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PeerSpectrum | Journeys in Medicine
68 minutes | a month ago
"Tracing Health," with Research Program Director for the Public Health Institute, Marta Induni, PhD
Today we are delighted to have Dr. Marta Induni with us on the show. She is a principal investigator with the Public Health Institute. She is also director of Tracing Health, a program launched in response to the COVID-19 pandemic that provides contact tracing and scientific support services to counties and local health departments on the US West Coast.
84 minutes | 2 months ago
Targeting PTSD with two Navy SEAL Physicians. Sean Mulvaney, MD with Guest Host, Robert Adams, MD
Today we are thrilled to embark on a new adventure here on PeerSpectrum. The first episode of our new guest host series. We’re inviting back some of our most popular past guests and handing over the microphone. As Keith and I have learned over the past few years, there is an art and craft to interviewing. Playing on the field has given us both a deeper appreciation and admiration for the true masters of the game. Masters such as the late Larry King (who passed away just last month) and his very close friend, and our most recent guest, Cal Fussman. As we discussed last time, one of my all-time favorite podcast interviews was Cal Fussman interviewing Larry King, on Tim Ferriss’s podcast. It was a rare opportunity to listen in as two masters discussed their game. These types of conversations are likely more common than we think. It’s just not as common to hear them. Today we are happy to have our good friend and past guest, Dr. Robert Adams back with us. As you may recall, Bob is a former US Navy SEAL and command surgeon for the army’s elite Delta Force. A recently retired family physician in the UNC health system, Bob is also the author of two books, “Six Days of Impossible,” and “Swords and Saints: A Doctor’s Journey.” Today Bob is joined by his good friend and former colleague, Dr. Sean Mulvaney. Sean is also a former US Navy SEAL turned army physician. Their conversation will take us all around the world from the battle fields of Iraq and Afghanistan, to a surprise birthday party for Colin Powell aboard a US Navy warship. More importantly, Bob and Sean will spend some time discussing PTSD, what we currently know about it and how it is and will be treated. They also discuss a new and very promising PTSD treatment called Stellate Ganglion Block. Sean has treated hundreds of veterans, trauma survivors and others suffering the effects of PTSD. This includes Medal of Honor recipients Dakota Myer, whose treatment by Sean was dramatically featured in a recent 60 Minutes report. Let us know what you think of this new format. Who would you like to hear as a future guest host? We love hearing your ideas so keep them coming. With that said, let’s get started…
73 minutes | 4 months ago
Big Questions with legendary interviewer & Esquire’s writer-at-large, Cal Fussman.
Think of someone accomplished, someone famous, someone you truly admire. Have you met them? If so, how did it go? What did you talk about? If not, what would you talk about? What questions would you ask them? For us, today’s guest is just that person. His name is Cal Fussman and he is a long time writer-at-large for Esquire Magazine through their “What I learned” series. He is also host of the Big Questions podcast. Cal has interviewed everyone and I mean everyone…Mikhail Gorbachev, Jimmy Carter, Bill Maher, Jeff Bezos, Richard Branson, Jack Welch, Robert De Niro, Clint Eastwood, Al Pacino, George Clooney, Leonardo DiCaprio, Tom Hanks, Bruce Springsteen, Dr. Dre, Quincy Jones, Walter Cronkite, Woody Allen, Barbara Walters, Pelé, Yao Ming, Serena Williams, Danny DeVito, Eric Clapton, Arnold Schwarzenegger, and Muhammad Ali. Just to name a few. For amateur interviewers like us, today’s conversation was like getting to play 18 holes with Arnold Palmer. It’s like being one degree away from Kevin Bacon. Cal interviewed both by the way. Cal is literally one of the best in the business. We discussed his extraordinary career and his new mission in our world of medicine. Most importantly we’ll cover how all of us can be more aware, more thoughtful and effective with the questions we use. With that said, let’s get started…
82 minutes | 6 months ago
Eisenhower’s Legacy of Lessons. “How Ike Led” with Susan Eisenhower
On the release of this episode, we find ourselves in October of 2020. Still deep in the Covid-19 pandemic, and exactly one week away from the 2020 presidential election. Instead of piling on with our own opinions and speculation, we’re heading to the past for lessons and perspective that might, just might, help us make better sense of the world around us. Lessons from someone I think many of us wouldn’t mind having around today. A man who led the fight to liberate Europe from the darkness of Nazism. A man who spent decades patiently preparing and training for that role, never knowing if it would ever come. A man who’s deep footprint on history still shapes the world we live in today. A man who served through multiple heart attacks, strokes, and other severe illnesses. A leader tested by pandemics from the 1918 Spanish Flu to Polio. A true citizen of the world who, as Lyndon Johnson described, left “America…a better nation—stronger, safer, more conscious of its heritage, more certain of its destiny---because Ike was with us when America needed him.” Today’s guest knew Ike well, though she never addressed him as General or Mr. President. She called him grandpa because Susan Eisenhower is one of Dwight Eisenhower’s four grandchildren. She is a writer, policy strategist and national security expert who leads the Washington, DC based consulting firm, The Eisenhower Group. Her recently published book, “How Ike Led, The Principles Behind Eisenhower’s Biggest Decisions,” and her personal perspective growing up with her grandfather are the focus of today’s episode. With that said, let’s get started.
65 minutes | 7 months ago
The Quantified Surgeon. Sensors, wearables & performance analytics. Stanford surgeon, Dr. Carla Pugh
You’ve no doubt heard this famous quote from science fiction writer, William Gibson, “The future is already here – it's just not evenly distributed.” What better way to describe technology and medicine? The runway for technological innovation and adoption is just a little longer in our world. What other profession or industry can you think of that still uses pagers and fax machines? So where can we look for a sneak peek into the future? How about sports? Motion tracking sensors, video analysis, performance modeling, biometrics, wearables, “Moneyball” data analytics. This is old stuff for the coaches, trainers, scouts, and team managers who use these technologies every day. But what can we learn by putting this same technology to work in the operating room? To answer that question, we’re thrilled to have Dr. Carla Pugh with us today. Dr. Pugh is a professor of General Surgery, and Director of the Technology Enabled Clinical Improvement Center at the Stanford University School of Medicine. She is one of the world’s leading researchers in the use of sensors and simulation technology to assess and quantitatively define hands-on clinical skills. This was a fun and eye-opening episode on what is coming around the corner. With that said, let’s get started…
81 minutes | 8 months ago
The Mad Men of Medicine Avenue. Investigative Journalist and “Pharma” author, Gerald Posner
All right, welcome back. If you think you have a pretty good handle on the opioid crisis, the pharmaceutical industry and how it all works, today’s episode may challenge that assumption. It certainly did for us. The modern pharmaceutical and biotech industries are like no other. How they got to where they are is a story like no other. The same businesses that have given us incredible lifesaving advances have also given us disasters like the opioid epidemic. The history of the pharmaceutical industry is more complex and captivating than you might imagine. Today’s guest in award winning investigative journalist, Gerald Posner. He’s written twelve books including national best sellers such as “God’s Bankers,” “Mengele. The complete Story,” and The Pulitzer Prize finalist, “Case Closed.” His latest book, “Pharma,” is master class history of the modern pharma and biotech space. Understanding that history is critical to understanding the present opioid crisis. In-fact, we didn’t even cover the opioid crisis until the final 15 minutes of the podcast. With so much to cover, we asked Gerald for an extra 30 minutes beyond our usual hour. Even that wasn’t enough, but it was lot of fun, and hopefully all the reason you need to read the book yourself. With that said, let’s get started…
64 minutes | 9 months ago
Overcoming rejection. Renowned transplant surgeon & heart transplant patient, Dr. Robert Montgomery
Imagine losing your father at 14, losing your brother a decade later, and looking down the barrel of the same heritable heart condition that killed them both. Imagine learning in your first year of surgical residency that your continued existence will depend a new implantable device, called an ICD. A device so new, you will likely be the first surgeon in the world to have one implanted. A device that will allow your life to continue, but most likely put an end to your surgical career. That’s exactly what happened to today’s guest, one of the nation’s renowned transplant surgeons, Dr. Robert Montgomery. Robert has performed over 1000 kidney transplants and his research has advanced the field in areas such as desensitization, multiple organ transplants, gene and cell-based therapies, and perhaps most famously, domino paired donations. And if that’s not enough, he is also credited in the Guinness Book of World Records for most kidney transplants performed in one day. One more thing…Robert is also heart transplant recipient. A heart transplant performed by the very surgical team he hired, and currently leads as the director of the Langone Transplant Institute at NYU. Wondering about the Ave Maria intro music? Well, that’s Robert’s wife, world famous mezzo-soprano, Denyce Graves. Get ready for a wild journey of an episode. With said, let’s get started.
57 minutes | 10 months ago
“No Man's Land.” The trailblazing women doctors of WWI with journalist & author, Wendy Moore
Barbara Tuchman, the Pulitzer Prize winning author of the WWI classic, “The Guns of August,” once observed, “The unrecorded past is none other than our old friend, the tree in the primeval forest which fell without being heard.” Not only must history be recorded, it must also be examined and retold. For most of us, who are not professional historians, we approach history through the curation and re-telling of the past, mainly via books and documentaries. Perhaps we are not so different from our ancestors, and their oral traditions. History may be written by the victors, but it’s kept alive through the story tellers. Today we are heading to London to meet with journalist and author, Wendy Moore. Like Tuchman, Wendy was also drawn to the period of “The Great War,” but in search of story many of you have likely never heard of. In a time when women in the UK, the US and most democratic nations were not even allowed to vote, there was a hospital called Endell Street. A hospital with women surgeons, women nurses, women administrators, and women staff. A hospital almost completely run by and run with women! A 573 bed hospital that performed over 7000 surgical operations and treated some 26,000 wounded soldiers, many with unprecedented battlefield trauma. A hospital led by two active suffragette doctors, one with a criminal record, having been sentenced to six weeks in prison for her protests. A hospital that also treated Spanish Flu patients before being shut down and nearly lost to history…until now.
62 minutes | a year ago
Mountaineering, photography and the Dalai Lama. Emergency and expedition doctor, Andrew Peacock, MD.
Today’s episode is not about Covid-19. Instead we’re going to give all of you a break and take you as far away from this as we possibly (and virtually) can. For that, we’re heading to Queensland, Australia to meet Dr. Andrew Peacock, an emergency physician, award winning photographer, accomplished climber and expedition guide for Lindblad expeditions, a travel company contracted with National Geographic. This conversation takes us everywhere from Antarctica to Nepal, aboard a Russian ice breaker ship, technical climbing in New Zealand, and even a private audience with the Dali Lama. We’ll learn how a lucky break in Antarctica sparked a side career for Andrew in photography. Best of all, we’ll uncover how a busy emergency medical physician has made this life possible, while literally setting the standard for work life balance. This was simply an incredible episode. We had a blast doing it. With that said, let’s get started.
51 minutes | a year ago
Overexposure. Law Professor and Health Economics Researcher, Christopher Robertson, PhD, JD
In January of 2018, Warren Buffett, Jeff Bezos and Jamie Dimon announced the creation of a new, co-venture, to tackle the rising costs of healthcare for their company’s employees. They immediately picked famous writer and surgeon, Atul Gawande to lead it. Short on details but big on promise, just the simple announcement of this venture sent shock waves through the media and the markets. Billions of dollars in stock value for insurance companies and other health sector players vanished over night. Two years later, we have a name for this venture (Haven Health) but little else. What they’re up to, and what they’re planning, is still a big mystery. Whatever ultimately happens here, it will matter, simply because names like Amazon and Warren Buffet are behind it. The question is, how much will it matter for the rest of us? How much can anyone (even powerful billionaires) really change the American healthcare system? Today’s guest is Christopher Robertson, Associate Dean for Research and Innovation and Professor of Law at the University of Arizona. His background and research interests overlap many academic disciplines, including bioethics, health law, incentives, behavioral economics and more. His CV includes a PhD in philosophy and a law degree from Harvard. Unfortunately, Chris doesn’t have behind the scenes access to Haven Health (we know, we asked him). But, he does have a new book exploring some unique ideas and research that should certainly be on their radar, and yours. The book, “Exposed: Why Our Health Insurance is Incomplete and What can be Done About,” also includes a historical overview of our modern American health system, a history often forgotten and overlooked in today's political debates. This was great conversation and we really enjoyed having Christopher on. With that said, let’s get started…
56 minutes | a year ago
Accelerating Bench to Bedside. Stanford University School of Medicine Dean, Dr. Lloyd Minor.
Today we have Dr. Lloyd Minor with us on the show. He's an ENT surgeon, scientist, innovator and currently dean of the Stanford University School of Medicine. We covered his early career path, a surgical treatment he actually developed and his new book, “Discovering Precision Health,” released just this month in March, 2020. As the leader of one of the nation's top medical schools, located right in the heart of Silicon Valley, Dr. Minor has a unique lens on medicine's innovation pipeline. His new book and our conversation offer a glimpse into this world. With that said, let's get started...
26 minutes | a year ago
Thank you from Colin and Keith. Brief thoughts on COVID-19.
This was a brief conversation between Colin and Keith regarding the COVID-19 pandemic. It was recorded on March, 24th 2020. For all of you on medicine's front lines, we're thinking about you every day, and we're deeply grateful for all you are doing, for all of us. Stay safe and take care.
83 minutes | a year ago
Keeping score. Seeking a grand equation for health with theoretical physicist, Laurence Jacobs, PhD.
All right, welcome back. If you're still around in the year 2061, two things will be true. You'll enjoy seeing the next passing of Halley's Comet, and your life insurance company will enjoy having collected four more decades of your life insurance premiums, without a payout. Standing there that day you and your insurance company can be grateful for the work of one man, the exact same man that comet is named for. The English astronomer, mathematician and physicist, Edmond Halley. Why you ask? Well, not only did Halley develop the calculations to predict the comet's periodicity, he is also developed the early mathematical tools for predicting human longevity, known very well to your insurance company as actuarial science. Today's guest, like Halley is also a physicist, a theoretical physicist to be exact. And like Halley he sees no need to limit his research interests to one academic domain. Laurence Jacobs began is career at MIT pursuing some of the broader mysteries of our universe. Today he's pursuing another ambitious project, quantifying all of the measures, signs, risk models, data sets, bio-wearable monitoring outputs, health history, genomics and more into (perhaps) one single accessible number. Something you may have heard called a health score. Something that promises to refine our ability to predict longevity, and even improve it. This was an amazing conversation and not a short one. The potential benefits of developing these tools are huge, but so are the challenges and dizzying complexities. Many of the answers will likely come from surprising and unexpected places. To quote one of our past guests, Dr. Robert Gale, the American physician at Chernobyl, “Progress is often made by those who investigate the boundaries of several areas, instead of having laser-like focus on a single discipline. That’s where many of the answers in science reside.” That's exactly where we find Laurence Jacobs today, in Zurich Switzerland where he continues to develop the main concepts and the risk models that underlie the Dacadoo Health Score and the remote disease monitoring and management system, remsmed / EMMA Care. With that said, let's get started..
60 minutes | a year ago
Harnessing the habitual mind. Psychologist & behavioral scientist, Wendy Wood, PhD
It's no mystery to most of you that poor health behaviors such as smoking, substance abuse, poor nutrition, lack of exercise and patient non-compliance account for a substantial portion of the disease burden, not to mention costs, in the US. Some recent estimates by the CDC and other researchers suggest behaviors account for 40-50% of increased risk associated with deaths before age 75. The problems are clear. What to do about them isn't. There's no “will power” medication to prescribe, and most public health efforts thus far have barely made a dent. But what if old fashioned will power really isn't the issue? What if something researchers call “introspection illusion,” is causing us to overestimate our own will power, and underestimate the capacities of others? Today's guest is psychologist and behavioral scientist, Wendy Wood. She is currently a professor of psychology and business at the University of Southern California, and a visiting professor at the INSEAD Business School in Paris. Wendy has spent much of her career studying what she considers the very building blocks of behavioral change, something we all know as habits. Angela Duckworth describes her as “the world's foremost expert in the field.” And according to Adam Grant, she is “widely recognized as the authority on the science of habits,” We'll explore her research and recent book, “Good Habits, Bad Habits.” Our conversation also touches on what's commonly called, the replication and reproducibility crisis. Wendy has a unique lens on this issue, having served as one of fifteen distinguished scientists chosen by the American Academy of Sciences to study the problem. This was a fun episode with a lot of ground covered. With that said, let's get started...
61 minutes | a year ago
Nullius in verba. Understanding uncertainty with statistician, Sir David Speigelhalter, PhD
Nullius in verba. Understanding uncertainty with statistician, Sir David Speigelhalter, PhD by Keith Mankin, MD & Colin Miller
69 minutes | 2 years ago
True Grit at Lost Rivers. Saving a hospital from the brink with CEO, Brad Huerta.
We've all heard the bad news about rural hospitals in the U.S. 60 million of our fellow citizens rely on these small hospitals, often known by their designation as critical access facilities. According to a recent analysis conducted by the consulting firm, Navigant, 21% of rural hospitals today are at a severe risk of closure. That includes 430 hospitals across 43 states, representing 21,000 staffed beds, 150,000 employees and $21 billion in revenue. When one of these hospitals closes (and 95 have so far since 2010) critical access to care isn't the only casualty. These hospitals are often largest employers and drivers of economic activity in their communities. The ripple effects are felt wide and deep every time a hospital shuts its doors. OK, that's the bad news. How about some good news? Today we're making the trip to a remote town in Idaho, known as Arco. With a population of only 900, Arco is small. You won't find many restaurants, you won't even find a Walmart but you will find a hospital. A small 14 bed hospital called Lost Rivers (by the way, what a cool name for a hospital, right). Its existence and survival in the face of overwhelming odds is the story of today's episode. When our guest, CEO Brad Huerta, took over in 2013, he wasn't there to save Lost Rivers, he was there to shut it down. With over three million dollars in debt, pending bankruptcy, and only seven thousand dollars of cash in the bank, the situation was beyond grim. Today this same hospital is cash positive, free of every dime of debt, running six years with a yearly profit, and getting ready to open a new surgery center. How is this possible and what happened after Brad arrived? Well, it's one heck of a ride and one hell of a story. So buckle in and get ready. With that said, let's get started.
60 minutes | 2 years ago
Crossing Medicine's Last Perimeter. Aging & Longevity with Harvard Geneticist, David Sinclair, PhD.
Today we're heading to the front-lines of research testing and challenging one of the most basic truths of the human experience...we all get older and we all eventually die. Today's guest doesn't buy this. In fact, he actually views aging as a diagnosable disease, a disease that can be managed today, and one day fully treated. Now, before you start rolling your eyes, let's meet today' guest. David Sinclair is a professor of genetics at Harvard Medical School and co-director of the Paul Glenn Center Biological Mechanisms of Aging. He is widely considered one the world's foremost experts on longevity research. A co-founder of the journal Aging and several biotech companies, he also holds 35 patents. A recipient of more than 25 awards and honors, including being knighted in the Order of Australia, and Time Magazine's top 100 most influential people. Besides his peer-reviewed research, his work is featured in five books, two documentary movies, 60 Minutes, Morgan Freeman’s, “Through the Wormhole,” and other media. David's newest book, “Lifespan, Why We Age and Why We Don't Have To,” is to quote the blurb on the cover, “an elegant and exciting book that deserves to be read broadly and deeply." That comes from Siddhartha Mukherjee, the famous Columbia University oncologist, and winner of the Pulitzer prize. Not bad! It was a rare treat to have David with us today. Our conversation is also a great reminder that these really are incredible and exciting times we're living in. With that said, let's get started.
56 minutes | 2 years ago
Lockdown. Inside Prison Medicine with ER Physician, Dr. Jeffrey Keller.
All right welcome back. Here's a quick trivia question, which group of US patients are constitutionally guaranteed access to free medical care? And no this is not a trick question. The answer...prisoners. Today we're jumping into an area of medicine few, if any of us, know much about. Let's be honest, how many of you out there have even seen the inside of a prison of jail? Not many, we guess. Criminal records and professional medical licensing don't mix well. For those of you who've been with us for awhile, you know this isn't a political program. I say this because I'm going to read a few stats here. Don't worry, we're not gearing up for a policy discussion on prison reform. It is an important issue, but outside the scope of our conversation today. As of 2016, there were 2.1 million people incarcerated in the US. That makes us the world leader both in the total number incarcerated and a per-capita incarceration rate (655 per 100,000). That rate beats everyone, even places like China, North Korea, Russia, Kazakhstan and Saudi Arabia. As of 2015, the US population represented only 4.4% of the global population, while we held a whopping 21% of the global prison population. We're reading these stats to show just how big US prison medicine is. That's over two million people who are constitutionally guaranteed free medical care. Just imagine how many doctors, nurses and other medical professionals it takes to deliver that amount of care. Today's guest is one of them. [Read more…] Dr. Jeffery Keller is emergency medicine physician. After 23 years working in a busy trauma center, Keller got a call from the local jail. They needed help. Working in prison didn't sound very appealing, so he politely declined. Six months later they called again. This time he reluctantly agreed, but only temporarily. Then a funny thing happened, Keller actually started to enjoy his work seeing and treating inmates. So began a new path in Keller's career. A path through a largely unknown area of medicine that we're going to explore today. With that said, let's get started.
53 minutes | 2 years ago
Trading Places. Do Doctors Make Better Patients? MIT Economist, Jonathan Gruber, PhD.
All right welcome back. If you could pick the ideal patient population, armed with the best knowledge, fluent in medical jargon, generally healthy and willing to comply with recommended treatments, who would you pick? How about doctors? Doctors may not be perfect patients but at least they should outperform similar non-clinicians, right? Surprisingly, little to no research has actually been done comparing the care, compliance and outcomes of doctors to comparable groups of non- physicians. For reasons we'll soon see, this is actually a difficult question to tackle, but it's a very important question with broader implications. Today's guest is MIT economist, Jonathan Gruber. He recently co-authored a study using a unique data source to examine just how good doctors and their family members are when they find themselves in the patient seat. Spoiler alert, obviously if the results aren't surprising, we probably would not be here talking about it. That's for the first part of this episode. In the second, we'll explore some of Jonathan's other work. Besides his 160 researcher papers, seven books, numerous awards and prestigious appointments, there's also something else Jonathan is known for. He was one of key advisors (come have even called architects) of Romney-care and Obamacare. Perhaps you've forgotten so let's see if this jogs your memory: www.youtube.com/watch?v=tLOV4oUXawg So if you've been listening to us long enough, you know PeerSpectrum, unlike CNN, is not your home for politics. There are plenty of other places to go for that. Not that Keith and I don't have our opinions, we just recognize our limitations. We aren't journalists and we don't pretend to be. We'll leave the politics to them. Did we bring up Gruber's history and talk about it? You bet. There was no way we could skip it completely. In his own words, Gruber became a virtual proxy for the intense debates taking place during the lead up the passage of the ACA. Whatever you think about Obamacare, or Gruber personally, he's important figure and someone worth talking with. With that said, let's get started.
66 minutes | 2 years ago
The American Doctor at Chernobyl, Part II: Dr. Robert Gale
As you heard last time, Dr. Gale (a bone marrow transplant specialist from UCLA) rose to international prominence after being the first American physician invited by the Soviet Union to treat patients suffering acute radiation trauma, only days after the horrific incident at Chernobyl. Our journey continues as Dr. Gale is flown in by helicopter to personally survey the Chernobyl nuclear power-plant. This only weeks after the meltdown of reactor number four. We'll see what it was like walking through the eerily empty streets of Pripyat. This was literally one of the most dangerous and heavily restricted areas on the planet. For an outsider, especially an American, to be personally inspecting this area, actually treating patients, all during the height of the cold war, was simply unthinkable... until it actually happened. For those of you who enjoyed the recent hit HBO series on Chernobyl, we'll spend a little more time there. Then we'll move on to subsequent nuclear incidents such as Tokiamura and Fukushima, and Dr. Gale's first hand experience with those. We'll discuss his lessons learned and his thoughts on the future of nuclear energy. We'll also see what he's up to today. It's an incredible part II for this rare series. With that said, let's get started.
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