Mismeasuring Medicine. “The Tyranny of Metrics,” with Jerry Z. Muller, PhD

 

Name: Jerry Z. Muller, PhD

Location: Catholic University of America. Washington, DC

Specialty: Professor of History.

Most of you know the quote, “If you cannot measure it, you cannot improve it.” It’s often attributed, incorrectly, to the famous nineteenth century physicist, Lord Kelvin. Wherever it came from, it’s sounds about right. Same goes for this familiar quote from a popular business book author, “What gets measured gets done.”

Well, in today’s episode were going to talk about what’s getting measured and what’s actually getting done. What’s getting measured are thousands of performance and quality indicators. What’s getting done is docking our medical system billions of dollars every year in costs and lost productivity. Nothing new to all of you out there. But what if this “metric fixation,” is doing more than just wasting time and money? Used correctly, metrics and big data analysis offer incredible promise for research, visibility and improvement. Used incorrectly, they can steer us off course, devalue professional judgment, manipulate, encourage fraud, and possibly cause real harm to physicians, hospitals and patients.

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Level I Guidance: “A Random Walk,” with Economist & Investment Icon, Burton Malkiel, PhD

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Name: Burton Malkiel, PhD, MBA

Location: Princeton University

Specialty: Economist, Author & Investment Icon

Today’s episode is about money, specifically your money. Now, if we’re going to take a break from interviewing astronauts, Navy SEAL’s, NFL surgeons and cutting edge researchers to do an episode on investing, you can bet we we have a very specific reason for doing so. You can also bet we have a rare and unique guest.

That guest is renowned Economist, Burton Malkiel. You can google him later but here’s a quick CV highlight reel: PhD from Princeton, Harvard MBA, author of 12 books and more than 150 articles, dean of the Yale School of Management, member of the President’s Council of Economic Advisers, corporate board memberships including Prudential Financial , the American Stock Exchange, and the Vanguard Group. At 86 years of age he isn’t stopping and currently serves as chief investment officer at Weathfront.

All very impressive you say, but what does this have to do with me? Well, Burton is also the author of one the most influential investment books of all time. First published over 45 years ago, “A Random Walk Down Wall Street,” has sold over 1.5 million copies and is now (as of Jan 2019) in its 12th edition. When it was first published in 1973, Burton called B.S. on the performance and excessive fees charged by professional money managers and other experts. He imagined a better, low cost investment tool that did not yet exist. Three years later that changed and today this simple investment tool is the vehicle of choice for 40% of the total invested stock market. Even Warren Buffet (the oracle of Omaha and one of the extremely rare few to actually outperform the market) now recommends this tool for investors.

What is this tool and how did Burton Malkiel’s ideas transform the financial world? How have his ideas become a sort of placebo control virtually no one can beat over the long run? How can an 86 year old economist help you avoid the time and money wasting decisions so many have, and will continue to make? Let’s find out, and with that said, let’s get started…

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Waking Up to Psychedelic Medicine. Neuropharmacologist, David Nichols, PhD

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Name: David Nichols, PhD

Location: UNC Chapel Hill, NC.

Specialty: Neuropharmacologist

 

All right, welcome back. We have really looked forward to this episode. Clinical research with Psychedelic compounds like psilocybin, LSD and MDMA have gotten a lot of press recently. Major institutions such as Johns Hopkins, UCLA and Yale are leading the charge with dramatic results in drug addiction, PTSD, end of life care, depression and other mental illness that is simply breathtaking.

When we think back to the psychedelic sixties, it’s hard to imagine that legitimate clinical research was taking place with psychedelics then, too; although much of it (think Timothy Leary) wouldn’t pass even the most lenient institutional review boards today. Much of this early research in the US came to a screeching halt with the passage of the Controlled Substances Act of 1970. Only now are we beginning to reawaken to the incredible healing and trans-formative effects these compounds can offer.

Today it’s our distinct privilege to speak with the researcher who carried the torch through a time when psychedelic research was nearly non-existent.

When it comes to the mechanisms of action, biochemistry and pharmacology of psychedelics, David Nichols is arguably the world’s foremost expert. He’s spent over 40 years researching and producing these compounds. And yes, all legally, as Nichols held one of the very few DEA licenses granted during this time.

If you’re skeptical about all this, hang in there. We’ll see how psychedelic tools can open new pathways to understanding neuroscience, mental illness and even perhaps change who we are and how we see the world. A majority of those who experience a psychedelic trip consider it among the most meaningful experiences of their entire lives. How is that possible? We’re going to find out. With that said, let’s get started…

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Examining, “The Dr. Death Podcast.” Award Winning Science Journalist, Laura Beil

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Name: Laura Beil

Specialty: Medicine and Science Journalist

Location: Dallas, TX

Today we have award winning science journalist, Laura Beil with us. Her investigative podcast series on the notorious former neurosurgeon, Christopher Duntsch is what brings her here today. Since its release last month, “Dr. Death,” as it is called is now one of top 5 ranked podcasts in the country. You’ve probably heard about this story but just a quick recap before we get started:

In 2011, neurosurgeon Christopher Duntsch began his first practice in Dallas, TX. Through the next two years, he operated on 37 patients. Of those 37, 33 suffered severe injuries and complications. Several were left permanently paralyzed, and two left dead from what all should have been fairly routine, elective procedures.

It’s an appalling story, later described by a surgeon (testifying at Duntsch’s trial) as a “complete and utter failure of the entire system of checks and balances for patient safety.” A failure that likely would have continued were it not for the heroic efforts of other doctors in the Dallas community who battled to stop him.

This episode covers a lot of ground in a short time, including followup information that has come to light since the podcast’s release. There’s nothing enjoyable about this story. But it’s also too important to ignore. With that said, let’s get started…

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Extreme Makeover: Hospital Edition. Physician & Architect, Dr. Diana Anderson

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For something this complicated, it’s really hard to design products by focus groups. A lot of times, people don’t know what they want until you show it to them.”

-Steve Jobs

Name: Diana Anderson, MD, ACHA

Specialty: Internal Medicine and Architecture

Location: Boston, MA. Harvard Medical School Center for Bioethics

Steve Jobs once said,”If Henry Ford had asked his customers what they want, they would have said a faster horse…[you see, he said] It’s not the customer’s job to know what they want.” When you create a trillion dollar company and the iPhone, you get to say stuff like that.

How would your life be different if Steve Jobs designed your EHR? Could a dream team from Apple design a perfect hospital without any input from the physicians and nurses who will work there? What if they said,” it’s not the doctors job to know what they want because we know what’s best for them.”

Yeah, probably not.

Medical space design is something we take for granted everyday, often only crossing our minds when we’re frustrated about it. And sometimes it’s really frustrating. Much of this frustration originates from the gulf between those who design these spaces and those of us who actually work in them. It effects our work, our mood and as research is now showing even patient outcomes.

As a trained physician and architect, Dr. Diana Anderson (the “Dochitect” as she is known) understands this better than most. She has worked on hospital design projects in the US, Canada and Australia, and is widely published in both architectural and medical journals, books and the popular press. She’s currently a Fellow at the Harvard Medical School Center for Bioethics. Just the kind of unique perspective we love to find on the show.

When it comes to problems in design, and medicine in general, perhaps we’re all looking for faster horses when what we actually need requires a different perspective. With that said, let’s get started…

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28 Days That Saved a City. Dr. Mona Hanna-Attisha & the Fight for Flint.

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Name: Mona Hanna-Attisha, MD

Specialty: Pediatrician and public health advocate

Location: Hurley Medical Center: Flint, MI

 

Today it’s our distinct privilege to have Dr. Mona Hanna-Attisha on the show. Before her best selling book, her countless TV interviews, before Time Magazine named her one of the 100 most influential people in the world, “Dr. Mona” (as she is known) was just another pediatrician taking care of children in one of the poorest cities in the country.

If you’re like us, you probably think you know the Flint story pretty well. This episode may change your mind. Here’s some things we didn’t know:

  • Flint Michigan was once one of America’s most prosperous cities. Many historians say the middle class was born there.
  • The crisis began when the city switched its water source to the Flint river. This river was once so polluted it caught on fire twice.
  • The entire crisis was completely avoidable, like 80 bucks a day avoidable!
  • Lead poisoning may be one of the largest threats to American children today. It’s literally everywhere around us.
  • The first abortion pill was made of lead
  • The same thing happened that happened in Flint happened in Washington DC in 2004. Thousands of adults and children were exposed to high levels of lead contamination and we still have really no idea what the long term effects will be.
  • Choosing to be a whistleblower carries tremendous risk. We only hear of the success stories. We never hear of about the whistleblowers who lose their jobs, go bankrupt, get divorced and even commit suicide.

This is an amazing and heroic story, but also a haunting one. You really have to wonder…what would have happened to Flint if there wasn’t a Dr. Mona to stand up and fight? We really don’t know. The best we can hope for is that by sharing her story, others may find the tools and the inspiration to do the same. With that said let’s get started…

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Emergency Medicine at 30,000 Feet: Dr. Paulo Alves, Global Medical Director for Medaire.

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Name: Paulo M. Alves, M.D., MSc, FAsMA

Location: Phoenix, AZ.

Specialty: Cardiologist & Global Medical Director for Medaire/ International SOS

If you fly often, it’s only a matter of time before you hear those not so welcome words over the intercom: “Is there a doctor or medical professional aboard?”

So, do you hit your flight attendant button, or wait for someone else to do it first?

When you’re stuck at 30,000 feet, options are limited. You might even feel a little like our past guest, Dr. Gavin Francis, serving as the only doctor available in a remote Antarctic research base.

So what are your options? Who can you call for assistance? Is there medical equipment available? What are your legal risks and ethical responsibilities? How often does this stuff actually happen?

Today we’re going behind the scenes with Dr. Paulo Alves, global medical director for Medaire, a company contracted with most the world’s commercial airlines to provide real-time medical assistance from their emergency command center in Phoenix, Arizona. If that’s not exciting enough, they also specialize in emergency medical evacuations, crew training, and medical and security preparations for private jets, yachts and even cruise ships.

It’s a fascinating world many of us know very little about. With that said let’s get started…

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