Healthcare in a Post-Election Landscape
This month’s episode of “News You Can Use” on HealthcareNOWRadio features news from the month of December 2024
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:
- The Election
- AI Safety and Government regulation
- Educating Everyone on Healthcare
- Carepods (Healthspot all over again)
- Robot learning and knots
From RFK Jr. to Dr. Oz: What the New Leadership Means for Medicine
This week, we discuss the future of healthcare in the wake of the recent election. They explore the potential impacts of new political appointees like RFK Jr. and Dr. Oz, and express some concerns about stance on vaccines and what these individuals if confirmed might bring to our healthcare system. One things is for sure the unpredictability of the next four years but maybe there is room for some positive changes.
Laughing Through the Pain
Dr. Glaucomflecken’s Take on Healthcare Chaos
We discuss artificial intelligence (AI) in healthcare and agree that while AI offers tremendous promise, it also presents significant risks, particularly in the absence of robust regulatory oversight. We discuss the need for caution and scrutiny when evaluating AI-driven solutions, and call out comedian, Will Flannery, (aka Dr Glaucomflecken)
who uses humor to shed light on the complexities and frustrations of the healthcare system, advocating for greater transparency and patient empowerment.
Carepods Collapse
The recent bankruptcy of a telehealth startup Carepods sparked a discussion about innovative care delivery models and soem thought son why they might have failed, perhaps because of their subscription-based business model, drawing parallels to the failure of similar ventures in the past.
We close excited by the potential of AI-powered surgical robots that can learn complex tasks like knot-tying through observation. They believe that AI is still in its early stages of development and anticipate even more groundbreaking advancements in the years to come. This concluding segment underscores their optimism about the future of healthcare, despite the challenges and uncertainties that lie ahead
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 week 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.
Listen along on HealthcareNowRadio or on SoundCloud
Raw Transcript
Nick van Terheyden
Welcome to the month of November. I’m Dr Nick and I’m Dr crag. This week, we’ll be dissecting the latest healthcare news, unraveling the twists and turns and making sense of all of those debacles. Just
Craig Joseph
remember, life’s a lot like a breaking news story, unpredictable, often absurd and occasionally leaves you wondering if it’s all just a cosmic prank.
Nick van Terheyden
This month, we take a look at robots and care pods, and
Craig Joseph
we dive into AI safety and privacy and Glock ’em. Flecket,
Nick van Terheyden
first off, this week, we’ve got to get into the election. Anyone surprised? Are you?
Craig Joseph
I think you’re talking about my daughter’s student council election? Yes, exactly. And that was I had predicted she was going to do quite well. She did. And so thank you for bringing that up in front of all of our all of our listeners. Oh, no, or it was in a different election year. Yeah,
Nick van Terheyden
it was, yeah, no, we’re we had a big one here that I’m gonna say the world was watching. Somebody said, Hold my beer somewhere. I think let’s see what we can deliver on. I mean, clearly there are some people around in our country who go, yeah, that’s what I thought would happen. That’s expected. I’m not sure that I did, irrespective of my political beliefs, which, you know, I’m not here to promote or push one way or the other. But I don’t think that was the way I thought it was going to unfold, and it was, I’m going to say, resounding on the sense of the Electoral College, which, you know, there’s a whole discussion around that, but not on the popular vote. I keep hearing that that number continues to decline, and may actually be less than 50% so it’s not quite the resounding mandate, but here’s my thing, or the relevance to us is, what’s that going to do for the next four years for health care and and in particular, the regulatory environment? We’ve seen a number of nominations. I have to say I’m, I’m just a teensy weensy bit concerned with RFK, Jr, who thinks that vaccines are a myth, and although he says he won’t ban them, I’m not convinced, and has a number of other beliefs. And most recently, Dr Oz, who over 50% of the content that he pushes out in his TV show, which I’ve never watched, but somebody analyzed has no supporting evidence whatsoever for for CMS of all things I didn’t know he was an expert in that space. Craig,
Craig Joseph
yeah, it’s if Yeah, these are, these are folks that are nominated to the position they they have to be, theoretically, they have to be approved by the
Nick van Terheyden
Senate. Mostly inserts the word theoretically, well, there’s, there are,
Craig Joseph
there are, there’s a way around that. But so I’ve heard, yeah, you know, I think it’s, I think the, you know, as a pediatrician, I generally tell people I’ve, I haven’t encountered too many vaccines that I’m not a fan of. There are, there are whole diseases that 50 years ago or 70 years ago were devastating to society and to anyone that was alive, that that I’ve never seen because of because of the power and the safety of vaccines, yeah, you know, with respect to RFK Jr, certainly no expert. I’m no expert on all of his positions. I know that some of the things he says make sense. So I will say that, like, you know, some food talking about food additives and coloring and talking about Ultra processed foods not being good for us. Hey, there’s science to support that. I think that’s a good thing to talk about. Other politicians have tried talking about that, mostly unsuccessfully. I think that’s great. However, there’s a lot of other things that he says, and you mentioned, kind of the vaccines and therapies for COVID that have absolutely no basis in science, those are very concerning to me, and that someone would be ahead of health and human. Services would, would believe those whether he pushes them on, you know, from policy or pushes them on us, is, is another question. But, yeah, so it’s a, it’s kind of a give and take. Dr Oz, clearly an accomplished cardiothoracic surgeon, but also someone who, when he when he got his TV show, kind of changed a lot, apparently, from people who knew him. And, yeah, I don’t know what interest he has in the Centers for Medicaid and Medicare Services. Or,
Nick van Terheyden
yeah, I do wonder, do you think somebody called him up and say, Hey, do you want, want this role? Or, here are the roles. What would you I just, I don’t know how any of that works, because I’m never going to be in that circle. Yeah, they
Craig Joseph
don’t call us for some reason. Dr, Nick,
Nick van Terheyden
not, not as yet, at least I haven’t had, I mean, well, maybe it went to spam. That’s always a possibility.
Craig Joseph
You could have been the CM just checked your spam folder.
Nick van Terheyden
Yeah, I gotta say that’s not, at the top of my list, for sure. Anyway, I think it’s going to be an interesting ride. It’s probably going to be a little bit bumpy. I’ve heard some interesting positives, you know, this is the time to sort of shake things up, to really try things out. You know, I’m not saying this is necessarily a good thing, but, you know, potentially, with the decrease in regulatory oversight, there’s more opportunity to try things that you go, Hmm, well, let’s see. And ultimately, there will be a Judgment Day, no questions. Subsequently, because if you unload solutions that do harm, you will be held accountable. So I think, you know, the onus is on us, the individuals within the profession. And you know those people putting it out who I think start with good intentions, most, most, if not all, or maybe not all, but most people start with good intentions, and I think they just go off the rails somehow. You know, it’s a small change initially, but
Craig Joseph
yeah, you’re that. You’re that’s a really great point to I want to emphasize the idea that sometimes even out of bad things, and I’m not saying it’s just necessarily a bad thing, but let’s talk about something that was a bad thing, COVID. Hey, we have telehealth now, and we barely had that before COVID, and it wasn’t because we didn’t know how to do it. It was because no one would pay for it, and now it’s paid for, and it’s really revolutionized the way healthcare is presented in the US that I take advantage of it, I can’t even think about it going away. And so, so I think you’re the idea that, hey, even if, even if it’s a rough ride, there might be some good things that come out of it, we just need to make sure that very bad things don’t come out of it as well.
Nick van Terheyden
Yeah, no, I think that’s exactly right. I often talked about the COVID challenge. I do take, I mean, I always talked about the silver lining, but qualified that by saying, you know, I feel I struggle with saying that, because it brought so much unwelcome results, things that happened to many, many people. I did see people talking about the work back to the office. Push by a couple of folks who talked about COVID era privilege, which I just I found that
Craig Joseph
that’s an interesting statement. Yeah, a little bit taxing
Nick van Terheyden
to my my neurons. But anyway, moving on, let’s move to AI. I’ve had the fortune of going to a couple of AI conferences, one focused on safety specifically, and I think, you know, the general consensus there was given the lack of regulatory oversight in part, I think the onus is on us. We have to bring more to the table. There is plenty of opportunity, but plenty of opportunity for missteps, challenges, safety issues. I think we continue to see options of that. There’s lots of push for it. I think I saw somebody so on Twitter, previously called twitter whatever. There was a request for posting of medical records, which you apparently are happy to do, is my understanding.
Craig Joseph
Yeah, I was Elon that asked for the posting of, I think he was asking, did get the call? Yeah, yeah. Well, he calls. I don’t want to get into my relationship with Elon, but I had mentioned that I have posted not to not to Twitter or x, but I have uploaded a report of a radiologist interpretation of an MRI of my back. And I. Uploaded it to open AI chat GPT, because I wanted to see how chat G, P, T would interpret the radios, the radiologists interpretation. And so I didn’t give them images. I just gave them the report. And what does this mean the images? Because, no, I don’t know. Those are kind of difficult to get. And
Nick van Terheyden
no DICOM standard, I get my my CD or
Craig Joseph
DVD, whatever it is. Oh, sure, you could do that, yeah, but
Nick van Terheyden
I don’t think it takes them unfortunately,
Craig Joseph
yeah. Well, I’m not sure it’s a good idea to upload your personal medical information?
Nick van Terheyden
Well, no, I can tell you, it isn’t, let me tell you. So years ago, I’m in the office in Pete Marwick offices. I was a consultant. I was also a physician. And I think people were, you know, somewhat bemused. This was many, many years ago, and somebody came back from a overseas trip and had been injured in the ocean, and he brought back his X rays, and he brought them into the office. It was a deliberate test of, Is he really a doctor? And a crowd gathered as they pulled out this abdominal X ray from this individual. And you know, apparently he’d suffered some back injury and sore back, and they wanted my clinical opinion. It was clearly a test. So I hold it up to the window light, I’m looking carefully. And I turned to him, and I said, Hmm, you look pretty constipated. That’s always not amused at all. And I said, Well, hey, that’s what I can see on this,
Craig Joseph
yeah. All right. All right, so it’s not so it’s not a good idea. Just
Nick van Terheyden
put your clinical records, at least. That’s my perception of this. I think you have to consider that phi and it’s attributable and has some, you know, potential of causing future challenges if you’re revealing all I think I’ve always said, you know, you can have my information if you don’t use it against me. I think that’s part of the problem.
Craig Joseph
Yeah, well, and we don’t, you lose control of it once it goes out there. So yeah, I was fine with uploading a report that didn’t have my name on it, so it was kind of hard to get it back to to me, and it was just gobbledygook of big words that I didn’t understand about the the things I formerly called bones in my back. Was
Nick van Terheyden
it 136 oh, no, that’s the total yeah in the back. Oh, I don’t know.
Craig Joseph
Yeah, it’s a mess, but yeah, so what did you learn about safety and AI, are we are we good, or are we not good?
Nick van Terheyden
No, I think, you know, the the onus is on us. I mean, I think there is a real challenge. It’s a little bit of the Wild West. And you know, as we referenced earlier, there is this potential challenge of roll out without proper testing. It can be difficult to actually apply appropriate testing to anything that is released on the population. And as a result of that, we should be we have to be cautious and question the results. And you know, there was even a very deep dive of, you know, how do you check the checkers? And, you know, can you use AI to check the output? And, you know, we get into this very meta discussion of, you know, where does it end up? But I think the onus is on ours. The highlight for me, and you know, this was at the safety conference was Dr glaucoma. I’m sorry, I just struggle with this. That’s why I gave you the intro to that. It’s
Craig Joseph
Glock and FLECKING block that is like I believe that is not his real name. No,
Nick van Terheyden
no will Flannery is his real name. Glaucom Sounds like Glock and Spiel to me, but anyway, I that’s a clinical Is it a sign or, I can’t remember, but
Craig Joseph
I think it’s a thing. It’s a thing in your eye, fine. Yeah. So something that an ophthalmologist maybe makes up, I’m not sure if it’s real, but they talk about it.
Nick van Terheyden
Yeah, no. Well, so he presented. He’s obviously the comedian of note in the healthcare space. I’m going to say outstanding, both online and especially in person. But I bring him up because, you know, nod to him in terms of his ultimate message. I mean, he’s got lots and, you know, he’s really taking on the the healthcare challenges that we all face. But his approach to this, and I think it’s one that’s worthy of sharing, is we need to educate everybody so that they understand the principles of what is going on around them. And. And specifically, you know, in his instance, he had all the challenges. He’s had some significant medical challenges. He’s in a pretty rare group based on some of the conditions that he’s shared publicly. But it was the subsequent series, or never ending series of denials, bills, ambulance bills, you didn’t go in network, out of network, and you know, he’s approached this with a sort of Whoa. I didn’t really fully understand, perhaps because I’m not on that side of the coin. And now he’s trying to educate the population. And his plea was, that’s what we healthcare professionals and everybody in the space that does understand should be trying to do is to communicate this effectively. So hopefully we do that with just the odd tinge of humor here or there.
Craig Joseph
The humor is what allows, I think, him, to get the message out effectively, right? Yeah, and, and. And the other thing is, he’s he’s not really speaking. He’s a physician, he’s an ophthalmologist, but he’s really speaking about his his experiences as a patient and as a as a consumer, as someone who, and I think he’s he’s talked about it before. His insurance company didn’t want to pay for his ambulance to the hospital after his heart had stopped beating, and his wife had done CPR on him for 20 minutes, she couldn’t even open the door to be clear, because she Yeah, she was doing CPR, and the police had to break into her house to let the paramedics in because her two small children were sleeping. So yeah, so he’s had these horrific experiences that we would not wish on our on our greatest enemy. And, and he’s hilarious, and so he can kind of present all of that. He’s says he’s got some awesome abilities. And, and I’m sorry I’ve never seen him in person. I’ve, I’ve watched his YouTube videos. They’re amazing.
Nick van Terheyden
He’s he’s even better, even better than the real thing. I can’t say enough positive things. Fantastic, individual, great message. And you know, I try and use him as a guiding star. I wish I was as funny as him, but I’ll keep working at it. So, all right, moving on, care pods. Did you see the news about care pods?
Craig Joseph
I did see the news about care pods. And we should talk about what? So the company behind care pods went bankrupt. It did with like no notice, like a day’s notice you’re done. What is a care pod? How do we describe what a care pod is? What is? What are this company? I’m
Nick van Terheyden
gonna say it’s a virtual setup of consultation. It’s like a pod enclosed, a fully enclosed space that is designed for clinical consultations that can be done by a variety of folks who may not physically be there, so a sort of remote access type of availability. So to your point of telehealth, we didn’t have it. Hey, we’ve suddenly got it. Now. There’s more of it yet. There they were failing. And surprised were you? Sounded like a hood of that. Surprised were
Craig Joseph
you? I, you know, it’s, it was kind of out there, so people had to pay. It was like a subscription service. So you paid X hundreds of dollars a month. They didn’t, I don’t think they dealt with insurance or any other third party. And if you were a member, you had access to these pods that Imagine you go to an, you know, an old shopping mall, or that’s, that’s where
Nick van Terheyden
those empty, empty
Craig Joseph
spaces, and I think there might have been like a medical assistant, or someone with kind of minimal clinical training who could maybe draw some blood or, you know, collect a urine specimen, do something like that. But even
Nick van Terheyden
generally, it was blood locally, I think possibly, yeah,
Craig Joseph
so it, I mean, I get it, but there’s a small clientele that’s going to be willing to pay hundreds of dollars a month in case they needed some services and and these are generally just primary care type things, so you’re not going to go there if you’re worried that you’re having you have a brain tumor, you know. So it’s really kind of just bread and butter medicine, and it’s often cheaper, faster, easier to still today to get care from either from a brick and mortar urgent care or if you have a PCP to go to your PCP. So it might have been that they were ahead of their time, or it might have been that they need the rest of kind of society to change a little bit so that the money makes sense. I wouldn’t pay that much money for access to the
Nick van Terheyden
I’m gonna say I’m on a different track there for. To and here’s partly why this was health spot all over again, and I was involved in that, I’m going to say, at least 10 years ago, similar, fantastic units, but, you know, limited by whatever the technology was. But you know, there was all this innovation that allowed you to examine the ear. There was a remote stethoscope. It was really well designed. And the best part of it was it was a full facility where you could put your kids in the back with you, so there was space. And it was the way it was designed. You felt like you were in a cloudless, you know, a room with no sky. It was so beautifully designed, completely failed for a variety of reasons, but they had local on site testing my I’m going to point the finger of blame, because I’ve got a BMI bonnet on this subscription service. Stuff that to me. Why am I going to subscribe? I it just, it’s so disingenuous to ask me to pay on a regular basis for something that I might use NET actually never, if I’m fit in health. I mean, that’s my I think there’s better models for this. And you know, the concept to me is just tele health that’s improved and could be, you know, better than the real version, or not the real version, the version that’s, you know, through a zoom equivalent call, where you’ve got limited access. But I it just start with this subscription service, please.
Craig Joseph
Well, I think that’s how they have to get if you don’t, I’m just guessing. I have no insights here for this real world.
Nick van Terheyden
To be clear, that’s mostly what we do. But okay,
Craig Joseph
yeah, to be clear, mostly I have no insights. Actually,
Nick van Terheyden
I’m, hey, I’m
Craig Joseph
gonna, let’s just go there. I think that it doesn’t, I think financially, they can’t do it if they don’t have regular income, and if they if you’re only going to be charged when you use it to your point, I may never use it for a year or two. Then it’s going to be, you know, $2,000 for your visit, which then we know, if
Nick van Terheyden
you want to
Craig Joseph
pay $2,000 for a sore throat, you might as well go to the emergency room and you can actually pay $2,000 first.
Nick van Terheyden
Yeah, no. And the rest, I’m just gonna say, based on one nonsense. Oh, and by the way, I got the two that the $4,000 bill. This was two, two plus years later. That seems no statue of limitations for some of these things anyway, let’s close, really intriguing. I think I shared with you. You’ve seen the video the the automated robot that learns to tie knots using essentially, you know, laparoscopic type tools, or it could be, you know, in the flesh. I’ve seen some of these before, so I have some videos that I’ve used in the past that I actually put into presentations where it was, it felt a little bit like a sewing machine, but this was just extraordinary. And they even tried to interfere and put things in the way. And I’m going, why can you tie a knot with one hand? Oh, no, you’re a pediatrician. That’s right, yeah,
Craig Joseph
no, that’s a no. That’s fine. You try to shame me, but it’s not going to work. No, I don’t do any of that stuff, but that’s okay. It was amazing to me that a robot can a learn how to do these, tie these knots, or or use, you know, make precise cuts. But what more amazing is that no one programmed it, yeah,
Nick van Terheyden
no, that’s it. They showed it videos. Exactly.
Craig Joseph
They showed you videos, I’ll
Nick van Terheyden
do it, yeah,
Craig Joseph
and it translated. They said, the article kind of explained it’s, it’s kind of like chat GPT uses words and reads words and understands what words go together. This is a similar version, but instead talks about motions, what you’re going to move, and how you’re going to move it, and kind of breaks it down and puts it back together in unique ways and amazing. Yeah,
Nick van Terheyden
absolutely. I mean, I’ve said elsewhere, but I think you know this technology, and I use it in the broader sense, AI to encapsulate all of that. So machine learning, deep learning, all of those, has not even started to ascend the peak of inflated expectations on that graph, I think we’re only touching what’s going to come, which, back to our earlier discussion, is going to make for some really interesting potential. Out comes solutions that might emerge as a result of taking. All the breaks off and, you know, seeing where we go. But I’m just going to say exciting time. I’m looking forward to it. Unfortunately, we find ourselves at the end of another episode exploring Healthcare’s mysteries before they become your emergencies. Until next time, I’m Dr Nick and I’m Dr Craig. You.
