The Accad and Koka Report

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

Show notes

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

Show notes

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

Show notes

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

Show notes

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

Show notes

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

Show notes

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

Show notes

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

Show notes

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

Show notes

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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