The Accad and Koka Report

Latest Episodes:

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

Show notes

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)

WATCH ON YOUTUBE:

Watch the episode on our YouTube channel.

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

Show notes

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)

WATCH ON YOUTUBE:

Watch the episode on our YouTube channel.

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

Show notes

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)

WATCH ON YOUTUBE:

Watch the episode on our YouTube channel.

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

Show notes

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

WATCH ON YOUTUBE:

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

Show notes

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)

WATCH ON YOUTUBE:

Watch the episode on our YouTube channel.

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

Show notes

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)

WATCH ON YOUTUBE:

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

Show notes

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)

WATCH ON YOUTUBE:

Watch the episode on our YouTube channel.

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

Show notes

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)

WATCH ON YOUTUBE:

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

Show notes

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)

WATCH ON YOUTUBE:

Watch the episode on our YouTube channel.

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

Show notes

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: