The Accad and Koka Report

Latest Episodes:

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

Show notes

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

Show notes

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

Show notes

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

Show notes

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

Show notes

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

Show notes

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

Show notes

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

Show notes

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

Show notes

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

Show notes

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)