Listen here for the latest updates on medical procedures, health insurance and managed care. Aired on audio broadcasts from leading radio shows and premium podcasts.
Trump promotes health care 'vision' but gaps remain
"Trump Trump signed signed an an executive executive order yesterday trying to fulfill healthcare promises he'd campaign back on in 2016. This executive order includes coverage for preexisting medical conditions measure Republicans have opposed for years. Most recently with a rush to appoint the conservative Supreme Court justice. Let's get more on the details from the order from CBS has Ben traces of president unveiled what he calls his vision for health care, But it's really an executive order directing Congress to pass legislation to deal with surprise medical billing. It also makes protecting preexisting conditions official U. S policy so we can put that to rest that was actually put to rest 10 years ago by President Obama when he signed the Affordable Care Act, which made covering preexisting conditions, US law President Trump's Order on Uncle. Bill's also does not carrying illegal weight unless Congress fails to pass legislation. In that case, it directs a J. Jess to issue a regulation. Now today, the White House
'Mr. 80 Percent,' An Intimate Portrayal Of Surviving Prostate Cancer
"We're talking about prostate cancer why we don't talk about it because of issues like incontinence, impotence, men's private parts, and so forth I'm joined by Boston Globe Mark Shanahan who is out with a new podcast Mr Eighty percent, which tells the very personal story about his own prostate cancer and a warning again to listeners, we are talking a very frankly about this disease about sexual function and so on and so forth, and so this might not be suitable for younger listeners. We just want to put that warning out there. mark I want to talk a little bit about how this diagnosis it didn't just affect you affected your loved ones too. So your audio, your daughter Julia was in junior high when you were first diagnosed. So I want to hear a little bit of the two of you talking in episode one of Mr Eighty percent. I think I just took it to like. Like he actually died I would basically lose my best friend. This is my daughter Julia she's in college. Now they say like we're not your best friend like where your parents by. Having. Cancer means you get a preview of what your kid might say at your funeral. You're the funniest person I've ever met I. Think one of the most supportive and hardworking people I've ever met and. I also think you one of the most intense people I've ever met and you have a very impressive career, and so I always like looked up to that and by impressive you mean I have talked to Bj. Novak. You took me to Taylor concert. She gave me her bracelet, right? So. So that's a cut from Mr Eighty percent I'm here with Mr, with Shanahan and mark that's really touching moment. But say a little more about that because you make this, you spend a lot of time in this podcast talking about. The effect that this has on your entire family, and by the way the way your wife stepped up in heroic ways and supported you and this is a huge theme about in this story. It's true Anthony that You know you just can't anticipate something like this and and again it's the nature of this disease that you know. This was something that as my surgeon says, at some point in the podcast, you know when you're when you're treating. Prostate cancer patient, you're really treating the couple. And So Michelle had a heavy lift Michelle, your wife correct. I should say right Michelle. My Wife. And she was Extraordinary and But so it's a learning process. For she and then in terms of our children. You well, I Beckett we would like to get back into the podcast but your son as fifty s fifteen year old boy now and You know we wanted him to say, well, we're going to have to talk about our penises and that was. He he just wasn't willing to go there. So again, it's it is. You know we say in the podcast that you get the cancer but everybody's life changes and you know I I don't think that unless you go through something like this, you can really appreciate what that means but I. Certainly do i WanNa talk a little bit about Get get you to talk a little bit about the course of treatment that you opted to follow. So so walk us through first of all the options that you had to consider. When you were first diagnosed well. So we want to also say that because prostate cancer. So slow growing and because many men who are diagnosed are much older I think that people should think very very carefully before embarking on any treatment that there is something called active surveillance, which means we watch it we pay attention to it. And but but. For Myself I was young I had two kids. I had forty years may be to live and. I had a gleason score, which is a score after they give you your biopsy and take a look at what's happening they grade basically of the severity of the intensity of your cancer in mind was seven. Out of ten that's considered to be intermediate I guess you know the options for me were to watch it to have surgery. Or to a radiate my prostate and. In, the end there have been enormous advances in the treatment of prostate cancer over just thirty years. If I had gotten prostate cancer fifty years ago. I. would be rough rough rough. And not just for me every man who had a prostatectomy which is surgical procedure to remove your prostate. before nine, hundred, eighty, two, left the hospital impotent every single Guy which is just incredible to me because nineteen eighty two is not that long ago. Right, it is incredible. So you went for the surgery but I did but that wasn't the end of your ordeal surgery. It turns out we learned didn't get all the cancer. So you had to go back and sign up for pretty radical course of hormone therapy, and this is really the most excruciating part of your journey to read into here about you describe it essentially as a kind of. Chemical. Castration. Well. Indeed and I don't just describe it that way. That's in fact what it is It removes the testosterone from your body and the reason that we do that is because it's the thing that feeds the cancer prostate cancer. Grows Thanks to to Saas thrown. So if you removed from your body to cells cancer cells week in some cases they die and then when they're at their weakest blast them with radiation. The problem is that when you take a testosterone out of a man's body it is a as you say excruciating I became a different person. ahead you know the the euphemism is mood swings. I didn't have mood swings had a I had tantrums and I will say that I was on the phone this morning, the guy who listened to the first three episodes of the podcast and. He. said, he'd never talked to anybody about his course blueprint and he was arrested he actually got arrested. Because a parking garage. because. He could he he got completely out of control. So it's scary. And and you know now as I sit here. There's you know at this surgery if if the prostate cancer should return, there is no surgery there is no radiation. Those are no longer alternatives. and. The prospect of more loop ron or any kind of hormone therapy is really terrifying
Canadas Single Payer Prevails Against Privatization Attempt
"I, Benjamin. Day. And I'm Stephanie Nakajima. And this is Medicare for all. The podcast for everybody needs healthcare. Today. We have Dr Monica debt who is on the board of Canadian. Doctors for Medicare and Public Health and family physician. Nova Scotia, we're thrilled to have her on today to talk about historic legal challenge to the Medicare program that was just heard by the Supreme Court of British Columbia and spoiler the victory delivered by the court to the country single payer system. I cannot wait to hear about this welcome Dr Dot and I'm just curious before we get into the topic. I mean. You're a family physician, but how did you get involved with? Felt the need to get involved with? Health reform. Protecting the Canadian universal healthcare system, but also trying to expand it and improve upon it. Here Hi. Thanks for having me on your podcast I'm really excited to be here. I've been a family physician about ten years. Now, I've worked in a range of settings from big cities to to mainly though northern. Towns across Canada and I've always been in settings where I've very much appreciated. The fact that my patients have access to healthcare wherever we are whether it's a small town or a big city. You know there's there's variations of cross across the country, but fundamentally, all of my patients do not need to worry about. Physician and hospital care. They do not need to pay when they come see knee or when they get to the hospital they know they can count on that care and that's always been really important to me. I also work in public health in very much care about health policies that. Benefit the health of a community of population and absolutely access to to healthcare is a fundamental determinant of Health I. Think it's something that I wanted to support in a in a everywhere I can in one of those ways has been through involvement with Canadian Doctors for Medicare for about the last ten years. and GM or Canadian for Medicare A as a nonprofit organization we've existed just over ten years and our. Fundamental goal is to maintain an improve our single payer publicly funded healthcare system in. Canada. So we want to maintain that single payer but at the same time know that there's there's always things we can do to make it better, but we can do that with a single payer system. So that it might be a bit confusing for our listeners. To hear that the Canadian single payer healthcare system is also called Medicare since we have a program called Medicare that only. Available for seniors sixty, five and older Whereas Canadian Medicare is of course. Accessible to everybody from to cradle-to-grave. So can you just talk a little bit about how Canadian Medicare works are there are there physician networks? Can you ever lose your coverage? Are you allowed to just out of the system or pay to jump the queue? So we do color our health care system Medicare in Canada at the same time when it actually is it's a series of we have provinces and territories, and so there are thirteen provincial and territorial health insurance programs across the country. So every province and territory is responsible for delivering care. Under the umbrella of what's called the Canada Health Act, which outlines the core principles of of Medicare and Canada and one imposes is universality but really it's a a series of health insurance plans that everyone is covered for primarily for physician and hospital services. So for example, where I work I see patients I build my provincial health insurance program I get paid in that way I cannot bill a private insurance program for for my services. Because it is publicly funded. I'm not allowed to then go in and bill a private insurance program. So for the pieces that are covered publicly through universal system, you cannot buy insurance to go see a physician or go to a hospital privately you need to access it through the public system just as as everyone else does we do have some of our care about thirty percent that is privately paid for either through supplemental insurance or through. Private payment, and that covers pieces like dental care some medications, physiotherapy other allied health professionals, and to be honest it's a gap in that we don't cover some of those pieces, but the vast majority of of care is covered under our public system.
Why Dr. Kumar is Changing The Wellness Game
"Welcome back once again, see the outcomes, rocket podcasts where we chat with today's most successful and inspiring health care leaders. I really WANNA. Thank you for tuning in again and I welcome you to go to outcomes rocket dot health slash reviews where you could rate and review today's podcast because he is one outstanding individual and healthcare is name is Dr Rajiv Kumar he's the president and chief medical officer at Virgin Pulse during medical school he realized that many of the worst health problems we face as a nation diabetes heart disease cancer hypertension. Et, CETERA. I related to the collective unhealthy lifestyle, and so he has pledged to make a difference in this industry. He's done and as a frontline physician and now through various different companies, some amazing things and so what I WANNA do is open up the microphone to Raji to fill in any of the gaps of the introduction and then a so we could get into the podcast. Reggie welcome to the PODCAST. Think saw glad to be here. So Rajiv, what would you fill in in your intro that I that I left out? I think that was pretty comprehensive. Just, a little bit about virgin pulse. You know what? I think that may not be familiar name to a lot of folks on your that are listening to your podcast. We are an employee wellbeing company. We work with large employers all around the world, and our goal is to help them activate their employees to lead healthier lifestyles which had to kind of go around the healthcare system a little bit, and go direct to the employees and figure out ways to motivate them to inspire them and to help them sustain behavior change over time, and it's not just about healthcare cost reduction. It really is about how do we help people be? Healthier, happier and more productive at work in their personal lives. So that's really what our mission is. That's beautiful and listeners for those of you who haven't connected the DOTS virgin pulse. One of Sir Richard Branson's Virgin Group companies. So you know with the gentleman like that behind something like this and and Rajiv as part of the executive leadership team, you can imagine some great things are happening. It's an exciting time for us. We definitely are inspired by Sir Richard Branson leadership in his philosophy is if you take care of your employees, they'll take care of your business, and so we're trying to empower employers to take better care of their employees. So strong, and and you know it's really interesting that you guys are tackling this employer perspective of the entire health career equation because costs are soaring and aside from labor costs, it seems like healthcare cost is oftentimes double digits in that front. What are your thoughts on what should be on every medical leaders agenda today? Well, I'm biased but I think it has to be a behavior change remember too often looking for a magic pill or magic device or something to kind of stem the tide of rising obesity, diabetes and heart disease in our country and at the end of the day, there's so much. We can do to actually change people's behavior a lot of what we're facing as a result of our diet, our physical activity or lack thereof the stress that we have in our lives just how we how we treat ourselves and how we don't take care of ourselves, and so I think it's not necessarily a hot topic I. Think it should be and and I wish there was more focus on it is the perennial that if we can change behavior, we can prevent a lot of disease and we can produce significantly greater outcomes and Reggie. What would you say right now at at at Virgin? Pulse. Is an example of how you guys are improving health outcomes. Well, I think we really tried to think outside of the box I think traditional health interventions and and health and wellbeing platforms have largely been ineffective and they've been around for decades. So we sat around and we said what if we took a different approach rather than making people feel like they're failures rather than telling them that they're sick what if we actually make them feel successful what if we make them feel good about themselves right off the bat what would that do for self esteem for their motivation and for their ability to change. Most of what we see in our industry is a heavy focus on screening, and so employers asked their employees to take health risk assessments and do biometric screenings and so forth, and the problem with that is they take a health risk assessment tells them you're sick. You know you have high risk, your unhealthy needs to do more change your lifestyle, get your biometric screening results and you have high blood pressure. You may not like the results that you get back and that can be very demotivating, and so we've said is, is there a scientist out there? Is there a behavior change model that focuses on success? We found a scientist by the name of Dr Bj fog out of Stanford University and Dr Fog is sort of a new guru of behavior change and he's come up with a behavior change model that he caused the fog behavior change model and it's very simple as model is is a formula to it is called B. Equals M. A. T.. Equals motivation times, ability times a trigger, and so what he means by that is to get somebody to do a behavior that we want them to do or they want to do. First of all, they have to have the motivation to do it. Second is they have to have the ability to do it, and a third is you have to trigger them. To trump to do that behavior and too often in the in the kind of behavior change space, we ask people to do things that require either too much motivation or too much ability. So we say something like go to the gym four times a week and exercise for sixty minutes. Each time you go that takes a lot of motivation and some people may not even have the ability a really know how to do that where to get started so forth so Dr Fog says, well, motivation is hard to change. Your motivation waxes and wanes on a daily basis on an hourly basis, we can't really change somebody's motivation that easily what you can do is changed the behavior you're asking them to do to make it easier. You can change the ability to perform the action, and so the idea is if you take a behavior like washing your teeth and you break it down to the smallest tiniest thing that somebody could possibly do like floss one tooth and you ask them to do that they can actually do. That very easily, it doesn't take a lot of motivation is very quick to do, and if they do that and you celebrate the fact that they did it, you can help them build what we call success momentum, and then they're going to feel better about going to the next step and try something harder and so in our entire approach to behavior change, we break behaviors down into their simplest most basic action we ask people to do that would trigger then and then when they do it we. Reward them make them successful. We give them social status. They might get some kind of points or some kind of reward, and then we ask them to do something harder the next time around and stuff feedback loop that builds up momentum, and it changes behavior in a very sustainable way in a very habitual way, which is really the key to behavior changes creating habits.
Dr. Richard A. Van Etten: Cancer
"Please welcome to the show Dr Rick van how you doing. Thank you very much Andrew and Brittany I greatly appreciate the opportunity to be able to come and talk to your talk your listeners today. Yeah. Well, thank you for taking the time out of your busy schedule to talk to us. So we're GONNA be talking about obviously cancer and how you can prevent cancer do your best to prevent it. But as I mentioned in the Intro, most likely someone knows someone who's had cancer or they've had cancer themselves even it's pretty it seems like it's touches a lot of people but can you kind of tell me how many people does cancer impact on a yearly basis? Well. Thank you for the question Andrew. The lifetime risk of getting cancer is approaching thirty eight or thirty, nine percent. So more than one in three Americans will get cancer during their lifetime. So that explains what you said that basically almost everybody is either been personally. Involved with cancer knows a close family member or a loved one that's been stricken by cancer. So some of the statistics nationwide in the United States, there's about one point seven million people diagnosed each year with cancer. And they'll be about unfortunately six hundred thousand Americans will die every year of cancer. Here in Orange County it's interesting that cancer has overtaken cart diseases, the number one killer, and as soon gonNA happen nationwide. So a very very. Prevalent disease what kind of has led to what's led to that trajectory? Why is that happening? Well, actually the the the death rate from cancer has been falling and it's been falling significantly over the past fifteen or twenty years, which is a success basically for the research that's gone into it through the National Cancer Institute and other mechanisms. But the fact that cancer is now the number one killer has actually also reflected progress in cardiovascular disease. So doing which used to be the number one killer. So we're doing a better job at preventing. Heart disease through the things that you know about treatment of the risk factors like high lipids, blood pressure, diabetes et CETERA. Right? Interesting. Okay. All right. So we got some work to do on the cancer and Kinda catch up. And, that generally, like I mentioned usually happens through education funding, which we'll talk about in a little bit What types of cancers are the most prevalent today? I know that you specialize are a believe in like blood cancers by what are the most prevalent that people run into so we can talk both about incidents, which is the new diagnosis that we have each year and prevalence, which is the number of people living with the disease at any given time. But the top four in both categories are pretty similar. So there's breast cancer which obviously predominantly affects women but also can affect men. Then there's lung cancer there's prostate cancer which obviously is a male cancer and the last one is colorectal cancer. Those are the big four. Close on their heels are diseases like skin cancer and melanoma that's particularly relevant for Orange County where we have two hundred and eight, hundred, ninety days per year rate. And after that come some blood cancers that I specialize in, which is mainly things like leukemia lymphoma and Myeloma Okay. What kind of leads to these types of cancers occurring out of those top four that you mentioned, what? What's the biggest contributor to people getting? Is it? Is it just genetics you got bad genes or something in your lifestyle or in your the world around you I guess causing it. So they're. Probably, equal contributions both from genetics and from lifestyle. Okay. When I say genetics I mean the cancer is principally in the opinion of a lot of primarily a genetic disease in the cancer cells have acquired mutations that contribute to their malignant or cancerous phenotype, their ability to grow and attack the body. Most of those mutations are acquired in other words they happened just within the cancer cell and they're not inherited. So you don't get them from your mother or your father. Now there are exceptions there are well defined cancer susceptibility syndromes the most the one that may be most familiar to your listeners is the bracket jeans Brca which segregating families particularly people, of Ashkenazi, Jewish descent that are inherited either from your mother or your father, and greatly increase your risk for developing breast cancer or ovarian cancer so that the risk for women who doesn't ever bracken gene mutation is about one about eleven percent or one in nine during your lifetime. If you inherit one of these genes, it's virtually almost everybody will get breast cancer ninety percent risk over your lifetime. So, this cancer susceptibility syndromes are very important the need. For instance when there's a new cancer diagnosis, you need to take a careful family history and in some cases be referred to a genetic counselor to determine whether testing family members is indicated. Yeah. Well, that's interesting that you bring that up because my wife actually we went through that process, and so she was found her mother had breast cancer and through that process they found out, she had the bracket gene Brac to and then and so my wife decided because they kind of give you choice like do you want to get screened? Do you not like you kind of have? Do you want to know more or or like not and stay naive to it I guess and so what I've discovered, we went through it and is interesting out of the split my wife got it and her sister didn't so the fifty, fifty there and. It. Seems like. It's I think my opinion is it's good to know because now they're just more aggressively screening her and is that typically the case when you find out about something like that, you're more your screened even more regularly than the average person should be. That's right. A change basically changes the surveillance. In it not to make it more complicated. But there are some genes like the broncos where the penetrates which means that the chance of actually getting breast cancer. If you have the have, the mutation is very high I think there it's pretty straightforward to decide whether to get screened. Right. There are other mutations that can be inherited that don't increase the risk that much increase it above the background, but it's not nearly as high and there it's more complicated to try to decide what to do about that. But. My advice to your listeners is to seek the advice of a NCI cancer center in a a qualified genetic counselor. Those are the people best qualified to help guide you through that decision making process right? Right. When you're going through like you said they ramp up the screening process if you had the genetic mutation but how does how did we get to discovering these genetic mutations I? It sounds like you kind of have somewhat of a background like you discovered or help discover this protein that was causing leukemia right and. How does that process even work? How do we make these discoveries? How do you make these? Discovery I was involved in is one of these acquired mutations not inherited, but it came about from studies done many many years ago actually nineteen sixty that showed that patients with this particular type of leukemia had an abnormal chromosome in their blood cells. And when to make a very long story short when that was tracked down, it was shown that the chromosome was actually an a Barrett. That was acquired in these cancer cells that lead to the expression of this abnormal protein. And that protein. Hasn't is an enzyme which means that it has a ability to catalyze chemical reactions. Okay and that particular reaction stimulated the growth of those blood cancer cells. So. That led a drug company, which is today is no artis to develop us a drug a small molecule inhibited the action of that protein. And that That drug which has the trade name GLIVEC revolutionized the treatment of that leukemia so that in the past everybody died of this leukemia, unless you had a bone marrow or stem cell transplant. Today everybody takes a drug likely. And most people go into remission and when they do, they have normal age adjusted life expectancy. That's example would that's Therapy likely that can do to cancer right? So does this all come from these discoveries? Does it come from just? Tons of data over decades like this one you're saying, it came from research started in the sixties and this didn't have until the early nineties. Is that right or wealth the the The structure of the protein was discovered. I'm saying Circa Nineteen, eighty-four which I got involved. The drug development efforts took place shortly thereafter I'm and the was FDA approved in two thousand one. So it's been on the market now for almost nineteen years I and there are many many other efforts in other cancers that are parallel parallel that. The thing that's happened today is because of our new technology and the genomics and the ability to determine, for instance, the genome sequence very quickly that's accelerated the progress that we can make. So what took forty years from sixty two to the drug being approved now can be done in a couple of years. Wow. Everything's happening much much faster. That's awesome. That's great news for those of US living right now.
Navigating the NICU with Nurse Tori
"Nurse Tori Welcome to the woman. I'm so happy to finally have you on here. Oh my gosh. Danny, thank you so much for having me I. I'm thrilled I'm excited. When I message like I've been missing the nick you can. We discussed and having Nikki episode, and of course, you were like Hell Yeah let's do it. Please I love it. I'm so excited reminisce about Nikki life plus it's Nikki awareness month which I didn't know of and I feel very ashamed of myself made twelve years and the. Only. Thing it's not you know I think it was established. Let's say I don't know couple of years ago. For making. Thank you. Know it's become a thing love so Well, that's amazing because I know we had like a Nikki nurse day right around there like okay. Hers also, November, which is like free maturity awareness month. So we're kind of all over the place just establishing Mon- says everything CAPEX. Nikki. Nurse. Day there's also I wanNA see. There's like now they're kind of breaking down day in. September. For the end of the month like twenty, seven, Twenty, eight, twenty, nine all are dedicated to different aspects of the nick you so. Love that. Yeah, it's pretty neat. It's special. So this is actually really cool. It's a cool month for late I would say the nurses, the doctors, the RT's, and then also courts the families and. The pass babies or pass patients than accused of reminisce and yeah. So like every year mild hospital would have a day where all the parents could come who had lost a child in the nick you and then they have like like. Not like a religious but like kind of like a reunion like A. Goodwill prayer you know type thing and you know some of the nurses could go down and like the families could go and like reunite with them. Does your hospital do anything like that? Yes. Oh, a couple of different hassles I worked have done things like that. I would say the most consistent thing I've seen that most hostels do and participate in is the march of dimes. Yes. Where you can do that some hustles will have separate time to do a reunion but the is a pretty condescending where you know we could raise funds or a walk and kind of I would say the one big time that we do our hustle also does do. It's a walk in the park and dots because we're near. Disneyland. Rona we were able to do it where. And nurses and doctors who ever wanted to go could go do walk in the park together and it sort of like a day to remember everything and should be together and so that's actually a pretty cool things well so. That's so lovely. Yeah, it's really special. I. Mean. Especially when you are, you know working with these families as you know for up to in the nick you up to a year really or more. Yeah. Exactly be restocked relationships you know yeah, and I feel like. That's kind of one of the things that really sets and Nick you apart from working in other areas of the hospital. Yeah I would agree even having some more recently I was working as a critical care. Nurse so I was working. Hickey NICU'S TV ICU arcologies. And it was a really interesting interesting thing to see the differences in the dynamics of the unit. So for example. I would say sort of. A, little bit more like that. Fast. Like you're you're out they you know primarily drink surgeries console. It's very fast paced. It's different or traumas and things like that. Is Nick you you know we really do have not long-term relationship. I would say similarly oftentimes on college, we'll have kind of relationship with their patients while actually. So that's true. That's true.
Concern begins to grow as flu season moves in
"Covered 19 surge at exactly the same time would be an incredibly difficult situation. Governor Charlie Baker says that 12 punch by flu and the virus would be devastating to the health care system, and he calls on everyone to get a flu shot. As the weather takes a sudden cooler turn. Officials in Boston get an earful from restaurant
Johnson & Johnson faces $2 billion lawsuit over opioids
"To pay back in New York State is looking to recover some $2 billion over a pharmaceutical giants alleged role in the opioid epidemic. The lawsuit says a division of Johnson and Johnson poured millions of dollars into marketing opioids and downplaying the risks and that the company continued to promote the drugs even after government officials warn that opioids were much more dangerous than other pharmaceutical products. The state is not suing Jay and Jay directly instead to suit being brought by the states the problem of financial services and alleges the company committed insurance fraud by encouraging doctors and patients to use the addictive painkillers.
Federal government releases plan on how it will roll-out COVID-19 vaccine when its available
"The federal government today, revealing initial plans to distribute a Corona virus vaccine once one has proven safe and effective. CDC director Dr Robert Redfield guidance for the local state territorial Public health programs and their partners to help him plan and operationalized vaccine program The grove in 19 introduce stations. The plan describes a program for vaccinations to begin in January or possibly later this year. President Trump has set a vaccine might be approved in weeks, but health officials say it will likely be months before one is
Vaccines and the Future of COVID with Epidemiologist Dr. George Rutherford
"This isn't the same rehashed discussion of covert. This is. Well more worth listening to. This is stuff that you need to know. This is medicine we're still practicing. I'm building. Of course, I by friend and Co host zooming in Dr Steven. Tailback he's a quadruple board certified doctor of Internal Medicine Pulmonary Disease Critical Care and neuro critical care, and he continues to fight on the front lines of the covert battle here in California for which we are eternally grateful. Steve. How you doing? Hey Bill. Good to see you. And R various special guest Dr, George Rutherford. He is the internationally lauded head of infectious disease and global epidemiology at the UCSF School of Medicine. He is also UCSF's professor of pediatrics and adjunct. Professor School of Public Health at California Berkeley. I had a chance to print out Georgia's see. It's one hundred, twenty, six pages long with two hundred and twenty one published papers and so many important accolades. So I'm going to read the whole thing to you now. Only. Kidding. Dr Authored although socially distance. Thanks so much for joining real pleasure. So Professor of epidemiology and biostatistics director at the prevention and Public Health Group. What do you do? Well, I'm an academic. So I teach school right I do research and I provide advice. So the mission of anybody in Academic Vinnie academic medical entity is education research, clinical care and public service. So my clinical care is really the clinical practice of public. Health and I advise the City Health Department San Francisco Department of Public Health, the California Department of Health and some of the various health departments around the state on approaches to controlling the Kobe deputy hammock. You did mention that your research is partly funded by CDC. Yes. That's correct. Yeah. Hell is a bit about that and how that affects your work during these crazy days. So I've worked with CDC for decades and most recently. I've been doing predominantly HIV related work in developing countries as part of the Presidential Emergency Plan for AIDS Relief I, have a large competent, very competent research group that basically tries to help governments and occasionally universities but mostly governments CDC missions in developing countries to understand what's going on with their. HIV. Epidemics, how things are working to evaluate progress and to discover new ways to try and stop the spread of HIV and try and. Improve. Clinical outcomes of people who already have HIV. So cases per one million population worldwide is running at about three thousand, five, hundred cases per one million in the US is running at about nineteen thousand, three hundred. So did we screw up or do we have a population that's more difficult to manage? Yes and yes, we have six fold higher numbers of cases than we should have and other countries like India may eventually catch up. I think that the US mister major opportunity early on and that was the problem with not having up tests and having the wrong tests and having tested didn't work and trying to control tests and trying to restrict out tests were being used for whom they are being used. I think they've always been you know a whole myriad lack of policy leadership which the states. have taken over and I think first of all the bay area in which the six county health departments acted in concert to move to a shelter in place ordinance early on on March. Sixteenth, and there is a very good reason for March sixteenth it was the day before Saint Patrick's Day, and then later the state moved in the same direction. So I think California's really been a leader in this. Now, you wouldn't know it from the last two months or three months since mid June under there's a huge wave of new infection a disappointed but I think we still are leaders in this. We showed data today in medicine grand rounds at UCSF that looked at numbers of deaths per hundred cases and in New York ten percent in. San. Francisco, it's zero point, seven percent. So it's less than one percent in San Francisco and the next best in a big city is something I one and a half percent did we screw up as a country? Totally? Did we screw up regionally in the north in northern California I don't think. So we scrub stay somewhat I think we made the reopening little to easy S. Really Hindsight Wealth speak that hindsight just for a second I mean in New York they've had four hundred, forty, five, thousand cases in thirty, three, thousand deaths. So they got a hold of this thing long before we did but we've already exceeded the case we're up to seven, hundred, fifty, thousand cases almost eighty percent more than they've had, and we've had fourteen thousand deaths. Half of what they've had when you say that we as a country may have screwed up, do we have a hold of this thing now and how much of it is that the population is not wearing masks enough especially young people who've decided that they're not as susceptible what New York was bad luck and they had continuous importation from Europe and may have had who? knows. Thousands of cases imported from Europe each one of which starts a new chain of transmission. We in San Francisco we probably at tens coming from Asia and you know the first death care was on February six dot and that was diagnosed retrospectively. Womanhood attended a convention in Las Vegas choose living in Santa, Clara County near San Jose and that convention probably people from China. or at least in the in the hotel that's probably where she got it. If she'd come home and hit a large crowd event at the wrong time with very high levels of virus inter nose and throat and spread it around we could have been just as bad office New York but we weren't and that's really a question of luck. So New York at Bath Block. But guess what we do. This was coming since the thirty first of December. That's when the UBA provincial CDC notified the central Chinese CDC that Oh, by the way, we may have a little problem here the central Chinese CD setup team to Wuhan on December thirty first basically started began an immediate investigation started closed down and drain the whole thing under control. That was the starting Bell I. Mean there was basically two months lost now CDC will say, well, we were having we we developed tests. We did this. We did that. Yeah, that's true. But then the FDA threatened to decertify their laboratory that was producing testing. They produce tests in the hundreds, not in the tens of thousands which was what was needed thousands. Of people came from Europe to New York and it got spread around helped by a couple of super spreader events where people in fact, at one person they affect hundreds of people at the same
Exploring The Future of Health through Dreams and AI with Antonio Estrella
"Welcome back to the podcast that I have the privilege of hosting Tony Australia. He's a managing director at Talladega Investment and advisory for health tech and insure tech startups. He's also a fiction novelist Tony's a global thought leader and fiction writer and digital health with experiences working in Asia, the US and Europe as a startup founder investor or Britain ovation leader and strategic advisor Tony currently sits on the board as an independent director, for C, x group, and Savannah CTS as both. An investor and adviser Tony Partners with Asia focus companies who are working to develop solutions to change the face of cancer human longevity and population health with core IP stemming from AI genomics blockchain smart devices, his previous work within both life insurance at metlife and farm out with Pfizer, it was focused to drive measurable business impact allowing him to help entrepreneurs enhanced their product market fit and commercial growth plans across Asian markets, his debut fiction novel comatose, which will touch on here. In today's discussion is a fiction novel about Lucid Dreaming and it's all about health tech fiction something that will cover with Tony as well. It's available in bookstores today in the UK and Amazon globally. Tony is has done tremendous mono- work and he spent some time at University of Pennsylvania's wharton getting his MBA there the London business school and the University of Pennsylvania School of Engineering and Applied Science in electrical engineering. So a tremendous individual and it's a privilege to host them. Here today. Tony thanks for joining the next. So the pleasure to be here, thanks for inviting me to share some of my thoughts and insights with with your audience. Absolutely my friend. So tell me a little bit about your journey. How did you decide on healthcare? So I academically studied electrical engineering and that's actually where I caught the bug Ford being more entrepreneurial minded and how I focused by professional life I used to build and race solar electric race cars really. Little coffee that I helped build up and and I started my career in consulting and during that period was great you know lots of. Ways to learn and be mentally intellectually challenged. But in two thousand, I had just finished doing work in Silicon Valley and that was the first Internet wave and lots of excitement about transformation and as I started business school I really thought about where did I want to dedicate my time and energy in terms of industry focus for several different reasons including personal wants healthcare just jumped out. I love the fact that you can build technology and it helps people live longer have better quality of life I had a couple of. Personal Peoria friends who dealt with health issues. I had an aunt who passed away from kidney failure and so all that just came together for me to say I can wake up every morning. Feeling excited that what I do is helping at least one individual of a better life love that man yeah. It's a compelling reason to choose the field and with your knowledge and background you've been able to make a big impact and so I'd love to hear from you. Tony will you think is should be the big thing. On health leaders agenda and how are you approaching it back when I started my first business in two thousand one, there was a lot of emphasis in terms of whereas the healthcare industry in the US the US at the time and fast forward through time they're still an enormous amount of of focus in the US in the healthcare sector is digital health or health tech has grown the US. Market clearly is an important one, but I'd say that equally as important that on every health leaders mind should be what can they Learn from what's happening in. Asia and Asia whether Asia's an opportunity or not is there are there things that Asia offers in accelerating growth and scale and product that can be leveraged for for their business and couple of facts about Asia that I think are important for plus billion people forty four countries over two thousand languages spoken and normally large region and from an investment perspective this two, twenty, eighteen we saw the Asia approaching the same amount of investment to help tech startups is in the US style so within the next. Eighteen months you'll see that Asia, actual have more capital being deployed from the venture community and startups. So when I say that every health leader medically look at Asia, it's because the region is just is as awards today with with a much greater growth potential in the number of people countries. So there was a book I read recently by Kaifu who was a venture investor, in China, who formerly headed up Google China and used to work. For Apple and driving their early AI, and he doesn't amazing job painting the picture for China's one country when when important region round where they're going with a and how it's different than the US and I think that's the key thing that a takeaway for health for health leaders it's just a different technical environment data standards, and in the way that the tencent and Alibaba by do have changed China much the same way that Google facebook. Changed West is lots of learning that can happen man that's fascinating stuff Tony and folks I forgot to mention to you that Tony Lives and works in Singapore. So he's he's been there for the last five years this time around but definitely, a global health leader focused on Asia that knows the INS and outs. So critical critical piece of of information there everybody. To know. Tony, without a doubt there's there's opportunity over there. The money's flowing over there. Give us an example of of what you've seen is working and creating results. Yeah. The landscape for Asia is complex As I said, there's lots of countries and so before a answered that question, let me give a little bit of context as to how to think about the region. So. One is mentioned China and you can group Hong Kong and China together from thinking about one of six hubs in the region. The other hubs are the Indian subcontinent, which obviously is driven largely by India, but there's other countries their third. It'd be Japan for the be the Korean. Peninsula, which includes South Korea Fifty Southeast Asia Singapore and then six to be Australia New Zealand and I didn't do these in any order of size of just kind of went north to south and regret yeah, an each hub has. Similarities that that make a logical grouping whether it's economic development or cultural lifestyle history or climate.
Self-Advocacy Through Storytelling with Katie Vigos, RN
"Welcome back to the moment everybody I am speaking with Katie Vigo's today she is a registered nurse and founder of the empowered birth project. I'm so excited to speak with you today we've had a few technical difficulties in hopefully those stay at bay now but yeah, welcome to the woman. I'm so glad we finally got you on. Thank you so much for having me. I'm excited for our conversation you work in Icu Poe right now correct yes. That's right. Critical Care is still my primary specialty the moment. Love that when did you know you want it to be a nurse led you to this field? I've always been interested in anatomy and physiology as a kid I found the human body to. Be. So fascinating and I was just drawn to those sciences and when I was a senior in high school my offered a free course to become certified as a CNA nursing assistant, and so I immediately saw Kinda, this golden opportunity to get certified to start working in this field that I'd always been interested in. So I took a class and then got my first job working in skilled nursing facility and I've pretty much never stopped. I love. That's the thing that's basically the road I talk to you like I. Well, I knew I wanted to be a nurse but like as soon as I could take that scene a course I did that a great way to get started. A it definitely will introduce you to to see if you can handle being around that much bodily fluid. That will particular job was like probably the most backbreaking Labor I've ever done in my life. Yeah. Yeah. All have only gone up hill from there their gotten better from there that was so hard. I was too young and inexperienced to even know any better I was just excited to be working in. You know getting started with my career yeah. One hundred percent I mean I started working on a med surge floor and I literally never been in more pain in my life than when I would come home from working. At. A shift there. I have so much respect for MED surge nurses. I S honestly think it's harder in many ways that what to do in critical care respect for floor nursing same same I ended up in the Nikki I've had enough of adults like I can't. I can't move them. No, it's. It's physically, very challenging. Mentally emotionally, spiritually challenging job it requires like our whole being so he has. Yes people. Yeah. What is life and free since the pandemic started with working still being in the ICU I it's you know it's been a roller coaster I at the time that Kobe really started to hit the United States where we went on lockdown here. In California, I was on a full time loan to cardiovascular is you which was a challenging assignment, but I took it because I wanted you know some fulltime work for a few months and I was just a few weeks instead assignment and starting to feel a little bit more comfortable, and because I was per diem and because all almost all elective non emergent surgeries completely stopped onus unindicted unit was way overstaffed and they're like, well we. Don't need you any more sorry and I was like, okay. So I lost that Gig and then I had been working in outpatient surgery as well with a facility for three years and back completely shut down. So ironically I was kind of gearing up in those early weeks. I'm like all right here we go. Like I've been training my whole life for this and I was it just didn't play out the way I expected a now a sudden I'm worried about you know getting enough work as I in pandemic. And there are a lot of reasons for that that you know I'm sure you're aware of many people listening are aware of, but you know the per diem crowd got hit hard and everything just shifted around so quickly and then it was like travel nurses coming in, you know my co workers are you know leaving and getting work elsewhere because they can't Get at our hospital and it just felt so chaotic and uncertain, and I have had also been working for the private sector for the last eight or nine years here in Los Angeles Oh come on a lot of pride in doing her thing and so I'm really networked into that field as well here and so I was able to just hustle in. Find some private work and just like piecing everything together like a lot of us per diem nurses are good at doing you know. Yeah. So I was able to get through you know kind of those early months and then things started to pick up again at my hospital and so now that I'm able to work more kind of back mostly full in the ICU again, doing some a private work as well and aside it's it's changed everything I mean regardless of where we work like. Especially, at first like the policies and procedures were just changing daily, you know as mere figuring out the best ways to protect ourselves, screen all of our patients and everything, and so that was overwhelming to keep up with, and for example, I was floated to. Telemetry one day at a unit I. Believe once before come on shift and I have a patient who is like in basically in respiratory distress did not like the level of a rapid response per se. But like he's on iphone as will Kanye like eighty percent like fifty liters or something like that, and you know he has tech Nick and all this stuff and I'm just like, are we going to test this guy for covert like your and? where's PP P now, as I kinda, don't want to go in the room unless I have that, and then I really had to advocate for myself and be like you know, let's test this guy that was before my hus-, my husband's testing everybody. But like those early weeks were really stressful that way because there are so many unknowns and it was it was scary to walk into work which previously was familiar and comfortable to me is an experienced nurse and two now just feel. So on edge
Housing, Healthcare, and COVID-19
"Today, we're speaking with Barbara Dipietro. Who Directs the policy and advocacy activities for the national healthcare for the Homeless Council. Barbara, thank you for joining us. Thank you for having me. Yeah it's so. I'm so glad you're you're you're with us today especially during covid nineteen where I feel like the healthcare and housing systems are really failing us and intersectional and kind of dangerous way. So we really wanted to focus on this today. But I could you tell us a little bit about yourself? How did you end up getting involved with this type of work and what do you do for your for your work? Thanks much I came to this work working for the state of. Maryland. In the Department of Health and did a public health policy for about ten years both of the governor's office and for the Department of Health I did interagency family and children's services and and was a staff to the. Agency. Council on Homelessness. I was the opportunity to write Maryland's first a ten year plan to end homelessness, and this was back when those ten year plans were really just getting going under the Bush administration and Interagency Councils to. A homeless policies within states were really becoming the thing to do and and so that was precisely the time when I was in public service and my eyes were opened at that point to the breadth of issues affiliated with Homelessness and just how preventable homelessness is if we could just get good public policies to address it. And that was obviously no more. Well, illustrated than health department and in healthcare, and so one the things that I, the partners that we worked with healthcare for the homeless out here in Maryland they introduced me to a network of healthcare for the homeless providers nationally, and that's where I was. Started working with the National Healthcare for the Homeless Council and came familiar with them, and then they had an opportunity for director of policy and I've been in this role for eleven years now. And really excited to be doing just so much more deeper work on healthcare on homelessness in good public policy. So just to start with. I feel like the image that people have of homelessness doesn't actually match the reality of who experiences homelessness, how people become homeless and what it really looks like to experience housing instability. Can You just define homelessness for our listeners and paint a picture to help us better understand what it really looks like sure. I know we tend to conjure in our mind a street homeless man who was a chronic. That is what most Americans think of when they think of as homelessness. Really that population is about ten percent of the total homeless population in the country. Overwhelmingly, what we are seeing our low income working families are working people If you look in shelters most shelters a third to a half of shelter. Shelter stays our children. When you look at it working families who when we think about. Earning eight nine or ten dollars an hour, ten dollars an hour is twenty dollars. Excuse me twenty thousand dollars a year at fulltime salary. That's still not enough to make rent and pay bills and meet your food needs and and and and so people even when they are working even if it's not minimum wage still maybe in the shelter because they can't afford housing. So the official definition of homelessness, it may not surprise your listeners to know that there are many federal different definitions of homelessness depending on the program you were looking to access and so the definition of homelessness if you were in a housing world is more narrow than in the healthcare world. and. So then it's different even for the schools. And so we're looking at obviously street homelessness but also people who were living in transitional housing programs, permanent housing programs, people who were doubled up with friends or family really unstable. There's just a really A. Many people do not just solely stay in one place so they may be staying in a shelter for few nights. They may bounce back onto the street they may be able to stay for a couple of nights with friends or family member. Maybe, a spare couch something like that. Many of our clients do work, and so they do have some income were there on disability and they have some income. So that income allows them to pay a hundred dollars for the for sleeping on a couch for a couple of weeks.
A Curious Way to Improve Outcomes in Substance Use Disorder Space
"Welcome, back to the outcome rocket podcasts for re chat with today's most successful and inspiring healthcare leaders really wish that you could visit us at outcomes rockets dot health slash reviews where you can rate and review today's episode. We have an amazing guest. His name is Jacob Levinson he's the CEO at map help management. Jacobs. Extensive career is focused on being very dialed into the healthcare center. He's member of board of Directors Levinson. Foundation privately funded Philanthropic Organization Charter to really develop, manage, and fund diverse portfolio and humanitarian activities around the world. He's a member try private capital. He's just done so many things in realm of just contributing to this humanitarian. Capacity that his fit in health care makes so much sense and you guys all hear the passionate voice when we dive deeper. But what I WANNA do is open up the microphone to Jacob. So he could fill in the gaps in the introduction Jacob Welcome to the PODCAST. Thanks for having me excited to be on with you know get good job introduction nothing to add looking forward to next forty five minutes or so of of hitting some of these were topics absolutely in so Jacob why did you decide to get into the medical sector? You could have done so many things, but you decided to land here. Why asked myself that often? It's like a Greek tragedy. For your run from it, the more you run into it. So I grew up around a lot of active substance use disorder in my house it. Oh, child of the late eighties nineties KINDA GROPE UNSEEN KINDA staff and Watch family members struggle, and the last thing I ever wanted to do was a line my professional career with anything that had to do with addiction or substance use disorder. So of course, that's exactly what happened. It wasn't by choice it was I I don't know some sort of gravitational pull maybe back to what I knew. So I it's no I don't think it's any secret that you grow up kind of around substance use disorder, and then someone like me ends up involved in writing algorithms to detect active substance use I. Mean I've been doing it too right. So I don't know if there's a coherent explanation but I was born. Into the addiction world in that sense. Yeah. It was woven into your fiber as as kid and it was sorta like something you've been doing. So why not continue to do it? There's a lot of work that needs to be done in this space out there and I felt like that we had an opportunity to make some change and we need to put our best foot forward go do something. So yeah, it's exciting time and really pivotal Kinda critical juncture in history we're watching so many things transformed are going to drive this for the next generation to generation. So kind of having a a front seat of somebody that's really exciting. Yeah that's super exciting and so for the listeners, maybe you could dive in a little bit on what some of the work that you guys do and how it's relevant to the space shirt. So I'll try to keep it simple. We focus predominantly on individuals who have a substance use disorder diagnosis. What we call addiction is to kind of put that some staggering terms twenty two and a half twenty, three, million Americans fit the criteria for substance use disorder, which is a big number of that high. High, and this year to bigger number mind blowing than national economic impact of substance abuse a little bit different than substance use disorder but substance abuse is about seven hundred, forty, billion dollars annually. So that's almost in line with our national defense budget. But that's things work lost productivity. That's every dollar that is extended. If you will as a result of substance abuse sweeping up glass after you I rex everything. So and trump a couple of weeks ago declared this a public health emergency, a public emergency. We have a public health crisis opioid crisis, which is grabbing headlines Yes, but it's by far not the number one cost driver, nor is it the number one kind of killer in Dash Ud world if you will out well, let's set tobacco aside but alcohol far kills more people than opiates still to this day just doesn't do it in a headline grabbing away like a fictional overdose but to jump to question quickly, we managed people who have a sense use disorder diagnosis using peers, I mean people. Who are in successful recovery but what we do the truly interesting we tech enable them and we date enable them. So we put a lot of tech and other tools at their fingertips that help them identify people who are struggling, make better decisions and helping them ultimately, the whole game here is to improve outcomes for people, substance use disorder, and chip away at that seven hundred, forty billion dollars that were emerging as a nation.
Uncontrolled hypertension is getting worse in the U.S., study finds
"New study is showing an increasing number of people in the US are suffering from uncontrolled high blood pressure. Brian Shook has more research from Jama showed that out of 18,000 subjects who had high blood pressure in 2017 and 2018, the number of uncontrolled hypertension cases rose by 10%. Nicknamed the Silent Killer. High Blood Pressure has also been linked to be a danger to anyone infected with the Corona virus.
Dr. Leana Wen responds to Trump intentionally downplaying COVID-19
"Are now joined by Dr Lino, when Former Health Commissioner Baltimore and. Professor of Public Health at George Washington University Dr Wen welcome back to skulduggery. Happy. To join you always. So as a public health professional. What is your reaction to hearing the president saying he did not want to level with the American people about the severity of the corona virus because he didn't want to create panic. While I. The first thing that I thought about was my patients I think about now my patients who? Lost their lives I think about the patients I treated who survived but are living with long-term effects of covid nineteen will now have to be on dialysis who now president heart failure who have had strokes a nail cannot move a part of their body or cannot speak as a result. I think about all those individuals lost their loved ones. I also think about the physicians and nurses respiratory therapists and EMT's gotten infected because they didn't have enough people. In what it would have meant if they knew, and as they will know about how this all did not have to happen, and so it's just incredibly distressing and devastating to learn about all of this because frankly when you look at. What's been hampering our response the entire time it's the mixed messaging and part of. The commentary around us was well, maybe the mixed messaging is due to lack of knowledge or maybe it's due to incompetence. But as it turns out if this is deliberate and if it's there is a deliberate if there has been a deliberate effort to mislead the American people and the cost is people's lives. What does that really mean in just wanted to to respond to? Two. mikes question about specifically this issue of panic that president trump at the White House of what we didn't want to cause panic. We didn't want to have some kind of fear as as the as the response from the American people will actually the best. To fear is the truth. The best thing in the most important thing that the American people in any people want to known in time of crisis is the truth what is actually happening what do we know? What do we not know? What are we going to do to find this out? What are the actions of the federal government is going to be taking? What are things that each individual person can be doing right now and it is beyond shameful and so devastating that week, this could have been done but it was not yeah. I mean, you know these are this is what you do on a daily basis as a as a physician and a public health professional. It seems to me that if you tell people the truth if you tell them how to mitigate. You give them agency that is exactly how you calm people down. But I guess the bottom line question is, is there any doubt in your mind at all that by withholding information and not leveling with the American people that what? President trump did. Cost, significant numbers of American lives. Well, we have the research to illustrate this. We have modeling studies done here in the US that showed that if we acted even a week sooner, and this is back, we're talking about these at home orders and margin acted a week sooner we could have saved thirty, six, thousand lives. We have our own counterfactual in the form of other countries that took prompt that had a national response that had a coordinated messaging to the public, and we saw for example, the case of South Korean that had their first diagnosis of Cova nineteen. A first goes case of nineteen. The same day that we did that they have infections, deaths that are many many. Fold, less than ours. They have jets ranging in the hundreds versus we have them in the hundreds of thousands. We also know that at that time exactly as you said that we could have given the American people agency I mean I think about there's so many allergies to this right you could imagine if there were a hurricane or tornado that's coming. What you want to do is to tell people there is time there is time for us to take action this you can protect yourself and your family imagine if you find out that the government knew about this impending weather catastrophe didn't tell people visiting they didn't want to cause panic, but actually people died as a result of that. would be the outrage or imagine I always think in terms of clinical analogies. Imagine if a physician didn't want to cause a patient panic and fear but then withheld in important diagnosis bump that patience and by the time the patient found out it was too late and that she was going to die versus if they found out a few months sooner, their lives could have been saved I mean. Imagine that. That's the equivalent of what's happening here a doctor when I imagine you had a chance to listen to the tape conversation between Bob. Woodward and president trump what was going through your mind when you listen to that what part of that conversation shocked you the most. I think was shocked me the most was that president trump had a good understanding of the risks and dangers of virus from as early as February seventh. That he had a conversation with President Xi. Of China which is already another kind of bizarre moment because it seems like it was you know there's been a lot of blaming of China but seems like the Chinese president. Action alerted president trump to potential dangers but president trump was. Can't what these dangers are and was able to articulate how that this was something that's more dangerous of the flu that could affect young people to that it was airborne and therefore is extremely contagious that back in end of January, he was warned by his own team that this could be a once in a generation type of dangerous virus at a he understood it comprises it and could articulate back in. So I, think back to. all these press conferences that president trump has had since then where he deliberately it seems now downplayed the severity of the virus and that. Contrast is so jarring when I think about what could have been done in the meantime. That February seventh phone call with Woodward really leaped out me. Now, I do have to say that I do think it would have been really difficult to persuade the American public in February when the numbers were so low to take the kind of socially distance restrictions and lockdowns and all the other requirements that would have been necessarily would it would have been difficult to get the. American, public on board win. So few cases had been reported in the United States, but that said when you look at that February, seven phone call where trump is telling Woodward. This is more deadly than even your strenuous flew. This is deadly stuff which is precisely the opposite of what he was saying to the public five times more. He said five times more deadly didn't he? But I mean that and on that same day he's tweeting. To the world, I'm the you know the the corona virus would disappear. You know when the weather starts to warm and on March seventh saying no, I'm not concerned at all. It's not. It's that dichotomy of saying privately to Woodward. He thinks it's private because it's for a book that isn't GonNa come out for a while you know, hey, this is really deadly stuff while telling the public don't worry it's all going to go away. That's right now, I'll give you that same analogy for a weather atrophy. Imagine if the president or governor or some other leader knew about this impending catastrophe and is saying this acknowledging this in some private setting but not letting people know whose lives would be directly affected and for do something about it I mean this is. This is not a storm that's going to hit us no matter what we're all going to die I mean this is something that we could actually prevent by taking steps I do think that you make a good point about how difficult it would have been to get the American people on board early on when we didn't yet have diagnosed cases and no deaths in the US that's true but. For Two things one is that the federal government could have been taken that time to prepare and arguably had we gotten our testing capacity up the very beginning way now. South Korea and many other countries did. We probably. Have even needed these dramatic shutdowns. The way that we did eventually, we had to have these shells the point that we did because we had so much community spread and not nearly enough testing couldn't rate it in. If we had the testing, maybe we didn't need those shutdowns in the first place but the other thing too is because the president consistently downplayed the severity of the election, the American people were left wondering what do I do now? Who Do I listen to? Is this even so serious, I mean. We are seeing something as basic as masks as you both know it as we talked about being politicized, and so I think that is key to all this ad. We actually still have a chance to turn this around and I. Hope I'm not sure that this will happen but I do hope that the president. Takes this opportunity now and instead of defending his own past actions says it maybe this crazy wild dream that this could occur but I hope you'll say now. Dan. Here's where we are. This is extremely serious whatever happened to the past happened in the past but here's what we can do moving forward and let science and public health finally lead
Southern Hemisphere Influenza Cases Are 60-70% Below Their Norms
"A doctor at the Ohio University Wexner Medical Center says flu cases in the Southern Hemisphere are 60 to 70% below their norms. That could mean a relatively mild flu season in the US, however, health experts hope people don't skip getting the seasonal flu vexing due to covert 19 vaccinations for the season are
Tylenol may make you take more risks, study says
"Over the counter medication may do more than just ease pain, CBS News correspondent Jim Crow Sula explains. Taking Tylenol may do more than just provide some pain relief. A new study from the Ohio State University found that taking a set of men, if in may also cause a person to take greater risks than they would otherwise. It was part of research to see how popular pain relievers affect decision making its estimated 25% of the US population takes Sit a minute fin each week. Jim
Experimental drug boosts muscle and bone mass of mice in space
"Mice have returned to Earth with bodybuilder physiques, a research team sent 40 young female black mice to the international space station aboard a space X rocket. After a month long stay 24 regular untreated mice lost considerable muscle muscle and and bone bone mass mass as as expected expected up up to to 18%. 18%. But But the the A A genetically genetically engineered engineered mighty mighty mice mice that that had had double double the the muscle muscle maintained maintained their their bulk. bulk. The The treatment treatment involves involves blocking blocking appear of proteins that typically limit muscle mass. The findings could help develop therapies for astronauts before they had to space as well as people on Earth who are confined to a bed or need will chairs
India passes Brazil to become the second worst-hit country by the pandemic with more than 4.2 million cases
"India is now surpassing Brazil as Thie. Second worst Corona virus hit country with cases topping 4.2 million In contrast, New York State is showing progress with the rate of positive test staying below 1% for 30 straight days for more K C. B s news anchor Dan Mitchinson spoke with Dr Amesh Ayala, senior scholar, Johns Hopkins Center for Health Security Doctor. What's happened in India? What do you think is contributing to this case, Serge? You have to remember that social distancing is the way we keep cases from spreading and social distancing is a luxury in many parts of the world in a place that has a population of over a billion people where you have people that live in close quarters and multigenerational household where There's a lot of use of mass transit. It's just going to be very hard to keep a virus that spreads this efficiently from moving through your population. So to me, it's not surprising what's happening in India. I think it's uh this is going to be something that we see in the developing world. This is going to be very hard to control. Well. The prime minister did order all businesses shut down earlier this year, didn't he when this started, but I mean, it hit the economy so hard that they've had to start re opening a lot of these businesses. Again. Yes, you can't. You cannot completely shut down people's productivity and not have consequences. So it's not surprising that in places where they don't have a lot of accumulated wealth, But there's not a lot of saving that people cannot. Tolerate a stay at home order for that long of a period of time and what the goal really should be is not necessarily economic shutdown and stay at home orders but targeted public health intervention, testing, tracing and isolating You need to have health infrastructure to be able to do that. And it's clear that some countries do not have it. And even in countries that do like United states, we still can't really executed that. Well. Yeah, you can tell a billion 1.3 billion people to stay at home. How does the mortality rate they'll compare with the U. S. I think it's hard to know exactly what we don't have full, full data capture there. But one of the things that the mortality rate you have to look at it. What is the rate of death of individuals who were hospitalized there? It's going to be higher than in the United States in terms of if you if you're treated their how effective are the treatment? How much access to critical care do you have? And we know that there are places in the world that don't have the same. Adeptness medical care as his other parts, so you will probably see higher rates of death for those who get hospitalized. However, the total population that was a little bit more complicated because that will affect that will be impacted by the age of the population of morbid conditions of the population. But I do suspect we will see the deaths rise. Teo Teo high levels in the developing world because of the lack of access to health care, and the fact that this is going to go through their populations in away unabated by any kind of social distance.
Getting More For Our Healthcare Dollar with Jill Yegian
"Welcome back to the outcomes rocket saw Marquez here and the privilege of hosting Jill the again she launched Gigi and help insights in two thousand eighteen providing consulting services to clients and healthcare and philanthropy. Dr Yan has held leadership positions in a variety of health care organizations in each she has focused on applying expertise in health policy payment and delivery to problems and opportunities most recently she served as vice president for public policy and strategic initiatives at Brown and Toland physicians. A large independent practice association in the San Francisco Bay area her background and PhD is in health services and policy analysis from. The University of California Berkeley and prior to the work that she's done she also served thirteen years with the California Healthcare Foundation where she worked to improve the California's financing and delivery system for healthcare, which is what we're going to be talking about today. We're GONNA BE TALKING ABOUT ACCESS WE'RE GONNA be talking about rising costs and things that we could be doing and thinking about US healthcare leaders and making it better. So with that, I want to go ahead and open up the microphone to jail and really give you a warm welcome and thanks for joining us so glad you're here Jill You saw it's great to be here. I really enjoy listening to your podcast and I'm really happy to be a part of it. Oh. Awesome. So glad you're here and and so you know one of the things that I love asking and I'm curious about is what inspires you. With your work in healthcare. So so from my perspective, it really what gets me up in the morning is collaboration to improve outcomes and increased value. I just feel like there's so much opportunity to make the system work better for patients for practitioners for those who are paying the bill and for taxpayers to, and that could be in terms of higher quality. More access lower costs more equitable, a better a patient or even provider experience lots of different aspects of improvement that are possible in our current system. You know, I've always been really interested in systems and interdisciplinary approaches to solving problems both undergraduate and graduate degrees are interdisciplinary bringing together economics political science and sociology ought to inform US systems perspective in. So now I have an opportunity to work. At the intersection of delivery finance and in policy and I think that's really important because changing policy may not result in the change on the ground. For example, changing expanding health insurance coverage won't create access to care if there aren't enough providers in a rural community or if reimbursement is is too low. So it's really important to think about a systems perspective that brings together different aspects to solve problems. Yeah I really think that's a great approach in a great way to think about this is you're right. You know if they increase access, there might not be enough people in the delivery aspect but then there's the financial piece that I think a lot of people are are concerned about in this country a lot of employers a lot of the even policymakers right where the concerned about it We'll touch on this folks. So don't worry about I'm curious from from your end Jill. What's the thing that's held you back in the past that you've conquered. That's a great question. So I would say that. It's really most recent related to starting again health insights. I've been an employee for most of my life and the transition to having my own company really required taking some risks So there's a lot less security and predictability. It's not always clear. What next year is going to bring and sometimes even next month earlier in my career I would say I probably wasn't as comfortable with that level of of uncertainty and I also didn't have the same level of confidence in my abilities and and I feel like all that is really come together at this point where I have a breadth of knowledge and experience I have confidence I'm comfortable with the uncertainty. And the variety in this world is fabulous being able to work with a whole array of clients on a whole array of issues and and make contributions in an array of different areas. No. That's A. that's a really great thing to share Joel I. Mean I know a lot of people listening today have had that. Challenge or are currently experiencing a and and so what is it? That got you to to make the move? It was an array of different circumstances that really lead to things falling into place. So I'm at a point in my career where I really have a pretty long checklists for what would really make me very excited about getting out of bed, and so the ability to make contribution is really a significant part of that and on the combination of flexibility autonomy variety and mission was best when in in the with creating my own company. So that's the path that I've taken and and I have really enjoyed.
Advancing Life Quality with Objective Research and Action with Jenna LeComte - Hinely
"Welcome back to the PODCAST. Privilege of hosting Dr on account timely she's the CEO of Hark Inc. Heart stands for health assessment and research for communities. She obtained her PhD at Portland State University in the field of applied psychology with an expertise in occupational health psychology, and she strives to keep workers happy healthy and productive. The idea of data and evaluation is something that we all tend to cringe when we hear. But today we're going to dive into why it's actually good and how it. Could really appropriately help the health of communities when we think about the topics of a social determinants of health and how he each WanNa Tackle B.'s whether you be a provider organization a Public Health Organization or just an entrepreneur trying to add value to the ecosystem. Today's conversations really gonNA dive into how we can take a look at data on evaluations as a positive thing Dr Lee count timely has served on the board of many nonprofits including John Senior Center. Health and HIV aging research project among others her passion for. The healthcare ecosystem and giving I really inspiring and I think you'll enjoy today's conversation. So Jenna privilege to have you with us today. Thank you for having me. So what are I missing your intro that maybe you want to share with the listeners? Pretty, comprehensive. So Hark is a nonprofit in addition to sort of serving on their boards of nonprofits. They also route one and that I think that they kadhamy that seeing it from both sides has been really important. So we're really a nonprofit that there's other nonprofits and other health and Human Services Agencies, which is a very rewarding thing to do love that. Now that's key. So what is it? That got you interested in in healthcare ecosystem to begin with? Well, I'd say we are more focused on health not health care health care is only a small piece of your overall health. The county health rankings models shows that clinical care only counts for about twenty percent of ultimate health. Outcomes the length of your life and the quality of your life. The rest is all about those social and economic factors, the physical environment, your health behaviors. So I typically think of myself as in the health sector, not the healthcare because it's so much broader, but it's a good distinction. Yeah. Yeah and I got into through research I started doing research when I was nineteen and I, just loved it. It's so fun to find the systematic way to find answers to your questions, but I always wanted to do meaningful research. So not which candy flavored do you like best but research that actually helps people. So I started off studying doing research in gender discrimination and from. There I got into occupational health psychology. So that's the how to keep workers happy healthy and productive. So that's what I studied in Grad School and my thesis and my dissertation were both on the topic of work life balance and its impact on your physical and mental health, and so after that, I was looking for a job and I found the job director of research at initially I was director of research for about three years and I became CEO about four years ago, and it was really exciting to me like I could not have crafted a better job because it's so fun to do. We have so many different clients and to do research one day on. A fall prevention programs for seniors and the next day on a literacy program for kids. It's so diverse that we really get this wonderful full circle picture of what is health and our community I love that and I could hear the passion in your voice when you when you talk about the different topics and I'm glad that at the beginning of our discussion and you prefaced it with, Hey, you know health health is big thing. It's not just the point of care that we're so used to focusing on and so as you've conducted the work that you do what's been an inside or an outcome that you've helped your your customers achieve that's different. Hard is really Where data geeks all of us and we're really designed to be that sort of outsourced, the many small nonprofits want to be evidence based, but they can't afford to have a researcher on staff fulltime. So that's where we come in to customize on. So that's how we have the this diversity of clients and honestly I'm not doing anything that changes lives. My clients are using the data that we give them to change lives, which is magical and so happy to be a part of. that. Is Sort of a negative connotation but I, it's it's accurate. In a positive way. Yeah. Yeah. So one of the things we do actually what was launched for us, we do this huge community health survey of the Coachella Valley in Southern, California and we provide that data back to the community at no charge so he can use it and I think what's most Encouraging and exciting is how some people have used it to change lives, and one of my favorite examples is desert. AIDS project is a federally Qualified Health Center, an FQHC here in the desert, and this really illustrates that we do this survey, every three years, and the first time. There was no questions about HIV and delegates projects. Said I think we need to. Add One. So at the next survey, we added a question whether an adult had ever been tested for HIV just ever in your entire life and we found out that almost seventy percent of adults in our region had never been tested for HIV, and they didn't know their status and that's terrifying given that we have an HIV prevalence that's twice the national average. So based on that. Desert AIDS project launched get tested Catella Valley, which was this three year public health campaign. It was five million dollars there was so many partners working together to get everybody tested, and for those who tested positive connecting them to care. So they had US do some research on wire people getting tested and wires some others not, and one of the things that we found was super important. We talked to you providers we talked to people who had been tested for HIV and said. Why did you get tested and one of the top to answer was my doctor offered it we talked people who'd never been tested and said, why haven't you been tested and one of the top two answers was my doctor never offered it so it became clear that physician input is really important to a really large component of the campaign focused on provider education rather than patient education I mean, it's always great if your patients are activated engaged in asking for an HIV test. But it's most important that the provider themselves is they're offering HIV test.
Nurses on New York's front lines call for minimum staffing ratios
"The front lines of New York's covert 19 pandemic are calling for the state to enact minimum staffing standards ahead of another wave of infections. Healthcare industry leaders warned that passing such a law would saddle facilities with billions of dollars in extra costs they can't afford. Under legislation now before a legislative committee the state would set minimum nurse to patient ratio is for the first time, including a standard of one nurse for every two patients.
Dr. Rachel Dolan Discusses The Antipsychotic Drug Epidemic
"Welcome to the healthcare policy podcast on the host David Intra. Kosovo. With me today Dr Rachel Dolan the US House of Representatives ways and Means Committee majority staffer to discuss the majority staffs recently released report titled Under enforced and over prescribed. ANTIPSYCHOTIC drug epidemic ravaging America's nursing homes. Dr Dole and welcome to the program. I David thanks so much for having me. Please call me Rachel. While this'll be the last time Dr Dolan's bio is posted on, of course, the podcast website. In testimony before the House Energy and Commerce Committee two, thousand seven, the FDA's Dr David Graham stated quote. Unquote. Fifteen thousand adults elderly people in nursing homes are dying each year from the off label use of antipsychotic medications. For an indication that the FDA knows the drug doesn't work the problem has been only FDA for years and years close quote. Legal the FDA does provide a black box warning label. Regarding off label use of these drugs, eleven years later, Human Rights Watch published a report titled They Want Docile. How. Nursing homes in the US overmedicated people with dementia. The report found in two thousand, sixteen, seventeen quote unquote massive use or abuse of Anti Psychotics, for example, Sarah. Quel. Doll and Rispler doll that have serious side effects including sudden cardiac death. The human rights report estimated in an average week over one hundred, seventy, nine, thousand, long-stay Nursing Home Facility patients who administered antipsychotic drugs. Without a diagnosis which the drugs are indicated or approved rover, polar disorder and schizophrenia in testimony the ways and means. Committee. Heard this past November Richard Mollet Executive Director of the Long Term Care Community coalition concluded quote the use of San Anti psychotics in skilled nursing facilities is so extensive that puts the US in violation of internal conventions and covenants on torture and cruel inhumane and degrading treatment or punishment. Close quote. This is my third related interview. In December twenty twelve I discussed the topic with Diana Zuckerman. And in February, eighteen high interviewed Hannah Lamb who authored the above mentioned human rights report. With me again to discuss the ways and means report just released titled Under enforced and over prescribed is Rachel Dolan the reports lead author. So that Rachel as background let's get right into this or immediate neatly into the specifics of the report. What did the report find regarding the extent to which? They're persists overuse or misuse of anti psychotics in skilled nursing. David. So the report showed what what you what we would expect from your introduction, which is the use of antipsychotic does persist in nursing homes across the country and it remains quite high and not of course, has implications for patient safety and and health We found in the fourth quarter of Twenty nineteen approximately twenty percent of all skilled nursing facility residents in the US. So that's about two, hundred, Ninety, eight, thousand, six, hundred, fifty people every week received some form of antipsychotic medication and most of that was without any psychosis diagnosis for which these drugs are indicated So specifically, we actually looked at trends and surveyor citations for unnecessary medication use in nursing home. So that's kind of the. Part of this study and what we found was a clear change in citation rates for these facilities between the change in administrations from the Obama Administration to trump administration So we found citations for antipsychotic misuse in sniffs increased by two hundred percent between twenty, fifteen, twenty seventeen but then declined by twenty two percent from two thousand, seventeen to twenty eighteen, and importantly a ten percent of citations associated with actual harm or immediate jeopardy to a residence health or safety. So those are some of the most severe citation surveyors ever capture resulted in no fine from twenty seventeen to twenty eighteen under the trump administration. So you know. I. Would say even though this study in particular couldn't determine causation we we did see a clear association between the Trump Administration's regulatory rollback campaign twenty, seventeen, twenty eighteen and a reduction in citations for these particular drugs. Okay thank you and we'll get into the trump administration's regulatory decisions in this regard in a minute let me just ask as a follow up or an aside question and I don't think I saw this new report. So you may not have these numbers top of mind but worth asking, can you give an approximation of the cost? To the Medicare program at least relative to the overuse I, mean, this is a massive amount of money in reimbursement for these medications. I don't remember offhand. Let's see I think in the in the actually in the report we got About one third of older adult Medicare part d enrolling with dementia who spent more than one hundred days in a nursing humber prescribed antipsychotic in two, thousand, twelve constituting roughly three, hundred, sixty, three, million part D plan payments that year and of course, there's also cost associated with hospitalizations for inappropriate use of these drugs So I would expect you know that that that is obviously very under an understatement understated estimate that does not capture the full realm of payments. So it's it's fairly substantial.
Stomping out Diabetic Foot Ulcers at Podimetrics
"Exciting to be here thrilled to get a chance to talk about the real pains and struggles the unglamorous parts of startups and. Just. Throw the be here today. Terrific terrific. Now, one thing that was a little bit interesting to do hopefully, listeners do as well is here a little bit about your back story or CEO's backstories how they got into Med tact. Their path to their venture in this case, Pota- metrics and Just learn a little bit about you was your path kind of almost predestined medicine and science was more secure this How did entrepreneurship fit into that? Tell us a little bit about your background. It's definitely not. Linear it's been a very. Interesting path to get to where I am today but grew up in in southern California. Used to do. I was going to be a musician. I was a fairly dreadful percussionist in various punk bands and you know I thought that was GONNA be Kinda my deal for while I went to Undergrad at at San Diego State University coming out of high school is Maybe C. Student something like that and I spent eight years. Undergrad is there for quite a bit you're really trying to figure out like, why am I here what am I WANNA do? It was Kinda on the hunt for something I didn't really know what it was. And I just never run out of the year, your four or five as I'm just GonNa just coasting along I end up meeting this this pre med student and. It was such an amazing I ended up your city. Just talking to this guy, he he had every everything was so well planned meticulously and he was talking about, you know why he was doing it and it instantly resonated with me I I'd been at this point thing I was a chemistry major with emphasis in biochemistry. But the idea that you could use those to you know make another person feel better. It's very practical use of everything that I had been learning and it was crazy. It instantly clicked holy smokes like this could be an amazing thing I just knew somebody with my sis stellar academic career going up until this point wasn't going to be an easy part. I'm I'm proclaims the Pre Med office and you know they're looking at my record like. John. There's other there's other pathways you could do. and. Out of it and there's also do schools but you know that may be a challenge and I was just like, okay. This is what I wanna do this is it. Around the same time I. Remember. I worked basically fulltime all of Undergrad and was on the phone this when these amazing people got to know her her husband was a cardiothoracic surgeon and she introduced me to him and then he he invited me to follow him in the or for doing this for a while and it was just you're at the same time there's something magical about you know for him his. CARDIAC, surgeon. So this is he was a patient who is you know so worried and scared and you're able to be with them in in in in fix it impact his life. So it was just this. Moment or it wasn't like I always wanted to be a doctor but yet it makes so much sense when I heard it and I ended up going to fortunately I. my academic record had a rocking mcat scores and was able to go to. The talk school at least that I had on my list, which was University of Pittsburgh is a very social school interesting where I remember somebody's told me the elevator at at the medical campus and the doors shut. If no one's talking, that's not the place for you to go and I just remember I was doing this elevator tests and people just wanted to chat about whatever it was. It was a really interesting place to be in there. That was really the first time we're technology started. Sort of come into my life I remember. A few of US students set at all levels of the school you know in their first year second year CETERA. We found each other for our love of tackling. We decided to create this this Tech Club where who's GonNa talk about technology and Madison and what was out there. And we're going of quickly realized that the schools tech infrastructure was terrible. This would have been two thousand and two thousand. One maybe something like that and Each each office medical education, and soon affairs they all had different websites none of them talk to each other as a very disjointed experience and we thought wouldn't it be cool to try to rebuild this for the students in getting sanctioned as a committee and that was really one of the I.