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09/30/2019

Five Upcoming Podcasts

October 24th: Mr. Bobby Watts, CEO of the National Health Care for the Homeless Council (NHCHC) will discuss the innumerable health care and social issues homeless Americans face and his organization's efforts to address these.  See: https://nhchc.org/

October 30th: Dr. Rick Doblin, Founder and Executive Director of the Multidisciplinary Association for Psychedelic Studies (MAPS), will discuss his organization's medical research and educational-related efforts regarding the therapeutic/clinical uses of psychedelics and marijuana.  Listeners may be aware Johns Hopkins recently announced it will create a Center for Psychedelic and Consciousness Research to study compounds like LSD and psilocybin for a range of mental health problems including depression and addiction.  Re: MAPS, see: https://maps.org/ and regarding Hopkins, see: https://hub.jhu.edu/2019/09/04/hopkins-launches-psychedelic-center/.

October 31st: Dr. Azra Raza, Professor of Medicine and Director of the MDS Center at Columbia University, is the author the the recently published work, The First Cell and the Human Costs of Pursuing Cancer to the Last.  The Kirkus Review described the work as "a welcome argument that we are overdue for a change in the paradigm for treating cancer."Week of November

Week of November 4th: 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 13th: 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/

   

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/.

08/12/2019

What About the Drug Shortage Problem? (August 12th)

This past Friday, August 9th, STAT published my essay titled, "Presidential Candidates Aren't Talking About the Drug Shortage.  They Should Be."   

For all the discussion/effort this Congress concerning drug policy reform, moreover regarding excessive pricing there is none about worsening drug shortages (generally an under pricing problem)  - and the related quality problem in the generic drug manufacturing sector.  On the latter, see my July 17th interview with Katherine Eban concerning her recent, Bottle of Lies.  Nor are any of the presidential candidates, at least to date, discussing.  

The essay is at: https://www.statnews.com/2019/08/09/drug-shortages-presidential-candidates-policy/.

 

07/25/2019

Dr. Georges Benjamin Discusses the Climate Crisis and APHA's Center for Climate and Health (July 24th)

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The news is grim.  Our planet has just experienced its hottest June in recorded history and likely the hottest July.  This year will likely join ten others since 2000 as the warmest ever recorded.  Several studies just published in Nature and Nature Geoscience have concluded there has never been a period over the past 2,000 years when temperatures have changed as fast and extensive as in recent decades.  To make matters worse, the climate crisis substantially explains the fact our planet is currently experiencing its 6th mass extinction – 4 of the previous 5 were also caused by high atmospheric CO2 concentrations, the worst of these extinguished 90% of all planetary life.  Despite the increasingly dire evidence, the federal leaders continue to do nothing.  The White House and the Republican Party not only refuse to admit reality but argue Americans have no fundamental right to a climate system capable of sustaining human life.  Congressional House Democrats refuse to move any meaningful legislation - even if that means simply putting Republicans on record for opposing maintaining life on earth and the health care industry, in sum, is neither working to reduce its own carbon emissions nor lobbying for requisite federal policy reforms.  Listeners may be aware this is my 8th climate crisis-related interview since last October.

During this 29 minute conversation Dr. Benjamin assesses the current stay of play relative to federal action concerning the climate crisis, he discusses the challenges the climate crises poses relative to achieving health equity and moreover the work of APHA's Center for Climate, Health and Equity (and how individuals can become involved in the APHA's climate crisis work). 

Dr. Georges Benjamin has served as Executive Director of the American Public Health Association since 2002.  He also serves as publisher of APHA's nonprofit's monthly publication, The Nation's Health, the association's official newspaper, and the American Journal of Public Health. Previously, Dr. Benjamin served as Secretary and Deputy Secretary of the Maryland DownloadDepartment of Health.  Dr. Benjamin began his medical career in 1981 in Washington State where he served as Chief of the Acute Illness Clinic at the Madigan Army Medical Center.  He subsequently moved to Washington, D.C. to serve as Chief of Emergency Medicine at the Walter Reed Army Medical Center.  After leaving the Army, Dr. Benjamin chaired the Department of Community Health and Ambulatory Care at the District of Columbia General Hospital, was promoted to Acting Commissioner for Public Health for the District of Columbia and later served as Interim Director of the Emergency Ambulance Bureau of the District of Columbia Fire Department.  He is the author of more than 100 scientific articles and book chapters.  His most recent book is, The Quest for Health Reform: A Satirical History is an exposé of the nearly 100-year quest to ensure quality affordable health coverage for all through the use of political cartoons.  Dr. Benjamin is a member of the National Academy of Medicine of the National Academies of Science, Engineering and Medicine and also serves on the boards for several organizations including Research!America and the Reagan-Udall Foundation.  In April 2016, President Obama appointed Dr. Benjamin to the National Infrastructure Advisory Council.  Dr. Benjamin is a graduate of the Illinois Institute of Technology and the University of Illinois College of Medicine.  He is board-certified in internal medicine and a Fellow of the American College of Physicians, a Fellow of the National Academy of Public Administration, a Fellow Emeritus of the American College of Emergency Physicians and an Honorary Fellow of the Royal Society of Public Health.

For information on the APHA's Center on Climate go to: https://apha.org/topics-and-issues/climate-change/center  
 
The APHA's 2016 "Climate Change and Health Strategic Plan" (noted during this interview) is at: https://www.apha.org/-/media/files/pdf/topics/climate/apha_climate_change_strategic_plan.ashx?la=en&hash=03D148BBD2A45E2A2B98BC4C98D33F32118244E1 
 
Phillip Alston's (United Nations' Special Rapporteur on Extreme Poverty and Human Rights) report, "Poverty and Climate" (also noted or quoted during this interview - and must reading) is at: http://www.guninetwork.org/files/unsr-poverty-climate-change-a_hrc_41_39.pdf

 

07/21/2019

Dr. Mark Fendrick Discusses Value-Based Insurance Designs (July 19th)

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One way to increase the value of insurance coverage is to eliminate or lower a patient's out of pocket costs (OOP), i.e., their co-pays and/or deductables, for health care services that are of high value, for example, vaccines and/or alternatively increase OOP costs for low value service, for example, certain imaging tests.  The concept is based on the straight forward rationale that, based on clinical evidence, certain health care products or services are proven to be more effective than others.  (This is the rationale for the Choosing Wisely program, at: https://www.choosingwisely.org/.)  OOP costs therefore should not be uniform for all services and medications, particularly when non-adherence rises along with rising health care OOP spending.  This largely explains the problem of medication non-adherence.  Phrased another way, we need need to solve for the increasing problem of under consuming high value care.  This idea was recognized in the 2010 Affordable Care Act, specifically Section 2713 [c] that eliminates patient cost sharing for specific preventive care services.  For example, OOP costs for significantly under-utilized breast and colorectal screenings, for which approximately only 72% and 60% of patients, respectively, are screened.  The value-based idea was furthered by the ACA-created CMS Innovation Center that in 2017 the launch the MA VBID demonstration - that was recently extended to 2024.  (This discussion is related to or can serve as a follow up to my May 11th conversation with Professor Andrew Ryan concerning measuring for value or spending efficiency.)

During this approximately 30 minute conversation, Dr. Fendrick discusses moreover the creation of the University of Michigan's VBID Center, provides his assessment of the current CMS Medicare Advantage VBID demonstration, the U. of MI Center's just announced V-BID X insurance design, VBID efforts at the state level and the Treasury Department's just-announced guidance allowing Health Savings Account/High Deductible Health Plans to practice VBID.   

Dr. A. Mark Fendrick is the Director of the Value-Based Insurance Design Center at the University of Michigan.  He is also Professor of Internal Medicine in the School of Medicine Amfenand a Professor of Health Management and Policy in the School of Public Health at the University of Michigan.  He has authored over 250 articles and book chapters and has received numerous awards for the creation and implementation of value-based insurance design.  Dr. Fendrick is an elected member of the National Academy of Medicine (formerly the Institute of Medicine or IOM), serves on the Medicare Coverage Advisory Committee, and has been invited to present testimony before the U.S. Senate Committee on Health, Education, Labor and Pensions, the U.S. House of Representatives Ways and Means Subcommittee on Health, and the U.S. Senate Committee on Armed Services Subcommittee on Personnel.  Dr. Fendrick is the co-editor in chief of the American Journal of Managed Care and is an editorial board member for three additional peer-reviewed publications.  He is also a member of the Institute for Healthcare Policy and Innovation at the University of Michigan, where he remains clinically active in the practice of general internal medicine.  Dr. Fendrick received a bachelor’s degree in economics and chemistry from the University of Pennsylvania and his medical degree from Harvard Medical School.  He completed his residency in internal medicine at the University of Pennsylvania where he was a fellow in the Robert Wood Johnson Foundation Clinical Scholars Program.

For information about U. of Michigan's Center for Value-Based Insurance Design to go: https://ihpi.umich.edu/center-value-based-insurance-design-v-bid.

A summary of the V-BID X proposal is at: https://www.healthaffairs.org/do/10.1377/hblog20190714.437267/full/.  The more complete white paper is at: http://vbidcenter.org/wp-content/uploads/2019/07/VBID-X-Final-Report_White-Paper-7.13.19.pdf.  

For information concerning Dr. Fendrick's mention of the just-released US Treasury guidance allowing HSA-HDHP plans the flexibility to cover specified medications and services prior to meeting the plan deductible go to: https://ihpi.umich.edu/center-value-based-insurance-design-v-bid

07/18/2019

Katherine Eban Discusses Her Just-Published Work, "Bottle of Lies, The Inside Story of the Generic Drug Boom" (July 17th)

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Nine in 10 prescriptions are today filled using a generic drug saving Americans tens of billions annually.   A significant amount of generic drugs, along with active ingredients in all drugs, are manufactured overseas.  However, how safely or to what quality standards are these ingredients and generics produced?   Bottle of Lies, published in May, tells the story of appalling practices foreign generic manufacturers use to produce these drugs at the most minimal cost.  The work moreover provides a detailed account of Ranbaxy, the former India-based generic manufacturer that after eight years of investigation was fined a then record amount,$500 million, for significant fraud.  The work questions or brings to serious doubt the FDA's ability to adequately inspect overseas generic manufacturers ensuring these drugs are safe for consumption in the US or around the world.  Listeners may recall I interviewed coauthor Paul Weinberg in September 2017 concerning his related work, Blood On Their Hands, How Greedy Companies, Inept Bureaucracy and Bad Science Killed Thousands of Hemophiliacs and Rosemary Gibson this past December concerning her related, China Rx, Exposing the Risk of America’s Dependence on China for Medicine

During this 37 minute interview. Ms. Eban provides an overview of Ranbaxy's manufacturing practices revealed by former employee and whistleblower, Dinesh Thakur.  She explains the mindset, termed "Jugaad," used in India to produce generics.  She discusses the adequacy of the 2013 US settlement with Ranbaxy , the role the Japanese firm, Daiichi Sankyo, a  major Ranbaxy stakeholder, the FDA's ability to adequately inspect Ranbaxy and other generic manufacturers around the world, e.g., Cipla and Mylan, recent and future related Congressional action, how poor or inadequate manufacturing practices complicate remedying the drug shortage problem and what precautions consumers or patients can take before consuming generic drugs.  

Katherine Eban, an investigative journalist, is a Fortune magazine contributor and Andrew Carnegie fellow. Her articles on pharmaceutical counterfeiting, gun trafficking, and 1811011_HS_114_RTcoercive interrogations by the CIA, have won international attention and numerous awards.  She has also written for Vanity Fair, The New York Times, Self, The Nation, the New York Observer and other publications. Her work has been featured on 60 Minutes, Nightline, NPR, and other national news programs.  She lectures frequently on the topic of pharmaceutical integrity.  Her first book, Dangerous Doses: a True Story of Cops, Counterfeiters and the Contamination of America’s Drug Supply, was named one of the Best Books of 2005 by Kirkus Reviews and was a Barnes&Noble Discover Great New Writers pick.  Her account of reporting on 9/11 was anthologized in At Ground Zero: 25 Stories From Young Reporters Who Were There. Her work has also been awarded grants from the Alfred P. Sloan Foundation, the Fund for Investigative Journalism, the Alicia Patterson Foundation and the McGraw Center for Business Journalism at CUNY’s Craig Newmark Graduate School of Journalism.  Educated at Brown University and Oxford, where she was a Rhodes Scholar.   

Information on Bottle of Lies is at: https://www.harpercollins.com/9780062338785/bottle-of-lies/.  

Ms. Eban's FAQ regarding how to learn about generics or best to consume is at: https://www.katherineeban.com/faqs

07/03/2019

"Can Medicine Be Cured?" (July 3rd)

Though I've been asked over the years to recommend readings I've avoided beyond noting those related to podcast interviews.   However, this work and lengthy review may be worth particular notice.  The book is Seamus O'Mahony's Can Medicine Be Cured? The Corruption of a Profession and the June review appearing in the Dublin Review of Books by Paul O'Mahoney is titled, "Made To Measure?"

At: http://headofzeus.com/books/can-medicine-be-cured

At: http://www.drb.ie/essays/made-to-measure-