Peerspectrum

You’ve no doubt heard this famous quote from science fiction writer, William Gibson, “The future is already here – it's just not evenly distributed.” What better way to describe technology and medicine? The runway for technological innovation and adoption is just a little longer in our world. What other profession or industry can you think of that still uses pagers and fax machines? So where can we look for a sneak peek into the future? How about sports? Motion tracking sensors, video analysis, performance modeling, biometrics, wearables, “Moneyball” data analytics. This is old stuff for the coaches, trainers, scouts, and team managers who use these technologies every day. But what can we learn by putting this same technology to work in the operating room? To answer that question, we’re thrilled to have Dr. Carla Pugh with us today. Dr. Pugh is a professor of General Surgery, and Director of the Technology Enabled Clinical Improvement Center at the Stanford University School of Medicine. She is one of the wo

All right, welcome back. If you think you have a pretty good handle on the opioid crisis, the pharmaceutical industry and how it all works, today’s episode may challenge that assumption. It certainly did for us. The modern pharmaceutical and biotech industries are like no other. How they got to where they are is a story like no other. The same businesses that have given us incredible lifesaving advances have also given us disasters like the opioid epidemic. The history of the pharmaceutical industry is more complex and captivating than you might imagine. Today’s guest in award winning investigative journalist, Gerald Posner. He’s written twelve books including national best sellers such as “God’s Bankers,” “Mengele. The complete Story,” and The Pulitzer Prize finalist, “Case Closed.” His latest book, “Pharma,” is master class history of the modern pharma and biotech space. Understanding that history is critical to understanding the present opioid crisis. In-fact, we didn’t even cover the opioid crisis until t

Imagine losing your father at 14, losing your brother a decade later, and looking down the barrel of the same heritable heart condition that killed them both. Imagine learning in your first year of surgical residency that your continued existence will depend a new implantable device, called an ICD. A device so new, you will likely be the first surgeon in the world to have one implanted. A device that will allow your life to continue, but most likely put an end to your surgical career. That’s exactly what happened to today’s guest, one of the nation’s renowned transplant surgeons, Dr. Robert Montgomery. Robert has performed over 1000 kidney transplants and his research has advanced the field in areas such as desensitization, multiple organ transplants, gene and cell-based therapies, and perhaps most famously, domino paired donations. And if that’s not enough, he is also credited in the Guinness Book of World Records for most kidney transplants performed in one day. One more thing…Robert is also heart trans

Barbara Tuchman, the Pulitzer Prize winning author of the WWI classic, “The Guns of August,” once observed, “The unrecorded past is none other than our old friend, the tree in the primeval forest which fell without being heard.” Not only must history be recorded, it must also be examined and retold. For most of us, who are not professional historians, we approach history through the curation and re-telling of the past, mainly via books and documentaries. Perhaps we are not so different from our ancestors, and their oral traditions. History may be written by the victors, but it’s kept alive through the story tellers. Today we are heading to London to meet with journalist and author, Wendy Moore. Like Tuchman, Wendy was also drawn to the period of “The Great War,” but in search of story many of you have likely never heard of. In a time when women in the UK, the US and most democratic nations were not even allowed to vote, there was a hospital called Endell Street. A hospital with women surgeons, women nurses,

Today’s episode is not about Covid-19. Instead we’re going to give all of you a break and take you as far away from this as we possibly (and virtually) can. For that, we’re heading to Queensland, Australia to meet Dr. Andrew Peacock, an emergency physician, award winning photographer, accomplished climber and expedition guide for Lindblad expeditions, a travel company contracted with National Geographic. This conversation takes us everywhere from Antarctica to Nepal, aboard a Russian ice breaker ship, technical climbing in New Zealand, and even a private audience with the Dali Lama. We’ll learn how a lucky break in Antarctica sparked a side career for Andrew in photography. Best of all, we’ll uncover how a busy emergency medical physician has made this life possible, while literally setting the standard for work life balance. This was simply an incredible episode. We had a blast doing it. With that said, let’s get started.

In January of 2018, Warren Buffett, Jeff Bezos and Jamie Dimon announced the creation of a new, co-venture, to tackle the rising costs of healthcare for their company’s employees. They immediately picked famous writer and surgeon, Atul Gawande to lead it. Short on details but big on promise, just the simple announcement of this venture sent shock waves through the media and the markets. Billions of dollars in stock value for insurance companies and other health sector players vanished over night. Two years later, we have a name for this venture (Haven Health) but little else. What they’re up to, and what they’re planning, is still a big mystery. Whatever ultimately happens here, it will matter, simply because names like Amazon and Warren Buffet are behind it. The question is, how much will it matter for the rest of us? How much can anyone (even powerful billionaires) really change the American healthcare system? Today’s guest is Christopher Robertson, Associate Dean for Research and Innovation and Profess

Today we have Dr. Lloyd Minor with us on the show. He's an ENT surgeon, scientist, innovator and currently dean of the Stanford University School of Medicine. We covered his early career path, a surgical treatment he actually developed and his new book, “Discovering Precision Health,” released just this month in March, 2020. As the leader of one of the nation's top medical schools, located right in the heart of Silicon Valley, Dr. Minor has a unique lens on medicine's innovation pipeline. His new book and our conversation offer a glimpse into this world. With that said, let's get started...

This was a brief conversation between Colin and Keith regarding the COVID-19 pandemic. It was recorded on March, 24th 2020. For all of you on medicine's front lines, we're thinking about you every day, and we're deeply grateful for all you are doing, for all of us. Stay safe and take care.

All right, welcome back. If you're still around in the year 2061, two things will be true. You'll enjoy seeing the next passing of Halley's Comet, and your life insurance company will enjoy having collected four more decades of your life insurance premiums, without a payout. Standing there that day you and your insurance company can be grateful for the work of one man, the exact same man that comet is named for. The English astronomer, mathematician and physicist, Edmond Halley. Why you ask? Well, not only did Halley develop the calculations to predict the comet's periodicity, he is also developed the early mathematical tools for predicting human longevity, known very well to your insurance company as actuarial science. Today's guest, like Halley is also a physicist, a theoretical physicist to be exact. And like Halley he sees no need to limit his research interests to one academic domain. Laurence Jacobs began is career at MIT pursuing some of the broader mysteries of our universe. Today he's pursuing anot

It's no mystery to most of you that poor health behaviors such as smoking, substance abuse, poor nutrition, lack of exercise and patient non-compliance account for a substantial portion of the disease burden, not to mention costs, in the US. Some recent estimates by the CDC and other researchers suggest behaviors account for 40-50% of increased risk associated with deaths before age 75. The problems are clear. What to do about them isn't. There's no “will power” medication to prescribe, and most public health efforts thus far have barely made a dent. But what if old fashioned will power really isn't the issue? What if something researchers call “introspection illusion,” is causing us to overestimate our own will power, and underestimate the capacities of others? Today's guest is psychologist and behavioral scientist, Wendy Wood. She is currently a professor of psychology and business at the University of Southern California, and a visiting professor at the INSEAD Business School in Paris. Wendy has spent m

Nullius in verba. Understanding uncertainty with statistician, Sir David Speigelhalter, PhD by Keith Mankin, MD & Colin Miller

We've all heard the bad news about rural hospitals in the U.S. 60 million of our fellow citizens rely on these small hospitals, often known by their designation as critical access facilities. According to a recent analysis conducted by the consulting firm, Navigant, 21% of rural hospitals today are at a severe risk of closure. That includes 430 hospitals across 43 states, representing 21,000 staffed beds, 150,000 employees and $21 billion in revenue. When one of these hospitals closes (and 95 have so far since 2010) critical access to care isn't the only casualty. These hospitals are often largest employers and drivers of economic activity in their communities. The ripple effects are felt wide and deep every time a hospital shuts its doors. OK, that's the bad news. How about some good news? Today we're making the trip to a remote town in Idaho, known as Arco. With a population of only 900, Arco is small. You won't find many restaurants, you won't even find a Walmart but you will find a hospital. A small 14 b

Today we're heading to the front-lines of research testing and challenging one of the most basic truths of the human experience...we all get older and we all eventually die. Today's guest doesn't buy this. In fact, he actually views aging as a diagnosable disease, a disease that can be managed today, and one day fully treated. Now, before you start rolling your eyes, let's meet today' guest. David Sinclair is a professor of genetics at Harvard Medical School and co-director of the Paul Glenn Center Biological Mechanisms of Aging. He is widely considered one the world's foremost experts on longevity research. A co-founder of the journal Aging and several biotech companies, he also holds 35 patents. A recipient of more than 25 awards and honors, including being knighted in the Order of Australia, and Time Magazine's top 100 most influential people. Besides his peer-reviewed research, his work is featured in five books, two documentary movies, 60 Minutes, Morgan Freeman’s, “Through the Wormhole,” and other medi

All right welcome back. Here's a quick trivia question, which group of US patients are constitutionally guaranteed access to free medical care? And no this is not a trick question. The answer...prisoners. Today we're jumping into an area of medicine few, if any of us, know much about. Let's be honest, how many of you out there have even seen the inside of a prison of jail? Not many, we guess. Criminal records and professional medical licensing don't mix well. For those of you who've been with us for awhile, you know this isn't a political program. I say this because I'm going to read a few stats here. Don't worry, we're not gearing up for a policy discussion on prison reform. It is an important issue, but outside the scope of our conversation today. As of 2016, there were 2.1 million people incarcerated in the US. That makes us the world leader both in the total number incarcerated and a per-capita incarceration rate (655 per 100,000). That rate beats everyone, even places like China, North Korea, Russia,

All right welcome back. If you could pick the ideal patient population, armed with the best knowledge, fluent in medical jargon, generally healthy and willing to comply with recommended treatments, who would you pick? How about doctors? Doctors may not be perfect patients but at least they should outperform similar non-clinicians, right? Surprisingly, little to no research has actually been done comparing the care, compliance and outcomes of doctors to comparable groups of non- physicians. For reasons we'll soon see, this is actually a difficult question to tackle, but it's a very important question with broader implications. Today's guest is MIT economist, Jonathan Gruber. He recently co-authored a study using a unique data source to examine just how good doctors and their family members are when they find themselves in the patient seat. Spoiler alert, obviously if the results aren't surprising, we probably would not be here talking about it. That's for the first part of this episode. In the second, we

As you heard last time, Dr. Gale (a bone marrow transplant specialist from UCLA) rose to international prominence after being the first American physician invited by the Soviet Union to treat patients suffering acute radiation trauma, only days after the horrific incident at Chernobyl. Our journey continues as Dr. Gale is flown in by helicopter to personally survey the Chernobyl nuclear power-plant. This only weeks after the meltdown of reactor number four. We'll see what it was like walking through the eerily empty streets of Pripyat. This was literally one of the most dangerous and heavily restricted areas on the planet. For an outsider, especially an American, to be personally inspecting this area, actually treating patients, all during the height of the cold war, was simply unthinkable... until it actually happened. For those of you who enjoyed the recent hit HBO series on Chernobyl, we'll spend a little more time there. Then we'll move on to subsequent nuclear incidents such as Tokiamura and Fukushima,

Thirty three years after the worst nuclear disaster in human history, the name Chernobyl rings ominously, and continues to inspire fear, outrage, debate and grim curiously. It's a captivating story now being re-told dramatically, though not completely accurately, through HBO's new and very popular mini-series. We've had some pretty unique people on this program but perhaps today's guest is more unique than most. Dr. Robert Gale is an academic physician who's spent his career researching and treating patients with Leukemia and other bone marrow disorders. He's published over 800 research articles and books, he's an international expert on nuclear disaster response, and get this...he's even written for, and appeared in several Hollywood movies. Oh, he's also the shared recipient of an Emmy award for his work in a, "60 Minutes" piece. As you heard in the opening news clip, Dr. Gale rose to international prominence after being the first American physician invited by the Soviet Union to treat patients suffering

Today's guest is Dr. Devi Shetty, a cardiac surgeon, entrepreneur and one of the most famous physicians in India. What's he famous for? Well, he performed the very first neonatal heart surgery in India, and actually served as Mother Teresa's personal physician after operating on her following a heart attack. Obviously, we weren't missing the opportunity to explore these unusual stories, but they are far from the main focus of our conversation. Dr. Shetty is best known for the unique and innovative health system he created. A system so revolutionary, the Wall Street Journal has nicknamed him the "Henry Ford of Medicine." We'll uncover what it takes to perform an advanced cardiac procedure, with western trained doctors, state of the art equipment, comparably lower complication rates than most US hospitals, for only $2,000 with a profit. The same procedure that would cost over $100,000 in the US with higher complication rates and additional OR time. Make no mistake, their model isn't simply about cheaper overs

Keith and I have long considered doing an episode on meditation. What held us back was our goal (as it is with every episode) to answer these two questions: how would the episode specifically benefit you, the physicians and medical professionals in our audience, and how would we avoid simply rehashing a well worn topic explored elsewhere? As you know, we're not big on chasing trends here. So we tabled it, until just recently, when we came across today's guest. Dr. Patrick Codd earned his M.D. in the Harvard Medical School/MIT Health Science & Technology Program. He then completed his residency in Neurosurgery at the Massachusetts General Hospital/Harvard Medical School. Patrick then served as the Director of the North Neurosurgical Service at Massachusetts General Hospital, and an Instructor in Surgery at Harvard Medical School before joining the neurosurgery staff at Duke University Medical Center where we find him today. [Read more…] Not only is Patrick a solidly credentialed neurosurgeon at a world clas

Most of you know the quote, “If you cannot measure it, you cannot improve it.” It's often attributed, incorrectly, to the famous nineteenth century physicist, Lord Kelvin. Wherever it came from, it's sounds about right. Same goes for this familiar quote from a popular business book author, “What gets measured gets done.” Well, in today's episode were going to talk about what's getting measured and what's actually getting done. What's getting measured are thousands of performance and quality indicators. What's getting done is docking our medical system billions of dollars every year in costs and lost productivity. Nothing new to all of you out there. But what if this “metric fixation,” is doing more than just wasting time and money? Used correctly, metrics and big data analysis offer incredible promise for research, visibility and improvement. Used incorrectly, they can steer us off course, devalue professional judgment, manipulate, encourage fraud, and possibly cause real harm to physicians, hospitals and pa