The Paradocs Podcast with Eric Larson
The Paradocs is a fun and lively discussion with a couple of docs on the practice of medicine. Occasionally serious, other times lighthearted, and accidentally informative. A show for physicians to learn more about what is going on and a great place for them to direct their friends and family to better understand the challenges they face.
info_outline
Episode 154: Rethinking Vaccine Mandates and the Omicron Variant with Dr. Monica Gandhi
12/10/2021
Episode 154: Rethinking Vaccine Mandates and the Omicron Variant with Dr. Monica Gandhi
Vaccine mandates, mask mandates, boosters, and variants have been a constant source of debate and controversy with the pandemic. My guest today is Dr. Monica Gandhi, an expert in immunology and infectious disease who runs the HIV clinic at UCSF. She has been a fairly prominent voice in support of the mask and vaccine mandates in her home state of California and city of San Francisco. She returns from her visit in June for SARS-CoV-2 in which she guessed that it wouldn't evade the vaccine or prior infection (spoiler alert: she was right). Do Vaccine Mandates Make Sense? Dr. Gandhi is the first to point out how she has been very supportive of mandating vaccines in the general population and specifically for health care workers. She has written extensively in many local and national outlets about the case for vaccines to reduce transmission of SARS-CoV-2 and hospitalizations. However, she has begun to rethink her support for these draconian measures because of a number of reasons: It can cause a problem with mental health in those who are restricted from interacting normally with society. It erodes the public trust in public health officials and well established measures. Even when vaccinated and boosted, those individuals can still become infected and infect others limiting its value as a way to stop transmission in its tracks. The political payback for politicians who support these measures may be significant at the ballot box. Are there Good Therapeutics Coming Out? One of the more exciting developments out of the pandemic is the emergence of designer drugs for this coronavirus. The newest therapeutic drugs are protease inhibitors which can be developed with a specific virus in mind. These drugs work by blocking the ability of the virus to successfully hijack your cell's ribosomes to create more viruses. Molnupiravir has been approved by the FDA but hasn't been shown to be all that effective because it was not designed with this specific virus. However, the new drug Paxlovid has show extremely high efficacy approaching levels seen with the vaccine around 90%. The advantage of these drugs is obviously that as soon as you show signs of symptoms it can arrest the extent of the infection and prevent hospitalizations and worse outcomes. Is Omicron Worth Worrying About? Finally, the question of whether the new SARS-CoV-2 variant, Omicron, is one that should concern us was posed to Dr. Gandhi. Much like the Delta variant, she is very confident that those who have gotten an adequate immune response from vaccination or prior native infection should be well protected from serious harm. Additionally, reports out of South Africa and elsewhere have seemed to show that this variant causes a much more benign infection. She believes it is possible that this variant - if it is truly more infectious but benign - might be the world's ticket out of this awful pandemic. Dr. Monica Gandhi is the director of the HIV clinic at UCSF where she is also on staff for their medical school. show notes : Today's show : Dr. Gandhi's previous appearance where she discussed the rise of Delta and whether our vaccines would still work. Dr. Gandhi's recent piece in the Atlantic. : The Paradocs is a proud partner and member of this outstanding podcast network. : This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. : Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. : Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.
/episode/index/show/theparadocs/id/21439253
info_outline
Episode 153: Crowd Health is Go Fund Me for Health Care on Nitro with CEO Andy Schoonover
12/03/2021
Episode 153: Crowd Health is Go Fund Me for Health Care on Nitro with CEO Andy Schoonover
What happens when you take Go Fund Me and put it into an ecosystem of likeminded folks who want to build a community to care for each other's health care expenses? You get which draws upon some of the concepts of crowd funding for one time health care expenses within its community. By taking people from all over the country and putting them into a community where there are expectations of caring for others, Crowd Health offers a solution to paying for health care expenses without breaking the bank. Is Crowd Health Insurance? If you've been paying attention to the US health care space for the last, well, forever, then you know that it is expensive and keeps getting more so. People stay at jobs they don't like just to keep their health care coverage which is often not very good anyway. However, for those who are self employed or with a very small business, it seems their only option is to go out onto the open ACA exchange and grab a lousy and expensive plan that hardly covers anything. Crowd Health offers an alternative to paying for health insurance. Although it definitely isn't insurance since you are asked to pay into your own bank account each month to be prepared to pay others' health expenses. There is also no guarantee that your expenses will be paid as you often have with a traditional insurance policy. However, oftentimes even with traditional insurance you don't get everything covered and have to cover up to the deductible and everything over until you hit your out of pocket maximum. And that's before considering the inflated prices paid by insurance companies. Is Crowd Health a Health Sharing Ministry? The answer to this question is more complicated. In short, yes and no. We discussed sharing ministries in and an episode with . Basically, in a sharing ministry you send your monthly 'premium' to someone in the community. If you have a health expense, you submit a claim after you pay the bill and people will then mail you checks to cover the expense. The down side of this process is that the delay to getting paid can be fairly long (months) meaning you will have to have the funds to cover the bill that might be fairly large. And people don't often have that much money sitting around in the bank. How Does Crowd Health Work? CEO Andy Schoonover describes the fairly simple mechanics of Crowd Health. You take a group of like minded people who want an alternative to the traditional way of paying for health care. Then you have them commit to contribute a small amount to run the overhead of the community which helps pay for the technology and people tasked with negotiating with local hospitals, etc. and assisting patients with their navigation through the health care space. Community members pay the first $500 of a health care event and then request the community fund the remaining amount. Each community member then has the option of helping out or not. Each member carries a social credit score determined by how often they 'help', ask for help, or shop around for less expensive health care options. Andy Schoonover is the CEO of Crowd Health, an alternative means of paying for health expenses that isn't insurance and isn't exactly a sharing ministry either. It's sort of highly efficient Go Fund Me. show notes : Today's show : Matt Bellis of Liberty Share talks about how sharing ministries work. : I recount my family's story living without health insurance for 15 months just using a health sharing ministry. : The Paradocs is a proud partner and member of this outstanding podcast network. : This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. : Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. : Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.
/episode/index/show/theparadocs/id/21362078
info_outline
Episode 152: The COVID Drawdown
11/25/2021
Episode 152: The COVID Drawdown
Today we are going to discuss the COVID drawdown. Essentially, this is what must inevitably happen for us to return to lives of normalcy where we have typical interactions with others at family gatherings, sporting events, concerts, and business meetings. Unless we are prepared to radically change the way we live our lives and choose isolation (which probably has far greater physical and mental health detriments) then we have to consider how the drawdown occurs and what conditions ned to be present for it to happen. What HaS TO HAPPEN FOR THE DRAWDOWN TO OCCUR? We've talked to numerous experts who all have various opinions on how the pandemic will play out and what strategies will be needed to get to the 'other side' of the pandemic. You can find the initial conversation with , immunology with , and science ethics with on the episode list at the end of this writeup. The following is a short list of what conditions need to be present to return to normal: Broad acceptance of the fact that the virus, SARS-CoV-2 which causes COVID-19, will become endemic. Recognition that the endemic virus cannot become eradicated and will absolutely infect everyone - probably multiple times. Understand that vaccination including booster shots will not significantly stop transmission of the virus but only provide protection from serious illness. Sterilizing immunity (protection from infection) for SARS-CoV-2 will be temporary whether one has had vaccination or prior natural infection. Accept that no measures to stop transmission outside of severely draconian restrictions on movement and social interaction have middling effects on the spread of the virus. We will have to be comfortable with no longer 'looking' for the virus with every respiratory illness and only test those whom we feel are at high risk or can use novel therapeutics. Public health officials, politicians, and policy makers have to accept that there is very little that can be done to 'contain' the virus. What the Drawdown Will Look Like The drawdown will look different depending on what part of life you are looking. Schools: Most schools will continue their current policies through the end of this school year. Next year, most school systems will have returned to pre-pandemic policies of no temperature checks, mask wearing, etc. Only the most heavily unionized schools or urban will mandate extreme measures like vaccinations. This will become even harder to enforce as the majority of the country has returned to normal and we see a striking similarity of outcomes between the two ways of schooling. Universities: Already there are differing policies in place between schools and the lack of differences with outcomes will move nearly all universities to eliminate all restrictions next school year. Mask Mandates: These will disappear completely by next year in almost the entire country. The political cost for maintaining these measures will be increasingly steep and politicians will declare victory over the virus and insist that their earlier measures did their job to save lives but are no longer needed. Vaccine Mandates: Despite attempting to impose these mandates through federal fiat on transportation and for air travel - these will disappear as more and more states reject their use. Hospitals: Health care facilities will still likely be burdened with extraordinary personal protection measures like masking at all times throughout all of next year. The federal government controls this regulation and unless there is extraordinary political pressure these will continue. Perhaps the loss of workers in health care will encourage the removal of this rule but that will take longer than this year. Dr. Eric Larson is the host of the Paradocs Podcast and not a fan of many of the mandates imposed on hospital personnel. show notes : Today's show : Dr. Gandhi discusses why the variants for COVID should not be a concern. : Dr. Bhattacharya explains why science is suffering so much in the current atmosphere. : Dr. Graham and I discuss how we were so right about so much of COVID : The Paradocs is a proud partner and member of this outstanding podcast network. : This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. : Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. : Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.
/episode/index/show/theparadocs/id/21278933
info_outline
Episode 151: Health Care for Those Who Don't Earn High Wages with Dr. David Berg
11/12/2021
Episode 151: Health Care for Those Who Don't Earn High Wages with Dr. David Berg
One of the scariest times for many workers is being presented with a bill for medical services. Even if they have insurance "coverage", the deductible or co-pay might be more than they can afford. For hourly workers in entry level jobs or low skilled positions, medical bankruptcy is a real fear. While barely making ends meet an additional bill for an ER visit or doctor's office stop can send you to collections and destroy your credit. Unfortunately, a lot of Americans are in this exact spot as they earn a living working these low paying jobs but have little medical security even if their employer provides them with insurance. A Plan for Those Who are Hourly Workers Just as I have recently spoken to people like and who seek to make business owners more successful with their health plans by direct contracting, sometimes the employer is too small or has low hourly wages to provide health coverage that covers its employees. It's not that employers don't want to provide those benefits for its workers, but just that the packages offered by insurance carriers are too expensive or require large deductibles to make it possible for small businesses to afford. That's where Dr. David Berg and his company, Redirect Health come in to solve this problem. Redirect Health was designed specifically with small businesses in mind as it utilizes a combination of telehealth and primary care physicians to keep costs down, provide excellent preventative health, and protect workers from costly medical bills. By emphasizing primary care physicians, Redirect Health then helps find affordable alternatives to imaging, laboratories, medications, and the use of specialists to minimize the expensive components of health care. Redirect Health Has a Mutual Insurance Company Interestingly, Dr. Berg said they discovered early on that a lot of the insurance they wanted to provide for stop gap loss was costing them a fortune. By creating their own mutual insurance company, they could pool their risk and keep all the funds in house and spool it out at no gain to lower their overall costs. By having a fully transparent insurance carrier, they can offer savings that other companies are unable to provide. Additionally, Redirect Health also created their own third party administrator in order to streamline the claims process and better help them get a handle on where they can provide less expensive care. It is a really good way to understand where the opportunities are to move employees towards primary care solutions or lower costs solutions to their health care needs. Dr. David Berg is the CEO and co-founder of Redirect Health. A business dedicated to helping businesses provide high quality health care for hourly workers. show notes : Today's show contact for Dr. Berg [email protected] : Dr. Berg's book on how to leverage health care as an advantage for your business. : David Berg's company where he helps businesses provide care for their hourly workers. : Katy Talento at All Better Health describes how she unbundles insurance. : The Paradocs is a proud partner and member of this outstanding podcast network. : This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. : Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. : Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.
/episode/index/show/theparadocs/id/21142811
info_outline
Episode 150: Make Sure Your Health Insurance Broker is Working for You and not the Insurance Company with David Contorno.
10/29/2021
Episode 150: Make Sure Your Health Insurance Broker is Working for You and not the Insurance Company with David Contorno.
When you run a business, one person you usually meet and hire is a health insurance broker. In theory, these brokers work with the employers to secure the best deals for health insurance to meet the company's health care objectives. However, in practice, the brokers serve as a sales force for the insurance companies who lavish them with bonuses, trips, and gifts. The seedy underbelly of the health insurance broker industry is that they are really not working to save money or get deals for their clients - the checks are written by the insurance carriers and that's who they answer to. Who do the brokers work for? You or the Carriers? I spoke to Katy Talento in who runs a business where she unbundles health insurance for employers and helps them run an efficient and less expensive health care plan. One of the problems she saw is that insurance carriers bundle all these services and then charge a very large administrative fee to run the plan. Also, their plans rarely save you money as they build in enough profit to cover the agents who sell those plans - the brokers. That's the world that David Contorno is trying to combat with his company at . The business was founded with the intent of looking at real ways of not just unbundling but finding high quality and inexpensive ways to receive care. As Contorno said, "The only way to pay less for health care is to pay less for health care." Health Plans Are Gimmicks Through his 18 years of experience in the health insurance broker field, David points out that most of the various plans sold by insurance carriers are really just gimmicks that don't really change the cost of care. Whether it is an HMO, PPO, of some hybrid FFS plan - it ultimately just ends up being the same in failing to control costs. The reason is that the care comes from the same hospitals and with the same contracts no matter how they make the employers and employees pay with copays, deductibles, and coinsurance. Even HSAs (health savings accounts) which are held up as a way to control costs by putting the patient in charge, rarely bring about the cost control as advertised. This is primarily because even using an HSA and picking where you get your care still is within the framework of hospitals, insurance contracts, and provider networks which all have massively marked up prices. Only by leaving the insurance network entirely can one see real savings. Why Don't the Brokers Work for You? Simply put, the work that health insurance brokers do is to carry water for the insurance carriers. The carriers are the ones who pay their bonuses, provide them with expensive trips to Tahiti, and give them sales targets for selling their plans. The checks aren't written by employers but by the insurance carriers. So naturally, the brokers respond first and foremost to what the carriers want. This doesn't make them bad people but understandably their incentives are not aligned with those you'd hope. The reason most brokers don't even know they're working for the wrong people is best summarized by the quote from Upton Sinclair, "It is difficult to get a man to understand something when his salary depends on him not understanding it." David Contorno is the CEO and founder of ePowered Benefits. David spent 18 years as a traditional broker in health insurance but felt that it could be done in a better way. show notes : Today's show Books suggested by David Cotorno contact for Contorno. : David Contorno's company where he helps clients save money through finding truly less expensive care. : February 6-9 conference with guest speakers like Marty Makary speaking about how to improve health care. : The organization Contorno is a part of that advocates for free market solutions in health care. : Katy Talento at All Better Health describes how she unbundles insurance. : This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. : Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. : Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.
/episode/index/show/theparadocs/id/20989283
info_outline
Episode 149: Is Asymptomatic Spread of SARS-CoV-2 a Thing? with Daniel Halperin, PhD
10/22/2021
Episode 149: Is Asymptomatic Spread of SARS-CoV-2 a Thing? with Daniel Halperin, PhD
Not only has the COVID pandemic politicized our country - it has led to a lot of misinformation and a shutdown of communication. For instance, is there really asymptomatic spread of COVID? Or just pre-symptomatic and symptomatic spread? That might seem like splitting hairs but it can have a profound effect on policy for quarantining and testing. We've talked about this before on the show as well as general discussions on COVID policy which can be found , , and . 12 Myths and 12 Facts About COVID-19 If there is one certainty during this confusing pandemic it is that there are plenty of myths circulating in the media and popular culture about COVID. In fact, many of the things we think we know are wrong. Public officials get them wrong. Doctors and nurses get them wrong. The CDC and FDA get them wrong. Unfortunately, once we discover the truth, often the word doesn't get out there widely enough to change behavior, regulations, or rituals. Dan Halperin points these out in his book on . One great example of this is the transmission of SARS-CoV-2 on surfaces. We have almost no instances of the virus transmitting in this manner and it travels almost exclusively through aerosol means. However, despite this, businesses, individuals, and regulatory agencies still act as if 'deep cleaning' and intense adherence to eliminating surface contamination will help prevent viral transmission. This is patently false but it's been over a year since we have known this and yet we are still wasting our time practicing this type of hygiene. Another example of a myth believed by many is the transfer of viral particles from asymptomatic individuals to uninfected people. There are almost no documented cases of this type of infection yet we treat asymptomatic infection almost as a common vector. It is important to note that there is pre-symptomatic spread but people who never develop any symptoms just aren't infectious. It is also true that you never know if you're about to become symptomatic but we could certainly change the way we approach close contacts if the infected person never develops any symptoms. Is the Current Environment of Scientific Debate Akin to McCarthyism? Not only has Dan Halperin written on the epidemiology of COVID but he has also weighed in on his concerns with the academic and public nature of scientific debate. He notes how one of the creators of the mRNA technology expressed some "strange views" which many did not agree with. But instead of rebutting the researcher's concerns, he was virtually eliminated from history. His contribution to the development of mRNA technology was removed from Wikipedia and he has been eliminated from all common public forums. Dr. Halperin says it feels a little like McCarthyism which happened in the 1950's over concern that the Soviet Union and communists were infiltrating American government and society. At the time, most Americans were in favor of the practice of 'blackballing' people because of the perceived threat of nuclear annihilation from our Cold War adversary. Only through the lens of time can we now look back and find the practice objectionable and he suspects the same will be the case with our current lack of public acceptance of differing opinions on COVID. Daniel Halperin is an epidemiologist and full professor at the University of North Carolina School of Public Health and the author of the book: Facing COVID without Panic: 12 common myths and 12 lesser known facts about the pandemic. show notes : Today's show : Dr. Halperin's piece in the Real Clear Policy where he discusses the squelching of real discussion in science. : Dr. Bhattacharya on the erosion of discourse in science. : Dr. Graham and I review how were were so right about COVID back in April of 2020. 6: COVID policy and what it should be summed up in 11 minutes. : This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. : Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. : Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.
/episode/index/show/theparadocs/id/20909705
info_outline
Episode 148: Urgent Care as Primary Care with Dr. Juliet Breeze of Next Level Medical
10/13/2021
Episode 148: Urgent Care as Primary Care with Dr. Juliet Breeze of Next Level Medical
There are a lot of urgent care clinics all over the country. But few of them, to my knowledge, also operate as regular primary care clinics. But that is exactly what is happening today in the Houston, Texas area with the emergence of Next Level Medical. If you think about it, it makes perfect sense to leverage all the facilities needed for a primary care clinic - exam rooms, physicians, etc. and use it to deliver regular and sometimes non-urgent care. We've discussed before that lower the cost of care with transparency so this seems like the next logical step with urgent care. We have also discussed but those never had the component of doubling as primary care. What is Urgent Care? Probably the most puzzling questions you can ask even someone who works in health care is: What is the difference between urgent care and emergency care? The answer is that it depends which is why you really need a better triage system that people (patients) can access before then head across town to either the ER or UC clinic. It's this triage that is probably the most important way to keep ER visit costs low and less frequent. This is one of the services offered by to their members. Why Urgent Care Membership? At first, it seems strange that one would establish any sort of membership status with an urgent care clinic. But Next Level has made it work by basically selling it as a one stop primary care clinic. Or a primary care clinic on steroids that comes equipped with supplies for taking care of fractures, lacerations, laboratory studies, and imaging. And if you have the same staff working a regular schedule you can get physician continuity for patients making well care a very achievable goal. Employers like the flexibility as it provides the primary care for their employees with convenience since there are clinics all over town. Additionally, the clinics can care for their employees who might get injured either at home or work. This added benefit means a whole lot less in expensive ER care and probably healthier employees since their primary care is taken care of without all the copays and hidden costs that keep lots of hourly employees from staying on top of their chronic conditions. Doctors Like the Schedule Doctors looking to become employed usually have to make a lot of concessions. First in their autonomy and second in the lack of control over their schedule. The amount of work they take home or 'unpaid' time can be large at times making a forty hour a week job quickly turn into 50 or 60. This is where Next Level can offer doctors the opportunity to truly do shift work, have a regular patient panel, but not take home their work and let the sophisticated call center triage their patients overnight. Dr. Juliet Breeze is the founder and CEO of Next Level Medical which offers membership based urgent care services in the Houston, TX area. show notes : Today's show : Dr. Breeze's urgent care clinic company. [email protected] - Dr. Breeze's email if you want to contact her. : Dr. Breeze's profile : Free standing and fully transparent ERs is Oklahoma : Pediatric urgent care clinics to eliminate a lot of the burden from the ERs. : This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. : Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. : Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.
/episode/index/show/theparadocs/id/20802872
info_outline
Episode 147: Has the Pandemic Led to Infants Losing IQ? - with Sean Deoni, PhD
10/07/2021
Episode 147: Has the Pandemic Led to Infants Losing IQ? - with Sean Deoni, PhD
The COVID pandemic has brought on all sorts of changes to the way we live our lives. From wearing masks, working from home, stay at home orders, and restrictions on social interactions, the virus has caused untold disruption to the way our society functions. Although the changes COVID has brought to our schools and the lives of our school age children, it is perhaps less appreciated what changes have occurred for our infants. It is a well known fact that our environment and meaningful stimulation is necessary for normal intelligence and brain development. Infants are completely dependent on their parents to put them in environments where they can maximally interact in the world. This interaction is what spurs on their brain development and social connections to others. Early Learning My guest today was Dr. Sean Deoni at Brown University described that the first 1000 days of a child's life are some of the most critical for its brain development. Babies interact with their environment and figure out how to communicate and manipulate the physical world through exploration. The less stimulation that is present, generally, the worse their neurodevelopment outcome is. One can use the Mullen Scales of Early Learning to test infants and young children on where they are developmentally on motor and language skills. Concerning Findings - A Drop in IQ Equivalents The lab at Brown University had been collecting infant and child development testing data for over ten years. Their findings generally fell in line with what would be considered 'normal' for children at that age. But suddenly, in 2020, their lab noticed a sudden change in the scoring for children. A massive loss in development scores (which are used as a proxy for IQ) were seen in infants born during the pandemic. The losses were on the order of 22 IQ points or 1.5 standard deviations from the norm. This was an incredible finding and one that they couldn't explain. The findings were more pronounced in those with low socioeconomic status and males. Where was the drop? One would expect that the drop in scores would be related to problems with language since we are now more frequently wearing masks. However, their findings were actually a massive drop in motor skills. This might explain why male infants were more significantly affected since early motor development seems to progress a little more in them than females What's Causing the Drop? Unfortunately, it is very hard to determine what is causing this decline in scoring for infants. The research team has been able to rule out a few factors like maternal stress or actual COVID infections. It is very probable that this is due to a general lack of physical interactions and stimulation for the infants with their parents and caregivers. Perhaps it's because of increased isolation at day care or parents working remotely at home and less capable to spending valuable time with their infants. Limitations to the Findings Whenever we get concerning findings like these we have to be sure of a few facts. Are the results corroborated/reproducible: The University of Columbia did a similar study and found the same results. However, they don't have long term validation to their testing methods so perhaps this finding is an outlier. Is this a representative sample: This study (and the one from Columbia) represent a probably skewed sample of families who live in urban areas and heavily rely on day care for their child care needs. It's possible that these findings would not be found in areas with lower levels of day care usage since parents probably don't interact that differently at home with their child. COVID restrictions: PPE, limited social interactions, and masking all varied throughout the country. It's possible that one, some, or all of these significantly affected the results of child development. Perhaps masking and limited social interactions decreased infant and toddlers' physical play. Also, maybe seeing less relatives who would physically interact with the child led to lower scores. How Permanent are these Deficits? This is the million dollar question. Can the children recover from such a huge developmental deficit. It's entirely possible that they will just reach these milestones later in life and it will have no impact on their future intellect. However, oftentimes, if one does not catch up by 2 years of age or so, one never catches up which could put these children at a huge disadvantage in academics, athletics, and the arts. The lab will continue to follow the children but only time will tell whether they are ever able to catch up. Sean Deoni, PhD, holds a doctorate in MRI Physics and is a lead researcher at Brown University studying neurodevelopment of infants and young children. show notes : Today's show : Dr. Deoni's Study from Brown University . - University of Columbia study referenced in the show. : The laboratory where Dr. Deoni works at Brown University. : An opportunity for children and adults with long COVID to enroll in research. : We were so, so, so, so right about COVID : Today's sponsor who helps you with staff scheduling. : The home for the Paradocs and a number of other physician based podcasts. : This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. : Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. : Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.
/episode/index/show/theparadocs/id/20746202
info_outline
Episode 146: Explaining COVID in 11 Minutes with Dr. Eric Larson
09/30/2021
Episode 146: Explaining COVID in 11 Minutes with Dr. Eric Larson
Imagine yourself in California at a clearing in a large forest. And it’s on fire. There are three groups of people standing before you. A large group is screaming and running around pointing at the fire. They’re yelling that we need to do something, anything we can to stop the fire. Meanwhile, there is another group (not as large) with their backs to the fire. They are mocking and ridiculing the group running around panicking. They tell them to calm down and to stop ordering people around. They insist there isn’t anything wrong at all. Of course, the largest group of people are standing between these groups and looking behind those panicking at an intact forest and behind the ones who don’t notice the giant flames licking at the backs of the those ridiculing the screamers. These people aren’t sure what to do but in the interest of safety feel that getting away from the flames is probably the right decision. They tend to stand with the group that’s worried. Obviously, this analogy describes our current situation with COVID in America. Most are not in one of the extreme camps. But we either identify with one or are left standing unsure of what to do or think. What needs to be done, and what I did with my friend Dr. David Graham in April of 2020, is to try and be reflective and better understand what it is that we are dealing with. What are the biological, historical, and medical facts or suppositions that we can make to understand this pandemic? If we return to our analogy of the forest fire, it would be best if we could somehow hop up in a hot air balloon and look down at the situation to assess what would be the best individual actions and true scope of the problem. History and biology could be used to understand the nature of fires, how they spread, what do you do to stop them, and what they are likely to do in their course. Contrary to popular opinion, we have some rough ideas about what happens in pandemics and where we will end up. And THAT is the critical fact that we have to accept - those in all camps and in between. Because if we get THAT wrong, then we get everything else wrong. The critical question we must ask is what is the endpoint for this pandemic? What is the biological consequence for SARS-CoV-2 (the virus that causes COVID-19) and its effect on humans. We have to agree on the ultimate end point in order to get our policies and strategies right for surviving the pandemic. What became obvious to us in April of last year was that this virus, despite some government efforts at the time, would become endemic. It would join the other four coronaviruses that currently cause the common cold as a virus that will circulate forever throughout the human population. It will not get eradicated. It will infect everyone probably multiple times throughout your life. This is the biological history of endemic coronaviruses. It really is the way all these common respiratory viruses operate. Rhinovirus, adenovirus, parainfluenza virus - they infect your upper respiratory tract (nose, sinus, mouth) and cause a cold because although you don’t have enough antibodies to prevent infection (because they’ve waned over time or it’s a new variant that looks different enough to evade your antibody response) you have memory T and B cells that mount a quick response after infection to prevent a systemic or lower respiratory infection (pneumonia). We know you get this immunity as a child and anyone who has kids knows small children are always sick with runny noses as they are constantly exposed to these different cold viruses which builds up their long term immunity to them when exposed later in life. The mRNA vaccines are a medical miracle and trick your body into generating an immune response. It’s not magical (except the technology) and an elegant way to get your body to do the work so when it sees the real virus in the wild, it will seek it out and destroy it. But respiratory viruses often infect us before we can mount a complete immune response so you get sick and can transmit the virus. This isn’t a failure - your body has done what it needs to do - and so has the virus which just wants to reproduce and move to the next host. We live in an equilibrium with these viruses, we develop immunity when we’re young so if we are exposed when we’re older we can prevent really bad outcomes. But we get sick and the virus continues to circulate in the world’s population with different viruses coming and going. It’s a sort of dance. So what does this all have to do with our wild fire? Well, we know this thing will burn until there isn’t any fuel. And fuel is considered people without immunity to the virus. There are only two ways to get immunity - a vaccine or infection. Until the virus has burnt all the fuel, it will continue to burn - there is nothing we can do to stop it. We might slow it down, we might find ways of treating the fuel on fire (although most treatments for viruses are not very good), but ultimately, everyone is going to get it. What does history tell us about coronaviruses? Well, until SARS-CoV-2, we had four endemic coronaviruses that cause colds. The youngest is OC43 which researchers believe jumped from cows to humans in the late1800s. This was at the same time as the “Russian Flu” worked its way around the world so perhaps that flu was actually a coronavirus. If so, OC43 caused a lot more problems to humans back then who were older and naive to the virus according to the news reports from all over the world. But by now, we have all had multiple infections with OC43 and its variants from when we were kids to today where we usually feel terrible for a few days or maybe a week. Over time, the virus does ‘mutate’ towards becoming more benign and infectious but that usually takes a long time. Anyway, it serves as a useful road map for what might happen to us in our biological dance with this new unwelcome visitor. We also know, that immunity to these respiratory viruses wanes over time. Either with natural infections or vaccines. The only way you can develop better immunity is through booster shots or infections. But what we really care about - ending up in the hospital - is focused almost entirely on the non-immune. This is a nasty bug, it affects the obese and elderly the most and it isn’t going anywhere. It has definitely killed hundreds of thousands of Americans. So this gets us to the important policy considerations - if we know that it is endemic (which was obvious over a year ago) then how should we approach our public health? Obviously, the only point to slowing the spread at this time is if you could get those without any immunity (no infection and no vaccine) vaccinated to minimize the number of people clogging our hospitals. But you can’t get to any vaccination rate that will stop the spread of the virus. There is no herd immunity threshold - no number of vaccinated and immune to perfectly prevent its spread. Besides the fact that our ability to slow the spread is questionable anyway, it just doesn’t make a difference in the end. We are all going to get this virus. Somewhere, there’s a date with you and you and you and me with this virus. Whether you’ve been vaccinated or not you will almost assuredly get infected. If you have some immunity through a vaccine or previous natural infection, you are much less likely to get very sick. So mandating vaccines - if we agreed that it was wise and just - wouldn’t matter much to those who are vaccinated. It may slow the spread and delay the next time they’re exposed but they will still get it when their immunity wanes. And again and again. If your mitigation measures worked, all you would do right now is extend the time it takes for everyone to get immunity unless you believe you can convince those who won’t get immunized to get the vaccine. Even so, that only really benefits those who have chosen to not protect themselves while inconveniencing everyone else and taking away a lot of rights and simple joys of life. It’s easy to see how we got here. Mission creep is not just something that happens with the military - it happens in public policy too. By believing that we could prevent people from getting infected, we have embarked on a strategy that is unwindable and with no clear end point. There is a preponderance of evidence that people can get reinfected multiple times with COVID and after vaccination. Both through research and observational data we know that infections with SARS-CoV-2 will continue to happen forever whether you are vaccinated or not, whether you have had it before and recovered, and no matter where in the world you are living. Fundamentally, we have been chasing a zero-COVID strategy in almost every aspect of our society. Obviously, vaccines are a great idea for those who are at risk. I like to point out to how getting chicken pox (Varicella) as an adult is a completely different experience for an adult than it is a child. Adults can die from chicken pox whereas kids almost never do. Also, an infection of varicella puts you at risk of getting shingles later in life which can cause pain and a host of other problems. This is one reason why we vaccinate children for chicken pox. But clearly, vaccination (since we know it won’t stop transmission in its tracks no matter how high the rate is) is a strategy to keep people out of the hospital and free up hospital resources for other things like heart attacks, strokes, cancer, etc. Masks, lockdowns, testing and quarantining and any other mitigation efforts are Zero-COVID policies which are of dubious efficacy and ultimately, make no difference since we will all get infected eventually. The most sensible reason to resist vaccine mandates, masking rules, and various lockdown measures in the US at this point is because they are attempting to stop what cannot be stopped. Even 60% of the deer in Michigan have had COVID and serve as a reservoir for the virus along with mice. SARS-CoV-2 is not going anywhere so acting like you can keep it out is akin to wrapping yourself with a towel when you go swimming to stay dry. Perhaps you could argue that you are waiting until there is a childhood vaccine but that might take months or years until you get large enough numbers of kids’ parents to get their kids vaccinated. What target are you looking at? It is exceedingly rare for kids to get really sick with this virus. Do these measures justify affecting their socialization and education and all the other aspects of life we take for granted? Is it worth having every child see other people as disease vectors rather than unique individuals to whom they can get to know, collaborate, play, love, and innovate? Some might argue that the infirm or immunocompromised (like those with solid organ transplants) are at risk and we should encourage vaccination to protect them. Again, the vaccinated can still spread the virus and the only thing vaccination does is frees up hospital resources (which is important). However, once people have had an infection once or maybe twice, they are much less likely to clog the hospitals. Either way, all you’re doing is maybe buying some time with these extreme measures but not significantly altering the course of the pandemic in any significant way. The effect of all these mitigation measures falls hardest on our youth. They are the ones who need socialization the most. They are the ones who need interactions for learning the most. I’d argue that right now our greatest generation is our youth, (gen Z and gen alpha) as they have given up the unique experiences of high school sports, graduation, dances, gatherings, the arts - in order to protect the elderly in our society. They have given up so much and we must recognize that and always ask ourselves how much more do we need them to sacrifice to slow the spread of an inevitable disease. We have become so locked in to thinking that we need a zero-COVID strategy to slow the spread that we have forgotten that that was only supposed to last as long as it took to protect those who wanted protection. We’ve gotten there and now it’s time to allow those who want to isolate go do it and let everyone else go about their lives. Dr. Eric Larson is the host of the Paradocs Podcast and an anesthesiologist in private practice. show notes : Today's show : Dr. Smith's 100% price transparent surgery center in Oklahoma City, OK. : We were so, so, so, so right about COVID : Dr. Jay Bhattacharya on how science is now broken : Dr. Monica Gandhi on T cells and long term immunity : Dr. Noorchashm on immunity from prior infections to SARS-CoV-2 : Independence Day from COVID : Today's sponsor who helps you find locum work as a doc. : The home for the Paradocs and a number of other physician based podcasts. : This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. : Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. : Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.
/episode/index/show/theparadocs/id/20653724
info_outline
Episode 145: Surgery without Insurance with Dr. Keith Smith
09/24/2021
Episode 145: Surgery without Insurance with Dr. Keith Smith
A lot has happened since we last met with Dr. Keith Smith from the back in 2018. . We also spoke about how the system was rigged to enrich the hospital systems, insurance carriers, and PBMs (what's new right?). So what's happened since then and how has the center done with the pandemic? Is the Surgery Center of Oklahoma Thriving or Just Surviving? Not surprisingly, Dr. Smith says that the center is doing just fine and has increased its market share from other states. Additionally, the international community from Canada is now being allowed to come back into the US for their surgeries which are more backed up than ever. His surgery center is a great alternative for an increasingly backlogged health system that is strained under the COVID crush of patients. Can Other Surgery Centers Dabble in Direct Contracting? One interesting aspect to Dr. Smith and his crusade for more transparency and market forces within medicine is the development of using clearinghouses for arranging surgery. The clearinghouse is used as a quick means for posting prices anonymously and then linking the agreeable surgery center and potential payers who are either patients or employers.. This is a great way to ease into direct contracting for a lot of surgery centers that are still dealing with commercial and government contracts. What is the Future for the Free Market Medical Association? Dr. Smith says the has grown significantly over the past few years as more and more facilitators, physicians, surgical centers, and administrators gather to learn how to harness the market to increase their book of business. Now that the pandemic has caused a lot of disruption in the market people are really starting to look for fresh solutions to survive and the FMMA feels like it has just what they need. Anyone can sign up and their next conference in in April 2022. Dr. Keith Smith is the co-founder of the Surgery Center of Oklahoma which has 100% price transparency which opened its doors in 1997. He also founded the Free Market Medical Association which works to promote the free market in all health care transactions. show notes : Today's show : Dr. Smith's 100% price transparent surgery center in Oklahoma City, OK. : The organization that Dr. Smith helped co-found to encourage using the free market in more US health care transactions. : Twitter for the Surgery Center of Oklahoma for Keith Smith, MD : The company that helps link employers with surgery centers without posting all their prices openly to allow some direct contracting. : Dr. Keith Smith on a fully transparent pricing system for surgery. : Today's sponsor who helps you with your employee scheduling and so much more. : The home for the Paradocs and a number of other physician based podcasts. : This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. : Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. : Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.
/episode/index/show/theparadocs/id/20584178
info_outline
Episode 144: Direct Contracting Has Fixed US Health Care with Ron Barshop
09/09/2021
Episode 144: Direct Contracting Has Fixed US Health Care with Ron Barshop
When I began this podcast in the Spring of 2018, there were a lot of things I felt needed to be said about the US Health Care system. Foremost among them was the problems with the third party payment system (using both commercial and government insurance to make most of the payments for services). Also, the system was becoming more and more consolidated and the power of those extracting that wealth continued to expand. It was a pretty depressing outlook for patients and doctors. However, most things aren't so black and white. While the regulatory capture of medicine is certainly a concern and no friend for docs and patients, there is a new movement that has sprung up in response to it. As my guest Ron Barshop says, it is leaderless, decentralized, and growing exponentially despite the powers that be. he loosely calls it direct contracting which is a way of bypassing the usual middlemen and gatekeepers in health care. It includes direct primary care (which we've discussed many times on the show , , , and ) but is so much more. How big is the Direct Contracting Movement? Ron Barshop, host of the Primary Care Cures podcast, describes the direct contracting movement broadly. It involves millions of patients who are employees at small, medium, and large corporations. He estimates that direct contracting for health services comprises maybe 10% of the US population or about 30 million. But it is hard to get an exact count because it depends on your definition of direct contracting. Sometimes, just negotiating with a separate pharmacy benefits manager (PBM) or laboratory is what is done by a company. Some, however, have gone all in and are putting their employees in direct primary care offices or virtual services and contracting separately for nearly every contact their employees have in the health care environment. What is Direct Contracting for Health Services? The best way to describe direct contracting for health services is by looking at the financial transaction. If it is between the employer and the facility or person providing the care then is is direct contracting. If you are using a middleman or intermediary like an insurance company to make the payment, then it is probably not direct contracting. This isn't always the cleanest definition but it is a good starting point. Right now, large employers are finding millions of dollars in savings by directly negotiating with hospitals, surgery centers, imaging centers, laboratories, pharmacies, and primary care physicians. They self fund their health care needs for employees and usually save money and provide better services because of the incredible amount of waste spent on administrators within the typical health plan. How does Direct contracting Save Health Care? Simply put, by direct contracting and eliminating a lot of the middle men who provide no value (but plenty of expense) to health care billions or maybe even trillions of dollars can be reinvested into employees pockets. Also, by pushing for an improved model of primary care and urgent care, direct contracting has the potential to keep people healthier too. It is truly a triple win of lower costs, happier providers of care (not dealing with refusals to pay by third parties), and improved health. The beauty of this movement is that it does not reside within any particular political ideology or camp and does not really require any legislation to occur. It is happening organically and is a quiet revolution that most still don't see. Ron Barshop is the host of the Primary Care Cures podcast. He has been on a personal detective hunt on how to fix the US health care system and discovered that it is fixing itself through direct contracting. show notes : Today's show : Ron Barshop's excellent podcast where he interviews disruptors, innovators, and thought leaders in the transforming health care in America. Dr. Amat on why she chose to become a direct primary care doctor : Dr. Josh Umbehr on DPC : Dr. Keith Smith and fully transparent pricing for surgery centers. : Rheumatologist, Dr. Ellen McKnight, describes her venture into direct contracting as a specialist : Zach Zeller of Scriptco talks about his direct warehouse membership pricing for generic pharmaceuticals. : Twitter for Dr. Graham : Today's sponsor who helps you with your employee scheduling and so much more. : The home for the Paradocs and a number of other physician based podcasts. : This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. : Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. : Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.
/episode/index/show/theparadocs/id/20423903
info_outline
Episode 143: We Were So, So, So, So Right about COVID
08/27/2021
Episode 143: We Were So, So, So, So Right about COVID
In April, 2020, serendipitously, my high school classmate reached out to me after one of my podcast episodes where I was talking about mask usage. I was incorrect in one of my assumptions with the use of masks and the spread of particles which he pointed out. I then read his blog post about COVID and how it pertained to his home state of Montana and recognized that the way he looked at the pandemic was completely different than most. He came on the show for and with today's episode will have been on five times. The perspective Dr. Graham brings to COVID is one with a clear insight about where we will end up. And if you know where you are going, it is much easier to figure out the best way to get there. COVID Is Endemic The greatest insight we spoke about way back at the beginning of this pandemic was that this virus, SARS-CoV-2, would become endemic. There was no chance of eradicating it no matter what type of vaccine was developed. The virus would be ubiquitous throughout the world with individuals always having a risk of exposure and infection. There would be no place to run or hide from the virus. And now we have animal reservoirs (animals that can become infected and spread the virus to other animals or humans) which means that even if you miraculously eliminated the virus from every human on the planet, it would pop up again as soon as it found new people who don't have immunity are born or their immunity wanes. How Do We Approach Endemic Viruses Differently? Endemicity is the key point to our discussion and one which has broad reaching policy implications. Your approach for controlling the spread of the virus and expectations completely change your strategies. It is why I've personally found the strategies promoted (and currently being promoted at this writing) so frustrating. Our current strategy is pointedly directed at preventing any and all transmissions of SARS-CoV-2. Whether that is using masks, distancing, restrictions on social gatherings, vaccine mandates, travel bans, or economic lockdowns we have been attacking this viral pandemic in exactly the wrong way. For an endemic virus, we recognize that we will all get infected multiple times throughout our lifetimes. Although we develop lasting T cell immunity to coronaviruses it does not completely prevent infections. That means that people will continue to contract and spread the virus but not get terribly sick. For the vast majority of people, these reinfections will be mild not requiring hospitalization. However, just because you don't require hospitalization it still might be a miserable few days similar to when you get the flu. If You Promote Masks, Promote Ones That Work We discussed mitigation measures and the colossal failure of any country, state, or city to successfully stop the spread of COVID-19 with either masks, lockdowns, or distancing. One important point was that we ned to be honest with people and if we are going to force kids to wear masks we should at least have them use masks that have some chance of making a difference. The use of cloth masks is pointless when you have a bunch of kids in an enclosed place for long periods of time. Ultimately, even good N95s probably wouldn't work very well because the kids wouldn't have good seals on them anyway. Dr. David Graham is an infectious disease specialist and the author of the book, From Killer to Common Cold: Herd Protection and the Transitional Phase of COVID-19. He is also the author of FIPhysician.com where he is a practitioner and advocate for early financial independence and retirement. show notes : Today's show Dr. Graham's first appearance : How we transition from pandemic to endemic : From Killer to Common Cold - We discuss Dr. Graham's book : We're in the transitional phase right now. : Dr. Graham's blog where he writes about the FIRE movement and also occasionally COVID. : Today's sponsor who will help you find good real estate investment opportunities. : The home for the Paradocs and a number of other physician based podcasts. : This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. : Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. : Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.
/episode/index/show/theparadocs/id/20284364
info_outline
Episode 142: What It's Like to Become a Doctor with Dr. Matt Moeller
08/21/2021
Episode 142: What It's Like to Become a Doctor with Dr. Matt Moeller
A big struggle for doctors is when they watch what goes on in the state and national legislatures and realize that there is very little knowledge of what they do, how they practice, and what they did to get where they are. There are no better examples of this failure to understand the nature of what physicians do than the debate over the Affordable Care Act (Obamacare) in 2013.That episode was what put the fire in the belly of today's author, Dr. Matt Moeller, to write his article that went viral and later led to a . Professional Stresses There are quite a few stresses that cause lots of problems for practicing doctors Inconsistent schedules making a home life difficult to plan Multitasking by expecting doctors to do multiple things at once No downtime to get away from work where patient concerns (following up lab results, etc.) never stop even on vacation or after hours Rules and regulations The Difference Between Income and Wealth Doctors usually command a big income but don't accumulate wealth until much later in life. This puts them at a disadvantage as income is taxed much more heavily than wealth. It also makes it much harder for doctors to catch up financially to others who began working in their 20s and compounded their wealth and were not as saddled with student debt. How Do You Discourage Doctors? Keep technology complicated and makes doing their job harder. Insecurity among medical staff with their pay and jobs in perpetual jeopardy Turning them from decision makers into decision implementers (algorithm medicine) Escalating productivity expectations Increased responsibilities with decreased autonomy leading to learned helplessness Placing more barriers between physicians and their patients Solutions to What Ails Health Care Simplify costs and reimbursement and increase transparency Reform tort laws Increase the role patients have in their own health through expanding HSAs Prevent chronic illnesses Reign in the numbers and salary of administrators Dr. Matthew Moeller is a gastroenterologist in Grand Rapids, MI and the author of What It's Like to Become a Doctor that addresses the journey through medicine training. The second half of the book spends time addressing the problems in medicine and some potential solutions. show notes : Today's show : Dr. Moeller's seminal piece that become viral and was reposted in mainstream media in 2013. Hosted by John Bush : LinkedIn link for Dr. Moeller. : Today's sponsor who will help you find locum tenens opportunities. : The home for the Paradocs and a number of other physician based podcasts. : This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. : Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. : Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.
/episode/index/show/theparadocs/id/20216321
info_outline
Episode 141: How Decentralized Finance in Cryptocurrency Can Help Your Medical Practice with John Bush
08/13/2021
Episode 141: How Decentralized Finance in Cryptocurrency Can Help Your Medical Practice with John Bush
Bitcoin was invented in 2008 by a pseudonymous programmer (or group of programmers) called Satoshi Nakamoto. It is a currency issued in a decentralized fashion using a complex mathematical equation on a block chain. Bitcoin then launched in 2009 and was adopted by very few people but it held out a promise to usher in a new way we can look at money and preserving value of our time and labor without a central bank debasing it. Bitcoin has since gone from a value of well under one penny to about $40,000 per coin in 12 years. What's Decentralized Finance? The first question to ask is what is centralized finance? Basically, this is traditional finance like using banks to acquire loans. This means that you go to a business and offer some collateral and receive your loan. Now, the advent of cryptocurrency allows for finance through a smart contract. This allows for people all over the world who has cryptocurrency access to capital no matter who they are. This is a powerful tool that can be used in areas of the world without much capital infrastructure and by businesses in the developed world too. What's a block Chain? The block chain is maybe best thought of as a sheet of paper that has every transaction of every coin on it. And with each new creation of a block, the transactions are updated, new coins are added as rewards, and all the decentralized nodes work to verify and agree with the transactions that are on the block. Then a new block is added to the previous as the process is continued forever. One can see the utility of this technology not only in verifying that the funds used to buy something were real and in someone's possession but also in other contracts or information. I spoke to Dr. Huston way back in where she described her plan on using block chains to protect the integrity of physicians' credentials. This means they would control the information and not some health system and would keep it far more secure. You could also use the block chains for other personal information like your health which is what my guest, Brendan Hodge, in proposed with Citizen Health. How Do You Get Started iN Cryptocurrency? As with everything, getting started is the hardest part of process. Buying, trading, and investing take a little experimentation. But if you have any technological saavy, it isn't too hard to figure out. You merely have to decide what cryptocurrency to buy (there are 8 thousand choices and counting) and then whether or not you want to be in charge of the coin itself or have someone else hold it for you. The exchanges will hold the key to the coins you purchase and allow you to take possession, hold them in their vault, or trade them with other currencies. Most of the exchanges like , , , or others allow you to convert your fiat (US Dollars) and purchase the new currencies for a fee using either your bank account or credit card. Trading and exchanging always cost some fee which varies depending on the types of coins being purchased and exchanged anywhere from a few dollars to fractions of a penny. [caption id="attachment_9951" align="alignleft" width="300"] John Bush is the lead instructor and owner of Live Free Academy where he teaches the basics of cryptocurrency. John also works with clients to help them grow their portfolios using advanced trading techniques.[/caption] show notes : Today's show : John Bush's learning institute where you can go for classes, one on one instructions, and much more. Hosted by John Bush : This is the signup page for his upcoming seminar. : Today's sponsor who will help your practice in its online presence. : The home for the Paradocs and a number of other physician based podcasts. : This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. : Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. : Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.
/episode/index/show/theparadocs/id/20128634
info_outline
Episode 140: The Basics of Bitcoin with John Bush of Live Free Academy
08/05/2021
Episode 140: The Basics of Bitcoin with John Bush of Live Free Academy
Bitcoin was invented in 2008 by a pseudonymous programmer (or group of programmers) called Satoshi Nakamoto. It is a currency issued in a decentralized fashion using a complex mathematical equation on a block chain. Bitcoin then launched in 2009 and was adopted by very few people but it held out a promise to usher in a new way we can look at money and preserving value of our time and labor without a central bank debasing it. Bitcoin has since gone from a value of well under one penny to about $40,000 per coin in 12 years. What's a Cryptocurrency? My guest today is John Bush, a cryptocurrency advocate and owner of the consulting/teaching institute Live Free Academy. He has been an advocate of bitcoin since 2013 where he gained some prominence attempting to travel around the country with his family using only bitcoins to buy what they needed. Since, he has been a podcaster and teacher for those who want to use bitcoin and other cryptocurrencies to improve their lives. He says all cryptocurrencies, like bitcoin, are basically computer programs that either require computers to solve complicated mathematical equations to verify all the transactions of the block. For their reward, these computers (or miners) are rewarded with newly minted coins. Likewise, with millions of computers attempting to solve this equation, there are a lot of computers that are verifying that all the transactions on the chain were legitimate and the integrity of the chain is preserved. What's a block Chain? The block chain is maybe best thought of as a sheet of paper that has every transaction of every coin on it. And with each new creation of a block, the transactions are updated, new coins are added as rewards, and all the decentralized nodes work to verify and agree with the transactions that are on the block. Then a new block is added to the previous as the process is continued forever. One can see the utility of this technology not only in verifying that the funds used to buy something were real and in someone's possession but also in other contracts or information. I spoke to Dr. Huston way back in where she described her plan on using block chains to protect the integrity of physicians' credentials. This means they would control the information and not some health system and would keep it far more secure. You could also use the block chains for other personal information like your health which is what my guest, Brendan Hodge, in proposed with Citizen Health. How Do You Get Started iN Cryptocurrency? As with everything, getting started is the hardest part of process. Buying, trading, and investing take a little experimentation. But if you have any technological saavy, it isn't too hard to figure out. You merely have to decide what cryptocurrency to buy (there are 8 thousand choices and counting) and then whether or not you want to be in charge of the coin itself or have someone else hold it for you. The exchanges will hold the key to the coins you purchase and allow you to take possession, hold them in their vault, or trade them with other currencies. Most of the exchanges like , , , or others allow you to convert your fiat (US Dollars) and purchase the new currencies for a fee using either your bank account or credit card. Trading and exchanging always cost some fee which varies depending on the types of coins being purchased and exchanged anywhere from a few dollars to fractions of a penny. Why Should You Purchase Cryptocurrency? The big question, is why buy this currency which seems to have so much volatility? John Bush thinks it is wise to be invested in crypto for a couple of reasons: Our fiat dollars/euros/yuan are being continually inflated away to lose their value. Many cryptocurrencies, like bitcoin, are very limited in their creation and can hold their value over time much better. The world is moving more and more to online and digital currencies will be more commonplace. There are a lot of other uses like decentralized finance (which we will discuss in ) which are available if you have cryptocurrency to use as collateral. It is a way for the unbanked to have access to capital in many parts of the world opening paths to financial freedom. John Bush is the lead instructor and owner of Live Free Academy where he teaches the basics of cryptocurrency. John also works with clients to help them grow their portfolios using advanced trading techniques. show notes : Today's show : John Bush's learning institute where you can go for classes, one on one instructions, and much more. Hosted by John Bush : This is the signup page for his upcoming seminar. : Today's sponsor who will help your practice in its online presence. : The home for the Paradocs and a number of other physician based podcasts. : This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. : Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. : Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.
/episode/index/show/theparadocs/id/20046329
info_outline
Episode 139: Mandatory COVID Vaccinations
08/01/2021
Episode 139: Mandatory COVID Vaccinations
Today we're going to wade into the uncomfortable land of mandatory vaccinations for COVID. You're already seeing these spring up in hospital systems, federal work forces, and universities.There's a lot to understand with these and I only offer my own perspective while hopefully acknowledging accurately my own biases to help you better understand the topic. We will review some science, the underlying political tension, and my conclusions. For the foundations of knowledge that you should have I'd recommend you read/listen to the following episodes: COVID is Real and Vaccines Work We need to start our discussion with some facts. SARS-CoV-2 is a virus that causes COVID-19. It is a potentially deadly disease that preferentially causes mortality in the elderly and frail. Young adults are relatively spared from the worst effects although on very rare occasions they can get seriously ill from COVID. For most though, COVID is somewhere along the spectrum of asymptomatic to mild/moderate disease rarely requiring hospitalization. Fortunately, children are almost entirely spared from the worst parts of the disease and rarely get very sick. Likewise, the mRNA vaccines are extremely effective at preventing people from getting severe disease requiring hospitalizations and death. That's why you see a disconnect now in many countries where even though people may get infected, they don't get severely ill. We've Figured out a Little with Treatment We've figured out a few treatments that work like avoiding ventilators, prone positioning, early dexamethasone for hospitalized patients. Monoclonal antibodies seem to help. Most other treatments are anecdotal or unproven at this time. We Still Don't Know a lot Just as we have learned a lot about COVID, there is still a lot we do not understand. We don't know how to limit its spread outside of massively restrictive policies like those seen in communist China and the island nations of New Zealand and Australia. Rolling house arrest lockdowns and almost total bans on travel have been the only government policies which have mitigated the spread of the virus. Mask mandates, economic lockdowns, and travel restrictions have shown zero correlation with the spread of the virus. There are also a lot of confounding factors making it almost impossible to prove any specific measure works or doesn't work as we've seen the virus indiscriminately affect every state and country on a timeline of its own. Tension Between Freedom or Bodily Autonomy and the Protection of Others The current debate with the mandatory use of vaccinations centers on the tension between our freedom to do as we wish with our bodies (refuse medical care, exercise or don't exercise, etc.) and the concern that if we carry an infectious agent we could unintentionally harm others by getting them infected. This is where the debate really stands and I believe it is necessary to look at the real risk, the locations for the risk, and the costs. We can't make decisions on our policy without taking those factors into account. As I stated before in , there is no reason why any adult in the US should be at risk for COVID because they have now had months to get a vaccine if they do not already have natural immunity from an infection (est. ~30% of Americans). Therefore, it would be unreasonable to require people to go to extreme measures in order to protect those who chose not to protect themselves. If the vaccine were not very effective, then we might have a different argument but when one is vaccinated, they are almost assuredly safe from serious illness. If someone is still concerned, they always have the option of avoiding social contact but others should not have to bow to their risk assessments. This would be more difficult if children were highly vulnerable because they are not yet allowed to get the vaccine. But despite the higher infection rates because of the newer variants, they still show no higher signs of significant disease than April of 2020. Again, the threat to children is almost negligible so those who find that level of risk too high can certainly find alternatives to getting by in life to avoid that small risk until a vaccine is out. Where is it OK to Mandate Vaccines? I definitely believe because COVID is mostly harmless to those vaccinated or who have natural immunity there is no reason to have any sort of mandatory vaccinations for most people. This means also that 'nudging' is not ok whereby the government restricts people and their ability to travel, earn a living, or leave their home. This soft house arrest or removing a means for supporting yourself financially is repugnant and should not be tolerated. That said, I do believe it is reasonable for some places to have mandatory vaccinations (or more accurately, immunity). Although it is unreasonable for those rare people who are immunocompromised to restrict the lives or most or to inject medications in their bodies against their will, it is probably reasonable for people who are most at risk to be able to safely get care when they are sick. These are places which can't be avoided by the sick and an extra level of safety is probably a reasonable expectation. SARS-CoV-2 just won't go away and the controversy keeps us fighting each other. Now some are calling for mass mandatory vaccinations. show notes : Today's show : Today's sponsor and a sister show on the Doctor Podcast Network hosted by Care Cloud that will give you a free assessment of your practice business. : The home for the Paradocs and a number of other physician based podcasts. : This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. : Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. : Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.
/episode/index/show/theparadocs/id/19996616
info_outline
Episode 138: Weight Loss that Works in Primary Care with Dr. Celia Egan
07/26/2021
Episode 138: Weight Loss that Works in Primary Care with Dr. Celia Egan
Ask any primary care physician and they will tell you the toughest thing about helping their patients change lifestyle is that they don't have enough time or contact with the patient. Especially when it comes to weight loss control, primary care docs are stretched so thin on time that they struggle to have the impact they'd like on their patient's healthy habits or lack thereof. Weight Loss Begins with Awareness It's no surprise that a successful weight loss program begins with awareness that you have a problem with weight and your lifestyle. Dr. Egan, says that to be successful one must stay focused on a number of things. All of these are a priority with her management style at her new practice: Relationship with food. One must pay attention to why they are eating and to recognize healthy and unhealthy options. This is all with an awareness of how we are often left with no perfect options because we don't have the right ingredients, time, or abilities. Movement. This goes beyond just saying someone needs to exercise. The movement program must be created with the specific patient in mind and their input. Medications. Sometimes once the other parts are optimized, it is best to look at medications to supplement the rest of the weight loss program. A well designed drug regimen including hormonal treatments can be the difference between success and failure. How to Pull Off Weight in Primary Care Dr. Egan is teaming with Dr. Bitner ( and using an entirely new model of care to help women lose weight. Instead of trying to develop a multidisciplinary clinic through an insurance based model, they have decided to go with a membership model where they limit the number patients to allow for more time and contact with the physicians. It's similar to direct primary care but probably more accurately described as direct contracting. I suspect it will be a much more successful model for getting patients the results they want than through the traditional insurance model. Dr. Egan is an internist who is board certified in weight management and will be starting at True Women's Health in August, 2021. show notes : Today's show : Dr. Egan's new practice where she will work with Dr. Bitner. : This is organization who conducted the survey and is committed to keeping a vibrant marketplace for physicians by helping advocate for them and providing resources to aid in their practices. : Twitter for the Physicians Advocacy Institute. : Dr. Bitner on leaving corporate medicine to practice OB/GYN in an innovative model. : Dr. Fung on the advantages of intermittent fasting. : Dr. Fung on cancer and how excessive weight puts you at increased risk for cancer. : Today's sponsor and a sister show on the Doctor Podcast Network hosted by Care Cloud that will give you a free assessment of your practice business. : The home for the Paradocs and a number of other physician based podcasts. : This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. : Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. : Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.
/episode/index/show/theparadocs/id/19936193
info_outline
Episode 137: Muffins and Experts
07/17/2021
Episode 137: Muffins and Experts
Being an expert has a lot to do with muffins. Or rather, when I was eating a fresh muffin the other day for breakfast it certainly got me thinking about experts. You see, I eat my muffins differently than the rest of my family. They break off the top of the muffin and butter the top and then the bottom. I felt like it would be better to cut my muffin down the middle so I could eat a muffin top with every bite (since the tops are the best). Well, this brought teasing from my kids and wife. The other day, my daughter got a broken muffin so she had to eat it 'my way' by buttering it down the middle. She admitted after eating it that I was right and my way was better. We both considered ourselves experts in what we liked to eat. Who Is an Expert? The definition of what an expert is is fairly well defined but the exact qualifications is not. Being an expert is probably more a matter of degrees of knowledge and mastery than any absolute number. I am certainly more an expert in all things medical than most people, but when compared to other physicians that would sometimes not be the case. Is the Expert Really an Expert in What We Are Discussing? The biggest problem with the use of the term expert over the last year and a half of the pandemic is that we proclaim people experts when they can't possibly be experts. No one has lived through a unique respiratory viral coronavirus pandemic such as we are having. Yet, many proclaim that they know the best treatments, mitigation measures, and modeling predictions. Certainly, some have a better foundational knowledge than others but since this is brand new there is no way anyone can be an expert in this particular disease/phenomenon. Stay Humble Ultimately, if you are in this space where you might not really be an exact expert in what is being discussed, you need to acknowledge it and accept some humility that you can't know. Also, you have to be open the possibility that you may, in fact, be completely wrong. Even experts in their own specialized field are occasionally wrong and must recognize that and be even more cautious when giving 'expert opinion' on topics in which they can't know as much. Self reflection on who an expert is and whether they might be wrong is critical. show notes : Today's show : Advice media helps you fix your online social media engagement issues. Click now to get a free $60 amazon gift card just with a complimentary consultation. : The home for the Paradocs and a number of other physician based podcasts. : This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. : Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. : Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.
/episode/index/show/theparadocs/id/19840616
info_outline
Episode 136: Doctors are Selling Out and Why You Should Be Worried
07/10/2021
Episode 136: Doctors are Selling Out and Why You Should Be Worried
Essentially, there are two main ways to classify physicians - independent or employed. Today's health care in the US is becoming increasingly consolidated as health systems and corporate entities (venture capital groups, etc.) are purchasing physician practices. With the advent of the pandemic of COVID-19 and the partial and complete shutdowns in medicine over 2020, the trend of selling practices accelerated. More and more physicians are now employed by someone - either a hospital system or corporation - eclipsing 70% of all physicians. The era of independent physicians may be coming to a close if these trends don't turn around. The question we should be asking is why is this happening and should we care? What are the Trends? The Physician Advocacy Institute surveyed physicians over 2019-2020 and found that there was an acceleration of physicians selling their practices to hospitals and corporate entities. This was not unique to any specific region of the country. You can see their paper and it is clear that this is a trend that is not going away any time soon. Over the last two years, 48,400 doctors left independent practice and moved to employed status. Nearly half of all physician practices are now hospital or corporate based leaving an ever smaller base of people who can be nimble and innovative in the health care space. It is important to point out that many I have spoken to over the past two years have left big systems and struck out on their own to be disruptors in the space like , , , and others. Reasons Docs Become Employed Cash out for retirement Avoid overhead/business frustrations like meeting payroll, etc. Market swings Paying off student debt (usually ~$250,000 from med school and undergrad) Perceived stable/reliable income Increasing regulations and reporting for things like value based care. MediCare reporting and data mining. Electronic medical records Audit processes Why Docs Leaving Independent Practice is a Problem for Us All Increased health care costs Less competition Less innovation in how to deliver care Prescription drug plan restrictions (and increased costs) Worse autonomy Increased utilization of midlevel providers Stagnant pay because no risk taking Doctors are increasingly becoming casualties of bigness in medicine. Both through health systems and corporate entities like venture capital groups. show notes : Today's show : This is the article we discussed regarding what's going on with physician practices. : This is organization who conducted the survey and is committed to keeping a vibrant marketplace for physicians by helping advocate for them and providing resources to aid in their practices. : Twitter for the Physicians Advocacy Institute. : Dr.Lovell in leaving corporate medicine to practice orthopedic hand surgery in a new way. : Dr. Bitner on leaving corporate medicine to practice OB/GYN in an innovative model. : Dr. Rosenfield on leaving corporate medicine to practice surgery in a more innovative way. : Today's sponsor and a sister show on the Doctor Podcast Network hosted by Dr. Errin Weisman. : The home for the Paradocs and a number of other physician based podcasts. : This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. : Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. : Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.
/episode/index/show/theparadocs/id/19765979
info_outline
Episode 135: Apple Failed at Health Care, Doctors Didn't with Dr. Doug Farrago
07/01/2021
Episode 135: Apple Failed at Health Care, Doctors Didn't with Dr. Doug Farrago
There has been no shortage of people or schemes to fix the US health care industry. US medicine consistently fails to deliver quality care at affordable prices and manages to irritate both doctors and patients alike. Politicians and think tanks come up with grandiose plans every day to treat what plagues the system. Likewise, big tech companies like Apple are now entering the fray and bringing their technology as solutions. Unfortunately for Apple (and its tech cousins like Amazon), the health space is extremely complicated and can't be solved simply using technology. Its attempt to "make it" flopped just as other ventures by tech companies have in the past. The common thread in all of those is the belief that they could replace doctors. Doctors Make it Work, Not Expensive A common misconception found at tech companies like Apple is that people are easy to replace with algorithms and gadgets. But humans aren't machines so you can't always predict how they will behave. Even with sophisticated devices monitoring heart rate, blood pressure, etc. that information is not useful in isolation. You must have someone who can figure out if any of the data is important based on examination, intuition, and experience that can't be found in any algorithm. Also, the companies believe that by removing the physician, they will find the cost savings they need to cut costs and deliver an equivalent service. But anyone who has been paying attention (or looked at expenses in medicine) will find that doctors are one of the smallest parts of the cost equation. They are easily surpassed by imaging, laboratories, pharmaceuticals and the biggest and baddest of them all - administrative. Middle men and the third party payor system in general are what are driving the majority of price inflation in health care. How to Really Solve the Shortage on Care - Hint: It's not getting rid of doctors My guest today is Dr. Doug Farrago, founding member of the DPC Alliance, newly retired direct primary care doctor, author of books on how to start your own DPC practice, and inventor of the knee saver for catchers and the cryo helmet for sufferers of migraines and concussions. Dr. Farrago points out the most obvious flaw in the plan from these tech companies - data is only as useful as the one applying it. Just as it wouldn't be recommended to get random batteries of tests to arrive at diagnoses, accumulating massive amounts of vital signs or rhythm data is just as useless without the context provided. A good example is familiar to any doctor who has ever ordered a chest x-ray. When you get the reading from the radiologist, their diagnosis of the problem is dependent on the history of the patient. Maybe that fluffy infiltrate is extra fluid, or pneumonia, or blood. You need to correlate what is going on to get the most out of that film. Without a correlation, it is just a random test that may or may not be significant. The Solution? Direct Primary Care So what is the solution to the cost and quality problem facing primary care in medicine? Dr. Farrago (and many others whom I've spoken with , , , and ) is direct primary care. The personal membership based relationship between a doctor and patient without insurance or any of the middle men allows for the best care. It is affordable and allows the doctor to use his or her intuition and clinical judgment based on their prior relationship with that patient and their previous health history. That's why Dr. Farrago thinks DPC is the clearest solution to what is plaguing us - not some new piece of tech. Tech are just tools that the clinician can use - they can't replace a human touch, physical exam, and experience. Dr. Doug Farrago is a recently retired DPC physician previously of Forest Direct Primary Care. He is the writer at Authentic Medicine and DPC News. He is the author of many books on DPC and the inventor of the Cryo Helmet and knee saver for baseball catchers. show notes : Today's show This is the article we discussed focusing on Apple's failure getting into the primary care space. : This is a great resource for those interested in what is going on in direct primary care. A news accumulator with some original content. : Dr. Farrago's blog of 20 years where he has commented on medicine. : This is an organization founded by Dr. Farrago that is committed to helping DPC doctors organize and learn from each other to become successful clinicians and business men and women. : Dr. Amat describes why she went into DPC. : Dr. Neuhofel explains what it was like starting one of the first DPC practices in the country. : Dr. Gross describes how DPC is a cornerstone for rebuilding our health care system. : Dr. Umbehr speaks about the resources he has created to help DPC docs be successful in their new practice model. : Today's sponsor for the show is Locum Story and how they help doctors find locum tenens positions.s : The home for the Paradocs and a number of other physician based podcasts. : This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. : Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. : Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.
/episode/index/show/theparadocs/id/19672127
info_outline
134: Science is Broken, It's Time We Fix It with Dr. Jay Bhattacharya
06/24/2021
134: Science is Broken, It's Time We Fix It with Dr. Jay Bhattacharya
There has been no shortage of casualties in the last year and half with the COVID pandemic. Schools have been closed, businesses shuttered, and families torn apart with different levels of concern for the virus. But one surprising victim has been science itself. The practice of scientific inquiry, discussion, and debate disappeared. Instead of science - which we can loosely define hypotheses that are then tested and either proven or disproven - is longer present when it comes to COVID.
/episode/index/show/theparadocs/id/19598066
info_outline
Episode 133: Building an Electronic Health Record That Won't Make You Pull Your Hair Out with Dr. Richard Sztramko
06/17/2021
Episode 133: Building an Electronic Health Record That Won't Make You Pull Your Hair Out with Dr. Richard Sztramko
If you want to get a doctor's blood pressure up or make her sweat, just tell her that you have a great electronic health record (EHR) to use. EHRs are the bane of a physician's life because they don't work well with your work flow, create extra work and inefficiencies, and cost a ton of money. That's why I spoke to Dr. Richard Sztramko of Hamilton, ON who is co-founder of Arya health technology company that has designed a new EHR.
/episode/index/show/theparadocs/id/19509971
info_outline
Episode 132: Don't Sweat the COVID Variants with Dr. Monica Gandhi
06/10/2021
Episode 132: Don't Sweat the COVID Variants with Dr. Monica Gandhi
"Beware the variants!" scream the headlines all over the news. Now that the vaccine is available for SARS-CoV-2, we are pounded with endless daily fear-filled stories about how the variants of COVID are coming and will continue to put people in the hospitals and funeral homes. Are the variants that dangerous? Are there really wholesale mutations occurring in this virus that will make our natural immunity or vaccine immunity ineffective? According to my guest, Dr. Monica Gandhi, the answer is a simple no.
/episode/index/show/theparadocs/id/19426697
info_outline
Episode 131: Colorado Threatens to Take Away Your License if You Don't Play Ball with Dr. Belen Amat
06/04/2021
Episode 131: Colorado Threatens to Take Away Your License if You Don't Play Ball with Dr. Belen Amat
This year, the Colorado legislature introduced a bill to radically change the way health care would be delivered in the state. HB 21-2132 was introduced this year with the hope of creating a public option health insurance for everyone in Colorado. Of course, their expectation is that they will lower health care expenses by over 10% with this plan. If this doesn't happen, the hammer comes down on everyone providing care and they lose their license to practice.
/episode/index/show/theparadocs/id/19360925
info_outline
Episode 130: The Failure of Fauci on Coronavirus with Peter Suderman
05/28/2021
Episode 130: The Failure of Fauci on Coronavirus with Peter Suderman
In many ways, Dr. Fauci's failure to properly handle the pandemic response with COVID was inevitable. Men like him - according to my guest Peter Suderman of Reason.com - believe in the general infallibility of the bureaucratic process. They think that by following a mechanical paperwork process that they will come to the best, safest, and correct conclusions. These public health bureaucrats also hold a paternalistic view of the average citizen and that those citizens need their protection.
/episode/index/show/theparadocs/id/19270601
info_outline
Episode 129: We are All Imperfect Dads with Dr. Jeremy Toffle
05/20/2021
Episode 129: We are All Imperfect Dads with Dr. Jeremy Toffle
Perfection. We all strive for it. Some more than others, but we all look to be better versions of who we are. In medicine, we tend to be high achievers so we want to 'conquer' parenthood. Being perfect isn't any more possible in parenting than it is in medicine. Human relationships are messy and raising children up to be the best versions of themselves has no handbook. The push and pull of you trying to get your kids to be who you think they should be is often at odds with who they think they should be.
/episode/index/show/theparadocs/id/19175954
info_outline
Episode 128: If You've Had COVID, Don't Get Vaccinated with Dr. Hooman Noorchashm
05/13/2021
Episode 128: If You've Had COVID, Don't Get Vaccinated with Dr. Hooman Noorchashm
The most important question we have to ask ourselves is who should get the vaccine? The question comes down to who should get the vaccine, or rather, who shouldn't get vaccinated?
/episode/index/show/theparadocs/id/19097630
info_outline
Episode 127: American Independence Day from COVID
05/10/2021
Episode 127: American Independence Day from COVID
We're talking about COVID and our American Independence Day from SARS-CoV-2 on June 1, 2021.
/episode/index/show/theparadocs/id/19040429
info_outline
Episode 126: How the Medical Boards are Fleecing America's Doctors with Chuck Kroll
05/01/2021
Episode 126: How the Medical Boards are Fleecing America's Doctors with Chuck Kroll
Today's episode strikes right to the heart of the reason I started this podcast - the injustice of maintenance of certification. If you're a doctor, you know all about the unfairness of this system which requires more money, paperwork, money, testing, money, time away from patients and families, and money. It contributes to physician burnout. For patients, it is why your doctor might retire early, look stressed out, or be unavailable when you need him or her most.
/episode/index/show/theparadocs/id/18936347
info_outline
Episode 125: Value Based Care Provides Neither Value Nor Care with Dr. Eric Bricker
04/22/2021
Episode 125: Value Based Care Provides Neither Value Nor Care with Dr. Eric Bricker
Health care, according to today's guest Dr. Eric Bricker, is filled with euphemisms. One you hear a lot is value based care. The claim is that we need to restructure insurance plans to reward health systems that provide care focused on outcomes instead of activity. Conceptually, it makes a lot of sense that you would reward the people providing superior outcomes with better pay. Unfortunately, this scheme has been tried before and failed. It's unlikely the outcome will be any different this time around.
/episode/index/show/theparadocs/id/18824999