Despite its many scientific and therapeutic advances, the field of psychiatry remains lacking in coherence or cohesiveness as compared to other areas of medicine. Part of the issue undoubtedly has to do with the intractable mind-body problem, but part of it may also be due to the effort of standardization of diagnosis set in motion by the Diagnostic and Statistical Manual. Is there a way to move forward?
Our guest is optimistic. Paul McHugh, MD, is one of the most important figures in academic psychiatry of the last 30 years. He is University Distinguished Professor of Psychiatry at Johns Hopkins University School of Medicine where he was department chairman from 1975 until 2001. He is the author or co-author of several academic books and texts of psychiatry.
Mention the phrase “industry-sponsored clinical trial” and many eyes will immediately roll back. But is the reaction justified? Are academic leaders who participate in phase 3 trials simply figureheads hired to rubber-stamp protocols designed by Pharma and spin the results in a positive way?
Our guest on this show has strong opinions on this question. Dr. Milton Packer is an internationally recognized clinician, teacher, and scientist in the field of heart failure research. He has served as Chief of Cardiology at Columbia University in New York City and, subsequently, as Chair of the Department of Clinical Science at the Southwestern Medical School in Dallas. He is currently the Distinguished Scholar in Cardiovascular Science at Baylor University Medical Center.
Dr. Packer has received many teaching awards, mentored dozens of young clinical investigators, completed innumerable successful research projects, and served as a leader in many professional organizations. He is now also well known and admired for his regular column on MedPage Today, “Revolution and Revelation,” in which he mixes wisdom and polemics to the delight of his many readers.
A massive push to increase the number of nurse practitioners and physician assistants and to extend their scope of practice is under way. The stated goal is to address a real or perceived shortage of primary care physicians. This effort worries many doctors who are concerned that patients are getting short-changed in the process. But is this concern justified or is it simply motivated by protectionist interests?
Our guest is Dr. Rebekah Bernard, a successful family physician from Fort Myers, Florida. She is board member of Physicians for Patient Protection, an organization calling for more transparency regarding the difference in training between physicians and non-physician providers, and advocating for legislative action to avoid misrepresentation of the capabilities and knowledge-base of nurse practitioners.
Effective pharmacological treatment for opioid dependence was introduced more than 15 years ago, yet the opioid epidemic continues to ravage our country and there are still important barriers that prevent patients from receiving the care that they need. The expansion of health insurance does not seem to mitigate this problem and, in fact, health insurance may be a hindrance for proper care.
What if the solution is to simply let doctors help patients directly and personally? Our guest today gives us an extraordinary testimony of what can be accomplished when physicians are free to care for patients privately, without the stigma associated with addiction and rehabilitation clinics.
Dr. Molly Rutherford graduated from Eastern Virginia Medical School in 2003 and completed a Family Medicine Residency in Portsmouth, Virginia in 2006. She and her family moved to Kentucky after residency so that she could practice rural medicine. In 2008, she obtained her DATA 2000 waiver to treat opioid dependence with buprenorphine and she became Board Certified in Addiction Medicine in 2012.
After a series of frustrations with employment and the dysfunctional health care system, she started her practice with the goal of providing comprehensive, individualized care to her patients at an affordable price, without the interference of 3rd-party payers. Dr. Rutherford is past President of the Kentucky Chapter of ASAM and current President of the Kentucky Academy of Family Physicians. Dr. Rutherford is also a member of the US Health and Human Services Pain Management Best Practices Inter-agency Task Force. She lives with her husband, a homicide detective with Louisville Metro Police Department and their 2 sons in La Grange, KY.
The lure of physician employment seems irresistible and, on the surface, the arguments to justify it are also compelling. But are physicians selling themselves short? Are they really better off if they become employees of the hospital? Do they become more efficient? Are they putting themselves in ethical quandaries? And what is the way forward when the forces at play seem so overwhelming?
Our guest is Dr. Arvind Cavale, an entrepreneurial endocrinologist form Pennsylvania who is bucking the trend with great success, showing that small private practice can remain nimble, adopt technology, and deliver high quality care efficiently. He shares with us his experience and tips for political advocacy.
Bright clinicians who are also trained as rigorous scientists can put healthcare policy under scrutiny and show that the wisdom of the wonks frequently falls short. Our guest on this episode is Dr. Rishi Wadhera, a prolific cardiology fellow currently in training at Brigham and Women’s Hospital in Boston and part of a team of health policy investigators at the Smith Center for Outcomes Research in Cardiology. Dr. Wadhera obtained his medical degree from the Mayo Clinic, a Master’s in Public Health from the University of Cambridge, and a Master’s in Public Policy from the Harvard Kennedy School of Government. He joins us to discuss 2 of his most recent papers which have made a big splash in the media.
Will it take data vigilantes to restore some order in the House of Science? With the replication crisis showing no sign of letting up, some committed scientists have taken it upon themselves to find ways to sniff out cases of egregious fraud. As it turns out, identifying scientific misbehavior is surprisingly easy!
Our guest is a full-time research scientist, author/consultant at Northeastern University in Boston in a Computational Behavioral Science lab. James Heathers completed his undergraduate work in Psychology and Industrial relations from the University of Sydney and obtained his doctorate degree on the topic of methodological improvements in heart rate variability at the same institution in 2015.
He and a couple of his colleagues have captured the limelight after exposing problems in the work of a world-famous nutrition researcher, which led to the retraction of 5 papers. These “data thugs” have since designed a couple of tools that can identify suspicious data through a simple analysis of descriptive statistics.
There was a time when communities took care of the medical needs of their members without the intervention of governments and without the corrupting influence of health insurance. Can we ever go back to a system of mutual aid at a time when healthcare costs have grown astronomical?
Our guest today shows us that the idea of cost sharing is not only viable but is a lived reality for thousands of families across the United States. Dale Bellis began his work in healthcare in 1988 as an administrator with the first cost-sharing ministry ever begun in modern times. He was instrumental in passing legislation in 11 states exempting cost sharing ministries from insurance regulations. He also introduced technology and administrative techniques to streamline person to person cost-sharing. In 2012, he founded Liberty Healthshare, which provides an opportunity to live free from insurance and government-mandated healthcare to a large and growing number of American families that share fundamental values and a strong belief in personal responsibility.
In the mind of the public, American physicians are represented by one prominent organization, namely, the American Medical Association. Yet, only a minority of American physicians currently belong to the AMA, which has long grown comfortable with political and government intrusions into healthcare.
Who should represent physicians when doctors may hold very divergent views on matters of politics, economics, ethics, and even science? Should there be one voice or a plurality of voices? Our guest today is the executive director of the Association of American Physicians and Surgeons (AAPS), an organization that sprung up in the 1940s as an alternative to the AMA and to staunchly defend private medicine free of government interference or coercion.
Dr. Jane Orient obtained her medical degree from Columbia University and is in a solo internal medicine practice in Tucson, AZ. She is a prolific writer, having penned hundreds of op-eds in national and local media outlets. She is the author of numerous books, notably Your Doctor is Not In: Healthy Skepticism About National Health Care and Sutton’s Law, a novel about where the money is in medicine. She is also the editor of the famous textbook Sapira’s Art and Science of Bedside Diagnosis, now in its 4th edition.
Radiology holds a special place in the medical ecosystem. Radiologists are “the doctors’ doctors” and the treatment of a patient rarely proceeds without a radiologist furnishing an opinion. But the field of radiology also faces challenges: the crusade against “wasted imaging,” the rise of artificial intelligence, the dependence of radiology on hospital systems, and the de facto barrier that separates radiologists from patients.
What does the future hold for radiology and what could one wish for it? Returning to the show is Dr. Saurabh Jha, Associate Professor of Radiology at University of Pennsylvania Perelman School of Medicine. He shares his perspective with his characteristic wit and humor.