Ep. 146 Diagnosing Brain Death: Clinical and Legal Quagmire
Our guests are Doyen Nguyen, OP, MD, STD and D. Alan Shewmon, MD. They join us to discuss troubling development on the legal treatment of brain death.
Dr. Nguyen was previously an academic hematopathologist and is currently a Catholic moral theologian and bioethicist. She has authored books and articles both in medicine and in moral theology/bioethics and authored a 600-page monograph that takes a critical look at brain death from a variety of perspectives.
Dr. Shewmon is Professor Emeritus of Pediatric Neurology at UCLA. His work, comprising decades of well-documented clinical observations and reflections, is now known as “Shewmon’s challenge,” a compelling rebuke to the principal arguments put forth to defend the concept of brain death.
LINKS:
- Shewmon DA. “Chronic “brain death”: Meta-analysis and conceptual consequences.” (in Neurology, 1998)
- Lewis A, et al. “Determination of Death by Neurologic Criteria in the United States: The Case for Revising the Uniform Determination of Death Act” (in J. of Law, Medicine, and Ethics, 2019)
- President’s Commission for the Study of Ethical Problems in Medicine, Biomedical and Behaviora Research. “Defining Death” (1981)
- Nguyen D. The New Definition of Death for Organ Donation: A Multidisciplinary Analysis from the Perspective of Christian Ethics. (2018, Amazon link)
- Nguyen, D. “Does the Uniform Determination of Death Act Need to Be Revised?” (2020, Linacre)
RELATED EPISODES:
Ep. 35 Why Brain Death Isn’t Death: An Introduction to “Shewmon’s Challenge” (with guest Alan Shewmon, MD)
Ep. 45 Brain Death at the Bedside (with guest Fred Rincon, MD)
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Ep. 145 Damian Carabello on Surprise Billing: Through the Looking Glass
Dr. Damian Carabello discusses the depths insurance companies go to make sure they end up on top.
GUEST:
Damian Carabello, MD: Twitter
LINKS:
- Anish Koka long read on surprise billing
- Damian Carabello “Let’s end surprise billing without a Trojan horse” blog on KevinMD about the problems with benchmarking.
- Twitter thread on the history of Ingenix
- Andy Slavitt’s involvement with health insurance fraud case
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Ep. 144 John Mandrola: Why Doctoring and Politics Shouldn’t Mix
Dr. John Mandrola returns to the show to discuss why doctoring and politics shouldn’t mix and how he got into hot water on Twitter for holding that unacceptable view.
Dr. Mandrola is an electrophysiologist in Louisville, Kentucky. He is is cardiology editor on Medscape where he writes a regular column and produces a weekly podcast.
GUEST:
John Mandrola, MD: Twitter and Website
LINKS:
- John Mandrola: “Doctoring and Activism“
- Sally Satel: “The Hypocritical Oath“
- Mandrola et al: The Case for Being a Medical Conservative (in the American Journal of Medicine)
PREVIOUS GUEST APPEARANCES:
Ep. 12 John Mandrola: The Case for “Less-Is-More”
Ep. 107 Independent Nurse Practitioners: Public Health Threat or Libertarian Step Forward?
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Ep. 143 Adam Mortara on Litigating Affirmative Action
Our guest is Adam Mortara, lead trial counsel in the case of Students for Fair Admissions v. Harvard University. We discuss the legal aspects of affirmative action in light of the paper by Dr. Norman Wang which set off a storm of controversy in academic medicine.
GUEST:
Adam Mortara, JD: Professional page
LINK:
Norman Wang’s paper: Diversity, Inclusion, and Equity: Evolution of Race and Ethnicity Considerations for the Cardiology Workforce in the United States of America from 1969 to 2019.
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Ep. 142 Robert Yeh on Harnessing Real World Evidence
Our guest is Robert Yeh, Associate Professor of Medicine at Harvard Medical School and Director of the Smith Center for Outcomes Research in Cardiology at the Beth Israel Deaconess Medical Center in Boston. We discuss the challenges of outcomes research and his excellent work to improve the reliability of observational studies
GUEST:
Robert W. Yeh, MD: Twitter and professional web page
LINKS:
- Strom JB, et al. Use of Administrative Claims Data to Assess Outcomes and Treatment Effects in Randomized Trials of Transcatheter Aortic Valve Replacement (in Circulation)
- Faridi KM, et al. Use of Administrative Claims Data to Estimate Treatment Effects for 30 days versus 12 months of Dual Antiplatelet Therapy After Percutaneous Coronary Intervention (in Circulation)
- Konstam M. Real World Data as trial End Points: Off and Running with a Long Way to Go (editorial in Circulation)
PREVIOUS GUEST APPEARANCE:
Ep. 19 Public Reporting: Necessary Evil or Harmful Fake News?
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Ep. 141 Amy Wax on Wokeness in Medicine
Our guest is Amy Wax, Robert Mundheim Professor of Law at the University of Pennsylvania Law School. Before attending law school she obtained her undergraduate degree from Yale University in biophysics and biochemistry, graduating summa cum laude. She then attended Harvard Medical School and trained as a neurologist at New York Hospital – Cornell Medical Center before completing her law degree at Columbia University. She is the author of Race, Wrongs, and Remedies: Group Justice in the 21st Century. In 2017, she was the target of academic backlash after co-authoring an opinion piece in the Philadelphia Inquirer on the societal benefits of “bourgeois values.”
GUEST:
Amy Wax: Faculty page and Wikipedia entry
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Ep. 140 Gabriela Gomes: Why Herd Immunity May Be at Hand
Our guest is Gabriela Gomes, Professor of Mathematics at the University of Strathclyde. She specializes in population dynamics and the modeling of herd immunity and her recent work suggests COVID-19 herd immunity may be at hand. We discuss how herd immunity thresholds are estimated and why she thinks classic models are flawed and must incorporate a measure of variation in individual susceptibility.
GUEST:
Gabriela Gomes, PhD: Twitter and Website
LINKS:
- Gomes et al. (May 2020 paper): Individual variation in susceptibility or exposure to SARS-CoV-2 lowers the herd immunity threshold in MedRxiv
- Aguas et al. (July 2020 paper): Herd immunity thresholds for SARS-CoV-2 estimated from unfolding epidemics in Medrxiv
- Britton et al. A mathematical model reveals the influence of population heterogeneity on herd immunity to SARS-CoV-2 in Science (Open Access)
- Kevin Hartnett. The Tricky Math of COVID-19 Herd Immunity in Quanta Magazine
- Fine et al. “Herd Immunity”: A Rough Guide in Clinical Infectious Disease (Open Access)
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Ep. 139 Diversity in Cardiology, with Martha Gulati
A recent article authored by Dr. Norman Wang on the history and current state of affirmative action programs in medical schools and cardiology departments has led to a storm of controversy and to Dr. Wang’s demotion as fellowship program director. To discuss that article and the controversies we are joined by Dr. Martha Gulati, division Chief of Cardiology at the University of Arizona. She is also the best-selling author of Saving Women’s Hearts and editor-in-chief of ACC’s CardioSmart.
LINKS:
The now retracted Wang paper: https://www.ahajournals.org/doi/pdf/10.1161/JAHA.120.015959
Journal of the AHA comment on retraction: https://www.ahajournals.org/doi/10.1161/JAHA.119.014592
Regents of Univ. of California v. Bakke, SCOTUS decision: https://supreme.justia.com/cases/federal/us/438/265/
GUEST:
Martha Gulati: Twitter and Website
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Ep. 138 How Health Care Intermediaries Profit
GUESTS:
Marion Mass is a pediatrician in the Philadelphia area where she has practiced in hospital, Emergency Room, delivery room, outpatient, and urgent care settings. She graduated from Duke University Medical School and trained in Pediatrics at Northwestern Memorial Hospital in Chicago. She has been writing about life inside medicine, published in the WSJ, Washington Times, and the Philly Inquirer. She is also co-founder of Practicing Physicians for America, a physician lead organization that advances the interests of practicing physicians. She has written extensively on the role of third party intermediaries in medicine.
Dr. Rupali Chadha is a Board Certified Psychiatric Physician who diagnoses and treats mental illness. She is also Board Certified Psychiatric Physician in the specialty area of forensics. She serves the LA Superior Courts in identifying inmates who are incompetent to stand trial and has also served as a forensic expert in criminal trials. She recently traveled to Washington DC to visit the White House and witness signing of a recent Presidential Executive Order on intermediaries in healthcare.
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LINKS:E
White House Executive Order: https://www.whitehouse.gov/presidential-actions/executive-order-lowering-prices-patients-eliminating-kickbacks-middlemen/
Overview of third parties that suck up most of the health-care dollars: https://www.medpagetoday.com/publichealthpolicy/healthpolicy/84795
The rebates that may fuel higher drug prices: https://www.washingtontimes.com/news/2019/feb/10/a-bipartisan-opportunity-to-cut-drug-prices/
John Arnold in statnews discusses the role of Pharmacy benefit managers (PBM): https://www.statnews.com/2018/08/27/pharmacy-benefit-managers-good-or-bad/
A detailed look at Group Purchasing Organizations and PBMs: https://practicingphysician.org/scrubs-vs-suits-the-battle-inside-the-nations-hospitals-part-2/
Needle stick story referenced in the podcast: https://nebula.wsimg.com/9e87fe4c7de204baccc77a2bc373daf1?AccessKeyId=62BC662C928C06F7384C&disposition=0&alloworigin=1
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Accad/Koka on Lockdowns
Anish Koka and Michel Accad discuss lockdowns in light of the experience of the last few months.
GUESTS:
Anish Koka, MD: Twitter
Michel Accad, MD: Twitter
LINK:
Michel Accad: It’s Not About Trade-Offs
YOUTUBE:
Watch the episode on our YouTube channel