Fixing Healthcare Podcast

This holiday season, Fixing Healthcare hosts Jeremy Corr and Dr. Robert Pearl are mixing things up with a look back in time—way back, in fact, to the first episode of the first season with Dr. Zubin Damania (aka ZDoggMD). Since this interview in 2018, Dr. Z has become one of this show’s most popular returning guests. Zubin Damania is a UCSF- and Stanford-trained internist and founder of Turntable Health, an innovative primary care clinic and model for Health 3.0. As a way to address his own burnout and find his voice, he started producing videos and live shows under the pseudonym “ZDoggMD.” His persona became a grassroots movement, reaching more than 1 billion people across a wide array of different media. Today’s program will be the first of three Fixing Healthcare flashback episodes airing throughout the holidays, each featuring ideas to fix American healthcare from some of the nation’s top leaders. The purpose? To quote Dr. Pearl: “My hope in replaying these ideas is to help listeners once again realize how much could be done to transform American healthcare and improve people’s lives. And simultaneously, help them recognize how far we are from delivering the excellence in healthcare Americans want, need and deserve.” Helpful links: Season 1 explainer: ‘Welcome to the toughest interview in healthcare’ Episode 1 recap: ‘ZDoggMD has a plan to fix American healthcare’ The full transcript of this episode with Zubin Damania ZDoggMD’s website: Health 3.0 * * * Dr. Robert Pearl is the author of a book about medicine’s invisible yet highly influential physician culture. Check out “Uncaring: How Physician Culture Is Killing Doctors & Patients.” All profits from the book go to Doctors Without Borders. Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple, Spotify, Stitcher or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn. The post FHC #72: Fixing Healthcare flashback with Zubin Damana (ZDoggMD) appeared first on Fixing Healthcare.

In this episode of Coronavirus: The Truth, Jeremy Corr and Dr. Robert Pearl discuss the latest buzzword of the Covid-19 era: Triple-demic. Earlier this month, the CDC alerted physicians about the triple threat of Covid, seasonal influenza and RSV (respiratory syncytial virus), warning that the threat of multiple infections (and resulting respiratory disease) was greatest among young children and the elderly. Is the triple-demic a legitimate public health threat and what should listeners do about it? You’ll find that topic and all the other [time stamped] questions from today’s show  here: [00:52] Each show begins with the most recent and relevant facts concerning the Covid-19 pandemic and its impact on American life. What’s happening and what does it mean? [05:18] Listener question: “Is the price of Covid vaccines going up next year?” [08:50] Why do government and insurers seem willing to pay for so many complex services and facilities to treat people once they have a heart attack, stroke or cancer, but reticent to make the investments needed to reduce the incidence of these frequently avoidable problems? [09:44] There’s still a lot of debate about myocarditis after vaccination. Any new research? [11:00] What is a “triple-demic” and should we be worried about it? [13:18] If everyone wore masks and washed their hands this winter, we could avoid millions of infections and thousands of deaths. So, why are Americans less likely than others to do? [14:38] Listener question: I was recently vaccinated with the old booster and I was wondering about the new bivalent one. Is there data that says I should take it? [16:30] What’s the latest on Long COVID (since it was featured in last month’s episode)? [17:47] What are the risks of Covid-19 relative to kids now? [18:59] What’s new in healthcare beyond Covid-19? [21:52] How much risk should patients/consumers be willing to accept vs. their social obligation to keep others safe? [23:13] Are parents of children with diabetes still cutting corners with insulin due to high prices? [26:05] How does racial bias play a role in the care doctors provide patients? This episode is available on Apple Podcasts, Google Play, Spotify and other podcast platforms. If you have coronavirus questions for the hosts, please visit the contact page or send us a message on Twitter or LinkedIn. *To ensure the credibility of this program, Coronavirus: The Truth refuses to accept sponsorship, outside funding sources or guests with any financial or personal conflicts of interest. The post CTT #67: Should Americans be worried about a ‘triple-demic’? appeared first on Fixing Healthcare.

This Fixing Healthcare podcast series, “Diving Deep,” probes into some of healthcare’s most complex topics and deep-seated problems. On today’s episode, hosts Dr. Robert Pearl and Jeremy Corr discuss the “Anatomy of Healthcare Leadership,” a new way of looking at the skills and qualities needed to transform American medicine. According to Dr. Pearl, leaders must apply logic and creativity (a function of the brain), they must show passion and express empathy (via the heart) and they must also demonstrate courage and resilience (using the proverbial strong spine). Later in the show, Corr gets Pearl to describe his leadership journey and the nationally recognized success he experienced for nearly two decades as CEO at Kaiser Permanente. For more information on healthcare leadership, check out Dr. Pearl’s latest columns on Forbes and LinkedIn. For listeners interested in show notes, here’s a discussion guide: THE ANATOMY OF HEALTHCARE LEADERSHIP How can strong leadership defeat the “middleman mentality” in healthcare? What proof is there that U.S. healthcare lacks effective leadership? What kinds of healthcare problems will be hardest for leaders to address? Can healthcare leaders really change how healthcare is paid? What are the benefits of “capitation”? If capitation is the solution, why is it so rare in healthcare today? How does the middleman mentality slow healthcare’s financial reform? Why would anyone who’s profiting from healthcare’s dysfunction want to drive change? Where should aspiring healthcare leaders begin? Why has the trio of cost, quality and access been so hard to achieve? How can aspiring winning over the people who deliver care? What is the “Anatomy of Healthcare Leadership” and how can it change medicine for good? How can leaders apply logic and creativity (their brains) to the challenge? How can leaders apply passion and empathy (their heart) to the challenge? How can leaders demonstrate courage and persistence (the spine) to the challenge? PEARL’S LEADERSHIP JOURNEY What was the arc of Pearl’s journey from plastic surgeon to CEO? How were healthcare problems similar/different early in Pearl’s career compared to today? How did Pearl become the CEO at Kaiser Permanente in 1998? What were his goals for the organization at the time?  What are the three biggest leadership lessons he learned as CEO? * * * Dr. Robert Pearl is the author of a book about medicine’s invisible yet highly influential physician culture. Check out “Uncaring: How Physician Culture Is Killing Doctors & Patients.” All profits from the book go to Doctors Without Borders. Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple, Spotify, Stitcher or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn. The post FHC #71: Diving deep into healthcare leadership appeared first on Fixing Healthcare.

Dr. Devi Shetty returns to the Fixing Healthcare podcast this week—making his first appearance on the show since 2019. At that time, listeners wrote in and posted messages on social media, expressing astonishment at Dr. Shetty’s accomplishments and outlook on healthcare. Shetty is a heart surgeon, trained in both London and the United States. Today, he owns and operates 11 hospitals in India and a new facility in the Cayman Islands. The cost of care in his health centers is as low as you’ll find anywhere in the world. Yet the quality of care is a good as you’ll find anywhere in the world. This success was made possible only by breaking the traditional rules of healthcare. In this interview, hosts Jeremy Corr and Dr. Robert Pearl ask Dr. Shetty about the rules of American medicine that must be broken in order to replicate the success he (and his hospitals) have achieved. Interview Highlights On breaking the rule of expensive healthcare “If a solution is not affordable, it is not a solution … But sadly, after spending $10 trillion (on global medical care), less than 20% of the world’s population has access to safe, accessible, secondary and tertiary level healthcare … So we have to break the rule and we have to do everything possible to make healthcare accessible, affordable, and safer for the patient.” On putting a price on human life “A typical doctor like me, I see about 50, 100, 130 patients every day in my clinic, apart from one or two surgeries. And good number of my patients are the little children sitting on their mother’s lap. I examine the kid, I look at the mother and tell her ‘Look, your child has a hole in the heart. She requires open heart surgery.’ She has only one question. The question is not about the scar, about the recovery or how to take care of the kid later on in life, nothing. Only one question, ‘How much it is going to cost?’ And if I tell her that it is going to cost, say, 100,000 rupees, which she doesn’t have, that is a price tag on the child’s life. If she has 100,000 rupees, she can save the child. This is what I do from morning till evening, putting price tag on human life. This is what every doctor in all the developing countries do from morning till evening, putting price tag on human life. This is not acceptable, Robbie. If society has given legally, officially the right to put a price tag on human life to people like us, we have failed as a society. This can’t go on.” On caring for Mother Teresa “I was privileged to be living in Kolkata at that time, and Mother happened to have a cardiac ailment. I was a senior doctor (of heart surgery) in the city, so it’s just a coincidence or God’s blessings that I had the privilege of being close to Mother when she needed the doctor’s help. And I’m grateful to God for the opportunity.” On insuring India’s poorest farmers (for the price of a pack of cigarettes) “There was a drought in the state of Karnataka, where I live. So, farmers lost their capacity to pay for the healthcare. At that time, we approached our government …  we told the government that if the (state) cooperative society members pay 11 cents per month, that’s approximately the price of one packet of cigarette or Beedi … that money he pays for his health insurance. And initially we had about 4.5 million people paying 11 cents per month. The insurance pays for the surgeries, starting from a routine surgeries like gallbladder, hernia, cesarean section to heart operation, brain operation, everything is cover … Over 1.5 million farmers had varieties of surgeries and about 130,000 farmers had a heart operation. All this was done with 11 cents per month. Poor people in isolation are very weak, but together they’re very strong.” On disrupting the cost of healthcare We are living in an amazing country, which supports innovation and supports a new way of doing things. I have no doubt that within the next five to 10 years, India will become the first country in the world to dissociate healthcare from affluence. India will prove to the world that the wealth of the nation has nothing to do with the quality of healthcare its citizens can enjoy. I have no doubt about it.” On inspiring the next generation of healthcare rulebreakers “I’m convinced that when you strive to work for a purpose, which is not about profiting yourself or your own personal interest, if the purpose of our action is to help the society, mankind on a large scale, cosmic forces ensure that all the required components come in place and your dream becomes a reality. I have no doubt about it. I have noticed this so many times, whatever we could do in India, if you really sit back and analyze it scientifically, lot of things couldn’t have been done, but it happens mainly because of the impact which is going to touch millions of people.” READ: Full transcript with Devi Shetty * * * Dr. Robert Pearl is the author of a book about medicine’s invisible yet highly influential physician culture. Check out “Uncaring: How Physician Culture Is Killing Doctors & Patients.” All profits from the book go to Doctors Without Borders. Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple, Spotify, Stitcher or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn. The post FHC #70: India-based doctor breaks rule that great healthcare must be expensive appeared first on Fixing Healthcare.

In world where it’s almost impossible to tell if someone is lying or delusional, where is line between an unintentional error in perception and intentional misrepresentation? This question is proving to have profound consequences in medical practice. In healthcare, where the difference between facts and opinion continue to blur, tribalism and factionalism are a growing concern. In this episode of Fixing Healthcare, cohosts Jeremy Corr and Dr. Robert Pearl join ZDoggMD to probe the many problems with medical misinformation in America. When both physicians and patients crave simple answers to complex problems, ultimately, is it our fears that drive our perception of what’s real? To find out, press play or peruse the transcript below. * * * Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple Podcasts or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn. UNFILTERED TRANSCRIPT Jeremy Corr: Welcome to Unfiltered, our newest program in our weekly Fixing Healthcare podcast series. Joining us each month is Dr. Zubin Damania, known to many as ZDoggMD. For 25 minutes, he and Robbie will engage in unscripted and hard hitting conversation about art, politics, entertainment, and much more. As nationally recognized physicians and healthcare policy experts, they’ll apply the lessons they extract to medical practice. I’ll then pose a question for the two of them as the patient based on what I’ve heard. Robbie, why don’t you kick it off? Robert Pearl: Hey, Zubin, welcome to this month’s show. Zubin Damania: Ah, it’s always a pleasure to be back, brother. Robert Pearl: With Halloween coming up, do you have a custome in mind? Zubin Damania: I’m going to go as a burned out physician who just doesn’t know what to do. In other words, I’m just going to go as myself circa 2009. Robert Pearl: Excellent. Yeah, I was planning to be a crazy knife bearing surgeon. I think reality and fiction often overlap and intersect, and I think we both have the same thoughts right now. Zubin Damania: Both characters are truly terrifying. Robert Pearl: I don’t know about you, but I feel like there’s a dark cloud over the world now with economic uncertainties that exist, the war in Ukraine, the evermore problematic American political system. Would you care to cheer me up? Zubin Damania: Yeah, I’ll cheer you up this way. I agree that it feels that way for sure. And actually the only way I cheer myself up is by realizing everything that we think is absolute reality like that is just all a thought matrix we live in. So we do the best we can in that relative world. But in reality, right here, right now is just absolute stillness and peace and perfection. And so those two things exist simultaneously. And if you can tap into both and feel into both, then it’s much less depressing because you realize in the end everything’s going to be okay because it already is. Robert Pearl: I love your Buddhist tranquility, but I’m still concerned that as our nation divides wider and deeper, something I’ve thought about a lot is trying to figure out where the line is or how do we establish the line between unintentional errors in perception and intentional misrepresentation. I often find it difficult to ascertain where the people are saying what they truly believe, but it’s just wrong, versus when they’re lying. Any thoughts of how you discern the difference? Zubin Damania: So this degree of discernment has become increasingly difficult because there is an aspect of self-deception that humans are really good at. We’re increasingly good at it when we’re divided into these tribal groups and social media creates a virtual belonging for us, this meaning crisis is solved by belonging to a group. So in a way when what we may think is misinformation from the standpoint of one virtual group may be absolutely believed as true from the standpoint of another. And therefore, if you were to say, create a law that says we’re going to fight misinformation this way by these criteria, there’s always going to be groups that say that’s total crap, because from our standpoint, we’re actually telling the truth. And actually humans have evolved to self-deceive potentially to some extent because in order to fool others in a tribe, in order to get away with something, we’re so good, we’re such good lie detectors as humans, that discernment that you’re talking about, that in order to fool people, we have to believe what we’re saying. And so to some degree, that degree of self-deception then projects in a way that it’s very hard to discern, does that person actually believe what they’re saying? Even though objectively I can measure things and say this is not true. And I think that’s where we are. We’re in this sense making crisis. How do you even know what’s true anymore and who believes what? So I share your frustration with that. It is very hard, but I think you have to get at the meta crisis underlying it, which is this meaning crisis, the sense making crisis and the tribalization. Robert Pearl: A few years ago I did some research with a neurologist, George York, and we looked at the literature on perception. What we found was fascinating. In times of great fear or opportunities for pleasure or wealth, people’s brains shift what they see. You put individuals in headsets and you ask them to ascertain where the two images that have been rotated are identical, and 95% of the time they’ll get it right. But you put them in a group of three others who are in on the experiment and all three of the others consciously report a wrong answer to particular problems, and two thirds of the time the unknowing subject will give the incorrect answer. Now people might say, Oh, this is just going along with the crowd, but interviews of the subjects later confirmed that what they actually saw were the wrong images. And this to me is the question, the tribalism that you’ve spoken about many times and you’ve discussed on your podcasts and other shows. How do we understand this and what can we do to minimize it? At least from my perspective, I don’t think it’s a good thing to have tribalism in healthcare. Zubin Damania: Yeah. So I think what you’re pointing at is the fact that we don’t so much perceive reality as constructed. And that construction is a complex interplay between whatever’s input to our senses and whatever we’re constructing. In fact, our occipital lobe, according to Professor Donald Hoffman, is so big and such a huge user of energy in the brain that it would be overkill to actually just re-represent what the senses are telling us. But it’s just about right to construct a world. So since we are humans, we’re contextual creatures, we’re social creatures where as we talked about the last time, we’re right brain and left brain creatures both. And that right brain wants to see things in their context and it sees these other creatures that are in our group or in our tribe constructing things a certain way and it influences our construction. This is absolutely true. It’s probably the explanation for a large component of the placebo effect in medicine too. That therapeutic alliance, that sense of being heard is bigger than even if you can tell them, Hey, this is a placebo, but we find it works for a lot of people and we’re going to sit with you. And even that just saying that has a therapeutic effect. So I think that tribalism, first of all, it’s recognizing that this is actually how humans are. That objective reality is a very tricky thing. And so if we’re constructing reality from these inputs, then let’s try to understand the ought to, what ought a good healthcare system, good society, good set of ethics look like? And I think that’s where we might agree a lot more than we disagree. We’re always arguing over the is like, well what’s going on? What is this? What is that? No, but what would we like? And I think once we start to align around that tribalism, we might be able to build that corpus callosum between the tribes. Robert Pearl: So let’s dive a little deeper. Let’s look at doctors who recommend treatments that prove lucrative to themselves but have been shown to add little clinical value for patients. Do you think they promote them out of conscious greed or do you think they actually see them as valuable regardless of what the literature concludes? Zubin Damania: Ooh, another great example of us constructing our reality and our sense of morality and ethics from first principles. And the first principles in this case are, we want to do good, but we also need to survive. We have the Maslow’s hierarchy we have to provide and so on. We’ve done all this training and now they’re telling me that maybe the colonoscopy that I trained to do for all these years, that’s the bread and butter of the generation of cash for my specialty in gastroenterology. Now there’s a study saying, well maybe it’s not as good as we thought as a population wide screening tool. Probably works on some individual level, but as a population, okay, what are you going to do? You are going to immediately, unconsciously, and to some degree consciously react and say, yeah, wait a minute now, you did the study wrong, there’s things you didn’t look at, you haven’t seen the patients I’ve seen. When a patient comes and says, You saved my life by detecting that precancerous polyp, you haven’t had that experience and you’re just a egghead and a data analyst and you’re missing the big picture. I think that’s all absolutely believed by the person. I think deep down there is a doubt that what if this is true and I must defend against that and so on because there is an existential risk to the income. And Upton Sinclair said it’s very difficult to have a man believe something when his livelihood depends on him not believing it. And that’s just how humans are. We’re constructing this reality. So how do we address that? Well that’s a difficult thing because a straight on attack throwing data at people is not going to change what’s happening. You need to shift in the overall sort of paradigm. And that’s very difficult to do. Robert Pearl: Does this phenomenon you’re talking about, explain the 180 degree contrasting views of people about vaccines. Zubin Damania: A thousand percent. So those vaccine views are based, I think increasingly on our morality and our moral taste buds. The six moral taste buds that Jonathan Haidt talks about, care versus harm, liberty versus oppression, sanctity versus degradation, fairness versus cheating, authority versus subversion, loyalty versus betrayal. Those are the six. How you feel those taste buds will determine how you look at vaccines. And one of those is loyalty versus betrayal. Let’s say you are conservative and you have loyalty to group and then the group is saying, we don’t trust these vaccines because it just so panned out that Trump wasn’t a big proponent of the vaccine. Well now that tribal loyalty has to conflict with the care versus harm, but they’ll feel care versus harm as, oh we’re actually harming young people by giving them myocarditis with these unnecessary vaccines. So, that’s how they’ll spin it. Now on the left they’ll say, Hey, care versus harm, I don’t want to kill grandma, I don’t want people to die. So we want vaccines. And their loyalty versus betrayal is, well, I’m loyal to these ideas of “the science,” which is increasingly a politicized feeling. So they will fight tooth and nail for a vaccine, even if in say a 13 year old boy there’s a risk of myocarditis, they’ll very much downplay that as, Oh, the risk of COVID myocarditis is worse. But really there isn’t great data to say one way or the other. So they won’t accept the uncertainty there. And I think that’s entirely moral matrix driven. They’re all trying to be good. And once you see that the tendency to be judgemental towards in group and out groups tends to soften a bit. And then you can just determine, okay, so how can we do the most good here? How can we build some bridges? And I think it’s existential a risk to us that we have to do that now, we have to start looking from that morality standpoint. Robert Pearl: I don’t know, it sounds like it’s a pretty big gap to close between people who see a intervention as being so life saving and people who see it as so problematic. I just rarely have seen a gap as big as this one. Zubin Damania: It’s really heartbreaking because previously, and actually this is spilling over into childhood vaccines. So now we’re seeing this hesitancy towards childhood vaccines, which was there at a small level before and now it’s increasing because again, the tribalization, the politicization and you can blame all kinds of people and you could probably blame some people more than others for this, but it is an increasing factor. And I think things like social media, the Zuckerverse and all this other stuff have really fed into this because their monetization models benefit from division, they benefit from the outrage and the headline clickbait stuff, but unfortunately, so okay, Robbie, I’m feeling into how you’re even phrasing these questions. You are very discouraged right now. That’s clear. You’ve said it explicitly, but you can also feel it in your tone of voice and I think many people are, I think many people who are smart people who’ve worked in healthcare feel as you do. I see them when I go talk and things like that. And all I can say is I happen to tend on the optimistic side because the only way out is through. And I think if we fail to destroy ourselves, I think we will increasingly wake up to what’s actually happening. It just is going to be ugly for a while. So we have to keep talking about it. We have to keep pushing through making the implicit that we think we understand more explicit so people can go, Oh this what’s really happening. But it is hard. Robert Pearl: Yeah, it’s particularly hard I’ll say as a scientist, you see data, you see logic. If people have problems with the specific information, you repeat experiments. There are ways you could explore questions, but when at the end of that process you still have two seemingly unconnected, completely contradictory conclusions, then that becomes hard to put in a scientific model for which the healthcare world has tried to achieve for 5,000 years. Zubin Damania: Yeah. And this is where the fundamental of schism between our science-based consensus reality that we’ve, like you said, 5,000 years of growth of the scientific method, and the way humans actually instantiate these hive mind group thinks that are powered by their moral taste buds and loyalty. And part of it, Robbie, I think is the meaning crisis in a bigger sense. We used to have a common mythology. You and I have talked about the hero’s journey. That’s a common mythology across cultures, but we’ve lost some of the sense. And so now we find our meaning in tribe, in group, in belonging. And when that becomes paramount, then the consensus reality starts to fracture because then we’re creating our own consensus reality within the group instead of within the collective as science has done since the enlightenment and prior. So it can feel very frustrating to a science minded person and it definitely has felt frustrating to me. Robert Pearl: Multiple times a month I get a call from a CEO of an artificial intelligence company and the calls are almost all exactly the same. They tell me that first of all, they’re the best engineers that exist in healthcare. Then they tell me that they have an application that will save three hours a day per physician, but they can’t understand why no one is buying it. Now I tell them that they’re delusional, although I say it in much nicer languages. Zubin Damania: Good for you. Robert Pearl: I say the problem they should be having is managing the line out the door. But we just talked about ourselves as scientists. In practice, we’re just as liable to be misled as anyone else. How do we as physicians minimize that risk? Zubin Damania: Yeah, this is great because again, we feel in the scientific community that we’re immune to this stuff, but we’re as susceptible like you said. And I think part of it is how we’re even training ourselves, educating ourselves. Do we talk about these issues of group think and cognitive bias and errors in thinking and even the kind of cardinal signs of conspiracy thinking, or cardinal signs of misinformation. We don’t even train people on that because sometimes we can turn that back on ourselves. Some of them are things like cherry picking data. Well, we in science do that well if we have an emotional investment in something. I gave the example of say colonoscopy. If you’re emotionally invested in something, you’ll cherry pick the data to support what you believe. So the fake experts, pulling up an expert that really doesn’t have a lot of business talking about this, but they have some credentials. The moving goal posts. No matter what information you present someone, they’ll say, well, but then what about this? And they’ll move the goal post further. The conspiracy thinking, the logical fallacies. If we trained ourselves on that stuff or had it as part of our curriculum, even in elementary school, junior high, high school, boy, we’d have the tools and the agency we then restore our agency, because right now it’s almost like we’re zombies walking towards the abyss. We don’t even know it. In science, outside of science, once we actually can see clearly the trajectory, I think there’s much more chance that we’re going to be motivated to do different. Robert Pearl: So let’s dive even a level deeper. You live in the Bay Area and I’m sure you’re well aware of Elizabeth Holmes and the Theranos debacle. Zubin Damania: Yeah. Robert Pearl: We had Tyler Schultz on our Fixing Healthcare podcasts a couple years ago. And of course there were numerous TV shows and books about what happened. As you know, the attorneys are battling over possible retrial. But I’m fascinated by the question, how much of the deception did she know versus how much was a subconscious shift in her brain that made her see reality different than it was? Of course no one including herself probably knows the answer. So your opinion is as valid as anyone else’s. What are your thoughts? Zubin Damania: I love my opinion being as valid as anyone else’s. That’s really empowering, also completely terrifying. Yeah. So with her it’s fascinating. There clearly had to… Again, again, and let’s just pretend that I know what I’m talking about because again, you can’t get in someone’s mind. This is a fallacy in itself, the mind reading policy. But I’ll say this, just looking at this in human nature, self-deception is powerful. She had every motivation to self-deceive and every motivation to then, by self-deceiving, actually be able to easily deceive others because she believes what she’s saying. And she’s got to convince George Schultz, she’s got to convince pretty smart people who’ve been around the block and she managed to do it and it got to be that she believed it herself. And yet you can actually have this cognitive dissonance where you believe that stuff and you’re still trying to cover things up and yo know there’s stuff going on and that’s totally squirrelly and all that can coexist. And I think with her, it’s a great example and I think there are a lot of people in the startup space and the tech space who are going through that. In a way they know, oh this business model’s never going to work. It’s a pipe dream, but if we just keep believing it, we’ll create a Steve Jobs reality distortion field and people will just go along for the ride and at some point things will work out. And that false optimism it’s actually a very left brain. The left brain is very optimistic because it just thinks it’s right and it can self deceive all day long. And then the right hemisphere goes, wait a minute, but it’s quiet. So I suspect there was something like that going on. Robert Pearl: Yeah, people’s desire to see the world differently than if they could be impartial. It’s just so prevalent. What about Anna Sorokin, the probably fake heiress made famous on the Netflix show, Inventing Anna. Here’s someone who’s spending money, throwing a hundred dollar bills around, convincing the world that she is incredibly rich when she’s basically on the verge of bankruptcy. Look at how many people, I don’t know if you watched the show, but how many people she was able to deceive. She’s in prison right now, but I don’t even know if she knows whether she’s a real heiress or a fake. Zubin Damania: It’s a great story. And again, it speaks to we create reality in our minds, in her mind, whatever she believes. And that reality distortion actually feeds out to other people, because we’re social. So it doesn’t surprise me at all. In fact, there have been con people throughout history that have pulled this off and continue to pull it off. Say what you will about, say a cryptocurrency, take two stances on, it’s a real thing, it’s deflationary, all these great things about cryptocurrency. And then, but you could also say, well this is a group think led by a few really loud people on social media that has taken people as the Dutch tulip bulb craze did. And if that’s true, then that’s a same self-deception. These people actually believe this. I know a lot of them and maybe they’re right, but if they’re not right, this is a huge self-deception and on a social level. Robert Pearl: We should probably spend an entire show on cryptocurrency. Zubin Damania: I know. We’ll get canceled for sure man. These guys are vicious, they’ll kill us. Robert Pearl: Because it’s a lot more than just the scarcity and fear of missing out on the soaring of the dollars as it was in the Netherlands during the tulip bulb inflation rate of the time. But the crypto has its own notion that somehow there’s this evil force out there that is manipulating the media, that is controlling our lives and that we the populous need to take it out. And we’re going to do that by using the blockchain technology that underlies cryptocurrency so that every voice becomes equal and equally important. So it has this aura of media three or whatever you want to label it to be, that drives not just the economic analysis of the various currencies, but the value, the mission, the purpose, the higher meaning for these dollar bills. Zubin Damania: Yes, yes. And what’s interesting, so there’s a moral crusade involved, there’s a deep set of beliefs, there’s a sense of belonging. You see it with the crypto bros on Twitter and all these guys that are, and mostly guys actually that are doing this thing. And I tell you, I know a lot of them, they are truly passionate about the woes of our current economic system. And what’s interesting is money is such a human construction anyways, it’s like when the dollar’s not backed by gold, what is it backed by? Well, the faith of the US government. So what is cryptocurrency backed by? Well the faith of the masses that believe it’s worth something. So it’s fascinating and I have to say this, and I’ll say this to immunize myself against, attacked by the crypto bros. I have no idea what the answer is. I’m not an economist. It’s just a fascinating unfolding and a social group think unfolding too on all sides of it. Robert Pearl: I don’t know if you’ve ever heard of a teacher named Ron Jones. He taught-. Zubin Damania: I haven’t. Robert Pearl: Oh, he taught at Cooley High School in Palo Alto in the 1960s. And he was a history teacher and his focus at the time was on fascism and Nazi Germany. And to teach the ethics, the values, the things that happened at the time, he started his class a movement that he called the Third Wave. On day one of the module he insisted that students stand when they spoke with him and always begin with Mr. Jones to demonstrate strength through discipline. On day two he said they had to salute with a cuffed hand to the opposite shoulder to show strength through community. On day three told the class that they were special and that certain others who didn’t belong were trying to pretend to be members, but they had to be stopped. And this was stray through action. By day four, the in group had gone from 30 students to 200 and harm was being inflicted on the out group. And, of course, they had to stop the project. In three days he had taken literally hundreds of students and gotten them to get behind a movement which had no value and was oppressing others. I think that’s the same phenomenon we’re seeing now in so many of these tribal areas that you’re describing. Zubin Damania: Yes. Again, and I believe all of it, it’s a social group think kind of thing that you can push through, especially if you have a charismatic leader and you don’t even need that honestly. Now with social media, the charisma is all virtual and you can do all kinds of things. Yeah, Robbie, that’s why just understanding even the nature of how we think and what our minds do and what even is consciousness is, I think a fundamental piece to avoiding falling into these traps. And even then you’ll fall into these traps. In fact, in these spiritual circles where you have these gurus, man, these things can devolve into cult-like craziness with all kinds of abuse and misbehavior among the teachers very, very quickly. Even in these groups that are purporting to be enlightened and awake and oh, we understand the nature of reality. Yeah. Okay, let’s see how that goes. Because again, we’re humans. Robert Pearl: There’s an expression that where the pie gets smaller, the table matters deteriorate. As the pressures are about to mount in healthcare, how do you see tribalism playing out? Zubin Damania: Healthcare is going to implode at the current rate of growth because it’s going to drag down everything. It’s a self-limiting process right now. It’s got no future in this current configuration. And when that becomes apparent, I think either the early adopters of the next phase of healthcare, whatever health 3.0 that I call it, I think will start to run with it and it’ll just go, or again, it’s going to be a bunch of Al Bundy’s sitting around the table with their hands down their pants burping, and the table manners will have degraded to that level because they’ll all be clawing for whatever’s left and it’s going to be really ugly. And I think we’ll see maybe some combination of that, I think. But again, as the eternal optimist, you’re already seeing these bright spots emerging. You’ve pointed them out, I’ve pointed them out. I think that’s just going to become essential and that’s just going to be the next phase. But yeah, who knows? Who knows? Robert Pearl: I have to say you’re not doing a great job of cheering me up today. In fact, I would say that I’m a bit more optimistic than you because I actually think there’s a range of technological solutions that actually could be the answer. But we’ll say that also for the next show. An idea that our view is right has killed hundreds of millions of people across history. One of my favorite anecdotes, and it’s a tragic historical story, comes from the 14th century. I don’t know how familiar you are with this history, but in 1349, the world was in the infamous black plague. And the leading experts from the government, science and academia of Western Europe came together to devise a plan to save the population. I realize by this time the black plague gets spread from the Eastern Mediterranean through most of Eastern Europe. It had killed hundreds of thousands of people over the previous three years. And those coming to the conference decided that they wanted to stop it from ravaging Western Europe. And they said that research had demonstrated that the plague was derived from fleas, which was correct. And then they made the assumption that since dogs carried fleas, by eliminating dogs, they could eliminate fleas and end the plague. So edicts were passed to each nation to kill all the dogs. But of course, as we know now, the fleas that carried the plague weren’t the ones in the back of dogs, but the ones carried by rats. And without dogs roaming the street, the rat population and the flea population soared. By three years later, nearly one in three people in the world had died of the plague. I wonder if 50 years from now people will look back at how we treat various diseases at the conclusions that we have reached in areas maybe such as maybe cancer or even heart attacks with similar disbelief about how ignorant we were. Zubin Damania: A thousand percent. They’re going to, there’s no doubt that they’re going to. They’re going to look at this and there’s a great scene in one of the Star Trek movies, I think it’s Star Trek four, where they go back in time to the 20th century and Bones, the doctor is seeing a patient who shows up in the hospital because they’re trying to rescue Checkov who’d fallen and had a head injury. And they’re trying to drill burr holes in Checkov’s head to relieve the pressure. And Checkov is like burr holes. You’re drilling big holes in his skull, man. Barbarians. And he’s applying this 23rd century or 25th century medicine to this and he’s just like, these people are barbarians. Woman comes up and says, I’m on dialysis doctor. And he gives her a pill and says, take one of these and call me in the morning. And the next scene she’s walking and fine and everything’s perfect. And I think that contrast of what the future paradigm of medical care is and what we’re doing now it’s huge chasm between it. And that’s why I think we really need to almost think completely differently. What we’re doing with this, oh, there’s a drug that finds a receptor and it does this or cancer is this. It’s like, no, no, no, no, it’s way more complex than that and we need a complexity science that fits that. And then where does the mind fit into that? Where does the placebo effect fit into that? Where does expectation, the fact that we create our reality fit into that? How do we merge those things? I think we’re going to look back and go, dude, this was primitive at best. Like, Gilligan’s Island primitive. Robert Pearl: My sense, Zubin, is that in medicine, both physicians and patients crave simple answers to complex problems, that it’s our fear that drives and alters our perception, that all of us are at risk of embracing approaches that can seem reasonable, but ultimately prove worthless. How can people as patients, as doctors, as caregivers, as nurses, minimize the probability of falling into that trap? Zubin Damania: I think we have to start change shifting a culture and the way we talk about things can’t be, take a pill and call me in the morning. It can’t be just steal heels and just cut this out and you’ll be better. It’s got to be realistic. It’s got to be relationship based. If you’re going to help a patient on their own hero’s journey, as their mentor, as their helper, you have to actually help them create that reality. And some of it is mind created, which means setting expectations, your bedside manner, your connection with them, your relationship, how you treat your peers and your colleagues actually, they pick up on that and your colleagues pick up on that, which changes how they treat the patients and the general level of stress and connectivity and connectedness. So all of that I think has to happen. And actually I think in many ways nurses can lead that because they’re right there with the patient in that relationship. Sometimes we can be a little detached. Robert Pearl: I love it. And when you start leading the parade, I’ll be marching right behind you. Jeremy, your question for us. Jeremy Corr: So we’re hearing that the COVID vaccine is likely going to be added to the vaccine schedule for children, which would make it a requirement for them to get to attend public schools. We’re also hearing the CDC is pushing ahead on getting the Omicron boosters approved in children as young as five, while not allowing the clinical trial data to be public. Many respected experts such as Marty Makary and Vanay Prasad have been very critical about how all of this is being handled. One of the most respected vaccine scientists in the world in Dr. Paul Offit is even raising red flags about the lack of transparency and how government agencies and big pharma are cutting corners to get this approved. What are both of your thoughts on what is happening, what is the long term harm of what is happening in terms of vaccine hesitancy for the tried and true vaccines that are already part of a child’s vaccine schedule and people’s faith in the CDC, FDA, NIH overall and increase the levels of tribalism in the country? And also, to sum it up, if you were to be asked to be the next head of the CDC, FDA, NIH, et cetera, what would you do to restore public faith in the organization? Zubin Damania: I love these easy questions. These are softball. Okay, so I’ll take a stab at this one. And I’ve had Paul on my show, I’ve had Marty on my show, I’ve had Vanay on my show, I’ve had people who are more aligned to give mandates for childhood vaccines. This is my take on this, a vaccine mandate implies a couple of necessities. One is that the thing that you’re mandating, because you’re trading off again these moral values. One is liberty versus oppression. So you’re saying, okay, I’m going to take away this liberty to decide whether or not to take this vaccine because the greater good of care versus harm and fairness versus cheating is important. So by vaccinating a five year old against coronavirus in school, we’re somehow going to prevent other children from getting sick or teachers from getting sick. There’s going to be a community benefit. And so the argument for the community benefit is not that it prevents transmission because it barely does if at all, maybe initially, but then it wears off. That’s just the nature of a respiratory virus like Coronavirus. The argument would be, well, we prevent schools from having absenteeism, you prevent other issues like the rare death or disability healthy child from COVID. But the question then is, well, do you mandate that? And when the majority, actually the vast majority of children have had exposure now to coronavirus or vaccine, mostly coronavirus, is it necessary to do that? And what’s the cost of doing that? So the psychological reactance against the loss of autonomy for parents is real because of our tribalized split society. So the actualization of this mandate may be that you create more vaccine hesitancy for other childhood vaccines, which are absolutely essential for the collective good, where you need a certain level of vaccination to prevent transmission like measles and mumps, et cetera. So that’s my take is I think mandating this for children right now is not going to accomplish an improvement in overall public health, but may have the opposite effect even though the intention is good. Jeremy Corr: And then to ask you to sum up the other parts, what are your thoughts on the whole lack of transparency with the clinical trial data and even like Paul Offit raising the flags about them wanting to approve that? Zubin Damania: I think that to a degree everything’s been politicized. So yes, it’s in the best interest of whoever’s in power right now to actually have lower case numbers and so on and have people vaccinated and they believe in that. And I think that’s fine. I think the lack of, it’s very easy to tell Pfizer and Moderna, Hey, you have the money, you have a lot of government money. Do a good human trial on these, because this is not flu vaccination, this is a different virus, it’s a different scenario, flu vaccination, and Paul Offit makes a good distinction between the two. You can’t just then say, Okay, this is going to… And because the main question is hospitalizations, severe disease and death. And we don’t have good evidence with a BA.4-5 vaccine in humans, that those issues are actually improved. You may reduce infection for a transient period of time, but then is that worth a mandate, especially for children? So it is concerning I think, in my mind. But again, it’s also concerning that there are people saying, Oh, this thing is causing cancers and it’s causing infertility. It’s not. So it’s just empowering, I think people to be even more divided about this. Robert Pearl: My sense, Jeremy, is that if we had all the data, we would find that the vaccine is safe and it does help reduce the rare 220 children have died under age five from COVID in a couple of years. So it’s not that it’s going to be negative or somehow data’s going to be hidden, that’s going to say that there actually is tremendous risk. But I’m a big believer, and if I led any of these agencies, that’s what I would do in telling the truth. And I think that what people are reacting to and intrinsic in your question is that a mandate doesn’t make sense in this particular circumstance, or if it does, I can’t fully explain it. And what I mean by that is the following. A polio mandate makes sense. Why is that? Because polio is a horrible, terrible, lethal disease that is easily spread amongst children. And a vaccine, from my viewpoint, not the old oral ones, but the current variety is safe and the problems are so much less than the consequences for children who get sick. Similarly, measles is one of the most contagious diseases, and there are well defined significant problems that children have who develop the disease, including one of my great grandparents, not grandparents, but children of my grandparents who died actually from measles as a young child. So those diseases have a logic. What’s missing in this situation is the logic of mandating it in young children, their risk is very small and you could mandate a lot of things that would have a more beneficial effect than this particular vaccine. Is it possible that the vaccine mandate would improve the health of the nation? It’s possible, worth debating, but that type of question is different than a mandate of the child who’s going to get the vaccine because we mandate vaccines for the individual, not for the bigger society. Now, experts can disagree upon how effective those vaccines are, whether that mandate for the individual is appropriate given the risks of the vaccine. In this case, risks are very low, but the benefits are equally low. And I think sitting in people’s minds and the critics you’ve described is this idea of why is it being mandated? What is the truth? Is it really being mandated for the people receiving the shots, or is it being mandated for other reasons? And that’s where I have the problem, because I’m not aware of vaccines that we mandate outside of a healthcare setting that is designed to protect other individuals surrounding them. And that’s why I think the skepticism and the lack of confidence in these agencies exists. And every time you cut a corner, you create a problem in medicine and that leads to more negative than positive, more harm than benefit. Jeremy Corr: We hope you enjoyed this podcast and will tell your friends and colleagues about it. Please follow Fixing Healthcare on Spotify, Apple Podcasts, your favorite podcast platform. If you like the show, please rate it five stars and leave a review. If you want more information on healthcare topics, you can go to our website, robertpearlmd.com and visit our website at fixinghealthcarepodcast.com. Follow us on LinkedIn, Facebook, and Twitter at Fixing HC podcast. Thank you for listening to Fixing Healthcare’s newest series Unfiltered with Dr. Robert Pearl, Jeremy Corr, and Dr. Zubin Damania. Thank you very much and have a great day. The post FHC #69: An unfiltered (uncensored) look at ‘medical misinformation’ appeared first on Fixing Healthcare.

In this episode of Coronavirus: The Truth, Jeremy Corr and Dr. Robert Pearl discuss new research out of Scotland that finds as many as 40% of people experience lingering Covid-19 symptoms months after infection. Is this data reliable and, if so, what does it mean for the long-term treatment of this disease? You’ll find that and all the other [time stamped] topics discussed during this show here: [00:49] Each show begins with the most recent and relevant facts concerning the Covid-19 pandemic and its impact on American life. What’s happening and what does it mean? [03:23] Are employer and government vaccine mandates gone for good? [04:48] Are other nations dropping Covid-19 restrictions, too? [06:43] Are U.S. healthcare providers still under “one-size-fits-all” restrictions? [08:58] Do Americans respect/heed CDC guidance? [09:41] Is Paxlovid worth taking for people with Covid-19? [11:54] What’s the latest on “Long Covid”? [15:04] Does Covid-19 infection alter the timing of women’s periods? [17:28] What’s the latest research on Covid-19 and kids? [20:48] Beyond Covid: Are people more optimistic and fulfilled? [22:00] Is polio making a worldwide comeback? [24:56] What is the primary care shortage doing to America’s health? [27:39] How bad is the medical debt problem in the United States? [30:14] What does the Amazon acquisition of One Medical mean for medicine? This episode is available on Apple Podcasts, Google Play, Spotify and other podcast platforms. If you have coronavirus questions for the hosts, please visit the contact page or send us a message on Twitter or LinkedIn. *To ensure the credibility of this program, Coronavirus: The Truth refuses to accept sponsorship, outside funding sources or guests with any financial or personal conflicts of interest. The post CTT #66: What’s the latest on long Covid?   appeared first on Fixing Healthcare.

This Fixing Healthcare podcast series, “Diving Deep,” probes into some of healthcare’s most complex topics and deep-seated problems. On today’s episode, hosts Dr. Robert Pearl and Jeremy Corr explore how the middleman mentality is killing American medicine, and then contrast it with how some of the nation’s largest retail companies (including CVS, Walmart and Amazon) are planning to expel the middlemen of medicine with an effective long-term strategy. Whether you provide medical care or receive it, you’ll learn much from this deep dive into the future of healthcare. For more information on these topics, check out Dr. Pearl’s latest healthcare columns on Forbes and LinkedIn. For listeners interested in show notes, here’s a discussion guide: THE MANY MIDDLEMEN OF MEDICINE What is a middleman? What did healthcare look like before middlemen? When and why did middlemen enter the picture? What is the ‘middleman mentality’? What are examples of it in healthcare today? Are middlemen medicine’s biggest problem? How does the middleman mindset harm patients and doctors? Why do middlemen love “fee for service” payments? How have insurers and insurance purchasers (employers) responded? What might effective leadership look like in healthcare? Where does change begin? AMAZON, CVS, WALMART: PLAYING THE LONG GAME Retailers are making major news in healthcare. Why? What are biggest, boldest healthcare acquisitions in recent months? Based on the past few years, are giant retailers doomed to fail in medicine? What reason is there to believe Amazon, CVS or Walmart can succeed? What is the short-term strategy for these retailers in healthcare? CVS and Amazon paid billions for primary care companies that are losing money. Why? What’s the middle game for these retailers? Why are they all interested moving from fee-for-service to capitation? How do their latest acquisitions and partnerships tie into Medicare Advantage? What does the long game look like and how long will it take to plat out? How will the winner be determined? * * * Dr. Robert Pearl is the author of a book about medicine’s invisible yet highly influential physician culture. Check out “Uncaring: How Physician Culture Is Killing Doctors & Patients.” All profits from the book go to Doctors Without Borders. Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple, Spotify, Stitcher or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn. The post FHC #68: Diving deep into the medicine’s middlemen & the future giants of healthcare appeared first on Fixing Healthcare.

Dr. Ezekiel Emanuel has spent a lifetime challenging the establishment. He says that tendency is very much a part of his family’s heritage. “My mother, not infrequently, would have to be in school because her sons were opposing rules and speaking out when everyone else was silent.” Those other sons happen to be Rahm Emanuel, the former Chicago Mayor and current U.S. Ambassador to Japan, as well as Ari, an American businessman and CEO of the massive entertainment agency Endeavor. Zeke, himself, is an oncologist, medical ethicist and a major contributor to the Affordable Care Act legislation. In this interview, hosts Jeremy Corr and Dr. Robert Pearl ask him about the rules of medicine that deserve to be broken and who among us can lead the charge for change. Interview Highlights   On the Emanuel Family “We are rulebreakers. My partner is always saying, ‘You think a rule is a good suggestion and not as a rule in the sense that most people think about it.’ I would say that it comes from our parents.. My mother, very early on, and I mean very early on, when she was a teenager, was very dedicated to Civil Rights well before white people and white women were heavily involved in Civil Rights … And then in 1965, right after the election, when Medicare was being debated and legislation was moving and the AMA opposed it, (my dad) quit the AMA.” On his reluctant path to medicine “I would report myself as a reluctant physician … I really was not very fond of medical school, mainly because I didn’t like the hierarchy of medicine that everyone deferred to whoever was the most senior person around as opposed to, let’s have a discussion about this. And I also did not like all the memorization of medicine and what really appeared to me during medical school to be a lot of irrelevancy that I couldn’t imagine would be really related to treating patients and making advances like relearning the Krebs cycle, like the Startling law and things like that. On regrets with the AFFORDABLE CARE ACT “There are a lot of things I wish I had pushed harder on, and a lot of things I wish I had thought more deeply about. I would say top of that list of things that I wish I had thought more deeply about and emphasized more is more simplicity in our system. One of the things I think that the Affordable Care Act unfortunately did is to actually make the system much more complicated, and I think that is a problem. I think it’s one of the major problems of the American healthcare system. It’s so damn complicated to use. It’s really, really hard for people who aren’t focused on health. And even if you are focused, we had to invent the whole new category of employment called Navigators because it’s become so mind-numbingly complex. On dealing with death as doctors “I do think that medicine has moved on since the time that you and I trained in the sense that when we were training almost every patient who died in the hospital got resuscitated. DNR orders were still controversial. Withdrawing treatment was still controversial. We didn’t talk to patients about it, and the majority of patients were dying in the hospital. Well, I spent a lot of time in the end-of-life care field, first of all trying to understand what really motivated patients and then trying to change our norms about it. And I think the norms have changed … I think that this notion of do everything no matter what has evolved, and I think that’s super important.” On ‘Why I hope to die at 75’ (his 2014 column in The Atlantic) “Human beings are on a spectrum or a bell-shaped curve or some kind of curve, where some people are cognitively intact, are physically intact well after 75. Most of us are not outliers like that. Most of us are solidly in the middle. And what you see is in the middle, the rate of Alzheimer’s goes up at 75 … People retire, they end up being less creative. They’re just not producing and contributing in the same way, and that’s not the way I see my life. I don’t want my children or other people to remember me in a particular way. I want to go out being very active, totally intellectually engaged, physically fit. And so that’s 75. And, again, it’s just playing the numbers.” READ: Full transcript with Zeke Emanuel * * * Dr. Robert Pearl is the author of a book about medicine’s invisible yet highly influential physician culture. Check out “Uncaring: How Physician Culture Is Killing Doctors & Patients.” All profits from the book go to Doctors Without Borders. Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple, Spotify, Stitcher or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn. The post FHC #67: Dr. Zeke Emanuel on the virtues of rule breaking appeared first on Fixing Healthcare.

Galileo, Darwin and Einstein: three historical figures who changed the way we view the world. Galileo broke the myth that we’re the center of the universe. Darwin proved that humans evolved slowly, not through sudden divine action. Einstein’s theories of relativity led to new ways of looking at time, space, matter, energy and gravity. Each of these critical thinkers helped humanity take massive leaps forward. But have some of their lessons been lost on the medical profession? In this episode of Fixing Healthcare, sans cohost Jeremy Corr who was out with illness, Dr. Robert Pearl joins ZDoggMD to probe the left and right brain for answers. Are doctors convinced they’re *not* the center of the universe – or least the center of health and medicine? Borrowing from Darwin, if life is evolutionary and *not* divinely given, then how much of the end-of-life care doctors provide does more harm than good? And if time and space are *not* static or objective, should the scientific method be the final arbiter for medicine or should we follow a different master? To find out, press play or peruse the transcript below. * * * Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple Podcasts or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn. UNFILTERED TRANSCRIPT Robert Pearl: Welcome to Unfiltered, our newest program on our weekly, Fixing Healthcare Podcast series. As usual, joining me today is Dr. Zubin Damania, known to many as ZDoggMD. Unfortunately, Jeremy has lost his voice, a terrible problem for a podcaster. As such, I’m going to have to do his part of today’s show as well as mine. For 25 minutes, Zubin and I will engage in unscripted, and I predict, hard-hitting conversation about art, politics, entertainment and much more. We’ll apply the lessons we extract to medical practice. I’ll then pose a question for the two of us to consider that Jeremy might have asked, to conclude the episode. Zubin, are you ready? Zubin Damania: Oh, I’m ready. It looks like all your years of being an understudy for Jeremy… Jeremy, they’re finally coming to fruition. You finally get to step up into the lead role. Robert Pearl: Excellent, excellent. So, let me start Zubin, by clarifying another of the many rumors about you that I see on social media. So, is it true that they asked you to be the king after the death of Queen Elizabeth, but you turned them down? Zubin Damania: I turned them down because honestly, I didn’t have a circular enough family tree to have the requisite recessive genes to be a monarch. I was too out bred, honestly, that was part of the problem. Robert Pearl: You could have had a poison ivy, poison oak kind of family tree, I think. Right? Zubin Damania: Exactly. I mean, all seriousness though. The loss of the queen was like the loss of a common mythology. We were talking about the hero’s journey the other week, and this idea that we have this shared identity. Most people in living memory do not remember not having Queen Elizabeth as the monarch of Great Britain. So, it actually is a grieving process for everybody in a way. Robert Pearl: Well, anyone under the age of 70 wasn’t alive, and probably they don’t have very many remembrances until at least age 10. So, anyone under the age of 80 can’t remember a time before that. Probably anyone over the age of 80 might have forgotten some of the things way back then, so we’re left with the fact that no one could remember a time without Queen Elizabeth. Zubin Damania: I think that math is correct. Yes. I believe it. Robert Pearl: So, anyways, we heard from lots of listeners that they enjoyed the conversation we had about Amazon’s acquisition of One Medical, and the implications it has for American medicine. Since then, as you know, CVS acquired a company called Signify, and the company employs 10,000 physicians to provide in-person and virtual at home care. United Health, which already employs over 50,000 doctors, signed a 10 year agreement with Walmart. In your opinion, Zubin, how nervous should physicians be and what do you recommend they do now? Zubin Damania: Well, I mean, I think this is clearly an epiphenomenon of how we’ve actually failed to do the job of healthcare that Americans actually want. So, private industry is stepping up, and with the probable some degree of hubris that they can do it better than physicians. But the truth is, they have the resources, the drive, the time horizon and the incentive because they’re paying, their footing the bill for their own employees. So, I would be concerned quite a bit if Amazon, if CVS, if these guys are all partnering to do this, that they’re going to at least have a shot at succeeding on some level. That’s going to put the pressure on regular physician groups and multi-specialty groups to step up as well. This is something that’s probably been a long time coming and probably overdue. Robert Pearl: I mean, I’d argue that we have refused to take the lead, and as long as there’s a vacuum and a void, someone else will come into it, so why not be one of the big businesses in the United States? Zubin Damania: Yeah. I mean I think that’s the bottom line. Especially with the Amazon thing, it’s interesting because again, Iora Health are partners at our clinic in Las Vegas, to see it go full circle back to Amazon, I’m just… Again, if they get it right, they really have a very powerful model in their hands. If they can scale it for chronic disease that the Iora model and for the consumer, the younger people, the One Medical model, I would be very nervous right now if I were in the traditional healthcare system. I think doctors can no longer just say, “Oh, you know what? I’m just going to keep my head down and hope it all settles out.” It’s like, we have to lead, because if we don’t, it really will be the technocracy that leads it, and it won’t be the best for, I think, the physician/patient relationship moving forward. So, we do have to start to lead, because we’ve really dropped the ball, like you said. Robert Pearl: This morning, Zubin, I published an article in Forbes on leadership, or at least what I see is its lack in healthcare today. So, the listeners should be aware, you probably haven’t had a chance to read it, but I’d like your thoughts on the following paradox. From my perspective, the challenges in healthcare are massive: lack of affordability, lagging quality burnout, healthcare disparities, we could go on for the entire show today, just listing the ones that are there. Yet most of the efforts I observe that people and companies inside healthcare are doing, they’re focused, Zubin, on a small opportunity often, an incremental improvement. Do you see the need for a massive change? If so, who should and who do you think will lead it? Zubin Damania: Well, what I think is happening is this is indicative of our societal shift in general towards this micro thinking, reductionism, left-brain scenario. There’s a lot of misunderstandings about left brain, right brain schism, by the way, Robbie. Like Iain McGilchrist, a psychiatrist, neuroscientist in Great Britain wrote a great book called Master and His Emissary, about the actual debunking some of that mythology. The mythology that the left brain is the rational clear thinker, sees strategically and so on, that’s not true. The left brain takes wholes and breaks it into parts. It always thinks it’s right. It has righteous anger, it’s a reductionist, and it is isolated from the whole, and that’s what it is. It’s a grasping tool. Zubin Damania: It’s the right brain that sees things holistically as a bigger picture, and sees parts in their context. In medicine, I think what we’ve done is we’ve tried to, oh, well we can improve this little thing, or we can build this little widget a little better, and we build this little widget, and you forget that this is a multidimensional interdependent organism that is healthcare. Who is going to lead that? It has to be the part of that organism that does the operating end of it, and that’s physicians and clinicians and people in that space. They really haven’t. What happens is now you have this technical reductionism, where you have people working on these different parts, and they talk about, “Oh, now I’m wearing a Fitbit, and here’s this data.” It’s like, how does that data plug into the bigger picture, and what are the hopes, dreams and fears of the patient that you’re getting that data from? How does this relate to outcomes that matter to them, and that also save money in the economic game and so on? Zubin Damania: It has to be, I think, physician leaders in partnership with business leaders, in partnership with economists, in partnership with businesses, because they have so much skin in the game. What is it? Half of all the spending in the country on healthcare is from our large employers, employers in general. We have to look at it more with a right brain, left brain collusion, more of a balance. We haven’t done that. It’s just like the rest of society, we reduce and reduce and reduce, and it becomes this technocracy. Robert Pearl: Are you saying that the right brain, and again, speaking really metaphorically not anatomically, but that the right brain is the more logical of the two hemispheres? Zubin Damania: No. It’s more that the right brain sees things more in context. It is actually more emotionally intelligent according to McGilchrist. He lays out in 1,000 pages why this is so. It actually was the master in the original relationship, and as societies and individuals evolve over time, the left brain, which was the servant, it actually evolved to help the right brain break things into parts and manage little tasks and things like that, it actually started to think it was the boss, and that by breaking things into parts, you could recreate wholes from the parts. It doesn’t work that way. It’s the emissary suddenly usurping the role of the master. This is metaphor, but it’s also based on studies off split brain patients, on people who’ve had strokes in different sides of the brain and seeing what happens. Zubin Damania: For example, people who’ve had right brain strokes, where parts of the right brain are knocked out, they tend to not see things contextually. They’re very concrete, they live in abstractions, they’re unable to function in society. Whereas left brain strokes, people tend to overcome them. Often you lose speech or language, and language is a very reductionist thing too because it breaks things into parts and subject and object. But you still function actually reasonably well. So, it’s really quite fascinating that… He points out to western civilization, as society evolves it shifts to a more left brain dominant space before it collapses. He goes to a lot of history and different big civilizations and what ends up happening. They become these huge bureaucracies. Bureaucracy is the domain of the left brain. What you really need is a corpus callosum that connects the two, that actually brings balance, where master and emissary are in harmony. We’re losing a little bit of that balance it feels like, definitely in healthcare, but in society in general. Robert Pearl: I love that analogy. Let me take it a step further. It seems to me that the context of medicine is the unaffordability for the patient. It’s the fact that we don’t do as good a job on prevention, avoids the complications from chronic disease, as we might. It’s looking at the technology that we value, like the operative robot and the technology that we tend to minimize, even now, like telemedicine. It seems to me that maybe what you’re saying is that as physicians, we are really trained in the left brain, multiple choice questions and four answers, and that we need to have a lot more of this sophisticated understanding of the right brain. Zubin Damania: That’s it exactly. I think you nailed it. I think in medicine we really are left brain oriented through our education. That right brain, that’s why we ought to be screening physicians, not so much on MCAT scores and these reductionist pieces, but on emotional intelligence, creativity, imagination, those pieces that are very right brain, left brain synergies. Like you said, I think taking a patient out of his or her context, is problematic. Their social determinants of health and all of that are a big piece of it, that’s their context. Their family, their community, their culture, all of that rolls in. Then it’s the same with medicine. If you take a piece of data out of context of the bigger picture, it doesn’t mean anything. Zubin Damania: In fact, it leads to more reductionist poking and iatrogenesis and cost from causing harm and those kind of things, where we’re doing things to people instead of for the larger person. So, I think it is a very good metaphor actually, a good model for where we might be going wrong. It’s not limited to medicine, but I think medicine is the best example of it, because it’s such a human enterprise. When you start to see it go out of balance, people know it. They may not be able to articulate it, but saying, well here’s a model that might actually put it in words, in some kind of structure, it might be helpful for people to go, okay. So, how can we overcome that? Robert Pearl: Do you have a view how it’s going to happen? Is it going to be an individual like yourself who started a program in Las Vegas? It had to close in the end. But today, might have been successful. Is it going to be a medical group led by some CEO? Is it going to be some type of medical society? How do you see this, I’ll call it massive change, disruption is what a business student would call it, happening, a transformation of how healthcare needs to be provided? How are you going to get ahead of the curve, rather than letting these other organizations like Amazon and CVS beat us to the punch? Zubin Damania: Yeah. That’s a great question. Disruption in the classical tech, say a tech company or something disruption, it really is a very… It’s almost like a single site mutation. You do this one thing better and you do it cheaper, and initially the quality isn’t as good. Then over time it gets better, and really suddenly that other big old school legacy company is out of business because you’ve disrupted their model. In healthcare that more reductionist left brain disruption can’t happen. It has to be a holistic, multifocal, almost like a caterpillar turning into a butterfly, every organ transforms. That means all the entities that you listed, I think, have to be a part of it. They all have to wake up a little bit to, okay. What’s the problem? Because a problem well defined is already half solved, as they say. Zubin Damania: Then each of us starting to work on solutions, but connecting with each other so that we never miss the big picture, because otherwise we’re just spinning our wheels in the dark. Like the old metaphor of the elephant, trying to figure out what is this creature, and blind people, these blind wise men, each touching a different part of the elephant and not understanding that it’s an elephant, until they actually talk to each other. So, that’s what we haven’t really done a lot of, is connecting across these different spectrum. Like you said, the medical societies and the big healthcare organizations and the small healthcare organizations, and the on the ground doctor and so on. Robert Pearl: Listening to you, Zubin, I’m reminded of something that I read about three historical figures who change the way we see the world, because I think what you’re describing is that doctors need to see things different, see them in context. These three people, pretty famous, Galileo, Darwin and Einstein, and how their discoveries contradicted how humans see the world and ourselves. Galileo broke the myth that we’re the center of the universe. Darwin proved that we became human through slow evolution, not a sudden divine action. Einstein demonstrated that everything is relative, and maybe we can apply this a little bit to medicine. As doctors, we see ourselves at the center of medical care delivery. We see our judgment as the best way to reach the optimal approach for a patient’s problem. But maybe, just what if it’s actually complex data analytics or even artificial intelligence? How will we know that we need to change and what do you think we’re going to do about it? Zubin Damania: Yeah. This is a great question, because as you’ve pointed out, Robbie, in your books, physicians in particular are the masters of denial. So, we can continue to drill down in our little piece of the world, thinking that we’re doing good and at least convincing ourselves of it, because we’re generally pretty good people. I think what happens though is we need to wake up that it’s not working. I think many of us intuitively feel it. Some people will say, well, this is a function of burnout and we don’t get enough resources and we don’t get enough tools and trust and teams and so on. To some extent that’s absolutely true. But to another extent it’s just that we are drilling down in the wrong direction. I think people who work in primary care feel this very acutely because they see what’s broken. Zubin Damania: They know intuitively what needs to happen with their patients, that it is a contextual thing. It’s a much more intricate web and they need the time to spend, but also the tools. Like you said, the AI and the data analytics to give them the best possible tools. Everything that can be mechanized is mechanized, and then apply it to that unique complex human entity that’s in front of you. That has spiritual components, it has scientific components, it has psychological components, everything is bio psychosocial at root. To some degree, it’s waking up from our own slumber on this, our own denial on this. I think people are waking up. So, it might be that we don’t even predict it, Robbie, that all of a sudden there’ll be this mass tidal wave, the culture will shift, we’ll all wake up and then it will just start to avalanche, the change. But that’s an optimists view and I tend to be an optimist, so I’m hoping that it’s right. Robert Pearl: When I look at it, I wrote a little bit about it in the piece today, it would seem that the people who would really be pushing for a move from Fee For Service to capitation would be primary care. I mean, in a Fee For Service world, the only way you can generate more revenue is seeing more patients. That’s what’s happening today. We’re seeing more and more patients all the time, which means that the amount of time per patient is going away, and all the things you just discussed, all of the contextual ways. We need to understand the individual in terms of the social world in which they exist. There’s no time to figure that out. Whereas in a capitated world, the way you are economically successful is by taking out the things that add little benefit for the patient, and by helping the individual avoid disease and avoid the complications from chronic disease. Yet outside of a few groups that are across the nation in primary care, I’m not hearing the big primary care societies pushing for it. Why not? Zubin Damania: I think they’ve been burned by the promise of capitation not actually panning out in their lives. So, if you’re capitated, and everything you said is absolutely correct, and that was our belief at Turntable and Iora, it’s like, give us a chunk of money to care for these patients, and we’ll do it right. Now, the question I think becomes, how much is that chunk of money? Because you can certainly spend more time and apply more levers and resources to those patients if you have a little more money per patient, per month. Then what your panel size is, what’s your support? What are the tools that you have and the teams, the human resources? Then are you given the trust to actually have those outcomes happen if your skin’s in the game somehow? You’re a part of the organization and you feel really invested in it, then you will do that. Zubin Damania: But we all know the stories of, there’s some people who… It’s almost like quiet quitting. They’ll phone it in because they know they’re getting this or that salary or whatever, and the patients are capitated so they’ll have a big panel, but they’ll do the minimal necessary and the organization suffers. So, I think it’s just getting the details right. It’s actually just figuring out those bits. Some of that is culture and leadership and those sort of things. But I’m curious what you think, since you led one of these large, very successful organizations for so many years. Robert Pearl: My sense is that capitation generates fear, because you’re now actually responsible. You can’t just do something and expect to get paid for it. If things go wrong, and you’re absolutely right, you’ve got to get the amount of capitation right, you have to have some protection against things like a transplant and other things that are just unexpected, COVID hitting this shore. So, you need to have it negotiated correctly. But it does require things that I think are not intrinsically built into doctors after their training. One is this willingness to take risk, that’s much more of an entrepreneurial piece. The second is it requires tremendous collaboration. Third, it requires that everyone agree on how they’re going to take care of a problem and having agreed, actually do it. We love autonomy. We like to be able to do whatever we want to do. I think that that is problematic, and ultimately all the things we learn as physicians are anti capitation. They favor Fee For Service. It’s just that in the current world, Fee For Service doesn’t work, from my perspective. Zubin Damania: I think that was really well put. I think that’s directly it. It’s our culture. I mean, there are many doctors even listening to this conversation, who’ll say, “Oh God. They’re talking about capitation, and they don’t understand that that’s a loss of autonomy, and it’s this and the other thing.” To that degree, they’re correct in the sense that you can’t just go and do anything you want. There is a collective shared agreement that you’re trying to coordinate, almost like an organism. If you’re a tissue in a body, you do coordinate with the other tissues and organs and systems, and there is a general ethos and telos and flow to where you’re going. I think we’ve not had that in health 1.0 and 2.0. 2.0 is more of a top down, okay, we’re just going to do this. And then there’s general rebellion or quiet quitting, just phoning it in. Zubin Damania: I think a 3.0 model is more, okay. Listen, no. Actually we need to change even our expectations, what it means to be a physician and what it means to work in a large organization, or even a smaller organization or as part of a defacto network of physicians. So, some people opt out and they go, I’m going to do direct primary care and I’ll get a capitated rate to take care of patients and I’ll do it my way. That’s wonderful, except that it doesn’t integrate with the larger system unless they generate structures to do that. So it is kind of one of the big challenges moving forward. Robert Pearl: Well, that model requires that people be able to pay a lot more to get the added convenience. There’s a segment that can do that, but it won’t solve the problem of the more general population. Again, I just see that I would much rather generate income by helping patients avoid heart attacks and strokes and cancer. When I became the CEO in Kaiser Permanente, our hypertension control rate, the number one cause of stroke, was similar to the rest of the nation, a little bit better. We were maybe at 60%, the nation was 55. We agreed that every doctor, not just primary care, would look at the blood pressure. Maybe the specialist couldn’t take care of it, but the specialist would know whether it was normal or not and could make sure the patient got taken care of. We got that over 90% diminishing strokes by 30%, the same when it came to heart disease with blood lipids, hypertension, smoking, et cetera. Robert Pearl: We dropped the rate of patients developing a heart attack by 40%, the chance of dying from heart disease by 50%. Same thing when it came to colon cancer. Every doctor can look on a chart and say, “Did you have your proper screening?” I don’t mean having some kind of colonoscopy. I’m talking about getting a FIT test, a fecal immunochemical test that you can do in your bathroom in five minutes at home without a bowel prep. How hard should it be? The nation is around 60%. We got up to 90%. Again, saving 40% of people from developing metastatic disease and cancer. These are the kinds of things I would think would drive doctors to say, I’d much rather do those things than add another patient and another patient and another patient. But somehow that passion isn’t there. Again, when you ask me why, I just think there’s this fear that somehow we’re going to give up what we have today. When I look at it, what we have today isn’t that great. Zubin Damania: Yeah. I think that’s it. The stuff you’re talking about isn’t sexy. It’s not sexy to prevent a colon cancer, or prevent a heart attack. It’s sexy to go in with a stent and dramatically open up, get Timmy three flow out of this thing that’s acutely occluded. That’s the cool autonomy, and that’s where you’re the Top Gun maverick, doing your thing. I think we’re very conditioned by that kind of glory, and not looking at the just sheer number of lives and suffering, and area under the curve of good we’re doing in the world, by what you’re pointing at. Again, that’s cultural conditioning from years. It’s almost like a karmic thing. How many millennia physicians have had this kind of autonomy and shamonic role in the community, and they feel that it’s being reduced? But I think there’s room for all of that. There is a holistic way of looking at this that actually incorporates all aspects of that. Again, some of it becomes a cultural shift. What gives us joy in medicine? Robert Pearl: So, I hate to think of a show when we’re not controversial, so let me look at that in the same context and move on to Darwin. If life is evolutionary and not divinely given, then might much of our end of life care be creating more harm than good? Or phrased differently, Zubin, is the idea to save a life at any cost an artificial construct? If it is an artificial construct, what should we doing? I mean, I think of patients I’ve taken care of with head and neck, cancer of the tongue, who’ve had a series of surgeries, they can’t speak, they can’t eat, they can’t breathe. Or I just read about a patient who spent 900 days intubated on a respirator in the ICU after COVID. When does medical care become torture? Zubin Damania: Oh. This, again, it gets back to this left brain, right brain thing. There is no part of a right brain approach to this issue that would do the 900 days COVID post ventilator thing. Because again, that’s doing things to people, it’s turning people into machines that are failing as a model. The left brain is a machine and the machine is working or not working. Humans are not… They can’t be reduced to mechanistics. They’re very dynamic, crazy, complex processes that include this element of spirituality. Even a non-religious spirituality where it’s like, no, there’s meaning, there’s purpose, there’s awareness. That’s what makes humans just absolutely beyond any mechanistic description of them, that could reduce anything to that. So, what we’re doing now is, from an evolutionary standpoint, it’s crazy, because it doesn’t make any sense. Of course, we’re a little beyond even standard evolution now because our technology is helping us. Zubin Damania: So, we’re evolving our technology as a proxy for our DNA. It doesn’t even make sense, I think, from any religious based, spiritual approach because it’s decidedly unnatural to draw things out in a way that is against what even the patient would want if they were able to speak. We haven’t had the conversations, we’re fear-based. Ultimately, Robbie, it’s our fear of death because we are in the dark as to what it is we actually are. So, we live in this dark hall of fear, and as doctors we suffer from it because we won’t even talk about it with our patients, because in some way it reflects back to us and our accomplishments and our conditioning and our culture. Robert Pearl: I wonder how you’re going to apply this left brain, right brain, right brain putting in context to the things we’ve learned from Albert Einstein. The idea that somehow everything is relative. Is that a question of putting into context, taking it out of context? Is the scientific method, the final arbiter for medicine, or should we follow a different master? Zubin Damania: Oh, man, you’re asking a good question. So, Einstein, fascinating guy, because what he would do, you would think, Einstein’s the epitome of the left brained scientist. Not at all. In fact, what McGilchrist argues in his book is that the idea of science and reason is not a left brain thing. Reason is a right brain scenario. It’s taking data from the world, taking information, and actually applying the filter of context and common sense. What Einstein used to do is he would bang away at a problem in a reductionist way as long as he could, and then he would stop and he would just give up and he would go to sleep. The inductive, intuitive processes that are much more right brain oriented, would speak. That’s how he would get these insights that were beyond. Zubin Damania: I mean, how would you derive the theory of relativity from first principles? You can’t. It’s almost an intuitive leap that he made. The fact that everything is relative, that time and space are plastic, was a transformative idea. Even Einstein would say things like, “We’re trying to probe the mind of God here. The more you look, the deeper the mystery, and you should celebrate the mystery.” So, again, I think it relates again to this idea that the mind is a mind divided into these realms. Increasingly one realm is becoming ascendant, and it may not be the realm that should be ascended. It’s the servant rather than the master. Robert Pearl: With Jeremy not being here today, I have to take a guess, Zubin, about a question he might ask. He’s an historian, so I’m going to ask you, given everything you’ve talked about for the past half hour, if you had to pick a president from the past to lead healthcare into the future, one who could understand this newer definition of left brain and right brain, who would it be and why? Zubin Damania: Wow, man. That’s putting me on the spot. Let me think of my history here. I think it would be a split between Teddy Roosevelt perhaps, FDR or JFK. The reason I picked these three is what they found, what they could do it seemed, was integrate very complex information like World War II with FDR. Teddy Roosevelt, more the general milieu of everything in the wars that were going on and so on. But in John F. Kennedy, with the moonshot, the Soviets, the Cuban Missile Crisis, integrate all this kind of reductionist data with deep understanding of the connections between humans, how to inspire them, how to move them through crisis, how to actually embody some of the values that we claim to have in America, and embody them and show them in a way that actually inspires others. I think I would vote for those guys. They were the perfect balance of right brain, left brain, and the transcendent quality that comes when those are in balance. Robert Pearl: I too think of three people. One person is Abraham Lincoln, who tackled probably the hardest question our nation has had, that of slavery. Which should be an easy question, but not in the context in which he lived. He had to balance the sides, he had to bring into his cabinet, as Doris Kearns Goodwin has pointed out, individuals from different backgrounds, often not from his own party. He was able to not do what most people would do, I will call it left brain, in quotes, logical approach. But to put everything into a context. I agree with you also about JFK. But to me, the big thing is, he was going to take the leap, put a man on the moon. I think for healthcare, that’s what we need. Robert Pearl: We need someone willing to take the risk, willing to make that commitment, not just sometime in the future, but he set a 10 year deadline and met that deadline. The third person I’d put is George Washington. I’d put him for two reasons. First of all, in the context of the immediate, he could see the difference between the United States being a free country, and being a country under Britain, he could see the opportunities through linking together with the French. Then, when he could have become a monarch and taken a third term and fourth term, he could see the problems that would create, and he put the nation in front of himself. I think that that’s going to be required for us to move healthcare into the future. We’ll see whether medicine can have the kinds of leaders that you and I both see and see what Jeremy says in the next program. Robert Pearl: For the listeners, we hope you enjoyed this podcast, and will tell your friends and colleagues about it. Please follow Fixing Healthcare on Spotify, Apple Podcasts, or whatever other podcast platform you use. If you like the show, please rate at five stars and leave a review. If you want more information on healthcare topics, you can visit my website, robertpearlmd.com, or our website @fixinghealthcarepodcast.com. You can follow us on LinkedIn, Facebook and Twitter, at Fixing HC Podcast. Thank you for listening to Fixing Healthcare’s newest series, Unfiltered, with Dr. Robert Pearl, Jeremy Corr, and Dr. Zubin Damania. Have a great day. The post FHC #66: Right brain vs. left brain in medicine  appeared first on Fixing Healthcare.

This Fixing Healthcare podcast series, “Diving Deep,” probes some of healthcare’s most complex topics and deep-seated problems. On today’s episode, Dr. Robert Pearl and Jeremy Corr talk about two of the world’s biggest tech companies and their potential impact on American healthcare. Later in the episode, the hosts revisit the three biggest threats facing healthcare and discuss solutions that can and must be implemented in the next two years. For more information on these topics, check out Dr. Pearl’s latest healthcare columns on Forbes and LinkedIn. For listeners interested in show notes, here’s a time-stamped discussion guide: AMAZON VS APPLE [01:08] How much of an impact has technology had on medical practice in the 21st century? [01:55] Don’t doctors want to be at the cutting edge of technology? [03:38] How are tech companies trying to penetrate healthcare’s $4.1 trillion market? [04:18] What is the unwritten rule of health technology? [05:32] Is Apple breaking or following this unwritten rule? [07:45] Can Apple make a meaningful difference on human health? [08:50] Can Apple profit in healthcare without fundamentally improving health? [11:21] What could Apple do differently? [12:35] What would be the impact of a medical device created by Apple? [15:14] Why hasn’t it happened yet? [16:00] How is Amazon’s healthcare strategy different? [17:03] What’s Amazon’s long-term goal? [17:44] Hasn’t Amazon failed twice before in this space? [18:39] What happened with Haven and Amazon’s telehealth platform? [19:42] What’s the biggest hurdle Amazon will need to overcome?   HEALTHCARE’S 3 BIGGEST THREATS [23:20] What is healthcare’s “perfect storm” and is it heading our way? [24:39] Where will the impact be the greatest from the three “mega forces”? [25:42] What options do hospital leaders have to temper the storm? [27:34] What’s the first action needed? [28:25] How, exactly, could hospital leaders quickly to reduce cost, increase access and improve professional satisfaction? [30:24] Could the right hire actually decrease the cost of care? [32:05] What’s the second action needed? [33:25] How might this concept be applied to the work that doctors do? [34:42] What’s the third action needed? [36:44] Why haven’t these changes been made yet and what’s next? * * * Dr. Robert Pearl is the author of a book about medicine’s invisible yet highly influential physician culture. Check out “Uncaring: How Physician Culture Is Killing Doctors & Patients.” All profits from the book go to Doctors Without Borders. Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple, Spotify, Stitcher or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn. The post FHC #65: Diving deep into Amazon and Apple’s healthcare ambitions appeared first on Fixing Healthcare.