This month’s episode of “News You Can Use” on HealthcareNOWRadio features news from the month of December 2023
News You Can Use with your Hosts Dr Craig Joseph and Dr Nick van Terheyden
The show that gives you a quick insight into the latest news, twists, turns and debacles going on in healthcare withmy friend and co-host Craig Joseph, MD (@CraigJoseph) Chief Medical Officer at Nordic Consulting Partners and myself, where every diagnosis comes with a side of humor. We hope you stay curious, stay engaged, and keep seeking the truth in healthcare in a world that thrives on information.
Buckle up as we dive into the ER of excitement, the ICU of irrationality, and the waiting room of wacky wisdom in this months show that features a review of:
GLP-1 Agonists
Our main focus was on the increasing use of GLP-1 agonists like Ozempic for weight loss and the challenges around long-term adherence and weight regain after stopping the medication. With lots of buzz, even more so as Oprah recently publicly acknowledged her own use of these medications, but as she and others note, they alone are not the answer.
We talk about physician burnout, with a startling 1/3 of academic physicians indicating moderate or high intention to leave their jobs within 2 years. Looking to combat this worrying trend, leaders should think about being “supportive” and making sure of organizational alignment with physician values.
We close on an interesting data point from Epic’s research that showed Hispanic women diagnosed with breast cancer on average 7 years earlier than white women, raising many questions about potential reasons for this disparity.
Perhaps the key highlight this month and perhaps for the year is to focus on the need for balance in all things that we do in healthcare.
We hope you enjoy our take on the latest news and developments in healthcare and want to help you keep untangling the web of information, dodging the sensational pitfalls, and emerging victorious, albeit a little dizzy, on the other side. In the end, the stories we uncover, and the discussions we ignite, all shape the narrative of our shared future. We want to hear from you especially if you have topics covered or questions you’d like answered. You can reach out directly via the contact form on my website, or send a message on LinkedIn to Craig or me.
Until next month or year keep solving healthcare’s mysteries before they become your emergencies
Listen live at 4:00 AM, 12:00 Noon or 8:00 PM ET, Monday through Friday for the next week at HealthcareNOW Radio. After that, you can listen on demand (See podcast information below.) Join the conversation on Twitter at #TheIncrementalist.
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Raw Transcript
Nick van Terheyden
Welcome to the month of December. I’m Dr. Nick.
Craig Joseph
And I’m Dr. Craig.
Nick van Terheyden
This week we will be dissecting the latest healthcare news, unraveling the twists and turns and making sense of some of the debark rules.
Craig Joseph
Just remember, life’s a lot like breaking news stories unpredictable, often absurd, and occasionally leaving you wondering if it’s all just a cosmic prank.
Nick van Terheyden
This week, we take a look at burnout and doctors quitting. And
Craig Joseph
we also dive into guidelines on health, wellness, obesity and weight management and breast cancer diagnoses.
Nick van Terheyden
But first off this week, we’re going to dive into GLP one agonists and I’m going to put you on the spot Craig GLP. What does it stand for?
Craig Joseph
Gosh, we’re living proud. It’s Oh, there you go. I that for the record. Ladies and gentlemen, I just made that up. I
Nick van Terheyden
glucagon, glucagon like peptide one receptor agonists. They
Craig Joseph
go, there you go.
Nick van Terheyden
I gotta be frank, if I didn’t have Google on my side, I probably would have failed at that. But I have been focusing a fair amount on it. And, you know, let’s, let’s dive in a second, there’s been a lot of news, some of it more surprising than others. Let’s pick off the first piece that I don’t know if I should be surprised, I think the endorsement of some of the more famous individuals, in this case, Oprah Winfrey, not somebody that I’ve spent a lot of time following, but she did have a book club. And what I did notice with her book club was as soon as somebody had their book featured in her book club, it appeared in The New York Times bestsellers list pretty much. And to be clear, I’ve read some of them. And I’ve only felt as good as that for me. And here she is, she’s come out categorically and said, and interestingly, she didn’t say I use it all the time. She says it’s part of her solution. I think that’s what I heard. What did you hear and what are your thoughts?
Craig Joseph
Well, I you know, she’s been very involved with organizations like Weight Watchers, and and certainly that’s been a hold
Nick van Terheyden
on a second. I think she’s an investor, isn’t she?
Craig Joseph
I said involved? Oh, okay. I said involved. That that’s me being careful to not overplay or underplay. But yes, I do think she’s an investor. You know, Nick, when I give Oprah advice about financial things, she calls me up fairly regularly. I have to be honest. And, you know, what should I invest in? What do you think about stocks? You know, those kinds of questions, I try to give her the best answer. I can, Nick. That’s all I’m saying.
Nick van Terheyden
And have you managed to get your book into the Oprah book club yet?
Craig Joseph
I thank you for mentioning my book,
Nick van Terheyden
designing for health. It is just so that it is those of you that haven’t read it. It’s a riveting read, riveting.
Craig Joseph
Now, they think you’re being sarcastic? No,
Nick van Terheyden
not at all. I never.
Craig Joseph
Well, thank you for mentioning it. And no, I have not been successful. I’m getting in on on Oprah’s book club. I’m thinking of starting my own book club. And we’ll see if I can rocketed up to the top of the bestsellers list. But an answer to your question. I think she’s doing a lot of different things, right. You have to eat well. I shouldn’t say you have to now you ought to eat well, you ought to exercise. You ought to be thoughtful about you know what you do with your body. And there’s all these medications out there now that can help as well. And I think it’s smart to be multimodal about this. It’s just taking a pill is probably not the best answer for everything that ails you.
Nick van Terheyden
Yeah, so And to be clear, some of the data that’s emerged in the last several weeks, let’s let’s talk about a couple of the things that I saw, first of all, and I don’t know that this spans across every single individual version of this category of drugs, but some are of the order of 50% of people are no longer on the therapy at the end of the year. And, you know, that’s problematic. It’s as a result of the side effects which are I don’t want to define as serious or unserious, but they certainly cause a cause enough problems that people stop taking the drugs so that means that they’re not going to be useful for obvious reasons. And then the other thing that seems to be rather similarly clear, although you know, we don’t have a huge data set is that if you stop taking the drug, it seems to be that the weight starts to return. So it’s that appetite suppressing element, which is contributory, whatever, I don’t think you can just take this and then stop and say who I’m there, if that’s what you’re desiring to do, which, of course, creates some challenges. And I think you’re right, as you highlight Oprah’s sort of approach to this, which is, you can’t just have it as a drug, it’s got to be part of a whole program of activity, you know, and I think the supporting services, and if I was hard on anything, I think it’s the digital health companies that say, we’re going to incorporate this, but we’re going to have a whole program around it that says, you know, break the cycle. I mean, I’ve seen it in a number of cases. And it’s I know, people are ecstatic with the results truly ecstatic. And I know how hard it is, I’ve certainly gone through my, you know, cycles and challenges, you know, I’m currently good, but I could not be, it’s great to sort of break that cycle and get out of it. And then it’s slightly easier to exercise and do better things. But I’m a little bit troubled by the fact that Europe is showing a shortage of these drugs. And it’s not the manufacturing, it’s the fact that they’re shipping them all to the US, because that’s where they’re making all the money out of them.
Craig Joseph
Yeah, well, certainly, there are some people here who are not obese and are just trying to, you know, lose some weight, and it’s not what the med was, was intended to do. And I think we’ve always had questions of, Wow, the initial data are amazing. But what happens after a while? And is this a medication that you need to be on forever? And, and so, if it and what happens when you stop? And we’ve we’re starting to see some of those some of those answers. So the question is, are there other things that you can do while you’re on the meds? And these are all just rhetorical questions that I don’t think we know any of the answers, but, you know, while you’re on the, on the meds, and they seem to be having, as we’ve talked about before, they have other effects? So certainly, there’s some side effects that we don’t want but they seem to be not only do they decrease your urge to, to over indulge in eating, but they might be helping other urges that are things that you would rather not be doing so watching, you know, watching less TV playing fewer video games,
Nick van Terheyden
like GLP drunk stop you from watching, too. I did not know that. They
Craig Joseph
can. Yeah, they they have something with the retina. It’s a retina thing. Yeah, no, I, there are all kinds of kind of claims that are out there. Again, this is all so preliminary. So we don’t really know but like that. You’re on social. That’s certainly one I read that you’re on social media less right now, again, or if these are things that you’re trying to stop doing, like, Hey, I don’t want I don’t most people that smoke, I would think if you ask them, like yeah, I’d rather probably not be smoking cigarettes, right? They’re hooked. And they don’t like the feeling when they stop. And they know that that’s not good for their health. And they know that it costs a lot of money and they know that it’s taxed like crazy. And if they could stop any word and so these, these GLP one agonists seem to help with lots of different things. I’m not saying that they don’t cure everything that ails you or decrease all of your all of the things you do that you’d rather stop doing but they seem to help with some Now my point being well, you’re on the meds let’s assume you’re not going to be on it forever. While you’re on the meds can we re Can you you know, change the way you do things? Can you start exercising regularly? Can you you know, retrain the way that what you buy when you go to the grocery store and how you eat and how fast you eat? Are there opportunities that are there for you while you’re on the mend that when you stop, inevitably, maybe taking the met that these now these better? Kind of workflows that you’ve established, either externally or internally are there and they’re still there? And, you know, it works. I just feel like even in my own in my own life, you know, if you see you know, if you’re exercising and eating better, and you see a reduction, you see the effects you know, you get clothes fit better and other clothes you couldn’t barely fit into now fit. Like that’s your incentive to keep going. Right and I gotta
Nick van Terheyden
say that I had the reverse experience my clothes, but yeah, my clothes start freezing better. unable to sax on. All right, I think if I didn’t keep I didn’t keep
Craig Joseph
you’re agreeing with me you’re.
Nick van Terheyden
Yeah. But that was actually a very positive experience I did, I didn’t feel good. Also a little bit embarrassed when I looked at the size of some of the things that I did fit into. So, you know, certainly been my experience. And, you know, I’ve managed to break the cycle. I think one of the things that’s interesting, too, it’s surprising that, you know, there’s some question as to whether it returns, and I think we still don’t fully know. But, you know, if you understand the psychology, the physiology, even, of eating and gaining weight, if you’re at a weight of 100, and you put on 20 pounds, and you’re now at 120, and then you go to lose five pounds, your body fights that as if 120 is now your new norm, the norm keeps moving up. And the fact that you can break that cycle with these drugs, bring it down, and maybe bring it down to 100. Maybe that resets the normal. So, you know, there’s potentially some great news in here. And I think, fantastic. I mean, I mean, I’m truly excited for people because like you smoking, you know, I’m sure people don’t get up going, how can I continue this? It’s how can I not, and there’s, you know, there’s a pathway to that point. There was, you know, some guidance and some commentary online on this whole advice, particularly for younger patients, which was your area of specialty, right. And we’ve seen this, we’ve seen the sort of transition to the younger age groups, we’ve seen more obesity, we’ve even seen more diabetes, I think, as a result of that. And two different groups came out with different guidelines that to me, were a little bit surprising. I’ve got to be honest. One said, you know, diet exercise, and the other said, gosh, we should focus on ozempic and surgery. You read it? What did you think? Well,
Craig Joseph
I think that both of those characterizations were a bit extreme. So the two organizations,
Nick van Terheyden
extreme opinions online, shocking.
Craig Joseph
I know. Yeah. I think with as with so many things in life, Dr. Nick, somewhere between the two extremes is probably the best area where exactly the most accurate and the most honest, the US Prevention Task Force, which is is not really a government organization with kind of a third party group that is collected experts around the country or are asked to come and give recommendations about healthcare usually about prevention and, and you know, how to deal with certain common problems and they their report on kids and obesity, there’s certainly an obesity epidemic, no one questions that. And their recommendations were kind of along the same where they were a little bit more conservative. So hey, kids should exercise more, they should eat better, they should avoid all the things that are, you know, empty calories, like juices and, and fast food and some of those things. Whereas another group that talks about kids all the time, the American Academy of Pediatrics, which I am a dues paying member, their recommendations were were certainly aligned with that, but kind of adding a little bit of hey, when appropriate, and I think that’s the thing that was missing. Physicians should consider both. See how I’m See how I’m playing that diplomatically. Consider both medications, these GLP one agonists and, and other medications, and bariatric surgery as appropriate. And I don’t think that any of that is I think the controversy is, well, how aggressive you know, is it supposed to be that you take your kid to the doctor for a checkup, and your doctor says a kid’s a little overweight or, you know, significantly overweight? And just like, hey, we’re not going to talk about any of the common things. We’re not going to talk about how much they exercise, we’re not going to talk about their diet, we’re not going to talk about anything else. We’re just going to go and here’s the script. Like, that is not the recommendations of the American Academy of Pediatrics. However, I think that they are seemingly more open based on evidence that they’re interpreting that’s out there now that these are medicines the medicines are should be in your on your list of have in your toolbox in your toolbox and armament. terrarium, but that’s probably not the best term. Yeah, toolbox. Sure, and that they’re okay to use. But they should I don’t think anyone thinks that they shouldn’t be first line for kids. And I’m not sure that they shouldn’t be first line for, for anyone I think you should always have a conversation about. It’s a very different conversation, to walk in to your doctor and say, I’ve been working I’ve been, I’ve had this problem for my entire life. For the last two decades, I’ve tried this, I’ve tried that I’ve tried, you know, I’ve tried, I’ve talked to the nutritionist, I’ve done all of those things. And none of those things seem to help me or help me as long or as effectively as I want. That’s a different conversation, then yeah, I’d like to lose some weight.
Nick van Terheyden
So I you in our conversation about toolboxes, I’m reminded of my first ever medical bag, and it was actually a gift to me from some fellows that I used to get out. And we had a shooting club we were in, it was a clay pigeon shooting club. And we were shooting one Sunday afternoon and the clay pigeon firing device sort of shattered, and this clay came flying out and hit somebody in the back of the head and they started bleeding wasn’t a terrible injury. But you know, it was, you know, bleeding, and, oh, they all called for me. So I ran to my car because I had not a doctor’s bag, but a plastic full of all my bits that I carried around. And despite the fact that this was a very serious, I wasn’t very serious, but it was serious. And I came running along, all I got was laughter I was laughed out of the place and they all clubbed together and bought me a proper fancy medical leather bag as a result of that. So. So I’m, I’m reminded of that wonderful story of my very good friends from many years ago when I was practicing. But anyway, so speaking of doctors, and you know, at the time, I was certainly a struggling young junior doctor, definitely burnt out. I’ve talked a lot about that, both on this podcast, and even in in pubs, blogs that I’ve written. We’re seeing a huge exodus or certainly an intention to leave. I think I’ve mentioned it, you know, with some of my individual interactions with clinicians, there was a article just recently published that sort of built on prior work that sort of talked about this, you know, intention to quit. And they’re finding that even more people are indicating a moderate or higher intention to leave their job within two years, which, given that we, I think I’m right in saying we have a shortage of physicians, is that true? We’ve got a bit of a problem, right?
Craig Joseph
We we have a shortage. Now, and it’s often it’s getting worse. But you know, the shortage is seen in certain areas more than others, right. So rural areas have far fewer physicians than urban areas. However, you know, this study which looked at academic doctor, so these are Doc’s that work for large academic medical centers, like universities, typically, a third of them, wow, according a third, right, that’s the number 32%, moderate or high intention to leave in the next two years. So, you know, is it safe to extrapolate that to all physicians?
Nick van Terheyden
I think you mean like a parachute study? Yes,
Craig Joseph
that’s a I’m not sure a lot of people remember that. But, you know, can you say because academic medical doctors are kind of burned out, and a third of them might be leaving in the next few years. Can you say that is true of Doxon urban air in rural areas and doctors and private practice? I think you can’t just that’s based not so much on science, but on talking to these folks. And, yeah, it’s not any easier out in private practice. In fact, many could make arguments that it’s more difficult, right? You’re having to make payroll. And as an academic doc, you’re kind of just you’re working and doing research and all that other stuff. But one of the things, though, that I thought was, was helpful that this article pointed outwards, things that actually help, you know, what can what can be done to lessen the likelihood of a third of physicians in the next two years, leaving practice either retiring or going to find something else to do. And number one on the list was supportive leadership, right? These are if you’re working at a big academic center or a big healthcare system, having leaders who seemed supportive and not just looking at you like cogs and you know, things that you’re not producing widgets and another factory. Just that kind of that feeling of support, I understand I hear you, I’m trying to help you was a big a big differentiator between people who are thinking of leaving and people who are seemingly going to stay are the things that they found organizational alignment with the doctors, personal values. So does the organization I work for seemed like they’re really trying to help people? Or is it seems like they’re trying to build another another nice building and maximize the amount of marble that they can put in the lobby. And finally, a point that really warms the cockles of my heart, helpfulness with the electronic health record. Right? Can Are there people out the organization who are actually trying to make it a tool that I can use as as opposed to a tool that’s used against me? Hmm.
Nick van Terheyden
I’ve always felt that was like the definitive requirement. You can have have something but as long as you don’t use it against me, so I’m willing to share my data, as long as it’s not used against me to the point of healthcare data. And EMR has certainly been used on both sides of that. So it seems like basic stuff to me, but then it’s been listed there. It obviously isn’t, the must be an awful lot of this stuff going on. It’s a little bit shocking. And I guess somewhat surprising. Let’s talk a little bit about epic research. I know a favorite area of yours. Lots of studies keep popping out some I look out and go interesting others, you know, not so much. That’s all individual. But I’m always excited about it. I think it’s an interesting source of information. The most recent, I actually wasn’t that recent, but the one that sort of struck me was the Hispanic women diagnosed with breast cancer them more than seven year young, seven years younger than white women on average. And I I just I gotta say, I started scratching my head, I couldn’t understand i i saw no sort of light through this as to what that was all about. Any thoughts?
Craig Joseph
Well, it’s it’s, it is counter intuitive, right? Because typically, more marginalized parts, right groups are not the ones that are getting the preventative care. And so and that’s what we’re talking about. with breast cancer, you know, are you getting your are women getting their mammograms. And so the interesting thing about epic, it’s an electronic health record company, I used to work there a while ago, they have access to all of these data points that are just really hard to believe. And so they say in this article that they they evaluated almost half a million diagnoses of breast cancer, more than half of them almost 480 5000 that we’re in their electronic health that that their customers, you know, that are in records that their customers shared with them. And that’s between its and in five years between 2018 and 2023. And so first of all, that number is very, very large. And so the larger your n is the more accurate and likely you’re more valid the results can be and so it’s hard to explain this, that one of their this is not a formal, peer reviewed journal article. They’re they’re basically just putting out some data points and saying, Hey, isn’t this interesting? And one of their suggestions was, well, maybe Hispanic women are getting diagnosed, not because of mammograms, but because they actually had symptoms. And and why would that be? I don’t I have no answer. As
Nick van Terheyden
in they they’re actually getting cancer at a higher rate. I mean, it’s is it a higher rate of cancer that’s occurring in that subgroup? While at an earlier age, is that a possible? I mean, there are so many threads to this, that sort of raises questions that you go, I’d really like to know more. Well, that’s maybe my pushback on this. So you did it. But tell us some more? Well, there’s,
Craig Joseph
you know, there’s I’m looking at the data now, and they say that 38% of Hispanic women were recently screened. I’m not sure I’m sure they define that within one year, as opposed to white women in the US. 48%. So 10% difference there. In terms of recently screened, wow, so clearly Hispanic women and are not screened at the rates that right we wish they would be. You know, we want 100%
Nick van Terheyden
Your point of equity unfortunately.
Craig Joseph
Yeah, well, well,
Nick van Terheyden
we find ourselves at the end of another episode and at the end of the year, exploring health care’s mysteries before they become your emergencies. Until next time and until next year. I’m Dr. Nick.
Craig Joseph
And I’m Dr. Craig.
