The Accad and Koka Report

Latest Episodes:

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

Show notes

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)

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

Show notes

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)

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

Show notes

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

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

Show notes

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

Show notes

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

Show notes

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

Show notes

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

Show notes

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

Show notes

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

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