We tackle issues that matter to doctors

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

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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.

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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

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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.

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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

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Ep. 44 Economic vs. Political Means to Healthcare: A Conversation with Jeff Deist

Jeff Deist

Economic knowledge should not be the sole province of technical experts, but it is—and we seem to accept the way it is.  The price we pay for this ignorance is that most people—including doctors—can easily fall prey to the political class and to the technocrats whose economic theory is generally far from sound.

Our guest on the show is Jeff Deist, President the Mises Institute, an educational institution that promotes a very noble tradition of economic theory and political thought.  Prior to taking the helm of the Mises Institute, Mr. Deist was chief of staff to Congressman Ron Paul for many years and, in that capacity, gained special insights into healthcare “sausage-making” in Washington DC. Read more

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Ep. 43 Doctors and Guns: Where Is the Lane?

Pradheep Shanker, MD

Should doctors have something to say about guns?  If so, what should they say?  A position paper by the American College of Physicians, followed by a blog post and a tweet from the National Rifle Association, have set off a storm of controversy on the issue of medical professionals speaking publicly about guns and gun control.

Our guest today is Pradheep Shanker, a radiologist based in Ohio and a prolific writer and conservative commentator who contributes regularly to a number of major national media outlets, including National Review, The American Spectator, Ricochet, and others.  He just published a piece entitled “Guns, Doctors, and Staying in Your Lane.”

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Ep. 42 The Tyranny of Metrics: A Historian Weighs In

Jerry Z. Muller

Bureaucratic appeal to measurement as a check on personal judgment rules the medical field but also permeates our entire culture.  Our guest is the author of a new book that comprehensively treats this unique phenomenon of modern life and brings a valuable historical perspective to the subject.

Jerry Z. Muller is Professor of History at Catholic University of America in Washington DC, where he served as Chairman of the department from 2009 to 2015.  Professor Muller’s focus is on Modern European Intellectual History and History of Capitalism.  His book, The Tyranny of Metrics, was published earlier this year by Princeton University Press. Read more

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Ep. 41 Healthcare Policy in the Crosshairs: The Hospital Readmissions Reduction Program

Ankur Gupta, MD

The Hospital Readmission Reduction Program is a recent policy designed to save the government money by imposing large financial penalties on hospitals whose readmission rates for certain medical conditions are found to be higher than the national average.  Could pushing policy levers on such a grand scale conceivably have negative unintended consequences?…

Our guest is Dr. Ankur Gupta, author of a 2017 JAMA article that examined mortality rates in heart failure in the aftermath of the HRRP development and implementation.  Dr. Gupta is an interventional cardiology fellow at University of Texas Southwestern Medical Center in Dallas.  He holds and MD from the All India Institute of Medical Sciences (New Delhi) and an interdisciplinary PhD in statistics and computational fluid dynamics from the University of Alabama.

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Ep. 40 Practicing Medicine in Canada: Promises and Realities

Shawn Whatley, MD

What’s the professional life of Canadian doctors really like?  Does the safety and stability of a single-payer system free them from business concerns and allow them to concentrate on patient care?  Or do the realities of central planning produce unexpected uncertainty and stress for patients and doctors alike?

To help us gain a realistic understanding of the Canadian system, we have as our guest Dr. Shawn Whatley who currently runs a primary care practice in Ontario, Canada.  Prior to this position, Dr. Whatley worked for many years as an emergency physician and he is the author of No More Lethal Waits: 10 Steps to Transform Canada’s Emergency Departments.

Dr. Whatley is past-president of the Ontario Medical Association and he is a senior fellow at the MacDonald-Laurier Institute for Public Policy in Toronto.  He also publishes a highly trafficked blog where he shares insightful and humorous comments about healthcare in Ontario.  In other words, he is the perfect guest to inform us about the realities of healthcare in Canada.

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