We tackle issues that matter to doctors

Posts by Michel Accad

Ep. 50 Thieves of Virtue: How Bioethics Stole Medicine

Tom Koch, PhD

Did bioethics emerge to defend the interests of patients or to rationalize the needs and actions of the state and its corporate allies?  Are bioethicists too complacent about their grasp of economics?  Do they have sufficient understanding of the complexities of medical decisions to weigh in on them? Are Hippocratic ethics so inadequate that they needed to be replaced by ever-morphing “Kantian” ethics?  A fascinating discussion with our guest, Tom Koch, a man whose resumé and whose many books read like great adventure stories.

Professor Koch is an author, journalist, historian, philosopher, and educator. He holds an inter-disciplinary PhD in medical cartography, ethics and medicine  He has taught medical ethics to medical students at the University of Toronto.  He is a consultant in gerontology.  And he has written numerous books both for an academic audience as well as for the general public.  His books include Cartographies of Disease, Ethics in Everyday Places, The Wreck of the William Brown, and the volume that will be the focus of our discussion today, Thieves of Virtue: When Bioethics Stole Medicine.

Read more

Leave a comment

Ep. 49 Why Are We Insuring Primary Care? Lee Gross on the DPC Movement

Lee Gross, MD

“We’re not going to ask permission to take care of our patients.”  It is with this epiphany, that our guest on this episode became one of the pioneers and leaders of the most hopeful trend in health care today: the direct primary care or DPC movement.

Dr. Gross shares with us how the light bulb went off in his mind that there is no good reason to insure primary care and, in fact, that insuring primary care hurts everybody: patients, doctors, and society.  He walks us through his success stories and the efforts he is leading at the state and federal level to remove regulatory barriers to direct care.

Dr. Gross is the founder of Epiphany Health in North Port, FL, and is regularly consulted by lawmakers at the local, state, and national level.  He has offered testimony on behalf of the direct care movement for the US Health and Human Services Department, the US Congress, and for the White House.  He also serves as president of the Docs 4 Patient Care Foundation and he is the recipient of the 2016 HCA Frist’s Humanitarian Award and of the Beacon Award from the Free Market Medical Association for his leadership in healthcare reform. Read more

6 Comments

When Scientists Know The Answer Ahead of the Experiment

On the day that we taped our podcast episode with Brian Nosek about the replication crisis, the renowned statistician Andrew Gelman published an essay in the New York Times on precisely that topic. Gelman echoes some of the remarks made by Nosek.  In particular, he draws attention to the point we discussed regarding what to believe when…

Read Full Post

Ep. 48 Many Statisticians, Many Answers: The Methodological Factor in the Replication Crisis

Brian Nosek, PhD

In 550 BC, the Greek philosopher Heraclitus famously declared: “No man ever steps in the same river twice, for it’s not the same river and he’s not the same man.”  In this episode, we learn from our guest whether scientists can step into the same data pool and obtain the same research results twice.

Brian Nosek is Professor of Psychology at the University of Virginia.  He is also the co-founder and Executive Director of the Center for Open Science, an organization dedicated to fostering transparency and collaboration in scientific research.

In 2015, Professor Nosek and his team published in the journal Science a widely acclaimed and widely discussed paper that shed light on the extent to which psychological research findings may not be reproducible when the research is conducted anew.

More recently, his Center conducted a unique project where a single data set was sent to be analyzed by about 30 independent teams of statisticians for the purpose of answering a single question.  The variability in the methods chosen and in the answers obtained was also perhaps sobering, if not perplexing.

Read more

4 Comments

Ep. 47 Drug Dosing: One Size Does Not Fit All

David C. Norris, MD

Patients come in all sizes and shapes, and with varying tolerance for complications and risk.  Is it plausible that a single dosing regimen can optimize treatment for everybody?  If not, what is keeping the pharmaceutical industry from endorsing a more dynamic and patient-centered drug dosing regimen?

Our guest is Dr. David Norris, a physician, mathematician, and inventor.  David operates a scientific and statistical consultancy focused on methodology development for ‎precision-medicine applications. He developed Dose Titration Algorithm Tuning (DTAT), a methodological framework that conceives dose individualization as a seamless learning process, beginning in early-phase trials and continuing throughout the drug development process.  Before earning his M.D. at Brown University, he worked in diverse application areas including mathematical finance, operations research and systems engineering. Read more

Leave a comment

The Case Against Shared Decision-Making

To conclude this 3-part series, I will discuss the relationship between shared decision-making (SDM) and evidence-based medicine (EBM), as the two are intimately connected. As I indicated in part 1, SDM did not attract the attention of academics until the late 1990s.  It is only then that publications on SDM began to appear routinely in the…

Read Full Post

Ep. 46 Reforming Medical Education: Beyond the Usual Platitudes

Adam Cifu, MD

The reform of medical education is a usually boring conversation that needs its own reform.  The discussion we have on this episode does just that.  It goes far beyond the usual proposals to tweak the curriculum and directly addresses the question of what it means to be a physician.

Our guest is Dr. Adam Cifu, an award-winning medical educator and author.  Dr. Cifu is a Master in the Academy of Distinguished Medical Educators at The University of Chicago.  He has been selected as a Favorite Faculty Member by the graduating class of students 14 times.  He is the author of Symptom to Diagnosis a manual on diagnostic reasoning, and co-author with Dr. Vinay Prasad of Ending Medical Reversal: Improving Outcomes, Saving Lives, one of the blockbuster medical books of the last few years.

Read more

5 Comments

When Scientists Discover New Body Parts

Soon after publishing our second podcast episode on brain death, this article from Newsweek came into my Twitter feed: “Endorestiform Nucleus: Scientist Just Discovered a New Part of the Human Brain.” According to the article, an Australian researcher may have discovered an island of neurons heretofore undescribed and which may be involved in important motor…

Read Full Post

Ep. 45 Brain Death at the Bedside

Fred Rincon, MD

We revisit the question of brain death, this time with a more practical focus.  What should doctors tell families of patients who fulfill neurological criteria for brain death?  Joining us on this program is Fred Rincon, MD, who is a Assistant Professor of Neurology at Jefferson University Medical Center in Philadelphia.  Dr. Rincon is a neuro-intensivist who, on a day-to-day basis, cares for patients with severe brain injury.  He also holds a Master’s in Bioethics from the University of Pennsylvania. Read more

4 Comments