This months episode of “News you can Use” in the traditions of “Ask Me Anything” on HealthcareNOWRadio features news from the month of May. You can read more about the series here and the concept of keeping up with innovating in healthcare. Please send me your suggestions on topics you’d like to see covered. You can reach out direct via the contact form on my website, send me a message on LinkedIn or on my Facebook page (DrNickvT), or on Twitter tagging me (@DrNic1) and #TheIncrementalist or you can click this link to generate a ready-made tweet to fill in:
As I did last month I am talking to Craig Joseph, MD (@CraigJoseph) Chief Medical Officer at Nordic Consulting Partners. Thanks to sponsor Atlantic.net for supporting this episode.
This week we dive into the latest CDC guidance for those that are fully vaccinated and in particular face covering requirements. This mirror much of what is already taking place in the US. We review the recent media attention to the rare neurological condition associated with vaccination (Acute transverse myelitis or ATM) and Craig breaks it down the risk assessment we all need to be making. We talk about the news out of Florida and the private school won’t employ vaccinated teachers, staff and this leads to the history of vaccine resistance that in large part gained a lot of momentum thanks to an individual out of the United Kingdom and a worthwhile book (The Doctor Who Fooled the World) that details the great work of Brian Deer exposing the truth behind the fraud perpetrated on millions of people, and we talk about the inequity in the roll out of Digital Health that sees 37 Million people without internet or PC access.
Shout out to the folks at LexisNexis Risk group who produced this great version of “Times Like These” (So much talent, array of instruments and professional studio setups)
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.
Listen along on HealthcareNowRadio or on SoundCloud
Raw Transcript
Nick van Terheyden
And today, as usual each month I’m delighted to be joined by Dr. Craig Joseph. He is the chief medical officer at Nordic consulting partners and also my regular appearance for news you can use. Craig, thanks for joining me. Pleasure. As always. Today’s episode is sponsored by Atlantic dotnet, the award winning cloud hosting company trusted with securing critical data for over 25 years. They’re industry leading HIPAA compliant cloud hosting solutions are backed by a fully audited 100% service level agreement and customer satisfaction guarantee. Get started today with your free trial at Atlantic dotnet. So Craig, this month, as usual, we’re now years into the pandemic. We continue to sort of focus on it. A little bit of news coming out of the CDC on mask and mask guidance. Any thoughts? And where does that fit into what you do day to day?
Craig Joseph
Yeah, well, the the thoughts are, I’m glad they they put out some guidance, and people have probably been doing a lot of the things that they’re now telling us that we can do. So. Yeah, you know, if you’re fully vaccinated, and just to go for definitions, fully vaccinated means at least in the United States, you’ve received two, you’ve received your your at least two weeks away from your your final dose. And so if that was a single dose j&j, that’s two weeks after that, or two weeks after your second of the Pfizer or maternal vaccine. So that Yeah, the recommendations are that you can go outside and do lots of stuff, if you’re fully vaccinated. And if you’re not, you should probably be wearing a mask or not doing some of those things. And I think the, you know, the, the simple way of looking at it was, or at least is if you’ve if you’re fully vaccinated, you’re probably okay to be outside without a mask at no risk to you or others, as long as you’re not in a large crowd. And I think that’s good advice. That’s the advice that I’ve been following even, quite frankly, before I was vaccinated.
Nick van Terheyden
Oh, Tish, Tish, you mean, you’ve not been following to the letter of the guidelines? I,
Craig Joseph
you know, there’s this thing called science. And I’ve been reading some of the, you know, articles for the last year. And the risk is so was so infinitesimally small, if not non existent when you’re just walking outside. And so yeah, if I’m walking outside, on the sidewalk, in the suburban area, where there’s not a ton of people, I don’t, I don’t think I needed to wear a mask long before I got vaccinated. And if I saw some people coming towards me, either they or I would, would move a little onto the grass or so we’re at least six or 10 feet away from one another. And, and I think that’s been fine. So it’s now officially fine. If you’re fully vaccinated, according to the CDC, and that’s great. We definitely want the government to start to paint a picture of the benefits of vaccination, I think. And so anything that the government does to say like, Hey, here’s some, here’s some of the good things that can happen when we get to enough of our enough of the population to be fully vaccinated. Anything Did you know, push people in the right direction, I think is a good thing. So I applaud them. And you know, want more I totally understand that their their scientific conservative organization. And that’s, that’s fine.
Nick van Terheyden
I think that’s the point, isn’t it, that that conservative because I want to sort of open things up appropriately. So it’s interesting, you may mentioned the science and the papers, I actually just reached over 500 papers in my stash of reading material for last year. All of the things that I process much beyond anything, I’m pretty sure I read in my entire medical school career.
Craig Joseph
Yeah, you know, it’s funny, the, the Master of Public Health degree was never something that I was even remotely interested in. Now, I think if I won the lottery and didn’t have to work anymore, I might go get one of those n patches. I just
Nick van Terheyden
even seen some online courses to give people a sort of foundation and I bet in my stack of watching material that I get to less frequently than I do for the reading. So all right, so I agree. I mean, I think opening things up to where they pretty much are. And you know, that’s good news. Some commentary about the complications, I think we’ve seen a little bit of headline grabbing, rare neurological condition, in this case, acute transverse myelitis, which is inflammation of the spinal cord is occurring in a number of cases. But not that many. I think the number I saw was 43. And that’s in the total of the countries covered. So we’re talking millions. So I think the incidence was less than one in 2 million or so. So not frequent, not to be discounted. There are other more pressing problems around long COVID.
Craig Joseph
Yeah, well, absolutely. And every, every everything we do has risk. Right, walking outside our front door has risk taking a vaccine for the flu has risk. And, and and so, you know, I think what you have to do is judge what is the risk of, of doing that thing versus the risk of not right. And so it’s certainly we want to make people aware, it’s similar to the Johnson and Johnson vaccine, there was a risk that we were not aware of found out about it. It’s still highly unlikely and you know, I think moving forward is most definitely the right thing to do. So transverse myelitis, Qian baray, there lots of diseases that are can be associated with, with vaccination, but the incredible benefits that come with it, from a societal standpoint, are clearly worth it. And yeah, you know, it’s a, it’s a risk to get in your car to go on the airplane. But I still do those things.
Nick van Terheyden
And also to be clear, not just from a society benefit, but also from an individual medicine, getting that vaccine gives you opportunities to do things that otherwise would be a little bit harder. I have to give you credit, I think you are the origin story, at least for me, for the explanation I use all the time, which is the seatbelt analogy that you talk about, that you used to use with your parents explaining that you can wear a seatbelt, but that doesn’t prevent you from having a car crash and dying in a car crash. It’s all about risk. So absolutely. In the somewhat I don’t know what to describe this news. But apparently, if you get vaccinated in a specific area in Florida, there’s a private school that won’t employ you. Any teachers or staff if you’ve been vaccinated, thought, Well, I
Craig Joseph
have many thoughts. Few of which I will, I will verbalize to you now. But yeah, you know, this is a group, the the founders of this school, I was not aware of this, their existence until until I started reading about them a couple days ago. You know, they they’ve been against a lot of things, but I think the scientific community has shown to be effective and safe. And vaccines are one of those things. And so they hold theories, or at least the people that run that school that somehow magically bad things happen. When you get vaccinated, I think for pretty much every vaccination, but certainly for the COVID vaccine. And so they have, you know, put out a decree that for teachers at their school, they are concerned for the safety of their children, and hence won’t allow their teachers to be vaccinated because they hold the belief. And I say it’s a belief because it’s there’s no science to in any way support this, that that adults who are vaccinated for COVID are somehow a healthcare danger to children.
Again,
Craig Joseph
it’s a great idea. Sorry,
Nick van Terheyden
I cannot hold my tongue for a second longer. It is you, you I it’s just shocking to me that that level of misunderstanding at best, and I that’s being generous of science, proven science that continues to be perpetuated. That seems in large part And to be clear, the anti vaccine movement predates Andrew Wakefield and his debacle of the 12 children that he published a study that was ultimately withdrawn. But that seems to be a sort of inflection or seminal moment. And you know, at this point, just a quick shout out to Brian deer who was the author of the excellent book, The Doctor Who fooled the world. He was the one that originally broke that story, much to my shame. This all is centered at the Royal Free hospital School of Medicine, which is where I trained and I’m very sad that we’re associated with that. Some of the people that I know got sucked into all of this, inadvertently, I’m not so sure any of it was entirely delivered. I think there was a lot of whirlwind around this. But one of the things that really challenges my thinking around this is, how is it that the United States of America welcomes Andrew Wakefield, brackets, not adopter, he was struck off the medical register for his disservice, fraud and changing of results proven? How is it that he’s allowed to come to the United States and live and work here?
Craig Joseph
I have no idea. You know, people are free to have their own opinions. Right. And, and when they have opinions about things, this is where it gets awkward for, for me, right. When they have opinions, you know, I have an opinion that I like a particular sports team, that that is clearly an opinion. And there’s no fact around that my sports team is the best sports team that there is. I acknowledge that other people like other sports teams, and that those are just opinions. However, when folks talk about their opinions as if they were facts, and discounting what we know about how the world works, and discounting the scientific process and how experiments work, you know, that it’s, it’s a danger. And so you can come you can say whatever you want, it’s it’s and I think one of the major problems that we have, in the US have many problems that we’re having in the US is the inability to critically reason, among a large proportion of our population. And so, you know, when you hear someone on TV, say something, and it doesn’t agree with, you know, tenants that you’ve been taught for a long time, and that you can, you know, prove empirically, you should question that. And I think some people don’t, and apparently, a lot of the parents at that school, don’t. That’s all that that’s all that I, you know, that’s all that I could come up with. Because,
Nick van Terheyden
well, I appreciate that. And I think, you know, reasonable analogy. It’s just a big struggle for me, because I know how hard it is, as an immigrant myself, to get into this country and prove that, you know, I have value to bring in, you know, appropriate measures and so forth. I know that immigration is an emotional subject, but I’m an immigrant, and therefore, I’m grateful to be here, but I just I struggle with that. Anyway, so those of you just joining, I’m Dr. Nick the incrementalist today, I’m talking to Dr. Craig Johnson, Chief Medical Officer at Nordic consulting partners, we’re in our news, you can use segment, just a reminder on today’s sponsor, and you can get started with your free trial at Atlantic dotnet. The simple solution for your HIPAA compliance and cloud hosting needs. We were just talking about vaccines and the debacle of anti vaccines. And, you know, the challenge that we’ve seen in terms of adoption was sort of we seem to be plateaued a little bit in the United States with COVID-19. What I’m hearing, almost universally and in fact, my email, I, I think I probably got 16 invitations to go register for a vaccine. And I’m pretty sure I did not register at 16 different sites, it seemed like something got stuck somewhere. But an indication that supply now exceeds the demand. I’m hoping that perhaps the United States might take the responsible and world leading position and start to allow for and actually promote the distribution of that on a more international basis to countries that are in desperate need of it. India being a case in point.
Craig Joseph
Yeah. And that you know, I think I agree with you. And my understanding is that we are sending some some vaccine that is not not yet approved may not may not be approved, in the US the AstraZeneca vaccine, but as used in Canada and all throughout Europe, sending that to to to Canada to Mexico and also sending a lot of raw materials that are used to produce immunizations to India to help. I think one thing that I that a lot of folks don’t think about. Certainly we have a moral and ethical calling to help our fellow man, but it’s in our best interest here in the United States to try to eradicate this This virus as quickly as we can, and the longer that takes, the more we are at risk from variants, right, so this is a virus that quickly mutates. And most of those changes are bad for the virus in terms of transmission or, or how serious it is. But every now and then something changes and it makes it a little easier for it to get into the, into the human and to, and to do its damage. And the more that that virus has time to mutate, all it takes is one airplane trip away. And that all of a sudden, many of us might lose the protection that we have, it might be that certain vaccine doesn’t work as well, whatever. And so there’s, besides the moral and ethical, which should really be the only reason we need to think about but but if you don’t have that don’t work, think about those two things. It’s really for our own self interest that we need to help all these other countries to, to get this pandemic under control.
Nick van Terheyden
100% I think, you know, this is an international problem that will never be solved in a single country. We owe a duty to our fellow humans around the world, and especially now more than ever, we have an opportunity, and I’m glad to hear that we are. But, you know, the more we can do I think the better. Before we get into the next topic, I just want to give a quick shout out to the LexisNexis risk group if you’re interested. Go check out their times like these video which I have to say, truly outstanding. I have so many questions about this, not least of all, who is the individual that had this phenomenal recording studio, which I envy you know, as a podcaster of occasional activity, with you know, full on soundproofing and that talent. Wow, amazing. Just have you seen it?
Craig Joseph
I have seen it. And you know I for one always knew that the Lexis Nexis risk group was full of very talented singers and musicians. I mean, I always put whenever I think LexisNexis risk group, but I think of musical talent,
Nick van Terheyden
talented musicians. Yeah. array of instruments. Absolutely. They don’t know
Craig Joseph
anything about consulting or risk. Let’s be clear, right. But their musicianship is par par not absolutely
Nick van Terheyden
fantastic. So thinking about digital health, one of the articles that ran across over the last couple of weeks was the inequity in digital access, where we’re talking, that’s obviously one of my areas of focus, I know you have a passion for it. We see digital health as an old mentor of the service that can help solve problems. It’s not an answer in itself, but it really has the potential. But the point that was made in this is we have this massive disparity in access, both in terms of technology, you know, not just internet access, but also in PCs and devices. Not everybody has a smartphone. And certainly not everybody has a device bigger device to be able to access. We’ve seen Google, they have their Project Loon that is trying to launch into low Earth orbit provide access. In fact, I got closer to that than I would have expected through a friend who moved into a remote area that was their only choice. Shockingly, that’s $100 a month and there’s, you know, some equipment costs. I don’t think that’s going to solve it. How do we fix this? What is it that we need to do to help reconcile this access problem?
Craig Joseph
Well, you’ve you’ve pointed out, you know, a multiple issues, you know, the first being infrastructure, right? So, you know, do you have access to the bandwidth on the internet that you need in order to do telehealth visit or in order to have an EKG that you might do at your at your house get sent with the detail and quality it needs to go to your doctor to to have them review it? And so that’s, you know, step one, and step two is if you do, do you know how to use it. And that that’s an ongoing problem, you know, telephone, so just to kind of switch the conversation just a tad. today because of the pandemic. Most insurance companies and the federal government will pay for telephone consoles. And so what that means is if you’re talking to your doctor on the phone, in the before times, that would never be something that the doctor could build the payer for. But now they can. If it’s a if it’s a conversation of significant length, not just to you know, tell you something Very quickly. And so even a telephone conversation which I can’t see you, I can’t send you any information that that’s being reimbursed. And and now the government’s talking about should that continue to be? And I think it’s related to your question. There are folks who don’t have a smartphone, there are folks who don’t have a computer in their house, and their only way of getting information to hear from their doctor is either by going in to see them or via the phone. And I think until we get in now, finally answer your question, until we get to a point where this technology is as ubiquitous and easy to use as the telephone. We’re gonna run into problems and the problems are not on just the patient side, let’s be clear. I’ve had some telehealth visits where my doctor couldn’t get it to work. And we reverted to telephone. So again, I’m not questioning the doctors ability to understand the technology, nor to have the infrastructure in place, it just didn’t work. It’s still a young technology, and they’re just gonna be times where we’re that guy. I don’t know what happened. But I’ve only got this 10 minutes slot. So we’re just gonna move to the telephone only. And that’s happening to me. So I know what’s happening to to others.
Nick van Terheyden
So it’s interesting, you bring that up, I mean, a little bit shocking that they’re trying to put that particular genie back in the bottle and say, Oh, no, no, Now, why it no longer COVID, this doesn’t apply anymore, whereas it did, before or during AI, it’s for me a struggle. And I’m not saying it’s, they’re not going to try very hard. There’s probably somebody somewhere that’s got some vested interest in this Genie getting back in. But, you know, the telephone is a phenomenal resource to interact. And some people that’s their level of comfort, it used to be that the diagram showed, you know, older generation silver tsunami, where much that they prefer that, but that’s not actually true. They just didn’t have access and weren’t as comfortable. And I thought where you were going to go was literacy, not just with health, but you know, technology. I don’t think it’s so much of that. It’s, it’s more about access, because I saw it with my own mother, as soon as she had access. And in fact, speech was a big enabler for her. When Siri showed up, she stopped calling me and texting me with 17 different messages on how to turn off the mute button on their iPhone. It took that long when we were texting together. Whereas she could just say, mute my phone and Siri, and it worked. So I just thought, That’s terrible. We can’t allow for this. You have got to stop this crap.
Craig Joseph
Yeah, I will. When I when we stop this recording, I will take care of this. Are there any other inequities you would like me to fix any other disease processes you want me I can take care of the pandemic as well, if you’d like that.
Nick van Terheyden
I think we’re not going to call on too much from you. Beyond that, if you could just fix that. I think that would be all right. Perfect for us. I’m on it. Excellent. So a couple of minutes left, thinking about privacy and the allocation of all of this information that’s now in the digital domain. Do you think we’re doing a good job around that securing and cyber security of information?
Craig Joseph
Well, you know, it comes to a point where it doesn’t really matter. And and I think we’re about to hit, I’m not answering any of your questions today, Dr. Nick, I apologize. You know, we’re at the point where patients are going to be very easily, it’s going to be very easy for patients to take their private medical information out of some very safe spots, like the electronic health record, or the patient portal, and move it to a third party company. And with their permission, of course, and once that happens, I think we’re gonna see a lot of that information kind of get out or move around in ways that people didn’t anticipate, either they didn’t anticipate because they didn’t read the agreement that they signed, or that the people that wrote the agreement didn’t abide by it,
Nick van Terheyden
or the fact that it was 17 pages, and they couldn’t read it because yeah,
Craig Joseph
they had to get through and But usually, somewhere in there, it says you give us permission to share this information with x for this reason. And so so you know, to answer your question, are we doing a good job of keeping patient private information safe? Absolutely. Because there’s a lot of laws and a lot of incentives to do so. However, once that information kind of escapes out legally, with your permission, it’s out there, and it’s gonna be hard to get that, that genie back in. So I’m not saying it’s a bad thing.
Nick van Terheyden
This is another Genie you’ve got to stop. So I think this is the subject of a future conversation but unfortunately, As we do each week, we’ve run out of time. So I just like to thank our sponsor today, Atlantic dotnet. Keeping your focus on the patient is essential. And having the wrong cloud service plan can be costly. Start with your free trial of HIPAA compliance cloud hosting today at Atlantic dotnet. And from you, Craig, thanks for joining me as you do every month. It’s always a pleasure. And I’m glad that you’re taking on the tough problems in healthcare to help us fix them and stop them from putting that genie back in the bottle. So thanks for joining me.
Craig Joseph
My pleasure.
