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 with my 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 month’s show that features a review of:
- The murder of United Healthcare’s CEO
- Capping anesthesia time
- Getting sleep in hospitals
- Which GLP is better than another,
- Pharmacy access
- 2025 predictions,
- Murder, Medicine, and Mayhem
We open with a quick discussion of the murder of a United Healthcare CEO, emphasizing that murder is a crime regardless of the circumstances and highlighting Dr. Will Flannery, perspective dual truth that murder is wrong but that healthcare insurance issues are real and acknowledging widespread dissatisfaction with healthcare insurance. We talk about the irony of announcing a cap on anesthesia by Anthem BCBS at a time such as this in a “what were they thinking moment”. We were both confused over the timing and implementation of the cap, noting that anesthesiologists do not control the duration of surgeries. It was withdrawn a day later, but the idea, ever….?
We highlight the recent reports of effectiveness GLP-1 agonists in particular that of Novo Nordisk’s GLP-1 agonist for obesity treatment, outperforming Eli Lilly’s drug by 47%. Meanwhile continuing from our discussion last month it seems the never-ending stream of other conditions that these “miracle” cures will treat continues and the pipeline of look-a-like drugs is massive. As we note however patients’ ability to access these drugs is shrinking, and not just because of healthcare insurance challenges and cost but because of pharmacy closures. This leads to an animated discussion on the possibilities of 3-D printed drugs which seem a long way off at best.
Is Healthcare Ready for 2025
We close our discussion by talking about the importance of sleep and the challenges patients face in getting a restful sleep in hospitals and while hospitals may be forming committees to address the problem perhaps there is plenty of low-hanging fruit here to fix. And finally, our prediction for 2025 is for chaos. We will see more AI ideas and solutions with the caution necessary. Some of that caution may be lost with the upcoming changes and we are both concerned about the potential for a negative impact of this.
“Fasten your seatbelts, it’s going to be a bumpy night”
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
Nick, welcome to the month of December. I’m Dr Nick, and I’m Dr Craig. This week, we’ll be dissecting the latest healthcare news, unraveling the twists and turns and making sense of some of the debacles.
Craig Joseph
Just 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 week, we take a look at capping anesthesia time and getting sleep in hospitals, and
Craig Joseph
we dive into which GLP is better than another 2025 predictions and pharmacy access.
Nick van Terheyden
But first off, this week, we’ll be covering the murder of the United Healthcare CEO. So just at the outset, let’s be clear, murder is a crime. I feel like I’m about to quote a song here from the clash, but I better stop at those lines. It’s wrong. No, no. You know, disputing that, but there’s been quite the reaction. I think lots of people have got opinions. I’m sure you and I both do. I’m going to say I’m going to keep the majority of my opinions to myself, in large part, because I think that’s who am I to discuss and whatever. But it was wrong. But I think the reaction not really that surprising to me. I think it surprised some of the folks, and then the subsequent downstream has just been a little bit disappointing. Let’s say, what about you? Craig,
Craig Joseph
yeah, you know, I agree with the sentiments. I think of Dr will Flannery, who’s a popular character on YouTube and and has done many a YouTube show and video against United Healthcare. He had some medical problems, and describes in detail his experiences with United Healthcare specifically. And he says, Look, two things can be true at the same time. One is that you should not murder people like that is wrong no matter what they did, whether they’re guilty of a crime or not, do not murder people at the same time. It doesn’t deny, you know, that doesn’t mean that his experiences with United Healthcare are never happened, or that they don’t happen over and over again, or that they don’t happen with many different you know, most or not all of the insurance companies, I’m sure people have had bad experiences with healthcare insurance. Some are are horrific, and some are just annoying, yeah, but, but we’ve all had them and and as you and I were preparing for, this kind of came across the idea that which is not new to either of us, but if you have never had at least an annoying time with healthcare insurance, it’s probably because you are pretty healthy and don’t use your healthcare insurance. My
Nick van Terheyden
response to that, whenever I hear it, is just wait. I think is fair commentary. I agree. I mean, I don’t want to sort of belabor the point. I think will is, and I think the extraordinary thing is, given all of the opinions and whatever that I’ve read and responses, even certainly from some of the companies, it’s funny to me that a comedian, and I know he’s also a physician, is somebody that just, you know, cracks that nut. He, he hit the nail on the head. And, you know, we, we shouldn’t be turning to our comedians for news, although, apparently, that’s what happens on Tiktok, I believe so although I don’t know anything about it, I’m not on Tiktok. At least I don’t think I am. Maybe I am.
Craig Joseph
You’re very popular. Maybe you’re very popular.
Nick van Terheyden
It’ll be my it’ll be my doppelganger, because there are one or two of those, so for sure. All right, so moving on. I thought the timing of this was just really it left me shaking
Craig Joseph
my head, but it was sub optimal. Sub optimal. It was sub optimal. That’s the word
Nick van Terheyden
Absolutely yes. Let’s announce that we are going to cap the amount of time that people could be under anesthesia. Or, to be accurate, how much they’re going to pay for. So if your operation exceeds the two hour time limit, that’s it. We’re out. Really, really, awesome, really,
Craig Joseph
yeah, I, you know, I still think it’s a little unclear. So one your clarification is very important, right? They’re not, not gonna wake you up. They’re not gonna wake you up. They’re simply saying, we’re not funny, but dear Lord, we’re not paying the anesthesiologist after two hours. I think that’s what they were saying, and it’s ironic. And you know, the timing could not have been worse. No, could not have been
Nick van Terheyden
worse. I’m sure they can work at
Craig Joseph
it. It’s, it’s, it was, it was excellent in terms of bad timing. If that was your goal, they certainly achieved it. The Yeah, I still have questions. Obviously, they, I shouldn’t say, obviously, they reversed their, their their position
Nick van Terheyden
a full day later,
Craig Joseph
it was just bad. It’s it just one of those things where, like, well, first of all, the anesthesiologist doesn’t control the operation, right? They’re the person at the patient’s head
Nick van Terheyden
refers to Dr will Flannery’s videos on said traffic.
Craig Joseph
I mean, it’s just astounding that you’re going to be judging the anesthesiologist, if I understand it right, based on how long the surgery is going, when the surgeon controls how long the surgeon surgery is going and and most of the time, that’s not because they’re slow. It’s just because they’ve run into complications or something’s happened, I don’t know. So again, it is pretty traditional. It’s an excellent part of health insurance in the US, at least, to hold people who have no responsibility for something, responsible for that, right? I, you know, I have a great example of that in my in my life, where I was held responsible for a hospital held responsible for something. Well, it’s rare, but it happens. You know, again, I was asked to pay this penalty because the hospital didn’t do some piece of paperwork that they were supposed to do, and it was impossible for me to do that piece of paperwork like I it was impossible. So this is another, it’s a it’s another great example of of kind of the crazy, upside down health insurance system that we live with here.
Nick van Terheyden
Yes, unfortunately, yeah, well, I they did reverse it, but I just some, some months are better than others in terms of opportunity for content this, this really, in this particular instance, I was just, I it was just shocking, but yes, they have reversed it, and know these controls, and you know people’s behavior, moving on. Glps, well, so let’s clarify. First of all, these are the obesity drugs that everybody, sorry, forgive me, not everybody, but a lot of people are taking. They’re they’re really ripping through in terms of numbers of folks. There’s even talk about coverage for them. I think we mentioned them last week as the miracle drug for hair loss. You name it, I think they were. I
Craig Joseph
think that’s the one thing that they have not been.
Nick van Terheyden
That’s the one hair loss, as I said, just wait.
Craig Joseph
You might be right. You might be right. But
Nick van Terheyden
there was a study that came out just recently that compared a decent, I mean, it was a decent number of patients taking two, at least two different sorts, and these are essentially drugs that are combating obesity by attacking gut hormones. I’ll simplify it there. And it turns out that one of them is actually better than the other. I mean, by a substantial margin. It was 47% more weight on average was lost on Novo Nordisk. We go V when compared against. Let’s see what’s the is it? Lily,
Craig Joseph
no, I don’t know. Who makes it. Talking about monger
Nick van Terheyden
Yeah, it was, yeah, monjaro. Is that the Yeah? So anyway, and actually, when you dive into the science of this, it turns out that that’s possibly, there’s a good reason for that. It actually targets two hormones or two pathways at least. So now this market, this horse race, is no longer a real horse race, because if you want, although maybe just attacking one and that weight loss is good enough, but I think that’s pretty significant, and I will get to predictions later, but I think we’re going to see more of these, this class, actually, I think there’s more of that class of drugs in the pipeline than anything else.
Craig Joseph
Say, big. It’s a big area of research, if it’s, you know, it’s a wonder that anyone’s doing research on other medications outside of GLP. One. Agonist, yeah, to your point that you made at the beginning, that one of them, I’m not even sure which one now, but was studied for sleep apnea, and found a decrease in sleep apnea. And again, how do you pick apart? Well, did it help sleep apnea? Because the patient lost the patient lost weight, right? And that’s why, or and so they tried to kind of tease that out and say, no, no, it seems to be having a separate effects. And so hair loss might be next. I’ll be taking I’ll sign up for it if that’s the case, as well as I’m hoping this will be shown to help people get taller, because I’m I’m definitely open to that medication.
Nick van Terheyden
We do live in a high test society, that’s for sure. But one of the challenges with this is, even if you get your prescription, you’re going to struggle to fill it, because we’ve lost one or two pharmacies in the last couple of years, right,
Craig Joseph
more than one or two. There was a study that came out a couple weeks ago showed one in three pharmacies closed between 2010 and 2021 or 2022 something like that, one in three pharmacies in the United States that was
Nick van Terheyden
here to this was, oh, yeah, that’s all the rural one. But this isn’t rural. Well,
Craig Joseph
it’s everywhere. It’s everywhere and and the reason is that it’s hard to it’s hard to staff, it’s hard to make money, and that there are now options that were that didn’t exist before. You know, in 2010 if you wanted, you wanted your your medication almost exclusively, you had to go to a drug store, to a pharmacy, and, and, and now there’s mail order through the insurance company, there’s there’s private companies that do mail order. There’s lots of, lots of other options, but, but you’re, I think the main loss, the main thing to be concerned about is the the loss of a person that you can talk to about your medication, who’s not your physician, right? Your friendly neighborhood pharmacist. That person is becoming increasingly a rarity. We still need pharmacists, of course, but they’re they’re super, super busy. They’re supervising people giving vaccines. I haven’t gotten a vaccine from my physician in probably five or six years. I only go to pharmacies taking over Yeah,
Nick van Terheyden
and I, you know, it’s interesting. I saw a piece this this month as well that talked about that, and there’s even some question as to whether they’re being kept deliberately busy so that they can’t focus on some of the things that are going on, so that they’re really missing opportunities for the value add that we know that they’re important to in terms of how that comes along. I mean, I’ll be honest, there’s a part of me that says, Well, gosh, you know, you can just get it mail order and ship it through the mail, although I’m wondering how much of that’s going to survive in the next sort of few years. We seem to struggle with delivery of mail. You can’t shoot this through the network. It’s, it’s a physical package.
Craig Joseph
It can’t. Well, we have, you know, maybe there’s going to be printing of of drugs. Maybe that’ll come next. That would be nice. That’s certainly, oh, I was joking. You’re serious. Oh
Nick van Terheyden
no, they’ve, they absolutely, I’ve. I think I have a video in one of my future thinking presentations that even talks about that, you know, patient is woken up to say, hey, we see that there’s going to be a problem tomorrow. We’re just printing you a new drug. And I know that’s a little bit out there, but it’s not really, if you think about it, if we’re just, you know, can you construct molecules in the same way that we construct other things with 3d printers? Doesn’t seem that unreasonable to me. Fair enough. Fair enough. They can tell, well, I
Craig Joseph
we’re, I think we’re very far away from that. Because if you can just, if you can just, yeah, you it’s, it boggles the mind to think about that, that you would be able to just create a molecule. Because if you could do that, boy, the things that you could do that were would be, yeah,
Nick van Terheyden
doing other things before we got to the Yeah, yeah, printing little Nano robots. But there are, I think there are Nano robots already. We see some of that, some pretty tiny ones. I’m
Craig Joseph
going to leave this to you. I have no idea you’re
Nick van Terheyden
you’re completely unconvinced. I am. I don’t I’m getting out of my depth here, and I have
Craig Joseph
nothing intelligent to say. And people, oh, that thought, just many people have told me that when that’s the situation, I should shut up. So I am. One’s going to listen to them. Yeah. I’ve never listened before, Dr Nick, but I’m starting
Nick van Terheyden
now. You’re not starting now. All right, so getting rest in hospitals, this really struck me. And I don’t know when was the last time you were in a hospital actually stayed overnight. I mean,
Craig Joseph
have you it was a good
Nick van Terheyden
10 years ago, maybe a while ago. So, yeah, all right, so, but you’ve had the experience, you’ve got to be sympathetic to this. I mean, essentially, patients cannot catch a break. I remember, I mean, we’re talking 20 plus years ago. I remember a time and motion study that somebody, you know, they sat in patients rooms quietly and just hand recorded people coming in and out. And the shocking number then was like 137 people in a 24 hour period. And you know, I remember at that time thinking, good God, you know. And that was just people, let alone all the noise. And you know, hey, let me come in at two in the I’ve I, hey, I have to take your vital signs at two in the morning. It’s, you know, whatever q4 or whatever the physician has written or has been mandated, I am going to wake you up. Measure your blood pressure, take your temperature, take your pulse. It was shocking, and we’re still doing some of this. It’s, I, I will never forget. I It’s been a long time since I’ve been in overnight, and it was awful, and I was in the quieter section because I was low acuity. But God forbid you should be in a high acuity. We really and it’s such an important part of everything that we I mean, I’m well,
Craig Joseph
on one hand, we say sleep is increasingly, we’re increasingly understanding the importance of good, good night’s rest. And then the other hand, we don’t allow it in the hospital, where the sickest of sick people are. It’s gotten better. I think, you know, there’s, I
Nick van Terheyden
think it’s gotten worse. Well, you know, with all the machines that go bing,
Craig Joseph
the study said something like a half of the of the US, News and World Report best hospitals have committees that focus on on restfulness and making it I’m
Nick van Terheyden
sorry, we all know what they say about committees if you want to stop anything from happening now.
Craig Joseph
Now, the another thing you know, hear me out. Hear me out.
Nick van Terheyden
That’s what yes minister told me, the
Craig Joseph
we’re when, when you get a survey after you are in the hospital, one of the things that they have asked you about on a regular basis now for many years, is how quiet was the environment, right? So now that’s just the patient’s opinion. Who cares what the patients say, right? Apparently, the US government, which is the biggest payer in the United States for healthcare, does care. And so I think it’s gotten better. You know, you don’t hear as many loud pages overnight, like they’re trying to just alert staff when they need staff, instead of alerting the entire hospital, things like that. So I think it’s getting better, but there’s still so much room for improvement to your point, and this study showed that they could improve, I don’t think you know night and day, but made some improvements, and often by I think one of the keys of this study was they involved nurses who are providing the care your point. One of your point was, hey, if a physician writes every four hours check vital signs, well that that probably doesn’t isn’t really needed unless the patient’s acutely ill. And so those are the kinds of things to kind of to say, hey, can we improve this? Or can we create an environment where our culture, yeah, yeah. Again, it’s the it’s better, but there’s lots of room for improvement. I
Nick van Terheyden
think you’re being awfully generous when you say it’s better, but maybe I’m a
Craig Joseph
generous person. Everyone says that, yeah,
Nick van Terheyden
you keep believing that. All right, no
Craig Joseph
one says it, but I just did. So now one person has said it, all right,
Nick van Terheyden
well, please, for the love of God, turn the beeps off. The machines off if you need to monitor. There’s technology that can do this, although I do accept, when you’re sleeping some of this, but, I mean, I can even do it in my own setting. I have monitoring that’s going on with my, you know, wearables, it’s just anyway, sleep is like the most it’s more important than what you eat. And by the way, what you eat in hospitals hasn’t gotten any better, at least, again, not based on my limited experience.
Craig Joseph
Think you’re right,
Nick van Terheyden
all right. So wrapping up. For the year we’ve, you know, it’s, it’s certainly been an interesting year. I think most years are, let’s, let’s be honest. Let’s think about 2025, and where that is all going. And what your thoughts are for predictions I’m going to give you. I’ll pick a serious one. I think you know, the whole concept of AI as a generic term is just going to be we’ve only scratched the surface. And the idea that, you know, on on that chart of peak of inflated expectations, trough of disillusionment, all of that, I don’t think we’ve even gotten to the peak at this point of, you know what’s possible. It’s a bit like the GLP agonist. We’re still, still up and up, very true. And I think there is plenty of scope now, all of this comes with a, you know, we’ve got to make sure that there’s sufficient oversight and so forth. So that’s where I think there’s, you know, real opportunity. My sort of offhand prediction for next year is, it’s just one word, it’s chaos. I can’t see anything else but significant chaos, just based on the run up to where we’re getting to in terms of some of the things. And I’ve heard some people say that’s a good thing, people that I respect, not you know, folks that are completely out there, but the idea that chaos is a good thing because we can try things out. I do think that comes with a little bit of a cost that is unfair on the folks that maybe we’re trying this out on, but it does concern me. I’ll be honest. It’s good news for this program. We certainly
Craig Joseph
have a lot it’s good news for content. Yeah, yeah.
Nick van Terheyden
Keep those ears listening, those clicks, clicking. What about you? Well,
Craig Joseph
I would, I would double your vote agree with you on on the chaos idea, there’s going to be a lot of changes and and some of them, it’s hard to know what’s what’s real and what what’s really going to happen. But I certainly think that some, some companies in the in the healthcare sector, in the US, are going to be benefited because of their relationships with the incoming administration, not because they’re the best or great at what they do, potentially, but because of their relationship. So I don’t see that as a positive. It’s going to be positive for some companies. One thing, you know, a long chaos is just kind of talking about vaccines. I have concerns that we are going to find out. There’s that term that ends with, you know, finding out. We’re going to find out what happens when you stop vaccines, either fully stop certain ones or enough people have decided that they’re not sure what to believe or whom to believe. And we’re going to find out, and we’re going to see diseases. I’m a, you know, I’m a pediatrician, and I often joke, not so jokingly, like I haven’t met a vaccine that I didn’t like. There are diseases that my mentors, that my teachers, when I was a resident, told me about that I’ve never seen, never seen, haemophilus influenza, type B, meningitis, my my mentor told me that he would when he was a resident, not a night went by where he didn’t admit a child with meningitis.
Nick van Terheyden
Worry To hell with
Craig Joseph
Oh, and if you survive, you have sequela and all kinds of problems. We’re gonna that yeah, it’s gonna happen. And it’s Yeah. So that’s, that’s a big worry of mine. And, you know, in a predictor, I guess I just see it goes along with your Chaos idea of people who don’t understand the risks and benefits giving opinions there are, and to be clear, there are risks and benefits for everything.
Nick van Terheyden
That’s exactly right, you know, no, no question, I think testing things out, you know, that’s that’s good news. We like to test things out, but we should do that in a responsible way. I’m not sure that that may be the way that it unfolds, but we shall see. As I said, we’ll have plenty of content end of the year. I will say, you know, I’m eternally grateful for these monthly discussions we have. They always elevate my mood. I hope they elevate our listeners mood. I enjoy them. I try to find humor in most things, including myself, and, you know, to be. Clear in Craig a lot, who is? He’s a he’s a good egg because he endures this and listens to my drivel. And you know, I’m grateful to have you around and to enjoy this each month. So Thanks Craig. Thank you for joining me each each month.
Craig Joseph
Well, thank you, Nick. I would love to stay the same. I’m in it for the money, and I’ve and just to be clear with the audience, I’ve yet to be paid, but you’ve promised me a lot of you’ve promised me a lot of money and but seriously, I’m with you, and it’s always good fun. All right,
Nick van Terheyden
well, we find ourselves at the end of another episode and another year exploring Healthcare’s mysteries before they become your emergencies, until next time, I’m Dr Nick
Craig Joseph
and I’m Dr Craig, you.
