The Healthcare Policy Podcast ® Produced by David Introcaso David Introcaso, Ph.D.

In Dobbs v. Jackson Women’s Health Organization, the Supreme Court in June 2022 reversed the court’s previous 1973 Roe v Wade decision, and 20 related cases, wiping out a half century of constitutional protections for women’s reproductive rights.  In Dobbs, the court found the Constitution now excludes a woman’s control over her body as well as the possible continuation of her life.  Compelled pregnancy, involuntary childbirth and forced parenthood is not, the court ruled, an essential part of the “liberty” protected under the 14th amendment - or presumably even the freedom of “involuntary servitude” protected under the 13th amendment.  Dobbs effectively demotes women to the status of an involuntary vessel entitled to no more respect than other forms of collectively-owned property.  Since some have termed the Dobbs decision a “break the glass” moment, Ms. Hoffman has published her “post-Roe abortion rights manifesto,” that leverages her five decades of reproductive rights work to shed light on the repercussions of overturning Roe and work she believes now needs to be done, or redone, to ensure the safety and legality of reproductive rights. 
Ms. Merle Hoffman is an American author, activist, feminist health care innovator who established one the first abortion clinics in the US, CHOICES Women’s Medical Center in Queens, New York. CHOICES also provides prenatal care, all-options counseling, GYN visits, mental health services, and trans health services.  Ms. Hoffman was the publisher and editor-in-chief of On the Issues magazine (1983–99) and is also the author of Intimate Wars (Feminist Press, 2012). She is the cofounder of the National Abortion Federation.
Information on Ms. Hoffman’s book is at: https://www.skyhorsepublishing.com/9781510776951/choices/.


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Over the past 12 years this podcast has discussed increasing corporate dominance of healthcare delivery, made evident in part by the fact the healthcare market is highly concentrated and highly leveraged, e.g., over the past decade private equity has spent roughly $1 trillion to acquire physician practices.  The corporate practice of medicine (CPOM) is problematic because allowing for corporate medicine can compromise a physicians’ independence and/or creates a conflict between physicians’ ethical duty to their patients and corporate interests in maximizing profits.  While states have historically prohibited corporate medicine, enforcement has both been limited and every state has created CPOM exceptions.  In part because the Biden administration has given priority implementing regulatory policies to promote market competition, there is renewed interest in revising corporate medicine statutes.   This past fall the AMA considered a resolution seeking a federal ban on CPOM informed in part by a 70-page report published last October by Take Medicine Back.  AMA delegates voted to refer the resolution to the AMA Bd of Trustees for further study. 
Dr. Mitchell Louis Judge Li is a practicing board certified emergency physician in North Carolina and founder of Take Medicine Back. Dr. Li has been an invited speaker to represent physicians to the FTC on the effects of mergers and acquisitions on healthcare, has spoken as a panelist at the Capitol Forum’s Conference on Healthcare Competition, and currently serves as the only physician-advisor to the Robert Wood Johnson Foundation’s committee on healthcare financialization. Dr. Li earned his MD at the University of Massachusetts and completed his emergency medicine residency at St. John Hospital in Detroit.
Information on Take Medicine Back is at: https://takemedicineback.net/. Their 70-page working paper discussed during this interview is at: https://qrco.de/beUEJm.
Sen. Warren’s Take Medicine Back video noted during the discussion is here.



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Research published last month in Advances in Atmospheric Sciences by Prof. Abraham and his colleagues once again show ocean temperatures, more specifically ocean heat content (OHC), once again dramatically increased in 2023.  (As I noted last year, many believe OHC is the best way of measuring anthropocentric warming because it is comparatively less variable on a year-to-year basis.)  Oceans, that cover over 70% of the earth’s surface, absorb roughly 90% of the sun’s heat trapped by an increasing Earth Energy Imbalance (EEI) due to our continuing inability to meaningfully curb our greenhouse gas emissions.  Oceans also serve as immense carbon sinks. Oceans determine the Earth’s energy, water and carbon cycles and increasingly warming oceans have an increasingly deleterious effect on the Earth’s climate and weather. Think: human survival, i.e., warming ocean water (and rising ocean acidification) disrupts marine life that in turn substantially threatens the availability of food we eat and the oxygen we breathe. 
John Abraham, Ph.D., is a Professor and Program Director in the Mechanical Engineering Department at the University of St. Thomas in Minnesota.  His studies largely concern geophysical science related to the climate crisis that includes the rate at which the planet is warming, particularly oceans.  His team’s warming measurements provide insights on future climate crisis effects over the coming decades.  Professor Abraham also studies the impact of increasing heat on the human body - information that has important health consequences particularly for at risk and minority populations.   Professor has conducted approximately 400 published scientific studies.  He is a frequent television and radio guest having participated in over 100 TV and radio interviews.   Professor Abraham earned his BS, MS and Ph.D. in  mechanical engineering at the University of Minnesota.
Prof. Abraham and his colleagues’ January Advances in Atmospheric Sciences article, titled “Another Year of Record Heat for the Oceans” is at: https://link.springer.com/article/10.1007/s00376-023-2385-2.


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In his soon-to-be-published book, Dr. Chaudhary argues the climate crisis or the Anthropocene era is the political product of rightwing climate realism - what he terms the “Rex Tillerson Position.”  Listeners should be aware politics, not technology or economics, explains why the US continues to emit an enormous amount of CO2e pollution. (The US healthcare industry contributes approximately 550 MT CO2e annually or roughly 9% of the nation’s total.) The politics of functional climate denialism, or the belief business-as-usual can mitigate global warming, has resulted in economic, ecological and social despair, disenchantment or in sum socioecological exhaustion.  What capitalism has built, Dr. Chaudhary argues, is an exhausted world.  Any workable solution or any effort to create a sustainable environmental niche requires a new climate realism.  Real ecomodernism he argues must be in sum grounded in decolonization - that essentially means the Global North no longer exploits the Global South.
Ajay Singh Chaudhary is the Executive Director of the Brooklyn Institute for Social Research and a core faculty member specializing in social and political theory. He holds a PhD from Columbia University and an MSc from the London School of Economics. His research focuses on social and political theory and economy, political ecology, media, religion, and post-colonial studies. He has written for The Guardian, The Nation, The Baffler, n+1, Los Angeles Review of Books, Quartz, Social Text, Dialectical Anthropology, The Hedgehog Review, Filmmaker Magazine, and 3quarksdaily, among others.
Information on the book is at: https://www.penguinrandomhouse.com/books/736324/the-exhausted-of-the-earth-by-ajay-singh-chaudhary/.


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Sepsis presents an enormous public health threat. There are for approximately 1.7 million hospital cases and 270,000 deaths per year. Sepsis is consistently in the top five for hospital case volumes and is the most expensive and resource intensive medical inpatient condition, representing approximately 15% of total hospital costs despite accounting for less than 4% of hospital stays.  Various studies estimate sepsis is present in 30% to 50% of hospitalizations that culminate in death.  Because two-thirds of sepsis cases are paid for by Medicare, beginning this January 1, HHS will add sepsis care Medicare’s Value-Based Purchasing/VBP program. Meaning, Medicare hospital reimbursement will be determined in part on adherence in meeting a multi-step sepsis treatment protocol focused on timely diagnosis and treatment.  Dedicated listeners of this podcast may recall ten years ago this week I interviewed Dr. Jim Palmer regarding the use of heart rate variability to identify the onset of infection.
During this 23-minute interview Dr. Scoggins begins by explaining why timely diagnosis of sepsis has remained challenging and why the Medicare program will now tie reimbursement to meeting a sepsis quality measure or protocol. He explains the SEP-1 measure, addresses concerns regarding the sepsis measure driving antibiotic overuse and administrative burden, whether paying for sepsis performance will unduly penalize hospitals serving poorer communities, how the Medicare rule will impact his program, comments on emerging technology improving sepsis diagnosis, the extent to which commercial payers will adopt a similar sepsis pay for value payment rule and finally why we are seeing more sepsis infections and mortality.
Robert Scoggins, MD, PhD, has been a practicing medicine for over twenty years as a pulmonary and critical care physician. He currently is Chief of Staff and ICU Medical Director at Kootenai Health in Northern Idaho. He earned his undergraduate degree in Molecular Biology from Vanderbilt University and his MD and a Ph.D. in Microbiology at the University of Virginia. Dr. Scoggins completed his residency in Internal Medicine and a fellowship in Pulmonary and Critical Care at Vanderbilt University.


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In part because there are over 10,000 known human diseases and symptoms thereof may have numerous possible explanations, frequently diagnostic tests can be in-determinative or less informative than observing (termed: watchful waiting) a suspected disease’s clinical course over time.  Because of diagnostic complexities population level diagnostic errors represent a significant public health problem.  Nevertheless, despite the progress made in treating cancer - as Ropeik writes in his introduction two-thirds of nearly 200 types of cancer are either treatable as chronic diseases or entirely curable - cancer today remains the emperor of nosophobias that in turn leads to over-screening, over diagnosis and false positives, over treatment, potentially harmful side effects, death and excessive healthcare budgeting and wasteful spending.  As one reviewer of the book wrote, “Ropeik details how the gravity force of cancerphobia warps risk perception, leading to personal and societal harms and legislative misdirection.” 
During this interview Mr. Ropeik begins by clarifying the book’s discussion is at the population level, disputes the belief cancer always needs be diagnosed as soon as possible and describes the US Preventive Services Taskforce’s (USPSFT’s) work upon which his book is based. He next discusses USPSTF’s (evolving) mammography screening recommendations for breast cancer, the prevalence of associated false positive diagnoses particularly related to DCIS (ductal carcinoma in situ). He discusses his chapter regarding environmental agents as cancer agents or contributing to the fear of cancer, the lack of a relationship between federal funding and the burden of disease, e.g., breast v pancreatic cancer funding. He concludes by discussing policy solutions that can simultaneously reduce cancer phobia and improve the effectiveness and cost cancer care.
Mr. David P. Ropeik is a retired Harvard University Instructor, author, and international consultant on risk perception, risk communication, and risk management. He worked as a television reporter for WCVB-TV in Boston from 1978 – 2000 specializing on environment and science issues, wrote a science column for The Boston Globe, taught journalism at Boston University, Tufts University, and MIT, was a Knight Science Journalism Fellow at MIT and a member of the Board of Directors of the Society of Environmental Journalists. Mr. Ropeik previously published “How Risky Is It, Really? Why Our Fears Don’t Always Match the Facts,” (2010, McGraw Hill), and co-author of “RISK, A Practical Guide for Deciding What’s Really Safe and What’s Really Dangerous in the World Around You,” (2002, Houghton Mifflin). Mr. Ropeik has also authored more than 50 articles, book chapters, and other essays on risk perception and risk communication published in The New York Times, The Washington Post, The Los Angeles Times, USA Today, Scientific American, The Atlantic Monthly, Health Affairs, Issues in Science and Technology and elsewhere. He writes a blog for Psychology Today and blogged at Big Think and The Huffington Post. Among numerous awards Mr. Ropeik is a two time winner of the DuPont-Columbia Award and seven regional EMMY awards.
Information on “Curing Cancer-Phobia” is at: https://www.press.jhu.edu/books/title/12956/curing-cancerphobia.



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