Healthcare Realities: Beyond the Headlines
This month’s episode of “News You Can Use” on HealthcareNOWRadio features news from the month of January 2024 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 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 expanding role of physician extenders
- The Promise and Challenges of GLP Agonists
- COVID long tail
- Whole Body Scan Services
We start our discussion with a review of the expanding role of physician assistants and other “physician extenders” in healthcare settings, especially in the UK’s NHS (Physician associates accused of illegally prescribing drugs and missing diagnoses), where they now appear to have too much independence.
The latest data on GLP-1 agonists like Ozempic shows that over half of patients maintained their weight loss after stopping the medication which is good news(Many Patients Maintain Weight Loss a Year After Stopping Semaglutide and Liraglutide). However, there are concerning side effects like severe nausea and vomiting that need to be monitored (10,000 patients have filed ‘gastro’ claims against Ozempic, Mounjaro drug makers). COVID also remains a threat, still actively infecting people, and causing potential long-term impacts like cognitive deficits that we are still working to understand (Persistent complement dysregulation with signs of thromboinflammation in active Long Covid).
Unmasking the Reality of Whole Body Scans
Listen in for our warning on against hype around costly “whole body scans” that claim to detect hundreds of conditions (Patients are lining up for $2,500 full-body MRI scans that can detect cancer early). These incidental findings usually cause more harm than good through unnecessary follow-up tests and procedures. Overall, screening should be clinically driven and personalized.
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 January. I’m Dr. Nick.
Craig Joseph
I’m Dr. Craig.
Nick van Terheyden
This week we’ll be dissecting the latest healthcare news, unraveling the twists and turns and making sense of all of the debacle.
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 COVID Back in the news and its long term effects.
Craig Joseph
And we dive into GLP, one agonists and whole body scans.
Nick van Terheyden
But first off this week, we’re going to talk about physician assistants and the assistant sort of expansion in the healthcare setting. And specifically, what’s happening in my original training area in the United Kingdom and the NHS.
Craig Joseph
Wait a second, can I stop you right there?
Nick van Terheyden
Oh, of course you can. Are you?
Craig Joseph
Are you saying that you’re not originally from the United States? You mean,
Nick van Terheyden
you can’t tell from my southern Alabama accent? Yeah, I
Craig Joseph
mean, I thought, I thought that’s how they talk in Virginia. But apparently, you’re from the UK. So I have to reassess everything. Now,
Nick van Terheyden
I have to tell you, it’s a little bit of a mix, because I got into an awful lot of trouble last week when I was staying at the Renaissance Hotel. And I was told that’s not the way you pronounce.
Craig Joseph
It is not it is not no one would pronounce it that way.
Nick van Terheyden
Well, just to be clear, they do. And I thought it was a British thing. But when I got home to sort of validate this with at least some insights from that country, I think it’s my French influence that’s causing that because that’s how the French would pronounce it. So it is the Rene science, I’m not moving on this.
Craig Joseph
That’s fine, you can be wrong and consistent.
Nick van Terheyden
Mostly, this is true. So let’s talk about these physician associates. So they’ve been around for a while. I mean, I think here in the US, that group has been here for an extended period of time. Did you have them during your sort of time practicing and in medical school? Or have they shown up since?
Craig Joseph
No, no, they have definitely been around. I think, you know, I think from a physician assistants standpoint, I think a lot of it started after Vietnam. I remember reading this, and so don’t don’t quote me if I’m wrong here. But a lot of GIS came back from Vietnam with very advanced medical training, but absolutely no degree. And they were doing, you know, kind of minor surgeries out in the field. And then they came back to the United States and had really no way to leverage all of those skills and knowledge that they that they had, unfortunately, had to had to, you know, process. And so I think the PA program kind of started from there. But yeah, so even when I was a resident, I remember one of my first surgeries where I was in the operating room, they were doing a coronary artery bypass graft, cabbage, and there was some dude, when we were opening up the chest at the top of the patient, there was some dude in the in the patient’s leg, harvesting a vein. And I asked who that was. And I was told that’s the PA. And so yeah, they’ve been that, that position and has been around for a long time in the United States.
Nick van Terheyden
Yeah, you know, it’s interesting that you say I had no idea it was that extended. I mean, it made a lot of sense. I do remember specifically, that whole harvesting of the, the veins and you know, that caused immense resistance on the part of the cardiac surgeon who wanted to do that. But in reality, when you look at it, in hindsight now, of course, having somebody super well trained to do that relieve them so that they could focus and in fact, we take them from different places now, but that was a huge deal. But it made a lot of sense. And, you know, this supporting act, I think is absolutely essential, extend the capabilities, have people doing those tasks. But here’s what’s going on in the UK recent article in The Telegraph, you know, I would say many of the physicians in the United Kingdom up apoplectic over the extension of all this, it seems like there’s a an intent on the part of government to create this two tier system where if you don’t have access, you get to see a physician assistant or you know, somebody like that in a general practice, and we’re even seeing them taking on call for what we would call registrar. So that’s like a PGY four or even a chief resident on liver transplant is taken. So nighttime call covered by a PA, which, you know, folks are really troubled by it. And there’s all of these examples of adverts saying, hey, couldn’t get into medical school, go to PA school. And you know, 18 months later, you’ll be practicing as a doctor, you know, and many of them sort of posting notes that just raise this enormous question. And I watched all of this. Just troubled, because I love the supporting capabilities. And, you know, I’ve often been heard to say that nurses were the saving grace for me as a junior doctor, certainly. And, you know, we see that extended practice, my wife was a midwife who had prescribing rights, essentially, in the delivery of babies and, you know, stitched and delivered, you know, very different to the US. But where’s the line? And how do we sort of manage this? And, you know, my fundamental point, I don’t know how you feel, but I struggle, even going in now to the physician’s office, there’s, there’s a procession of people who show up, never introduce themselves or their role. They just say, Hi, I’m Joe or Jane, and start doing things. And I have no idea who they are. And I always ask, and they seem somewhat offended when I do, but it seems like there’s trouble ahead, as we’d say, trouble ahead at Mill.
Craig Joseph
Yeah, I don’t I don’t know. I mean, the I certainly have, I think mixed opinions as does everyone. It’s a complicated issue, you know, you have, you know, if we, we brought him out this conversation, we’re talking about physician extenders, I think is the term right. And in the US, that’s typically physician assistants, pas, and nurse practitioners and nurse midwives, as you just referenced, and you know, different steps, obviously, they’re not so obvious. There is no national license for physicians, or nurses, or pas in the United States. Right. And so
Nick van Terheyden
wait a second, this is important, when you say national, you mean a centralised, single one?
Craig Joseph
I do. So, yeah, you know, and again, it seems obvious to me, but apparently, I’m a physician. So I deal with this. And so normal people may not realize that, just like your driver’s license, you don’t get a driver’s license from the, from the federal government, you get a driver’s license from the state that you live in. And and, and similarly, you get a medical license or a nursing license, or whatever, a PA needs a PA license from that state. And if you practice in five states, then you need to deal with five different licensing
Nick van Terheyden
authorities, because we know that medicine is different in it is that when you go in Flint, Michigan,
Craig Joseph
to Ohio, it’s like Oh, my God, you’re on a different planet, of course. But they all for fun, for fun, they all have the right so
Nick van Terheyden
we’ve not offended anybody from either of those.
Craig Joseph
I have a difference to practice in the state of Michigan, and I suspect my my practice patterns would be very similar in Ohio when I crossed that line. And so every state has their own rules around what physician extenders can do. And you mentioned that your wife had prescribing authority. And that is the case in many states, however, where it starts to get a little dicey, and I think that’s where you’re, you’re, you’re seeing some of that in England, is practicing independently or not. And can a PA, it’s one thing to, and the way I’ve seen it in doctors that I’ve visited is that there’s a PA or a nurse practitioner, and in general, in an office setting, like they can handle most things. But there’s there’s always a physician, either nearby or virtually available so that, you know, if we run into something that’s uncomfortable for them, or they don’t have a lot of training and that they can, they can get a second opinion and there’s someone kind of who has their back. Much like a an intern or a resident is making decisions but has, you know, supervised attendings looking looking over their shoulders. And so where’s that line? You know, and I think the line is independence or not, are these folks allowed to make decisions without any anyone kind of second co signing, you know, or giving a second look,
Nick van Terheyden
I think based on what you’ve just described, the UK is definitely stepped over the line because some of the examples that I’ve read have a physician assistant in the community in a general practice office. seeing a patient with no oversight and referring to a hospital where that referral is seen by another physician assistant. That, for me is way over the skis. And I think in the latest data study, there was an extraordinary number of missed diagnoses, I want to say it was like 170, that they identified tied to this. I mean, it seems like a real problem. And I, boy, do they need to fix that. But you know, from my perspective, interesting that it’s now sort of occurring, and causing major problems in other countries, I think this isn’t going to go away, and we do have to fix it. Let’s move on. Since you know, otherwise, we’ll run out of time, we won’t get to all our topics. And, you know, GLP agonists are very much in the news you picked up on the epic research. So always good, because there’s significant data, tell us what we’re seeing with those GLP agonists and what the data showed?
Craig Joseph
Yeah, so you know, we’re talking about ozempic. And those kinds of medications, in this case, epic, and this is a big electronic health record, software vendor that we’ve talked about that gets their customers to share, de identified data if they so choose, and then puts it all in this very large database. And so and then, what epic does, once or twice a week is kind of puts out a little mini, little mini study, it’s not peer reviewed, it doesn’t have the same force as something coming from a major journal, but at least it’s kind of directionally appropriate. And in this case, what they did is they were curious to see what happens when patients are taking in this case, semaglutide GLP, one agonist, or liraglutide, actually, so taking one of those two medications, and then stopping? And that’s always been the question, right, with these wonder drugs, they seem to allow you to lose a significant amount of weight. And we’ve talked previously on the show about some of the benefits of, of, of these medications, in terms of other things besides weight loss, mostly around urges to do things that, you know, we we generally would like to stop doing. Anyway, the worry was, well, is this a medicine you have to be on for the rest of your life, you know, if you’re taking a cholesterol lowering medication, you’re on it, if it’s working, you’re on it forever. And so were these medications going to be like that. And oh, by the way, these medications are exponentially more expensive, at least right now than other things that we take forever, like high blood pressure medicines, or cholesterol medicines. And I won’t bury the lead here. It looks like from some of these preliminary data that actually more a lot of people, I’ll just say it that way, a lot of people did maintain the weight loss that they had. And so you know, somewhere around 60% or so, either maintained, or lost a little bit more weight after they stopped taking the medication. And so, you know, this is only one year after discontinuation, and so, are a little bit more, but, you know, we certainly don’t have five or 10 years of data, because these medications have not been around that long. But from a preliminary standpoint, it’s it’s pretty reassuring, to see that the majority of people, not all people, I mean, we’re still talking over a third of people regained some or all of their weight when they stopped taking the medication. But some folks did manage more than not to keep the weight off. And so interesting study, Will, we’ll see, as we get more patients, this was, this was with 20,000 patients taking semaglutide and 17, almost 18,000 patients taking liraglutide, which is seems like a small number, but it’s, um, it’s a bit of
Nick van Terheyden
a big number. And certainly for studies, studies go so that’s great news. And, you know, I think we’ve we’ve certainly seen the value proposition, there’s definitely a cynical side to this, you know, take a pill solve a problem. You know, as its core if it just breaks the cycle. I mean, I think the fairly well established fact is no matter what weight you are at your body says this is the perfect weight and anything you try and do to reduce it, it’s going to fight so if you’re, you know, three acts of what you should be, your body’s saying, oh my god, this is the best way Don’t ever give up on this. And you know, if this breaks the cycle and allows you to get back down I think, you know, phenomenal However, as you might expect, not quite all good news. And, you know, to your point of, of the sort of move to this and large numbers, there’s an awful lot of heat currently around the gastro or the, you know, stomach side effects, nausea, vomiting, there was a case in Australia of a patient who essentially tried in into this sort of hole, slim down for a daughter’s wedding and essentially died. There is now a lawsuit currently undergoing that, you know, is identifying these individuals and saying that they downplayed all the gastro effects. But the most striking thing that I saw right in this was, and I’m gonna quote it directly. But this January, gym goers and diet gurus may notice that the usual crowd of New Year’s resolution is has shrunk compared to previous years, I’m going to say, yeah, absolutely. And their supposition, I hadn’t occurred to me, I, I saw barely any of the crowd that I would, you know, fight with to get to the machines and so forth. And it had disappeared, and they are attributing that to the GLP agonist. So, I’m not sure that’s a good side effect. It definitely is, you know, let’s be clear. It’s definitely not go to the gym and taking these things are actually both maybe, but you know, a little bit troubling. So interesting whole area. Moving on, let’s talk about something we haven’t talked about in a while, which is COVID. And I think the major thing here is that COVID continues to impact the world. And let’s be clear, both as an active infection that people are having, but also, we’re seeing this long, COVID impact that has been studied in NASA as extensively as I think needs to but essentially, it is the something to this. And, you know, the findings of this extended study suggests that there are numerous, numerous effects of this virus that continue to persist. I, I don’t know about you, but I certainly have friends that have both suffered to a greater or lesser degree recovered, and some who have absolutely not, and continue to be essentially incapacitated, one of the most troubling things was, but the brain seems to be impacted, and they’re seeing cognitive deficits, you know, an extended period of time, which, you know, as you think about from an age standpoint, I think we saw a tilt towards the elderly, maybe I don’t know if this is going to affect the younger years. But any thoughts?
Craig Joseph
Yeah, the more we know, the more we don’t know. And, you know, by all VivoCity Yes, thank you very much. Thank you. Don’t forget to tip your waiters and waitresses. Listen, you know, for those who think COVID is over, it ain’t. And certainly the days of the, of the raging pandemic, and hospitals being overrun by COVID patients, many of whom, for many of whom they there was no treatment, and there was nothing that they could do. were clearly not there, thank God. And so, so that’s gone. But it’s, it’s still, it’s still out there, there are still patients dying from from COVID, some of whom have other are elderly and have other problems, you know, other chronic care problems. So there’s really nothing that could have been done and much like we still have patients who die from the flu every year, like these things are going to happen. However, we have medications like Paxil, COVID, and others that I think are becoming less prescribed and people are kind of Pooh poohing them. Well, it’s just like a cold. Well, it’s apparently not like a cold for a lot of for a lot of people, for a lot of people. And so and you don’t want to be one of those few few folks. And but there’s really no way of predicting, you know, who’s going to who’s going to who’s going to be impaired for a long time or forever. And we have not gotten we’re doing there’s a lot of science about why why are some some patients clearly a minority but why are some patients who get COVID either had a bad case or maybe not such a bad case but now they they’ve got all kinds of problems from you know, temperature problems, heart rate, kind of their heart racing to brain fog. again and everything else and trying to trying to come up with one, one easy to understand way to explain all of that is eluding us now and might elude us forever. And so certainly not getting COVID is a good suggestion. I’m not sure that anyone in the United States probably has, has not had COVID, even if your religions is what your Yeah, yeah, I suspect, I’m sure there are some out there. But even people who think they’ve never had COVID, have probably had COVID. And so because of the vaccines because of the medication, because now so many of us have had at least one bout with with COVID. We’re all out there. But but not getting it again, is a good idea. It’s certainly not the cold. It’s certainly much more complicated than that. And so I certainly when I’m in a large crowd, or if I’m on a plane with someone hacking behind me, you can bet that I’m going to have a well fitting a mask i Yeah, you
Nick van Terheyden
and me both. Actually, there’s a good, there’s another good reason to wear one of those bars. Because if you’ve ever been on one of those planes with somebody crop dusting, you want to put that fee.
Craig Joseph
Yeah, no matter what Right? Like,
Nick van Terheyden
because that’s the best test. If you can’t smell stuff, then you know, it’s good. So
Craig Joseph
I, you know, I’ve had people kind of look at me, like, it’s just a cold, and I, you know, my responses and I don’t want it, I don’t Why are you telling me it’s just I don’t care whether you have pneumonia, or whatever you have, you have something that I don’t want to get it. And so thank you very much. I’m gonna I’m gonna pass on your I definitely. It’s,
Nick van Terheyden
it’s the gift that keeps on giving, unfortunately. So let’s finish off, shall we talking about whole body scan. So good news, you can for a mere snippet. 2500 from one of the many emerging companies, get yourself a whole body MRI, or full body, whatever they want to call it. And gosh, they can detect 500 conditions, apparently. And wow, this is fantastic. Because they can point to a single patient that save their life, you know, this is this no one. And I, you know, before I let you loose on this, you know, to me, this is absolutely slick marketing, that is fear mongering, and, you know, is essentially selling a resource that should be used appropriately. I mean, to this day, we still have challenges, determining whether screening is appropriate or not, let’s talk, you know, for a second, mammography, you know, colonoscopy is I’m not saying don’t that’s that’s to be absolutely clear. But the risk reward benefit is not as simple as you might think. And the idea that a you spend that money, so let’s add to the medical debt, but by the way, and I’ve seen this personally, you essentially find things that then have to be investigated the incidental Omers and all the downsides. Terrible, terrible, terrible. It’s just I just don’t do it is what I would say. Well,
Craig Joseph
wait, wait, let’s not don’t do it in terms of a whole body scan. Yeah. I don’t think you’re saying don’t do routine calling. No, no,
Nick van Terheyden
no, absolutely. It’s it. I only use those as examples. Because everybody’s familiar with them and say, Hey, we do this. And yeah, it makes sense. But it’s not quite as simple. I do those I you know, have my screening, and entirely appropriate, but there is a risk balance. But yeah,
Craig Joseph
absolutely. Yeah. Whole body. Would you have one? No, no and refer exactly for No, you said, No, it doesn’t matter. Because, again, you’re you’ve got one out of a gazillion where they do find something and treat it and maybe save someone’s life. No doubt that’s accurate. But a lot more they’re not going to find anything. And but a big chunk of those, like you said an incidental Loma right? Hey, there’s this thing, and we don’t know what it means. We can’t really be sure. It might be nothing, it might be deadly. We’re going to recommend another test and then we’re going to recommend a biopsy. And then oh, well, the you know, you’re you started bleeding. So we had to do so to your point of Yeah, none of these screening tests are they all have side effects. And in general when we talk about things like colonoscopy and mammography and, and vaccinations and other things, like we we know, over years and years and years that the benefits outweigh the risks, right for most almost all patients, right? Almost all patients have been we don’t know that about things like whole body screens. And I suspect if we if we did have the data it would show that most of the time it’s not showing anything that we can that wouldn’t be found through other other venues most of the time, but there will always be those stories like there are, you know, that they’re advertising where I my life was ruined by this,
Nick van Terheyden
always find that but it has to be and that’s the point. Same with you know, generalized screening has to be clinically driven based on the individual, their particular risk profile, all of those things age risk reward, but you know, this sort of, hey, spend all this one just a it’s a hard no from me. Unfortunately, we find ourselves at the end of another episode exploring health care’s mysteries before they became your emergencies. Until next time, I’m Dr. Nick. And I’m Dr. Craig.
