The Healthcare Policy Podcast ® Produced by David Introcaso

Listeners of this podcast are aware the US suffers from extreme wealth and income inequality.  (E.g., see my “The Unrecognized Tragedy of Working Class Immiseration” STAT News essay posted here on December 31st.)  Concerning CEO compensation in the health care industry, the highest ten paid CEO’s in 2020 were paid an average of $20 million.  By comparison, according to 2020 data from the Bureau of Labor Statistics, the average salary for a BS nurse is $80,000.    During this 33 minute conversation Dr. Saini and Ms. Garber discuss CEO bonuses during the pandemic, discuss generally CEO compensation as an outlier in the nonprofit sector, discuss the substance of their research findings including what explains CEO compensation and conclude by discussing what criteria should be used in calculating CEO compensation.   Dr. Vikas Saini, a clinical cardiologist, is President of the Lown Institute.   Previously he has taught and conducted research at Harvard.   Prior still he was in private practice for over 15 years on Cape Cod where he also founded Aspect Medical Systems.  Dr. Saini is an expert o optimal medical management of cardiologic conditions, medical overuse, hospital performance and evaluation.  He has presented his research at professional meetings around the world. Judith Garber is a Senior Policy Analyst at the Lown Institute.  She joined the Lown team in 2016, after receiving her Master of Public Policy degree from the Heller School of Social Policy.  She previously worked at the  Aspen  Aspen Institute Financial Security Program, the Midas Collaborative, and Pearson Education.   She has a BA in American Studies and Political Science from Rutgers University.   Saini and Garber's article, "Nonprofit Hospital CEO Compensation: How Much Is Enough? "  It's at: https://www.healthaffairs.org/do/10.1377/forefront.20220208.925255.   Information on the Lown Institute is at: https://lowninstitute.org/.     This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Our economy is frequently defined as one of unpaid costs.  (Think: Garret Hardin and the tragedy of the commons.)  Nature or natural resources are considered either inexhaustible and/or the byproducts of their use, such as polluted air and degraded water quality, are externalized costs borne by society, i.e., no one.   Our economic model perfectly well explains the climate crisis.  Treating our atmosphere and our oceans as open sewers has resulted in both global warming and helps to explain the planet's ongoing and accelerating biological annihilation, or the sixth mass extinction.  The field of ecological economics attempts to, in two words, internalize externalities.   During this 30-minute interview Professor Costanza begins by briefly describing the field of ecological economics.   The interview progresses to his discussion of the valuing nature, here costal wetlands, he explains common asset trusts, the development of more rational measures of economic development (beyond GDP) such as the Genuine Progress Indicator and of course provides comment regarding the climate crisis (including the use of motivational interviewing in defining climate goals).   Robert Costanza is Professor of Ecological Economics at the Institute for Global Prosperity (IGP) at University College London (UCL).  He is also currently a Senior Fellow at the Stockholm Resilience Centre in Stockholm, Sweden, and Honorary Professor at the Australian National University, an Affiliate Fellow at the Gund Institute at the University of Vermont, and a deTao Master of Ecological Economics at the deTao Masters Academy in Shanghai, China.   Previously, he taught at the Crawford School of Public Policy at the Australian National University.  He has also taught at Portland State University, was Gund Professor of Ecological Economics and Director  of the Gund Institute for Ecological Economics at the University of Vermont, prior still he was Director of the University of Maryland Institute for Ecological Economics and Professor at the University of Maryland's Center for Estuarine and Environmental Science at the Chesapeake Biological Lab.  Professor Costanza is a Fellow in the Academy of Social Sciences in Australia (ASSA) and the Royal Society of Arts (RSA) in the UK, and is an Overseas Expert in the Chinese Academy of Sciences (CAS).  He is co-founder and past-president of the International Society for Ecological Economics and was founding chief editor of the society’s journal Ecological Economics. He currently serves on the editorial board of ten other international academic journals.  He is also founding co-editor in chief of Solutions a unique hybrid academic/popular journal and editor in chief of the Anthropocene Review.   He currently serves on the editorial board of eight other international academic journals and is past president of the Intl. Society for Ecosystem Health.  He is a Senior Fellow of the Stockholm Resilience Centre, a Senior Fellow of the National Council for Science and the Environment and a Distinguished Visiting Professor at Lincoln University in New Zealand.Professor Costanza's UCL webpage is at: https://www.ucl.ac.uk/bartlett/igp/news/2021/oct/spotlight-professor-robert-costanza. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Over the past several years the earth's oceans, that cover 70% of the planet's surface, have dramatically warmed.  In a paper published last week in Advances in Atmospheric Sciences researchers concluded for the sixth consecutive year ocean temperatures in 2021 reached record levels.  Compared to 2020, 2021 ocean temperatures were 14 zettajoules (14 followed by 21 zeros) warmer.  This amount of energy is 145 times greater than the world's annual electricity generation - equal to a half a zettajoule.  Warming oceans can/do essentially explain or account for human-caused (Anthropocene) global warming, oceans absorb 90% of climate-crisis related warming, the climate crisis in sum and resulting human health harm.   Sadly however this reality is seldom if ever discussed in health care policy circles.  For example, the only mention of rising ocean temperatures and/or resulting health effects in Health Affairs is my discussion in my December 2018 Health Affairs Blog post on climate crisis-caused health effects.   During this 34-minute interview Professor John Abraham begins by providing an overview of his Advances in Atmospheric Sciences (AAS) paper.  (He is the paper's second author.)  Moreover, he unpacks the extent of rising ocean temperatures, e.g., 2021 warming would be comparable in energy to exploding an Hiroshima bomb every second of every minute, day, week, month and year).  He discusses resulting increasing ocean acidity and the effect of undermining marine food stock that feeds over 3 billion people worldwide, how rising ocean temperatures affect global climate and weather patterns and weather disasters, the effect ocean warming is having on AMOC (Atlantic Meridional Overturning Circulation) and the extent to which we will be able to build resilience in responding to the climate crisis.   John Abraham, Ph.D., is a Professor and Program Director in the Mechanical Engineering Department at the University of St. Thomas in Minnesota.  He studies include the geophysical science related to the climate crisis that includes the rate at which the planet is warming, particularly oceans.  His team’s warming measurements provide insights on future climate crisis effects over the coming decades.  Professor Abraham also studies the impact of increasing heat on the human body - information that has important health consequences, particularly for vulnerable populations.   Professor has conducted approximately 400 scientific studies that have been published widely.  He is a frequent television and radio guest having participated in over 100 television and radio interviews.Professor Abraham's January 11 article in The Guardian concerning his AAS publication are at: https://www.theguardian.com/commentisfree/2022/jan/11/ocean-temperatures-earth-heat-increase-record. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

The climate crisis threatens human health in innumerable ways including injury from extreme weather events, respiratory illness, zoonoses, water-borne, vector borne, and non-communicable diseases, malnutrition, behavioral health and psychosocial problems and finally heat related illnesses and death. Climate crisis-related health effects are and will be particularly be hard felt by the elderly and children and within minority communities.  For example, The Lancet's most recent “Countdown on Health and Climate Change” report found heat-related deaths in people older than 65 reached a record high of 345,000 in 2019, or 81% higher than the 2000-2005 average. Children under one year of age experienced an estimated 626 million additional person days of heatwave exposure in 2020 comparted to a 1986-2005 baseline average. Despite these numbers, a recent World Health Organization (WHO) report found countries’ Nationally Determined Contributions (NDCs), or pledges by governments to reduce their carbon emissions, found that only 13% of NDCs commit to quantifying the health co-benefits of carbon emission reduction policies. Listeners may recall I interviewed Professor Ebi in November 2018 concerning the UN IPCC's landmark report, "Global Warming at 1.5º C."  At: https://www.ipcc.ch/sr15/.During this 3o minute interview Professor Ebi begins by making brief comment on the just concluded COP 26 meeting. Professor Ebi then explains the impetus for the "Heat and Health" series,  explains the physiological responses to heat stress, discusses health threats via occupation and the urban heat island effect.  She next discusses the second article in the series that identified strategies to address heat extremes in senior care settings and in hospitals and nursing homes ,or the importance of response planning for heat waves including the use of action plans and early warning systems by among others emergency and public health departments.  The discussion concludes with comments concerning related core competency education efforts at the University of Washington and the economic benefits resulting from climate crisis mitigation efforts.               Kristie L. Ebi is Professor in the Center for Health and the Global Environment at the University of Washington. She has been conducting research and practice on the health risks of climate variability and change for nearly 25 years, focusing on understanding sources of vulnerability; estimating current impacts and future health risks; designing adaptation policies and measures to reduce the risks of the climate crisis in multi-stressor environments; and estimating the health co-benefits of mitigation policies. She has supported multiple countries in Central America, Europe, Africa, Asia, and the Pacific in assessing their vulnerability and implementing adaptation measures. She has been an author on multiple national and international climate change assessments. She has more than 200 publications and has edited fours books on aspects of the climate crisis.  Professor Ebi earned her BS at Michigan State, her MS at MIT and her MPH and Ph.D. at the University of Michigan. The Lancet's recently published "Heat and Health" series is at: https://www.thelancet.com/series/heat-and-health.The World Health Organization's (WHO's) recent report, "The Health Argument for Climate Action," referenced during this interview, is at: https://www.who.int/publications/i/item/cop26-special-report. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Concerning the recent United Nation’s COP 26 meeting in Glasgow, again unverifiable pledges were made moreover to cut methane gas emissions by 30% by 2030, limit deforestation and adequately finance converting to a green economy.  The US continued to exhibit intransience and/or fecklessness moreover by refusing to sign a pledge to phase out coal despite the fact it is the single biggest source of CO2 emissions worldwide and the fact the US still generates 20% of its electricity from coal. The US also continued to oppose adequately funding countries to recover (termed "loss and damage") from climate-fueled disasters - disproportionately caused by US carbon emissions.  The US is responsible for 40% of excess carbon emissions since 1750. Concerning the US's performance, the Third World Network's Meena Raman commented, "You walk out of the Kyoto Protocol [1997].  You walk out of Paris.  You come back and want us to think you're doing more?  What you're actually encouraging is people to walk out and then come back.  And then you're applauded."  Concerning the credibility of the US "doing more," earlier this week the Biden administration announced it would launch the largest ever auction of oil and gas drilling leases in the Gulf of Mexico. A decision Earthjustice defined as amounting to a “climate bomb.” As a related aside, the Biden administration has been to date issuing oil and gas drilling permits at a faster pace than the Trump administration. In sum, based on an analysis of countries’ 2030 GHG emissions goals, the latest Climate Action Tracker finding shows global warming doubling to 2.4 Celsius above pre-industrial levels, considerably warmer than the 2015 Paris Accord goal of 1.5 Celsius of warming - that substantially runs the risk of causing runaway global warming, or what's been termed Hothouse Earth.  As for the US healthcare industry’s considerable contribution to the climate crisis, the industry has still not taken any meaningful action.  This past Friday the House passed the Build Back Better (BBB) Act that would in part provide $550 billion to address the climate crisis, or in sum allow the US to get halfway to the Biden administration's goal to reduce emissions by approximately 50% (over a 2005 baseline) by 2030. Passage of BBB in the Senate is, as widely reported, in doubt.Listeners may recall I interviewed Dr. Bernstein’s colleague, Dr. Renee Salas, in June and again in December 2019 regarding the climate crisis.During this 33 minute conversation Dr. Bernstein begins by commenting on the COP 26 meeting and its results, comments on the clinicians' knowledge of the climate crisis (i.e., the John Kotcher survey that I discussed with Professor Kotcher on May 27th), C-CHANGE's policy work, use of Conditions of Participation and/or a value based payment system to regulatorily require hospitals to limit their carbon emissions (and the financial benefit thereof to hospitals), argues regulation is unnecessary to decarbonize healthcare if legislatively carbon fuels can be appropriately priced (i.e., externalize costs are accounted for), if not, use of regulatory payment incentives can be used to persuade providers.  Dr. Bernstein discusses the National Academy of Medicine's Action Collaborative's effort to decarbonize the healthcare industry and concludes with comments regarding the climate crisis in context of the current sixth mass extinction and in context of improving health equity.              Dr. Aaron Bernstein is an Assistant Professor of Pediatrics and the Interim Director of Harvard's Center for Climate, Health and Global Environment (C-CHANGE) at the T.H. Chan School of Public Health. Dr. Bernstein has been a member of the Harvard President’s Climate Change Task Force and co-Chairs the University Food Standards Committee. He serves on the American Academy of Pediatrics Council on Environmental Health Executive Committee, the Board of Scientific Counselors to the CDC’s National Center for Environmental Health and Agency for Toxic Substances and Disease Registry and is Chair of the Board of Directors of the U.S. Green Building Council. In 2015, he was awarded a Lokey-Businesswire visiting professorship at Stanford University and has also been a visiting professor at Columbia University.  After receiving his bachelor’s degree in Human Biology from Stanford University, he received graduate degrees in medicine (MD) and public health (MPH), from the University of Chicago and Harvard University, respectively. He is a recipient of Stanford University’s Firestone Medal for Research and a Harvard University Zuckerman Fellowship. An avid bicyclist, Dr. Bernstein pedals to and from work year-roundInformation on Harvard's C-CHANGE program is at: https://www.hsph.harvard.edu/c-change/.  This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Last November 9th I discussed declining life expectancy in the US with Dr. Steven Woolf, i.e., US life expectancy stopped increasing in 2010 and had been decreasing since 2014.  This is significantly due to increasing mortality rates among men, disproportionately white men aged 25-64, for approximately 30 disease conditions ranging from cancer, cerebrovascular, circulatory, genitourinary, infectious mental and behavioral, musculoskeletal, nervous, and respiratory diseases.   These premature deaths have become popularly termed, "deaths of despair," a phrased coined by Princeton's Anne Case and Angus Deaton and is the title of their 2020 book, “Deaths of Despair and the the Future of Capitalism."  These authors define these deaths, numbering on average 70,000 per year, as those resulting from alcohol and drug abuse and suicide.  For example, per CDC findings in July drug overdoses increased to 90,000 in 2020, or by 30% over 2019.  While deaths of despair have been identified at least since the 1890s, federal policy makers have yet to seriously address this issue. During this 35 minute interview Prof. Graham begins by recognizing Émile Durkheim's related anomic suicide work from the 1890s, she goes on to discuss why poverty is different or more hopeless in the US, moreover among white poor, and what explains this difference between races, discusses what helps to explain why deaths of despair, or diseases of despair, have not been addressed by federal healthcare policy makers, discusses her recommendation for the creation of a federal, interagency task force to address this problem and metrics to track, for example, anxiety, depression, life satisfaction and well being.           Dr. Carol Graham is the Leo Pasvolsky Senior Fellow at the Brookings Institution, a College Park Professor at the University of Maryland and a Senior Scientist at Gallup.  She is the author of numerous books including : “Happiness for All? Unequal Lives and Hopes in Pursuit of the American Dream” (2017); “The Pursuit of Happiness: An Economy of Well- Being” (2011); “Happiness Around the World: The Paradox of Happy Peasants and Miserable Millionaires” (2009); and, “Private Markets for Public Goods: Raising the Stakes in Economic Reform” (1998).  She is also the author of numerous articles in journals including Science, Social Science and Medicine, the Journal of Economic Behavior and Organization, the Journal of Population Economics, Economica, Perspectives in Psychological Science, the World Bank Research Observer, Health Affairs, Health Economics and  Foreign Affairs.  She is senior editor of Behavioral Science and Policy, and an associate editor at the Journal of Economic Behavior and Organization and on the editorial boards of numerous other economic journals.  She served on a National Academy of Sciences panel on well-being metrics and policy and won the Pioneer Award from the Robert Wood Johnson Foundation and a Lifetime Distinguished Scholar award from the International Society of Quality of Life Studies.   She has served as a Special Advisor to the Deputy Managing Director of the International Monetary Fund and served as a consultant at the Inter-American Development Bank, the World Bank, United Nations Development Program, and the Harvard Institute for International Development.  Born in Peru, she received her A.B. from Princeton, her M.A. from The Johns Hopkins School of Advanced International Studies, and her Ph.D. from Oxford.  She is the mother of three children.Professor Graham's Brookings' writings discussed during this interview are at: https://www.brookings.edu/experts/carol-graham/.  (Please excuse this interview's varying sound quality.)     This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Greenwashing is generally defined as a public relations or marketing practice used to deceptively persuade the public an organization is environmentally responsible.  In recent related news, after an Exxon lobbyist was caught on tape admitting efforts to undermine the Biden administration's efforts to address the climate crisis, last week the House Government and Oversight Committee requested documents by Exxon and others regarding the industry’s long running campaign to spread disinformation about the climate crisis and requested Exxon and other oil companies to testify before the Oversight Committee on Oct 28th.  Earlier this month NEJM published an editorial calling for emergency action to limit global temperature increases.  The editorial, intentionally or not, incorrectly stated the “health institutions have already divested more than $42 billion in asses from fossil fuels.”  This statistic is wildly incorrect.  Per the source NEJM cites, the $42 billion figure constituted the sum total of assets held by 23 international health institutions that had pledged to divest in fossil fuels.  The actual divested amount by these 23 organizations totaled $886 million total for 2018 and 2019.   Today, the National Academy of Medicine announced its "Action Collaborative on Decarbonizing the US Health Sector" (at: https://nam.edu/programs/climate-change-and-human-health/).  There is concern the action collaborative, composed of industry executives, will result at least in part in greenwashing whereby the industry reverts to form by pledging net zero emissions by some distant year.  During this 32 minute interview Mr. Whitman begins by providing overall comments regarding greenwashing.  He moves on to offer an explanation of why the healthcare industry significantly lags behind other economic sectors in reporting its carbon footprint (see the Senay and Landrigan study cited below), discusses avoided emissions as part of a net zero formula, the value of the US adopting something akin to the EU's proposed Corporate Sustainability Reporting Directive (CSRD), other solutions to counter greenwashing, i.e., what constitutes more meaningful or genuine effort and his hopes for the upcoming UN COP 26 meeting in November and the DHHS's newly-created Office of Climate Change and Health Equity (OCCHE).         Mr. Austin Whitman is the CEO of Climate Neutral.  Previously Mr. Whitman served as Vice President of Climate Change Capital, and as Vice President of M.J. Bradley & Associates, two leaders in climate-focused investing and asset management.  In 2019, Austin started Climate Neutral, a 501(c)(3) nonprofit aiming to accelerate the decarbonization of global emissions through its achievable certification framework.  The framework certifies brands who measure their carbon footprint, offset it with verified offsets, and create future reduction strategies.  Mr. Whitman is a graduate of Dartmouth College and Yale. Dr. Emily Senay and Philip Landrigan's 2018 JAMA-published research article, "Assessment of Environmental Sustainability and Corporate Social Responsibility Reporting by Large Health Care Organization," discussed during this podcast, is at: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2695076. Listeners will recall I interviewed Mr. Whitman in September 2020 about entities attaining climate neutral certification.  Information on Climate Neutral is again at: https://www.climateneutral.org/.  This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

This interview discusses the recently published series of ten articles edited by Professors Gibson-Davis and Heather D. Hill titled, "Wealth Inequality and Child Development: Implications for Policy and Practice," appearing in the August issue of The Russel Sage Foundation's Journal of the Social Sciences. The US suffers both extreme economic inequality.  For example, per June Federal Reserve data, the wealthiest 1% of Americans control approximately $42 trillion in wealth compared to the bottom 50%’s $2.6 trillion.  Children represent the poorest age group, nearly half of all children live in poverty or near poverty.   A disproportionate percent of poor children are minorities, e.g., 30% of Black and 27% of Hispanic children live in poverty.  According to the American Academy of Pediatrics children who suffer poverty experience numerous health harms through their life course including infant mortality and chronic illnesses, among others, cardiovascular, immune and psychiatric disorders and related lifelong hardships including unemployment, poor education, housing and healthcare.  During this 39 minute interview Professors Gibson-Davis and Hill editors begin by defining and discussing extremes or vast disparities in wealth inequality among families with children, e.g., the top 1% of families with children have 43% of all wealth among families among children, the bottom 50% have less than 0.1%, or  the difference between $29.5 million versus $300.  The authors discuss next childhood health effects, specifically the negative correlation between family wealth and children's BMI (the Boen, et al. article) and what explains this correlation, discuss the Conwell and Ye study, "All Wealth is Not Created Equal," i.e., Black families may not or do not enjoy the same economic standing of White families, e.g., Black families are less likely to own a home, and this translates to fewer opportunities for the Black family children.  The authors discuss next policy solutions, i.e., the Huang, et al. article concerning Child Development Accounts (CDAs), the Michelmore and Lopoo EITC article and the Jackson, et al. article regarding the dissimilar effect Medicaid expansion has on White family wealth versus Black family wealth.             Heather D. Hill is a Professor and Director of the PhD Program in Public Policy and Management at the Evans School at the University of Washington.   Professor Hill is also a faculty affiliate of the West Coast Poverty Center and the Center for Studies in Demography and Ecology at the U of WA and the Institute for Research and Poverty at the U. of Wisconsin and a member of the Executive Council for the U of WA Population Health Initiative.  Previously, Professor Hill worked as a research analyst at Mathematica Policy Research in Washington, DC and spent two years as a Peace Corps volunteer in the Ivory Coast.  Professor Hill received a Ph.D. in Human Development and Social Policy from Northwestern University in 2007, her MPP from the University of Michigan and a BA in Political Science from the University of Washington.Christina M. Gibson-Davis is a Professor in the Sanford School of Public Policy with a secondary appointment as a professor of Sociology at Duke University.  She is also a Faculty Reearch Scholar of DuPRI's Population Research Center and an Affiliate of the Ctner for Child and Family Policy.   Her research interests concern social and economic differences in family formation patterns.  Her current research focuses on the how divergent patterns of family formation affect economic inequality.  She earned her Ph.D. at Northwestern and her BA at Bates College.   The Russell Sage Foundation's Journal of the Social Sciences August issue, again titled, "Wealth Inequality and Child Development: Implications for Policy and Practice."  is at: https://www.rsfjournal.org/content/7/3.   This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Ken Langa's dust jacket summary appropriately states, the authors, "make clear that, in order to understand health and cognitive decline more fully, we must consider the quality and inclusiveness of the environment through which we travel from birth to death."  Alzheimer's or brain health should not be simply conceived or understood, the authors' argue, at a biological level but also the result of material conditions of life mediated by political-economic organizations that dictate public policy - and these from a brain health perspective are what's demented.   The work should remind listeners of my May discussion with CUNY Professor Nick Freudenberg regarding his work, At What Cost, Modern Capitalism and the Future of Health.  Dedicated listeners may recall I interviewed the Alzheimer's Association's Robert Egge in April of 2015.)This 33 minute conversation begins with the authors explaining the problems associated with the paradigm used to define or understand Alzheimer's, i.e., the so-called amyloid cascade hypothesis - made evident by the recent, and very controversial, FDA approval of Biogen's drug, aducanumab (brand name Aduhelm).   The authors go on to discuss/define an alternative definition or paradigm to define Alzheimer's and brain health, one that recognizes or appreciates or accounts for the material conditions of life shaped/determined by socio-economic policies and how these have changed over the past 50 years via the advent of neoliberal policies (deregulation, etc.) compared to just previous post-WWII policies that included comparatively more progressive taxation, education, environmental and public health policies.  Among other comments the authors weigh in on the adequacy of healthcare industry efforts to address or counter-act the adverse brain health effects of neoliberal policy.                  Prof. Daniel R. George, PhD, MSc, is a medical anthropologist and associate professor in the Department of Humanities and Public Health Sciences at Penn State College of Medicine.  His research on intergenerational issues in dementia care has been recognized by the global advocacy group Alzheimer’s Disease International.  In addition to teaching and research at Penn State, Dr. George has co-founded the Farmers Market in Hershey, PA and a Community Garden on the hospital campus.Prof. Peter J. Whitehouse, MD, PhD, has a primary appointment as Professor of Neurology, with secondary positions as Professor of Psychiatry, Cognitive Science, Neuroscience, and Organizational Behavior at Case Western Reserve University. He is also Professor of Medicine at the University of Toronto. Dr. Whitehouse founded, with his wife, Intergenerational Schools, unique public, multiage community schools in Cleveland. He has served in national and international leadership positions in neurology, geriatrics, and public health.For more information on the book and the authors' related work go to: https://sites.psu.edu/americandementia/. Noted during this interview is the authors' August 25th Scientific American article titled, "Alzheimer's Inc.: When a Hypothesis Becomes Too Big to Fail."  At: https://www.scientificamerican.com/article/alzheimers-inc-when-a-hypothesis-becomes-too-big-to-fail/.Drs. Whitehouse and George are the coauthors of The Myth of Alzheimer's (St. Martin’s Press, 2008). This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Approximately 100,000 Americans are waiting an organ transplant.  The vast majority will are awaiting a a kidney - that, on average, will take five years.   Approximately 20 Americans die every day awaiting an organ.  These and related statistics rank the US well below other developed countries.  For example, only 30% of US kidney failure patients have a functioning transplant and only 3% have received a preemptive transplant.   For these reasons CMS recently announced three kidney disease demonstrations: the ESRD Treatment Choices demonstration that began this past January 1st; and, the Kidney Care First and the Comprehensive Kidney Care Contracting demonstrations scheduled to start this coming January 1st.   These efforts aside, the the optimal solution appears to be 3D bioprinting as an avenue for generating artificial organs.  The first demonstration of such occurred in 1999 when Wake Forest’s Institute for Regenerative Medicine’s implanted an bioprinted human bladder into a patient.  (This interview was conducted on September 3rd.)  During this 32 minute conversation Mr. Troy begins by providing additional details concerning the state of organ transplantation in the US and internationally and meeting the demand going forward with increasing chronic disease and potential long term COVID health effects.  Mr. Troy provides an overview of how 3D bioprinting, discusses why FDA regulation is required, e.g., such that bioprinting has pathway to market and how bioprinting is regulated by the FDA, e.g., as a device and/or a biologic.   He too comments on the potential conflict of selling bioprinted organs in context of limitations under the National Organ Transplant Act of 1984, concerns regarding social stratification or who gets 3D printed organs, and the life, theoretical at least, of bioprinted human organs and to the extent bioprinted organs can be protected as intellectual property.                      Mr. Dan Troy currently serves as Chief Legal Officer & General Counsel for Valo, the Boston-based drug development company.  Previously,  Mr. Troy served as the General Counsel of GlaxoSmithKline from 2008 until 2018.  Before that, Mr. Troy was a partner in the FDA practice at Sidley Austin which he joined after serving as FDA Chief Counsel.   Previously still, he practiced constitutional, administrative, and appellate law at Wiley Rein and Fielding, served in the Office of Legal Counsel at the US Department of Justice, and clerked for DC Circuit Judge Robert H. Bork.  Mr. Troy earned his JD at Columbia Law School, where he was a Kent and Stone Scholar, and a BS from the Cornell University School of Industrial and Labor Relations.  He is the author of numerous publications and currently chairs the US Litigation Center.  In 2013, the Burton Awards named him a “Legend in the Law.”  Mr. Troy's related June STAT essay, "3D Bioprinting Can Help End Organ Transplant Waitlists - if the FDA Stops Delaying,"  is at: https://www.statnews.com/2021/06/18/3d-bioprinting-organ-transplant-waitlists-fda-delay/.  This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com