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11/06/2019

Upcoming 2019 Lancet "Countdown" Report (November 6th)

Listeners may be aware I've conducted over ten interviews regarding the climate crisis, see most recently my August 28th interview with Professor Philip Alston, UN Special Rapporteur on Human Rights, regarding his report, "Climate Change and Poverty."   

The 2019 Lancet Countdown Report that tracks the effect the climate crisis has on public health will be released November 18th.   (For those living in Washington, D.C., there will be an event that morning at the Senate Russell Building.)   I hope to conduct a related interview soon after the report is released.  For information on the Countdown report go to: http://www.lancetcountdown.org/.   

Listeners may recall I interviewed Dr. Jeremy Hess last December 13th regarding the 2018 Countdown report. 

See, also, the just released "Viewpoint" appearing in BioScience titled, "World Scientists' Warning of a Climate Emergency," at: https://academic.oup.com/bioscience/advance-article/doi/10.1093/biosci/biz088/5610806.   The essay is signed by more than 11,000 scientists and states in part, "The climate crisis has arrived and is accelerating faster than most scientists expected.  It is more severe than anticipated, threatening natural ecosystems and the fate of humanity."   The Guardian's November 5th write-up is at: https://www.theguardian.com/environment/2019/nov/05/climate-crisis-11000-scientists-warn-of-untold-suffering

 

11/04/2019

Three Upcoming Podcast Interviews

November 13th: Dr. Kate Goodrich, CMS Chief Medical Officer and Director of the agency's Center for Clinical Standards and Quality (CCSQ) will discuss CMS' Medicare quality measurement programming including the agency's recent proposal to create MIPS (Merit-based Incentive Payment System) Value Pathways (MVPs) program.  

November 15th: Mr. Chris Palmieri, President and Chief Executive Officer of the (Massachusetts) Commonwealth Care Alliance (CCA), will discuss the Alliance's efforts to care for 32,00 low income, disabled and elderly patients, in part, via its Mobile Integrated Health pilot program.  See: http://www.commonwealthcarealliance.org/

November 20th: Capt. Valerie Jensen, Director, Drug Shortage Staff, FDA, will discuss the agency's October 29th report, "Drug Shortages: Root Causes and Potential Solutions."   At: https://www.fda.gov/media/131130/download.  

Dr. Azra Raza Discusses Her Recently Published Book, "The First Cell and the Human Costs of Pursing Cancer to the Last" (November 1st)

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Dr. Azra Raza's recently published book, The First Cell and the Human Costs of Pursing Cancer to the Last, has been described as a "searing account of how both medicine and our society (mis)treat cancer, how we can do better, and why we must."  It has been termed "a clarion call . . . [that] repudiates the approach . . . that biomedical science has taken to attempt to find new treatments and curers."  The lack of progress in treating cancer is "an embarrassment" and "equally embarrassing is the arrogant denial of that embarrassment."  We spend over $150 billion annually on treating cancer and a patient diagnosed today is as likely to die from the diagnosis as a patient diagnosed 50 years ago.   

During this 35 minute conversation Dr Raza begins by discussing what causes cancer (we do not know or know completely).  She moreover discusses the urgent need for a new cancer research paradigm, i.e., the current use of tissue culture cell lines and mouse models have proven to be inadequate.  She also argues cancer researchers need to spend less time chasing the last cancer cell and instead ID the first cancer cell, i.e., we should place greater emphasis on early detection.  She explains her criticisms of the pharmaceutical industry and the federal government funding in researching effective cancer treatments.  Dr Raza also explains her relationship with her patients, her belief treating oncologists need to develop empathic relationships with their patients and she notes her view regarding palliative sedation. 

Dr. Raza is the Chan Soon-Shiong Professor of Medicine and Director of the MDS Center at Columbia University in New York.  She started her research in Myelodisplastic Syndromes (MDS) in 1982 and moved to Rush University, Chicago, Illinois in 1992, where she was the Charles Arthur Weaver Professor in Oncology and Director, Division of Myeloid Diseases.  The MDS ArazaProgram, along with a Tissue Repository containing more than 50,000 samples from MDS and acute leukemia patients was successfully relocated to the University of Massachusetts in 2004 and to Columbia University in 2010.  Before moving to New York, Dr. Raza was the Chief of Hematology Oncology and the Gladys Smith Martin Professor of Oncology at the University of Massachussetts in Worcester.  She has published the results of her research and clinical trials in numerous, peer reviewed journals such as The New England Journal of Medicine, Nature, Blood, Cancer, Cancer Research, British Journal of Hematology, Leukemia, and Leukemia Research. Dr. Raza serves on numerous national and international panels as a reviewer, consultant and adviser and is the recipient of a numerous of awards including the First Lifetime Achievement Award from APPNA, Award in Academic Excellence twice (2007 and 2010) from Dogana and The Hope Award in Cancer Research. 

For more on The First Cell go to: https://www.basicbooks.com/titles/azra-raza/the-first-cell/9781541699526/

Dr Raza's related 2006 3 Quarks Daily post, "Rx: Reductionist Vs.. Pluralist Views of Cancer," is at: https://www.3quarksdaily.com/3quarksdaily/2006/01/rx.html.

Per my mention of Thomas Kuhn's seminal, The Structure of Scientific Revolutions, the Wiki overview is at: https://en.wikipedia.org/wiki/The_Structure_of_Scientific_Revolutions

11/01/2019

Dr. Rick Doblin Discusses the Potential/Real Therapeutic Benefits of Psychedelic Agents (October 31st)

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Psychedelic agents or drugs, for example Lysergic Acid Diethylamide or LSD (a cereal fungus and first synthesized in 1938), were widely researched for their therapeutic potential through the 1950s.   Among other noted users of these agents was the actor, Cary Grant.  However, when these drugs escaped the research lab in the 1960s, moral panic set in.  America's youth would, it was feared, "turn on, tune in and drop out" (a phrase popularized the Berkeley/Harvard psychologist Timothy Leary) and social upheaval would ensue.  By 1970 LSD, psilocybin and other psychedelic agents were banned for both research and recreational use purposes.  Beginning in the 1990s the FDA began giving limited approval to conduct psychedelic-related efficacy studies.  Two decades later it appears the US has now, finally, turned the corner on researching the potential wide spread therapeutic benefits of psychedelics.  This was again made evident last month when by Johns Hopkins announced opening its Center for Psychedelic and Consciousness Research.  This announcement was preceded in April by the Imperial College in London announcing the opening of its Centre for Psychedelic Research.  

During this 26 minute interview, Dr. Doblin begins by describing what effect these agents have on the brain or what parts of the brain are stimulated to what effect.  He discusses moreover his organization's MDMA (methylenedioxy-methamphetamine) research, currently a Phase 3 trial to study the effects on patients suffering from PTSD (oddly not supported by the DoD or VA), and a wide range of other current research efforts concerning treating, among other diagnoses, addiction, depression, eating disorders, phobias, OCD, schizophrenia and terminal illnesses.  He also weighs in on the future legal status of these drugs, again currently illegal or banned as Schedule I controlled substances. 

Rick Doblin, Ph.D., is the founder and executive director of the Multidisciplinary Association for Psychedelic Studies (MAPS).  He received his doctorate in Public Policy from Rick_doblinHarvard's Kennedy School of Government, where he wrote his dissertation on the regulation of the medical uses of psychedelics and marijuana and his Master's thesis on a survey of oncologists about smoked marijuana vs. the oral THC pill in nausea control for cancer patients.  His undergraduate thesis at New College of Florida was a 25-year follow-up to the classic Good Friday Experiment, which evaluated the potential of psychedelic drugs to catalyze religious experiences.  He also conducted a thirty-four year follow-up study to Timothy Leary's Concord Prison Experiment.  Rick studied with Dr. Stanislav Grof and was among the first to be certified as a Holotropic Breathwork practitioner.  His professional goal is to help develop legal contexts for the beneficial uses of psychedelics and marijuana, primarily as prescription medicines but also for personal growth for otherwise healthy people, and eventually to become a legally licensed psychedelic therapist.  He founded MAPS in 1986.

For information on MAPS go to: https://maps.org/.

Information on Michael Pollen's 2018 work noted during this discussion, How to Change Your Mind,What the New Science of Psychedelics Teaches Us About Consciousness, Dying Addiction, Depression and Transcendence, go to: https://www.penguinrandomhouse.com/books/529343/how-to-change-your-mind-by-michael-pollan/.

For a recent personal account of a psychedelic experience, see, for example, Helen Joyce, "My Adventures in Psychedelia," at: https://www.3quarksdaily.com/3quarksdaily/2019/10/my-adventures-in-psychedelia.html.  

10/28/2019

Essay: We Should Scrap Medicare Site Neutrality (October 23rd)

Last week The Hill published my essay/editorial, "We Should Scrap Medicare Site Neutrality."  At: https://thehill.com/opinion/healthcare/467169-we-should-scrap-medicare-site-neutrality.  For those who study Medicare payment policy, the essay explains site neutral payments have become viewed as sine qua non, or essential or indispensable policy.  The problem is, as I argue, the policy, among other things, is based on little supportive research evidence and MedPAC's argument constitutes circular reasoning, or where the proposition and premise support one another.  Here, HOPD volume increased because of additional physicians and additional physicians increased HOPD volume. 

10/25/2019

NHCHC's Bobby Watts and Barbara DePietro Discuss Health Care for the Homeless (October 24th)

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Though difficult to accurately calculate for obvious reasons, the Department of Housing and Urban Development's (HUD's) 2018 point-in-time survey identified over 550,000 individuals living in emergency shelters, transitional housing or were unsheltered.  One-third were families, a disproportionate number were African American and/or veterans and a growing number were victims of wildfires or a severe climate event (think: Hurricane Florence or Michael).  The homelessness problem is worsening for numerous reasons including growing income inequality and the lack of livable wages, failed federal policy, an insufficient stock of affordable housing, the criminalization of poverty and health care that leaves nearly 30 million non-elderly uncovered and/or is ill equipped to diagnose and treat a homeless population that bears a heavy disease burden that includes psychotic and affective disorders.  

During this 30 minute conversation Mr. Watts and Dr. DePietro begin by briefly explaining how NHCHC is organized and its mission.  They discuss moreover upstream or systemic causes of homelessness, the inadequacy of affordable housing and the failure of related federal policy, the criminalization of homelessness and its effects,  the prevalence and largely unmet physical and behavioral health care needs, associated health care costs and what some health care institutions are doing to recognize the necessity of combining medical care with social service supports including housing. 

Mr. G. Robert (Bobby) Watts is the CEO of the National Health Care for the Homeless Council.  Mr.Watts has more than 25 years of experience in administration, direct service, and implementation of homeless health services. He began his work with people experiencing homelessness as a live-in staff member of the New York City Rescue Mission in Manhattan.   Previously Watts-photo-200x200he served as the ED of New York City’s Care for the Homeless where he significantly expanded the organizations FQHC and constructed a women’s shelter.   Mr. Watts is also the former Finance Officer of the New York City HIV Health and Human Services Planning Council.   He has served on the Steering Committee of the New York City Medicaid Managed Care Task Force and a member of the New York State Interagency Council on Homelessness and numerous other related committees, task forces and work groups.  He earned his undergraduate degree at Cornell University, his a MPH and Master's of Science in epidemiology from Columbia University and holds a Certificate of Theological Studies from Alliance Theological Seminary in Nyack,

Barbara DiPietro, Ph.D.,  directs the policy and advocacy activities for the National Health Care for the Homeless Council. Barbara-3-200x173This includes conducting policy analysis, providing educational materials and presentations to a broad range of policymakers and other stakeholders, coordinating the Council’s policy priorities with national partners, and organizing staff assistance to the Policy Committee and the National Consumer Advisory Board.   Previously, she worked for the State of Maryland in the Governor’s Office as well as the Department of Health.  Dr. DePietro holds a Master’s Degree in Policy Sciences and a Doctorate in Public Policy, both from the University of Maryland, Baltimore County.  Her dissertation research focused on the impact of homelessness on emergency departments in Baltimore City. 

For information on NHCHC go to: https://nhchc.org/  

Per my mention of the 2018 UN report on poverty in the US, i.e., "Statement on Visit to the USA, by Professor Philip Alston, United Nations Special Rapporteur on Extreme Poverty and Human Rights" go to: https://www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?NewsID=22533&LangID=E

Per my mention of Amazon's opposition last year to a Seattle tax that would have helped the homeless, see: https://www.nytimes.com/2018/06/12/technology/seattle-tax-amazon.html

09/24/2019

Catalyst for Payment Reform's Suzanne Delbanco Discusses State Health Care Innovation (September 23rd)

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Largely with the exception of the 2010 passage of the ACA, federal legislative (and regulatory) efforts to reform health care over the past few decades has lagged.   This is the result of an increasingly dysfunctional Congress.  For example, Congressional productivity, measured by the number of enacted laws, has decreased every decade since 1990 by over 20 percent.  For this reason and because states are required to balance their annual budgets (with the exception of Vermont and possibly North Dakota and Wyoming as well), health care policy innovation has shifted substantially to the states.  For example, the 2019 legislative session resulted in 29 states passing Medicaid-related legislation, 13 states passing health insurance legislation and 10 states passing health care assignment and billing legislation. 

During this 24 minute conversation, Dr. Delbanco begins by briefly explaining the Catalyst for Payment Reform's mission and members.  She moreover discusses state policy reforms related to data (i.e., All Payer Claims Databases) and price transparency, efforts to improve state market competition, delivery and payment reforms, for example, reference pricing or benchmarking to Medicare reimbursement and she identifies states that are particularly noteworthy in their efforts to improve care delivery and lower spending growth.

Dr. Suzanne F. Delbanco is the Executive Director of Catalyst for Payment Reform (CPR), an independent, non-profit corporation working to catalyze employers, public purchasers Delbanco-headshot-200x200and others to implement strategies that produce higher-value health care and improve the functioning of the health care marketplace.  In addition to her duties at CPR, Suzanne serves on the advisory board of the Blue Cross Blue Shield Institute.  Previously, Suzanne was the founding CEO of The Leapfrog Group.  Suzanne holds a Ph.D. in Public Policy from the Goldman School of Public Policy and a M.P.H. from the School of Public Health at the University of California, Berkeley. 

For information on CPR go to: https://www.catalyze.org/

Dr. Delbanco (and colleagues') recently published article, "The State of State Legislation Addressing Health Care Costs and Quality," is at: https://www.healthaffairs.org/do/10.1377/hblog20190820.483741/full/.

Per Dr. Delbanco's reference to The Source, U. of CA Hastings College of Law's recently posted online database of state laws impacting health care cost and quality, go to: https://sourceonhealthcare.org/legislation/

09/13/2019

Harvard's Michael Chernew Discusses the Administration's Hospital Price Transparency Efforts (September 12th)

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In CMS' proposed hospital outpatient rule published in the Federal Register in early August, the agency proposed requiring hospitals to make public a list of its negotiated rates for common items and services.   The proposed rule is based on two White House executive orders and is an expansion of a related regulatory rule that went into effect this past January 1st that requires hospitals to make publicly available a list of current standard hospital charges (on their so called chargemaster list).  Despite the administration's enthusiasm for price transparency (and state's - approximately half have passed price transparency legislation) the evidence to date demonstrates that price transparency has not led to or enabled patients to lower their out of pocket costs, lower health care prices, improve market competition creating greater care value.   

During this 24 minute conversation Professor Michael Chernew begins by discussing related anti-trust enforcement.  He moreover discusses his research findings concerning price transparency, alternative practices providers have or can exhibit that have demonstrated success in lowering patient out of pocket spending and potential unintended negative consequences, e.g., hospitals may demonstrate less willingness to make price concessions for fear of having to extent them to all payers, should CMS' rule go final as proposed in November. 

Professor Michael Chernew is the Leonard D. Schaeffer Professor of Health Care Policy and the director of the Healthcare Markets and Regulation (HMR) Lab in the Department of ChernewHealth Care Policy at Harvard Medical School.  Professor Chernew is a member of the Congressional Budget Office’s Panel of Health Advisors and of the Institute of Medicine’s Committee on National Statistics (CNSTAT).  He is also a research associate at the National Bureau of Economic Research.  In 2011, he served on the Institute of Medicine’s Committee on Determination of Essential Health Benefits and in 2010 was elected to the Institute of Medicine of the National Academy of Sciences.  Prof. Chernew is the former Vice Chair of the Medicare Payment Advisory Commission (MedPAC).  In April 2015, Massachusetts Governor Charlie Baker appointed Professor Chernew to the Massachusetts Health Connector Board of Directors.  Dr. Chernew is currently a co-editor of the American Journal of Managed Care and editor of the Journal of Health Economics.  He is a former senior associate editor of Health Services Research.  Professor Chernew earned his undergraduate degree from the University of Pennsylvania and his PhD in economics from Stanford University.

 
The White House's related, "Reforming America's Health System" paper is at: https://www.hhs.gov/sites/default/files/Reforming-Americas-Healthcare-System-Through-Choice-and-Competition.pdf
 
CMS' current proposed rule discussing expanding hospital price transparency regulations is at: https://www.govinfo.gov/content/pkg/FR-2019-08-09/pdf/2019-16107.pdf . See pages 39571, ff. 

The summary of Prof. Chernew, et al. April 2018 New England Journal of Medicine price transparency research article noted during this podcast is at: https://newsatjama.jama.com/2019/08/22/jama-forum-price-transparency-in-health-care-has-been-disappointing-but-it-doesnt-have-to-be/ 

09/01/2019

Dr. Lewis Cohen Discusses His Just-Published Book, "A Dignified Ending, Taking Control Over How We Die" (August 29th)

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Medical aid in dying is now legal in nine states and the District of Columbia or is available to approximately one-fifth of the US population.  State medical societies allow physicians to provide treatment that comports with their conscience, survey data shows the practice enjoys substantial public support and the option is available in numerous foreign countries including the Netherlands where it is available to children with their parents' consent.  Nevertheless, the practice remains controversial.  Listeners may be aware I've discussed end of life care during several previous podcasts dating back to June 2013 when I discussed advanced care directives with the American Bar Association's Charlie Sabatino.  

During this 35 minute discussion, Dr. Cohen begins our discussion by explaining how suicide became defined as a mental illness and life insurance coverage in instances where aid in dying has been exploited.  the problems associated with medical aid in dying for patients with disabilities and those suffering with Alzheimer's or related cognitive impairments and whether aid in dying should be restricted to the terminally ill.  He discusses several case histories including the aid in dying deaths of Admiral Chester J. and Joan Nimitz, Jack Kevorkian's work and efforts by the Hemlock Society, Caring Friends and the Final Exit Network.  

Dr. Lewis Cohen is a Professor of Psychiatry at the University of Massachusetts-Baystate School of Medicine, and an Adjunct Professor of Psychiatry at the Tufts University School of Cohen-lewis-1679597439
Medicine.  He is the recipient of a Guggenheim Fellowship for Medicine and Health, two Rockefeller Foundation Bellagio Residency awards, and a Bogliasco Fellowship for the Arts and Humanity, as well as the Eleanor and Thomas Hackett Award from the Academy of Consultation-Liaison Psychiatry.  He is the author or co-editor of several previously published books, including No Good Deed.  Dr. Cohen earned his MD at the State University of New York Upstate Medical University and is board certified by the American Board of Psychiatry and Neurology.

For more information on A Dignified Ending go to: https://rowman.com/ISBN/9781538115749/A-Dignified-Ending-Taking-Control-Over-How-We-Die.

For information on Compassion and Choices and Final Exit Network (successor organizations to the Hemlock Society) go to: https://compassionandchoices.org/ and http://www.finalexitnetwork.org/.

 

08/29/2019

Philip Alston, the United Nations' Special Rapporteur on Extreme Poverty and Human Rights, Discusses His Recent Report, "Climate Change and Poverty" (August 28th)

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In late June, Professor Philip Alston, the UN's Special Rapporteur on Extreme Poverty and Human Rights, published "Climate Change and Poverty."  The 20-page report is unsparing in its criticism of the response, or lack thereof, by corporations, governments, NGOs and the human rights community to the climate crisis, moreover their response concerning the effect the crisis will have on the poor - whom will disproportionately bear the burden of climate emergency.   "Government, and too many in the human rights community," he wrote, "have failed to seriously address climate change for decades."  "Most human rights bodies have barely begun," he stated, "to grapple with what climate change portends for human rights."  "There is no recognition of the need for seep social and economic transformation."  As a result, "Climate change threatens to undo the last 50 years of progress in development, global health and poverty reduction."  Professor Alston concludes his report by writing, "The human rights community, with a few notable exceptions, has been every bit as complacent as most governments in the face of the ultimate challenge to mankind represented by climate change. The steps taken by most United Nations human rights bodies have been patently inadequate and premised on forms of incremental managerialism and proceduralism which are entirely disproportionate to the urgency and magnitude of the threat.  Ticking boxes will not save humanity or the planet from impending disaster."  (This discussion is my 10th concerning the climate crisis over the past 2 plus years.)  

During this 27 minute conversation Professor Alston describes the role of the Special Rapporteur on Extreme Poverty and Human Rights, discusses the genesis of his report and provides an overview of its findings.  He comments what he terms the "patently inadequate" response to date by the human rights community including the UN's Human Rights Council, in response to the climate crisis.  He also discusses how the growing climate crisis refugee crisis is being addressed, as an international criminal law professor his view regarding prosecuting corporations and their CEOs for having devastated the environment, the Juliana and related court cases seeking climate justice, and the upcoming UM climate summit this September 23rd.   

Philip Alston has served as the United Nations' Special Rapporteur on Extreme Poverty and Human Rights since 2014.  In forwarding his work he has reported on Chile, China, Mauritania, Romania, Saudi Arabia and the US.  He was previously UN Special Rapporteur on extrajudicial, summary, or arbitrary executions from 2004 to 2010.  He was a Download
member of the Group of Experts on Darfur appointed in 2007 and served as special adviser to the UN High Commissioner for Human Rights on the Millennium Development Goals.  He has also served as UNICEF's legal adviser.  In the field of international law, Professor Alston was editor-in-chief of the European Journal of International Law from 1996 through 2007.  He was a co-founder of both the European Society of International Law and the Australian and New Zealand Society of International Law.  As a UN, he worked in Geneva on human rights issues from 1978 to 1984.  He has worked as a consultant to the ILO, the UNDP Human Development Report, the Office of the UN High Commissioner for Human Rights, UNESCO, OECD, UNICEF, and many other inter-governmental and non-governmental organizations.  Professor Alston is also presently the John Norton Pomeroy Professor of Law at New York University's Law School where his teaching focus is on international law, human rights law, and international criminal law.  He also co-chairs the NYU Center for Human Rights and Global Justice.  During the 1980s Professor Alston taught at the Fletcher School of Law and Diplomacy and at Harvard Law School.  Afterward, he became Professor of Law and Foundation Director of the Center for International and Public Law at the Australian National University, a post he held until 1995.  From 1996 to 2001 he was Professor of International Law at the European University Institute (EUI) in Florence, Italy, where he was also head of department and co-director of the Academy of European Law.  Professor Alston received degrees in law and in economics in Australia and a JSD from Berkeley.  

Professor Alston's report is at: https://chrgj.org/wp-content/uploads/2019/06/UNSR-Poverty-Climate-Change-A_HRC_41_39.pdf.

In May 2018 Professor Alston published a related report on extreme poverty in the US, it is at: “Report of the Special Rapporteur On Extreme Poverty and Human Rights on His Mission to the United States."  My summary of this report is at: https://thehealthcareblog.com/blog/2018/08/22/the-uns-extreme-poverty-report-further-evidence-us-healthcare-is-divorced-from-reality/.