The Accad and Koka Report

Latest Episodes:

Ep. 6 “Real ACOs have never been tried!” May 12, 2018

Show notes

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

Show notes

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

Show notes

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

Show notes

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

Show notes

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

Show notes

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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