The Accad and Koka Report

Our guest is Charlie Deist, author of Hormetics: Physical Fitness for Free People. We have an engaging and somewhat philosophical conversation on principles of health. How do we identify good nutritional and exercise habits? Amongst the myriad of fads, what rules should guide one’s health choices and behaviors? SHOW NOTES Charlie Deist: Website and TwitterHormetics: Physical Fitness for Free People (on Amazon)Watch the episode on our YouTube channel

Our guest is Elise Amez-Droz, program manager for the Open Health program at the Mercatus Center at George Mason University, where she also manages the health policy portfolio. Ms. Amez-Droz is a Public Policy Fellow with the Fund for American Studies and a member of the Millennial Cohort of American Enterprise Institute’s Leadership Network. SHOW NOTES The Mercatus Center website“Labeling Us ‘Essential’ or ‘Non-Essential’ Makes Us Less Human” (Discourse Magazine)Related episode: 21. Inside the Swiss Healthcare System (with guest Marc Fouradoulas, MD)Watch the episode on our YouTube channel

Our guest today is Terence Kealey, Professor Emeritus of clinical biochemistry at the University of Buckingham in the United Kingdom, where he served as Vice Chancellor until 2014. He is also a Research Fellow at the Cato Institute. Professor Kealey trained in medicine at Bart’s Hospital in London and obtained his doctorate at Oxford University following which he pursued a career in clinical biochemistry research, before joining the faculty at Buckingham University.  He is the author of 3 books. The first, published in 1996 and titled The Economic Laws of Scientific Research is a sweeping exploration of the relationship between government and science and argues against public funding of scientific research. The second, Science, Sex, and Profits, published in 2008, continues the same theme and develops the notion that science is not a public good but is organized around what he terms “invisible colleges.” His third book, Breakfast is Your Most Dangerous Meal, was published in 2014 and links government intervention to very unhealthy nutritional advice. SHOW NOTES Watch the episode on our YouTube channel

Our guest is Professor Stephen Senn, a world renowned statistician whose career has spanned the gamut of activities that involves statistical analysis in medicine, from teaching to research to consultancy. Professor Senn obtained his PhD in Statistics from the University of Dundee and became a Chartered Statistician from the Royal Statistical Society in 1993. He has held professorships at University College London and at the University of Glasgow. He is the author of several books, notably Statistical Issues in Drug Development and Dicing with Death: Chance, Risk, and Health. SHOW NOTES Stephen Senn, PhD: Twitter and WebsiteWood FA, et al. N-of-1 Trial of a Statin, Placebo, or No Treatment to Assess Side-Effects (Open Access in New Engl J Med)Araujo, A Julious S, Senn S. Understanding variation in sets of N-of-1 trials (Open Access in PLOS One)Senn S. Statistical pitfalls of personalized medicine (Open Access in Nature)Senn S. Mastering Variation: Variance components and personalized medicine (Open Access in Stat in Med)

Does it matter if we call irreversibly comatose patients “dead?” Our guest is Doyen Nguyen, OP, MD, STD. Dr. Nguyen was previously an academic hemato-pathologist 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. SHOW NOTES Nguyen D. The New Definition of Death for Organ Donation: A Multidisciplinary Analysis from the Perspective of Christian Ethics. (2018, Amazon link)Nair-Collins, M and Miller, FG. “Do the ‘Brain Dead’ merely appear to be alive? (in J of Med Ethics, open access)Related Episode: Ep. 35. Why Brain Death Isn't Death: An Introduction to "Shewmon's Challenge" (with Guest Alan Shewmon, MD)Related Episode: Ep. 45. Brain Death at the Bedside (with guest Fred Rincon, MD)Related Episode: Ep. 146. Diagnosing Brain Death: Clinical and Legal Quagmire (with guests Alan Shewmon and Doyen Nguyen)Watch the episode on YouTube

Our guests are Professors David L. Heymann and Paul Fine from the London School of Hygiene and Tropical Medicine. Professor Heymann is a physician who held leading positions at the WHO for more than 20 years, coordinating global responses to epidemics such as Ebola, AIDS, polio, and SARS. He also served as Chairman of Public Health England from 2009 until 2017. Professor Fine is also a leading academic figure in epidemiology and public health with broad interests in infectious diseases. Professor Heymann and Professor Fine, along with colleague Ken Eames, have co-authored an landmark review paper on the concept of herd immunity. SHOW NOTES David Heymann: Professional page and Wikipedia pagePaul Fine: Professional pagePaul Fine, Ken Eames, and David Heymann: “Herd Immunity”: A “Rough Guide (Open Access in Clinical Infectious Diseases)David Heymann: How SARS Was Contained (Opinion in New York Times)Related Episode: Ep. 140. Gabriela Gomes: Why Herd Immunity May Be At HandWatch the episode on YouTube

Our guest is physician and author Sally Satel, MD. Dr. Satel is a resident scholar at the American Enterprise Institute and staff psychiatrist at a local methadone clinic in the Washington DC area. She earned a bachelor’s degree from Cornell University, a master’s degree from the University of Chicago, and an MD degree from Brown University. She has written widely in academic journals on topics in psychiatry and medicine, and has published articles on cultural aspects of medicine and science in numerous magazines and journals. She has testified before Congress on veterans’ issues, mental health policy, drug courts, and health disparities. She is the author of numerous books including The Health Disparities Myth: Diagnosing the Treatment Gap with co-author Jonathan Klick and, most recently, Brainwashed: The Seductive Appeal of Mindless Neuroscience co-authored with Scott Lilienfeld. SHOW NOTES Sally Satel, MD: Twitter and Website“The Hypocritical Oath” (in Persuasion online community)The Health Disparities Myth: Diagnosing the Treatment Gap (with co-author Jonathan Klick)Watch the episode on YouTube

Dr. Damian Carabello discusses the depths insurance companies go to make sure they end up on top. SHOW NOTES Damian Carabello, MD: Twitter​Anish Koka long read on surprise billingDamian Carabello “Let’s end surprise billing without a Trojan horse” blog on KevinMD about the problems with benchmarking.Twitter thread on the history of IngenixAndy Slavitt’s involvement with health insurance fraud caseWatch the episode on YouTube

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. SHOW NOTES John Mandrola, MD: Twitter and WebsiteJohn 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)Watch the episode on YouTubeDr. Mandrola's previous appearances on the show: Ep. 12 and Ep. 107

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 that set off a storm of controversy in academic medicine. SHOW NOTES Adam Mortara, JD: Professional page​Watch the episode on YouTubeNorman 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.

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. SHOW NOTES Robert W. Yeh, MD: Twitter and professional web pageWatch the episode on YouTubeStrom 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?  

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.” SHOW NOTES Amy Wax: Faculty page and Wikipedia entryWatch the episode on YouTube  

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. SHOW NOTES Gabriela Gomes, PhD: Twitter and websiteGomes et al. (May 2020 paper), "Individual Variation in Susceptibility or Exposure to SARS-CoV-2 Lowers the Herd Immunity Threshold" in MedRxivAguas et al. (July 2020 paper), "Herd Immunity Thresholds for SARS-CoV-2 Estimated from Unfolding Epidemics" in MedrxivBritton 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 MagazineFine et al., "'Herd Immunity': A Rough Guide" in Clinical Infectious Disease (open access)Watch the episode on YouTube  

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. SHOW NOTES Martha Gulati: Twitter and WebsiteThe now retracted Wang paperJournal of the AHA comment on retractionRegents of Univ. of California v. Bakke, SCOTUS decisionWatch the episode on YouTube

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. SHOW NOTES White House Executive OrderOverview of third parties that suck up most of the health-care dollarsThe rebates that may fuel higher drug pricesJohn Arnold in statnews discusses the role of Pharmacy benefit managers (PBM)A detailed look at Group Purchasing Organizations and PBMsNeedle stick story referenced in the podcastWatch the episode on YouTube

Anish Koka and Michel Accad discuss lockdowns in light of the experience of the last few months. SHOW NOTES Michel Accad: It’s Not About Trade-Offs​Watch the episode on YouTube

Joshua Gottlieb is an economist who co-authored a recent paper examining the effect of government policy and physician income. The paper was recently presented at a conference co-sponsored by the NBER and NIA and its pre-publication has generated significant controversy among doctors. SHOW NOTES Joshua Gottlieb, PhD: Twitter and WebsitePaper: Who Values Human Capitalists’ Human Capital? Healthcare Spending and Physician Earnings Watch this episode on YouTube

Manny Sethi is a trauma surgeon running to be the next senator from the state of Tennessee. He is the son of immigrants, and an unabashed conservative who discusses his journey from medicine to politics, as well as his views on healthcare. SHOW NOTES Manny Sethi: Twitter and BioWatch this episode on YouTube

Reopening schools in the midst of a pandemic is a controversial topic. FREOPP, a non-partisan think tank founded by Avik Roy recently released a plan for reopening schools. We discuss some of the data from around the globe, as well as practical considerations related to opening schools. SHOW NOTES FREOPP: Reopening America’s Schools and Colleges During COVID-19Iceland Study (NEJM)Dutch National Institute StudySupreme Court Decision on school fundingWatch this episode on YouTube

Dr. Leamer is a Professor of Economics and Statistics at UCLA who comes on the show to discuss the recent arrival of econometric analyses in medicine. He is a longstanding skeptic of the robustness of conclusions derived from econometrics and has some advice for clinicians puzzling over what to do with these analyses. SHOW NOTES Ed Leamer warns of the science of econometrics in 1983The Credibility Revolution in Empirical Economics: How Better Research Design is Taking the Con out of Econometrics – Angrist and Pischke argue in 2010 that new econometric tools : pseudorandomization, instrumental variables, and natural experiments mark a credibility revolution for the fieldTantalus on the Road to Asymptopia- Ed Leamer responds to Angrist/PischkeWatch this episode on YouTube

Our guest is Rohin Francis, MD. Dr. Francis is a Cardiologist in London, who also hosts a popular YouTube channel. He recently discussed what COVID may tell us about racism in science and medicine, and comes on the show for a wide ranging discussion on racism in medicine, COVID in Britain, and how minority groups have fared in Britain. SHOW NOTES Watch Rohin’s video on Racism in Science and MedicineWatch the episode on YouTube

Marilyn Singleton, MD, JD joins the Accad and Koka Report.  Dr. Singleton comes from a long line of American physicians. She shares with us her fascinating family history and her insights into the rich history of Black physicians in America. We also discuss the deleterious effects of race victimization manifest today.

In the wake of the murder of George Floyd, Dr. David Howard comes on the show to discuss his experiences in America, and more broadly racism in America. Dr. David Howard was originally born in Jamaica and immigrated to the U.S. at the age of eighteen. He received his Bachelor of Arts in Psychology from the Johns Hopkins University and then pursued his Md and PhD in Epidemiology through the Medical Scientist Training Program at the Johns Hopkins School of Medicine. He completed an internship at the New York Presbyterian Hospital followed by a residency in Obstetrics and Gynecology at the University of Missouri-Kansas City. He also completed a post-doctoral fellowship in Epidemiology at the University of North Carolina Chapel Hill. He is currently a Board Certified Obstetrics/Gynecology Specialist practicing in Las Vegas, Nevada, and is affiliated with several different hospitals in the area.

Dr. Rao is an interventional cardiologist and researcher who has been at Duke University for over 10 years. He also works in the Veteran’s hospital in Durhum, is a leader in the cardiology social media community with 16k followers on Twitter, and is also editor-in-chief of the journal Circulation Interventions. In this podcast he discusses his perspective on the recent retractions of papers involved in the Surgisphere scandal. Links Article from the-scientist on Lancet/NEJM retractions

Our guests Mary Davenport and George Delgado have developed a treatment protocol that can reverse the effects of the abortifacient mifepristone and be given to women who change their mind after a medical abortion. They tell us the story of their pioneering work and of the international network of physicians that is now in place to provide the therapy. We discuss the challenges that remain when the medical establishment is ideologically resistant to supporting women in their second choice. Links: Abortion Pill Rescue websiteDelgado, G, et. al. A Case Series Detailing the Successful Reversal of Mefiprestone Using Progesterone (In Issues in Law and Medicine)Creinin, M, et al. Mifepristone Antagonization with Progesterone to Prevent Medical Abortion: A Randomized Clinical Trial (free access in Obstetrics and Gynecology)Graham, R. A New Front in the War Over Reproductive Rights: “Abortion-Pill Reversal” (in The New York Times)Grossman D and White K. Abortion “Reversal”: Legislating Without Evidence (in New England Journal of Medicine)  

Our guest is Neurosurgeon Chengyuan Wu. Dr. Wu specializes in functional neurosurgery, a field that focuses on using brain surgery to restore function to patients. He discusses Elon Musk’s initiative to create a new brain-human interface using implants in the brain that communicate with the environment.

What does it mean to promote a politically conservative vision for health care? Our guest is Dr. Leo Valentin, a radiologist running as a Republican candidate for US Congress in Florida’s District 7.

Our guest is Eric Weinhandl, an epidemiologist whose investigation of a JAMA paper on dialysis patients lead to its retraction—and subsequent republication. Eric discusses the steps leading to the paper’s eventual retraction, and what this signals about the larger research enterprise. Eric also discusses the role of bias, conflicts of interest, big data and home dialysis, as well as some thoughts on the field of epidemiology during the COVID pandemic. Eric Weinhandl is an epidemiologist with fourteen years of research experience in kidney disease, mostly regarding dialysis and pharmaceuticals. Eric worked at the United States Renal Data System (USRDS) Coordinating Center between 2004 and 2015 and has conducted studies with Amgen, Baxter, DaVita, NxStage, Sigma Tau, and the Peer Kidney Care Initiative. He recently worked for Fresenius Medical Care, one of the major dialysis companies in the United States, and currently works with the chronic disease research group as part of the Hennepin County Medical Center.

Our guest is Gregg Gonsalves, Assistant Professor of Epidemiology at Yale University Medical School as well as Associate (Adjunct) Professor of Law and Research Scholar in Law at Yale Law School. His research focuses on the use of quantitative models for improving the response to epidemic diseases and he will help us understand better what a strategy of testing and contract tracing might look like, and what the challenges ahead are.

Our guest is Adam Rodman, host of the podcast Bedside Rounds, a great show on the history of medicine. With his deep knowledge of the vagaries of medical thought, Dr. Rodman sheds light on the COVID-related challenges that clinicians are now confronting.

Our guest is Andrew Althouse, statistician at the Center for Clinical Trials and Data coordination in Pittsburgh. He holds an undergraduate degree in Statistics and a PhD in Epidemiology from the University of Pittsburgh. His main area of interest is the design of randomized control trials. He discusses adaptive randomized control trials, and dissects the recent news of the positive Remdesivir trial.

Our guest is Dorit Reiss, Professor 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.

Our guests are Dr. Swapnil Hiremath for the University of Ottawa and Saurabh Jha from the University of Pennsylvania. We discuss the controversies surrounding the COVID-related opinions and research findings of John. P.A. Ioannidis, the notorious Stanford data scientist and physician.

Our guest is Dr. Anupam Singh, Assistant Professor of Medicine at Santosh Medical College and Hospital, one of the designated COVID hospitals in Ghaziabad, Utter Pradesh, India. He returns to the show for a great conversation about the surprising aspects of the pandemic in the Indian subcontinent.

Should we wait for COVID testing benchmarks to be met before we can reopen the economy? What if testing remains imperfect and uncertainty remains high? Our guest is Avik Roy, head of the Foundation for Research on Equal Opportunity. He returns to the show to discuss FREOPP’s plan to bring people back to work.

Our guest is economist Ryan McMaken, senior editor at the Mises Institute. He was the economist for the Colorado Division of Housing from 2009 to 2014. He is also the author of Commie Cowboys: The Bourgeoisie and the Nation-State in the Western Genre ​— a book that reveals his aptitude for analyzing economic events in their broader cultural context. Additional Reading Thanks to Lockdowns, State and Local Tax revenues Are PlummetingThe Fed’s Balance Sheet Skyrockets As It Doubles Down on Inflating Asset PricesAnother Right Abolished by the Government’s COVID Lockdown: The Right to a Speedy TrialColorado County Says It Will Arrest All Tourists, Including Those Who Own Property ThereThe COVID Lockdowns Are What Twenty-First Century Mob Rule Looks Like

Our guest is Jeff Deist, President of the Mises Institute. We discuss the unprecedented governmental response to COVID, the trade-offs that are unaccounted for, and the inability of local communities to set their own course when, in fact, “all crises are local.” Additional Reading "End the Shutdown" by Mises.org Editors "What Governors Can Do" by Jeff Deist "All Crises Are Local" by Jeff Deist

Our guest is Dr. Nicole Saphier. She is a radiologist and a breast imaging specialist at Memorial Sloan Kettering, Monmouth, New Jersey. She appears frequently as a medical contributor on Fox News, and comments on a variety of medical as well as health policy issues. She comes on today to discuss her new book – Make America Healthy Again.

Our guest is Per Bylund, Assistant Professor of Entrepreneurship at Oklahoma State University where he holds the Records-Johnston Professorship of Free Enterprise in the School of Entrepreneurship. We talk about regulations in the age of COVID, and he also shares his perspective on Sweden’s response to the pandemic.

Our guest is Aaron Kheriaty, MD, Associate Clinical Professor of Psychiatry at the University of California, Irvine, where he is Director of the Bioethics Program. Dr. Kheriaty is the chair of his hospital’s ethics committee and is presently working on a task force with the University of California Office of the President to prepare for the possibility that a surge in demand for intensive care due to the coronavirus pandemic will outstrip the supply of equipment and staff. He is the author of numerous articles in peer-reviewed journals and in the lay press, many of which are focused on end-of-life issues.

Our guest is intensive care specialist Mark Tonelli, Professor of Medicine at the University of Washington Medical Center in Seattle. He shares with us the encounter with the COVID-19 pandemic as it emerged from a nursing home in King County, Washington, and how the Seattle area medical community has responded to this first US cluster of cases.

Anish discusses the COVID19 pandemic with Dr. Daniel Jafari, an emergency physician and surgical critical care specialist working at the North Shore University Hospital in New York. Dr. Jafari speaks to us about watching the pandemic unfold, the problems being wrestled with, the remarkable response, and what’s needed in the coming weeks.

Accad and Koka welcome Dr. Paul Offit, an expert on vaccines, immunology, and virology. He is the Maurice R. Hilleman Professor of Vaccinology, Professor of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania, and Director of the Vaccine Education Center at The Children’s Hospital of Philadelphia. He shares his thoughts on the response to the COVID pandemic, a response that should take into account the health costs of a severe economic downturn.

Anish Koka discusses the COVID19 pandemic with Christos Argyropoulos, Chief Nephrologist at the University of New Mexico. Dr. Argyropoulos has been warning for some time about COVID19. Here he discusses from where his early concerns emerged, missteps by the US in handling the virus early on, and what to do now.​

Hordes of independent nurse practitioners are on the horizon. Many physicians are raising the alarm bell, but Dr. John Mandrola views things differently.

Geoffrey Rose published The Strategy of Preventive Medicine in 1992, and thus gave birth to the “Population Health” movement. In this podcast episode, Dr. Michel Accad critically examines Rose’s influential ideas.

Dr. Bob Gill, producer of the documentary The Great NHS Heist, discusses what life in the National Health Service is like, how it differs from practice in the United States, and most importantly, his fears of what is undermining the mission of the NHS — a hostile takeover by American corporate interests.

Many physicians feel ambivalent about assisted suicide and neither endorse the practice nor outright condemn it. As a result, they also avoid discussing the topic altogether. Accad and Koka's guest is Dr. Adam Cifu, who kindly agreed to engage in a conversation on this difficult question. Dr. Cifu is author of Ending Medical Reversal and Symptom to Diagnosis.

Accad and Koka's guest is the highly successful and widely respected blogger who writes anonymously under the pen name “Skeptical Scalpel.” He is a former Chairman of Surgery at an academic institution, and they discuss the state of surgical education and its present-day challenges.

Should the medical school curriculum include health inequity, climate change, and gun control? Accad and Koka interview Professor Stanley Goldfarb, author of a recent and controversial op-ed in the Wall Street Journal on the politicization of medical education.