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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.GUEST:Stephen Senn, PhD: Twitter and WebsiteLINKS:Note: The Accad and Koka Report participates in the Amazon Affiliate program and may earn a small commission from purchases completed from links on the website.Wood 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)Stephen Senn. Dicing with Death: Chance, Risk, and Health (Amazon link)WATCH ON YOUTUBE:Watch the episode on our YouTube channelSUPPORT THE SHOW:Make a small donation on our Patreon page on and join our discussion group or receive a free book.

Our guests are Rebekah Bernard, MD and Niran Al-Agba, MD, authors of a soon-to-be-published book examining the rise of nurse practitioners and physician assistants in healthcare.Dr. Bernard is a family physician from Fort Myers, Florida. She is board member of Physicians for Patient Protection, an organization calling for more transparency regarding the difference in training between physicians and non-physician providers.Dr. Al-Agba is a board-certified pediatrician in private practice in Washington State. She is a prolific writer who speaks widely and openly on a variety of issues, including policy, ethics, and medical practice. GUESTS:Rebekah Bernard: Twitter and websiteNiran Al-Agba: Twitter and websiteLINKS:Note: The Accad and Koka Report participates in the Amazon Affiliate program and may earn a small commission from purchases completed from links on the website.Niran Al-Agba and Rebekah Bernard: Patients at Risk: The Rise of the Nurse Practitioner and Physician Assistant in Healthcare (Amazon link and book website)WATCH ON YOUTUBE:Watch the episode on our YouTube channelSUPPORT THE SHOW:Make a small donation on our Patreon page on and join our discussion group or receive a free book.

Our guest is Kevin McKernan, founder and chief scientific officer of Medicinal Genomics, a company specialized in genetic testing of medicinal plants, including cannabis for strains, traits, and pest infestation, including plant viruses. He is here to shed light on the process of PCR testing as applied to the COVID pandemic.GUEST:Kevin McKernan: TwitterLINKS:Note: The Accad and Koka Report participates in the Amazon Affiliate program and may earn a small commission from purchases completed from links on the website,Jaafar R. et al. "Correlation Between 3790 Quantitative Polymerase Chain Reaction–Positives Samples and Positive Cell Cultures, Including 1941 Severe Acute Respiratory Syndrome Coronavirus 2 Isolates" (Open access in Clinical Infectious Diseases)WATCH ON YOUTUBE:Watch the episode on our YouTube channelSUPPORT THE SHOW:Make a small donation on our Patreon page on and join our discussion group or receive a free book.

Our guest is Peter McCullough, MD, MPH, consultant cardiologist and Vice Chief of Medicine at Baylor University Medical Center in Dallas, Texas. He is an internationally recognized authority on the role of chronic kidney disease as a cardiovascular risk state with more than a thousand publications and more than five hundred citations in the National Library of Medicine. His works have appeared in the New England Journal of Medicine, Journal of the American Medical Association, Lancet and other top-tier journals worldwide.However, he is not with us to discuss the cardiorenal syndrome nor his many illustrious achievements in cardiology. Rather, he joins us to tell us about an article on the outpatient treatment of COVID-19 of which he is first author. The paper is titled and was published in the American Journal of Medicine online on August 6, 2020.GUEST:Peter McCullough, MD, MPH: TwitterLINKS:McCullough P, et al. “Pathophysiological Basis and Rational for Early Outpatient Treatment of SARS-CoV-2 (COVID-19) Infection” (Open Access in Am J. Med)WATCH ON YOUTUBE:Watch the episode on our YouTube channelSUPPORT THE SHOW:Make a small donation on our Patreon page on and join our discussion group or receive a free book.

Our guest is Vinayak K. Prasad, hematologist-oncologist. He was an associate professor of medicine at the Oregon Health & Science University School of Medicine and in the summer of 2020 moved to the University of California San Francisco.He is a prolific researcher with a particular interest in the quality of medical evidence and trial design. He is also author of 2 best-selling books: Ending Medical Reversal (2015) co-authored with Dr. Adam Cifu and Malignant: How Bad Evidence and Bad Policy Harm People With Cancer, released earlier this year.We have a broad ranging conversation about the tenor of medical discourse today and about his main ideas regarding the quality of medical evidence.GUEST: Vinay Prasad: Twitter, Website, and PodcastLINKS:Note: The Accad and Koka Report participates in the Amazon Affiliate program and may earn a small commission from purchases completed from links on the website,Prasad, V et al. "A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices." Open Access in Mayo Clinic Proceedings with accompanying video of Dr. PrasadVinay Prasad and Adam Cifu. Ending Medical Reversal. Amazon link.Vinay Prasad. Malignant. Amazon link.WATCH ON YOUTUBE:Watch the episode on our YouTube channelSUPPORT THE SHOW:Make a small donation on our Patreon page on and join our discussion group or receive a free book.

Our guest is Dr. Somalaram Venkatesh, interventional cardiologist In private practice in Bengaluru, India. He obtained his medical degree and completed his cardiology training at PGI, Chandigarh. He is now director of cardiology at Aster Hospital, Bengaluru. He discusses India's historical legacy of discrimination, and the solution built into the Indian constitution to rectify this : the reservation system.GUEST:Somalaram Venkatesh, MD: Professional websiteWATCH ON YOUTUBE:Watch the episode on our YouTube channelSUPPORT THE SHOW:Make a small donation on our Patreon page on and join our discussion group or receive a free book.

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 moralhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5749302/ 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.LINKS: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 EPISODES:Ep. 35 Why Brain Death Isn’t Death: An Introduction to “Shewmon’s Challenge” (with guest Alan Shewmon, MD)Ep. 45 Brain Death at the Bedside (with guest Fred Rincon, MD)Ep. 146 Diagnosing Brain Death: Clinical and Legal Quagmire (with guests Alan Shewmon and Doyen Nguyen)WATCH ON YOUTUBE:Watch the episode on our YouTube channelSUPPORT THE SHOW:Make a small donation on our Patreon page on and join our discussion group or receive a free book.

Our guest is David Cayley, author and broadcaster based in Toronto, Canada, whose career focused on the philosophies of major contemporary thinkers and on the history of intellectual thought. For 30 years, he made radio commentaries for the acclaimed Ideas radio series produced by the CBC. He is well known for his close collaboration and friendship with the philosopher and social critic Ivan Illich who is the subject of this episode.GUEST:David Cayley: WebsiteLINKS:Note: The Accad and Koka Report participates in the Amazon Affiliate program and may earn a small commission from purchases completed from links on the website."David Cayley. "Questions about the current pandemic from the viewpoint of Ivan Illich." (blog post, April 8, 2020)Ivan Illich. Limits to Medicine: Medical Nemesis; The Expropriation of Health (Amazon link)David Cayley and Ivan Illich. Rivers North of the Future: The Testament of Ivan Illich (Amazon link)WATCH ON YOUTUBE:Watch the episode on our YouTube channelSUPPORT THE SHOW:Make a small donation on our Patreon page on and join our discussion group or receive a free book.

An American-born author, mathematician, and political commentator, Dr. James Lindsay has written books spanning a range of subjects including religion, the philosophy of science and postmodern theory. He is the co-founder of the website New Discourses and is currently promoting his new book "Cynical Theories". Enjoy a wide ranging discussion on the Post-Modern movement and how it impacts MedicineGUEST:James Lindsay: Twitter and New Discourses Web pageSHOW NOTES:Amazon book link: Cynical Theories John Stuart Mill Essay: On Liberty Anish's article in Quilette on the Real Gender gap in Cardiology: https://quillette.com/2019/06/12/the-real-gender-gap-in-heart-disease/New Discourses website: https://newdiscourses.com/Podcast on race and estimated GFR: https://podcasts.apple.com/us/podcast/race-and-estimated-gfr/id1461664501?i=1000488650915WATCH ON YOUTUBE:Watch the episode on our YouTube channelSUPPORT THE SHOW:Make a small donation on our Patreon page on and join our discussion group or receive a free book.

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.GUESTS:David Heymann: Professional page and Wikipedia pagePaul Fine: Professional pageLINKS:Paul 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 EPISODES:Ep. 140. Gabriela Gomes: Why Herd Immunity May Be At HandWATCH ON YOUTUBE:Watch the episode on our YouTube channelSUPPORT THE SHOW:Make a small donation on our Patreon page on and join our discussion group or receive a free book.

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.GUEST:Sally Satel, MD: Twitter and WebsiteLINKS:"The Hypocritical Oath" (in Persuasion online community)The Health Disparities Myth: Diagnosing the Treatment Gap (with co-author Jonathan Klick)RELATED EPISODES:Ep. 144 John Mandrola: Why Doctoring and Politics Shouldn't MixWATCH ON YOUTUBE:Watch the episode on our YouTube channelSUPPORT THE SHOW:Make a small donation on our Patreon page on and join our discussion group or receive a free book.

Our guests are Doyen Nguyen, OP, MD, STD and D. Alan Shewmon, MD. They join us to discuss troubling development on the legal treatment of brain death.Dr. Nguyen was previously an academic hematopathologist and is currently a Catholic moral theologian and bioethicist. She has authored books and articles both in medicine and in moral theology/bioethics and authored a 600-page monograph that takes a critical look at brain death from a variety of perspectives.Dr. Shewmon is Professor Emeritus of Pediatric Neurology at UCLA. His work, comprising decades of well-documented clinical observations and reflections, is now known as “Shewmon’s challenge,” a compelling rebuke to the principal arguments put forth to defend the concept of brain death.LINKS:Shewmon DA. "Chronic “brain death”: Meta-analysis and conceptual consequences." (in Neurology, 1998)Lewis A, et al. "Determination of Death by Neurologic Criteria in the United States: The Case for Revising the Uniform Determination of Death Act" (in J. of Law, Medicine, and Ethics, 2019)President's Commission for the Study of Ethical Problems in Medicine, Biomedical and Behaviora Research. "Defining Death" (1981)Nguyen D. The New Definition of Death for Organ Donation: A Multidisciplinary Analysis from the Perspective of Christian Ethics. (2018, Amazon link)Nguyen, D. "Does the Uniform Determination of Death Act Need to Be Revised?" (2020, Linacre)RELATED EPISODES:Ep. 35 Why Brain Death Isn't Death: An Introduction to "Shewmon's Challenge" (with guest Alan Shewmon, MD)Ep. 45 Brain Death at the Bedside (with guest Fred Rincon, MD)WATCH ON YOUTUBE:Watch the episode on our YouTube channelSUPPORT THE SHOW:Make a small donation on our Patreon page on and join our discussion group or receive a free book.

Dr. Damian Carabello discusses the depths insurance companies go to make sure they end up on top.GUEST:Damian Carabello, MD: TwitterLINKS: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 ON YOUTUBE:Watch the episode on our YouTube channelSUPPORT THE SHOW:Make a small donation on our Patreon page on and join our discussion group or receive a free book.

Dr. John Mandrola returns to the show to discuss why doctoring and politics shouldn't mix and how he got into hot water on Twitter for holding that unacceptable view.Dr. Mandrola is an electrophysiologist in Louisville, Kentucky. He is is cardiology editor on Medscape where he writes a regular column and produces a weekly podcast.GUEST:John Mandrola, MD: Twitter and WebsiteLINKS:John Mandrola: "Doctoring and Activism"Sally Satel: "The Hypocritical Oath"Mandrola et al: The Case for Being a Medical Conservative (in the American Journal of Medicine)PREVIOUS GUEST APPEARANCES:Ep. 12 John Mandrola: The Case for "Less-Is-More"Ep. 107 Independent Nurse Practitioners: Public Health Threat or Libertarian Step Forward?WATCH ON YOUTUBE:Watch the episode on our YouTube channelSUPPORT THE SHOW:Make a small donation on our Patreon page on and join our discussion group or receive a free book.

Our guest is Adam Mortara, lead trial counsel in the case of Students for Fair Admissions v. Harvard University. We discuss the legal aspects of affirmative action in light of the paper by Dr. Norman Wang which set off a storm of controversy in academic medicine.GUEST:Adam Mortara, JD: Professional page LINK:Norman Wang's paper: Diversity, Inclusion, and Equity: Evolution of Race and Ethnicity Considerations for the Cardiology Workforce in the United States of America from 1969 to 2019. WATCH ON YOUTUBE:Watch the episode on our YouTube channelSUPPORT THE SHOW:Make a small donation on our Patreon page and join our discussion group or receive a free book.

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 studiesGUEST:Robert W. Yeh, MD: Twitter and professional web pageLINKS:Strom JB, et al. Use of Administrative Claims Data to Assess Outcomes and Treatment Effects in Randomized Trials of Transcatheter Aortic Valve Replacement (in Circulation)Faridi KM, et al. Use of Administrative Claims Data to Estimate Treatment Effects for 30 days versus 12 months of Dual Antiplatelet Therapy After Percutaneous Coronary Intervention (in Circulation)Konstam M. Real World Data as trial End Points: Off and Running with a Long Way to Go (editorial in Circulation)PREVIOUS GUEST APPEARANCE:Ep. 19 Public Reporting: Necessary Evil or Harmful Fake News?WATCH ON YOUTUBE:Watch the episode on our YouTube channelSUPPORT THE SHOW:Make a small donation on our Patreon page on and join our discussion group or receive a free book.

Our guest is Amy Wax, Robert Mundheim Professor of Law at the University of Pennsylvania Law School. Before attending law school she obtained her undergraduate degree from Yale University in biophysics and biochemistry, graduating summa cum laude. She then attended Harvard Medical School and trained as a neurologist at New York Hospital - Cornell Medical Center before completing her law degree at Columbia University. She is the author of Race, Wrongs, and Remedies: Group Justice in the 21st Century. In 2017, she was the target of academic backlash after co-authoring an opinion piece in the Philadelphia Inquirer on the societal benefits of "bourgeois values."GUEST:Amy Wax: Faculty page and Wikipedia entryWATCH ON YOUTUBE:Watch the episode on our YouTube channelSUPPORT THE SHOW:Make a small donation on our Patreon page on and join our discussion group or receive a free book.

Our guest is Gabriela Gomes, Professor of Mathematics at the University of Strathclyde. She specializes in population dynamics and the modeling of herd immunity and her recent work suggests COVID-19 herd immunity may be at hand. We discuss how herd immunity thresholds are estimated and why she thinks classic models are flawed and must incorporate a measure of variation in individual susceptibility.GUEST:Gabriela Gomes, PhD: Twitter and WebsiteLINKS:Gomes 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 ON YOUTUBE:Watch the episode on our YouTube channelSUPPORT THE SHOW:Make a small donation on our Patreon page on and join our discussion group or receive a free book.

A recent article authored by Dr. Norman Wang on the history and current state of affirmative action programs in medical schools and cardiology departments has led to a storm of controversy and to Dr. Wang's demotion as fellowship program director. To discuss that article and the controversies we are joined by Dr. Martha Gulati, division Chief of Cardiology at the University of Arizona. She is also the best-selling author of Saving Women's Hearts and editor-in-chief of ACC's CardioSmart.LINKS:The now retracted Wang paper: https://www.ahajournals.org/doi/pdf/10.1161/JAHA.120.015959Journal of the AHA comment on retraction: https://www.ahajournals.org/doi/10.1161/JAHA.119.014592Regents of Univ. of California v. Bakke, SCOTUS decision: https://supreme.justia.com/cases/federal/us/438/265/GUEST:Martha Gulati: Twitter and WebsiteWATCH ON YOUTUBE:Watch the episode on our YouTube channelSUPPORT THE SHOW:Make a small donation on our Patreon page on and join our discussion group or receive a free book.

GUESTS:Marion Mass is a pediatrician in the Philadelphia area where she has practiced in hospital, Emergency Room, delivery room, outpatient, and urgent care settings. She graduated from Duke University Medical School and trained in Pediatrics at Northwestern Memorial Hospital in Chicago. She has been writing about life inside medicine, published in the WSJ, Washington Times, and the Philly Inquirer. She is also co-founder of Practicing Physicians for America, a physician lead organization that advances the interests of practicing physicians. She has written extensively on the role of third party intermediaries in medicine.Dr. Rupali Chadha is a Board Certified Psychiatric Physician who diagnoses and treats mental illness. She is also Board Certified Psychiatric Physician in the specialty area of forensics. She serves the LA Superior Courts in identifying inmates who are incompetent to stand trial and has also served as a forensic expert in criminal trials. She recently traveled to Washington DC to visit the White House and witness signing of a recent Presidential Executive Order on intermediaries in healthcare.WATCH ON YOUTUBE:Watch the episode on our YouTube channelLINKS:EWhite House Executive Order: https://www.whitehouse.gov/presidential-actions/executive-order-lowering-prices-patients-eliminating-kickbacks-middlemen/Overview of third parties that suck up most of the health-care dollars: https://www.medpagetoday.com/publichealthpolicy/healthpolicy/84795The rebates that may fuel higher drug prices: https://www.washingtontimes.com/news/2019/feb/10/a-bipartisan-opportunity-to-cut-drug-prices/John Arnold in statnews discusses the role of Pharmacy benefit managers (PBM): https://www.statnews.com/2018/08/27/pharmacy-benefit-managers-good-or-bad/A detailed look at Group Purchasing Organizations and PBMs: https://practicingphysician.org/scrubs-vs-suits-the-battle-inside-the-nations-hospitals-part-2/Needle stick story referenced in the podcast: https://nebula.wsimg.com/9e87fe4c7de204baccc77a2bc373daf1?AccessKeyId=62BC662C928C06F7384C&disposition=0&alloworigin=1SUPPORT THE SHOW:Make a small donation on our Patreon page on and join our discussion group or receive a free book.