Is the body a machine? Are doctors mere technicians who simply “fix” biological defects in their patients? In a very real sense, that’s how modern societies conceive of medical practice, so much so that healthcare is now frequently experienced as an industrial process: doctors and nurses churning patients through an assembly line. And that process is taking a huge economic, physical, and mental toll on everyone.
The mechanical model on which modern medicine is based has obviously brought technological wonders to the practice of medicine—and it should be celebrated for these extraordinary achievements. But have we become so wedded to the machine metaphor that we ignore more fundamental aspects of human reality? Can another way of conceiving of health and life be brought to bear on the practice of medicine positively, without discarding the achievements of the scientific age?
Our guest is Dr. Victoria Sweet, author of the best-sellers God’s Hotel and Slow Medicine, two of the most important books on medicine in recent times. Those books were inspired by Dr. Sweet’s rediscovery of the medical texts of Hildegard of Bingen, a 12th-century mystic and nun whose practical approach to medicine may well contain the very principles that can help cure 21st-century health care from its seemingly irremediable predicament.
Quality ratings of hospitals and physicians: help or hindrance? Surely, the general public demands and is entitled to an assessment of hospital quality based on sound methodology. And ratings coming from the private sector are far more likely to be unbiased and to adjust to an ever changing healthcare landscape than those coming from the government and public policy sector. But is there a downside to scrutinizing the healthcare enterprise?
We have a fascinating conversation with one of the most knowledgeable persons on the topic. Ben Harder is Chief of Health Analysis and US News and World Report and oversees the team of analysts and statisticians who produce the most recognized ranking of hospitals in the country. Ben holds a Bachelor of Science in Biological Anthropology from Harvard University and began his career in health and science journalism before taking the job of quality czar at US News and World Report and
Two distinguished guests join us to debate the issue of vaccine mandates.
Dorit Reiss is Professor of Law at UC Hastings College of the Law in San Francisco, California. She holds an undergraduate degree in Law and Political Science from the Faculty of Law at Hebrew University in Jerusalem and a PhD in Jurisprudence and Social Policy from the University of California, Berkeley. She is a legal authority on the question of vaccines and vaccine mandates. She has published numerous articles on this topic in a variety of law review journals and her expertise is recognized around the world.
Jonathan Howard is Assistant Professor in the Departments of Neurology and Psychiatry at New York University Langone. He is Director of the Neurology Service at Bellevue Hospital and Director of Clerkship Director for the Clinical Neurological Sciences at NYU.
Dorit and Jonathan have co-authored a book chapter entitled “The Anti-Vaccine Movement: A Litany of Fallacy and Errors,” in Pseudoscience: A Conspiracy Against Science.
If ‘health’ is an elusive concept, how much harder it must be to articulate what a healthy community should be. But that should not stop us from grappling with foundational ideas and from sketching a forward-looking vision for a better society. Our guest on this episode is Pritpal Tamber, a physician who has devoted his career to understanding better what it means to live in a healthy community.
Dr Tamber is the former Physician Editor of TEDMED, TED’s dedicated health event, a former editor at the British Medical Journal, and the former Medical Director of Map of Medicine, a company that tried to improve the flow of patients through health care on the basis of clinical evidence. Through his work with TEDMED, and informed by his insights into clinical evidence and system change, Dr Tamber is convinced that the glamorous, tech-led world of health innovation is unlikely to have much impact on the patients with the worst health—those lower down the socioeconomic gradient.
Since 2013, he has spent time with numerous community projects, principally in the US and the UK but also in The Netherlands, New Zealand and Mexico, to explore and understand the realities of the work. Through his work he has described 12 recurring principles that offer a practice-based structure for how the health sector can work with communities. Collectively, these principles describe an inclusive and participatory process, effectively illustrating that people are sick because they have little influence over their lives. Social epidemiologists have called this ‘having a sense of control’, and it is something that requires agency—the ability to make purposeful choices.
Does the vaccine debate have to be polarized according to “Pro-Vaxx” or “Anti-Vaxx” camps? Is it possible to have a reasonable discussion about harms and benefits of vaccines? Are public health concerns about unvaccinated children sufficient to trump individual liberty?
Exploring the question with us is Dr. Niran Al-Aqba, a board-certified pediatrician in private practice in Washington State, an area hit by the recent outbreak of measles. Dr. Al-Aqba is a prolific writer who speaks widely and openly on a variety of issues, including policy, ethics, and medical practice. She is a regular contributor to the Kitsap Sun, to The Deductible blog, and to a variety of other outlets, including her own blog, MommyDoc. She is a mother of four children who’s been voted best doctor in Kitsap County on multiple occasions. She also serves on the clinical staff and admission committee at the University of Washington School of Medicine.
Is there a conservative path to universal healthcare? Our guest certainly believes so. Avik Roy is one of the most influential conservative voices in healthcare. A graduate from MIT and Yale Medical School, Avik spent many years with the investment firm Bain Capital. In 2009, in response to the debates leading up to Obamacare, Avik started a blog to share his insights. Those were soon noticed by the media and the policy world, and he quickly became the go-to policy wonk on healthcare among conservatives.
In 2012, Roy joined the campaign of Mitt Romney as policy adviser and later went on to advise Texas Governor Rick Perry as well as Senator Marco Rubio. In 2016, he founded FREOPP, the Foundation for Research on Equal Opportunity, a conservative public policy think tank based in Austin, Texas. He continues to edit his blog, The Apothecary, now hosted by Forbes where he serves as Senior Opinion editor.
Should a pass-fail exam designed to determine a student’s competence to practice medicine be scored numerically and used for residency selection? Every year, thousands of students sink an increasingly large number of hours and dollars to prepare for “Step 1” of the US Medical Licensing Examination, a task which seems to be disproportionate to the relevance the test bears to the practice of medicine.
Our guest on this show is Bryan Carmody, MD, a pediatric nephrologist who practices at the Children’s Hospital of the King’s Daughter in Norfolk, VA, and teaches medical students at the Eastern Virginia Medical School. Bryan himself has recently spent countless hours studying and blogging about the machinations that constitute licensing examination in the United States.
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.