editor of the textbook The Business, Policy, and Economics of Neurosurgery. His op-ed/policy work has been published in the Wall Street Journal, Forbes, Navy Times, the Hill and others. He has a joint appointment as Assistant Professor of Political Science at the University of South Alabama.

GUEST:

Richard Menger MD, MPA: LinkedIn

LINKS:

Articles by Richard Menger:

“Imagine Your Surgeon Wasn’t Allowed to Train Enough” (Washington Times, February 8, 2018)
“The Insurer Will See You Now” (Wall Street Journal, September 3, 2018)
“Expanding Medicaid Won’t Save Obamacare” (Foundation for Economic Education, January 2, 2018)
“Non-Profit Hospitals Are Making a Killing” (Foundation for Economic Education, July 16, 2019)

Milton Friedman at the Mayo Clinic: YouTube video

Michel Accad. “The Mayo Clinic and the Free Market” (Mises Institute website)

RELATED EPISODES:

Ep. 10 Free Market Medicine: Ethical, Workable, Unstoppable (with guest G. Keith Smith, MD)

Ep. 22 Free Markets in Healthcare: Objecting to the Objections (with guest Roman Zamishka)

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Make a small donation on our Patreon page and join our discussion group or receive a free book.

Ep. 92 Why Is the Antibiotics Market Broken? Sep 24, 2019

David Shlaes, MD, PhD

Big Pharma is abandoning its R&D efforts for antibiotics. What are the regulatory, scientific, and economic factors responsible for this potentially dangerous trend?

Our guest on this episode is Dr. David Shlaes. Dr. Shlaes is an infectious diseases specialist who trained was formerly professor of medicine at Case Western medical school in Cleveland, Ohio. He left academia in 1996 to become Vice President for infectious diseases at Wyeth Pharmaceuticals. He has been very prominent in the field of antibiotics research and development. In 1998 he was on the cover of Business Week in recognition of his contributions. In 2005 he established a consulting company and has been active in advising companies and policy makers. He has since retired but remains involved in the field. as an editor for the journal Antimicrobial Agents and Chemotherapy and as a blogger on his site called Antibiotics, The Perfect Storm, which is the title of a book that he wrote a few years ago.

GUEST:

David Shlaes, MD, PhD Website

RELATED EPISODE:

Ep. 15 Lethal Regulations: The 1962 FDA Amendments (with guest Mary Ruwart, PhD)

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Make a small donation on our Patreon page and join our discussion group or receive a free book.

Ep. 91 On Abortion Sep 10, 2019

Niran Al-Agba, MD

This past May, the governor of Alabama signed into law a piece of legislation that imposes great restrictions on abortion. Niran Al Agba recently wrote an op ed about that law and she returns to the show to discuss that op ed and, more generally, to share with us her position on abortion. We are very grateful for her willingness and ability to carry this conversation with utmost civility.

Dr. Al-Agba is a board-certified pediatrician who is also a prolific writer. She speaks widely and openly on a variety of issues, including policy, ethics, and medical practice. She is a regular contributor to the Kitsap Sun, to The Deductible blog, and to a variety of other outlets, including her own blog, MommyDoc. She is a mother of four children who’s been voted best doctor in Kitsap County on multiple occasions. She also serves on the clinical staff and admissions committee at the University of Washington School of Medicine.

GUEST:

Niran Al-Agba, MD Twitter

LINKS:

Niran Al-Agba. “Alabama’s Law Is Not Pro-Life. Here’s Why.” (Kitsap Sun)

Niran Al-Agba’s columns for Kitsap Sun

Niran Al-Agba’s personal blog

Niran Al-Agba’s page on The Deductible

UCSF Bixby Center for Global Reproductive Health: Abortion page

RELATED EPISODE:

Ep. 74 Can We Have a Reasonable Discussion About Vaccines? (with guest Niran Al-Agba)

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Make a small donation on our Patreon page and join our discussion group or receive a free book.

Ep. 90 Why Employer-Funded Health Plans Are Turning to Free Market Medicine Sep 05, 2019

Jay Kempton

How do businesses purchase healthcare services for their employees? What are the factors that bear on their purchasing decisions? These important questions are rarely part of the policy conversation. Our guest on this episode is Jay Kempton, President and CEO of the Kempton group, helping employers obtain and administer health care benefits for their employees. He relates his professional journey, shares his insights as a third-party administrator, and tells us about his recent efforts to turn employers away from the wasteful and corrupt health insurance benefit model.

Mr. Kempton is one of the founding members of the Free Market Medical Association, a board member of the Society of Professional Benefit Administrators, and a member of the Health Care Administrators Association. He obtained a Bachelor of Science degree in Business Administration from Oklahoma State University and holds Life, Health, AD&D, and Property and Casualty Insurance licenses in multiple states.

GUEST:

Jay Kempton (Twitter), CEO of The Kempton Group.

LINKS:

Free Market Medical Association website

RELATED EPISODES:

Ep. 10 Free-Market Medicine: Ethical, Workable, and Unstoppable (with Keith Smith)

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Make a small donation on our Patreon page and join our discussion group or receive a free book.

Ep. 89 From Fortress to Frontier in American Health Care, with Bob Graboyes Aug 09, 2019

Robert Graboyes, PhD

According to our guest, American health care is stuck in a fortress mentality that stifles innovation, constrains medical advances, and yield low quality care. That fortress was erected more than 100 years ago but, in many ways, is being circumvented by creative actors who are seizing opportunities to make changes outside of the political process.

Bob Graboyes is Senior Research Fellow at the Mercatus Center at George Mason University. He holds a PhD in Economics from Columbia University and has held a number of academic positions in higher education in Virginia. He is the author of “Fortress and Frontier in American Health Care,” a booklet which offers many examples of individuals adopting a risk-tolerant frontier attitude to compete with insiders and pave the way to the future without having to rely on political reform. Prior to focusing his career on health care, Bob Graboyes was regional economist/director of education at the Federal Reserve Bank of Richmond.

GUEST:

Robert Graboyes Twitter

LINKS:

Robert Graboyes. “Fortress and Frontier in American Health Care” (2014, Mercatus Center)

RELATED EPISODES:

Ep. 83. The Faulty Economics of Health Insurance: Arrow Revisited (part 2, with Bob Murphy)

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Make a small donation on our Patreon page and join our discussion group or receive a free book.

Ep. 88 The Stupidity of the American Healthcare Consumer? Jul 31, 2019

Dr. G. Keith Smith

The Affordable Care Act was allegedly passed thanks to “the stupidity of the American voter.” The economist who made that claim—and who is also considered to be one of the architects of the law—has recently published a working paper that examines whether better informed patients make better healthcare decisions. He and his colleagues conclude in the negative.

To help us gain a better perspective on that paper we’ve invited Dr. Keith Smith back to the show. Dr. Smith is the co-founder of the Surgery Center of Oklahoma, a pioneering institution in free-market medicine. As such, he has direct knowledge of the behavior of healthcare consumers and offers us his insights on the chasm that exists between the way healthcare policy makers conceive of medical practice and how ordinary patients actually seek the best possible healthcare value for themselves.

GUEST:

G. Keith Smith’s blog and Twitter

LINKS:

Michael Frakes, Jonathan Gruber, and Anupam Jena. “Is Great Information Good Enough? Evidence from Physicians as Patients” NBER Working Paper 26038

Free Market Medical Association

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Make a small donation on our Patreon page and join our discussion group or receive a free book.

Ep. 87 Trump’s 7/10 Executive Order: A Turning Point for Nephrology? Jul 24, 2019

Joel Topf, MD

President Trump’s July 10, 2019 Executive Order on Advancing American Kidney Health may represent a major turning point in regard to how patients with chronic kidney disease are treated. We have the pleasure of having as our guest Dr. Joel Topf. Dr. Topf is a nephrologist in private practice and a popular blogger and leader in medical social media. He is an adviser to the American Society of Nephrology and was present at the signing or the executive order. He joins Anish Koka to share his insights on the good and bad of the executive order and on the state and future of kidney disease in the United States.

GUEST:

Joel Topf, MD. Twitter and website.

LINKS:

The White House. Executive Order on Advancing American Kidney Health

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Make a small donation on our Patreon page and join our discussion group or receive a free book.

Ep. 86 Tales of a Recovering Hospital CEO Jul 16, 2019

John Chamberlain

Hospital executives with a conscience may have a tough time navigating the corrupting waters of our healthcare system. Mr. John Chamberlain is a self-described “recovering” hospital CEO with over 35 years of experience as a hospital and physician practice executive. In this interview with Anish Koka, he relates how his attempts to do right by the patient became increasingly arduous.

Mr. Chamberlain eventually saw the light of free market medicine and currently serves as Chairman for Citizen health, an organization dedicated to “rebuilding healthcare for the next generation.”

GUEST:

John Chamberlain. Twitter

LINKS:

Citizen Health’s website

SUPPORT THE SHOW:

Make a small donation on our Patreon page and join our discussion group or receive a free book.

Ep. 85 Trump’s 6/24 Executive Order: A Turning Point for Direct Primary Care? Jul 11, 2019

Lee Gross, MD

President Trump’s June 24, 2019 Executive Order on health care transparency contains a key provision regarding direct primary care. We have the pleasure of having back on the show Dr. Lee Gross. Dr. Gross and colleagues in the DPC movements were instrumental in getting the White House to clarify a prior ambiguity regarding how direct primary care membership fees ought to be considered from a tax standpoint. Dr. Gross will be telling us about this effort and about the implications of that change for the growth of the direct care movement.

Dr. Gross is a family physician in North Port, FL. He is a pioneer and a leader in the DPC movement. He is a health care consultant to physician practices, medical organizations, insurance groups, hospitals and private businesses. He founded and serves as President of the Docs 4 Patient Care Foundation and he is chairman of a new lobbying organization called DPC Action.

GUEST:

Lee Gross, MD. Twitter

LINKS:

The White House. Executive Order on Improving Price and Quality Transparency in American Healthcare to Put Patients First

DPC Action’s website

Lee Gross. Direct Primary Care Can Rein In America’s Out-of-Control Healthcare Costs (in the Washington Examiner)

Epiphany Health: Dr. Gross’ practice website

Doc 4 Patient Care Foundation’s website

RELATED EPISODE

Ep. 49. Why Are We Insuring primary Care? (with Dr. Lee Gross)

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Make a small donation on our Patreon page and join our discussion group or receive a free book.

Ep. 84 “You’ll Be Dead in a Year!” A Patient’s Journey Through the Healthcare System Jul 03, 2019

Anish Koka, MD

What can we learn from the experience of a 90-year-old patient who is told point-blank “You’ll be dead in a year!” and who survives to tell the story?

This is a first of its kind in the annals of the Accad and Koka Report. The episode starts with a 15-minute interview conducted by Dr. Koka of a patient of his, about her journey through the healthcare system. After the interview, we have an in-depth conversation, prompted by the patient’s testimony, about what to take into consideration when making decisions for elderly patients who contemplate expensive and risky procedures.

SUPPORT THE SHOW:

Patreon.com/accadandkoka

Ep. 83 The Faulty Economics of Health Insurance: Arrow Revisited (Pt. 2) Jun 28, 2019

Robert P. Murphy, PhD

It is commonly believed that healthcare is a sector plagued by “market failure.” A heavy dose of government intervention is therefore necessary to optimize the needs of society. A paper most commonly cited in support of that view is one published in 1963 by Nobel Prize winner Kenneth Arrow, one of the giants of economic theory in the 20th century, and titled “Uncertainty and the Welfare Economics of Medical Care.”

But how does economic theory arrive at the concept of market failure and how do economists conceive of health care when they apply their theoretical models to medical practice?

To help sort this out, we have as our guest Robert P. Murphy, economist, teacher, and author of many books. Dr. Murphy obtained his PhD from NYU and is Senior Fellow at the Mises Institute. He is co-host, with Tom Woods, of the popular podcast Contra Krugman and he is also host of The Bob Murphy Show, “a podcast promoting free markets, free minds, and grateful souls.”

The episode in in 2 parts. In the first part, we reviewed the theoretical framework that forms the background to Arrow’s paper. In this second part, we delve into the paper itself, discuss how economists conceive (or misconceive) of medical care, and what the implications have been for the US healthcare system as a whole.

GUEST:

Robert P. Murphy: Website and Twitter

LINKS:

Kenneth Arrow. “Uncertainty and the Welfare Economics of Medical Care” (1963, in American Review of Economics)
Bob Murphy. Choice: Cooperation, Enterprise, and Human Action (2015)
Bob Murphy and Doug McGuff. Primal Prescription: Surviving the “Sick Care” Sinkhole (2015)
Bob Murphy. The Politically Incorrect Guide to Capitalism (2007)

SUPPORT THE SHOW:

Patreon.com/accadandkoka

Ep. 82 The Economics of Healthcare: Market Failure or Faulty Models? (Part 1) Jun 21, 2019

Robert P. Murphy, PhD

It is commonly believed that healthcare is a sector plagued by “market failure.” A heavy dose of government intervention is therefore necessary to optimize the needs of society. A paper most commonly cited in support of that view is one published in 1963 by Nobel Prize winner Kenneth Arrow, one of the giants of economic theory in the 20th century, and titled “Uncertainty and the Welfare Economics of Medical Care.”

But how does economic theory arrive at the concept of market failure and how do economists conceive of health care when they apply their theoretical models to medical practice?

To help sort this out, we have as our guest Robert P. Murphy, economist, teacher, and author of many books. Dr. Murphy obtained his PhD from NYU and is Senior Fellow at the Mises Institute. He is co-host, with Tom Woods, of the popular podcast Contra Krugman and he is also host of The Bob Murphy Show, “a podcast promoting free markets, free minds, and grateful souls.”

The episode in in 2 parts. In this first part, we review the theoretical framework that forms the background to Arrow’s paper. In the upcoming second part, we will delve into the paper itself, discuss how economists conceive (or misconceive) of medical care and what the implications have been for the US healthcare system as a whole.

GUEST:

Robert P. Murphy: Website and Twitter

LINKS:

Kenneth Arrow. “Uncertainty and the Welfare Economics of Medical Care” (1963, in American Review of Economics)
Bob Murphy. Choice: Cooperation, Enterprise, and Human Action (2015)
Bob Murphy and Doug McGuff. Primal Prescription: Surviving the “Sick Care” Sinkhole (2015)
Bob Murphy. The Politically Incorrect Guide to Capitalism (2007)

Ep. 81 The Opioid Epidemic: Is Pharma To Blame? Jun 15, 2019

J.J. Rich

The Commonwealth of Massachusetts’ lawsuit against Purdue Pharmaceuticals exemplifies a common narrative that lays a large part of the blame for the opioid epidemic at the feet of the manufacturer of prescription opioids for manipulating physicians into prescribing the drugs more liberally. Is there merit to that story?

To examine that question, we have as our guest Jacob James Rich, a policy analyst at Reason Foundation. Mr. Rich holds master’s degrees in economics and mathematics from Eastern Michigan University. Prior to joining Reason, he conducted research for the Cato Institute focused on opioids and the drug war.

GUEST:

J.J. Rich: Profile and Twitter

LINKS:

J.J. Rich and Robert Capodilupo. “Examining the Lawsuit Massachusetts Filed Against Purdue Pharma About the Opioids Problem.” (Reason, May 15, 2019)
Michael H. Levy. Pharmacologic Treatment of Cancer Pain (New Engl J Med, 1996)

RELATED EPISODE:

Ep. 68 The Opioid Epidemic: A Solo Physician’s Hopeful Response (with guest Molly Rutherford, MD)

Ep. 80 How To Rollback Bad Health Care Laws Jun 03, 2019

Marcelo Hochman, MD

Is the healthcare mess so hopeless that physicians should either leave it or wait for it to collapse? Are there legislative steps that doctors can take to tangibly improve the practice of medicine? And, if so, how should physicians act within the problematic framework of “organized medicine” to bring about such changes?

Our guest is Dr. Marcelo Hochman, who is sharing with us some hopeful successes in introducing important legislation by working in conjunction with his local and state medical societies. The 3 issues he has focused on are 1) a repeal of certificate-of-need laws, 2) a ruling against “non-compete clauses” in physician contracts, and 3) a tax deduction for charitable work provided by physicians. All 3 issues appeal to the notion that expanding the settings in which physicians can be free to practice will benefit both doctors and society.

Dr. Hochman is an independent solo pediatric facial plastic surgeon who practices in Charleston, South Carolina. He has specialized in the treatment of congenital vascular anomalies. He is a recipient of the Order of the Palmetto, South Carolina’s highest civilian award, and of other national and local professional and community honors. He currently serves as the President of the Charleston County Medical Society, as Chair of the Coalition to Repeal CON (Certificate of Need), and as Director of The Hemangioma Treatment Foundation.

GUEST:

Marcelo Hochman, MD: Website and Twitter

LINKS:

Coalition to Repeal CON. 501c-4 organization founded by Dr. Hochman to repeal CON laws.

RELATED EPISODE:

Ep. 18 A Doctor Fights Against CON Laws, with guest Gajendra Singh, MD

**Ep. 79 Can 12th-Century Medicine Save 21st-Century Health Care?** May 23, 2019
Victoria Sweet, MD

Is the body a machine? Are doctors mere technicians who simply “fix” biological defects in their patients? In a very real sense, that’s how modern societies conceive of medical practice, so much so that healthcare is now frequently experienced as an industrial process: doctors and nurses churning patients through an assembly line. And that process is taking a huge economic, physical, and mental toll on everyone.

The mechanical model on which modern medicine is based has obviously brought technological wonders to the practice of medicine—and it should be celebrated for these extraordinary achievements. But have we become so wedded to the machine metaphor that we ignore more fundamental aspects of human reality? Can another way of conceiving of health and life be brought to bear on the practice of medicine positively, without discarding the achievements of the scientific age?

Our guest is Dr. Victoria Sweet, author of the best-sellers *God’s Hotel* and *Slow Medicine,* two of the most important books on medicine in recent times. Those books were inspired by Dr. Sweet’s rediscovery of the medical texts of Hildegard of Bingen, a 12th-century mystic and nun whose practical approach to medicine may well contain the very principles that can help cure 21st-century health care from its seemingly irremediable predicament.

**GUEST:**

Victoria Sweet, MD: Website

**LINKS:**

Victoria Sweet *God’s Hotel* and *Slow Medicine* (Amazon links)

Michel Accad. How Western Medicine Lost Its Soul. *Linacre Quarterly*, 2016 (open access)

Lenore Buckley. “What About Recovery?” (April 2019 in *JAMA’s* “A Piece of my Mind”)

**SPECIAL CONTENT:**

Dr. Sweet’s Letter to the Editor to the New England Journal of Medicine, published Nov 25, 1993, in response to an article analyzing the high administrative costs of American hospital care.

Ep. 78 In the Footsteps of Donabedian: The US News and World Report Hospital Ranking System May 16, 2019

Ben Harder

Quality ratings of hospitals and physicians: help or hindrance? Surely, the general public demands and is entitled to an assessment of hospital quality based on sound methodology. And ratings coming from the private sector are far more likely to be unbiased and to adjust to an ever changing healthcare landscape than those coming from the government and public policy sector. But is there a downside to scrutinizing the healthcare enterprise?

We have a fascinating conversation with one of the most knowledgeable persons on the topic. Ben Harder is Chief of Health Analysis and US News and World Report and oversees the team of analysts and statisticians who produce the most recognized ranking of hospitals in the country. Ben holds a Bachelor of Science in Biological Anthropology from Harvard University and began his career in health and science journalism before taking the job of quality czar at US News and World Report and

GUEST:

Ben Harder Twitter

LINKS:

An Expert on Health Care Evaluate his Own Case. New York Times 2001 interview of Avedis Donabedian

Avedis Donabedian. Evaluating the Quality of Medical Care (1966, Milbank Quarterly)

Anish Koka. The High Cost of Public Reporting (2017, in The Health Care Blog)

Michel Accad. Key Problems for Report Cards (2018, Accad & Koka blog)

RELATED EPISODE:

Ep. 19 Public Reporting: Necessary Evil or Harmful Fake News? (with guest Robert Yeh, MD)

**Ep. 77 A Debate on Vaccine Mandates** May 07, 2019
Dorit Reiss, PhD

Two distinguished guests join us to debate the issue of vaccine mandates.

Dorit Reiss is Professor of Law at UC Hastings College of the Law in San Francisco, California. She holds an undergraduate degree in Law and Political Science from the Faculty of Law at Hebrew University in Jerusalem and a PhD in Jurisprudence and Social Policy from the University of California, Berkeley. She is a legal authority on the question of vaccines and vaccine mandates. She has published numerous articles on this topic in a variety of law review journals and her expertise is recognized around the world.

Jonathan Howard, MD

Jonathan Howard is Assistant Professor in the Departments of Neurology and Psychiatry at New York University Langone. He is Director of the Neurology Service at Bellevue Hospital and Director of Clerkship Director for the Clinical Neurological Sciences at NYU.

Dorit and Jonathan have co-authored a book chapter entitled “The Anti-Vaccine Movement: A Litany of Fallacy and Errors,” in *Pseudoscience: A Conspiracy Against Science*.

**GUESTS:**

Dorit Reiss, PhD Twitter and professional page

Jonathan Howard, MD Twitter and professional page

**LINKS:**

Jonathan Howard and Dorit Reiss. “The Anti-Vaccine Movement: A Litany of Fallacy and Errors” in *Pseudoscience: The Conspiracy Against Science* MIT Press, 2018

Orsoo, O et al. Epidemiological characteristics and trends of a nationwide measles outbreak in Mongolia, 2015-2016. *BMC Public Health,* 2019 (open access)

**RELATED EPISODES:**

Ep. 74 Can We Have a Reasonable Discussion About Vaccines (with guest Niran Al-Aqba)

**SUPPORT THE SHOW:**

Our Patreon page allows you to join the Accad and Koka Secret Facebook Group and get a free copy of *Moving Mountains*.

Ep. 76 Defenders of the Status Quo: Arthur Caplan and the Modern Bioethics Movement May 02, 2019

Michel Accad, MD

A short episode commenting on a recent piece in Medscape by Arthur L. Caplan, one of the most influential bioethicists of the last 40 years.

LINKS:

Arthur Caplan. “No, Patients Are NOT Consumers, and MDs Are NOT Providers,” Commentary in Medscape, April 2019

Tom Koch. Thieves of Virtue. MIT Press 2012

RELATED EPISODE:

Episode 50. Thieves of Virtue: How Bioethics Stole Medicine (with guest Tom Koch)

Ep. 75 Bridging Health and Community with Pritpal Tamber Apr 25, 2019

Pritpal S. Tamber, MBChB

If ‘health’ is an elusive concept, how much harder it must be to articulate what a healthy community should be. But that should not stop us from grappling with foundational ideas and from sketching a forward-looking vision for a better society. Our guest on this episode is Pritpal Tamber, a physician who has devoted his career to understanding better what it means to live in a healthy community.

Dr Tamber is the former Physician Editor of TEDMED, TED’s dedicated health event, a former editor at the British Medical Journal, and the former Medical Director of Map of Medicine, a company that tried to improve the flow of patients through health care on the basis of clinical evidence. Through his work with TEDMED, and informed by his insights into clinical evidence and system change, Dr Tamber is convinced that the glamorous, tech-led world of health innovation is unlikely to have much impact on the patients with the worst health—those lower down the socioeconomic gradient.

Since 2013, he has spent time with numerous community projects, principally in the US and the UK but also in The Netherlands, New Zealand and Mexico, to explore and understand the realities of the work. Through his work he has described 12 recurring principles that offer a practice-based structure for how the health sector can work with communities. Collectively, these principles describe an inclusive and participatory process, effectively illustrating that people are sick because they have little influence over their lives. Social epidemiologists have called this ‘having a sense of control’, and it is something that requires agency—the ability to make purposeful choices.

GUEST:

Pritpal S. Tamber, MBChB Twitter

LINKS:

Pritpal Tamber My perspective (including the we principles)

Richard Smith. The Hegemony of ‘Health People’. BMJ October 2018

Ep. 74 Can We Have a Reasonable Discussion About Vaccines? Apr 18, 2019

Niran Al-Aqba, MD

Does the vaccine debate have to be polarized according to “Pro-Vaxx” or “Anti-Vaxx” camps? Is it possible to have a reasonable discussion about harms and benefits of vaccines? Are public health concerns about unvaccinated children sufficient to trump individual liberty?

Exploring the question with us is Dr. Niran Al-Aqba, a board-certified pediatrician in private practice in Washington State, an area hit by the recent outbreak of measles. Dr. Al-Agba is a prolific writer who speaks widely and openly on a variety of issues, including policy, ethics, and medical practice. She is a regular contributor to the Kitsap Sun, to The Deductible blog, and to a variety of other outlets, including her own blog, MommyDoc. She is a mother of four children who’s been voted best doctor in Kitsap County on multiple occasions. She also serves on the clinical staff and admission committee at the University of Washington School of Medicine.

GUEST:

Niran Al-Agba, MD Twitter

LINKS:

Dr. Al-Agba’s article mentioned in the show “In Defense of Pediatricians (and a Few Words of Advice for Doctors and Public Health Types)” in The Deductible blog.

Niran Al-Agba’s columns for Kitsap Sun

Niran Al-Agba’s personal blog

Niran Al-Agba’s page on The Deductible

Niran Al-Agba’s practice Facebook page

Ep. 73 Conservative Means to Progressive Ends? Avik Roy on Healthcare Apr 10, 2019

Avik Roy

Is there a conservative path to universal healthcare? Our guest certainly believes so. Avik Roy is one of the most influential conservative voices in healthcare. A graduate from MIT and Yale Medical School, Avik spent many years with the investment firm Bain Capital. In 2009, in response to the debates leading up to Obamacare, Avik started a blog to share his insights. Those were soon noticed by the media and the policy world, and he quickly became the go-to policy wonk on healthcare among conservatives.

In 2012, Roy joined the campaign of Mitt Romney as policy adviser and later went on to advise Texas Governor Rick Perry as well as Senator Marco Rubio. In 2016, he founded FREOPP, the Foundation for Research on Equal Opportunity, a conservative public policy think tank based in Austin, Texas. He continues to edit his blog, The Apothecary, now hosted by Forbes where he serves as Senior Opinion editor.

GUEST:

Avik Roy. Twitter

LINKS:

The Apothecary

The Foundation for Research on Equal Opportunity (FREOPP)

Avik Roy. A conservative case for universal coverage (The Washington Examiner, 2014)

RELATED EPISODES:

Ep. 21 Inside the Swiss Healthcare System, with Marc Fouradoulas

Ep. 24 Making the Case for Medicare-4-All, with Adam Gaffney

Ep. 72 Taking the USMLE to Task Mar 31, 2019

Bryan Carmody, MD

Should a pass-fail exam designed to determine a student’s competence to practice medicine be scored numerically and used for residency selection? Every year, thousands of students sink an increasingly large number of hours and dollars to prepare for “Step 1” of the US Medical Licensing Examination, a task which seems to be disproportionate to the relevance the test bears to the practice of medicine.

Our guest on this show is Bryan Carmody, MD, a pediatric nephrologist who practices at the Children’s Hospital of the King’s Daughter in Norfolk, VA, and teaches medical students at the Eastern Virginia Medical School. Bryan himself has recently spent countless hours studying and blogging about the machinations that constitute licensing examination in the United States.

GUEST:

Bryan Carmody, MD, MPH. Twitter and Blog

LINKS:

Chen DR, et al. Students Perspectives on the “Step 1 Climate” in Medical Education. Academic Medicine, March 2019.

Katsufrakis PJ and Chaudhry HJ. Improving Residency Selection Requires Close Study and Better Understanding of Stakeholder Needs. Academic Medicine, March 2019.

RELATED EPISODES:

Ep. 46 Reforming Medical Education: Beyond the Usual Platitudes (with guest Adam Cifu)

Ep. 17 Hope in the Fight Against MOC (with guest Westby Fisher)

Ep. 71 Psychiatry: Past, Present, and Future Mar 24, 2019

Paul McHugh, MD

Despite its many scientific and therapeutic advances, the field of psychiatry remains lacking in coherence or cohesiveness as compared to other areas of medicine. Part of the issue undoubtedly has to do with the intractable mind-body problem, but part of it may also be due to the effort of standardization of diagnosis set in motion by the Diagnostic and Statistical Manual. Is there a way to move forward?

Our guest is optimistic. Paul McHugh, MD, is one of the most important figures in academic psychiatry of the last 30 years. He is University Distinguished Professor of Psychiatry at Johns Hopkins University School of Medicine where he was department chairman from 1975 until 2001. He is the author or co-author of several academic books and texts of psychiatry.

GUEST:

Paul McHugh, MD. Professional web page

LINKS:

Paul R. McHugh and Philip R. Slavney, D. Mental Illness: Comprehensive Evaluation or Checklist? (New Engl J Med, 2012)

Paul McHugh and Philip Slavney. The Perspectives of Psychiatry (Wolters Kluwer, 2nd ed. 1998)

Ep. 70 Industry-Sponsored Clinical Trials: An Insider’s View Mar 20, 2019

Milton Packer, MD

Mention the phrase “industry-sponsored clinical trial” and many eyes will immediately roll back. But is the reaction justified? Are academic leaders who participate in phase 3 trials simply figureheads hired to rubber-stamp protocols designed by Pharma and spin the results in a positive way?

Our guest on this show has strong opinions on this question. Dr. Milton Packer is an internationally recognized clinician, teacher, and scientist in the field of heart failure research. He has served as Chief of Cardiology at Columbia University in New York City and, subsequently, as Chair of the Department of Clinical Science at the Southwestern Medical School in Dallas. He is currently the Distinguished Scholar in Cardiovascular Science at Baylor University Medical Center.

Dr. Packer has received many teaching awards, mentored dozens of young clinical investigators, completed innumerable successful research projects, and served as a leader in many professional organizations. He is now also well known and admired for his regular column on MedPage Today, “Revolution and Revelation,” in which he mixes wisdom and polemics to the delight of his many readers.

GUEST:

Milton Packer, MD. Professional web page

LINKS:

Milton Packer. Exactly What Does a Principal Investigator of a Clinical Trial Do? (on MedPage Today)

Ep. 69 MD vs NP: Patient Protection or Turf War? Mar 13, 2019

Rebekah Bernard, MD

A massive push to increase the number of nurse practitioners and physician assistants and to extend their scope of practice is under way. The stated goal is to address a real or perceived shortage of primary care physicians. This effort worries many doctors who are concerned that patients are getting short-changed in the process. But is this concern justified or is it simply motivated by protectionist interests?

Our guest is Dr. Rebekah Bernard, a successful family physician from Fort Myers, Florida. She is board member of Physicians for Patient Protection, an organization calling for more transparency regarding the difference in training between physicians and non-physician providers, and advocating for legislative action to avoid misrepresentation of the capabilities and knowledge-base of nurse practitioners.

GUEST:

Rebekah Bernard, MD: Twitter and practice website

LINKS:

“What’s ruining medicine for physicians: replacing primary care physicians with NPs/PAs” Medical Economics Staff Editorial, December 4, 2018

“Can I see a nurse practitioner instead of a doctor?” Cedars-Sinai Blog January 28, 2019

IOM Report. The Future of Nursing: Leading Change, Advancing Health. Institute of Medicine (National Academies of Science, Engineering and Medicine) Report.

Rebekah Bernard. How to Be a Rock Star Doctor: The Complete Guide to Taking Back Control of Your Life and Your Profession

Rebekah Bernard. Physician Wellness: The Rock Star Doctor’s Guide

Ep. 68 The Opioid Epidemic: A Solo Physician’s Hopeful Response Mar 07, 2019

Molly Rutherford, MD

Effective pharmacological treatment for opioid dependence was introduced more than 15 years ago, yet the opioid epidemic continues to ravage our country and there are still important barriers that prevent patients from receiving the care that they need. The expansion of health insurance does not seem to mitigate this problem and, in fact, health insurance may be a hindrance for proper care.

What if the solution is to simply let doctors help patients directly and personally? Our guest today gives us an extraordinary testimony of what can be accomplished when physicians are free to care for patients privately, without the stigma associated with addiction and rehabilitation clinics.

Dr. Molly Rutherford graduated from Eastern Virginia Medical School in 2003 and completed a Family Medicine Residency in Portsmouth, Virginia in 2006. She and her family moved to Kentucky after residency so that she could practice rural medicine. In 2008, she obtained her DATA 2000 waiver to treat opioid dependence with buprenorphine and she became Board Certified in Addiction Medicine in 2012.

After a series of frustrations with employment and the dysfunctional health care system, she started her practice with the goal of providing comprehensive, individualized care to her patients at an affordable price, without the interference of 3rd-party payers. Dr. Rutherford is past President of the Kentucky Chapter of ASAM and current President of the Kentucky Academy of Family Physicians. Dr. Rutherford is also a member of the US Health and Human Services Pain Management Best Practices Inter-agency Task Force. She lives with her husband, a homicide detective with Louisville Metro Police Department and their 2 sons in La Grange, KY.

GUEST:

Molly Rutherford, MD: Twitter and practice website

RELATED EPISODES:

Ep. 54 How to Jump Ship and Practice Medicine on Your Own Terms (with guest Kathleen Brown, MD)

Ep. 67 Are Doctors Selling Themselves Short? Mar 03, 2019

Arvind Cavale, MD

The lure of physician employment seems irresistible and, on the surface, the arguments to justify it are also compelling. But are physicians selling themselves short? Are they really better off if they become employees of the hospital? Do they become more efficient? Are they putting themselves in ethical quandaries? And what is the way forward when the forces at play seem so overwhelming?

Our guest is Dr. Arvind Cavale, an entrepreneurial endocrinologist form Pennsylvania who is bucking the trend with great success, showing that small private practice can remain nimble, adopt technology, and deliver high quality care efficiently. He shares with us his experience and tips for political advocacy.

GUEST:

Arvind Cavale, MD: Twitter and practice website

LINKS:

Anna Wilde Matthews and Melanie Evans. The Hidden System that Explains How Your Doctor Makes Referrals. (in the WSJ, December 27, 2018)

Michel Accad. In Defense of the Employed Physician (in Alert & Oriented)

RELATED EPISODES:

Ep. 54 How to Jump Ship and Practice Medicine on Your Own Terms (with guest Kathleen Brown, MD)

Ep. 66 Cardiology Health Policy: The Clinicians Strike Back Feb 27, 2019

Rishi Wadhera, MD

Bright clinicians who are also trained as rigorous scientists can put healthcare policy under scrutiny and show that the wisdom of the wonks frequently falls short. Our guest on this episode is Dr. Rishi Wadhera, a prolific cardiology fellow currently in training at Brigham and Women’s Hospital in Boston and part of a team of health policy investigators at the Smith Center for Outcomes Research in Cardiology. Dr. Wadhera obtained his medical degree from the Mayo Clinic, a Master’s in Public Health from the University of Cambridge, and a Master’s in Public Policy from the Harvard Kennedy School of Government. He joins us to discuss 2 of his most recent papers which have made a big splash in the media.

GUEST:

Rishi Wadhera: Twitter

LINKS:

Wadhera RK, et al. Association of State Medicaid Expansion With Quality of Care and Outcomes for Low-Income Patients Hospitalized With Acute Myocardial Infarction. (in JAMA Cardiology, January 2019)

Wadhera RK, et al. Temporal Trends in Unstable Angina Diagnosis Codes for Outpatient Percutaneous Coronary Interventions (in JAMA Internal Medicine, February 2019)

Christian A. McNeely and David L. Brown. Gaming, Upcoding, Fraud, and the Stubborn Persistence of Unstable Angina (editorial commentary in JAMA Internal Medicine, February 2019).

RELATED EPISODES:

Ep. 41. Healthcare Policy in the Crosshairs: The Hospital Readmission Reductions Program (with guest Ankur Gupta, MD)

WATCH ON YOUTUBE:

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Ep. 65 James Heathers: Why Science Needs Data Thugs Feb 22, 2019

James Heathers, PhD

Will it take data vigilantes to restore some order in the House of Science? With the replication crisis showing no sign of letting up, some committed scientists have taken it upon themselves to find ways to sniff out cases of egregious fraud. As it turns out, identifying scientific misbehavior is surprisingly easy!

Our guest is a full-time research scientist, author/consultant at Northeastern University in Boston in a Computational Behavioral Science lab. James Heathers completed his undergraduate work in Psychology and Industrial relations from the University of Sydney and obtained his doctorate degree on the topic of methodological improvements in heart rate variability at the same institution in 2015.

He and a couple of his colleagues have captured the limelight after exposing problems in the work of a world-famous nutrition researcher, which led to the retraction of 5 papers. These “data thugs” have since designed a couple of tools that can identify suspicious data through a simple analysis of descriptive statistics.

GUEST:

James Heathers, PhD: Twitter, podcast, and website

LINKS:

Brian Wansink. The Grad Student Who Never Said “No” (from the WayBack Machine internet archives)

James Heathers. Introducing SPRITE and the Case of the Carthorse Child

Adam Marcus and Ivan Oransky. Meet the Data-Thugs Out to Expose Shoddy and Questionable Research (Blog post in Science, Feb 2018)

Tom Bartlett. “I want to Burn Things to the Ground”: Are the foot soldiers behind psychology’s replication crisis saving science — or destroying it? (Article in The Chronicles of Higher Education, September 2018)

RELATED EPISODES:

Ep. 48 Many Statisticians, Many Answers: The Methodological Factor in the Replication Crisis (with Brian Nosek)

Ep. 57 Neither Fisher Nor Bayes: The Limits of Statistical Inference (with Michael Acree)

WATCH ON YOUTUBE:

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Ep. 64 Cost Sharing: Paying for Healthcare in an Ethical and Sustainable Way Feb 18, 2019

Dale Bellis

There was a time when communities took care of the medical needs of their members without the intervention of governments and without the corrupting influence of health insurance. Can we ever go back to a system of mutual aid at a time when healthcare costs have grown astronomical?

Our guest today shows us that the idea of cost sharing is not only viable but is a lived reality for thousands of families across the United States. Dale Bellis began his work in healthcare in 1988 as an administrator with the first cost-sharing ministry ever begun in modern times. He was instrumental in passing legislation in 11 states exempting cost sharing ministries from insurance regulations. He also introduced technology and administrative techniques to streamline person to person cost-sharing. In 2012, he founded Liberty Healthshare, which provides an opportunity to live free from insurance and government-mandated healthcare to a large and growing number of American families that share fundamental values and a strong belief in personal responsibility.

GUEST:

Dale Bellis, Founder of Liberty Healthshare

RELATED EPISODES:

Ep. 10: Free-Market Medicine: Ethical, Workable and Unstoppable

Ep. 49 Why Are We Insuring Primary Care? Lee Gross on the DPC Movement

WATCH ON YOUTUBE:

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Ep. 63 A Voice for Freedom in Medicine Feb 14, 2019

Jane Orient, MD

In the mind of the public, American physicians are represented by one prominent organization, namely, the American Medical Association. Yet, only a minority of American physicians currently belong to the AMA, which has long grown comfortable with political and government intrusions into healthcare.

Who should represent physicians when doctors may hold very divergent views on matters of politics, economics, ethics, and even science? Should there be one voice or a plurality of voices? Our guest today is the executive director of the Association of American Physicians and Surgeons (AAPS), an organization that sprung up in the 1940s as an alternative to the AMA and to staunchly defend private medicine free of government interference or coercion.

Dr. Jane Orient obtained her medical degree from Columbia University and is in a solo internal medicine practice in Tucson, AZ. She is a prolific writer, having penned hundreds of op-eds in national and local media outlets. She is the author of numerous books, notably Your Doctor is Not In: Healthy Skepticism About National Health Care and Sutton’s Law, a novel about where the money is in medicine. She is also the editor of the famous textbook Sapira’s Art and Science of Bedside Diagnosis, now in its 4th edition.

GUEST:

Jane Orient, MD. Twitter and professional website

LINKS:

Association of American Physicians and Surgeons website
Jane Orient. Collectivism in Medicine: An Exception or a Hook? (Originally published in The Freeman, 1982)
AAPS workshop: Thrive Not Just Survive –Beat the Bureaucrats and Restore the Joy in Medicine.

RELATED EPISODES:

Ep. 37. Sham Peer-review: What Doctors Need to Know

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Ep. 62 Radiology Makeover, with Saurabh Jha Feb 09, 2019

Saurabh Jha, MBBS

Radiology holds a special place in the medical ecosystem. Radiologists are “the doctors’ doctors” and the treatment of a patient rarely proceeds without a radiologist furnishing an opinion. But the field of radiology also faces challenges: the crusade against “wasted imaging,” the rise of artificial intelligence, the dependence of radiology on hospital systems, and the de facto barrier that separates radiologists from patients.

What does the future hold for radiology and what could one wish for it? Returning to the show is Dr. Saurabh Jha, Associate Professor of Radiology at University of Pennsylvania Perelman School of Medicine. He shares his perspective with his characteristic wit and humor.

GUEST:

Saurabh Jha, MBBS. Twitter and professional page

LINKS:

Saurabh Jha’s writings on The Health Care Blog
Oren O, Kebebew E, and Ioannidis JPA. Curbing Unnecessary and Wasted Diagnostic Imaging. (January 2019 in JAMA)
Jha, Saurabh. From Imaging Gatekeeper to Service Provider (2013, “Perspective” in the NEJM)

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Ep. 61 The Ups and Downs of Drug Prices: An Economist’s View Feb 05, 2019

Amitabh Chandra, PhD

Some drugs cost more than diamonds though their health benefit seems marginal. Others cost less than a package of M&Ms though they are demonstrably life-saving. Some drug prices have spiked to 3-fold, 4-fold, or even 10-fold from what they were just a few years ago. Drug pricing seems to be an irrational and incomprehensible aspect of our economy.

To help us gain clarity on the matter, we have as our guest Amitabh Chandra, the Malcolm Wiener Professor of Public Policy at the Harvard Kennedy School of Government and the Henry and Allison McCance Professor of Business Administration and the Harvard Business School. He is among the best decorated healthcare economists alive, having received the highest awards in the field. He is an elected member of the National Academy of Medicine, a member of the Congressional Budget Office panel of health advisors, and a research associate at the National Bureau of Economic Research.

Professor Chandra has published seminal papers in the most highly ranked journals of economics and medicine. His research has been featured in The New York Times, The Washington Post, CNN, Newsweek, and on National Public Radio and has testified to the US Senate on matters of healthcare policy.

GUEST:

Amitabh Chandra, PhD. Twitter and professional pages at HBS and HKS.

LINKS:

Bagley N, Chandra A, Garthwaite C, and Stern A. It’s Time to Reform the Orphan Drug Act. (NEJM Catalyst, Dec 19, 2018)
Chandra A and Gartwaith C. The Economics of Indication-Based Pricing. (NEJM Perspective, 2017)

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Ep. 60 Three Cardios Talk Keto Jan 31, 2019

Ethan Weiss, MD

For decades, the academic cardiology community has focused its attention on pharmacological interventions to prevent heart disease. Our guest is an accomplished clinician-scientist who tells us his personal story that led him from the lab bench to becoming interested in dietary interventions and in the ketogenic diet in particular.

Dr. Weiss is Associate Professor of Medicine at the University of California San Francisco. He has a stellar academic pedigree, having received his MD degree from Johns Hopkins Medical School, where he also trained as part of his internship and residency. He completed his fellowship in cardiology at UCSF and has had an illustrious career as a basic science investigator at UCSF, studying the relationship between heart disease and metabolism. He is also the co-founder of a start up company, Keyto, to help people measure their blood ketone levels in real time as part of a diet management program.

GUEST:

Ethan Weiss, MD. Twitter and UCSF professional page.

LINKS:

Alexander Marble. “John Rollo” (1956 article in the journal Diabetes about the 1797 paper describing the treatment of diabetes with on all meat and animal fat diet)
Keyto website.
Michel Accad. Risk factors, causes, and the diet-lipid hypothesis (blog post on Alert & Oriented).

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**Ep. 59 When Opinion Becomes Crime: Doctors and Medical Fraud** Jan 26, 2019
Kyle Clark, JD

Doctors have been suspected, accused, or convicted of fraud since time immemorial. But, in the era of third-party payment for health care, such charges have taken on an entirely new form, particularly when the third party in question is the federal Medicare program. How does the government proceed to establish that Medicare fraud has taken place? How does it distinguish fraud from poor judgment or incompetence? And what does that mean for the practicing physician who submits thousands of claims a year to Medicare?

Andrew George, JD

To help shed light on the legal procedures, tactics, and tricks that can send a physician to a federal jail, our guests are Kyle Clark and Andrew George, defense attorneys who specialize in white collar crime and healthcare fraud. Messrs. Clark and George work for the global legal firm Baker Botts, LLP, and they recently authored an op-ed in the *Wall Street Journal* on this subject entitled “A Second Opinion Becomes a Guilty Verdict.”

**GUEST:**

Kyle Clark. Professional web page

Andrew George. Professional web page

**LINKS:**

Kyle Clark and Andrew George. When a Second Opinion Becomes a Guilty Verdict (*WSJ,* December 27, 2018)

**WATCH ON YOUTUBE:**

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Ep. 58 The Rise and Fall of the American Medical School Jan 22, 2019

Milton Packer, MD

For a few decades in the mid-twentieth century, the American Medical School represented the pinnacle of academia and its faculty were mightily engaged in the “triple threat” of research, teaching, and patient care. Today, however, the medical ivory tower is subordinated to hospital systems, overburdened with the menial task of “generating revenue,” and is but a pale image of its former self. On this episode, our guest helps us trace the history of the American medical school from its humble 19th century beginnings to its present day turmoils.

Dr. Milton Packer is an internationally recognized clinician, teacher, and scientist in the field of heart failure research. He has served as Chief of Cardiology at Columbia University in New York City and, subsequently, as Chair of the Department of Clinical Science at the Southwestern Medical School in Dallas. He is currently the Distinguished Scholar in Cardiovascular Science at Baylor University Medical Center.

Dr. Packer has received many teaching awards, mentored dozens of young clinical investigators, completed innumerable successful research projects, and served as a leader in many professional organizations. He is now also well known and admired for his regular column on MedPage Today, “Revolution and Revelation,” in which he mixes wisdom and polemics to the delight of his many readers.

GUEST:

Milton Packer, MD. Professional web page

LINKS:

Milton Packer. The Med Schools’ Business Model Is Officially Dead (on MedPage Today)

Milton Packer. Do You Want to Return to the ‘Days of the Giants’? (on MedPage Today)

Michel Accad. Flexner versus Osler (from the Alert & Oriented blog)

Michel Accad. An Economic History of the American Health Care System – I (from the Alert & Oriented blog)

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Ep. 57 Neither Fisher nor Bayes: The Limits of Statistical Inference Jan 18, 2019

Michael Acree, PhD

How do we know that a treatment works or not? Billions of healthcare dollars are at stake in the answer to that question. For decades, that answer has largely hinged on theories from a field of human inquiry that combines the precision of mathematics with the accuracy of astrology. We are talking of course, about statistics and statistical inference.

To help us understand better this mystical science, we have as our guest Dr. Michael Acree who has spent his entire career working for the University of California San Francisco as a data scientist and a teacher of statistical science, helping countless researchers make sense of the data they had obtained. Michael is now retired and is completing a book on the history and philosophy of statistical inference. He joins us to tell us the whole truth about what is sometimes referred to as the science of mendacity!

GUEST:

Michael Acree, PhD.

LINKS:

Michel Accad. Statistics and the Rise of Medical Fortunetellers (open access editorial, Texas Heart Institute Journal, 2009)

Anish Koka. Statistical certainty: Less is more

Stephen Ziliak and Deirdre McCloseky. “The Cult of Statistical Significance.” (2009 , JSM)

RELATED EPISODES:

Ep. 48 Many Statisticians, Many Answers: The Methodological Factor in the Replication Crisis

WATCH ON YOUTUBE:

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Ep. 56 Conflicts of Interest in Health Policy: A Different Ball of Wax? Jan 14, 2019

Anish Koka, MD

We have become highly sensitized to the question of conflict of interest in healthcare—and rightly so. But the dominant narrative seems to be one-sided: doctors and scientists getting personally paid by industry sponsors and letting those payments color their judgment, consciously or unconsciously.

Personal financial conflict of interest is certainly an important and pervasive problem, but there are many aspects of COI that get less attention and may be equally harmful to society at large. To discuss this topic, our own Anish Koka engages Michel Accad in a lively discussion that tries to probe the topic in depth, even when such probing reveals uncomfortable truths.

GUEST:

Anish Koka, MD. Twitter

LINKS:

Anish Koka. Commissioning Health Policy: Hospital Readmission and Its Price Tag

Michel Accad. The Institute of Medicine and the Doctrine of Perpetual Conflict

Michel Accad. Austin Frakt’s Conflict of Interest Disclosure

Michel Accad. COI and empirical fundamentalism

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Ep. 55 Waste in Healthcare: Is the Narrative Too Simplistic? Jan 09, 2019

Lisa Rosenbaum, MD

It doesn’t take great insight to assert that healthcare waste is rampant. There is an obvious epidemic of testing and treatments that make no difference in patients’ lives or could possible even harm. But what is the cause of the epidemic and what should be done about it? In the last decade, a popular narrative has emerged, claiming that the waste has obvious causes and remedies. That narrative, however, overlooks the complexities of the problem and the trade-offs and potential harms of the remedies proposed.

Our guest to discuss the “Less-Is-More” movement is Lisa Rosenbaum, MD, one of the best medical writers of our generation. Dr. Rosenbaum is a national correspondent for the New England Journal of Medicine, a cardiologist at the Brigham and Women’s Hospital, and an Assistant Professor of Medicine at Harvard Medical School.

GUEST:

Lisa Rosenbaum, MD. Twitter

LINKS:

Lisa Rosenbaum. The Less-Is-More Crusade—Are We Overmedicalizing or Oversimplifying? (2017 New England Journal of Medicine. Free preview available)

Lisa Rosenbaum. Let Fear Guide Early Breast Cancer Detection. (2015, Open access in The New York Times)

Lisa Rosenbaum. The Problem With Knowing How Much Your Health Care Costs. (2013, Open access in the New Yorker)

Michel Accad. The Apostles of Less-Is-More (blog post on Alert and Oriented)

Michel Accad. On Squandering Medicare’s Money (blog post on Alert and Oriented)

Michel Accad. Overdiagnosis: The Disease That Cannot be Diagnosed. (blog post on Alert and Oriented)

RELATED EPISODES

Ep. 12 John Mandrola: The Case for Less-Is-More

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Ep. 54 How to Jump Ship and Practice Medicine on Your Own Terms, with Dr. Kathleen Brown Jan 04, 2019

Kathleen Brown, MD

The healthcare system continues to inflict “moral injury” on physicians, causing burnout, depression, or apathy. And, built as it is on a mountain of debt, the edifice may also not provide any long term security for those who choose to remain on board. Yet the prospect of jumping ship may seem daunting to many.

Our guest today shares with us her personal story of how she did abandon the titanic and forged for herself a successful path to professional sanity.

Kathleen M. Brown, MD, obtained her medical degree from the Eastern Virginia School of Medicine and practiced dermatology and internal medicine for several years in Maryland. In 1997, she and her family moved to the coast of Oregon to join a multi-specialty group of which she was a partner in the group until mid-2011. This group was a good fit but the administrative and financial burdens of the system were increasingly taking a toll on her enjoyment of medicine.

After passage of the Affordable Care Act in 2010, she saw that continuing to stay within an insurance-contracted system would make her style of medical practice impossible. In July, 2011, with help from her husband, Jack, she opened a direct pay Dermatology practice with a transparent fee schedule. Within a month of opening she had a full schedule and a restored sense of professional satisfaction.

GUEST:

Kathleen Brown, MD. Email and Practice Website

LINKS:

Facebook page of the Oregon Chapter of the Free Market Association.

RELATED PODCAST EPISODES:

Ep. 10 Free Market Medicine: Ethical, Workable, and Unstoppable

Ep. 49. Why Are We Insuring Primary Care? Lee Gross of the DPC Movement

WATCH ON YOUTUBE:

Watch the episode on our YouTube channel

Ep. 53 Health vs. Illness: Pat Caslin on Living with Multiple Sclerosis Dec 30, 2018

Pat Caslin

We spend billions of dollars a year on healthcare yet no one can give a satisfactory definition of health. Is our inability to articulate what health is precisely the reason for our insanely dysfunctional healthcare systems?

Our guest today will give us his very personal reflections on that question. Pat Caslin is a business strategist from Dublin, Ireland who’s had a successful career nationally and internationally, working for a variety of financial and business development institutions. Eleven years ago he was diagnosed with relapsing-remitting multiple sclerosis. Five years ago the disease became progressive and he lost his ability to walk.

Instead of letting the illness take over his life, Pat went through a profound change of perspective regarding his health and what it means to be healthy. As a result, he has been sharing his insights, both in writing and in speaking engagements, with students, with physicians, with patients, and with the public at large. He was recently selected to give a Ted talk in Dún Laoghaire, Ireland.

GUEST:

Pat Caslin. Twitter

LINKS:

Pat Caslin. Chronically Ill, Very Healthy (Tedx talk)

Michel Accad. Taking Stick of Our Existence: Gawande vs. Frankl on the Meaningful Life (blog post)

Michel Accad. That Most Nagging Question in Healthcare (blog post)

The Widowmaker (documentary, available on YouTube)

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Ep. 52 Should Doctors Get Involved in Healthcare Policy? A Med Student’s Perspective Dec 26, 2018

Aamir Hussein, MD Candidate 2019

Doctors are embroiled in a healthcare system they appear to have no control over. It therefore seems plausible that if they got involved in healthcare policy, they might be in a position to “steer the ship” or at least have a say in how the ship is steered.

We discuss the pros and cons of healthcare policy in general—and of a doctor’s involvement in such policy—with Aamir Hussein, a 4th year medical student at the University of Chicago Pritzker School of Medicine.

A native of Farmington, CT, Mr. Hussain also holds a master’s degree in public policy from the University of Chicago Harris School of Public Policy and a BA from Georgetown University in Government. He writes frequently about interfaith dialogue, Islam, and the intersections between healthcare and spirituality and has given lectures around the United States on these topics. He has been interviewed by The New York Times, Al Jazeera, and PBS, and his writings have been featured in medical journals and several online outlets including Religion News Service and The Huffington Post.

GUEST:

Aamir Hussein: Twitter.

LINKS:

Milton Friedman at the Mayo Clinic: YouTube clip

RELATED EPISODES:

Ep. 44 Economic vs. Political Means to Healthcare: A Conversation with Jeff Deist

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Ep. 51 The Expert vs. the Algorithm: Gary Klein on Decision-Making in Healthcare Dec 18, 2018

Gary Klein, PhD

Doctors are increasingly asked to follow decision rules, guidelines, and “evidence-based” algorithms. Is that the right approach to take care of patients? Are cognitive errors over-emphasized in healthcare?

Our guest on this episode is Gary Klein, one of the most important figures in cognitive psychology in the world. His pioneering work in the field of naturalistic decision-making has become a major challenge to the established schools of thought on how experts make good decisions.

He is a leader of a growing research community focused on understanding how human beings acquire and apply knowledge to complex situations under uncertainty. He has developed novel explanatory models and training methods for decision-making that are widely recognized as ground-breaking. He is the author of numerous books, including the best-sellers Streetlights and Shadows: Searching for the Keys in Adaptive Decision-Making and Seeing What Others Don’t: The Remarkable Ways We Gain Insight. He is notorious for having gained the respect and admiration of his intellectual opponent, Nobel Prize winner Daniel Kahneman, with whom he co-authored a widely read paper contrasting their somewhat divergent views.

GUEST:

Gary Klein, PhD: Website and Twitter.

ShadowBox training website.

LINKS:

Gary Klein. Streetlights and Shadows: Searching for the Keys in Adaptive Decision-Making. A Bradford Book. 2001 (Amazon link)

Gary Klein. Seeing What Others Don’t: The Remarkable Ways We Gain Insight. Public Affairs. 2015. (Amazon Link)

Daniel Kahneman and Gary Klein. Conditions for Intuitive Expertise: A Failure to Disagree. American Psychologist. Sep 2009 (open access).

Klein ED, Woods DD, Klein G, and Perry SJ. Can We Trust Best Practices: Six Cognitive Challenges of Evidence-Based Approaches. Journal of Cognitive Engineering and Decision-Making. 2016 (open access)

RELATED EPISODES:

Ep. 30 Beyond EBM: Case-Based Reasoning and the Integration of Clinical Knowledge

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Ep. 50 Thieves of Virtue: How Bioethics Stole Medicine Dec 13, 2018

Tom Koch, PhD

Did bioethics emerge to defend the interests of patients or to rationalize the needs and actions of the state and its corporate allies? Are bioethicists too complacent about their grasp of economics? Do they have sufficient understanding of the complexities of medical decisions to weigh in on them? Are Hippocratic ethics so inadequate that they needed to be replaced by ever-morphing “Kantian” ethics? A fascinating discussion with our guest, Tom Koch, a man whose resumé and whose many books read like great adventure stories.

Professor Koch is an author, journalist, historian, philosopher, and educator. He holds an inter-disciplinary PhD in medical cartography, ethics and medicine He has taught medical ethics to medical students at the University of Toronto. He is a consultant in gerontology. And he has written numerous books both for an academic audience as well as for the general public. His books include Cartographies of Disease, Ethics in Everyday Places, The Wreck of the William Brown, and the volume that will be the focus of our discussion today, Thieves of Virtue: When Bioethics Stole Medicine.

GUEST:

Tom Koch, PhD. Website

LINKS:

Tom Koch. Thieves of Virtue: When Bioethics Stole Medicine. MIT Press. 2011 (Amazon link)

Tom Koch. Ethics in Everyday Places: Mapping Moral Stress, Distress, and Injury. MIT Press. 2017 (Amazon Link)

RELATED EPISODES:

Ep. 29 Why Hippocrates Still Matters

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Ep. 49 Why Are We Insuring Primary Care? Lee Gross on the DPC Movement Dec 09, 2018

Lee Gross, MD

“We’re not going to ask permission to take care of our patients.” It is with this epiphany, that our guest on this episode became one of the pioneers and leaders of the most hopeful trend in health care today: the direct primary care or DPC movement.

Dr. Gross shares with us how the light bulb went off in his mind that there is no good reason to insure primary care and, in fact, that insuring primary care hurts everybody: patients, doctors, and society. He walks us through his success stories and the efforts he is leading at the state and federal level to remove regulatory barriers to direct care.

Dr. Gross is the founder of Epiphany Health in North Port, FL, and is regularly consulted by lawmakers at the local, state, and national level. He has offered testimony on behalf of the direct care movement for the US Health and Human Services Department, the US Congress, and for the White House. He also serves as president of the Docs 4 Patient Care Foundation and he is the recipient of the 2016 HCA Frist’s Humanitarian Award and of the Beacon Award from the Free Market Medical Association for his leadership in healthcare reform.

GUEST:

Lee Gross, MD. Twitter

LINKS:

Lee Gross. Direct Primary Care Can Rein In America’s Out-of-Control Healthcare Costs (in the Washington Examiner)

Epiphany Health: Dr. Gross’ practice website

Doc 4 Patient Care Foundation’s website

US Department of Health and Human Services. Reforming America’s Healthcare System Through Choice and Competition (Report)

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Ep. 48 Many Statisticians, Many Answers: The Methodological Factor in the Replication Crisis Dec 04, 2018

Brian Nosek, PhD

In 550 BC, the Greek philosopher Heraclitus famously declared: “No man ever steps in the same river twice, for it’s not the same river and he’s not the same man.” In this episode, we learn from our guest whether scientists can step into the same data pool and obtain the same research results twice.

Brian Nosek is Professor of Psychology at the University of Virginia. He is also the co-founder and Executive Director of the Center for Open Science, an organization dedicated to fostering transparency and collaboration in scientific research.

In 2015, Professor Nosek and his team published in the journal Science a widely acclaimed and widely discussed paper that shed light on the extent to which psychological research findings may not be reproducible when the research is conducted anew.

More recently, his Center conducted a unique project where a single data set was sent to be analyzed by about 30 independent teams of statisticians for the purpose of answering a single question. The variability in the methods chosen and in the answers obtained was also perhaps sobering, if not perplexing.

GUEST:

Brian Nosek, PhD. Profile and Twitter

LINKS:

Silberzahn R, Uhlmann EL, Martin DP et al. Many analysts, one dataset: Making transparent how variations in analytical choices affect results. (2018, Advances in Methods and Science in Psychological Research, open access pre-print here)

Klein RA, Vianello M, Hasselman F, et al. Many Labs 2: Investigating Variation in Replicability Across Sample and Setting. (2018, open access pre-print here)

Open Science Collaboration. Estimating the reproducibility of psychological science. (2015 in Science, open access here)

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Ep. 47 Drug Dosing: One Size Does Not Fit All Nov 30, 2018

David C. Norris, MD

Patients come in all sizes and shapes, and with varying tolerance for complications and risk. Is it plausible that a single dosing regimen can optimize treatment for everybody? If not, what is keeping the pharmaceutical industry from endorsing a more dynamic and patient-centered drug dosing regimen?

Our guest is Dr. David Norris, a physician, mathematician, and inventor. David operates a scientific and statistical consultancy focused on methodology development for ‎precision-medicine applications. He developed Dose Titration Algorithm Tuning (DTAT), a methodological framework that conceives dose individualization as a seamless learning process, beginning in early-phase trials and continuing throughout the drug development process. Before earning his M.D. at Brown University, he worked in diverse application areas including mathematical finance, operations research and systems engineering.

GUEST:

David C. Norris, MD. Patreon and Twitter

LINKS:

Norris DC. Dose Titration Algorithm Tuning (DTAT) should supersede ‘the’ Maximum Tolerated Dose (MTD) in oncology dose-finding trials. F1000Research. 2017 (open access)
Norris DC. One-size-fits-all dosing in oncology wastes money, innovation and lives. Drug Discovery Today. 2018 (open access)
Norris DC. Precautionary Coherence Unravels Dose Escalation Designs. bioRxiv. 2017 (open access)

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Ep. 46 Reforming Medical Education: Beyond the Usual Platitudes Nov 27, 2018

Adam Cifu, MD

The reform of medical education is a usually boring conversation that needs its own reform. The discussion we have on this episode does just that. It goes far beyond the usual proposals to tweak the curriculum and directly addresses the question of what it means to be a physician.

Our guest is Dr. Adam Cifu, an award-winning medical educator and author. Dr. Cifu is a Master in the Academy of Distinguished Medical Educators at The University of Chicago. He has been selected as a Favorite Faculty Member by the graduating class of students 14 times. He is the author of Symptom to Diagnosis a manual on diagnostic reasoning, and co-author with Dr. Vinay Prasad of Ending Medical Reversal: Improving Outcomes, Saving Lives, one of the blockbuster medical books of the last few years.

GUEST:

Adam Cifu, MD. University of Chicago website and Twitter

LINKS:

Scott Stern and Adam Cifu, Symptom to Diagnosis: An Evidence-Based Guide (Amazon link)

Vinay Prasad and Adam Cifu, Ending Medical Reversals: Improving Outcomes, Saving Lives (Amazon link)

Michel Accad. Intolerable Laissez-Faire: The Early Years of the Mayo Clinic (Alert and Oriented blog)

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Ep. 45 Brain Death at the Bedside Nov 22, 2018

Fred Rincon, MD

We revisit the question of brain death, this time with a more practical focus. What should doctors tell families of patients who fulfill neurological criteria for brain death? Joining us on this program is Fred Rincon, MD, who is a Assistant Professor of Neurology at Jefferson University Medical Center in Philadelphia. Dr. Rincon is a neuro-intensivist who, on a day-to-day basis, cares for patients with severe brain injury. He also holds a Master’s in Bioethics from the University of Pennsylvania.

GUEST:

Fred Rincon. Professional Website

LINKS:

Michel Accad. Of Wholes and Parts: A Thomistic Refutation of Brain Death. (Open Access, Linacre Quarterly)

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Ep. 44 Economic vs. Political Means to Healthcare: A Conversation with Jeff Deist Nov 18, 2018

Jeff Deist

Economic knowledge should not be the sole province of technical experts, but it is—and we seem to accept the way it is. The price we pay for this ignorance is that most people—including doctors—can easily fall prey to the political class and to the technocrats whose economic theory is generally far from sound.

Our guest on the show is Jeff Deist, President the Mises Institute, an educational institution that promotes a very noble tradition of economic theory and political thought. Prior to taking the helm of the Mises Institute, Mr. Deist was chief of staff to Congressman Ron Paul for many years and, in that capacity, gained special insights into healthcare “sausage-making” in Washington DC.

GUEST:

Jeff Deist. Mises Institute Website, Twitter and Podcast

LINKS:

Michel Accad. Undue Aggregation Isn’t Just for Economists. (Mises Institute Blog)

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Ep. 43 Doctors and Guns: Where Is the Lane? Nov 15, 2018

Pradheep Shanker, MD

Should doctors have something to say about guns? If so, what should they say? A position paper by the American College of Physicians, followed by a blog post and a tweet from the National Rifle Association, have set off a storm of controversy on the issue of medical professionals speaking publicly about guns and gun control.

Our guest today is Pradheep Shanker, a radiologist based in Ohio and a prolific writer and conservative commentator who contributes regularly to a number of major national media outlets, including National Review, The American Spectator, Ricochet, and others. He just published a piece entitled “Guns, Doctors, and Staying in Your Lane.”

GUEST:

Pradheep Shanker, MD. Twitter

LINKS:

Pradheep Shanker. Doctors, Guns, and Staying in Your Lane. (article in Ricochet)

Reducing Firearms Injuries and Death in the United States: A Position Paper from the American College of Physicians (free access in Annals of Internal Medicine)

NRA blog. Surprise: Physician Group Rehashes Same Tired Gun Control Policies

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Ep. 42 The Tyranny of Metrics: A Historian Weighs In Nov 12, 2018

Jerry Z. Muller

Bureaucratic appeal to measurement as a check on personal judgment rules the medical field but also permeates our entire culture. Our guest is the author of a new book that comprehensively treats this unique phenomenon of modern life and brings a valuable historical perspective to the subject.

Jerry Z. Muller is Professor of History at Catholic University of America in Washington DC, where he served as Chairman of the department from 2009 to 2015. Professor Muller’s focus is on Modern European Intellectual History and History of Capitalism. His book, The Tyranny of Metrics, was published earlier this year by Princeton University Press.

GUEST:

Jerry Z. Muller, PhD. Professional Website and Twitter

LINKS:

The Tyranny of Metrics (Amazon)

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Ep. 41 Healthcare Policy in the Crosshairs: The Hospital Readmissions Reduction Program Nov 08, 2018

Ankur Gupta, MD

The Hospital Readmission Reduction Program is a recent policy designed to save the government money by imposing large financial penalties on hospitals whose readmission rates for certain medical conditions are found to be higher than the national average. Could pushing policy levers on such a grand scale conceivably have negative unintended consequences?…

Our guest is Dr. Ankur Gupta, author of a 2017 JAMA article that examined mortality rates in heart failure in the aftermath of the HRRP development and implementation. Dr. Gupta is an interventional cardiology fellow at University of Texas Southwestern Medical Center in Dallas. He holds and MD from the All India Institute of Medical Sciences (New Delhi) and an interdisciplinary PhD in statistics and computational fluid dynamics from the University of Alabama.

GUEST:

Ankur Gupta, MD. Twitter

LINKS:

Gupta A, Allen LA, Bhatt Deepak, et al. Association of the Hospital Readmissions Reduction Program Implementation With Readmission and Mortality Outcomes in Heart Failure. (Open Access in JAMA, 2017)

Gupta A, Fonarow G. The Hospital Readmission Reduction Program: Evidence for Harm. (in JACC: Heart Failure 2018)

Khera R, Dhamarajan K, Wang Yonfei, et al. Association of the Hospital Readmissions Reduction Program With Mortality During and After Hospitalization for Acute Myocardial Infarction, Heart Failure, and Pneumonia. (Article from Dr. Krumholz’s group in JAMA 2018, Open Access)

Khera R, Dhamarajan K, Krumholz H. Rising mortality in patients with Heart Failure in the United States. (Counterpoint to Dr. Gupta’s analysis in JACC: Heart Failure 2018)

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Ep. 40 Practicing Medicine in Canada: Promises and Realities Nov 03, 2018

Shawn Whatley, MD

What’s the professional life of Canadian doctors really like? Does the safety and stability of a single-payer system free them from business concerns and allow them to concentrate on patient care? Or do the realities of central planning produce unexpected uncertainty and stress for patients and doctors alike?

To help us gain a realistic understanding of the Canadian system, we have as our guest Dr. Shawn Whatley who currently runs a primary care practice in Ontario, Canada. Prior to this position, Dr. Whatley worked for many years as an emergency physician and he is the author of No More Lethal Waits: 10 Steps to Transform Canada’s Emergency Departments.

Dr. Whatley is past-president of the Ontario Medical Association and he is a senior fellow at the MacDonald-Laurier Institute for Public Policy in Toronto. He also publishes a highly trafficked blog where he shares insightful and humorous comments about healthcare in Ontario. In other words, he is the perfect guest to inform us about the realities of healthcare in Canada.

GUEST:

Shawn Whatley, MD. Blog and Twitter

BOOK:

Shawn Whatley. No More Lethal Waits: 10 Steps to Transform Canada’s Emergency Departments (Amazon)

LINKS:

Milton Friedman at the Mayo Clinic speaks on Free Markets in Healthcare (YouTube, 9 minutes)

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Ep. 39 Freedom of speech regained: How NIFLA v. Becerra could impact medical practice Oct 29, 2018

Paul Sherman

A recent US Supreme Court decision has struck down the “professional speech doctrine” which was elaborated by lower courts to justify restricting or regulating the activities of anyone offering advice or counsel to another individual. This decision may have far reaching implications across a number of human activities, including health care.

To help us understand this decision and what effects it might have, we have as our guest Mr. Paul Sherman, senior attorney at the Institute for Justice and an expert in constitutional cases protecting the First Amendment, economic liberty, property rights and other individual liberties.

GUEST:

Paul Sherman. Website and Twitter

LINKS:

Paul Sherman. Occupational Speech and the First Amendment. (Free access in Harvard Law Review)

Paul Sherman and Robert McNamara. NIFLA v. Becerra: A Seismic Decision Protecting Occupational Speech. (free access in Cato Supreme Court Review)

Parmet WE, Berman ML, and Simth JA. The Supreme Court’s Crisis Pregnancy Center Case — Implications for Health Law. (Open Access in New England Journal of Medicine)

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Ep. 38 Sally Pipes: The case against single-payer healthcare Oct 25, 2018

Sally Pipes

Support for a single-payer healthcare system in the United States seems to be growing inexorably. Before we resign ourselves to the inevitable fate of “Medicare-4-All,” it may be prudent to remind ourselves or understand better the arguments against a single-payer system

Our guest on this episode is Sally Pipes, president and CEO of the Pacific Research Institute, a San Francisco-based think tank dedicated to promoting free market principles across a variety of fields, including education, health care, and the environment. Ms. Pipes is widely published on healthcare issues and a regular contributor to Forbes.com.

GUEST:

Sally Pipes. Website and Twitter

LINKS:

Sally Pipes. The False Promise of Single-Payer Health Care (Amazon)

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Ep. 37 Hospital sham peer review: what doctors need to know Oct 20, 2018

Lawrence R. Huntoon, MD, PhD

Peer review by colleagues is an important process by which doctors who misbehave or malpractice can be held accountable and, if necessary, prevented from harming patients. Unfortunately, the process can also be used in bad faith, and many physicians are completely unaware of how career-destroying traps can be set up under the guise of peer review, compromising even the most caring and competent of doctors.

Our guest is Lawrence R. Huntoon, MD, PhD, a world expert on the topic of “sham” peer review. Dr. Huntoon is editor-in-chief of the Journal of the Association of American Physicians and Surgeons and he leads the organization’s Committee to Combat Sham Peer Review.

GUEST:

Lawrence R. Huntoon, MD, PhD

LINKS:

Sham Peer Review: Resources for Physicians (Association of American Physicians and Surgeons, includes Physician’s Hot Line)

Articles by Dr. Huntoon:

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Ep. 36 Conversation with a clinical trialist Oct 16, 2018

Ajay Kirtane, MD

The life of a clinical trialist involves juggling multiple demands. Beyond the purely scientific questions are the clinical interests of the patient and the personal demands on the physician.

Our guest on this episode is Ajay Kirtane, MD, Associate Professor of Medicine at Columbia University Medical Center in New York. In this conversation with Anish Koka, Dr. Kirtane shares his professional journey and his perspective on one of the most surprising and hopeful clinical trials in recent times, the COAPT trial of mitral valve repair in patients with congestive heart failure.

GUEST:

Ajay Kirtane, MD. Website and Twitter

LINKS:

Stone G, et al. Transcatheter mitral valve repair in patients with heart failure. (in New England Journal of Medicine, 2018)

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Ep. 35 Why brain dead isn’t dead: An introduction to “Shewmon’s Challenge” Oct 11, 2018

D. Alan Shewmon, MD

One of the most fundamental questions that a doctor may be asked to answer is the following: Is this man or is that woman dead? And one would think that any substantial controversy regarding the determination of death would feature prominently in the medical curriculum and in basic medical textbooks. Instead, such discussions and debates have been relegated to narrow specialty medical and philosophical journals, and most practicing physicians are remarkably unaware about the state of knowledge on this question.

Our guest on this episode is D. Alan Shewmon, MD, Professor Emeritus of Pediatric Neurology at UCLA. His work, comprising decades of well-documented clinical observations and reflections, is now known as “Shewmon’s challenge,” a compelling rebuke to the principal arguments put forth to defend the concept of brain death.

GUEST:

D. Alan Shewmon, MD. List of scholarly publications on PubMed.

LINKS:

Shewmon DA. Chronic “brain death”: Meta-analysis and conceptual consequences. (in Neurology, 1998).

Shewmon DA, Holmes GL, and Byrne PA. Consciousness in congenitally decorticate children: A self-fulfilling prophecy. (Open Access, in Developmental Medicine and Child Neurology, 1999)

Shewmon DA. Truly reconciling the case of Jahi McMath. (in Neurocritical Care, 2018)

VIDEOTAPED LECTURE: The Case of Jahi McMath: A Neurologist’s View. (Starts at [41:53] mark. Part of the 2018 conference at Harvard Medical School, Defining Death: Organ Transplantation and the 50-year Legacy of the Harvard Report of Brain Death.)

Rachel Aviv. What does in mean to die? (article on the case of Jahi McMath in The New Yorker, 2018)

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Ep. 34 Free-market solutions in a world of third-party payers Oct 07, 2018

Vatsal Thakkar, MD

The arcane procedure patients must follow to file out-of-network claims is an important obstacle for a more widespread embrace of a third-party free medical practice. Could that process be made less daunting?

Our guest is Vatsal G. Thakkar, MD, Clinical Assistant Professor of Psychiatry at the NYU School of Medicine, as well as op-ed contributor to Doximity and The New York Times. He is the founder and CEO of Reimbursify, a startup in the out-of-network reimbursement space.

GUEST:

Vatsal Thakkar, MD, Doximity profile

Company: Reimbursify

LINKS:

Vatsal Thakkar. The Illicit Perks of the M.D. Club (Op-Ed in The New York Times)

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Ep. 33 Moving mountains: The folly of population medicine Oct 02, 2018

Michel Accad, MD

In a matter of a couple of decades, the concepts of population health and population medicine have taken center-stage in healthcare, displacing the traditional aim of medicine and distorting the doctor-patient relationship.

Our guest today is your co-host, Michel Accad, who highlights the errors of the population health theory as revealed in his recently published book Moving Mountains: A Socratic Challenge to the Theory and Practice of Population Medicine.

GUEST:

Michel Accad, MD: Twitter

LINKS:

Michel Accad. Moving Mountains: A Socratic Challenge to the Theory and Practice of Population Medicine

Accad, M. Population health: At odds with person-centered health care (Editorial in the European Journal of Person-Centered Healthcare)

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Ep. 32 Sexual harassment and bias in medicine: Will metrics help? Sep 29, 2018

Jane van Dis, MD

In the wake of the #MeToo movement, a sweeping report was recently published by the National Academies of Science, Engineering, and Medicine detailing 30 years of research on the sexual harassment of women in academia. In addition, reports of discrimination and evidence of a pervasive “pay gap” between men and women are also coming to the surface.

Our guest is Jane van Dis, MD, an obstetrician-gynecologist who recently co-authored a perspective in the New England Journal of Medicine on the occasion of the NASEM report. Dr. van Dis sheds light on the report and highlights what future steps must be taken. She is the co-founder of Equity Quotient, a data-analytics firm that provides workplace assessments of gender culture to help organizations create equitable work environments.

GUEST:

Jane van Dis, MD: Twitter

LINKS:

Choo E, van Dis J, and Kass D. Time’s Up for Medicine? Only Time Will Tell (New Engl J Med)

NASEM Report: Sexual harassment of women: Climate, Culture, and Consequences in Academic Sciences, Engineering, and Medicine.

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**Ep. 31 Is moral injury the cause of physician burnout?** Sep 23, 2018
Wendy Dean, MD

Physician burnout has attained epidemic proportions. It is highest among all professions and new research indicates that doctors commit suicide at a rate that is twice that of the general population, leading to a loss of approximately one physician per day. And it’s not only doctors who are at risk. Patients too may suffer the consequences, as medical errors have now been linked to the issue of physician depression and burnout.

The true causes of this epidemic remain hotly contested but our two distinguished guests have recently published a highly provocative essay whose thesis has resonated with many doctors.

Simon Talbot, MD

Wendy Dean is a psychiatrist who is senior vice-president of program operations at the Henry M. Jackson Foundation for the Advancement of Military Medicine. Simon Talbot is an Associate Professor of Surgery at Harvard Medical School in the Brigham Hospital’s division of plastic surgery.

**GUESTS:**

Wendy Dean, MD: Twitter

Simon Talbot, MD: Professional profile

**LINKS:**

Wendy Dean and Simon Talbot. Physicians aren’t ‘burning out.’ They’re suffering from moral injury. (In *STAT* *News*, July 26, 2018)

Website: End Moral Injury

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Ep. 30 Beyond EBM: Case-based reasoning and the integration of clinical knowledge Sep 19, 2018

Mark Tonelli, MD

Can anyone question evidence-based medicine and not be considered some kind of fringe lunatic? Fortunately it’s possible, as will be demonstrated by our guest, Mark Tonelli, professor of medicine from the University of Washington, and one of the earliest, most thoughtful, and most articulate academic critic of the EBM dogma.

Dr. Tonelli holds a BA in philosophy form the University of Colorado in Boulder and a medical doctorate from the University of Colorado in Denver. He is the author of numerous peer-reviewed articles and book chapters on various aspects of medical science and medical philosophy. His critique of EBM and his proposal for “case-based reasoning” are both cogent and compelling.

GUEST:

Professor Mark Tonelli’s faculty Website

LINKS:

Mark Tonelli. The limits of evidence-based medicine. (Video of Grand Rounds lecture, University of Washington, 2016)
Tonelli MR. Integrating evidence into clinical practice: an alternative to evidence-based approaches. (pdf of paper in J Clin Eval Pract 2006)
Tonelli MR. The philosophical limits of evidence-based medicine. (pdf of paper in Acad Med 1998)
Accad M and Francis D. Does evidence-based medicine adversely affect clinical judgment? (BMJ 2018)

NOTE: Dr. Tonelli will kindly make a copy of his book chapter on case-based reasoning available upon request. You may contact him via his professional website above.

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Ep. 29 Why Hippocrates still matters Sep 16, 2018

Thomas Cavanaugh, PhD

For most doctors, Hippocrates is a quaint figure of the past with hardly any relevance to the modern practice of medicine. We may label him as the “father of medicine,” but we have no idea what really connects us to him. We may occasionally and sanctimoniously proclaim “first, do no harm!” but we ignore the origin and real significance of that phrase.

Some of us may have taken some modified version of the Oath of Hippocrates upon graduating from medical school, but few of us think of it as a serious pledge with any real consequence for our day-to-day practice. And, over the last decades, most bioethicists have openly set aside the Hippocratic tradition, deeming it inadequate to help us deal with the moral quandaries that arise in the age of scientific medicine.

So, is there are any reason, besides historical curiosity, to become familiar with Hippocrates, let alone take him seriously? To help us sort this out we have a distinguished guest who is the author of a brand-new book entitled Hippocrates’ Oath and Asclepius’ Wound: The Birth of the Medical Profession, published by Oxford University Press.

GUEST:

Professor Thomas Cavanaugh’s faculty Website

LINKS:

Thomas A. Cavanaugh. Hippocrates’ Oath and Asclepius’ Wound. (Oxford University Press)

Thomas A. Cavanaugh. Double Effect Reasoning: Doing Good and Avoiding Evil. (Oxford University Press)

Michel Accad. Physician-assisted dying: A deadly choice for the medical profession. (Alert & Oriented blog)

Michel Accad. On the deactivation of implantable devices. (Alert & Oriented blog)

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Ep. 28 Jeanne Lenzer: The case for tougher medical device regulation Sep 13, 2018

Jeanne Lenzer

Are doctors patsies for the medical device industry? Are patients put in harm’s way for lack of tough standards on new device approvals? We examine the question with Jeanne Lenzer, award-winning investigative journalist and author of The Danger Within Us: America’s Untested, Unregulated Medical Device Industry and One Man’s Battle to Survive It.

GUEST:

Jeanne Lenzer’s Website and Twitter

LINKS:

The Bleeding Edge (documentary)

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Ep. 27 The Coronary Disease Pandemic: A Medical Historian’s Perspective Sep 09, 2018

Coronary heart disease remains shrouded in mystery as to its causes and natural history. Our guest is Dr. William Rothstein, Professor Emeritus of Sociology at the University of Maryland, who has just published The Coronary Heart Disease Pandemic of the Twentieth Century: Emergence and Decline in Advanced Countries. This fresh look at the patterns of coronary mortality rates throughout the world over the last 8 decades calls into question received notions about this disease.

GUEST:

William G. Rothstein

LINKS:

William Rothstein. The Coronary Heart Disease Pandemic of the Twentieth Century: Emergence and Decline in Advanced Countries

William Rothstein. Public Health and the Risk Factor: A History of an Uneven Medical Revolution

Accad, M and Fred HL. Risk-Factor Medicine: An Industry Out of Control? (in Cardiology)

Michel Accad. The Public Health Myths of Cardiovascular Disease Prevention (a piece I wrote 10 years ago on the Alert & Oriented blog, which touches on many of the themes discussed on this episode)

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Ep. 26 Scientific gatekeepers in the age of Twitter: A journal editor’s perspective Sep 05, 2018

Dr. Brahmajee Nallamothu

Are medical journals still needed in the age of the internet and social media? Our guest is Brahmajee Nallamothu, editor of the journal Circulation Cardiovascular Quality and Outcomes. We have a wide ranging conversation, covering everything from the financial incentives of publishing, ideological biases in medical journals, the peer review process, the Twitter effect, and a new editorial position of independent troller!

GUEST:

Brahmajee Nallamothu Twitter and Profile

LINKS:

The following articles are all Open Access articles in Circulation Cardiovascular Quality and Outcomes

Robert W. Yeh. Academic cardiology and social media: Navigating the wisdom and madness of the crowd

Michael Thompson. Science and social media: Debating the effects of readmission penalties

RELATED EPISODES:

Ep. 23 Buying doctors with lunches: Fact or fiction?

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Ep. 25 Exposing medical students to free market ethics and principles Sep 02, 2018

Dr. Beth Haynes

US medical schools overwhelmingly support centralization of healthcare and health care decision-making. That is not a surprise since, over the decades, academic institutions have greatly benefited from healthcare policy.

Because centralization of health care is detrimental to the doctor-patient relationship, students who begin their training motivated by a genuine desire to practice medicine in a meaningful and personal way can easily fall into disabuse or disillusion or may adopt a more cynical attitude toward their profession.

Our guest today is Beth Haynes, medical director of the Benjamin Rush Institute, a non-profit organization dedicated to offering medical students an alternative perspective on healthcare and its possibilities by exposing them to free-market principles and ethics, centered on the supremacy of the doctor-patient relationship.

LINKS:

Benjamin Rush Institute website and student-led podcast

Will Craghead and Daniel McCorry. Direct Primary Care: Improving Medical Students Interest in Primary Care. (“White Paper”)

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Ep. 10 Free market medicine is ethical, workable, and unstoppable
Ep. 22 Free markets in healthcare : objecting to the objections

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Ep. 24 Making the case for Medicare-4-All Aug 29, 2018

Dr. Adam Gaffney

For an increasing number of Americans today, a single payer system seems to be the only conceivable next step in the cataclysmic and ruinous history of our healthcare system. Our guest today is Adam Gaffney, MD, a longtime supporter of a single-payer system and president-elect of Physicians for a National Health Program. He has kindly agreed to be subjected to our objections.

GUEST:

Adam Gaffney: Twitter and website

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RELATED EPISODES:

Ep. 22 Free markets in healthcare: objecting to the objections
Ep. 10 Free market medicine is ethical, workable, and unstoppable

**Ep. 23 Buying doctors with lunches: fact or fiction?** Aug 26, 2018
Dr. Rafael Fonseca

Dr. John Tucker

Do medical journals apply scientific standards selectively? On the subject of the effect of pharmaceutical lunch gifts on physician behavior, all that may be required from a paper is that the conclusions drawn be compatible with the expected narrative—even if the data presented suggests the opposite. Joining us are Rafael Fonseca and John Tucker who shared with us their eye-opening analysis of a recent article published in *JAMA Internal Medicine* and the fascinating reaction to their analysis from journal editors and from the community at large.

**GUESTS:**

Rafael Fonseca, MD: Twitter and Website

John Tucker, PhD: Twitter

**LINKS:**

Rafael Fonseca and John Tucker. Are doctors bribed by Pharma: A critical analysis of a recent study by Hadland and colleagues (In *The Health Care Blog*).

Rafael Fonseca and Jeffrey Singer. Politics, Confirmation Bias, and Opioids. (Cato Institute blog)

Rafael Fonseca. How physicians interpret research funding disclosures. (*New England Journal of Medicine*)

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Ep. 22 Free markets in healthcare: Objecting to the objections Aug 22, 2018

Mr. Roman Zamishka

Many ardent supporters of free markets still believe that healthcare is an exception where government intervention is, for some reason, necessary. Our guest on this episode is Roman Zamishka, a financial analyst and medical school applicant who authored a witty and carefully constructed article titled “A Libertarian’s Case Against Free Markets in Healthcare.” The piece garnered a lot of positive comment on The Health Care Blog where it was published. Mr. Zamishka kindly agreed to be cross-examined about the points he made.

GUEST:

Roman Zamishka: Twitter

LINKS:

Roman Zamishka. A Libertarian’s Case Against Free Markets in Healthcare. (In The Health Care Blog).
Caption-generator video meme: Hitler reacts to 8 years of the ACA

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Ep. 21 Inside the Swiss healthcare system with Dr. Fouradoulas Aug 18, 2018

Dr. Marc Fouradoulas

The Swiss healthcare system is frequently proposed as a model for the rest of the world to emulate. Our guest is Marc Fouradoulas who practices medicine in Zurich, Switzerland. He is a board-certified internist who holds a Master’s degree of advanced studies in managed health care and health economics from the Winterthur Institute of Health Economics, School of Management and Law, in Zurich.

GUEST:

Marc Fouradoulas, MD: Twitter

LINKS:

Marc Fouradoulas. The Swiss Healthcare System: A Model for the US? (Alert and Oriented blog)

Marc Fouradoulas. From Direct Democracy to Centralization: The Swiss Healthcare Experiment (Mises Wire)

Michel Accad. An Economic History of the American Healthcare System. (Alert and Oriented blog)

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Ep. 20 How healthcare systems scapegoat physicians: the Bawa-Garba case Aug 12, 2018

Dr. Saurabh Jha

Hadiza Bawa-Garba was convicted of involuntary manslaughter by a British court for her role in the care of a patient in a hospital setting fraught with system failures. Our guest is Dr. Saurabh Jha who returns on the show to share his insights on this case. Dr. Jha trained in the NHS but practices in the United States as Assistant Professor of Medicine at University of Pennsylvania Perelman School of Medicine. He is intimately familiar with the details of the Bawa-Garba case and has recently returned from London where he attended the most recent legal proceedings in the physician’s appeal of the General Medical Council’s decision.

GUEST:

Saurabh Jha, MD: Twitter

LINKS:

Saurabh Jha. To Err is Homicide in Britain: The Case of Dr. Hadiza Bawa-Garba (The Health Care Blog).
Saurabh Jha. If Hadiza Bawa-Garba Worked in the US She Would Still Be a Doctor. (The Guardian)
Saurabh Jha. The Doctor Who Thwarted the Charge of the General Medical Council (The Health Care Blog)
Saurabh Jha. Dr. Jonathan Cusack versus the General Medical Council (The Health Care Blog).
Ganfyd site entry of the Bawa-Garba case, with all the relevant facts and court documents.

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Ep. 19 Public reporting: necessary evil or harmful fake news? Aug 11, 2018

Dr. Robert Yeh

Public reporting of outcomes aims at improving quality but has also harmed patients and doctors alike. Can any good come out of it? Our guest on this episode is Dr. Robert W. Yeh, Associate Professor of Medicine at Harvard Medical School and Director of the Smith Center for Outcomes Research in Cardiology at the Beth Israel Deaconess Medical Center in Boston. He is an expert on the outcomes of outcome reporting.

GUEST:

Robert W. Yeh, MD: Twitter

Papers by Dr. Yeh and colleagues on public reporting:

http://www.onlinejacc.org/content/65/11/1119– paper suggesting an association between public reporting of PCI mortality and lower rates of PCI especially for high risk patients, and higher mortality for MI patients overall.

https://jamanetwork.com/journals/jamacardiology/fullarticle/2537379 – paper showing that after New York removed cardiogenic shock patients from public reporting of PCI, PCI rates went up and shock-related mortality went down.

https://www.ncbi.nlm.nih.gov/m/pubmed/28249879/ – study showing that hospitals identified as PCI mortality outliers tend to be the large hospitals with CT surgical programs where complex patients are referred. In addition, after being identified as outliers, hospital appeared to improve mortality without worsening risk avoidance.

https://jamanetwork.com/journals/jamacardiology/article-abstract/2680626 – a survey of interventional cardiologists in public reporting states on the extent to which reporting programs have changed their and their colleagues practice.

RELATED LINKS:

Anish Koka. The High Cost of Public Reporting (published in “The HealthCare Blog”)

RELATED EPISODES:

The dangerous business of public reporting.

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Ep. 18 A doctor fights against CON laws Aug 04, 2018

Dr. Gajendra Singh

Our guest on this episode is Dr. Gajendra Singh, a well-respected surgeon who decided to provide affordable ultrasound, CT, and MRI imaging to his community. A few months into his endeavor, he was confronted by his state’s “certificate of need” laws telling him that providing affordable healthcare was illegal. His response: to sue the government.

GUEST:

Gajendra Singh, MD: Twitter and E-mail

LINKS:

Dr. Singh’s Forsyth Imaging Center: Website and Facebook Page
“Healthcare Favoritism:” The Mercatus Center at George Mason University’s analyses on Certificate of Needs Laws
Article featuring Dr. Singh on Vox.com
Dr. Singh featured on the Institute for Justice’s website

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Free Market Medicine is ethical, affordable, and unstoppable.

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Ep. 17 Hope in the fight against MOC Jul 29, 2018

Dr. Westby Fisher

Our guest this week is Dr. Wes Fisher who is leading the fight against the American Board of Internal Medicine and its self-serving tactics to force thousands of physicians to comply with the onerous Maintenance of Certification Program. We learn of Wes’ new initiatives that stand a realistic chance of turning the tide against the quasi regulatory monopoly of the board-certifying agencies.

GUEST:

Westby Fisher, MD website and Twitter

LINKS:

GOFUNDME link to raise funds to complete the pre-litigation investigation.

PRACTICING PHYSICIANS OF AMERICA A grassroots organization co-founded by Dr. Fisher.

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Ep. 16 The EHR will see you now Jul 22, 2018

Ms. Twila Brase

Our guest is Twila Brase, RN, PHN, Executive Director of the Citizen’s Council for Health Freedom. We discuss her freshly released book that reveals the ugly truths about the electronic health records and what can be done to escape from this modern day Panopticon.

GUEST:

Twila Brase, RN, PHN website and Twitter

LINKS:

Big Brother in the Exam Room: The Dangerous Truth About Electronic Health Records

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Ep. 15 Lethal regulation: The 1962 FDA amendments Jul 15, 2018

Dr. Mary Ruwart

Our guest is Dr. Mary Ruwart, scientist, ethicist, and author of a new book that examines the history of the last 6 decades of drug regulation and highlights the unintended consequences on the 1962 amendments to the FDA. Her meticulous research is an eye opener for anyone interested in health.

GUEST:

Mary Ruwart, PhD website and Twitter

LINKS:

Death by Regulation: How We Were Robbed of a Golden Age of Health and How We Can Reclaim It

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Ep. 14 EBM “India-style,” with Dr. Anupam Singh Jul 10, 2018

Dr, Anupam Singh

We took the EBM controversies to India and consulted with Dr. Anupam Singh, Assistant Professor of Medicine at SMC in Ghaziabad. He offered a very sound and intelligent perspective on the proper role of clinical trials and clinical judgment in medical care.

GUEST:

Dr. Anupam Singh’s Twitter and ResearchGate profile

LINKS:

The EBM Wars: Manufacturing Equipoise (part 1)

The EBM Wars: When Evidence has a Price – The ECMO Trials (Part 2)

The Evidence Crisis: Causal Inference–Don’t Be a Chicken (part 3)

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Ep. 13 A buffet of blood pressure guidelines Jun 30, 2018

Dr. Swapnil Hiremath

We have fun discussing the controversies about blood pressure guidelines with our guest, Dr. Swapnil Hiremath, Assistant Professor of Medicine at the University of Ottawa and Co-founder of NephJC, a highly successful Twitter-based journal club. Dr. Hiremath sits on the Canadian blood pressure guideline committee and shares his insights about the question of BP management.

GUEST:

Swapnil Hiremath’s Twitter

NephJC Journal Club

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Ep. 12 John Mandrola: The case for “Less-Is-More” Jun 24, 2018

Dr. John Mandrola

We explore the “less-is-more” movement with Dr. John Mandrola, one of its most articulate and popular champions. We discuss the problem of practices that have no scientific justification and the conundrum of out-of-control costs. What is the best way to curtail unwarranted therapies? Should there be more top down regulations or is it possible that more health care freedom will lead to less utilization?

GUEST:

John Mandrola’s website

John Mandrola’s Twitter

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Ep. 11 The case against shared decision-making Jun 16, 2018

Shared decision-making (SDM) has become a sacred cow of medical ethics almost overnight. What’s more, doctors are now being forced to practice it in order to get paid for certain procedures. We review the history of this concept and why it is contrary to a sound doctor-patient relationship.

LINKS:

Merchant F., et al. Mandating shared decision-making (JAMA)

Presidential Commission: Making Medical Decisions. (Kennedy Center for Bioethics at Georgetown University)

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Ep. 10 Free-market medicine: Ethical, workable, and unstoppable Jun 09, 2018

Dr. G. Keith Smith

We have a terrific interview with G. Keith Smith, co-founder of the Surgery Center of Oklahoma and of the Free Market Medical Association. Keith gives us an overview of his pioneering experience and clearly makes the case that free markets are ethical, workable and, ultimately, unstoppable.

LINKS:

Surgery Center of Oklahoma (Twitter: @SurgeryCenterOK)

G. Keith Smith’s blog

Free Market Medical Association

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Ep. 9 Jade eggs and Francis Bacon Jun 02, 2018

We discuss a blog post by obesity therapy guru Jason Fung in which he pushes back against “debunkers” and self-appointed guardians of “science-based medicine.” We look at the question of science and pseudo-science and how it bears on actual medical care.

LINKS:

Jason Fung: Debunking the Debunkers

David Gorski: An Unholy Combination of Methodolatry and Quackery

Michel Accad: Is Medicine a Scientific Enterprise?

Goop.com: Jade Eggs for Healing

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Ep. 8 The dangerous business of public reporting May 26, 2018

We discuss the background policies the effects of public reporting of outcomes on the behavior of physicians and the reactions to a paper that was just published on this topic. Anish shares a real life experience of a patient of his who was a tragic victim of these misguided healthcare policies.

LINKS:

Blumenthal et al. A Survey of Interventional Cardiologists’ Attitudes and Beliefs About Public Reporting of Percutaneous Coronary Intervention (JAMA Cardiology)

Anish Koka. The High Cost of Public Reporting (published in “The HealthCare Blog”)

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Ep. 7 “No tears for you!” say the pharmascolds May 19, 2018

We discuss a tweet and a paper claiming that pharmaceutical companies don’t even need to produce effective drugs anymore. All they need is “an effective marketing campaign” and billions of dollars in annual sales soon follow. This is a very dubious claim on the face of it, but Anish did some investigating of his own.

LINKS:

Schwartz, LM, and Woloshin, S. A Clear-Eyed View of Restasis and Chronic Dry Eye Disease

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Ep. 6 “Real ACOs have never been tried!” May 12, 2018

We take to task healthcare policy wonks who lament that the government can no longer mandate hospital systems to participate in new “value-based” payment schemes. These alternative payment plans have been a disaster from the get-go, but it seems that central planners never lose hope.

LINKS:

Levy, S. Bagley N, and Rajkumar R. Reform at Risk: Mandating Participation in Alternative Payment Plans.

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Ep. 5 Saurabh Jha: Normal is fuzzy May 06, 2018

We have a free-wheeling and fun conversation with Dr. Saurabh Jha on the philosophical question of “what is normal.” The conversation was prompted by an editorial by John Ioannidis who thinks that “Big Data” could help clinicians get a handle on the vexing problem of normal values. We discuss the merits of that idea.

GUEST:

Twitter: @RogueRad

LINKS:

Saurabh Jha: Artificial Intelligence in Radiology

John Ioannidis: In the Era of Precision Medicine and Big Data, Who Is Normal? (JAMA)

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Ep. 4 The Alfie Evans case: lessons for doctors Apr 28, 2018

There precise rationale invoked by the courts to prevent Alfie Evans’ parents from transferring the child out of the UK is widely misunderstood. In many ways it worse than what many people imagine. We discuss this chilling case and the ethical doctrine that informs the courts’ decision.

LINKS:

Royal College of Paediatrician’s guidelines: Making decisions to limit treatment in life-limiting and life-threatening conditions in children: a framework for practice.

Michel Accad: Charlie Gard, disproportionate care, and assisted suicide

Anish Koka: The price of progress

Michel Accad: The body language of assisted suicide

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Ep. 3 Should doctors protect their turf? Apr 24, 2018

We discuss a “white paper” jointly written by Jeffrey Flier, former dean at Harvard Medical School, and Jared Rhoads, from the Dartmouth Institute, calling for some deregulation of the apparatus that rules the supply of physicians and their scope of work. We touch on the question of safety, patient sovereignty, alternatives to licensing, and whether protectionism is ever a legitimate option.

LINKS:

Jeffrey Flier and Jared Rhoads. The US Health Provider Workforce (Mercatus Center website)

Michel Accad: An Economic History of the American Healthcare System (Alert and Oriented blog)

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Ep. 2 Francis and Accad on EBM Apr 21, 2018

We have a fun chat with Professor Darrel Francis, from Imperial College in London and the UK’s National Heart and Lung Institute. Dr. Francis takes the “pro” side and Michel the “con” side in regards to evidence-based medicine.

GUEST:

Darrel Francis’ Twitter handle and website

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Ep. 1 Confessions of a pharma-fed doctor Apr 14, 2018

After an opinion piece in JAMA Internal Medicine once again showed the influence of drug company payments on physician practices, Anish comes clean about his relationship with Big Pharma. We discuss that potential conflict of interests but place it in the context of broader COIs in health care that no one ever talks about.

LINKS:

Mitchell et al. Pharmaceutical Industry Payments and Oncologists’ Selection of Targeted Cancer Therapies in Medicare Beneficiaries. (JAMA Internal Medicine)

Michel Accad, The Pharma-Fed Doctor (Alert and Oriented blog)

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