Healthy Rounds With Dr. Anthony Alessi

An outbreak of an uncommon but not unheard-of illness is responsible for the deaths of at least three people who were on an international cruise ship. With the rest of the passengers and crew under observation in their home countries — including 18 Americans who went to a quarantine facility at the University of Nebraska — how worried do we need to be about hantavirus? Dr. David Banach, UConn Health infectious diseases physician and hospital epidemiologist, explains what we're dealing with, the public health implications, and how, unlike COVID, the medical community at least has some history with this virus. Submit questions for Healthy Rounds: [email protected] Dr. David Banach: https://www.uconnhealth.org/providers/profiles/banach-david UConn Health Infectious Diseases Division: https://www.uconnhealth.org/infectious-diseases UConn Health Orthopedics and Sports Medicine: https://www.uconnhealth.org/orthopedics-sports-medicine UConn Health: https://www.uconnhealth.org Grant support from Coverys: www.coverys.com Transcript Dr. Alessi: Welcome to the Healthy Rounds Podcast, where we provide you with up-to-date and timely medical information from national and international leaders in their fields. This podcast is brought to you by UConn Health, with support from the Department of Orthopaedic Surgery and a grant from Coverys. It is not designed to direct your personal healthcare, and that should only be done with your physician. I’m your host, Dr. Anthony Alessi, and it’s great to have as my guest today Dr. David Banach. Dr. Banach is an infectious disease specialist and he is head of the infection prevention program here at UConn Health. David, welcome to the show. Dr. Banach: All right. Thank you. Dr. Alessi: Let’s talk. I mean, there’s a lot of information out there about the hantavirus and how this all came about. Let’s go back and really address how this infection developed. What does it mean to our listeners? Dr. Banach: Sure. So, kind of taking it back to the basics, hantavirus is a virus that we’ve known about now for many years, even maybe upwards of decades, that exists in the rodent population. So it’s primarily circulating among rodents, particularly in certain geographic areas. And then on certain situations it does infect humans, typically humans who are in close contact with rodents or rodent excrement. It causes what we call a zoonotic infection, where a virus that typically is present in animals moves into a human host. And in most situations, those are one-offs. Someone will have some sort of environmental exposure, could be in any part of the world, could be here in Connecticut, getting sick from this particular virus, and not pass it on to anyone else. But occasionally we do see it occur in clusters, and that’s what’s happened with this most recent situation on the cruise ship that returned and several individuals on that ship became sick and were eventually diagnosed with hantavirus. I think in terms of the big picture, again, this does seem to have caused a bit of an outbreak on that ship. What it means for the larger public, I think we’re still kind of keeping an eye on it right now. I think the general feeling is that the risk for the general population is low, but I think it’s something that we’ll have to keep a close eye on in the coming weeks. Dr. Alessi: What’s interesting when we talk about hantavirus, I’d never heard the term until Gene Hackman died of it, right? In the, in the past year, right, Gene Hackman and his wife die of hantavirus, and now we hear about hantavirus again. What’s the difference? He wasn’t in South America. Can you talk a little bit about why he’s dead and now these other people are dead. Dr. Banach: Sure. I think the illness that his wife, I believe, contracted was the hantavirus, and that, there’s different strains of hantavirus. This particular strain, on the cruise ship, is the Andes virus. That’s like a type of hantavirus, if you will, that causes a specific illness. But there’s also, as I mentioned earlier, hantavirus that’s present in rodents throughout the world, and I think the situation with Gene Hackman’s wife, I think, was linked to some sort of environmental exposure to rodents that she was in contact with. So it’s same virus, but a little bit different in terms of the way that it’s showing, in terms of individual cases versus, like, a cluster of infections like we’re seeing with this cruise ship. Dr. Alessi: Now, when we talk about viral outbreaks, right, everybody immediately thinks of COVID. And there’s that fear of, are we going to be dealing with another pandemic? And obviously, with the hantavirus, the mortality is much higher than COVID. So can you talk a little bit about the differences and why this should not be similar to COVID? Dr. Banach: Sure. “Viruses” is such a broad term. We think about our seasonal influenza viruses. COVID, of course, got so much attention over the last five years in the light of the pandemic. But then there’s other viruses. You remember Ebola was a big viral outbreak from a few years prior to the COVID pandemic, and they cause a wide range of illnesses. Hantavirus can cause quite severe illness. It causes a very severe cardiopulmonary symptom that can often lead to people needing ICU care and even succumbing to the virus. In contrast to COVID, where the virus tends to be sort of uniformly a respiratory virus, so a little bit different in terms of, like, the clinical illness that they cause. In terms of the way they spread, also different. So COVID was different in a lot of ways. It was a virus that, first of all, we had never seen circulating in human populations. As I mentioned, hantavirus is not new in that sense, so we’ve known about hantavirus, and we’ve seen individual infections. We’ve even seen clusters in the past. There was a large cluster around 2018, 2019 in South America that was well-studied and described. There’s actually a very notable New England Journal of Medicine publication on this hantavirus outbreak that came as COVID was starting to take off, so it went under the radar in that sense. But it was well-described, related to sort of a cluster of hantavirus infections, this particular type of hantavirus specifically. And so we understand a little bit more about how it’s transmitted. It doesn’t spread in the same way that COVID does in the sense that there’s no established sort of asymptomatic or pre-symptomatic spread. Remember, that was a big challenge with COVID, that people could potentially be contagious before they showed signs of illness. But then on the other end of the spectrum, hantavirus does cause quite severe illness, and often has a much higher morbidity and mortality associated with it than COVID. So, yeah, I think there’s differences. I think there’s some differences that make this less likely to spread in a larger fashion as COVID did. But I think it’s still early, that we have to kind of keep an eye on things, and what we’re going to be looking for in the coming weeks are any evidence of secondary transmission. At this point, the people with infections have all been directly linked to the ship and the original cases of the two individuals who were first ill. But if we start to see additional spread, that would raise some concern that there may be a little bit more going on in terms of its ability to transmit to a the broader population. Dr. Alessi: David, do antivirals help? I mean, these people who are being treated now who are symptomatic, and are they treating them with antivirals, or, what are they doing for these people? Dr. Banach: Yeah, at this point, it’s really supportive care. As I mentioned, these patients can develop really severe cardiopulmonary illness, requiring pretty intense supportive care at times. There’s a wide spectrum of illness. Some individuals may recover with sort of minimal support, but some do become quite sick. So it’s really supportive care at this point. We don’t have an established antiviral per se, and there’s no vaccine available for hantavirus at this point, and that’s largely because these infections, although we’ve known about them for many decades, are quite infrequent. I think, and the CDC I think, they reported that there’ve been something like 800 cases described since 1990 of hantavirus in the US. So it’s been circulating, but very sporadically. So there hasn’t been kind of a need for sort of a wide-scale public health intervention. But, I think we’ll have to keep an eye on this particular outbreak and see how things unfold. Dr. Alessi: Do we need to do anything here in Connecticut? Dr. Banach: I think at this point, the most important thing for people here in Connecticut is to kind of listen to what’s happening. There doesn’t seem to be a direct risk to people here in Connecticut from this infection, but listen to what you’re hearing on the news. See what’s being reported by the public health authorities and, how the situation evolves. My optimistic hope is that this will be very limited, and the outbreak will subside with now that the appropriate measures are being taken to try to quarantine people who are exposed and prevent spread, but we’ll have to keep an eye on things. Dr. Alessi: When you say listen, that raises a flag because we don’t know who to listen to anymore, right? We’ve had some issues with scientists leaving the CDC. Do you listen to the WHO? I- if you go on the internet, we’re all going to be dying in the next week from hantavirus. So who do you listen to? I mean, who should, who do you consider the reliable source here for our listeners? Dr. Banach: I think that is a real challenge for the public to really understand how to get accurate information. With this particular situation, the World Health Organization seems to be the most tied in. Remember, this is an outbreak that started outside the U.S. The initial cases were detected, and those patients are being taken care of in various countries, including, I think, countries in South Africa and other parts of the world. So the WHO is really leading this effort, and they’re keeping updated stats and updated reports on how things are unfolding. So I think that they’re the most attuned to what’s going on, and I would have confidence in what they’re reporting out. But now the news is taking hold of this story, sometimes for better, sometimes for worse. And take the information that you’re getting as it’s coming to you, but, think about, I think the CDC has been reporting updates on the hantavirus situation based on information they’re getting from WHO and other international sources. But I think those are the kinds of voices that we can listen to at the moment and learn as much as we can. Dr. Alessi: I want to talk to you a little bit about the incubation and the isolation period. In European countries, most notably Spain and France, people who were exposed on the ship are isolated for 42 days, and they feel that that’s the safest thing to do. Here in the United States, we’re kind of letting people decide for themselves how much they need to isolate, which always shakes me up a little bit. Can you talk about why we’ve taken this relaxed view of isolation as opposed to other countries? Dr. Banach: I think it is varied in terms of the way that isolation is handled. So the incubation period, like you mentioned, is up to 40 days, so that means patients may not become sick for that period of time. And different approaches are taken to how patients are going to be monitored who were potentially exposed, and different countries are taking different approaches. I think here in the U.S. we have a few different ways that we’ve handled it. I know there are, the highest risk individuals, I think, are being monitored very closely. I think several people, especially those who are showing any signs and symptoms, are being monitored in, like, a biocontainment unit in Nebraska, I believe. But other lower-risk exposed individuals can be monitored by public health authorities in a less invasive kind of way. And we’ve seen this also with, thinking about individuals who returned from Africa after taking care of Ebola patients, they were still monitored by public health authorities. For instance, the state or local health department would be checking on them frequently after they returned. They weren’t necessarily confined to their homes. They were allowed sort of limited public exposure as long as they were checking in with the appropriate public health authorities. So I think we, we sort of triage exposed individuals, the highest-risk individuals being monitored the most intensely. I mean, certainly anyone who has symptoms gets really the most intense monitoring. But we sort of triage based on the level of exposure and ensure that we have monitoring that’s appropriate. But I think the different countries are taking different approaches, and I think we have to rely on our public health authorities here in the United States to monitor exposed individuals appropriately. Dr. Alessi: David, thank you. Thank you for your time today. Thank you for jumping on this on short notice. You’re always our trusted resource when we have questions around here. So thanks again. Dr. Banach: Thanks, thanks for having me on, and happy to give any updates as needed. Dr. Alessi: Thanks again. If you have any questions or ideas for future programs, you can reach out to me at [email protected]. Jennifer Walker is the executive producer for the Healthy Rounds Podcast. Christ DeFrancesco is our studio producer. Until next time, this is Dr. Anthony Alessi. Please stay healthy.  

Gone are the days of stroke having only two outcomes — death or disability — now that we have a window of time to treat what still is very much a medical emergency. For Stroke Awareness Month, Dr. Priya Narwal, medical director of UConn Health’s stroke program, joins to discuss how stroke care, recovery, and even prevention have evolved over the years, how the UConn Health Stroke Center harness that expertise, and why it remains critically important to “BE FAST.” The UConn Health Stroke Center is certified as a Primary Stroke Center by the Joint Commission. Submit questions for Healthy Rounds: [email protected] Dr. Priya Narwal: https://www.uconnhealth.org/providers/profiles/narwal-priya  UConn Health Stroke Center: https://www.uconnhealth.org/neurology/stroke  UConn Today: “First in Connecticut: Ischemic Stroke Survivors Have Renewed Hope with the Vagus Nerve Stimulation Device Now Available at UConn Health” https://today.uconn.edu/?p=214132 UConn Health Orthopedics and Sports Medicine: https://www.uconnhealth.org/orthopedics-sports-medicine UConn Health: https://www.uconnhealth.org Grant support from Coverys: www.coverys.com Transcript Dr. Alessi: Welcome to the Healthy Rounds Podcast, where we provide you with up to date and timely medical information provided by national and international leaders in their fields. This podcast is brought to you by UConn Health, with support from the Department of Orthopaedic Surgery and a grant from Coverys. This podcast is not designed to direct your personal care in any way, but that should only be done in conjunction with your physician. I’m your host, Dr. Anthony Alessi, and it’s great to have as my guest today, Dr. Priya Narwal. Dr. Narwal is an Assistant Professor here at UConn Health in the Department of Neurology. She’s also director of the stroke program. This is especially timely because the month of May is stroke month where we raise awareness about stroke and the treatments for stroke. And what better than to have an expert in that field with us. Priya, welcome to the show. Dr. Narwal: Thanks, Tony. Dr. Alessi: Let’s talk a little bit about your directorship of the stroke program. Again, that’s a fairly new term in terms of having a program in neurology to direct one specific entity. Can you talk about the stroke program here at the University of Connecticut? Dr. Narwal: Sure. So when we say a stroke program, it means that the hospital is equipped to provide specialized stroke care and meet the needs of patients who have stroke or are experiencing stroke-like symptoms. So, what that entails is being able to identify stroke symptoms, realizing how urgent it is to address stroke symptoms, and also have a team in place, a team that consists of different specialties and departments such as emergency department, radiology, neurology, neuro intervention, ICU, to be able to provide expedited care to these patients. Dr. Alessi: Let’s back up a little bit. Let’s define stroke because it’s an old term. We’ve been using this term for many, many decades, and yet it’s still so relevant. Can you share for our listeners a little bit about the specific types of stroke? Dr. Narwal: Sure. So, a stroke is a medical emergency that is caused by interruption of blood flow to the brain. When we typically use the term stroke, in general, we are alluding to ischemic stroke or strokes caused by a blood clot interrupting the blood flow. However, strokes can be ischemic due to lack of blood flow or hemorrhagic or bleeding types of strokes that are caused due to rupture of blood vessels in the brain. Dr. Alessi: So, when we talk a little bit about the history of stroke itself, I’m still old enough to know when it was an untreatable condition, right? Where you brought someone to the hospital and you had them do some physical therapy, but there was nothing to do, right? And then we went to baby aspirin or using aspirin only, and now we’re using terms like “neuroplasticity” and “penumbra” and “antithrombin therapy”. Can you take us through that history of treating strokes a little bit? Dr. Narwal: Right, so as you said, you know, earlier we did not have much to offer to our stroke patients in terms of acute treatment or minimizing the risk of disability going forward. The main focus was on secondary prevention, meaning you had a stroke, and what do we do to prevent it from happening again, which is where the aspirin came in. However, in the late 90s, we had this incredible drug that was FDA approved, which was Alteplays or tPA or loosely called the clot buster, which if patients met certain criteria, we could give that medication and it had a positive impact on their long-term functional outcome. So that was a huge game changer when it came to acute stroke treatment, and that was the case for a long time, however, the treatment window was four and a half hours. So, if you were last known well within, you know, the previous four and a half hours, then we could treat you with the medication. But if you know, someone went to bed, woke up with stroke-like symptoms, there wasn’t much more to offer. Also, if patients have a blood clot in the brain that is large, the clot buster may not work too effectively and those patients may not have as good of an outcome. So, in the past decade or so, we have this new intervention that we’re able to offer to patients, which is called “clot retrieval” or “mechanical thrombectomy”. So again, if patients meet certain criteria based on what their exam findings look like, what their imaging findings look like, and they have a blood clot that we can go after, we will do that, and that has shown to have a positive impact as well. Dr. Alessi: You know, it’s so interesting to me because as someone who doesn’t do that in the field of neurology, I think of it as literally they’re going in there and fishing out a clot from the brain. Dr. Narwal: Right.   Dr. Alessi: It’s something that we would never even think of. And then watching someone get their function back, I think, for of those of us who have used these clot busting drugs, watching someone get better before our eyes after the administration is, it’s a powerful experience. Dr. Narwal: It’s pretty incredible, and I think one particular case that left a mark on me was a patient who came with a top of the basilar occlusion, which as you know can be catastrophic. Dr. Alessi: Right.  Dr. Narwal: And the patient came in, we were able to do a thrombectomy and he was discharged the next day from the ICU. That’s how good the outcome was. The patient had practically no deficits. Dr. Alessi: Alright, and can you describe a little bit, I think our listeners may not know what a "top of the basilar syndrome” is. Dr. Narwal: Mm-hmm. Dr. Alessi: Can you explain that severity to folks? Dr. Narwal: Right, so the basilar artery is a big blood vessel in the back of the brain that supplies several critical areas that are essential to our basic function pretty much like being able to breathe and, you know, move our eyes and just be awake or conscious. So, when someone has an occlusion sitting at the very top of their basilar artery, this whole area of the brain that allows for wakefulness is disrupted and patients look comatose and have a really poor outcome. Dr. Alessi: So that is phenomenal, really. Lately, we’ve used the "BE FAST" acronym. Can you talk a little bit about the acronym itself, and you know, has it been effective? Dr. Narwal: I would like to think so. I do think it has helped a lot with community outreach. I do see patients in office who will tell me, you know, we called 911 because we saw this or read this somewhere. I don’t know if we have a way to measure how effective it’s been, but the "BE FAST" acronym itself stands for “balance issues or dizziness”, “eye problems”, which could be double vision or blurry vision, or missing parts of your vision, “facial droop”, “arm or leg weakness”, “speech changes”, which could be slurred speech or word finding difficulties, and T stands for “time to call 911.” Dr. Alessi: It’s kind of interesting because, you’re right, it’s probably hard to measure the success of it, but you know, I tend to think that anything that empowers a patient is important, whether it be breast exam, testicular exam cell, any self-examination, and certainly "BE FAST” lets somebody do their own self-examination. So, I’d have to think it’s effective. Dr. Narwal: Yeah, I’d like to think that too. And also, you know, earlier it used to be "FAST” and then we added the "BE” because very commonly, again, symptoms affecting the back of the brain can be a little bit subtle, like patients may just feel dizzy or unsteady, and oftentimes they wouldn’t think much of it. So that’s why having the "BE” in there has definitely made a positive impact as well. Dr. Alessi: I want to talk a little bit about the role of rehabilitation. And, I go back to share a story. Back in the early 80’s, actually, I had just finished medical school, it was 1981, and my wife to be’s uncle had a stroke, and her mother would go to the rehab to see her brother-in-law and make him squeeze a ball so many times with this bad hand. I mean, he would have to do it, so every day she would drive this home while he was in the rehab. And, you know, naturally I just graduated medical school, so I knew everything, right? So, I told my fiance at the time I say, “you know, I don’t know what she’s doing. That doesn’t do any good. OK? It’s a stroke, nothing’s going to get better.” And sure enough, the guy regained the use of his hand, left the hospital, went back to enjoy his boating and whatever. So, I was proven wrong. Now we go forward another 40 years, right? And that’s all we do. We know to now use the bad hand to the point where sometimes, right, we immobilize the good hand... Dr. Narwal: Right Dr. Alessi: ...to get it going. So, I like to tell people that I learned the most about stroke rehabilitation from my now deceased mother-in-law more than any conference I ever went to. So can you talk a little bit about rehabilitation and the importance of early rehabilitation after a stroke. Dr. Narwal: Absolutely. Rehab, you know, is still the cornerstone of post-stroke recovery. Early rehab is what we really like to emphasize on, which is why when patients are admitted to the hospital, they will be evaluated by physical therapy, occupational therapy, speech therapy, to make sure we have an appropriate plan in place when they leave the hospital, whether that’s going to a rehab or outpatient services. You know, rehab makes a huge amount of difference. There are times when I’ll see someone in the hospital and they come to see me in office and I don’t recognize them ’cause that’s how much better they’re doing, just with rehab alone. And there have been advances in rehab as well. So, the new device that was FDA approved was Vivistim, which is a vagal nerve stimulation. It’s approved for patients with ischemic stroke who have upper extremity weakness. So Vivistim combined with rehab has shown to have a positive outcome in terms of functional recovery. So that’s been incredible, and we have a bunch of patients here. We do offer Vivistim here at UConn as well. Dr. Alessi: Is it an external stimulator or an internal stimulator? How is that done? Dr. Narwal: Patient can do it themselves, but it’s an implant. Dr. Alessi: Yeah. Dr. Narwal: But the patient, so, either they do it during rehab with the therapist, or they can self-stimulate it as well. Dr. Alessi: OK. Going back to my mother-in-law story, do we ever do enough rehab? Right. Someone may go to a skilled facility, right, and they’ll get physical therapy once a day, right? Dr. Narwal: Right. Dr. Alessi: And even in the hospital, it’s not possible for the physical therapist to be there the whole time, right. And it impresses to me the importance of family involvement, right. And we see that in foreign countries, right. Dr. Narwal: Right. Dr. Alessi: I practiced in Italy before when I went to medical school, and you know, the family is always at the bedside, and, even in Haiti, we would instruct the family on how to do the therapy. Have we gotten to a point where we can increase that, but what’s the solution to that? Dr. Narwal: So, I think a lot depends on how much the patient can participate. I think that guides a lot of where they end up going. So, if someone is requiring a lot of support or cannot stand up without 2% assist, they cannot go to an acute rehab and undergo that intensive therapy, versus someone who was able to do that. So, I think how much therapy they end up getting also depends on how much they can tolerate. And, you know, once they leave the nursing facility, there’s always the option of doing at home rehab. And a lot of my patients actually just like you said, do exercises on their own. Like they will ask the therapist what can they do on their own and they will just, you know, squeeze the ball or open and close their fist and do all of that stuff all by themselves. Dr. Alessi: Priya and wrapping up, what’s the future? What are we looking at in the future of stroke care, and I know it’s such an exciting field, but when you go to meetings and talk to people, what could we expect? Dr. Narwal: I think in terms of acute treatment, one of the big next steps is broadening the number of patients we can offer acute treatments to, right? So like if someone has a large vessel occlusion and their scan doesn’t meet the current parameters that we look for, we’re trying to broaden those parameters. Like even if someone has a larger core infarct, can we still go in and perform thrombectomy? Will that have a positive outcome on them? So that’s absolutely the big next step. And the other thing that’s of great interest is focusing on etiology. You know, a lot of times people say, oh, they had a stroke. All you can do is give aspirin and that’s it. But it’s not that straightforward. I think a lot of focus is now shifting on doing targeted therapy in the sense of really, you know, focusing on the stroke etiology, trying to identify that and then addressing that as opposed to like a blanket approach. Dr. Alessi: Priya, thank you. Thank you for your time today, and really thank you for everything you do here at the University of Connecticut and for our patients. Dr. Narwal: Thank you for having me, Tony. Dr. Alessi: Many thanks to our guests today, Dr. Priya Narwal, who’s director of the stroke program here at the University of Connecticut. If you have any questions. Or ideas for future programs or any specific question for Dr. Narwal, you could just reach out to me at [email protected]. Jennifer Walker is executive producer of the Healthy Rounds podcast. Chris DeFrancesco is the studio producer of the Healthy Rounds Podcast. Until next time, this is Dr. Anthony Alessi. Please stay healthy.

In between studio guests, Dr. Alessi brings new information to earlier conversations about messenger RNA and how it’s showing promise in treating pancreatic cancer, a study further debunking the Trump Administration’s assertions about the safety of Tylenol, and whether reasonable solutions to physician licensing challenges could improve access to care. Submit questions for Healthy Rounds: [email protected] Jan. 27, 2026, with DPH Commissioner Manisha Juthani: https://healthyrounds.podbean.com/e/the-impact-of-public-health/  Jan. 13, 2026: with Dr. Andy Agwunobi, UConn Health CEO: https://healthyrounds.podbean.com/e/premiere-with-dr-andy-agwunobi-uconn-health-ceo/ Feb. 24, 2026: with DSS Commissioner Andrea Barton Reeves: https://healthyrounds.podbean.com/e/medicaid-myths-keeping-ct-families-healthy/ UConn Health Orthopedics and Sports Medicine https://www.uconnhealth.org/orthopedics-sports-medicine UConn Health: https://www.uconnhealth.org Grant support from Coverys: www.coverys.com Transcript Dr. Alessi: Welcome to the Healthy Rounds Podcast, where we provide you with up-to-date, timely medical information brought to you from national and international leaders in their fields. This podcast is brought to you by UConn Health, with support from the Department of Orthopaedic Surgery and a grant from Coverys. It is not designed to direct your personal healthcare, which should only be done by your physician. I am your host, Dr. Anthony Alessi, and this week we’re going to chat a little bit about some topics that, some of which we’ve talked about in the past, but now we have new information on, and I think it’s information that we need to provide you, our listeners to provide best healthcare overall, and really pay attention to what’s going on that is publicized and how it affects all of you. And there are three specific topics I want to touch on. The first is pancreatic cancer. I also want to talk a little bit about a exciting study that was just published in The Lancet on Tylenol use in pregnancy, and then we’re going to talk about physician licensing in the United States. So with that, let’s get started. This week at the National Oncology meetings, they presented new data on the treatment of pancreatic cancer. Now, for those of you unfamiliar with pancreatic cancer, it is one of, if not the most deadliest cancer, and the reason being that typically by the time you find evidence for the tumor, it has already metastasized, it is already spread to vital organs. So with that, it’s very difficult to treat. In the studies published, one in particular I want to talk about, they use messenger RNA as the vehicle for treatment. Now, I know I’ve talked about this before, but it bears repeating messenger. RNA is just that, it’s a messenger, and we chatted with Dr. Juthani about this. It does not alter your DNA in any way, shape or form. So the best analogy I could come up with was, it’s a messenger. So if you get a delivery, right, to your house, whether it be from Amazon or GrubHub, a messenger comes and delivers a package, then they leave. That’s exactly how messenger RNA works. So when the messenger comes to your house, they don’t go in your house and start rearranging your furniture, right? And I think that’s the misunderstanding here is they think the messenger RNA goes in the cell and starts mixing things up. That’s not the case. But what it does do, it brings a message that trains your immune system to fight the cancer with your own body. Your own T cells are now redirected to fight the tumor. So in the case of pancreatic cancer, what they do is they go in, a surgeon goes in, removes the tumor. They take the tumor and use material from the tumor to create your own personal vaccine through messenger, RNA, which is injected by infusion. And the cases that were presented, it’s typically eight infusions. And the results have been fairly astounding. Now it’s a small, early study and only 16 people were studied, but eight of those had a positive response. The first patient has actually lived six years beyond the diagnosis, which is astounding for pancreatic cancer. For two people, their tumors actually returned and they worsened, and the other six had no benefit. So it’s interesting to look at this, but we also have to bear in mind that the federal government has stopped all research on Messenger RNA, because the person in charge of Health and Human Services, Bobby Kennedy, he is against messenger, RNA, because it’s a vaccine. Even if it’s a vaccine to kill cancer, he’s against it. So the research being done is being privately funded. Our government has walked away from this, what has become one of the greatest hopes we have in the treatment of cancer, and it just, it makes me personally upset. Because these cancers have affected my family, as many of you who listen to this podcast. So we need to stay on this and really follow this along, and it’s just so hopeful. The next topic is one to revisit, and this is a recent article published in Lancet Obstetrics and Gynecology, where again, there has been misinformation out there regarding the use of acetaminophen, where they are out there saying that during pregnancy, if you use acetaminophen, it increases the risk for autism and other neurodevelopmental conditions. So again, this comes directly from the president of the United States, who says, don’t take acetaminophenm and again, our esteemed director of Health and Human Services, who is a non-physician, non-scientist, Robert F. Kennedy Jr. And I wanna stress the “Junior” because he’s far from his father. But with that, what we have is a situation where they looked at retrospective studies. And they look back at 43 studies, so talk about a waste of time, but here they are. They go back and do a meta-analysis of 43 studies. And once again, when they focused on these studies, they found that there is no evidence that acetaminophen in any way causes ADHD or causes children to be on the autism spectrum. So I’m hoping we could put this aside. The next topic I wanted to touch on was licensure, physician licensure, and what happens is, in the United States, we don’t have national licensure for physicians. Every other country in the world, when you get a license, you could practice anywhere in that country. But in the United States, you have to have an individual license for every state, and it’s pretty costly. Here in Connecticut, I believe it’s now $575 a year we pay for a license. So in every state you, you pay a fee commensurate with that; some states, I know it’s 600, but you have to reapply. And and the reason that this becomes a problem is because there’s a shortage of physicians in many rural areas. So a field of telemedicine has developed, especially for neurology and other specialties, where there aren’t enough people in these rural communities, they can be accessed by video and through telecommunication, something we talk about a lot on this program. So what has happened is that even to do telemedicine in another state, you need a license In that state. That wasn’t the case during COVID. That rule was waived, but now they’re back on it. And it’s really sad, from the standpoint that they are in any way inhibiting physicians who are duly licensed and have credentials that have been presented to a state, from practicing in other states. But here’s what’s happened. So there’s been a push for national licensing, and what they’ve come up with is the Interstate Medical Licensing Compact, and this is the IMLC. This was just approved in March, and it’s basically a system where you can apply with all your credentials, and those credentials can then be shared with other states so that you can more easily get a license in another state. The one thing these states did not give in on was paying those fees in that state. So again, we come up with the problem of greed versus care, and it’s something we talked about with Dr. Andy Agwunobi and the fact that if we’re going to revise our healthcare system in any way, shape, or form, we have to have everybody having their incentives aligned. So the idea of a state saying, “Wait a second. I might be able to get more physicians, give the people of my state more access, should be something I want to do,” without trying to make a few hundred bucks off of a doctor who may only be called on to see one patient or two patients a year in that area in your state. But you want access to those doctors. So again, it’s something we really need to rethink. Apropos to that, commissioner Andrea Barton Reeves and I had a conversation off-mic when she did the podcast with me a few months ago, and that was regarding retired physicians. Many physicians are retiring at a younger age. So when they retire, often they give up the license, they give up their medical license ’cause they don’t want to pay the $575 each year. But many also have the desire to volunteer their time. They’re willing to volunteer to just stay active in medicine without being reimbursed. It’s kind of like paying back the system that supported you all this time. But clearly if you’re going to go volunteer, it’s not worth paying five or $600 so you can volunteer. So I introduced to her the idea that the state of Connecticut may want to consider that if a physician is willing to volunteer in a qualified health facility. And the one we used as an example was the Homeless Hospitality Center in New London, where homeless patients who are discharged from the hospital can come and get some extended care until they’re able to go live independently. So I know of several physicians who would be willing to volunteer and give their time. But again, there’s this hurdle, actually there are two hurdles: One, getting a license, and two, med malpractice insurance. Now, fortunately, when you participate in a federally qualified health facility, you are indemnified by the federal government, so there isn’t a need for additional malpractice insurance, but I’m hoping Commissioner Barton Reeves does bring this to the governor and possibly something could be worked out so that physicians who retire and may want to spend some time volunteering and giving back can do so without the encumbrance of having to pay for a license in their state. Many thanks to all you listeners for getting ideas into us about topics that we’re going to be talking about in some of these future sort of podcasts that we use in between having guests. This has been a lot of fun for me ’cause it’s a chance to really update everybody on topics we have been discussing over the past several months. So if you have questions or ideas for future programs, you can reach out to me at [email protected]. Next week we’re going to resume having guests, and our guest is going to be Dr. Priya Narwal. Dr. Narwal is a neurologist, she’s the chief of the stroke service here at the University of Connecticut, and we’re going to be chatting with her in honor of stroke awareness. Many thanks to Jennifer Walker, who is the executive producer for the Healthy Rounds Podcast. Chris DeFrancesco is our studio producer here, and Tessa Rickart is in charge of social media for the Healthy Rounds Podcast. Until next time, this is Dr. Anthony Alessi. Please stay healthy.

It’s impossible to definitively measure how many lives were saved or prolonged, or how much illness or disease prevented or made less severe, as a direct result of public health initiatives. Douglas Brugge, chair of the UConn School of Medicine’s Department of Public Health Sciences, explains the “invisible” benefits of things like policies that regulate toxins in our water or pollution in our air, and discusses how COVID changed the perception of public health (and lessons learned from that). Submit questions for Healthy Rounds: [email protected] Douglas Brugge https://health.uconn.edu/public-health-sciences/person/doug-brugge/ UConn School of Medicine Department of Public Health Sciences https://health.uconn.edu/public-health-sciences/ UConn Health Orthopedics and Sports Medicine https://www.uconnhealth.org/orthopedics-sports-medicine UConn Health: https://www.uconnhealth.org Grant support from Coverys: www.coverys.com Transcript Dr. Alessi: Welcome to the Healthy Rounds Podcast, where we provide you with up-to-date, timely medical information from national and international leaders in their fields. This podcast is brought to you by UConn Health, with support from the Department of Orthopedic Surgery and a grant from Coverys. It is not designed to direct your personal health care, which should only be done by your physician. I’m your host, Dr. Anthony Alessi, and it gives me great pleasure to welcome as my guest today. Dr. Doug Brugge, who is professor and chair in the Department of Public Health Sciences here at the University of Connecticut. Doug, I really wanted to have you on the program today to talk a little bit about public health initiatives. You know, it’s been public health initiatives that have provided what are among the greatest contributions to humanity and medical sciences in general. When we think of sanitation, water purification, vaccines, these are all things that make people safe and healthy. And yet I don’t think a lot of people understand and appreciate that these are public health initiatives. Dr. Brugge: Yeah. Thank you for that. And I certainly agree with your introduction to public health. Public health is, I think frequently does not get the attention it deserves because the benefits are more invisible to people. If you have an illness, if you have a heart attack, or you have cancer and you go to a hospital, and you receive treatment, and you get good treatment and it makes you better, that is really tangible. You know that somebody has saved your life or improved your life. If you don’t get cancer or don’t have a heart attack because someone, as you said, regulated toxins in the drinking water, or in my field, the pollution in the air, it’s invisible. You just don’t know that it happens. And so, I think we in public health work in a bit of a obscurity and underrepresented the impact we have now. That said, we have a really nice department here at UConn Health. We’re a very, very vibrant and enthusiastic department within the medical school. We have over 30 faculty. We have over a hundred students in our graduate programs and we represent a very broad range of approaches to research and education, as well as topical foci, in terms of public health, including those you mentioned, but others, substance use, diet, and nutrition, many, many other things as well. And so, I’m proud of the department that I chair. I’m really privileged to sit here and be in this position. Dr. Alessi: Yeah. What’s interesting to me is actually your background and your background was in biology and chemistry. You got a PhD in biology and then went into industrial hygiene. Can you tell us about what pointed you in that direction personally, to go to industrial hygiene? Dr. Brugge: Yeah. From third grade onward, I wanted to be a biologist, basically. And in third grade I thought it was a naturalist, but I didn’t know the difference. But, and I pursued that all the way through college. And at some point in grad school, I began to realize that there were aspects of laboratory science that were not right for me. And the two main ones were one, that it was very far removed from real world impact. You’re doing basic science. Someday, somewhere down the road, someone might use it for good or even not for good. You don’t know. And I wanted to have a more direct impact on the world. The other thing was I found working in a laboratory socially isolating, and I preferred to interact with people. This department is great in that regard. There are all these wonderful people and I’m interacting with them all the time. But, so I had a choice to make. What was I going to do? And I did the degree, it’s a public health degree in industrial hygiene at Harvard School of Public Health in order to shift my emphasis over into public health and do something that was both science, and more directly impacting real world problems. And so that, so it solved a problem for me, and I wish sometimes that I had known about public health in third grade, but no one introduced it to me until much later in my life. So, you know, it’s worked out okay. Dr. Alessi: You mentioned before that, you know, people in public health are relatively anonymous and in the background, but that’s not the case anymore since COVID. Dr. Brugge: Right, yeah. Dr. Alessi: I mean, let’s face it. In the headlines today, right? Canada is going to lose their measles free designation, right? In 1998, they were a hotspot. In 2000, their cases were rare. COVID took away your veil of anonymity. Dr. Brugge: Yeah. Dr. Alessi: And now to the point where there are attacks, there are threats on public health professionals. Can you talk to us what it’s like from the public health side? I know what it’s like from the medical side looking at this, but from the public health side, is there fear? Do people not want to go into public health because of these changes? Dr. Brugge: Those are all very good questions, and probably the basis of several hours of conversation between us, Tony. Dr. Alessi: Absolutely. Dr. Brugge: But anyway, let me see if I can be brief. I agree with you that COVID was an inflection point for public health. Maybe before COVID we were somewhat obscure, but largely, more largely respected. Maybe people didn’t know how polluted the United States was in 1970. Maybe they didn’t appreciate how much public health measures led to clear skies and much better health. Again, to focus on my field of environmental health. But, they weren’t against it. They weren’t angry about it. They weren’t resisting it, I don’t think. COVID was a crisis, and it was a very intense national and global crisis. I remember the early months, it was very hard to tell what was happening, how great the risk was, and what to do. It was a very scary time in my opinion. I remember driving from Hartford to Boston, ’cause my wife and I have a place outside Boston, to hide away for the early month or two of COVID, and thinking how surreal it was that I was running away from this infection that was spreading wildly. So, I think one thing that gets lost in all of this, and some of it is exacerbated by the media and by politics, in my opinion. The media plays up the conflict. That’s what they want because it gets clicks and views. Dr. Alessi: Sure. Dr. Brugge: And politicians play up conflict and accusations in order to get elected and to pursue their agenda. And so, we have this really scary situation that’s exacerbated in the media and the political sphere. And I think it got really, instead of sort of a level-headed public health approach, it became something more than that. And I think public health image was tarnished in the process. Now, I think the biggest problem was the resistance to public health, the pushback, the politicization, the media exaggeration, and drama. But I also think the public health field fell short in communicating well in that context also. And, let me just speak for myself. I’m not speaking for anyone else. Dr. Alessi: Sure. Dr. Brugge: But, I do community-based participatory research where we bring the community in and we have them as partners in our research process. And what I think I’ve learned from that is that if you engage people, and you talk to them, and you respect where they’re coming from, and even if they disagree with you or they have misconceptions, you work with them over time, you can form a good relationship and mutual respect. And maybe it’s partly just things were happening at a national level and really fast, but I feel like public health failed to reach out and engage people who were scared, and then felt that they were being commanded to do things that they either didn’t understand or that they doubted were effective. And so I think that it’s the lesser of the evils, but I think public health could learn something from this experience and hopefully do better in the future if there, hopefully there isn’t another one of these, but if there is, I would hope we’d learn some lessons from the past experience. Dr. Alessi: You know, unfortunately, Doug, I think people don’t realize that as we’re kind of going through this process, people are dying. I mean, right now, I was reading where there are over a thousand state bills in this country addressing public health. Over 400 of them are designed to weaken our protections on vaccines. Right, fluoride, milk safety. Okay. Dr. Brugge: Yeah. Dr. Alessi: I mean, I think a lot of people are confusing ideology and science. And, how do we get past that? I know you’re talking about communication, but as we’re communicating and trying to reach out to these people, people are losing their lives. Dr. Brugge: You’re absolutely correct. And we should be pursuing evidence-based public health measures that are protective and that save lives or improve the quality of life, absolutely. I think where it becomes challenging is when the evidence is not fully convincing at a causal level. Now, in the COVID situation, it was almost impossible to come up with that because it was evolving and happening so fast. This is a question of science and evidence. It should be possible to discuss it. Dr. Alessi: Well, I think some of that comes from the sudden lack of scientists in the CDC in places such as that. And I think to have that health discussion, that’s where we get into politics, right? Dr. Brugge: Yeah. Well, maybe, and that is going to exacerbate it certainly. I feel like we in public health, we need to be more willing to engage with ideas that do not conform to our public health orthodoxy and to examine the evidence fairly and engage in discussion about these issues that are potentially politically and in the media controversial in a way that is transparent and informative rather than trying to shut them down. That’s my view. Dr. Alessi: Let me shift gears a little bit and give you a real world example that a pediatrician came to me with. And that was, had a student whose family did not want them to get the MMR vaccine or the second dose of the MMR vaccine. So, naturally, here in the state of Connecticut, they could not attend school. So, the family went and got a note. It was a stamped note from a doctor in Texas.  Dr. Brugge: Wow. Dr. Alessi: And, naturally, that was not accepted either. And so, the child was not able to attend preschool. And what was interesting, the pediatrician said, you know, I’ve been seeing more of this in certain ethnic communities where there’s more of a belief or whether it be rumor or whatever. How does that pediatrician get over that? Right? I mean, the parents are kind of locked in now because their neighbors, and members of their church, and members of their ethnic community are not, they’re all saying it’s bad for you, and yet, we’re going to have a problem. I mean, we’re having a problem now with taking measles. Dr. Brugge: Right. Dr. Alessi: So, how does a pediatrician, how does a doctor who’s listening to this podcast kind of get over that? How should they react or discuss this with a patient? Dr. Brugge: Yeah, so let’s be clear. MMR vaccination is not something that’s equivocal. The evidence is very strong. It’s something that children should all get, how to convince, and it’s a very, very unfortunate outcome of the COVID epidemic in again, in my opinion, that vaccine hesitancy and questioning of vaccines has spread to other vaccines beyond just specifically COVID. And I agree with you completely, that presents a substantial problem and an obstacle for us. I don’t know how, I’m not a clinician, so I don’t know how a pediatrician dealing with a specific family should approach this, but I would go back to my more public health roots, my approach to collaborating with communities and say that engaging, not necessarily on an in one-on-one basis, in a clinical setting, but in a broader community way, engaging the community in a mutually respectful conversation, in which they can ask questions, they can express their views, and we who have our knowledge and evidence can express ours. And people in public health who are behavioral experts, who are social scientists, can take what they’re hearing and think about how to address the concerns and fears and doubts that are out there. I think it’s more of a societal population approach than it is probably one-on-one because the one-on-one conversation, even if that pediatrician succeeds, it’s just one person. There’s still the rest of the community. So, that would be my thought. Now, vaccine hesitancy is not my area of expertise. Dr. Alessi: Sure. Dr. Brugge: So I haven’t tried to convince people, but I tend to fall back on sort of the public health community roots of my perspective. Dr. Alessi: Let me ask you another question. You know, you’re a department chairman, Doug, so you should be able to predict the future, right? That’s what you guys do, right? Dr. Brugge: Right. I didn’t see the current financial crisis coming, Tony. But anyway, go ahead. Dr. Alessi: Well, I mean, are we going to get confidence back? How’s that going to look? I mean, how does that look in the future in terms of when do you see that? How do you see that developing? Dr. Brugge: Yeah, my success in predicting the future has been almost zero, but let me give it a try anyway. I think we will get confidence back. I think that these things go through cycles for one thing. I also think there is a whole new generation of public health professionals. We’re training some of them and they’re going out into the world there. There are some people who are hesitant to go into public health right now. I think we’ll get past that, and I think public health is resilient. I hope, as I said earlier, I hope we make some corrections and improve our ability to relate to and communicate with the public, especially parts of the public that are not immediately in agreement with us. But I think we’ll get there. And I also, you know, working with community partners has given me a deep respect and faith in regular people. And I feel like most people, most of the time, if you approach them and talk on a, you’re not through the media, not through political politics, but you’re just having a conversation with them, they’re very reasonable, they’re very open-minded. They’ll listen to you. You can learn from them, they can learn from you. And I think we need a lot more of that, frankly. Dr. Alessi: Well, let’s hope this podcast helps us in that respect and we’ve reached some people with this and with the benefit of your knowledge. Doug, listen, thank you. Thank you for spending time with us today. I really appreciate you taking time for this. Dr. Brugge: It was a pleasure and I enjoyed the conversation, Tony. Thank you. Dr. Alessi: We’re going to be doing it again soon ’cause we didn’t even get into environmental stuff, which is your strong point. Dr. Brugge: I could talk to you for hours about that too. Dr. Alessi: Sounds good. Many thanks to my guest today, Dr. Doug Brugge, who is chair of the Department of Public Health Sciences here at the University of Connecticut. If you have questions or ideas for future programs, you could reach out to me at [email protected]. Jennifer Walker is executive producer of the Healthy Rounds podcast. Chris DeFrancesco is the studio producer for the Healthy Rounds podcast. Until next time, this is Dr. Anthony Alessi. Please stay healthy. Dr. Alessi: Welcome to the Healthy Rounds Podcast, where we provide you with up-to-date, timely medical information from national and international leaders in their fields. This podcast is brought to you by UConn Health, with support from the Department of Orthopedic Surgery and a grant from Coverys. It is not designed to direct your personal health care, which should only be done by your physician. I’m your host, Dr. Anthony Alessi, and it gives me great pleasure to welcome as my guest today. Dr. Doug Brugge, who is professor and chair in the Department of Public Health Sciences here at the University of Connecticut. Doug, I really wanted to have you on the program today to talk a little bit about public health initiatives. You know, it’s been public health initiatives that have provided what are among the greatest contributions to humanity and medical sciences in general. When we think of sanitation, water purification, vaccines, these are all things that make people safe and healthy. And yet I don’t think a lot of people understand and appreciate that these are public health initiatives. Dr. Brugge: Yeah. Thank you for that. And I certainly agree with your introduction to public health. Public health is, I think frequently does not get the attention it deserves because the benefits are more invisible to people. If you have an illness, if you have a heart attack, or you have cancer and you go to a hospital, and you receive treatment, and you get good treatment and it makes you better, that is really tangible. You know that somebody has saved your life or improved your life. If you don’t get cancer or don’t have a heart attack because someone, as you said, regulated toxins in the drinking water, or in my field, the pollution in the air, it’s invisible. You just don’t know that it happens. And so, I think we in public health work in a bit of a obscurity and underrepresented the impact we have now. That said, we have a really nice department here at UConn Health. We’re a very, very vibrant and enthusiastic department within the medical school. We have over 30 faculty. We have over a hundred students in our graduate programs and we represent a very broad range of approaches to research and education, as well as topical foci, in terms of public health, including those you mentioned, but others, substance use, diet, and nutrition, many, many other things as well. And so, I’m proud of the department that I chair. I’m really privileged to sit here and be in this position. Dr. Alessi: Yeah. What’s interesting to me is actually your background and your background was in biology and chemistry. You got a PhD in biology and then went into industrial hygiene. Can you tell us about what pointed you in that direction personally, to go to industrial hygiene? Dr. Brugge: Yeah. From third grade onward, I wanted to be a biologist, basically. And in third grade I thought it was a naturalist, but I didn’t know the difference. But, and I pursued that all the way through college. And at some point in grad school, I began to realize that there were aspects of laboratory science that were not right for me. And the two main ones were one, that it was very far removed from real world impact. You’re doing basic science. Someday, somewhere down the road, someone might use it for good or even not for good. You don’t know. And I wanted to have a more direct impact on the world. The other thing was I found working in a laboratory socially isolating, and I preferred to interact with people. This department is great in that regard. There are all these wonderful people and I’m interacting with them all the time. But, so I had a choice to make. What was I going to do? And I did the degree, it’s a public health degree in industrial hygiene at Harvard School of Public Health in order to shift my emphasis over into public health and do something that was both science, and more directly impacting real world problems. And so that, so it solved a problem for me, and I wish sometimes that I had known about public health in third grade, but no one introduced it to me until much later in my life. So, you know, it’s worked out okay. Dr. Alessi: You mentioned before that, you know, people in public health are relatively anonymous and in the background, but that’s not the case anymore since COVID. Dr. Brugge: Right, yeah. Dr. Alessi: I mean, let’s face it. In the headlines today, right? Canada is going to lose their measles free designation, right? In 1998, they were a hotspot. In 2000, their cases were rare. COVID took away your veil of anonymity. Dr. Brugge: Yeah. Dr. Alessi: And now to the point where there are attacks, there are threats on public health professionals. Can you talk to us what it’s like from the public health side? I know what it’s like from the medical side looking at this, but from the public health side, is there fear? Do people not want to go into public health because of these changes? Dr. Brugge: Those are all very good questions, and probably the basis of several hours of conversation between us, Tony. Dr. Alessi: Absolutely. Dr. Brugge: But anyway, let me see if I can be brief. I agree with you that COVID was an inflection point for public health. Maybe before COVID we were somewhat obscure, but largely, more largely respected. Maybe people didn’t know how polluted the United States was in 1970. Maybe they didn’t appreciate how much public health measures led to clear skies and much better health. Again, to focus on my field of environmental health. But, they weren’t against it. They weren’t angry about it. They weren’t resisting it, I don’t think. COVID was a crisis, and it was a very intense national and global crisis. I remember the early months, it was very hard to tell what was happening, how great the risk was, and what to do. It was a very scary time in my opinion. I remember driving from Hartford to Boston, ’cause my wife and I have a place outside Boston, to hide away for the early month or two of COVID, and thinking how surreal it was that I was running away from this infection that was spreading wildly. So, I think one thing that gets lost in all of this, and some of it is exacerbated by the media and by politics, in my opinion. The media plays up the conflict. That’s what they want because it gets clicks and views. Dr. Alessi: Sure. Dr. Brugge: And politicians play up conflict and accusations in order to get elected and to pursue their agenda. And so, we have this really scary situation that’s exacerbated in the media and the political sphere. And I think it got really, instead of sort of a level-headed public health approach, it became something more than that. And I think public health image was tarnished in the process. Now, I think the biggest problem was the resistance to public health, the pushback, the politicization, the media exaggeration, and drama. But I also think the public health field fell short in communicating well in that context also. And, let me just speak for myself. I’m not speaking for anyone else. Dr. Alessi: Sure. Dr. Brugge: But, I do community-based participatory research where we bring the community in and we have them as partners in our research process. And what I think I’ve learned from that is that if you engage people, and you talk to them, and you respect where they’re coming from, and even if they disagree with you or they have misconceptions, you work with them over time, you can form a good relationship and mutual respect. And maybe it’s partly just things were happening at a national level and really fast, but I feel like public health failed to reach out and engage people who were scared, and then felt that they were being commanded to do things that they either didn’t understand or that they doubted were effective. And so I think that it’s the lesser of the evils, but I think public health could learn something from this experience and hopefully do better in the future if there, hopefully there isn’t another one of these, but if there is, I would hope we’d learn some lessons from the past experience. Dr. Alessi: You know, unfortunately, Doug, I think people don’t realize that as we’re kind of going through this process, people are dying. I mean, right now, I was reading where there are over a thousand state bills in this country addressing public health. Over 400 of them are designed to weaken our protections on vaccines. Right, fluoride, milk safety. Okay. Dr. Brugge: Yeah. Dr. Alessi: I mean, I think a lot of people are confusing ideology and science. And, how do we get past that? I know you’re talking about communication, but as we’re communicating and trying to reach out to these people, people are losing their lives. Dr. Brugge: You’re absolutely correct. And we should be pursuing evidence-based public health measures that are protective and that save lives or improve the quality of life, absolutely. I think where it becomes challenging is when the evidence is not fully convincing at a causal level. Now, in the COVID situation, it was almost impossible to come up with that because it was evolving and happening so fast. This is a question of science and evidence. It should be possible to discuss it. Dr. Alessi: Well, I think some of that comes from the sudden lack of scientists in the CDC in places such as that. And I think to have that health discussion, that’s where we get into politics, right? Dr. Brugge: Yeah. Well, maybe, and that is going to exacerbate it certainly. I feel like we in public health, we need to be more willing to engage with ideas that do not conform to our public health orthodoxy and to examine the evidence fairly and engage in discussion about these issues that are potentially politically and in the media controversial in a way that is transparent and informative rather than trying to shut them down. That’s my view. Dr. Alessi: Let me shift gears a little bit and give you a real world example that a pediatrician came to me with. And that was, had a student whose family did not want them to get the MMR vaccine or the second dose of the MMR vaccine. So, naturally, here in the state of Connecticut, they could not attend school. So, the family went and got a note. It was a stamped note from a doctor in Texas.  Dr. Brugge: Wow. Dr. Alessi: And, naturally, that was not accepted either. And so, the child was not able to attend preschool. And what was interesting, the pediatrician said, you know, I’ve been seeing more of this in certain ethnic communities where there’s more of a belief or whether it be rumor or whatever. How does that pediatrician get over that? Right? I mean, the parents are kind of locked in now because their neighbors, and members of their church, and members of their ethnic community are not, they’re all saying it’s bad for you, and yet, we’re going to have a problem. I mean, we’re having a problem now with taking measles. Dr. Brugge: Right. Dr. Alessi: So, how does a pediatrician, how does a doctor who’s listening to this podcast kind of get over that? How should they react or discuss this with a patient? Dr. Brugge: Yeah, so let’s be clear. MMR vaccination is not something that’s equivocal. The evidence is very strong. It’s something that children should all get, how to convince, and it’s a very, very unfortunate outcome of the COVID epidemic in again, in my opinion, that vaccine hesitancy and questioning of vaccines has spread to other vaccines beyond just specifically COVID. And I agree with you completely, that presents a substantial problem and an obstacle for us. I don’t know how, I’m not a clinician, so I don’t know how a pediatrician dealing with a specific family should approach this, but I would go back to my more public health roots, my approach to collaborating with communities and say that engaging, not necessarily on an in one-on-one basis, in a clinical setting, but in a broader community way, engaging the community in a mutually respectful conversation, in which they can ask questions, they can express their views, and we who have our knowledge and evidence can express ours. And people in public health who are behavioral experts, who are social scientists, can take what they’re hearing and think about how to address the concerns and fears and doubts that are out there. I think it’s more of a societal population approach than it is probably one-on-one because the one-on-one conversation, even if that pediatrician succeeds, it’s just one person. There’s still the rest of the community. So, that would be my thought. Now, vaccine hesitancy is not my area of expertise. Dr. Alessi: Sure. Dr. Brugge: So I haven’t tried to convince people, but I tend to fall back on sort of the public health community roots of my perspective. Dr. Alessi: Let me ask you another question. You know, you’re a department chairman, Doug, so you should be able to predict the future, right? That’s what you guys do, right? Dr. Brugge: Right. I didn’t see the current financial crisis coming, Tony. But anyway, go ahead. Dr. Alessi: Well, I mean, are we going to get confidence back? How’s that going to look? I mean, how does that look in the future in terms of when do you see that? How do you see that developing? Dr. Brugge: Yeah, my success in predicting the future has been almost zero, but let me give it a try anyway. I think we will get confidence back. I think that these things go through cycles for one thing. I also think there is a whole new generation of public health professionals. We’re training some of them and they’re going out into the world there. There are some people who are hesitant to go into public health right now. I think we’ll get past that, and I think public health is resilient. I hope, as I said earlier, I hope we make some corrections and improve our ability to relate to and communicate with the public, especially parts of the public that are not immediately in agreement with us. But I think we’ll get there. And I also, you know, working with community partners has given me a deep respect and faith in regular people. And I feel like most people, most of the time, if you approach them and talk on a, you’re not through the media, not through political politics, but you’re just having a conversation with them, they’re very reasonable, they’re very open-minded. They’ll listen to you. You can learn from them, they can learn from you. And I think we need a lot more of that, frankly. Dr. Alessi: Well, let’s hope this podcast helps us in that respect and we’ve reached some people with this and with the benefit of your knowledge. Doug, listen, thank you. Thank you for spending time with us today. I really appreciate you taking time for this. Dr. Brugge: It was a pleasure and I enjoyed the conversation, Tony. Thank you. Dr. Alessi: We’re going to be doing it again soon ’cause we didn’t even get into environmental stuff, which is your strong point. Dr. Brugge: I could talk to you for hours about that too. Dr. Alessi: Sounds good. Many thanks to my guest today, Dr. Doug Brugge, who is chair of the Department of Public Health Sciences here at the University of Connecticut. If you have questions or ideas for future programs, you could reach out to me at [email protected]. Jennifer Walker is executive producer of the Healthy Rounds podcast. Chris DeFrancesco is the studio producer for the Healthy Rounds podcast. Until next time, this is Dr. Anthony Alessi. Please stay healthy.

This week we revisit the conversation with Dr. Scott Allen, UConn Health’s chief medical officer. Dr. Alessi digs deeper into what we mean by the terms “quality” and “patient safety,” exploring the patient experience as well as how to measure quality and how the increasing complexity of medicine makes safety such a priority. He also differentiates between internists and family medicine practitioners. Submit questions for Healthy Rounds: [email protected] Dr. Scott Allen: https://facultydirectory.uchc.edu/profile?profileId=Allen-Scott  UConn Today: Make It 10 Straight A’s for UConn Health’s Hospital Safety https://today.uconn.edu/2025/11/make-it-10-straight-as-for-uconn-healths-hospital-safety/  UConn Health Orthopedics and Sports Medicine https://www.uconnhealth.org/orthopedics-sports-medicine UConn Health: https://www.uconnhealth.org Grant support from Coverys: www.coverys.com Transcript Dr. Alessi: Welcome to the Healthy Rounds Podcast, where we provide you with up-to-date, timely medical information from national and international leaders in their fields. This podcast is brought to you by UConn Health, with support from the Department of Orthopaedic Surgery and a grant from Coverys. It is not designed to direct your personal health care, which should only be done by your physician. I’m your host, Dr. Anthony Alessi, and it’s great to be with you to really dig deep into some of the topics we discussed last week with Dr. Scott Allen. As you’ll recall, Dr. Allen is the chief medical officer here at UConn Health. He is an internist and specializes in primary care internal medicine, and was he went over his personal history, we can see that he’s always had a passion for improving the quality of medical care, and it has really evolved as, that’s almost as a subspecialty of medicine has evolved. But what was also interesting, and I wanted to clear up some things, is that he is a specialist in primary care internal medicine, and that differs from primary care family physicians. There’s different training involved. So family physicians are primarily people who do general medical care, but includes things like obstetrics and gynecology, different subspecialties may be doing some minor surgeries and other areas, so it’s a more broad field and it’s truly family medicine because they also treat children, so they treat the entire family. And it came about really in people in rural communities as well as now we see more and more this has developed to folks in bigger cities as well, where it’s hard to get access to care. So there’s a difference between primary care family medicine and primary care internal medicine, whereas internists treat adults only, and also a broad range of treatments for those adults. And among the things he talked about and that I really got out of this was the approach to quality of care and patient safety. These are things that I wasn’t familiar with in terms of how they relate to the patient. And as you’ll recall, he talked about the first of the three phases being the patient experience, followed by the quality of care and followed by safety. As he explained it, for patients who come to receive medical care, they want to be treated well; they want high quality care, so they want to get better; and more importantly, they don’t want to be hurt. So let’s talk about the patient experience itself. That’s a lot to do with actual having contact with the patient, that initial contact. And there are a lot of things that I’ve learned over the years that help that contact. So even today when I see a patient, I’m asking things like, “Who sent you here?” “What do you like to do?” try to make things conversational. At the same time. I’m trying to identify the patient, speaking to the checklist that we talked about with Dr. Allen. Things like what side is being affected, right versus left, instead of asking again for their date of birth. Now people ask the date of birth a lot ‘cause that’s a big identifier, but I’ll ask the patient’s age. I’ll try to make this part of a conversation. But by the same token, I’m trying to improve their experience as well as identify the proper patient and why we’re there. One other trick I learned, and it’s not really a trick, it’s actually something that speaks quite well to being in contact with patients, is when I would make rounds with patients and go into their room, often you have all these doctors standing around the bedside, right? So when, when I was the attending, I would primarily be the lead physician. I’ll have residents with me in the whole group. I always made a point of sitting down, whether the patient was in a chair or in bed. I wanted to sit down somewhere so that it wasn’t always this feeling of I’m looking down at them. It also gives the impression that I’m spending more time. I spent enough time to sit down and ask my questions rather than having it seem like I’m on the run, getting ready to get out of this room and get going. So there are those things that affect the patient experience. When it comes to quality of care, there are a lot of different measures, right? We measure outcomes, frequency of infection rate, how often does a patient have to be readmitted after being discharged from the hospital? So those are the quality issues, but safety is another issue. And we talked somewhat about why is safety more of a problem now than it was in the past. And I think from my standpoint, it’s clear that medicine has become much more complex. It’s really like the difference between flying a small aircraft and flying some huge jet liner. So there are a lot of things that can go wrong and it’s important to stay on top of those. And that’s where we got into the checklist and that’s why I used the flight analogy, because you always have these checklists. Now obviously when you’re on a huge jet, the checklist becomes much longer. As opposed to flying a small two-seater plane, and I think that’s what has happened now in terms of the evolution of medicine and its complexity with regard to computers and so many other things that are going on with the patient at the time care is being delivered. One of the things I wanted to mention, we have a grant to do these podcasts from a company called Coverys.  Coverys is an insurance company that provides medical malpractice insurance to physicians, and they’ve been my insurer for many years. What’s interesting is that, you think that, well, it’s insurance, they get the lawyer, and now you go through a process. But at Coverys, they spend a lot of time trying to improve quality by continuing medical education and requiring that continued medical education of the physicians, physician assistants, nurse practitioners who are all their insureds. And some of the courses they take are so important and I’ve learned a great deal from them over the years. So we really appreciate having them on board to support this podcast as we move forward. With that, I want to thank again Dr. Allen for his time that he spent with us. It was really enlightening overall. Next week we’re going to be chatting with Dr. Douglas Brugge. Dr. Brugge professor and chair of the Department of Public Health Sciences here at the University of Connecticut, and we spent a lot of time talking about public health initiatives and the effects that these folks out there who are against science have now really impacted public health, and it’s something we all need to be mindful of. If you have any questions or ideas for future programs, you can reach out to me at Healthy [email protected]. Jennifer Walker is the executive producer for Healthy Rounds. Chris DeFrancesco is our studio producer for the Healthy Rounds Podcast, and Tessa Rickert is in charge of our social media. Until next time, this is Dr. Anthony Alessi. Please stay healthy.

We hear a lot in health care about patient safety and quality. While those terms would seem like a given, when it comes to patient care, they in fact are very strategic and measured. As Dr. Scott Allen, UConn Health’s chief medical officer, explains, much has to do with acknowledging the possibility of human error and how to mitigate its impacts, with practices such as daily safety huddles, checklists, empowerment to “stop the line,” and even use of artificial intelligence that can lead to an earlier diagnosis or assist with documentation in real time and enable physicians to focus more on the patient. It’s part of why UConn John Dempsey Hospital is in the running for an 11th consecutive “A” grade from Leapfrog for patient safety. Submit questions for Healthy Rounds: [email protected] Dr. Scott Allen: https://facultydirectory.uchc.edu/profile?profileId=Allen-Scott  UConn Today: Make It 10 Straight A’s for UConn Health’s Hospital Safety https://today.uconn.edu/2025/11/make-it-10-straight-as-for-uconn-healths-hospital-safety/  UConn Health Orthopedics and Sports Medicine https://www.uconnhealth.org/orthopedics-sports-medicine UConn Health: https://www.uconnhealth.org Grant support from Coverys: www.coverys.com Transcript Dr. Alessi: Welcome to the Healthy Rounds Podcast, where we provide you with up to date and timely information that’s brought to you by national and international leaders in their fields. This podcast is brought to you by UConn Health, with support from the Department of Orthopedic Surgery, in addition to a grant from Coverys. This podcast is not designed to direct your own personal medical care, and that should only be done by your physician. I’m your host, Dr. Anthony Alessi, and it gives me great pleasure to have as my guest today, Dr. Scott Allen. Dr. Allen is the Chief Medical Officer for the University of Connecticut here at UConn Health. He’s also a specialist in internal medicine and specifically in primary care internal medicine. Scott, welcome to the show. Dr. Allen: Thank you for having me. Dr. Alessi: Scott, can you tell our listeners a little bit about your background and how you got here? Dr. Allen: I’m a general internist by training. I actually trained at the University of Massachusetts Medical Center, came down here in 1994, mainly as a medical educator, also functioning as a primary care physician. And over time, I took on responsibilities within residency programs, became a residency program director for eight years, and then really had the opportunity about 15 years ago to kind of morph into the quality world. Became a medical director for our quality department when it was first initiated, and then became the first chief quality officer, now as first chief medical officer. Dr. Alessi: Now, we hear a lot of these terms as physicians here in practice. We hear about quality, we hear about risk management, we hear about patient safety. Can you address those terms and what they all mean to us? Especially patient safety. I find that to be an odd term, right? Because it gives the impression - do you mean it’s not safe? So, can you talk a little bit about those programs and those terms and what they mean to the public as well as physicians? Dr. Allen: So, when patients come to see a physician or a practitioner or come to the hospital, they really are looking for three things. First, “be nice to me”, which really is the patient experience piece of health care. Dr. Alessi: Sure. Dr. Allen:, The second is “heal me”. Maintain my health or restore my health. And that’s really the quality component of health care. And then the last is, “don’t harm me in that process”. So that’s really sort of the patient’s safety. So, all three are really connected to one another. So, the safety piece is really keeping people from harm. And so designing systems of care to allow that. Health care is a very complicated world. It’s high risk. And so, as humans, we’re always subject to making human mistakes, errors. And so, part of our job is to create systems that reduce making those human errors. Dr. Alessi: Very interesting because back about 26 years ago, as I went back and got a master’s degree in medical management, and one of the things that struck me was much of what we were studying were industrial engineering principles, and back then it was all about Toyota and their industrial engineering and how we could take that and apply it to medicine. And it was funny ’cause my father was an industrial engineer. And I never had any idea what he did until I went back to school. Can you talk a little bit about that movement of taking industrial engineering principles and how they kind of cover medical care? Dr. Allen: So, the Toyota model was the ability to quote unquote, “stop the line.” So, anybody on the production line could basically, in essence, push a button and stop production any time they had a concern. And that empowered those individuals to be invested in the quality and, if you will, the safety of their product. Carry forward to health care. We now empower everybody to be able to voice their concern. So, if you have a concern about somebody’s safety or quality, you should be able to quote unquote, “stop the line” and be able to say, “I have a concern.” People stop, listen and address those concerns. So, what we’ve learned from Toyota is that empowerment piece to allow people to raise their voices of concern. Dr. Alessi: Now, that works pretty well, I guess, in the operating room, right? Because now it’s pretty standard. We take a timeout and make sure everybody knows what we’re doing. But how does that work in clinic? I mean, how do you take that and apply it to something that’s so scattered? Is that what the huddle is for and things like that? Can you explain that to me? Dr. Allen: So, the timeout for those that are listening is when you go in the operating room, there’s a formal checklist that we will go down. You know, we’re doing the right procedure, the right side of the body, if you will. All those things, all the equipment is ready. And that’s the checklist. And that’s just making sure that we are in fact prepared to do what we’re supposed to be doing. And so, what we’ve learned from, in this case, the airline industry, when the pilot goes into the cockpit, every single time they go down the checklist. Whether they just flew the plane and they knew it was flying safely, they’re going to go through the checklist. And so, it’s the same mentality now in health care. We go down those checklists because we have to make sure everything is correct, every single time. So, no matter what’s really going on, you actually go through that checklist. That’s in sort of an OR, very sort of structured environment. In a clinic where it’s unstructured, it’s one of those sort of behaviors, safety behaviors that we promote called attention to detail. And it’s really stopping and taking that sort of mini mental timeout. So if I’m in the medical record and I can actually have four charts open, four different patients, and I’m going to put an order in, I have to sort of take that mini mental timeout to say, “am I in the right patient’s chart?” before I hit that send button. So, teaching people to take that, what we call STAR moment: stop, think, act, review. Mini mental timeout, and so that we’re not rushing. We’re all very busy in medicine, but it’s when we rush is when we create those errors. Dr. Alessi: Is that the biggest fault? I mean, is it the rushing, like we’re trying like in the OR was it always “let’s rush ’cause we gotta turn over the room” and things such as that? Is that what we’ve found to be the biggest harm? Dr. Allen: Rushing certainly contributes. And that’s why we actually promote not doing the rushing and actually taking the timeout so that again, we’re prepared every single time that we go in. And so, we do have to sort of take that sort of momentary stop, that pause if you will, so that we are not rushing, and we’re keeping patients safe. Dr. Alessi: Have we applied checklists? I mean, we talked a little bit before this interview about The Checklist Manifesto and Atul Gawande’s efforts in that regard. Do we use checklists in other areas of medicine other than the OR now? Dr. Allen: So anytime patients, let’s say, get admitted to the hospital, there will be checklists that nurses go through in terms of their initial assessment. You do a history and a physical on the part of the practitioners, there are certain elements of that template, if you will. So, there’s a lot of elements of those checklists. We build templates into our electronic medical records so that we don’t forget to add a certain element, if you will. There are questionnaires that have, again, a checklist of items. You go in to have an MRI, that MRI tech is going to ask you a series of questions, probably 15 to 20, and they’re going to go through that checklist every single time to make sure that in this case, you don’t have, let’s say, a ferro metallic object that could be a risk for you when you go into the MRI. Dr. Alessi: How about, let’s talk a little bit about, and you know, now that I’m removed and only in the clinic, I remember we used to have morning huddles, right? Is that still a practice? Dr. Allen: Absolutely. Dr. Alessi: Yeah, can you explain that to our listeners what the morning huddle is? Dr. Allen: Yep. So, we have actually two huddles in the hospital. The first one, we do every morning at 8:30, and it’s about 100, 120 actual middle level, middle management, if you will, folks that are joining that, including senior leadership from the hospital. And we go through the previous 24 hours, all the new safety events that were submitted within our electronic system. A brief review. We will spend time if we feel that there’s a critical need to, to understand why that happened, initiate some plans, if you will, to mitigate those things from happening again, or deciding when we need to do a deeper dive in terms of an analysis. All those events are reviewed, and then we also then follow up on previous events to make sure that those corrective action plans were in fact completed. And we go through every single clinical area in the hospital, all our ancillaries, lab radiology, facilities. All those different aspects of care. Every part of the hospital is actually on our safety huddle. Nursing has its own separate huddle after that, which includes all of our nursing units. They go through more sort of the throughput issues. Dr. Alessi: Sure. Dr. Allen: And our outpatient clinics also have huddles, again, at the sort of middle management level. Dr. Alessi: What’s the biggest challenge you think, in terms of your job, in terms of quality and safety? What do you find the hardest -  what keeps you up at night? How’s that? Dr. Allen: The hardest thing is establishing really a culture of safety. I think we’ve made great strides. Establishing a culture starts really with leadership. Dr. Alessi: Yep. Dr. Allen: And we have great leadership even at our board of directors, which then carries down through Dr. Agwunobi, our CEO and hospital leaders to establish the accountability. The expectation is high quality and high, you know, safety. So, starts with leadership, and then it’s that culture of reporting. We want people to report safety events. We want them to be able to speak their concerns, if you will. So, establishing reporting, so having an electronic system that makes it easy to report, you can report anonymously or you can have your name attached to it. And then the last piece really from a culture perspective is what we call fair and just culture. And that’s sort of the middle ground between patient safety and sort of the safety culture. So, we do have accountability in health care, you have to be accountable for all of your actions. So, if you have somebody that is willfully not following policy and procedure, then they should be held accountable and appropriately disciplined. But as we’ve said before, patient safety is also about human error. And if people create a mistake, they have a human error - they shouldn’t be disciplined for that, they should actually be more consoled. So, establishing this culture where people feel, what we call psychologically safe, to be able to report safety events and not be disciplined for those if it was truly just a human error. So that’s what we continue to work on, is establishing this fair and just culture. Dr. Alessi: You know, one of the other terms I guess we mentioned is risk management and Coverys gave us a grant to sponsor this program, and as a medical malpractice carrier, they are very forthright in requiring their insureds to do courses and things for risk management. Is that the same here in terms of, does this all come under the umbrella of risk management? Dr. Allen: So, quality and safety, interdigitates with risk management. It interdigitates with regulatory. We all work very closely together. So, if we have a patient safety event, somebody was harmed. Risk will be involved. Is this going to be a malpractice issue or not? But if it’s a patient safety event, we think it was preventable, we want to be actually upfront and transparent. Days of old, we would sort of circle the wagons. We wouldn’t say anything we would sort of defend, right. Now it’s be transparent, be open. Those lines of communication, that trust, if you will, that you build with your patients, really goes a long way in terms of preventing malpractice and litigation. So, we have a model here called candor and that that’s basically C-A-N-D-O-R. Communication and optimal resolution. Be upfront, be transparent, and that actually helps resolve things on the back end. Dr. Alessi: Scott, what do you think has been the biggest success? I mean, you’ve been doing, you’ve been at this for 15 years. What do you think the biggest success has been in terms of managing patient safety and quality? Dr. Allen: One of the things that people will look at are external scorecards. Things like the Leapfrog Hospital Safety Grade. Dr. Alessi: Sure. Dr. Allen: We’re pretty proud that, you know, we have a letter grade A for 10 times in a row, and that’s one of the longest running in the state of Connecticut. So, you can look at those external scorecards, you can look at other awards like Health Grades being in the top 15% in the nation for patient experience. So, as I’ve said before, patient experience is one aspect of quality. You have quality and sort of the outcomes of care and then patient safety, and they all kind of interdigitate. So, I look at the Leapfrog Hospital Safety Grade as just one marker of that success. I think establishing high reliability training is really a marker of success. So, we train everybody, and this was initially through a collaborative with the Connecticut Hospital Association back in about 2011, where we train every staff member in techniques of high reliability. And that really then carries forward to preventing errors. And so, training everybody, establishing that safety culture really is what I look at in terms of whether we’re successful or not. And yes, we’ve been very successful in improving our safety culture, but it’s one of those things that it’s a never ending journey. Dr. Alessi: My next question, I guess, is it working? And I don’t mean this to be facetious, but if we look back 50 years ago, right? Do we have these programs now because it’s become so complex? Because there are so many other avenues for error as opposed to the way medicine was practiced before? Dr. Allen: Yes, health care, I think, has become more complex. Dr. Alessi: Right. Dr. Allen: Especially with the electronic medical record, the need to document because of all the regulatory requirements. And so, we spend a lot more time documenting and sort of checking the boxes now. But I think yes, health care has become more complicated. There’s more sophisticated techniques, tools, people are living longer, so their, if you will, their comorbidities are more complex. So, when people come into the hospital, they are technically sicker than they were in the past. Dr. Alessi: Thus the risk? Dr. Allen: Hence the risk. Dr. Alessi: Okay. Very important. Well, tell us about the future. Take out your crystal ball for me. What do future programs look like in quality and safety? Dr. Allen: Well, obviously the buzz term is “artificial intelligence”, and so we are using artificial intelligence now. And then I’ll give you a couple of examples and maybe this will speak to patient safety. So, in our ambulatory clinics, you can just pull out your cell phone and turn it on and it will record the entire encounter. We’ll actually create the encounter note for you. It’s designed to be able to recognize who the patient is, who the physician is, and so that allows more time for the physician or the practitioner to spend time with the patient as opposed to spending time on the computer, typing in notes, if you will. So, the focus is in now, on the patient interaction as opposed to the documentation. So it allows the physician or practitioner, again, to spend more time focused on what’s important to the patient. Patient experience improves. Again, the focus on health care improves. Second example is, we use artificial intelligence in radiology. So, we have the ability to pull out all of the reports that have what are called pulmonary nodules, so things that are growing, if you will, in the lungs and shouldn’t be there, and all those reports then get pulled into a database. And the specific software associated with this AI then can actually look at each individual chest x-ray or CAT scan and grade the likelihood of malignancy of that nodule. What does that do? It actually catches lung cancer earlier. So, if we need to, because of the higher risk, get somebody in for a lung biopsy sooner than somebody who’s low risk, let’s repeat a CAT scan in three or six months, the artificial intelligence is helping us actually catch lung cancers earlier. Dr. Alessi: Wow. I find that fascinating. I guess one other question is, are patients generally receptive when a doctor goes in the room and explains they’re using the DAC system or the AI system as we know it, are patients generally receptive? Dr. Allen: They are, I think they’re also in tune to AI and what’s coming down the road. Everybody knows what cell phones are, so it’s sort of a comfortable environment for them. It’s on the cloud, it’s not something that’s kept in the computer. So, in terms of the risk of a HIPAA breach seems pretty darn low in that sense. So, I think patients are quite comfortable with it. Dr. Alessi: Scott, thank you. Thank you for your time today and especially thank you for all you do for keeping quality at the highest here at the University of Connecticut. Thanks again for your time. Dr. Allen: Thank you for having me. Dr. Alessi: Many thanks to our guest today, Dr. Scott Allen. If you have questions or ideas for future programs, you could reach out to me at [email protected]. Jennifer Walker is executive producer for the Healthy Rounds podcast. Chris DeFrancesco is our studio producer here at the Healthy Rounds Podcast, and Tessa Rickart is in charge of social media for our podcast. Until next time, this is Dr. Anthony Alessi. Please stay healthy.

Dr. Alessi goes more in-depth on the topic of dementia in follow-up to his earlier conversation with Dr. Kristina Zdanys, geriatric psychiatrist at UConn Health and co-director of the James E. C. Walker Memory Assessment Program in the UConn Center on Aging. He takes a closer look at the multifaceted nature of an effective memory assessment program, the role of imaging and monoclonal antibodies in slowing dementia’s progression, reducing dementia risk with lifestyle choices such as the “MIND diet,” misleading medication marketing, and the challenges of decisions around continuing to drive. Submit questions for Healthy Rounds: [email protected] March 24, 2026, Episode: “Dealing With Dementia” with Dr. Kristina Zdanys: https://healthyrounds.podbean.com/e/dealing-with-dementia/  Dr. Kristina Zdanys: https://www.uconnhealth.org/providers/profiles/zdanys-kristina UConn Center on Aging: https://www.uconnhealth.org/geriatrics-healthy-aging UConn Center on Aging’s Memory Assessment Program: https://www.uconnhealth.org/geriatrics-healthy-aging/services-specialties/memory-assessment-program Geriatric Psychiatry at UConn Health: https://www.uconnhealth.org/behavioral-mental-health/services-specialties/geriatric-psychiatry  UConn Health Orthopedics and Sports Medicine https://www.uconnhealth.org/orthopedics-sports-medicine UConn Health: https://www.uconnhealth.org Grant support from Coverys: www.coverys.com Transcript Dr. Alessi: Welcome to the Healthy Rounds Podcast, where we provide you with up-to-date and timely information from national and international leaders in their fields. This podcast is brought to you by UConn Health, with support from the Department of Orthopaedic Surgery and a grant from Coverys. This podcast is not designed to direct your personal health care, which should only be done by your physician.  And today we’re doing what we call the deep dive where we look back at, in this case the interview we did with Dr. Kristina Zdanys. Dr. Zdanys is a geriatric psychiatrist and she’s associate professor of psychiatry at the University of Connecticut. She’s also the director of the James E.C. Walker Memory Assessment Program at the UConn Center on Aging.  It was great to chat with her and I think there were several points worth discussing. First of all, her directorship in a memory assessment program. I think this goes back to things that we’ve discussed before, and the fact that approaching a problem now is not the purview of one single specialty. And the fact that these programs are multidisciplinary and involve a variety of specialists, typically they will have a geriatric psychiatrist.  You can have neurologists as well as support staff, nurse practitioners, nurse navigators, as well as neuropsychologists as being part of the team. Radiologists who specialize in various imaging studies of the brain, as she discussed, are all part of a program and a multifaceted approach to a problem, in this case, the problem being dementia.  And dementia, as she mentioned, affecting currently 7 million Americans, with the thoughts that that’s going to go up to 14 million Americans over the course of the next several decades, so again, that multidisciplinary approach and making funds available for more research in the field of memory disorders, including Alzheimer’s disease and other dementias.  She also talked a lot about imaging, and it’s something I just mentioned with neuroradiologists, because now we can get images due to PET scanning that look for amyloid, which is one of the main culprits that we find in the brains of people who have dementia and Alzheimer’s disease. So the fact that we can do a scan and look at these deposits and where they’re located helps us a lot in terms of planning for treatment.  Now we do have some new treatments, and those are in the form of the monoclonal antibodies. In this case, and we hear that term a lot, monoclonal antibodies are used for a variety of problems, typically autoimmune problems, but in this case, these monoclonal antibodies are directed against the amyloid in the brain.  So essentially it goes in and cleans up the amyloid that’s been deposited. Now, is that a cure? It’s not. It will slow the progression of dementia, a neurodegenerative disease like dementia, and it does involve going for very expensive infusions every two weeks. So there is a real time commitment, but there has been really good data to show that it slows the progression of the process. So I think that that’s a very important finding and something that’s available to us at UConn Health.   Also, we talked with her somewhat about how to avoid. Dementia. And it was interesting because we’ve talked in the past about stroke and heart disease, and it seems like it also pertains to heart health and brain health overall, and that’s why when we think of ways to avoid dementia.  We think of things that are just basic, right? Adequate sleep, exercise, diet. It’s not rocket science. And naturally you have to control those risk factors. Blood pressure, smoking, drinking alcohol, all work against you in the long run. So it’s important for us to realize that. And she brought up the idea of what’s called the MIND diet, M-I-N-D, and basically it’s called that because it’s the Mediterranean-DASH intervention for neurodegenerative delay. So it’s a diet that’s designed to help avoid progression of a neurodegenerative process, not just dementia. And it consists a lot of the Mediterranean things, lean meats, fish nuts using olive oil, things such as that. So really changing the diet overall, because we also want to control blood pressure and salt intake, and that’s where the DASH [dietary approaches to stop hypertension] part of it comes in. So again, it’s a combination diet to affect heart disease as well as changes in the brain.   We also brought up the topic of some misleading ads. You know, we’re seeing a lot of these ads now. I know we mentioned a product called Prevagen and making false claims. There’s so many of these and they seem to target broadcasts where older people are more likely to be tuned in, like news broadcasts and things such as that. So it’s important to really discuss, before you start taking any of these supplements, really talk to your physician and find out what is a legitimate thing to be taking and what you need.  The other topic we mentioned toward the end of the interview is operating a motor vehicle. And this is a tough one because obviously when someone has dementia, they’re going to be slow to react, slow to pick up the signs of potential accidents and what we call defensive driving. And it’s a problem as we all get older, but specifically in people who have dementia.  Unfortunately, we’ve created a society where we rely so much on operating a motor vehicle. People who live in big cities don’t have the same problem because there’s plenty of public transportation, things within walking distance. If you live in the suburbs, it becomes much more difficult. It’s also a problem because people feel so much like they’re giving up their freedom, their independence, having to rely on others.   Now, what has helped is the fact that we have services like Lyft and Uber, and I think promising technology is going to be these vehicles that are self-operating. But the important thing is to realize your loved one is not safe operating a motor vehicle. And they may not have that same insight. Now, it’ll cause some distress, and actually the best thing is to have them go for a driving test. In our area, Easterseals provides that and they will tell you if it’s safe or not to operate a vehicle. But again, it’s a very difficult decision point for families.  So we learned quite a bit about dementia and the things that are going on at UConn Health in this regard with Dr. Zdanys and her fine work. I want to thank her for her time, and I really want to thank Jennifer Walker, who’s our executive producer here at Healthy Rounds.   If you have any questions or ideas for future programs, you can reach out to me at [email protected].  

There are many disorders that can cause memory problems, which fall under the category of “dementia” when those memory problems interfere with daily living. The most common dementia is Alzheimer’s disease, which afflicts more than seven million people in the U.S. As Dr. Kristina Zdanys, geriatric psychiatrist at UConn Health, explains, we can’t cure dementia; our best bet is to try to slow its progression, or even delay its onset with healthy habits in our younger years. Dr. Zdanys, who co-directs the James E. C. Walker Memory Assessment Program in the UConn Center on Aging, also discusses with Dr. Alessi how genetics factor into dementia, the “mind diet,” the challenge of taking away a loved one’s car keys, and what drew her into the field of geriatric psychiatry. Submit questions for Healthy Rounds: [email protected] Dr. Kristina Zdanys: https://www.uconnhealth.org/providers/profiles/zdanys-kristina UConn Center on Aging: https://www.uconnhealth.org/geriatrics-healthy-aging UConn Center on Aging’s Memory Assessment Program: https://www.uconnhealth.org/geriatrics-healthy-aging/services-specialties/memory-assessment-program Geriatric Psychiatry at UConn Health: https://www.uconnhealth.org/behavioral-mental-health/services-specialties/geriatric-psychiatry  UConn Health Orthopedics and Sports Medicine https://www.uconnhealth.org/orthopedics-sports-medicine UConn Health: https://www.uconnhealth.org Grant support from Coverys: www.coverys.com Transcript Dr Alessi: Welcome to the Healthy Rounds Podcast, where we provide you with up to date timely medical information from national and international leaders in their fields. This podcast is brought to you by UConn Health, with support from the Department of Orthopaedic Surgery in addition to a grant from Coverys. It is not designed to direct your personal healthcare, which should only be done by your physician. I’m your host, Dr. Anthony Alessi, and it gives me great pleasure to welcome today, Dr. Kristina Zdanys. Dr. Zdanys is a geriatric psychiatrist here at the University of Connecticut where she serves as an associate professor of psychiatry. Kristina, welcome to the show. Dr. Zdanys: Good morning. Thanks for having me. Dr Alessi: Let’s talk. Can you describe your background and what it takes to become a geriatric psychiatrist? Dr. Zdanys: Absolutely. So, after medical school, I completed four years of a general adult psychiatric residency down at NYU. And treating adults, you also treat older adults, but I wanted to really enhance my understanding of working with the older adult population, so I went to Yale for a fellowship in geriatric psychiatry, which focuses on the mental health of folks who are 65 and over generally. And that may be a primary psychiatric problem like depression or anxiety or a sleep disorder, but it can also be dementia, which I think we’ll talk about quite a bit today. Dr Alessi: Why did you choose that field? Dr. Zdanys: Well, I think going back a long way, I’ve always been very connected to older adults in my family and my community, and have really enjoyed listening to their stories from when they were growing up and when they were younger adults and raising their kids, and there just seemed to be just this, you know, beautiful tapestry that every individual can present to you that I just found so enticing. So that’s how I initially got that interest. But at the same time, I also was really interested in the idea of memory problems because when you think about illnesses that affect older adults, you can kind of wrap your head around, okay, somebody’s heart’s not working the way it’s supposed to be, or somebody’s kidneys aren’t working the way they’re supposed to be, and you can kind of point to what that is. But a memory problem seems much more abstract. And, not just abstract, but I also think it affects the individual in a way that’s so unlike any other illness because in a way it robs them of their core identity and I just felt very compelled to try to work with them. And even if I don’t have a cure for their problem, just to try to help improve their quality of life. Dr Alessi: You know, just thinking of the field of geriatric psychiatry and geriatrics in general, it’s gotta be interesting because it’s such a growing field. We’re living longer. Dr. Zdanys: Mm-hmm. Dr Alessi: Right. And I think the statistics regarding memory loss and dementia are outstanding. Can you talk a little bit about that? It’s tremendous growth. Dr. Zdanys: That’s very true. So, the number one risk factor for developing dementia is age. So, the older you get, the higher your risk of developing dementia. And I should also clarify what we mean by the term dementia, Dr Alessi: Please. Dr. Zdanys: So, dementia is a cluster of different illnesses that presents with memory problems that interfere with somebody being able to do what they need to do day to day. And in most cases, those dementias are progressive. So just like there’s the term cancer, we know there’s all different kinds of cancers. There’s the term dementia, which means there’s all different kinds of disorders that can cause memory problems. So, in the United States, Alzheimer’s is the most common. It probably makes up about three quarters of our patients who present with memory problems, and that makes up about 7.2 million people in the United States who are currently living with Alzheimer’s disease. Dr Alessi: The projections are something like, what 30 million people by 2050 or something of that nature? Dr. Zdanys: Yeah, I don’t think it’s quite that high, but probably around 14 million by 2050, 2060, so Dr Alessi: Wow. Dr. Zdanys: Yeah, and the problem is without a cure, we don’t really have the infrastructure in our society to take care of these patients. Right? So most of the care burden is falling on family members who are often juggling jobs and their own children and trying to navigate the difficult course of the disease. Dr Alessi: Kristina, what’s your practice look like when someone comes to see you? Are there tests you do? Is it mostly talking to them? Kind of walk me through what a typical visit would be for one of our listeners. Dr. Zdanys: Sure. So as a geriatric psychiatrist specifically, my primary job is to listen, right? So, I want to hear what’s going on with somebody in their life, what’s important to them, and what is the reason they’re coming to see me in the first place? So, we might say broadly as our chief complaint, “oh, somebody is coming in because they have problems with their memory.”  But what does that mean for them? Is it that they are now relying on their family for transportation because they’ve been getting lost when they’ve been driving? Or does it mean that their hypertension is poorly controlled because they keep forgetting to take their medication? So, I want to hear what the patient’s experience is, first of all, so I can understand how it’s impacting their life. And I think that might be a way in which a geriatric psychiatry approach might be a little bit different than some other specialties. But, at the same time, we do perform the same type of blood work that we would do for somebody coming into an internal medicine office or a neurology office. We typically do recommend head imaging. Brain imaging has come a long way in the past decade that I’ve been here at UConn Health. Previously, we were only able, typically to get an MRI. Now we have special MRIs called NeuroQuant analysis where you can actually measure out the size of different parts of the brain, and that helps us get a better idea of what the patient might be suffering from that’s causing their memory problems. We do more advanced scans, like PET scans that can actually show us whether or not somebody has amyloid in their brain, which is the protein that we see in people who have Alzheimer’s. So, when I started here, we were making general clinical impressions. To make our best guess about what might be causing somebody’s memory problems. But now we’re using specific biomarkers to have very specific diagnoses available for our patients and inform our treatment plans going forward. Dr Alessi: How big a factor do you find genetics to play in dementia? I mean, old people are always asking me that in respect to their father and mother who may have Alzheimer’s disease. How big a factor do you find genetics and the APOE4 studies and things like that? Dr. Zdanys: Yeah, that’s a really good question. So there’s different types of Alzheimer’s too, and I won’t get into too much of the details about that, but there’s earlier onset Alzheimer’s that tends to have more of a familial component where people have something called an autosomal dominant inheritance, where if they have a parent who has an early onset Alzheimer’s, they may have a 50% chance of developing it themselves. That’s a very small portion of our population, probably under 5%, if not under 1% of our population. The gene you mentioned, the APOE4 gene. This gene is a risk factor for developing Alzheimer’s disease, but doesn’t mean necessarily that people are going to get Alzheimer’s. So it wasn’t necessarily something that we would typically test for prior to the advent of these new treatments that we have available now. But what’s interesting about the APOE gene is that based on the version of the gene that somebody has, we can actually predict their risk factor for side effects from some of our new medications. So now we are routinely screening for the APOE gene as opposed to even five years ago when we were maybe considering it, but it wasn’t standard of practice. Dr Alessi: It’s interesting ‘cause with my practice in sports, there was a period of time where people were advocating to test for the APOE gene in boxers before they got into the sport. And obviously that met with tremendous resistance on the part of promoters and athletes. And as you describe it, I don’t know that it would’ve been very predictable from that standpoint. Let’s talk a little, let’s get into the drugs, right? I think this has been one of the exciting fields in memory disorders and dementia is the new drugs to kind of clean up the brain. Can you describe a little bit about them and what they do? Dr. Zdanys: Sure. So, since 2021, we have had a new class of medications available for the treatment of Alzheimer’s disease. This is not a pill that you take. These are actually infusion medications. So our patients are coming into our infusion center once every two weeks and getting the medication through an IV. What these medications do as a class, they’re called monoclonal antibodies, and essentially what they’re doing is what you described. They’re vacuuming up the amyloid plaque that I mentioned earlier and really exquisitely clearing it out of the brain so that the brains of people with Alzheimer’s no longer have this burden. Now, the tricky part is that doesn’t mean it’s a cure for Alzheimer’s disease because there’s multiple different factors that play into a person’s development and progression of Alzheimer’s. So, they very well slow down the progression of the disease. They help improve people’s independence, so they’re able to stay more independent longer, in terms of those activities of daily living that they need to do, whether it’s driving, or managing their medications, or doing their finances, or doing their shopping. But there’s other factors that the medications don’t address. So, one of those is another protein in the brain called tau, which we see in something called the development of tangles in Alzheimer’s disease, which is a marker of neural degeneration. And then also there’s an inflammatory process that happens in the brain of people with Alzheimer’s disease. And these monoclonal antibodies don’t address that either. So, what I tell patients is it’s not a cure, but it’s really currently the best tool we have for slowing down the progression. But I will say that not every individual who has Alzheimer’s disease is necessarily a candidate for these medications, and there are other medications that have been around for decades that we continue to use for all our patients to slow the progression. Dr Alessi: Let’s switch gears a little bit in terms of treatment. What should people do? ‘Cause what a lot of people are thinking who are listening to this is, “I don’t have dementia, but I want to avoid it.” Dr. Zdanys: Mm-hmm. Dr Alessi: What should people be doing in order to avoid, and there are so many studies about this and people have mid-forties, this is what you should start doing, and a variety of things. Can you talk about what you recommend to patients? Dr. Zdanys: Absolutely. So I think the general theme that encompasses all those recommendations is that your heart health is your brain health. So, what keeps your heart healthy is going to keep the blood vessels in your brain healthy, and is going to keep your memory working better longer. Now, just because you have a perfect adherence to all of those recommendations doesn’t mean that you will prevent the development of Alzheimer’s disease, but we know that you can potentially stave off the onset by doing a few things. So, one is cardiovascular exercise and the recommendation for cardiovascular exercise is a half hour of moderate cardio. You don’t have to be running, you can be doing a brisk walk. Half an hour, five days a week is shown to reduce risk of development of Alzheimer’s disease. Dietary modifications. You don’t have to do a crazy diet, but we generally recommend something called the Mind Diet, which is a combination of a traditional Mediterranean diet, lean protein, fish, chicken, leafy greens, nuts, olive oil, those sorts of things in combination with a low sodium diet called the Dash Diet. So that’s going to help keep your blood vessels healthy, keep your cholesterol in check, keep your blood pressure in check. I also want to emphasize blood pressure maintenance is really critical. There was a study called the Sprint Mine Study, where folks who kept their systolic blood pressures below 120 during the duration of this monitoring period actually reduced their risk of developing Alzheimer’s by about 20%. So, blood pressure maintenance is important, not smoking - critical, and also moderation of alcohol use is important as well. Dr Alessi: So everybody wants a magic pill, right? Dr. Zdanys: Yes, of course. Dr Alessi: And their supplements and things like that, most commonly, Prevagen. Dr. Zdanys: Mm-hmm. Dr Alessi: Does it work? Dr. Zdanys: No. Dr Alessi: Okay. Dr. Zdanys: So, the FDA is actually after them for misleading advertising. Dr Alessi: Okay. Because if you follow the ads and it’s all out there. Let me ask you a question. How hard is it for you, and I know it’s hard in my practice to tell people they can’t drive anymore? Dr. Zdanys: Mm-hmm. Dr Alessi: You must have to do that a lot. Dr. Zdanys: Yeah, so, and it’s tricky because I’m not sitting in the car as a passenger with them. So, I don’t know each individual kind of where they are and what they’re doing. But what I know is that when people have forms of dementia, like Alzheimer’s disease, one of the most majorly impacted aspects of their cognition is actually, it’s not just memory, but also their reaction time. And what I tell people is, listen, if you’re driving down the street, and a kid or a dog runs in front of your car, if you can hit the brake in half a second, that kid might be okay. But if you hit that brake in a second and a half, then we could have a completely terrible outcome. So looking at it from that perspective of safety of an individual, I think can sometimes be very compelling for folks to actually go and get a professional driving assessment where things like reaction time can be measured. So it’s not a, you know, punitive measure. And I know symbolically taking away someone’s license is horrible in terms of their kind of self-concept and their independence. Dr Alessi: Only because we don’t have good public transportation. Dr. Zdanys: Well, this is a whole nother category that we could talk about. Dr Alessi: I mean, if you lived in a city with public transportation, it’d be fine. Dr. Zdanys: That’d be totally different. Dr Alessi: But I think that’s it. Dr. Zdanys: Yeah, no, here, you know, if you’re living in Farmington or Avon or somewhere, you may feel extremely isolated. Dr Alessi: Yeah. So along that lines, when you’re thinking of in your field, what’s something our listeners need to know? What are some of the things that are happening in your field that folks need to know about? Dr. Zdanys: Yeah, so I think historically talking about mental health and cognitive health has been taboo, especially in the generation of adults who are older now, but number one, we do have effective treatments for many of our mental health conditions like depression and anxiety, and for folks who are experiencing memory changes, it’s worth mentioning to your doctor as soon as you are concerned. Because the treatments that we have are most effective in the very earliest stages of our disease. Once the Alzheimer’s progresses to a more moderate stage, somebody might no longer be a candidate for things like our infusion medications. So, I think the earlier you can bring it up with your doctor and start that process of working it up, the better. And if your result is, “hey, you don’t have Alzheimer’s”, then wonderful, you know that. But if it is, “hey, yeah, it looks like your brain has the changes consistent with Alzheimer’s disease”, well, let’s talk about that and what we can do to get started on treatment as soon as possible. Dr Alessi: Kristina, thank you. Thank you for your time today. Thank you for everything you do for our patients here at the University of Connecticut. Dr. Zdanys: It’s my pleasure. Thank you for doing this. Dr Alessi: Many thanks to our guest today, Dr. Kristina Zdanys. If you have any questions or ideas for future programming, you can reach out at [email protected]. Jennifer Walker is executive producer of the Healthy Rounds podcast. Chris DeFrancesco is the studio producer of the Healthy Rounds podcast. This is Dr. Anthony Alessi. Until next time, please stay healthy.

A glimpse into the future of surgery came last year, when a surgeon in Orlando operated on a patient 7,000 miles away! Yet diagnosing a painful disc still comes with a number of challenges. Could figuring that out lead to better decisions on surgery versus conservative management? Dr. Alessi revisits his conversation with Dr. Moss, chair of UConn Health’s Department of Orthopaedic Surgery, particularly in the area of advances in spine surgery, including robotic and augmented reality procedures. Submit questions for Healthy Rounds: [email protected] Dr. Isaac Moss: https://www.uconnhealth.org/providers/profiles/moss-isaac UConn Health Comprehensive Spine Center: https://www.uconnhealth.org/spine The Brain and Spine Institute at UConn Health: https://www.uconnhealth.org/brain-spine UConn Health Orthopedics and Sports Medicine https://www.uconnhealth.org/orthopedics-sports-medicine UConn Health: https://www.uconnhealth.org Grant support from Coverys: www.coverys.com Transcript Dr. Alessi: Welcome to the Healthy Rounds Podcast, where we provide you with up-to-date, timely medical information from national and international leaders in their fields. This podcast is brought to you by UConn Health, with support from the Department of Orthopaedic Surgery and a grant from Coverys. This podcast is not designed to direct your personal health care, which should only be done by your physician. I’m your host, Dr. Anthony Alessi, and today what we’re doing is what has come to be known as our deep dive, where we talk a little bit about the previous week’s interview. And in this case, it was done with Dr. Isaac Moss, who is professor and chairman of the Department of Orthopaedic Surgery at the University of Connecticut. He’s also a fellowship-trained spine surgeon. And there were several issues that he brought up that I feel need further attention and I went back and dug out a little bit more information on that I’d like to share with all of you. I think one of the things he talked about is comparing our system with that in Canada, where we have so many spine surgeons in Hartford as opposed to Montreal, and he talks about increased access here in the United States to surgery. And I think that that’s important because, and it’s not necessarily a bad thing, but nevertheless, it has us shy away from conservative management. In many cases, when he discusses diagnostics, it appears that over a period of time where you may be waiting for surgery, your symptoms resolve. What I found also interesting was that from a diagnostic standpoint, we really can’t diagnose a painful disc, and I see that in electrodiagnostics all the time in EMG, which is what I do, in the sense that I’m going to see someone who has a painful disc and you would think that would have neurologic impairment and does not. By the same token, you’ll see somebody who has a horrible MRI and has no pain at all, but clearly has neurologic deficit on their exam and on the electrodiagnostic studies. So he raises such a good point with respect to how we are lacking in the field of diagnostics. We haven’t really figured that out yet. And as he points out, as you get to over the age of 50, you’ve got a 50% chance of having an abnormal MRI. So is it an imaging issue? Is it a clinical issue? And I think we really have to resolve that if we’re going to be treating the right patients with surgery or conservative management in order to make that decision. The other thing, the two other things actually I wanted to talk about: First, he talked about these enabling technologies, and I thought that was a good way to put it. You know, we’re dealing a lot with robotics now and how much that has really changed the practice of surgery, and medicine in general. But in terms of surgery, with these enabling technologies that we are fortunate to have here at the University of Connecticut through UConn Health, it really gives you a totally different image. Now, he brought up something I didn’t know about, and that is using robotics through augmented reality. And with this augmented reality, he’s able to make a smaller incision, right, so really a limited surgery from the standpoint of it being invasive and at the same time really making it more accessible to him. So he can see the same things that he would if he did a much broader surgery, with a bigger incision and being more invasive, with this new technology. And with these robotics, it’s really eliminated a lot of complication and longer recovery times. Let’s just think about that. I mean, smaller incision with augmented reality, less recovery time, and people are enabled, a good word for it, to get back to work sooner, get back to their life, get back to their sports, rather than being more sedentary. So these enabling technologies were interesting, but he also mentioned the idea of telesurgery, and I wanted to really discuss that a little bit. In May of last year, 2025, they performed the first long-distance surgery from the standpoint that a patient in Angola had prostate surgery by a physician in Orlando, Florida. So how does that happen? Well, you have to understand this telesurgery is really where the patient is in an operating room, in this case, in Angola, with a surgeon, with a nurse and a full operating room. But when it comes to the particular part of the surgery that requires more skill, someone who is fellowship trained, as in this case, Dr. Patel in Orlando, he can take over the surgery. And it’s an interesting device. I mean, his head goes into, I mean, it’s a computer with a kind of virtual reality kind of thing here, and he’s able to do surgery. Now, the biggest obstacle has been, whenever you do something online, there’s a lag time, right? So there’s a time where there’s a lag between when you do something and when it gets done, when that motion happens. And that’s been the biggest difficulty. We’ve now, thanks to technology, been able to get that down to six milliseconds, so six thousandths of a second. And that allows enough surgical accuracy and precision to do the surgery. And again, it’s done in three dimensions. The vision of the surgeon in Orlando was three dimensional. That is also going to be the case with complicated spine surgeries, as Dr. Moss mentioned. And this opens up really a tremendous opportunity for patients who live in isolated areas, in the United States and throughout the world. Again, you need technology on the other end as well. So there is a mobile 3D unit operating in Africa, in Angola in this case, so that it can go from hospital to hospital. So not every hospital has to invest millions of dollars in this technology. Just thinking about this in terms of brain surgery, in terms of cancer, removing complex tumors of people who can’t get to huge medical centers, I believe is fascinating and really, for me, just so hopeful of the future of medicine. So I’m so happy Dr. Moss brought that up so we have some time to really delve into it, and I recommend you read more about it. There’s a lot of it online, a lot of articles, about telesurgery. With that, I want to once again thank Dr. Moss for his time in doing this podcast. If you have any questions or ideas for future programs, you can reach out to me at [email protected]. Jennifer Walker is the executive producer of the Healthy Rounds podcast. Chris DeFrancesco is the studio producer of Healthy Rounds, and really the guy who puts all this together. Tessa Rickart is in charge of all our social media and does a phenomenal job of getting the word out, and you could always get this podcast on Apple, or you’ll see it on Instagram and other outlets. I look forward to next week, when we will have as our guest, Dr. Kristina Zdanys. Dr. Kristina is going to talk to us about dementia and potential treatments for dementia. Until next time, this is Dr. Anthony Alessi. Please stay healthy.

More than eight in 10 of us have had or will have back pain, but far fewer will have surgery for it. Those who do have surgery enter a realm of innovation like few other areas of medicine. That’s what drew Dr. Isaac Moss into the specialty, yet he says there’s still so much we don’t know. Dr. Moss, renowned spine surgeon and the chair of UConn Health’s Department of Orthopaedic Surgery, discusses the advances in spine surgery, its promising future, and the importance of academic medicine, and offers his first-hand perspective on the health care systems in the U.S. and Canada. Submit questions for Healthy Rounds: [email protected] Dr. Isaac Moss: https://www.uconnhealth.org/providers/profiles/moss-isaac UConn Health Comprehensive Spine Center: https://www.uconnhealth.org/spine The Brain and Spine Institute at UConn Health: https://www.uconnhealth.org/brain-spine UConn Health Orthopedics and Sports Medicine https://www.uconnhealth.org/orthopedics-sports-medicine UConn Health: https://www.uconnhealth.org Grant support from Coverys: www.coverys.com Transcript Dr. Alessi: Welcome to the Healthy Rounds Podcast, where we provide you with up to date and timely information that’s brought to you by national and international leaders in their fields. This podcast is brought to you by UConn Health, with support from the Department of Orthopedic Surgery, in addition to a grant from Coverys. This podcast is not designed to direct your own personal medical care, and that should only be done by your physician. I’m your host, Dr. Anthony Alessi, and it’s great to have as my guest today, Dr. Isaac Moss. Dr. Moss is professor and chairman of the Department of Orthopedic Surgery here at the University of Connecticut. He is also a fellowship trained spine surgeon. Welcome to the show, Isaac. Dr. Moss: Thank you, Tony. Great to be here. Dr. Alessi: First of all, let me thank you for your support of this podcast, which we’re looking forward to really furthering medical information coming from our institution. To begin, I want to go back a little bit, back to 2019. Here you are at the University of Connecticut. You’re a very successful, well-known spine surgeon. You have grant support and suddenly you are thrust into the limelight of being chairman of one of the largest departments at the University of Connecticut, certainly one of the busiest. Walk me through that. I mean, did you want to become a chairman because you were fairly young at the time? And when I think of chairs, I mean, they’re usually older folks. Dr. Moss: So, I appreciate first of all that shout out and calling me young. I’ll let my kids know. But yeah, I think I was a little, I was typically a little bit younger than the average person who takes this kind of job on, but, you know, sometimes kind of opportunities come your way and they’re hard to say no to. And this particular opportunity, you know, we’re lucky. We have a tremendous, tremendous orthopedic department, all specialties, great people, great education, great research. And at the time there was a transition at the health center and the leadership came to me and said, “Hey, you know, we need some leadership in the department at this time, we think you’re well suited to do it.” And that was flattering, first of all, and somewhat hard to say no to, especially if you ask my mom. But, you know, so I took a step back and said, okay, is this something, well, you go from a sort of your own practice to leadership, you have to change your focus from what’s good for you and what’s good for your patients is obviously your main focus, to what can you do for everybody else? And, you have to be at a certain point in life where you can do that, first of all, and a certain attitude to do it. And, so actually the first thing I did was I sat down with a group of orthopedic surgeons. I said, “Hey guys, is this something you want me to do?” Right? Because one of the great things we have in a department is we have a tremendous team, right? So even though we’re individual surgeons, we all have our subspecialties, we really work as a team together. And I think that’s one of the strengths of our department because we get that whether it comes to patient care, right, so in fact, yourself, Dr. Alessi, you’re part of our department. And so how often do I send you a patient saying, I’m not sure what to do with this person. They have some particular neurologic problem. Can you help me define it so that I can give them the right care? That also happens sometimes somebody comes in, we think is a neck problem, maybe it’s a shoulder problem. I have great colleagues that can do that too, so that is a tremendous asset to our department. And so, which is one of the reasons I said, “Hey team, if we can do this together and we can make ourselves better, I’ll take this on as a responsibility.” And it was, you know, a tremendous privilege to be able to do it. Certainly, I’m not sure that it made my life any easier, but it’s been an education and a privilege to do so for the past six or seven years. Dr. Alessi: You know, and I think that’s a rarity. Having lived through that, those events with you, I mean, to have the unanimous support of your department, makes a big difference when becoming chair. But let’s talk about now. I mean, so now you’re chair of the department the last six years. What’s the biggest challenge? I mean, there are a lot of challenges. I mean, you have to coordinate clinical care, right? We have research to deal with, funding, teaching. What’s the biggest headache? Dr. Moss: That’s a tough question. I’ll start off with saying what’s the, you know what’s interesting is, and one of the nicest things about this job is I certainly don’t need to motivate my employees, right? So, like, orthopedic surgeons are intrinsically motivated to work hard. And so in a way, while it’s a blessing certainly, but you know, we also work in a large institution and there’s a lot of moving parts to this institution. So really what I lose sleep over is how do I set things up or how can I work with the rest of the institution to almost allow our surgeons to be as productive as they want to be, right? And not only surgeons, we have, as you know, surgeons, neurologists, non-operative doctors, physiatrists and all these, there’s all these providers who want to provide care for their patients and sometimes their pace may exceed the pace of the rest institution for certain cases. And that’s again, it’s not to the fault of the institution. It is a big place and there’s a lot of priorities, so how do I make sure that our providers can almost work to their capacity. And again, everybody wins that way. We’re getting them, the institution’s getting the most out of their providers. Our patients are getting the most of their providers and the department. That’s one challenge. But we also have to balance clinical care is one of our pillars. But there’s three pillars in an academic environment. There’s patient care, there’s research, there’s education. And trying to balance all those things, especially in an environment where one of them is financially is driving, some are less so. But again, we don’t want to lose our mission, which is again, to make sure we’re educating the rest of the next generation of orthopedic surgeons to develop the new knowledge through research that’s making everybody’s care better and at the same time treating our patients in Connecticut and making sure they have excellent orthopedic care. Dr. Alessi: So, I think you may have answered the next question, but what do you think are the goals for the department now that you look at the future of orthopedic care? I mean, you must go to meetings, you must meet with other chairs, and what are the trends towards departments? Are most people facing the same challenges? Is funding an issue? Dr. Moss: Sure. Yeah, I mean, actually one of the, it is nice to go to some of these meetings sometimes because you realize that regardless of an institution, we all have the same problems to a certain extent, and they may be highlighted more in one than the other, and there may be particular nuances, but really if you look at it in general as orthopedics, we’re very lucky because we can generate significant revenue, but we also need to get that reinvested in our business, right? Which means to provide care, which is whether that’s expansion, whether that’s new technology and equipment which we’ll talk about later, whether that’s just ensuring that, again, we have the infrastructure to provide the care we want. The second part though, is how do we balance that with some of the non-revenue generating activities, right? Like research, which can, but not always, or like education, which again, without that why we’re really here. I mean, our doctors are here because A, they love to provide care, but B, they want to be teaching. That’s exciting. That actually just makes our job interesting, and in fact, I think it actually improves the quality of care because we have a young doctor asking us, “Hey, why are you doing that today?” Right? I’m not just sitting there doing whatever I want. I’ve got to justify my decisions to a very smart orthopedic resident or spine surgery fellow every day, which actually makes me a better doctor I think, and makes me give better care to our patients. Dr. Alessi: Absolutely. I agree wholeheartedly. You came here from Canada and trained in Chicago at Rush in spine. How does your experience here compare to medical care in Canada? And I use it as a general term, you know, delivery of care, quality of care, access to care, how do we compare? Because people are always saying, “well, the Canadian system, everything’s paid for”, and things like that. Give us some insight since you’ve worked on both sides of the water. Dr. Moss: Yeah, so it’s interesting. I think first the easy part is I think quality of care is the same once you get down to, once you get the healthcare that you’re getting in Canada, and again, being part of that system, having relatives and colleagues that work in the Canadian healthcare system, once you are there, once you get to the doctor, you’re getting very high quality care. I think the issue that the system has is access, right? And if I compare to here, we almost have too much access, right? So I grew up and I went to medical school in Montreal, which is the city of, I don’t know, four and a half million people or something like that, at this point. I think there are more spine surgeons in Hartford, for instance, than there are in Montreal. Dr. Alessi: Really? Wow Dr. Moss: Right, which is probably a quarter of the population. And again, so, the issue we have here is it’s, in certain respects, access is almost too easy, right? You have an itch in your nose, you’re going to go see an ENT surgeon. That’s not necessary, right? Probably you should wait it out or go to your doctor, right? Or for instance, I remember when I started my training when I was in Chicago and somebody came to our spine surgeon’s office with like two days of back pain. Now, back pain is ubiquitous. 85% of people have it and most of it goes away. So you know the idea that you’re in a spine surgeon’s office within a couple of days. To me, this was in Canada that would never happen. By the time you get to the surgeon, you need the surgeon. Whereas here, because of access, because of market forces, it is just different, right. And so to me, I think some of the, now granted there’s extremes to all of this, and there are people that are probably waiting too long for their care in the Canadian healthcare system. And that’s been the subject of some debates, that’s been the subject of some healthcare changes that are happening up there. But the flip side is, it is a bit of a barrier and probably does in a way regulate some of the care, which may not be entirely necessary that happens in this country. Dr. Alessi: It’s interesting, but I guess it leads into my next question. Do we operate too much here in America? When you look at the literature, right? I remember the early Swedish studies done at the Volvo plant, and they were really seminal articles about how, you know, conservative management really help these people stay on the line. And that must be, what, 30 years ago or more. Do we operate too much? Dr. Moss: As a surgeon, I would say I think to a certain extent we do, right? And I think there’s a lot of things, though. I don’t know that it’s necessarily driven by physicians, driven by patients, driven by marketing. But again, when you have access to something and people are, I mean, again, people are in pain, right? And part of it is you can see as a patient, and you’ve seen these patients yourself as a neurologist, you know, if you have a really bad sciatica and I’m telling you, "Hey man. Most likely you waited out six weeks, this will go away.” Not everybody wants that. Dr. Alessi: No. Dr. Moss: Right. And I’m a very conservative surgeon in general, and I will really sit there and in fact, it’ll take me more time to talk a patient out of surgery than I would just say, “Hey, have your discectomy. It's a quick operation,” but I know that if it was me or if it was my family member, which is how I always try to treat my patients, I would say, wait. In fact, I had a hernia disc in my neck a couple years ago. I waited. It was a miserable three months. But it went away. I never ended up with surgery. So for the not wrong reasons, right? Patients are there, they have issues that we can help. But this idea, and then part of it is we just live in a quick fix society. Everybody wants everything now. And if I say, wait six weeks, you’ll get better versus have surgery next week and you’ll get better next week, a lot of people would sign up for that. Right or wrong, it may not be necessary. Dr. Alessi: Good point. Let’s talk about some of the advances. I mean, spine surgery is one of the fields that we look at where we’ve seen so many advances in how things are done. I mean, the operating room looks nothing like when I was a medical student and when I was in training and certainly over the last 30 years. Dr. Moss: That was candlelight then, right? Dr. Alessi: It was candlelight. And, you know, you just had to wash your hands. No gloves. But just looking at that, what are some of the biggest advances you’ve seen since you’ve been practicing spine surgery? Dr. Moss: It’s funny you should ask that because that is actually the reason, one of the reasons I went into spine, so I remember my first rotation of residency, two amazing things happened. So number one, I showed up and turned out the attending was actually my hockey coach when I was six years old. So Stephen Lewis, who’s a tremendous spine surgeon in Toronto, taught me how to skate as well. Which again is funny from a very stereotypical Canadian story I think. But, so I showed up, I said Coach Steve, and he was doing these amazing things and, him and this other guy, Raj Rampersaud, who this was 2003, so it was the beginning of some of this navigation technology, minimally invasive surgery. And I walked into this OR, things I had never seen before in my life as a medical student. And I said, wow, there is opportunity in this field to innovate. And that was actually one of the things that really drove me towards spine surgery, I ended up learning from them. I took two years in the middle of residency, I did a master’s of bioengineering looking at how to regenerate, some of the, because there was just such a need, right? We didn’t know what we were doing to a certain extent. We could do certain things, but really when you look at the larger picture, there was so much we didn’t know about spine surgery. And to me that was the most exciting thing and which is honestly what pushed me to choose that as a specialty. There are things in my practice I do now I never even heard of in residency, which is pretty cool, right? I mean, that’s over 15 years ago. But it’s procedures that I do routinely that did not exist. There’s technology that I use routinely that did not exist. And when I think of what’s coming next, I mean, it’s a super exciting field, right? And there’s so much we don’t know. So, I’ll hit on two things. So, number one is diagnostics. So, if you think about it, and again, you see this in your practice. We have no idea how to diagnose a painful disc in your spine, as crazy as that is, right? So again, back pain is ubiquitous. Everybody has it to a certain extent. But the problem is if you take an MRI, if you do an MRI of everybody, whatever decade you’re in, more or less, that’s the chance you’ll have an abnormal MRI. So if you’re 50 years old, there’s a 50% chance you’ll have an abnormal MRI regardless of symptoms. So, I see patients with terrible MRIs and basically no pain, patients with beautiful MRIs and tons of pain. So, there’s something we’re missing, right? And there are studies, there are things being done on this front. So, there’s different MRI sequences that people have been experimenting on. There’s a group in San Francisco that’s been doing this and trying to commercialize how to say what is painful. We’re looking at some different kinds of nuclear medicine studies, but again, that whole world, we can’t even diagnose. Imagine this, we have this whole treatment. We can treat, we can do all these things, but we don’t even say, “Hey, this is the disc that hurts.” So, I think that’s a huge opportunity for the future and we’re going to see a lot of investment, I would say, in making that, because if we could narrow that down, the reason spine surgery gets a bad wrap is a diagnosis problem. It’s not a surgery problem, right? The surgery generally works, but are you doing it on the right person at the right place? So that’s one side of things. The other side is what we call enabling technology. So, enabling technology allows us to do surgery that we were doing before, but in an easier way. So, this robotics was one thing. So, we were actually one of the first in New England to have robotic-assisted spine surgery where that helps us, almost guides us. And it used, it’s actually an Israeli company that used missile-tracking technology to allow us to then track and put screws in the spine. And, very, very cool technology. So we had that for a while, and now over the past several years, been using Augmented Reality. And so what this is, it’s actually x-ray vision, more or less. It’s like a really awesome thing. So it will project the spine through your body. So now through tiny incisions, I can see exactly where I am, do exactly what I was doing in open surgery, but without the morbidity of that kind of a procedure. Dr. Alessi: So, it sounds like these enabling technologies are things we’re going to be seeing. So, when you’re sitting back here 10, 20 years from now, do you think these enabling technologies are going to be the thing that we’re talking about?  Dr. Moss: Hopefully we’re not talking about them ’cause they’ll be so commonplace, right? It’s like we don’t talk about FaceTime anymore. I mean, we think about the iPhone in our pockets, right? Like when that came out in 2000 and whatever, nine, that blew our minds, right? We had Blackberries and all of a sudden we’re like, you know? So I don’t think we’ll be, we probably won’t be talking about it. I think it would be cool ’cause we probably won’t be talking about it, but what would be awesome would be, and again, not necessarily good for our business here, but this should commoditize surgery. It should make no difference if Tony Alessi is having a spine surgery at the University of Connecticut or in the middle of a cornfield somewhere, right? So as long as you have a spine surgeon, this technology should level the playing field and allow us to that everyone’s care, to deliver the same care no matter where you are. And I think then society will be better on a whole. Dr. Alessi: Boy, you’ve certainly given all of us something to really think about. Isaac, thank you for your time today. It’s been great to have you. And, thank you for all you do for our patients here at the University of Connecticut. Dr. Moss: Thank you, Tony. Pleasure. Dr. Alessi: Many thanks to our guest today, Dr. Isaac Moss, who is professor and chairman of the Department of Orthopedic Surgery here at the University of Connecticut. If you have any questions or ideas for future programming, you could reach out to [email protected]. Jennifer Walker is our executive producer here. Chris DeFrancesco is our studio producer for the Healthy Rounds podcast. Until next time, this is Dr. Anthony Alessi. Please stay healthy.

Dr. Alessi drills down on a number of topics discussed with Connecticut's Social Services Commissioner Andrea Barton Reeves, including Medicaid truths, social determinants of health, and how the ACEs survey fits into overall health. Submit questions for Healthy Rounds: [email protected] DSS Commissioner Andrea Barton Reeves: https://portal.ct.gov/dss/knowledge-base/articles/home/dss-commissioner UConn Health: https://www.uconnhealth.org Support from UConn Health Orthopedics and Sports Medicine: https://www.uconnhealth.org/orthopedics-sports-medicine Grant support from Coverys: www.coverys.com Transcript Dr. Alessi: Welcome to the Healthy Rounds Podcast, where we provide you with up-to-date and timely medical information from national and international leaders in their fields. This podcast is brought to you by UConn Health, with support from the Department of Orthopaedic Surgery and a grant from Coverys. It’s not designed to direct your personal health care, which only you should work out directly with your physician. I’m your host, Dr. Anthony Alessi, and it’s great to be with you for what has come to be known as our deep dive, and that is where we look at the most recent podcast we did and try to drill down on some of the topics that were only able to glance over. This particular podcast was done last week with Commissioner Andrea Barton Reeves. Ms. Barton Reeves is the commissioner for the Connecticut Department of Social Services. That is the part of our state government that oversees Medicaid, and Medicaid is a pretty general term here in Connecticut. We refer to it as HUSKY, but we always think of it as just being this kind of handout program where it just takes care of one thing, like doctor’s visits. Medicaid is an all-encompassing program, and it’s done in conjunction with the federal government for people who qualify economically. Now these are people, many of whom work, but they don’t make enough. They are below what is determined as the poverty line, and when you’re below that, you’ll need some assistance in order to provide meals for your family, to provide health insurance or health care, which is the HUSKY program, and some of it is hospitalization. It is used for durable goods, such as crutches and canes. It’s used for home health care, so there are a lot of different facets of it. Among them is also the nutrition program. We call it SNAP, the Supplemental Nutrition Assistance Program here in Connecticut. People refer to it as food stamps in the past, or an EBT card. This also provides free breakfast for children. So it looks at a lot of different aspects, and there are over a million people who’ve received some form of Medicaid in the state of Connecticut. So that’s a big part of our population and it has a $9 billion budget. But as I mentioned, it’s got a lot to do with a lot of different services. One of the things we talked about is the importance of those services in terms of childhood development and the risk factors going forward. I brought up the idea of childhood separation, which is something we’re hearing a lot about with people who might be undocumented immigrants who came here trying to find a better life for themselves now being separated from their children. And it brought to mind something we mentioned, which is the ACEs score, the Adverse Childhood Experiences score or survey. And this is a survey that was designed to look at experiences in childhood before the age of 18 that may in some way impact the future of children, specifically with respect to health. There are a lot of variations on the ACEs survey, but particularly what they look at are childhood experiences related to trauma, meaning death in the family, shooting. Was a parent or a close relative put in prison or incarcerated for a long period of time? Was there a lot of divorce or fighting in the family? Was it a broken home in some way, shape, or form? So these are all experiences. Also more violent ones: Were they witness to a crime? Did a close relative die by suicide? And what they have done is really looked at the social outcomes and these scores. And it’s interesting because it has clearly shown that children with a higher adverse score were more prone for increases of injury to themselves, sexually transmitted infections, early pregnancy were among them, but also chronic illnesses like cancer, diabetes, heart disease, and taking their own lives by suicide. So these scores are quite important in terms of how they stress the entire social services system, and it’s important that we look at that. The other factor that we talked about are the social determinants of health. And the social determinants of health was something I brought up, because it’s a firm belief of mine that unless we address social issues, we’re not going to make progress in terms of improving the health. We all hear about this Make America Healthy Again. Well, we need to take a step back and look at how we got unhealthy. And if you look back at that, a lot of it has to do with how society has changed and how we have to deal with these social determinants. So there are five basic social determinants of health. We look at education, access to education, and quality of education for an individual. We look at health care, access to health care. Do you live in a rural community? Do you not have transportation to get to good health care? And what is the quality of the health care where you’re living? We look at your neighborhood or what we call the built environment. Where are you living in terms of the physical structure? Is it an apartment? Is it a house? And the next thing that goes with that is kind of the social and community context of where you’re living. Is it truly a community? Is it a supportive community? It could be a church community, it could be a very supportive neighborhood and ethnic community. But again, it’s an important determinant. And obviously the last one being economic stability, economic stability being so important for these social determinants of health. What I found interesting is, in looking at some articles on social determinants of health, is how it relates back to a previous podcast we did with Dr. Peter Schulman. Dr. Schulman impressed upon us the fact that heart disease has really changed. It’s been a paradigm shift from ischemic heart disease or heart attacks to now heart failure, where the pump begins to fail, the heart itself, whether it be by infection or primarily old age as we live longer. So with heart failure, we are trying to address that with different medications, a lot of different care. It’s very different from angioplasty and bypass surgery and things such as that. So a recent article looked at people who were hospitalized for heart failure and they wanted to look at the readmission rate. So this has been a big factor throughout health care and something we monitor, when someone is in the hospital and gets discharged, how long before they are readmitted for the same problem? Right? Because when you’re thinking about it, you start thinking, “Well, maybe we didn’t fix the original problem and that’s why they needed to come back. Why did these people have to come back?” And what they found was in heart failure, one of the biggest reasons for people being readmitted were these social determinants of health, meaning we addressed the problem, but they were going back to an environment which was not supportive. They did not have good access to health care. They did not have the support. They lived alone, for example, didn’t have a support system for them, or it was just basic economic stability. Could they afford these very expensive medications to keep them out of heart failure? So I think when I came away from the interview we did with Commissioner Barton Reeves, it was awakening for me to see that how much her whole department really impacts everything we do in health care at UConn Health. And I think it’s important for us as people who deliver health care, as those of us who are friends of people who are ill, is that we have in the back of our minds how to keep our patients healthy, and work with them and ask more questions about their social position and what support services they have, after we treat patients. With that, I look forward to our next encounter. Next week we’re going to be chatting with my boss here at UConn Health, Dr. Isaac Moss. We did a taped interview with him that I know you’re going to enjoy about spine surgery, but also what’s it like being chairman of a department of a very busy, active department here at UConn Health? And I think you’re going to be amazed when I ask him the question of, what does the future look like in spine surgery? Many thanks for listening today, as always. If you have any questions or ideas for future programs, you could reach out to me at [email protected]. Jennifer Walker is executive producer of the Healthy Rounds podcast. Chris DeFrancesco is our studio producer for the podcast. Tessa Rickart is in charge of social media for Healthy Rounds. Until next week, this is Dr. Anthony Alessi. Please stay healthy.

Recognizing and addressing social determinants of health can have a great impact on our overall well-being. That also goes for the people who are responsible for the care of others, be it their children or an aging or sick relative. Connecticut has a number of services and programs available to help, and Department of Social Services Commissioner Andrea Barton Reeves joins Dr. Alessi to explain them, clear up misconceptions around some of these programs, and discuss some of the challenges around social services in 2026. Commissioner Barton Reeves recently joined the UConn Heath Board of Directors. Submit questions for Healthy Rounds: [email protected] DSS Commissioner Andrea Barton Reeves: https://portal.ct.gov/dss/knowledge-base/articles/home/dss-commissioner UConn Health: https://www.uconnhealth.org Support from UConn Health Orthopedics and Sports Medicine: https://www.uconnhealth.org/orthopedics-sports-medicine Grant support from Coverys: www.coverys.com Transcript Dr. Alessi: Welcome to the Healthy Rounds Podcast, where we provide up to date, medical and timely information from national and international leaders in their fields. This podcast is brought to you by UConn Health, with support from the Department of Orthopedic Surgery and a grant from Coverys. It is not designed to direct your healthcare, which should only be done by your physician. I’m your host, Dr. Anthony Alessi, and it gives me a great pleasure to have as my guest today, Commissioner Andrea Barton Reeves. Commissioner Reeves is the commissioner for the Department of Social Services here in Connecticut. She’s also a recently appointed member of the Board of Directors of UConn Health. Welcome to the podcast. Commissioner Barton Reeves: Thank you for having me. Dr. Alessi: Let’s start out. You’re an attorney. What drew you to your career in advocacy? Commissioner Barton Reeves: I would say that my parents were always, they were people that were very clear that we owed more to our community than just being three privileged children. So my father was a physician, he was a board certified child and adolescent psychiatrist, and my mother was a nurse. She held a master’s degree and she taught at Columbia and worked at a large hospital in New York. But they were immigrants. They came really with nothing and worked very hard to get their own educations and to educate my brothers and I. But in the course of that, they made it clear that they actually had careers and, you know, in the medical profession that gave back to people. And because so many people had made their lives and the success in their lives possible, that we had a responsibility to do that as well. So I think it’s been ingrained from the time I was very young. It’s my nature and all my brothers and I, we all are in similar fields in the helping professions and do very similar work. Dr. Alessi: What a great legacy for your parents. You might be wondering why I’m having you on. Most of our guests have been physicians, but I wanna let you know that I firmly believe that the key to better health starts with the social situation of patients, whether they’re homeless, whether they have enough to eat, and now we’re hearing a new term, right? The social determinants of health. Commissioner Barton Reeves: That’s right. Dr. Alessi: And with that here in the state of Connecticut, we have a Medicaid program. Can you talk a little bit about the program and somewhat profile the people who are on it because there’s so much misinformation and disinformation out there. I read a recent opinion piece where they touted the fact that the people on Medicaid are here illegally, they are undocumented people. And I know that for a fact that that is not the case. So can you really talk to us a little bit about who are the people on Medicaid in Connecticut? Are they working? Who are these people? Commissioner Barton Reeves: Sure. And thank you for this opportunity because there is so much disinformation and really I think negative stereotyping of people who are on Medicaid. People who are on Medicaid can be individuals or families. And your eligibility for Medicaid depends on what percentage of your income places you at or below the federal poverty level. And it’s a large, complex calculation with lots of charts and we won’t go into that, but in this state, over a million people are on Medicaid. What people also don’t understand is Medicaid is complex in the sense that it’s not just an individual or collective insurance policy for working adults or for children. Medicaid dollars also pay for care in hospitals, and they pay for long-term services and supports with people who are at home. And Medicaid dollars also pay for federally qualified health centers and places where people get lots of care, and I don’t think people really understand that, and they believe that we’re spending the amount of money that we spend, we have a $9 billion budget for Medicaid in this state, but it also goes to pay for pharmacy. And as I mentioned, it pays for people to be able to live at home, to stay out of nursing homes. It pays for acute care in nursing homes. It pays for a number of things that aren’t necessarily what people believe is their own belief around Medicaid, which is a person who is deliberately trying to suppress their income so that they can become Medicaid eligible. That is far from the truth of how this works. It also covers so many people who are disabled and can’t work. And so that there is no single profile of people who are on Medicaid, simply put. For every person that’s on Medicaid, it is a different and unique story. Dr. Alessi: More recently, there have been changes in the regulations, right? Especially with result to the Supplemental Nutritional Assistance Program in terms of work requirements. And when looking at that, I found that interesting because it’s almost like the old HUSKY C we used to have where someone would have to be either working, looking for work, but in this case volunteering is one of the factors. As I’m sure you are, I’ve been a big advocate for volunteerism, even in people when a patient tells me, “well, I’m retired”. Well, what does that mean? What are you doing? Okay, because there are people who need your help. So, can you talk to me a little bit about how is that gonna work? How are people supposed to do that? We know, and I think the number is what, 350,000 people, or some ridiculous number. They’re not gonna go out and find a job, so they’re either going to have to claim disability or volunteer. Commissioner Barton Reeves: Well, let me try to provide some context around the numbers. The changes that happened in HR1, OBBBA, the One Big Beautiful Bill, all the ways that people refer to it only reference a specific population in Medicaid. It is not the entirety of those who are on Medicaid. So the vast majority of people who are on Medicaid in this state that include all the populations that I just named, they are not impacted by this. It’s only what we call our HUSKY D because our program here in Connecticut, right, is called HUSKY. That’s Medicaid, right? Lot people don’t know that either, and that’s what we call the expansion population. Those are people who, during the Biden administration, were given an opportunity to join the Medicaid program who normally would not have qualified because they’re just a bit over income and a bit over the assets for what you would normally have, but still not enough to be able to provide themselves private insurance. As an incentive to have more people enrolled in Medicaid, which are fewer people that are uninsured, right, conversely, we were offered, and all states who agreed to this were offered a very generous federal match of 90% of what we spend, and then the state would have to come up with the 10%. So now for the expansion states, as we call them. In this state, we have 365,000 people about who are in that expansion population. About a third of them are at risk of being impacted by these newly changed rules for what we call HR1, meaning that if they cannot find a way to fit into the categories of exemption, then they’re gonna have to find a way to provide proof of being involved in community engagement. And, you know, the same thing, it’s called work requirements. Those terms are used interchangeably. But it means that they have to volunteer, they have to work, or for Medicaid, they have to have income that’s equivalent to $580 a month, which is really the federal minimum wage times 80 hours or some combination of those monthly in order to continue to qualify for Medicaid. If they can’t, then they’ll drop off. Then they have to find a way to get back on by complying with the 80 hours. Conversely, or comparatively, SNAP is completely different. The Supplemental Nutrition Assistance Program has always had work requirements. This is what people don’t know, right, they’ve had it since 1971. But now with HR1, there’s been some changes in the categories of people who were formally exempt from those work requirements that now are, so now it’s up to age 64. If you’re caring for a child who’s up to the age of 14, you may be exempt. If you’re caring for a child with a disability who’s up to the age of 18, you’re no longer exempt because you or your child is no longer in that exempt category. Kids who were formally in foster care and then they aged out at 24, they were exempt before. They’re not exempt now. So that new category of people under SNAP now, they also have to find work using the SNAP rules, which have not changed. And then in this state, the Medicaid rules that are now nationwide apply to people on Medicaid, which has never happened in Connecticut before. There are other states that had work requirements, Kentucky, Georgia, a few others. Some were more successful than others, but now every state has them because of the new federal law. So that’s really how it works. Dr. Alessi: So will we now have to monitor to make sure people are doing their volunteer hours? Commissioner Barton Reeves: Well, not necessarily “we”, you know, the royal, “we” state of Connecticut. But there will be, and there have to be reporting requirements. So that’s part of what every state now has to figure out how to hire a vendor who will adjust our systems and make all the changes so that people will be able to report. Yes, I no longer fit into the categories of exemption, and I have to meet the work requirements for Medicaid and SNAP. Here’s how I’ve been doing that. I’ve been volunteering 10 hours at the library. I’ve been, you know, 5 hours at the hospital and I’ve got a job where I work 20 hours a week. Or for Medicaid, I’ve done those things or I don’t need to do those things because I do have $580 a month in income, whatever that looks like. Yeah, so we have the responsibility to do that. That’s built into the statute. We have until January of 2027 when it becomes live for Medicaid. And we are running furiously at this moment to get everything ready so that when people start to be subject to these requirements in January for Medicaid, we will be ready for them. Yeah. Dr. Alessi: I’m gonna shift gears a little bit. Commissioner Barton Reeves: Sure. Dr. Alessi: In your career, you’ve been a particular advocate for children. Commissioner Barton Reeves: That’s right. Dr. Alessi: You were the guardian ad litem, and, the past few days, we have all been focused on Liam Ramos. Okay, an undocumented child. One study came out today and said that he’s just one of up to 4,000 children who have been detained because their parents are undocumented. We’ve not heard those stories here in Connecticut. And, for some reason I think we’re somewhat protected. Are these children safe here in Connecticut and what can we be doing to keep them safe? Commissioner Barton Reeves: I wish I knew the answer to that question. I think it’s hard to define what safe looks like because the behavior of those that are charged with enforcing our immigration laws appears to be unpredictable. So we don’t really know what safe looks like. We’ve seen children across the country moved from schools, you know, kind of picked up off the street, at the grocery store, wherever there happens to be. But I would say this, knowing what I know, in the 10 years that I’ve represented children, whatever children are violently and unexpectedly separated from their families, there is significant trauma that they experience. There is no question about it. Dr. Alessi: Absolutely. Commissioner Barton Reeves: And the child’s ability to recover from that resiliency has everything to do with what happened to them during the time that they are away from their families and how well they’re supported when they return. Some children will be deeply affected for a very long time by what has happened, and some children will be affected but not necessarily scarred, and they’ll be able to move on with their lives, but will always have had that experience. We tend to think that children sometimes are little adults or that they should be expected to get over very traumatic circumstances, but I can tell you that especially within the first five years of their development, traumatic separation from family can shape how they grow up for the rest of their lives. So, you’re absolutely right and we all are to be very careful and very mindful about the indiscriminate ways in which we’ve seen children separated from their families and detained because the long-term damage from that that we’ll see societally, we haven’t even begun to measure yet. Dr. Alessi: Yes, and many of us are familiar with the ACEs survey, right? The Adverse Childhood Experiences survey, in which we have found that these experiences not only lead to psychological issues of PTSD, but diabetes, hypertension, obesity. So, you know, again, we get to the social determinants of health. You know, I take care of a lot of patients who have had brain injuries as a neurologist. And one of the programs, if you could talk a little bit about, is where in home assistance is given by a family member and, is that only for traumatic brain injury or has it been extended to other people? For example, people with stroke who would otherwise be in a skilled nursing facility? Commissioner Barton Reeves: That’s right. Dr. Alessi: Can you bring us up to speed a little bit about that? I think a lot of physicians would be interested in that. Commissioner Barton Reeves: So the state has a program known as Community First Choice. We refer to it by its initials, CFC as an acronym, and it is a program that is designed to provide individualized support in the home for people that need it. Not just people with traumatic brain injury or stroke, but people who may have significant physical disabilities who without the support would most likely end up being in a long-term facility or a nursing home. There are two ways in which the state provides this support. One is what we call agency based care, and there are other private agencies that actually hire, excuse me, personal care attendants, PCAs, that go out into the community to a person’s home and provide them with support. Then there is another population that is known as self-directed care. So, we have people who act as their own employer. And they can hire the personal care attendant that they’d like to care for them in their home, and that can include a family member. And there’s a whole process for that to occur. It does help people be more independent. It does help keep people out of nursing homes, which we know can be very expensive and a congregate care setting, and it can help to contribute to a much better quality of life. It can. Dr. Alessi: You know, there are so many topics, and we could go on and on. But in closing, I’d like to ask you, if you were to design your own social services system, what would it look like? Commissioner Barton Reeves: Such a great question. I would love to see social services be more individualized because we serve so many people, many states, not just ours. We’re in a legacy system where people have to go to 1 of 12 offices. They’re out usually in the middle of an industrial park, and people have to find their way to us. It would be so much better if we had smaller spaces that were more connected to individuals in their communities where they could talk face to face to someone and not be on a line and not be in a building looks like a bus stop. You know, that’s my greatest wish is that we could really deliver services differently so that people could have the dignity that they deserve. Just because you need Medicaid and SNAP doesn’t mean that you don’t deserve dignity, and I’d really love to see that change. Dr. Alessi: I think that’s so important, especially the individuality of it because not everybody fits into the same box. And have different situations. So I really appreciate it. Commissioner, I can’t thank you enough. It’s really been an honor to chat with you. I hope at some point we continue the conversation and thank you. Thank you for your time. But more importantly, thank you for everything you are doing for the people of Connecticut and our patients. Commissioner Barton Reeves: I appreciate that. Thank you so much. Thanks for having me. It’s been great. Dr. Alessi: Thanks. If you have any questions or ideas for future programs, you can reach out to me at [email protected]. Jennifer Walker is Executive Producer of the Healthy Rounds podcast. Chris DeFrancesco is the Studio Producer for the Healthy Rounds podcast. Tessa Rickart is in charge of social media. Until next time, this is Dr. Anthony Alessi. Please stay healthy.  

Dr. Alessi revisits his American Heart Month conversation with UConn Health cardiologist Dr. Peter Schulman, drilling down on advances in prevention, treatment, and management of heart disease, heart attack, and heart failure, how they've changed over the years, and further changes potentially on the horizon. The Healthy Rounds Podcast at UConn Health: https://www.uconnhealth.org/healthyrounds Submit questions for Healthy Rounds: [email protected] Dr. Peter Schulman: https://www.uconnhealth.org/providers/profiles/schulman-peter Pat and Jim Calhoun Cardiology Center at UConn Health: https://health.uconn.edu/cardiology/ UConn Health: https://www.uconnhealth.org Support from UConn Health Orthopedics and Sports Medicine: https://www.uconnhealth.org/orthopedics-sports-medicine Grant support from Coverys: www.coverys.com Transcript Dr. Alessi: Welcome to the Healthy Rounds Podcast, where we provide you with up-to-date, timely medical information from national and international leaders in their fields. This podcast is brought to you by UConn Health, with support from the Department of Orthopaedic Surgery and a grant from Coverys. It is not designed to direct your personal health care, which should only be done by your personal physician. I’m your host, Dr. Anthony Alessi, and it’s great to be with you on what has become known as our deep dive. And this particular episode of our deep dive is dedicated to a show we did with Dr. Peter Schulman last week. As you’ll recall, Dr. Schulman is a cardiologist and professor of medicine here at the University of Connecticut, where he has practiced for 44 years, and he has been a cardiologist for longer than that. But before we get to Dr. Schulman, I want to go back to something that was discussed in a previous episode with Dr. Juthani, and that was the use of messenger RNA. We’re hearing a lot about that this week, because the Food and Drug Administration refused to review a flu vaccine that is based on messenger RNA, that’s put out by the Moderna company. And they really haven’t given good reason for why they have refused to review this. Now, let’s take a step back, because we know that the current administration has stopped research to the degree of $500 million cut, just on the topic of messenger RNA. And that’s because there is misinformation out there -- I almost think it’s disinformation, but it’s misinformation -- that messenger RNA, somehow changes a cell structure, and that’s not the case at all. Dr. Juthani used a good example of it, but I’m going to go a step further. Messenger RNA is just that. It’s a messenger. It brings a message to a cell. Think about it this way: If you were to order food from Uber Eats or DoorDash, right, that food is brought to your door by a messenger, he leaves the food and then leaves your premises. Think of messenger RNA as just being that messenger. He doesn’t come in your house and start telling you how to rearrange your furniture. He just brings the message about what it is your body needs to be fighting, in this case, the flu. Now, one of our problems is that we keep coming up a little bit off target when it comes to influenza, and Dr. Juthani explained that it’s because we have to decide in February. So right now in February, we’re deciding what flu we’re going to be fighting in the fall. We base that on information that we get from the southern hemisphere with the flu. That is the flu strain that is most prominent there. It takes a long time because you grow it in eggs and that’s how you produce the vaccine messenger RNA. And thanks to Operation Warp Speed, we are now able to come up with a vaccine in a much shorter period of time. So let’s think about it. If we could do it in a shorter period of time, we will have a better idea of what our target is. For influenza that year. So now we’re talking about instead of February, possibly doing it in May or June when we have a better idea of the target and a better chance of hitting it. So again, I want to emphasize the fact that messenger RNA is purely a messenger and it’s not changing your cell structure in any way. But let’s get to our discussion with Dr. Schulman, which we put out on the airwaves on February 9, and that is, we wanted to get him on because this is American Heart Month. That’s something that was started in 1964 by Lyndon Johnson, and they did it to coincide with Valentine’s Day and the heart. And I guess, many of you listeners are probably my age or thereabouts. And remember, the one thing about the heart I remember is, Dr. Christian Barnard, right? Dr. Barnard, on December 3, 1967, he performed the first human heart transplant into a fellow by the name of Louis Washkansky in South Africa. Now it only lasted 18 days and, and that was ostensibly because we didn’t really have immune-suppressant drugs that would avoid this rejection of the heart. But it suddenly really brought to light that great things were possible. And indeed, great things have developed since 1964. In a recent study -- and this is because I like to know, are we getting our money’s worth out of something, right? So we’ve made changes in our lives, changes in our lifestyle that Dr. Schulman talks about, right? A better diet, stop smoking, exercise regularly, and, and taking newer medications, but has it made a difference? And it’s interesting because a recent study published looked at heart disease mortality, so everybody who died of any heart disease from 1970 to 2022, and those deaths are down by 66%, the biggest drop being in ischemic heart disease, the typical heart attack from a clogged artery. That dropped from 91% of the overall deaths to only 53%. But what we have also seen is an increase in heart failure, where the heart, as Dr. Schulman again explained very clearly, the pump of the heart begins to fail. And a lot of that is because we’re getting older. So there are newer medications to really work on that because heart failure was up 146% since 1970. So again, we really want to emphasize that we’re making great strides, but now we are redirecting our efforts to a large extent. The other things we talked about that were really most striking, we had a question from Bob about taking aspirin -- and again, if you have questions for me or things you want to address on the show, you can go to [email protected] -- and this was a question about aspirin. At first everybody thought everybody should be taking a baby aspirin as you got older. But again, it’s something you need to discuss with your physician because there are certain risks to doing that. But the other thing we talked about was cardiac arrest. We’ve gone through great efforts to have programs to teach people CPR and how to use these automatic external defibrillators, the AEDs, and these are very important devices if we’re going to save lives. But once again, I asked him, has it been worthwhile? And what was interesting to me, that 90% of deaths from heart attack occur before getting to the hospital. But when we looked at CPR and AEDs, we looked at the survival being about 25 to 35%. So again, if you have. A cardiac arrest where your heart stops outside the hospital, you still only have a 30% chance of survival. But again, we do know that the quicker you have CPR or use an A ED, your chances of survival are better. But when you address the issue of, am I having a heart attack? Everybody has come up against this, and we hear about this all the time: I’m not sure if it’s indigestion. I’m not sure if it’s a heart attack. Dr. Schulman made it very clear that cardiologists don’t mind a false alarm here because 90% of the deaths from heart attack -- so everybody who dies from a heart attack, 90% of those -- occur before getting to the hospital. So it’s important, I think if there’s one message to take away from this podcast, it’s that if you believe you are having symptoms of a heart attack, the typical ones crushing chest pain, pain radiating from your chest to your jaw, to your left arm, or both arms. Any of those signs, especially the crushing chest pain, shortness of breath, get to an emergency room, it will certainly in many cases, be lifesaving. One of the best parts of all our shows I enjoy is when we ask our guests. What will we imagine in the future, 40 years from now? What is the treatment of heart disease going to look like? And it was so interesting hearing from Dr. Schulman, because he talked about rebuilding the heart. Because we talked about that heart failure number having gone up. How do we rebuild the heart? And that’s where he thinks the greatest strides are going to be made, either by using stem cells that can be used for growing new heart muscle, or devices that can be placed in the heart, even just through the groin, that would again help the heart to pump more efficiently. Well, anyhow, I think that’s about it from my end here. I really enjoyed Dr. Schulman and all the information he was happy to share with us, and I hope you’re enjoying this deep dive as we do them, and the guests as we come up with them. Next week, I’m excited because we taped an interview with my guest, who will be Commissioner Andrea Barton Reeves. She is the commissioner for the Connecticut Department of Social Services, and we had a lively discussion about Medicaid, the people who are on Medicaid, and a lot of, again, misinformation that’s out there about the Medicaid program and SNAP programs here in the state of Connecticut. If you have any questions or ideas for future programs, as I always mention, reach out to me at [email protected]. Jennifer Walker is executive producer of the Healthy Rounds podcast. Chris DeFrancesco is the studio producer for our podcast, and Tessa Rickart is in charge of social media for the Healthy Rounds podcast. Until next time, this is Dr. Anthony Alessi. Please stay healthy.

Heart disease and heart attack are much more treatable, manageable, and preventable today than they were 40 or 50 years ago. For American Heart Month, Dr. Alessi speaks with Dr. Peter Schulman, UConn Health cardiologist, about the evolution of care for and prevention of cardiovascular disease, from medications to procedures to lifestyle changes. Still, some things haven’t changed, including the crucial difference early intervention, defibrillation, CPR, and getting to the hospital as soon as possible can make with a suspected heart attack. They also discussed the evolving recommendations on baby aspirin, the current and future state of statins, the difference between the sexes when it comes to heart disease, and the continued trajectory of cardiology care in the future. Submit questions for Healthy Rounds: [email protected] Dr. Peter Schulman: https://www.uconnhealth.org/providers/profiles/schulman-peter Pat and Jim Calhoun Cardiology Center at UConn Health: https://health.uconn.edu/cardiology/ UConn Health: https://www.uconnhealth.org Support from UConn Health Orthopedics and Sports Medicine: https://www.uconnhealth.org/orthopedics-sports-medicine Grant support from Coverys: www.coverys.com Transcript Dr. Alessi: Welcome to the Healthy Rounds podcast, where we provide you with up-to-date, timely medical information from national and international leaders in their fields. This podcast is brought to you by UConn Health, with support from the Department of Orthopedic Surgery and a grant from Coverys. It is not designed to direct your personal health care, which should only be done by your physician. I’m your host, Dr. Anthony Alessi, and it gives me great pleasure to welcome my guest today, Dr. Peter Schulman. Dr. Schulman is a professor of medicine here at the University of Connecticut, where he is also a cardiologist and has worked in the Department of Cardiology for the past 44 years. Peter, welcome to the show. Dr. Schulman: Thank you very much. I’m happy to be here. Dr. Alessi: So, this is American Heart Month and it’s kind of interesting ’cause it’s one of those concepts that’s developed over time where we make people a little bit more aware of heart disease. But I’d like to take a step back a little bit, since you’ve been here 44 years and you and I are relatively of the same generation. Can you talk a little bit about kind of the evolution of cardiology and the things you’ve found over the past 44 years? Dr. Schulman: Well, that’s a very good question. I think I would almost call it a revolution, but evolution is pretty good. So, I was just thinking back on this, when I started cardiology practice more than 45 years ago at one other institution, if you had a heart attack and you survived the heart attack, you would probably have your second heart attack within 5 or 10 years, almost for sure. Because there was such a high risk of recurrent heart attacks, we didn’t have ways to prevent the second heart attack once you had one. Actually, we didn’t even have ways to reduce your risk of your first heart attack. Now, 45 years later, in 2026, we not only have ways to dramatically reduce your risk of your first heart attack, but should you be unfortunate enough to have one, we can substantially reduce your risk of a second heart attack. So, people who have a heart attack, that may be the end of it. They may have no further heart problems for the rest of their lives, and that’s what we’re striving for. Now, the same thing happened in heart failure. If you had severe heart failure back 50 years ago, if your heart was weak, well, sorry about that, but you probably would not live another 5 or 10 years. Your heart function, it’s like a motor of a car, would just lose horsepower over the years and decades and you’d be possibly gasping for breath in 5 or 7 years. Heart function would decline inexorably, just keep on going down. Nowadays, we have ways to reduce the risk of heart failure, and we have ways to actually improve heart function if you already have a weakened heart. We have whole host of medications and many are very new within the last 5 years and we have devices that can strengthen the heart. So really, it’s major advances in heart disease prevention, heart disease treatment, and patient wellbeing that I’ve seen over the past 50 years. Those are just two examples. Dr. Alessi: You know, that’s interesting because you talked about, you know, this revolution in medication as opposed to the more sexy things, right? The angioplasties, bypass surgery, so many of them, replacing valves through a catheter. I mean, those are the things you hear about and yet, I’m impressed that we’re hearing about the medical things, in terms of treating with drugs, as opposed to those. Have those things changed things a lot? I mean, it used to be an angioplasty was a big deal. And now it’s kind of routine, isn’t it? Dr. Schulman: That’s correct. If you have a blocked artery, let’s say from, you have a heart attack and that’s usually due to a blocked artery, you can have an angioplasty. What that does is they put a little tube in the coronary artery. That’s the artery that supplies the heart with blood and oxygen, like the fuel line to our car. If that gets clogged, you can go in there with a little tiny balloon at the end of this long tube, open up the balloon, open up the blockage, and then put a stent in there, like the spring from a ballpoint pen. It expands, it stays open, and it keeps the vessel open sometimes permanently. That’s all you’ll need. The stents never come out, they stay in the heart, and the heart tissue grows over the stent so that it almost becomes a new artery again with no blockage whatsoever. So yes, that’s a sexier way of treating heart disease. But if we can prevent heart disease from the beginning, that would be a better way. Now, you brought up the sort of sexy way to treat heart disease. Now we’re realizing now that you can make lifestyle changes and a lot of them are very helpful, like getting more exercise, keeping an ideal weight, not smoking cigarettes, making sure your diabetes is controlled, keeping your weight controlled, diet, et cetera. We realize now that that can be helpful. The lifestyle changes are important, but the newer medications really sort of outrun the lifestyle changes, so you should be doing both, in many cases. Dr. Alessi: And that brings up, I had a listener question to bring in, and Bob had asked me this question, and the question was about a baby aspirin. Now, you know, we’ve gone through these changes where, you know, when I was in training, we all knew that well, most doctors are taking a baby aspirin every day. We know it reduces heart attack and stroke. And then we start hearing that aspirin can also reduce colon cancer. And then all of a sudden more data says it’s not that useful. Where are we on the use of a baby aspirin? ’Cause it, it seems like such a benign way of causing such a catastrophe. Dr. Schulman: So, that’s very interesting, baby aspirin. It has gone both ways about 81 milligrams. Some countries actually use 75 milligrams, some use 100 milligrams. Well, it turns out that aspirin does reduce the risk of heart attack and stroke in just about everybody. However, in many people, and if your risk is very low, that is taken into consideration. The other side of the coin with aspirin is that it slightly increases your risk of bleeding, so you can have a bleed into your brain. So, every recommendation is based on trying to balance the risk of taking aspirin, causing bleeding, versus the benefit of aspirin reducing the risk of a stroke or a heart attack. So, in general, the long story short is that for people who’ve never had a heart problem and don’t have a ton of risk factors, we generally do not recommend aspirin because even though it does reduce the risk, your risk is already so low, and your risk of a bleed into the brain is not very big, but it’s a little bit higher with aspirin. So balancing risk/benefit. Most people with no heart disease, no stroke in the past, we would not recommend aspirin. Dr. Alessi: Okay. Alright. Thank you for that. Bob, you got your answer now. And in talking about American Heart Month, I wanted to talk a little bit about something probably less sexy than even medication, and that is, we’ve had this revolution of using CPR and defibrillators and making them more available. How has that impacted cardiac disease and cardiac death in the field? I mean, are we wasting our time or has this been, do we have real data to support putting money behind that and training people? Dr. Schulman: Well, we do have data to support that. It turns out that the quicker that if someone has a cardiac arrest, out of a hospital, in the hospital it’s different, but if someone has a cardiac arrest outside of the hospital, their recovery, their neurologic recovery, in other words, how well they can function, and their probability of survival depends on how quickly the CPR is given and how quickly the patient is defibrillated, if there is a portable defibrillator on site. It’s called an AED, “automatic external defibrillator”. So, yes, there are data that shows that the quicker you get those treatments, the greater the survival. Unfortunately, the overall survival in out-of-hospital cardiac arrest is not great. If you have a cardiac arrest, a true cardiac arrest, it’s probably in the neighborhood of 25, 30, 35%, something like that. So, there’s a pretty high chance you’re not going to make it. But, if someone, if a man has a heart attack and the wife knows CPR and can get EMS to the house, to the patient very quickly, then there’s a much greater chance of survival. And one thing that brings up, if someone is having a heart attack, the chance of a cardiac arrest is higher. So, it’s important to realize that 90% of deaths from a heart attack occur before the patient reaches the hospital. So, the best thing to do if you’re having a heart attack or you think you even might have a heart attack, is get to the hospital very quickly. If you end up in the emergency department, you have already jumped over 90% of the risk of dying from that heart attack. So, we cardiologists would rather see a few false alarms. You know, people have crushing chest pain and maybe it’s heartburn, but we don’t know at that time. Better to get to the hospital, let the ED figure that out, because if you do have a heart attack, we could provide treatment immediately and it’s dramatic in improving the chance of your surviving and improving your long-term health. Dr. Alessi: Wow, I didn’t realize it was that big a hurdle. That’s so important for us to know. What’s the most common thing you see in your practice? Over the years, has that changed? Is it mostly coronary artery disease? Is it valvular disease? What do you usually see? Dr. Schulman: So, the most common, basically the most common disease is coronary artery disease, heart attack, and stroke to a lesser extent. But stroke is still important. So, heart attacks and coronary artery disease - that’s blocked arteries that supply the heart muscle with blood and oxygen - that’s still the most common. But now that people are living longer and healthier, we’re seeing a lot of other conditions. We’re seeing heart failure, and that means that the heart, it’s not failing completely, but it’s failing to do its job properly. Heart failure comes in two different shades, one of which is a weak pumping heart, that’s called systolic heart failure. And the other is a not-well-relaxing heart. It’s too stiff, and that’s diastolic heart failure. Both of those are becoming more important. And the other condition that’s very common, more in the senior population over the age of 70 and 80 is atrial fibrillation. And that’s a condition where the heart rhythm is, the upper chamber is beating very fast and irregular, and the main issue, the main risk of atrial fibrillation, is you know, is stroke. Dr. Alessi: Yeah, it’s interesting that you say heart attack and stroke, because I guess the old saying is “if it’s happening in your heart, it’s happening in your brain at the same time” when it comes to cerebral vascular disease and cardiovascular disease. Dr. Schulman: That’s exactly right. And we tell patients that coronary artery disease means cholesterol buildup, atherosclerotic cholesterol buildup, sludge in the arteries. That can be arteries in any place in the body. It could be arteries in the heart that cause a heart attack, arteries in the brain cause a stroke, arteries in the leg that cause peripheral vascular disease, and many other places too. Dr. Alessi: I’m going to shift gears a little bit since we’re moving into that topic a little bit, and something I didn’t anticipate us chatting about is the use of statins. In a neuromuscular practice I see people who try to shun the use of a statin, they’ve heard it makes you weak, things such as this. Can you talk a little bit about the benefit of being on a statin medication? Dr. Schulman: Yes, and we get that question every week in our clinic. Statin medication, what it does is it lowers the level of your bad cholesterol. And that is very helpful. Yes, every medicine we take can cause side effects. Statin side effects that are significant are maybe 5%, and if you stop the statin, the side effects go away. So, it’s basically a very safe drug. Some people think there may be a teeny, very, very small incidence of diabetes that’s triggered by that, but that is infinitesimal. It’s so tiny. But the benefit of risk reduction for heart attack is dramatic. You can reduce your chance of a heart attack by 25 or 30% or even more by taking a statin. So, patients ask me, “well, what are the side effects of statins?” So I tell ’em, “Yeah, a few percent of muscle aches, is very rare. You stop it, it goes away. What are the side effects from not taking the statin is a heart attack and a stroke. So take your pick.” Dr. Alessi: Yeah, it’s a good way to put it. And I think about that because, I mean, when we started practice we didn’t have these drugs, really. Lipitor, Crestor, things like that, you know. It has made a big difference. The other thing in American Heart Month, recently, we’ve emphasized heart disease in women. And is that because they’ve been kind of an ignored population? I think have they thought that in the past that women didn’t get heart attacks. What has happened there? Why the need for more awareness now? Dr. Schulman: Yes, many of the things you mentioned are correct. So, women were felt initially to have a lower risk of heart attack. Partly in the past, because there were fewer women who were smokers. The women were less likely to have more of the risk factors, hypertension, et cetera. Now we see that men and women are more alike from a physiologic standpoint. Women are more commonly in the workforce. The instance of smoking is closer to the same, the instance of diabetes. So, all the risk factors for developing heart disease are the same. And then on top of, so women for initially underrepresented or non-represented in major clinical trials. For example, the first major trial of heart disease was the Framingham study that was started in the late 1940s. And there were no women included. There were about 4, 5,000 men from Framingham, Massachusetts who were studied to see who would develop heart disease and what risk factors they had. So now we recognize that more frequently women are getting heart disease. But, the other side of the coin is their symptoms can be atypical. So, women in heart disease, it’s in part an effort to assure that physicians and cardiologists and primary care providers are recognizing that A) women can have heart disease just like men, and B) the way that their symptoms could be somewhat atypical. So instead of, for example, a heart attack, instead of chest pain, like an elephant on the chest or a squeezing in the chest, women may have just shortness of breath, or weakness, or fatigue. So, we have to remember that those could be symptoms of heart problems, and we need to take those seriously. Dr. Alessi: If we were to have this conversation, I don’t know, 40 years from now, what do you think is developing in the field? What’s the future in terms of heart disease and treating heart disease? Is it in mechanics? Is it in medication? Is it genetics? What do you think we’re going to be? Or are we going to be dealing with routine heart replacements? What do you think? Dr. Schulman: That’s a difficult question. You know, I see patients coming into the office every day and I’m just trying to treat them for heart failure or atrial fibrillation. I think, number one, we will have major strategies to prevent heart attacks. For example, right now, if you don’t get your cholesterol lower enough to prevent a heart attack with a statin, there are now injectable drugs. There are a class of drugs called long name PCSK9 inhibitors. They inject under the skin. They substantially reduce the cholesterol levels to less than 40, let’s say. Dr. Alessi: Really? Dr. Schulman: And these drugs will be available in pill form in the next 2 to 5 years. So, we’ll start to get fewer heart attacks down the road. Heart failure will be treated with even more medication. Now we can, in most people, stabilize the weakened function of the heart. Few people, we can make it stronger. But, down the road we’ll have more medications that will clearly get the heart stronger. We may be able to infuse cells, stem cells that are targeted for the heart. They implant themselves in the heart muscle and they regenerate normal heart muscle so any weakened heart will be strengthened again. Dr. Alessi: Wow. Dr. Schulman: We’ll have devices. There probably won’t be heart transplants, there’ll be little battery powered, AA-powered mechanical hearts that we could just slip in maybe through the leg instead of by open heart surgery. I’m just speculating, I don’t know, but I see things going in that general direction. Dr. Alessi: Wow. Well, Peter, I want to thank you for your time today. But more importantly, I understand you’re going to be retiring this year, so I really want to thank you for everything you’ve done for our patients over the years and the care you’ve given them. So many patients speak so highly of you and the personalized care they’ve gotten from you, and I want to thank you for that publicly. Dr. Schulman: Thank you very much. Dr. Alessi: Many thanks to our guest today, Dr. Peter Schulman. If you have any questions or ideas for future programs, you can reach out to me at [email protected]. Jennifer Walker is Executive Producer of the Healthy Rounds podcast. Chris DeFrancesco is the Studio Producer for the Healthy Rounds podcast. Until next time, this is Dr. Anthony Alessi. Please stay healthy.  

Dr. Alessi dives further into the discussion he recently discussed with Connecticut Public Health Commissioner Manisha Juthani. Topics include how Connecticut stacks up against other states in terms of citizens' health, confusion over health recommendations and waning confidence in the federal government, the continued importance of vaccines, and potential lost ground on research as a result of a culture trending toward an attack on science. Submit questions for Healthy Rounds: [email protected] DPH Commissioner Manisha Juthani: https://portal.ct.gov/DPH/About-the-Commissioner  UConn Health: https://www.uconnhealth.org Support from UConn Health Orthopedics and Sports Medicine: https://www.uconnhealth.org/orthopedics-sports-medicine Grant support from Coverys: www.coverys.com Transcript Dr. Alessi: Welcome to the Healthy Rounds Podcast, where we provide you with up-to-date, timely medical information from national and international leaders in their fields. This podcast is brought to you by UConn Health, with support from the Department of Orthopaedic Surgery and a grant from Coverys. The podcast is not designed to direct your personal health care, which should only be done by your physician. I’m your host, Dr. Anthony Alessi, and it’s great to be with you for what we’ve come to be known as “the Deep Dive” in terms of looking back at a recent podcast we did. In this case, one we did last week with Dr. Manisha Juthani. Dr. Juthani is the Commissioner of the Connecticut Department of Public Health. She’s a medical doctor and a specialist in infectious diseases, and my conversation with her was very educational and brought out so many things that I didn’t know about the Department of Public Health and the vast job that she faces. We started off the interview by asking her how she ended up getting this job and it’s interesting because she related the situation where she was working at Yale and COVID was developing, and basically it was a situation where Governor Lamont felt that he had a confidence in her and really it was the fact that he saw something in her in terms of her ability to lead, that he brought her into his cabinet and into this executive role. And it relates back to my conversation with Dr. Agwunobi, who again talked about his father as an inspiration for him. And it brings to me in my own life that there are so many people who professionally inspired me to move ahead in the medical field. And, it’s something that I’ve always felt is as adults, we have somewhat of a responsibility to encourage young people to inspire them when they may not have that confidence in themselves to achieve great things, things that they want to do, whether it be medicine, whether it be business. If we recognize some attribute in that child or in that young person, it’s worth mentioning like, you know, “you really have a future”. And really those words from an adult can really change someone’s life, as it does for so many people. I think many professionals, many successful people, whether they be actors or sports stars again, have gone through that. Probably the single most important question I asked Dr. Juthani was, “are we safer living here in Connecticut as opposed to other states in this country?” And the reason I ask that is because we have seen such a dramatic change in leadership with respect to health here in the United States. People have lost confidence in the Centers for Disease Control. Just think about that. The Centers for Disease Control have been really the hallmark of research in many areas, and it’s been the hallmark for people throughout the world. And yet we here in the United States have lost confidence in them. That loss of confidence primarily comes from their positions now on childhood vaccination, and as she explained it, the difference is basically at this point surrounding three vaccinations. Here in Connecticut, we require 14 vaccinations that are administered at different points in a child’s development. The CDC has made three of those now optional, specifically measles, meningitis, and hepatitis. So, here in Connecticut, those are still required if a child is going to attend public school and be around other children. So, here in Connecticut, when it comes to these vaccinations, from that standpoint, we are somewhat safer because they’re still required. But the CDC has raised doubt. It’s raised doubt in parents’ minds that these vaccines may cause autism, for which there is no scientific proof, and we’ll get into some of that a little bit later. But, the point here is that you need to really discuss this with your physician, and I think everyone believes that. It’s also a thing that she mentioned that, so childhood vaccinations are administered to prevent disease. That’s the idea. To prevent polio, to prevent smallpox, or measles, any of these contagious diseases that could lead to death in some cases, or be crippling in the case of polio. Whereas as adults, when we get vaccines like the flu and shingles, as much as they may prevent disease, that’s not the overall objective. The objective is to prevent hospitalization. To prevent days lost from work, from enjoying your life, and put you at risk for other illnesses. So, you may still get a flu, you may still get shingles, but it would be such a mild form that you would not require a hospitalization, and that’s a very important distinction. So, we have a situation where there’s distrust. The other problem we’re having and that she brought out is when I asked her what keeps her up at night, what worries her the most, and her answer was very interesting from the standpoint that it wasn’t so much the future, when I asked what the future may hold. Her biggest concern is making up for lost ground. Are we going to be able to make up for the research that’s been halted and stopped because of federal funding? And specifically centering around messenger RNA. So, I thought it would be worthwhile to talk a little bit about that. It’s not just messenger RNA, but HIV research has also been set back. But, I did want to talk a little bit about messenger RNA because I think there’s so much misinformation about it. Messenger RNA is just what it says, a messenger. It is a messenger that brings information to cells that produce a protein. It’s a RNA is basically the recipe. Messenger RNA is something that’s just that, it’s a messenger. It’s only there for hours, maybe a day, and then it’s gone. When we design vaccines, the messenger RNA is basically the chassis. It is like when you go to buy a car, you buy a General Motors car, you’ll get a chassis. That chassis may be on a Suburban, it may be on a Cadillac Escalade, it may be on a GMC. It’s the same chassis, but they changed the body. And that’s the story, the same story we have with messenger RNA. It is the chassis for which you change the body based on what you are fighting. The big problem is, and messenger RNA provided it saved millions of lives just based on COVID. But now we are embarking on a situation where messenger RNA can treat a variety of cancers by creating personalized vaccines against someone’s own cancer, or generalized vaccines to target the cancer proteins and alter them, these destructive proteins. A recent study looked at people with lung cancer. And they looked at people with lung cancer who got the COVID vaccine, and those who did not get the COVID vaccine using messenger RNA. And what they found was that those who got the COVID vaccine with messenger RNA lived longer, across the board, lived longer than the people who did not. So again, we believed that the messenger RNA serves to prime our immune system, our own natural cells to fight this cancer. And it’s amazing that we are on the cusp of this, and yet all research has stopped pertaining to messenger RNA, based on the edict from the federal government. And as I mentioned, they stopped HIV. Another one, I mean, let’s talk about it. Acetaminophen, right? We are hearing about acetaminophen and the fact that acetaminophen can cause autism. That’s the latest thing we’ve been trying, that has been told to us, and that we have been fed, directly from the mouth of the president of the United States. But, again, a scientific study looking at 43 studies on acetaminophen during pregnancy concluded that there is no evidence that this painkiller increased the risk of autism or other neurodevelopmental disorders. And this was just published in The Lancet. But the point here was also that this looked at sibling studies. So, where twins both got acetaminophen, mom got acetaminophen during pregnancy, twins were born, one became autistic, the other did not. Had nothing to do with acetaminophen. That’s just common sense. But again, we’re being fed information that is false, and it’s part of the attack on science that we’re living with, and she made that very clear. But most importantly, I think again, it’s important to discuss these things with your physician. What that’s led to now are physicians being inundated with questions, and there are so few physicians. It was another part of our conversation was how do we encourage more people to go into primary care? Because it’s the primary care physician who you’re going to approach with these questions, and it takes time to answer them. So again, it puts our health care system kind of in a hole and somewhat behind. I came away from the interview with Dr. Juthani hopeful. Hopeful in the sense that we know that there are people in charge in our state who understand science and who understand how to keep us safe. But by the same token, it increased my frustration over the fact that we have ignored science, and we are moving in the wrong direction right now. With that, I thank you for your time today and really I urge you to listen to Dr. Juthani’s interview, as well as this Deep Dive, and reach out to me. If you have questions, if you have ideas for future programs, or questions I can go back to Dr. Juthani with, just reach out to me at [email protected]. As always, Jennifer Walker is the Executive Producer for the Healthy Rounds podcast. Chris DeFrancesco is our Studio Producer who’s taken time to put this all together as a Deep Dive. Be sure to listen next week as we kick off American Heart Healthy Month, and we talk about the importance of screening for heart disease and treating heart disease. My guest is going to be Dr. Peter Schulman, who’s a Professor of Medicine and a cardiologist here at UConn Health. Thanks again for listening, and until next time, this is Dr. Anthony Alessi. Please stay healthy.

Despite what’s coming out of Washington, Connecticut’s public health commissioner says the state has not changed its recommended vaccine schedule. Dr. Manisha Juthani joins Dr. Alessi to discuss the state of public health, beyond the confusion over current government recommendations. Topics include Connecticut’s standing among the most vaccinated states, the challenges of public health policy, access to health care, how the flu shot formula is determined, some of the Department of Public Health’s lesser-known functions, and how she came to be DPH commissioner. Submit questions for Healthy Rounds: [email protected] DPH Commissioner Manisha Juthani: https://portal.ct.gov/DPH/About-the-Commissioner  UConn Health: https://www.uconnhealth.org Support from UConn Health Orthopedics and Sports Medicine: https://www.uconnhealth.org/orthopedics-sports-medicine Grant support from Coverys: www.coverys.com Watch a video of this interview: https://youtu.be/BA1Tg6CXA9A Transcript Dr. Alessi: Welcome to the Healthy Rounds Podcast, where we bring you up to date and timely medical information provided by national and international leaders in their fields. This podcast is brought to you by UConn Health, with support from the Department of Orthopedic Surgery, in addition to a grant from Coveris. This podcast is not designed to modify or in any way influence your medical care. That should only be done with the cooperation of your physician. I’m your host, Dr. Anthony Alessi, and it’s great to have with me today my guest, Dr. Manisha Juthani. Dr. Juthani is a medical doctor and she also serves as the Commissioner of the Connecticut Department of Public Health. Dr. Juthani: Thank you so much for having me. Dr. Alessi: Manisha, let’s start with a little bit about your background. How’d you end up with this job? Dr. Juthani: It’s a really interesting story, actually. I was an Infectious Disease Physician in practice at Yale School of Medicine, was there for about 20 years, ran the fellowship program, saw patients, did research, and then the COVID-19 pandemic hit, and we as a hospital had to figure out a way to care for a hospital full of COVID-19 patients, had to expand our fellowship services from 3 services to 10 over three different hospitals. And as the pandemic wore on, the first wave was our biggest hit. And in the second wave, if you think back, it was December of 2020, and indoor dining had reopened in the state of Connecticut. And, we were seeing patients coming in who never left their home, but whose son went to a restaurant or a bar and came home and infected their immunocompromised mother. Or somebody who had just had a transplant who, again, never left their home, but whose relative went to a restaurant and brought the virus back home. Again, remember back to December, 2020, this was pre vaccines. Dr. Alessi: Sure. Dr. Juthani: And at that time, a friend of mine said, let’s write a letter to the governor complaining, and would you sign on asking him to shut down indoor dining again? And I said, yeah, I can sign on to that. And I’m seeing these patients myself. So I signed on. And the governor, to his credit, said, there are a bunch of these physicians complaining, and I think we should meet with them. So, he met with us and I told him the stories of the patients that I was seeing, and he said, you know, “Manisha, I think the people of Connecticut need to hear what you have to say, will you come onto one of my press conferences?” So I said, sure. And the next week I was on one of his press conferences. And even though I had a feeling the policy of the administration was not gonna change because I know the governor really felt like businesses had struggled, and if people were gonna gather, they were either gonna gather at home or gather in restaurants, so might as well let the restaurants stay open. And I thought that may be the case, but I still advised people what he asked me to do, and that really built a connection for us and a foundation for public health principles, maybe you could say. And six months later they asked me to take this job, which was a complete diversion from what I had done for 20 years of my life. And here we are, four years in running that I have stuck with it. Dr. Alessi: Do you like it? Dr. Juthani: I do really like it. And maybe part of that is in infectious diseases you are tasked with dealing with emergent problems and challenges, and I was brought into one, which was the COVID pandemic and public health, as you already mentioned, is the backbone of so much in our society. And so, I really started to enjoy more than just addressing the pandemic in the job. And now we’re in a phase where we are losing guidance from the federal government on certain things, and so now I feel a responsibility to the state to try to lead us during a time when we do not have the same guidance that we’ve been used to at a federal level. Dr. Alessi: I’m glad you brought that up because it’s something I planned on discussing with you. So, I mean, we’re at a stage now where people don’t trust the CDC. They have opted for ideology over science. In fact, Peter Hotez just wrote a book, right, Science Under Siege. So, we sit here in Connecticut and we hear about South Carolina, New Mexico, all these measles outbreaks. We hear about this rising flu. Are we safer here in Connecticut? Dr. Juthani: I do believe we are safer for several reasons. First of all, although we have vaccine hesitancy, at the moment, we are the most vaccinated state as it relates to measles in the country when you look at kindergarten vaccination rates at 98.7%. So, we lasted two years without a case of measles. I thought for the last two years we would have one. We had our first in December of 2025. But that one case did not lead to any other cases so far. We’ve made it through one incubation period. We’re waiting for a second, so there is still a small chance, but that says a lot about the herd immunity we have in the state. So, I think that reflects on our population at large. I would also say as it relates to the flu, we have vaccination rates this year that are finally higher than they were at this same time last year. That means that people know we’re in the middle of a flu surge and they’re getting vaccinated. Now, do we have more people that we could vaccinate? For sure. And that’s why we continually try to message that it’s still not too late to get a flu vaccine. But I do think that we are safer. We do have a very highly immunized population. We do have lots of people that have questions, and it’s our job in medicine to answer those questions. But in many ways, as it relates to vaccine preventable diseases, I do think we are safer. Dr. Alessi: You brought up the flu, right? And a lot of people we now know we’re dealing with an H3N2 or the Clade K, or whatever nomenclature it has, but it’s not something we were ready for, in terms of the guesswork. Can you talk a little bit about the guesswork that’s involved? Because I think a lot of people don’t understand that it takes so much guesswork to figure out which strain is gonna affect everyone. And can you also mention the importance of still getting the vaccine, even if it’s not a bullseye? Dr. Juthani: Every year the flu goes with the weather. So, seasonally, what we look for and plan around is what were the strains circulating in the Southern Hemisphere during their winter that then usually predicts what strains are going to impact the Northern Hemisphere in our winter, and the cycle goes on and on, year over year. So, for this year’s flu vaccine, we looked at what the Southern Hemisphere had, the vaccine components were put forward, and you’re right, it’s not a hundred percent match, however, it is still doing pretty well. And we have data from Europe and we’re looking at data from here in the United States. Different estimates based on children or older adults, anywhere from 30 to 60% protection from hospitalization and death. And that’s still pretty good as it relates to a flu vaccine. So, the key difference that I think people need to understand is that the childhood vaccine schedule that we talk about is really meant to prevent disease. When we talk about measles, 97% of people will not get measles, if you’ve gotten both shots. With the flu shot, it’s not necessarily preventing disease altogether, but it is preventing you from severe disease and it’s preventing you from prolonged disease, it’s preventing you from going into the hospital and it’s preventing you from dying. That is considered a success, as it relates to the flu shot. And let me tell you, when you think about days lost from work, from school, potentially being in the hospital, that is still really, really important. And we are seeing that play out even now with the current flu shot. It’s not a total miss. Dr. Alessi: Good. I wanna get to, you mentioned the standard vaccine schedule, and in the past week we’ve seen our illustrious CDC decide that it’s time to change that. Yet, again, not based on any science that I’m aware of, and so how do we get around that here in Connecticut? Because it’s almost ludicrous, right? That we have to think of how to keep people safe here when our federal authorities are telling us something different. So, what’s your plan to get the word out that we still need to do that? Dr. Juthani: The few things that we’ve been doing ever since this announcement came out are, number one, make clear that in Connecticut, the recommended vaccine schedule to prevent 17 diseases as opposed to just 11, which is what the new guidance recommends, has not changed in Connecticut. We’re still recommending the same schedule. The second thing is that out of that schedule, there is a subset that are required for in-person school attendance. Again, that schedule is not changing. Dr. Alessi: See, and that’s what I always thought. I always thought school attendance was where the rubber meets the road. So, now what? Dr. Juthani: The way it works in Connecticut is the Department of Public Health establishes a standard that should be met for schools to maintain safe communal education. The point of school standards is that when you have highly communicable diseases that can be prevented and you have certain children that may not even be able to get those vaccines, we wanna try to protect the community at large. And so, that schedule was last updated in 2011. It’s been a long time since that schedule was updated. And, it’s actually in our regulations as a state what that schedule is. As you mentioned, there’s been no new science put forward to suggest that we should not be vaccinating school aged children against meningitis, hepatitis A, hepatitis B. These are three vaccines for which the recommendations changed by the federal government, and that are on our required list of school vaccines. So, given that, we have no new changes in recommendations. Those are standing as they have been. The other thing to make clear is that these vaccines are available even though the recommendation changed from recommend to shared clinical decision making on these vaccines. They’re still available. They’re still covered by insurance, and there’s no evidence that has changed. So, what message we’ve been trying to get out is that although you are hearing a change from the federal government, for people in Connecticut, status quo is what we are hoping for. That’s the best way to protect our kids. Dr. Alessi: Manisha, I’m gonna switch gears a little bit because we’ve been spending a lot of time talking about infectious disease, but as the Commissioner of Public Health, you have a lot more responsibility than just outbreaks, right? I mean, we still have food safety, water safety. How do you go about doing all of that? I mean, I don’t think people understand that. And you also oversee practitioner licensure, right? Not just physicians, but dentists and everything else. How do you get your arms around that, and what’s the biggest problem that keeps you up at night? Dr. Juthani: So you’re absolutely right. I learn something new every day because we do do so much. We have regulatory functions, which means that we need to keep certain industries accountable to make sure that our hospitals are safe, our nursing homes are safe, our providers are doing what they’re supposed to do, and that our water is safe for people to drink. These are regulatory functions that the Department of Public Health does. We have functions as it relates to communicable diseases, as you mentioned. A whole host of infectious diseases that we try to prevent, whether they be vaccine preventable, or whether they be things that are endemic in society, things like tuberculosis, HIV. There are many things that we monitor at the level of the state: Lyme disease, obesiosis, all different types of infectious diseases. And then we have a bunch of diseases that are more chronic diseases that we also do interventions on: cancer prevention, diabetes prevention, hypertension prevention, a whole host of diseases. And then we prepare for the scenarios what we don’t know is coming. If we get a power outage and a nursing home loses power, what are we going to do for the safety of those nursing home residents? Some of that responsibility comes back to the Department of Public Health. So, you’re absolutely right. There’s something new I have to think about every single day. There are things that I don’t even know what to plan for sometimes and new things that come up because new diseases come up, new problems come up, new scenarios come up, and we try to plan for all of those as we go forward. Dr. Alessi: So, what’s the biggest problem? What’s the biggest thing that’s always on your mind? Dr. Juthani: Right now the thing that’s really on my mind is the fact that people don’t know where to turn and there is an inherent lack of trust that developed during the COVID-19 pandemic, which has been morphed into a different type of distrust now. And the messaging that we are hearing from the federal government only creates more confusion. So, what gives me most concern is that people don’t know where to turn, don’t know who to trust, and we can tell people to talk to their doctor, to talk to their provider, to listen to that person. But you know, the reality is that when providers have 15 minute slots to go over highly complex issues, it is very difficult for a provider to answer all the questions that somebody might be coming up with in addition to the specific health questions that that individual has. So, I really have been spending a lot of this year, this past year, 2025, coming now into 2026, trying to figure out how to get ahead of this, and yet what I get challenged with is not knowing what new hit is going to come that’s gonna throw us off course, that’s gonna lead us down a different rabbit hole where people now have additional questions and concerns that they might not have had yesterday. Dr. Alessi: Something you mentioned, and I think is important, and I think it’s access to health care and physicians. So, I mean, you oversee physicians and regulation. And, I mean, how do we attract more physicians to come to Connecticut? I have to tell you, Connecticut to some degree is a hostile environment from a medical-legal standpoint. I mean, we’ve all heard this and we know that. But how do we get especially primary care physicians, ‘cause we train so many physicians here and at Yale and at Quinnipiac, and they leave. What are your thoughts on that? Dr. Juthani: So the first thing I’d say is that we do have people who leave, but we also have a very robust training environment in Connecticut. So, we have outstanding residency programs and fellowship programs, and so by the very nature of that, there is going to be some attrition. There’s going to be people who come here, train here, and go elsewhere. Your other point though, on being able to recruit primary care into this state is a real challenge. We know that there’s been an expansion of the primary care workforce, whether it be PAs, NPs, who are also helping to fill some of the primary care needs in the state. But part of that also is because we do have a hard time recruiting and retaining people who do wanna practice primary care. I do think that there are things that have happened in the legislative sessions in these last couple years, you know, potentially increasing rates of reimbursement for some providers. These are small things, but you know, the reality is we have a long way to go as it relates to that, and I do think that when we train Connecticut natives, they often do wanna stay in Connecticut or come back to Connecticut. So, we’ve had a physician’s working group that the legislature has asked and tasked with trying to come up with strategies. For the last two years, they’ve been meeting to come up with strategies to help retain physicians in the state of Connecticut. We’ve talked about loan forgiveness. That is one strategy. But you know, the reality is when we look at some of these medical schools around the country that have gone to free tuition, they are not necessarily training up more primary care physicians. They are ending up recruiting some of the most talented physicians because they’ve now become the most competitive places to go because it’s tuition free. And many of them are going on to be very highly specialized. So, I think it’s been a very challenging nut to crack throughout this country, actually. And I do think that we’ve tried to do certain things to help facilitate retaining primary care providers, but there’s definitely more to do. Dr. Alessi: Are there any discussions statutorily, to protect physicians, like they do in other states against frivolous malpractice suits, and things such as that? ‘cause when you go, you know many physicians are in private practice, when you go to pay that med mal bill, it’s a big deal. Is there ever any discussion about that? Dr. Juthani: That is a topic that comes up all the time and it is not something under the purview of the Department of Public Health, so we don’t have any controls over it, but particularly this physician working group that I mentioned that comes up every single year. And I think when we talk about tort reform and potentially having physicians be in a situation where they could be more protected from that type of situation, I know that it is something that many physicians bring up every year. Dr. Alessi: I’m gonna shift gears on you again. Injury prevention, right? The CDC has an injury prevention center that has now closed due to funding, and when we think of injury prevention we don’t think of public health. But, certainly now we’re seeing, you know, the promotion of bicycle helmets, God forbid, a motorcycle helmet but, in addition to that, you know, seat belts and things such as that, those are public health moves. Do we have our own injury prevention commission or a center that work on these issues? Dr. Juthani: That is another part of DPH. So, in fact, we have a large group that works on injury prevention. As you mentioned, there are things like helmets and seat belts. Seat belts are one of the most profound public health interventions that we’ve had in this country. Dr. Alessi: It’s right there with cigarette smoking, right? The surge in generals...  Dr. Juthani: Yeah, Absolutely. Absolutely. And so, you know, when I tell people that, as you know, think about seat belts. If you look at the 1960s to the number of people who died in car crashes to today, seat belts are one of the most impressive public health interventions that are out there. And most people don’t think of that as a public health intervention, but it is. And helmets are the same thing. Suicide prevention, that is also in our injury prevention work. Gun safety, we have a lot of funding that we get from the state that we have funded 18 different groups to date to work on gun buyback initiatives, locks and safes. A whole bunch of other interventions that work with children from a young age to try to prevent them from engaging in gun violence down the road, primary prevention of gun violence in the first place. You think about opioid overuse and unfortunately deaths that occur from that. That is a core data function that we do at the Department of Public Health. Figuring out when people die from opioid overdoses, which drugs they might be dying from. We have a lab that tests for those types of things, and we generate a report regularly where we partner with other sister agencies and towns throughout our state so they know what’s actually happening in their jurisdictions. That’s just a smattering of the types of injury prevention work that happens at DPH. Dr. Alessi: Any discussion about, since you brought it up, in terms of injury prevention in drug overdose, safe sites. They have them in some cities. They naturally have them in Europe. Has that ever been under discussion here in Connecticut, safe places for people to go and use narcotics? Dr. Juthani: It’s been under vigorous debate for the last three years, I believe. And, you know, I’ve heard people from New York that have talked about it and in other places, and I know that one of the challenges in Connecticut and right now in particular is that because we know that there have been certain federal laws in place that make it challenging to open these facilities, it has posed a challenge here in Connecticut. So, it has remained under discussion and under debate, and every single legislative session it has come up. Dr. Alessi: In closing, I wanna ask you what’s the next innovation we’re gonna hear about in public health? Dr. Juthani: You know, I have often thought of what new vaccine might be out there? What scientific inquiry might be out there that might help us get to the next level as it relates to public health? I hate to say that I’m in a position right now where I’m just trying to preserve the status quo. And I say that because we’re in a situation right now where mRNA vaccine research has been completely cut. If you think about the COVID vaccines that came to market so quickly and people had a lot of concerns over, how could that happen so quickly. That’s because money was put into research and technology and innovation in a way that we were on the precipice of cancer cures from mRNA technology and all of that has been stopped in its tracks. Dr. Alessi: And the money was put in by the same people who took it away. Dr. Juthani: It was, that’s correct. I mean, that was an accomplishment of the first Trump administration, and so to think about what we could have been doing today, tomorrow, or the next day, what cure was just over the horizon that we now won’t have. When we think about HIV vaccine research that was just eliminated. You know, we’ve made strides in that arena for a very long time. Having said that, look, we want to work with this administration where we can find common ground. And in government, it is our job to try to find a path forward. We recently had new dietary guidelines that came out. Dr. Alessi: Sure. Dr. Juthani: Now do I agree with everything that’s in there? Not everything. You know, I would say take saturated fats in moderation, and that means butter and red meat, et cetera. But, if we can have Americans think about eating real food and actually operationalizing that, where they minimize sugar, minimize alcohol, eat real food, eat real fruits and vegetables, and there are people who aren’t doing that, who start doing that because this messaging resonates with them, that would be a win. That is what we all should be doing. That is what the old guidelines also said, but it’s packaged in a different way. And maybe there are more people that it will reach. So, I think that I really, really worry about scientific inquiry in this country. The United States of America was the beacon of research in our academic centers, at the NIH, in private industry. That does not mean that new things still won’t happen. In public health, the interventions are often very, very simple. And we’ve done great strides with that, right? Like, if you think about water safety, going back to the origin of water safety, they realized that, this was in London, there was an area where cholera was happening and everybody was getting cholera. And they realized that if you just kept water different, you know, sewage separate from drinking, and you just purify the drinking water, people all of a sudden stopped getting diseases. If you think about our restaurants, you do simple food safety things, people can go to a restaurant and eat the food safely. But if you don’t, then you’re gonna get sick. Dr. Alessi: Absolutely. Dr. Juthani: These are the types of interventions we’ve done in public health. Seat belts, as I mentioned, helmets. These are the vast things that we’ve done. But again, in public health, our successes are when things don’t happen. So when things don’t happen, people think things don’t work right. And so right now, unfortunately, I think we’re in a phase where there’s a little bit of pullback from public health. Fortunately in Connecticut, maybe less so, but we need to keep on reminding people when we do have the successes so that we can give the opportunity for new and other innovative public health interventions to actually come forward, which are often simple interventions, but can make a huge difference. Dr. Alessi: Thank you. Thank you for your time today, and thank you for keeping us safe. Dr. Juthani: Thank you for having me, and it’s been my pleasure to be here. Dr. Alessi: Many thanks to our guest today, Dr. Manisha Juthani, who is the Commissioner for the Connecticut Department of Public Health. If you have questions or ideas for future programs, you can reach out to me at [email protected]. Jennifer Walker is Executive Producer of the Healthy Rounds Podcast. Chris DeFrancesco is our Studio Producer here at the Healthy Rounds Podcast. Until next time, this is Dr. Anthony Alessi. Please stay healthy.

In our first “bonus episode,” Dr. Alessi further explores some of the relevant topics from his conversation with Dr. Andrew Agwunobi, UConn Health CEO and executive VP for health affairs, such as patient safety, the per-capita cost of health care in the U.S. compared to other parts of the world, how aligned incentives might address that, and electronic medical records. Watch for periodic “deep dives” released as bonus episodes as Dr. Alessi brings in more guests throughout the year. Submit questions for Healthy Rounds With Dr. Anthony Alessi: [email protected] Dr. Andrew Agwunobi: https://www.uconnhealth.org/about-us/leadership UConn Health: https://www.uconnhealth.org Support from UConn Health Orthopedics and Sports Medicine: https://www.uconnhealth.org/orthopedics-sports-medicine Grant support from Coverys: www.coverys.com Transcript Welcome to the Healthy Rounds Podcast, where we provide you with up-to-date timely medical information from national and international leaders in their fields. This podcast is brought to you by UConn Health, with support from the Department of Orthopedic Surgery and a grant from Coverys. Our podcasts here are not designed to direct your personal healthcare, which should only be done by your physician. I’m your host, Dr. Anthony Alessi, and today we’re going to do something a little bit different. Our first episode last week was with Dr. Andrew Agwunobi, the Chief Executive Officer for UConn Health and the Executive VP for Health Affairs. And, in our discussion with him, he brought up several topics and you know, we only have 20 minutes or so to have the conversation, but he brought up many topics and I think this is going to be happening as we do more and more of these interviews because they provide topics for us to really take what we’re going to be calling the “deep dive”. And that being these topics that we discussed really provoke further thought and the need for further explanation. So, I thought we’d have some fun with that by looking at some of the topics he brought up and maybe looking at them a little more carefully. Among the things he talked about were research, education, things that UConn can be doing to improve the stature of the university and you know, I guess we expect research and education to be part of it. But he also talked about patient safety, patient satisfaction, improving the patient experience. You know, when I first heard the term patient safety, I thought it was an odd term because you think right away, “well, I’m in a hospital, I should be safe.” But years ago, and I would say about 20, 30 years ago, we started looking at the entire hospital system and how we deliver care from the standpoint of industrial engineering. For those of you familiar with industrial engineering, it’s a way of looking at a process and finding a way to make it more efficient. So, you look for the weak points in that process and make corrections. So, in the case of healthcare, we looked at a lot of different things and I guess probably the most relevant change came in the operating room where we now have a timeout that’s mandatory. So, before surgery begins, when everyone who’s involved is in the room, they take a timeout to make sure we’ve identified the right patient by their armband, make sure we’ve identified what side or what procedure we’re going to be doing and where it’s going to be done. We also make sure we have all the proper equipment in the room.  So basically, you have a checklist. And that brings me to a book called The Checklist Manifesto by Atul Gawande. Dr. Gawande is a surgeon and a famous author, but he looked at the use of checklists in medicine. Much like a pilot, right, before a pilot takes off, they go through a whole checklist to make sure various things are working, we know who’s available, what they should do, but they go through a checklist of all their buttons and dials before they even initiate taking off. So, medicine took that same, those same practices and applied it to really every procedure we do. If I’m giving an injection, say a nerve block, right, part of what I have to do is make sure that I’ve identified the procedure I’m doing, what side I’m doing, how have I marked my landmarks, and what I’m using. So again, a checklist to do a procedure. And that is to really help patient safety, and that’s just one example. We’re going to get Dr. Scott Allen on the show. Dr. Allen is an internist who is really the guru here in the state of Connecticut when it comes to patient safety and quality, and he won a great award last year from the Connecticut Hospital Association, so, I look forward to having him on as a guest as well and talk a little bit about that. One of the other things Dr. Agwunobi brought up was the per capita cost of care in the United States versus Europe. We spend twice as much as everyone else in delivering healthcare. The cost in the United States per capita is $14,000 per year, as opposed to Europe where that same cost is only $7,000 per year. That’s a big difference. Now, you might say, well, it’s worth paying more if you’re getting a better result. But the interesting part is when you look at us compared to Europe, they live longer. They’re living longer and getting better care. So we talked about how the fact that the United States is second to no one in developing new technology, but it’s finding out how to deliver that technology that’s been a real obstacle. And one of the solutions we discussed was that of aligned incentives, meaning that all the constituents to the process of delivering healthcare have to have an aligned incentive, the same incentive. In our discussion I actually brought up the example of the Veterans Administration and I thought it would be worthwhile to really talk a little bit more about The Veterans Administration and how it all started. The Veterans Administration and the Department of Veterans Affairs as we know it today actually started 150 years ago. It was back on March 3rd in 1865, it was called the “National Asylum for Disabled Volunteer Soldiers”, and the first branch of it was established in 1866 in Augusta, Maine, and the idea was established by President Lincoln to go out and find a way to care for volunteer soldiers, union soldiers who fought in the Civil War. In 1917, it started branching into other things like life insurance, disability compensation, and now instead of being called the “Veterans Administration”, it’s the “Department of Veterans Affairs” because it’s so all-encompassing. But our discussion was based on the fact that in a VA system of medical care, all the incentives are aligned. And basically, the incentive is to deliver the best care. There are no financial incentives, right? A doctor isn’t getting paid more or less based on the number of procedures or the complexity of the procedures. Pharmacies are not making more money because there’s a fixed rate for medication. So, there is a formulary that is the federal formulary, the federal list of drugs that are made available for free to veterans or at nominal cost. So again, pharmacies are aligned. And the hospitals themselves, there’s no incentive for upcharging, right, to find new ways of charging money because it’s all paid by the federal government and it’s paid in the same system. What’s also interesting about the VA system is that many of the hospitals became aligned with universities. For example, here in Connecticut, the West Haven VA is really an arm of Yale University. Where I worked in Ann Arbor, Michigan the Ann Arbor VA was part of an arm of the University of Michigan, and you’ll see that throughout the country. But one specific example I brought up and discussed with Dr. Agwunobi was the electronic health record. So, the goal of an electronic health record was so that someone’s chart, someone’s medical information, would be easily accessible. The VA was the first to really design that and put it into practice. Where a veteran who may have had an x-ray here in Connecticut and spends his or her winter in Florida, when they went to a VA there to get follow-up care, their x-ray, the reports, their medications were instantly available. It wasn’t a paper record that needed to be mailed down there or tracked down. And we were able to do that because it was a national system. So, with that, part of the Affordable Care Act was to push electronic health records further, and it was a great plan. The problem was that there were so many electronic health records, they didn’t all talk to each other. Now we’re starting to get away from that and there’s a lot more communication, with Epic and Cerner and other companies, but, we had so many different companies, so many different electronic health records that didn’t speak to each other. It really was an obstacle. And the VA, some 30 or more years ago, got around that. Unfortunately, the VA really hasn’t been able to keep up with it, their own designed record, and I’m sure they’re now using a commercial system. A couple of the other topics that we discussed with Dr. Agwunobi included primary care incentives. Really, primary care physicians are probably the least paid of physician specialists, and how to get them more, how to encourage more people to go into primary care and especially rural care. We also talked a little bit about home care and shifting the focus of care from institutions like skilled nursing facilities or hospitals to the home. And there’s been a big push for that, and I think we all agree that we need to do that more.  So with that, I hope you enjoyed this deep dive and have given you some food for thought. If you’d like to get back in touch with me about any of these topics or if you have ideas for future shows, reach out to me at [email protected]. Many thanks to Jennifer Walker, who’s the Executive Producer for the Healthy Rounds Podcast, as well as Chris DeFrancesco, our Studio Producer, who is kind enough to put all this together. I hope you’re enjoying the podcast, and next week we’re going to be chatting with Dr. Manisha Juthani, who is the Commissioner for the Department of Public Health here in Connecticut, and I know you’re going to enjoy that conversation. Until next time, this is Dr. Anthony Alessi. Please stay healthy.

In our debut podcast, Dr. Alessi starts at the top, with “Dr. Andy” — Dr. Andrew Agwunobi, UConn Health CEO and executive VP for health affairs. Dr. Andy shares his thoughts on the state of health care delivery, what he learned from his experience in the private sector, and the big things on the verge of happening with the upcoming partnership between UConn Health and Waterbury HEALTH. Submit questions for Healthy Rounds With Dr. Anthony Alessi: [email protected] Dr. Andrew Agwunobi: https://www.uconnhealth.org/about-us/leadership UConn Health: https://www.uconnhealth.org Support from UConn Health Orthopedics and Sports Medicine: https://www.uconnhealth.org/orthopedics-sports-medicine Grant support from Coverys: www.coverys.com Watch this interview on YouTube: https://youtu.be/bdH6geAXAAY Transcript Dr. Alessi: Welcome to the Healthy Rounds Podcast, where we provide you with up-to-date, timely medical information from national and international leaders in their fields. This podcast is brought to you by UConn Health, with support from the Department of Orthopedic Surgery and a grant from Coverys. It is not designed to direct your personal health care, and that should only be done by your physician. I’m your host, Dr. Anthony Alessi, and it gives me great pleasure to welcome my guest today, Dr. Andy Agwunobi. Dr. Agwunobi is the CEO of UConn Health, as many of us know. He’s also the executive VP for Health Affairs here at the University of Connecticut. Andy, welcome to the show. Dr. Andy: Thank you, Tony. Great to be here. Dr. Alessi: Well, first of all, let me thank you for this opportunity. I mean, this opportunity would not happen without you and other people and the opportunity to produce a podcast and bring together a community of people from our community who want better health care, and we appreciate that. And especially this is our first episode Dr. Andy: Right. Dr. Alessi: So it’s great to have you as our first guest. Dr. Andy: Well, it’s a pleasure. Dr. Alessi: But let’s get started. As far as your career goes, what made you want to make kind of the switch from clinical medicine to really, to health care administration? Dr. Andy: Well, I think the short version is it probably started with my father, who was a general surgeon, British trained, but he also was a businessman at varying levels of success. I mean, he had at one time he had a pharmaceutical import export business, and at one time he was doing selling I think he had clothes that he was doing import, export, so a trucking business. So I grew up believing that you could do both, you could do sort of business and health care together and that was a normal thing. But I think maybe even more important to me was I just, I just like people and I like solving problems. And I always felt like if I could bring my, sort of, my, my, my love of interacting with teams, but use that to help solve problems in health care that would be perfect for me. Dr. Alessi: You know, several years ago you left us, and I like to think you went behind enemy lines, okay. you went and found out the secrets that they’d been hiding from us over in managed care. how had that experience helped you and what was that like? Dr. Andy: It was great. Just, for people, that are listening, I started as the CEO in UConn Health in 2015. And in 2022 I decided to join Humana which is a national managed care organization, to run their home solutions service, which basically is everything that happens outside of hospitals, so home health care, nursing homes, et cetera. And I did it for a couple of reasons. One is, I wanted to really understand that, that business, because I feel like a lot of care is going to go into the homes where meet people where they need the care. But I also wanted to see what it was like to run a national health care organization. And so I learned a lot, I enjoyed it, but it did teach me that we don’t put enough resources into making sure that the services that, I’m talking about in general, hospital industry, Dr. Alessi: Sure. Dr. Andy: but the services that we provide to patients are paid for fairly. Dr. Alessi: Very interesting, and, and since you bring up the national picture, I’d like to know, I mean, let’s face it, in the United States, we’re great at innovation, we’re great at research. But we’ve kind of failed when it comes to delivery of health care, and you’re a national leader, you understand the national perspective. How do we fix this? Dr. Andy: Well, I think you’re right. I mean, one thing I do want to underscore is how great we are in innovation. If you think about the NIH, NIH is the world’s largest funder of biomedical innovation, something like 37 billion a year. And then you think about venture capital, you think about private equity, you think about startups, entrepreneurial culture, we are sort of a center for innovation and, and entrepreneurial. And not just within our country. People come from all over, from Israel, Dr. Alessi: Absolutely. Dr. Andy: from everywhere to do that. So, that’s one piece of it. But the other piece of it is when that innovation comes into health care, number one, it comes typically at a very high cost or very high price. And it’s partly because of the way we’re set up and I think delivery of care, I mean I could talk about sort of tactically, we don’t have the right primary care, we don’t have full primary care coverage, we don’t have full insurance coverage, we have gaps in access. But I think one piece I want to highlight is when those innovations come into what is a broken care delivery system, they’re not coming, they’re coming at a very expensive cost. And I’ll just give you an example, just hypothetically. Dr. Alessi: Sure. Dr. Andy: when startups pitch to hospitals and they pitch to clinical groups, they’re typically pitching a high price, no risk, per click, fee for service for an innovation, Dr. Alessi: Sure. Dr. Andy: and that can drive up the cost of health care instead of being a solution. Hopefully AI will be different. Dr. Alessi: When we think about it, and you brought it up in terms of health care delivery, what are the biggest touch points? Is it pharmacy benefits? Is it physician fees? Is it hospital costs? If you were to attack this, people like to just pick one target, and I understand there are a lot of targets here, Dr. Andy: Right. Dr. Alessi: But where do you think our biggest failing is? Dr. Andy: So, you’re right. I mean, costs are, there’s so many pieces to our system. So for example, hospitals are 30% of costs. Pharmaceuticals are, although they’re only sort of 10% of costs, they’re growing at a rate faster than all of the other cost categories, particularly hospitals, et cetera. And if you look at our pharmaceutical prices compared to other developed countries, we are double what their cost are, right? Dr. Alessi: Sure. Yeah. Dr. Andy: So we could look at all of those. And even when you look at physician prices their costs are like 20% of the total long-term care is like 25%. So there’s a, there’s a lot of categories. One of which, by the way, is administrative burden, when you, when you take both payers and providers, and you put the administrative costs, and we’re talking about things like billing costs, revenue cycle management costs, HR, prior authorization, you take all of those, denials management. Dr. Alessi: Sure. Dr. Andy: You take all on both sides. You take all of that, that’s 15% of the costs, right. Dr. Alessi: Wow. Dr. Andy: So, and by the way, they believe it’s, it’s studies have shown that of the total, which is about 950 billion, about 260 billion of that is wasted, right. So, so there’s a lot of categories, but, but getting to your question, if I had to choose one, I would choose misaligned incentives. Because if you think about it, there’s a lot of money in health care. But the insurance companies are maximizing their margins, the hospitals are maximizing their margins in order to deliver care, doctors who are not employed by hospitals are doing the same. And so if, if we all got together and if, if there was trust and we came together and said, okay, wait a minute. How can we best spend this money so that we’re not 17.9% of the, the economy of the United States and growing. How can we get it down where, where we’re not wasting anything that we don’t need to waste and we’re delivering it? I think we could, we could make big headway. So I would say misaligned incentives are the biggest piece. Dr. Alessi: I think that’s a, it’s a great point. It, what it brings to mind is the VA. Dr. Andy: Mm-hmm. Right. I’ve worked in a VA system for a while when I was at the University of Michigan at the Dr. Andy: Right. Dr. Alessi: And if we look at that as a socialized system, for example, they had really the first efficient medical records, right? Dr. Andy: Yes. Yes. Dr. Alessi: In the 1990s, a vet could go anywhere in the country. Dr. Andy: With great medical record. Dr. Alessi: And their records were there. Dr. Andy: Yeah, perfect. Dr. Alessi: But they couldn’t afford to keep it up. Dr. Andy: Right, right, right. Dr. Alessi: would that be the kind of system we should strive for? I hate to use socialized or universal, but in at the VA, right, everybody is kind of aligned, I mean, from that standpoint. Is that a kind of system we should be thinking of or? Dr. Andy: Yeah I, I do think directionally that’s the system in the sense that studies have shown that when you have, that in countries that have universal health care, their access to care, their equity across different socioeconomic groups, their costs are less per capita than the United States, so I do believe that. But having said that, the, the problem is our foundational system, again, going back to misaligned incentives is so, I don’t wanna be doom and gloom, but it’s so broken. Dr. Alessi: Yeah. Dr. Andy: That just laying on universal health care on top of that would not work. Dr. Alessi: Sure. Dr. Andy: So there has to be fundamental design changes. And also you want to avoid, we need to learn from others, and one thing we, one thing we can learn is to not have the wait times that they necessarily have in the UK or maybe even have in Canada for certain types of care. Dr. Alessi: Absolutely. Dr. Andy: By the way, I wanna say this. Even though in terms of the other countries, we have higher costs per capita costs is about 14,000 per person versus 7,000 average for those countries, we do have the clinical quality and the clinical capacity to do something really special because what we’ve seen is that the care processes we’re number two when it comes to care. So that’s like safety. Safety and like prescribing. Dr. Alessi: Sure. Dr. Andy: We’re number two. We’re not at the bottom like we are in Dr. Alessi: Absolutely. Dr. Andy: In sort of life expectancy and things like that. Dr. Alessi: And that’s the point, right? I mean the life expectancy issue is surprising, right? That we spend so much money and we’re not living as long as people, for example, in the UK. Dr. Andy: Right. Exactly. But, but I think ’cause there’s always this sort of a dissonance where people are like, well, but yeah, but people come to the United States for care and I think that’s because we do have quality. Dr. Alessi: Yeah. Dr. Andy: We just don’t have coverage for everybody. We we don’t, we have a fragmented insurance system and we don’t have the primary care that we need. We don’t have enough pri-, we don’t have enough general practitioners. Dr. Alessi: Absolutely. Dr. Andy: And by the way, I’ll put a plug in to say, people say, well, what’s the solution for general practitioners? I think the solution for general practitioners is to pay them more. Dr. Alessi: Absolutely. Dr. Andy: Right? Dr. Alessi: I mean, that’s what they do in Canada. Dr. Andy: Right, if you pay them more, people will go into that profession. People don’t realize that a medical student can choose anything he or she wants to choose. And when you have such a difference between a specialist hard work Dr. Alessi: Sure. Dr. Andy: I mean, really hard work in primary care relatively low pay, you’re not gonna get people going into it. And loan forgiveness on its own is not going to work. So, so anyway, I, I don’t wanna go on a tangent. Dr. Alessi: No, I think it’s a good point and, and I think one of the issues in primary care is the paperwork. My gosh. They get dumped on more than anybody with forms and things like that, that people need. But, but I wanna move on a little bit. Dr. Andy: Right. Dr. Alessi: UConn itself, let’s drill down on UConn. Academically, how do we get ourselves into more of a national conversation? Dr. Andy: Mm-hmm. Dr. Alessi: Right? I hate to use the example of US News and World Report ’cause I think that’s really a PR move than anything… Dr. Andy: Mm-mm. Dr. Alessi: …but how do we get to that level? Or, or are we there Dr. Andy: Right. Dr. Alessi: and I’m just missing it. We are there in, in, I think pockets, but Dr. Andy: Right. Dr. Alessi: Not as an overall institution. Is it funding? Is it the fact that we’re not a private institution like Mayo Clinic or someplace like that? Dr. Andy: Right. Dr. Alessi: How do we get there? Dr. Andy: Yeah, I mean it’s a good, good question. I wish we had our, our Dean here as well, Dr. Alessi: Sure. He’s Bruce Liang and Dr. Lepowsky. But I do think part of it is, well, first of all, our schools, Schools of Medicine, Schools of Dental Medicine are extremely strong, right? Dr. Alessi: Absolutely. Dr. Andy: Which is the basis, right? I mean. They had something like 5,600 applicants for 112 slots in the, in the medical school, and 1,600 for 50 slots in the dental school. So we’re very competitive. Great academicians, great researchers and scientists. But I think maybe some of it is focus and really trying to carve our own niche for what are we best known for.  one of the areas that myself and Bruce have been working on is translational research, particularly since our clinical enterprise is so strong right now, growing faster than any other health care system in Connecticut. Leveraging that for translational research, clinical trials. And the other piece that I think we can really sort of supercharge a little bit is our commercialization of research. So I think we just we do a lot really, really well and we can talk about things that we are nationally known for, but I think we can, there are some areas that we can definitely strengthen and Dr. Liang is, is helping lead that. Dr. Alessi: I’m gonna put a plug in for my department over in Orthopedics. But I mean I came here from private practice. Dr. Andy: Right. Dr. Alessi: And I’ve worked with a lot of institutions over the years, Dr. Andy: Right. Dr. Alessi: … and our sports medicine people, I mean, as evidenced by our success in sports, Dr. Andy: Yes. Dr. Alessi: it doesn’t just happen. And Bob Arciero, Dr. Andy: Yes. Dr. Alessi: And, and the whole crew over there have done such a phenomenal job, but, I, it’s an honor to work with them. Dr. Andy: Well, I wanna thank you for your leadership and them, because there’s so many areas that we stand out in. If you think about things like Geriatrics Dr. Alessi: Sure. Dr. Andy: You think about Orthopedics, Sports Medicine. Think about Neurosurgery. I mean, I could go down the list. Dr. Alessi: I know, absolutely. Dr. Andy: but it’s, it really makes me proud. It’s one of the reasons I came back. I came back because I was sort of like, this is such an amazing academic medical center and the sky’s the limit in terms of the future. Dr. Alessi: Well, let’s talk a little bit about the future. You know, we’re going through this, I don’t know, purchase or alignment with other hospitals, Dr. Andy: Right. Dr. Alessi: Is that crucial to us moving forward? Dr. Andy: Yeah. Dr. Alessi: And is it because bigger is better? It gives us a better, I mean, now that you’ve been on the other side of Humana, does it give us more power? I, and I’m assuming that’s it, I don’t know? Dr. Andy: So yes, I think that this is a key part of our strategy. Now, it doesn’t mean that it’s only expansion outside. We also are doing what people call organic, which is inside expansion of all our different departments. But the reality is that we’re small. We’re one of the smallest academic medical centers in a consolidating market. So you have Yale New Haven Health System, you have Northwell, you have Hartford Health care, you have Trinity, all of which are huge, right? And then you have UConn Health and a few independent hospitals. Dr. Alessi: Sure. Dr. Andy: And so it’s important that we expand and expand why? Because of economies of scale, right? Where we can Dr. Alessi: Absolutely. Dr. Andy: We, we have the top line growth, we have revenue growth, we have patients. Dr. Alessi: Right. Dr. Andy: We’ve tripled our patient revenue in the last 10 years, but we’re out of space. So our surgeons don’t have space to operate. You know, they have space but they don’t have… Dr. Alessi: I understand. Dr. Andy: … extra space to operate, right, and so on and so forth, so continuing to grow that top line revenue, but doing it in an efficient way, right? Not as a state organization, but as a public private partnership. So those hospitals we’re talking about, Waterbury being the first. Dr. Alessi: Sure. Dr. Andy: These are going to be private. They’ll be a community network, private community network that we have influence on and can make sure that we’re proud of, the quality of care, the safety of care, and make sure that patients come back to those hospitals. But one of the other things that’s really important is what we’re doing for the state. We’re a public health system. We’re the state’s only acute care academic medical center, and the state wants to make sure that hospitals don’t close Dr. Alessi: Sure. Dr. Andy: because then that decreases access to care, but also that the economies of those communities remain. And so they’ve looked to us and said, you guys are doing such a great job, help us, the state, to do this. And it’s a huge responsibility and one we’re proud of. Dr. Alessi: When, and, and I think you, you actually brought up the topic already and that is when you merge or kind of work with these other hospitals, there’s always a problem of merging the culture. Dr. Andy: Mm-hmm. Dr. Alessi: It sounds like you want to keep the culture there ’cause obviously there’s a different culture in Waterbury than there is at Day Kimball Hospital, Dr. Andy: Mm-hmm. Dr. Alessi: or Bristol Hospital. So it sounds like you don’t want to bring, kind of destroy the local culture, Dr. Andy: Right. Yeah. Yeah. Dr. Alessi: Is that, is that the idea? Dr. Andy: Well I, it’s a tricky balance. Dr. Alessi: Yeah. Dr. Andy: Because we wanna do a couple of things. One, respect the local culture, but two, bring a level of specialist care to those hospitals that elevates their quality and their safety and everything that’s necessary in their patient experience. And we also want to treat them the way we believe they should be treated in a partnership. So there’s going to be some sharing and blending of cultures, but without losing either our culture or losing their culture. So it takes, it takes a little bit of it’s gonna be tricky, but again, I think leadership is all about working within ambiguity as opposed to clear, clear guidelines. Dr. Alessi: Andy, in closing, if we were to do this podcast 10 years from now, what does UConn look like? Dr. Andy: So, 10 years from now, UConn Health will be much bigger. It will be a model for the nation in terms of how you do public-private partnerships with state academic medical centers in the right way, where it benefits everyone, it benefits the state, and it benefits those private organizations in community networks. We will be independent on the clinical side, independent of state support. And by the way, last year that was $60 million was coming to us on the clinical side. This year, we’re down to about 10 to $15 million, but we would be independent of the state, so in other words, the state funds the schools… Dr. Alessi: Absolutely. Dr. Andy: … which it should do, schools and the research. But clinically we’re able to fund that through patient revenues, et cetera, and diversification of revenues. But I think most important to me as a physician is that we’re providing that we’re the best in the state, and I hate to be competitive, but we’re the best in the state in terms of quality, patient experience, and safety because ultimately that is the business of clinical health systems is patient care. And then you touched on it on the academic side, we continue to be a fantastic, high ranked, even higher ranked in terms of our schools, but have a national stature in terms of research, particularly related to clinical trials and translational. I think if that, if we did that alone, that would be, that would be enough. Dr. Alessi: Andy, listen, thank you. I want to thank you for your time today, but more importantly, as a physician practicing here, I want to thank you for your leadership. It’s great to have you back. I’m glad we got you back from Humana, and I look forward to the future with you. Dr. Andy: Well, I look forward to the future with you, and I wanna thank you and your colleagues for your leadership too. And thanks for doing this podcast. Dr. Alessi: Many thanks to my guest today, Dr. Andy Agwunobi. If you have questions or ideas for future podcasts, you can reach out to me at [email protected]. Jennifer Walker is the executive producer of the Healthy Rounds podcast. Chris DeFrancesco is our studio producer for the Healthy Rounds podcast. Until next time, this is Dr. Anthony Alessi. Please stay healthy.

Coming January 2026 Healthy Rounds covers a range of topics, including new medical technologies and treatments, research, disease prevention. Its host, Dr. Anthony Alessi, also shares insights on current developments in health care policy, emphasizing the importance of being an informed patient, understanding preventive measures, and taking control of your health through proactive choices and awareness of new medical guidelines. Subscribe today and never miss an episode! This podcast includes conversations between the participants and does not necessarily represent the position of UConn Health.