Healthcare Unfiltered

Bishal Gyawali (@oncology_bg), MD, PhD, Queen’s University Cancer Research Institute (Canada), joins the show to discuss the measurement of clinical benefit of new therapies and optimizing clinical trial design. Dr. Gyawali recaps a presentation he gave at last year’s ESMO Annual Meeting on clinical trial characteristics leading to artificial improvement of ESMO-MCBS scores for cancer drugs, goes on to list in detail the ten trial design characteristics that inflate the scores (including the use of surrogate endpoints and quality of life reporting, among others), and wraps up with a comment on future opportunities for clinical trial reform. View Dr. Gyawali’s recent publication on clinical trial design https://www.esmoopen.com/article/S2059-7029(21)00075-2/fulltext

Recurring guests Saurabh Jha (@RogueRad), MD, radiologist in Philadelphia, and Vinay Prasad (@VPrasadMDMPH), MD, MPH, hematologist/oncologist in San Francisco, seek to settle the debate surrounding COVID vaccine passports. Both scholars defend their recently published viewpoints – Dr. Jha arguing for passport mandates and Dr. Prasad arguing against them. Will requiring proof of vaccination be driven by the business sector, local or federal governments, or anywhere in between? Will vaccines help jump start or continue to stall economies? When is the right time to impose a vaccine passport, if ever at all? This is a real barn-burner of a discussion that you won’t want to miss. View Dr. Jha’s publication on The Health Care Blog https://thehealthcareblog.com/blog/2021/04/29/the-market-forces-behind-vaccine-passports/ View Dr. Prasad’s publication in Medscape https://www.medpagetoday.com/blogs/vinay-prasad/92107

To truly understand the gravity of the somber COVID situation in India, Chadi hosts Parameswaran Hari, MD, MRCP, chief of oncology, Medical College of Wisconsin, and Nikita Mehra, MD, associate professor of medical oncology, Cancer Institute Adyar (India). Dr. Hari begins by providing a ground-floor perspective of the COVID situation in India from his visit there just a few weeks ago, including how the country fared in 2020 compared to the current day and how hospital systems are managing in different parts of the country. Dr. Mehra then joins the show to share how shocked India has been with the second wave. The trio discuss the “hypotheses” of why COVID never hit India that hard last year, initial stages of vaccine hesitancy among health care workers and trust levels with the central government, and whether or not the situation is dire enough to consider rationing care on a patient-by-patient basis. The conversation wraps up with comments on the US actions to support India during this crisis. Spoiler alert: all three are very critical.

Chadi hosts three medical oncologists to break down “near equivalence” for alternative standard-of-care cancer therapies – a new paradigm published in detail in the Journal of Clinical Oncology. Ian Tannock, MD, PhD, Princess Margaret Cancer Center (Canada); Mark Ratain, MD, University of Chicago; and Daniel Goldstein, MD, Rabin Medical Center (Israel), describe what is meant by “near equivalence” and the practice of generating evidence to support global alternative cost-effective treatments. How do you design and implement studies that show lower drug doses are as effective as the labeled doses and treatment schedules? Does listing drugs at a lower price than comparable drugs impede innovation in a capitalistic society? How do poor control arms make it through regulatory and IRB approvals? How can the oncology world come to terms with “imperfect data” for supporting alternative standard-of-care treatments? These questions and more are answered in this meeting of the minds. View the publication in the Journal of Clinical Oncology https://ascopubs.org/doi/full/10.1200/JCO.20.02768

Chadi hosts two thoracic oncologists to dish and debate on the nuances of lung cancer screening: Charu Agarwal, MD, MPH, University of Pennsylvania, and Lecia Sequist, MD, MPH, Massachusetts General Hospital and Harvard Medical School. The trio start by making the case for screening the healthy, low-risk population as well as people with a smoking history, and then jump into a round-up of clinical trials that have shown a positive impact from screening. The highly-questioned JAMA publication on the USPSTF recommendations for lung cancer screening is brought to the table, including the risks and scalability across larger and smaller hospital systems. No stone is left unturned in this riveting dialogue. View the JAMA publication on screening for lung cancer https://jamanetwork.com/journals/jama/fullarticle/2777244

George Dawson (@dawso007), MD, addiction and neuropsychiatrist in Minnesota, joins Chadi to discuss mental illness and COVID – of having the virus itself, as well as the result of isolation and lack of social interaction. Dr. Dawson shares how individuals with drug or alcohol addictions have struggled to stay sober while being stuck at home without in-person meetings and human interaction, whether there is reason to believe the COVID lockdowns and social restrictions have worse health ramifications than the disease itself (eg, suicide rates), burnout and other negative effects pervading the health care provider workforce, and how fluctuating school schedules may be negatively impacting the mental health of children.

Krishna Komanduri (@drkomanduri), MD, chief of the division of transplantation and cellular therapy, University of Miami Sylvester Comprehensive Cancer Center, joins the show to provide a fascinating account of the history of allogeneic and autologous transplantation, the discovery of the difference between B cells and T cell, and up through modern cellular therapy with a forecast for the future decades. This is a crash course in cellular and CAR-T therapy that you won’t want to miss.

Chadi invites Amy Barhorst (@amybarnhorst), MD, and Rocco Pallin, colleagues at UC Davis Health, to tackle the stigma and underdiagnosing of mental health in America and how mental illness intersects with gun violence in this country. The experts delve into whether community and person-to-person violence should be largely attributed to mental illness as well as why policy changes are the clearest way to eliminate mass shootings. Then, the conversation pivots to a true story of how their Review article on ways HCPs can help prevent injury and suicide from firearms was rejected and then plagiarized by the journal editor, all of which was all covered in a viral Twitter thread. View Dr. Barnhorst's interview with CNN on whether shootings are a mental health issue https://www.cnn.com/videos/tv/2018/11/27/exp-gps-1125-gupta-barnhorst-mental-health-guns.cnn Read Dr. Barnhorst's op-ed in the New York Times on why the mental health system cannot stop mass shooters https://www.nytimes.com/2018/02/20/opinion/mental-health-stopping-mass-shooters.html

Aziz Nazha (@AzizNazhaMD), MD, former hem/onc at Cleveland Clinic, self-taught computer science expert, and now practice manager in the Data and Machine Learning Team at Amazon Web Services, joins the show to discuss artificial intelligence (AI) and machine learning from an entirely unique perspective. He details the pitfalls of unstructured healthcare data, privacy and ownership issues related to healthcare data and whether hospitals should be allowed to sell their patient data, why AI lagged in the healthcare industry compared to other industries, whether AI will ultimately replace physicians, and many other topics.

Chadi is joined by Priya Sampathkumar (@PSampathkumarMD), MD, infectious disease specialist and hospital epidemiologist, Mayo Clinic, to detail the COVID vaccine effort over the past 12 months and how the currently approved ones came to be safe and effective in such a short period of time. She then compares each vaccine in relation to their clinical trials and study populations, side effects (including some rare ones), and efficacy. Chadi and Dr. Sampathkumar converse on what it will take for herd immunity to be reached in the US, how worried we should be about the virus variants, proper precautions to be taken after vaccination, and so much more.