PeerSpectrum | Journeys in Medicine

All right, welcome back. If you think you have a pretty good handle on the opioid crisis, the pharmaceutical industry and how it all works, today’s episode may challenge that assumption. It certainly did for us. The modern pharmaceutical and biotech industries are like no other. How they got to where they are is a story like no other. The same businesses that have given us incredible lifesaving advances have also given us disasters like the opioid epidemic. The history of the pharmaceutical industry is more complex and captivating than you might imagine. Today’s guest in award winning investigative journalist, Gerald Posner. He’s written twelve books including national best sellers such as “God’s Bankers,” “Mengele. The complete Story,” and The Pulitzer Prize finalist, “Case Closed.” His latest book, “Pharma,” is master class history of the modern pharma and biotech space. Understanding that history is critical to understanding the present opioid crisis. In-fact, we didn’t even cover the opioid crisis until the final 15 minutes of the podcast. With so much to cover, we asked Gerald for an extra 30 minutes beyond our usual hour. Even that wasn’t enough, but it was lot of fun, and hopefully all the reason you need to read the book yourself. With that said, let’s get started…

Imagine losing your father at 14, losing your brother a decade later, and looking down the barrel of the same heritable heart condition that killed them both. Imagine learning in your first year of surgical residency that your continued existence will depend a new implantable device, called an ICD. A device so new, you will likely be the first surgeon in the world to have one implanted. A device that will allow your life to continue, but most likely put an end to your surgical career. That’s exactly what happened to today’s guest, one of the nation’s renowned transplant surgeons, Dr. Robert Montgomery. Robert has performed over 1000 kidney transplants and his research has advanced the field in areas such as desensitization, multiple organ transplants, gene and cell-based therapies, and perhaps most famously, domino paired donations. And if that’s not enough, he is also credited in the Guinness Book of World Records for most kidney transplants performed in one day. One more thing…Robert is also heart transplant recipient. A heart transplant performed by the very surgical team he hired, and currently leads as the director of the Langone Transplant Institute at NYU. Wondering about the Ave Maria intro music? Well, that’s Robert’s wife, world famous mezzo-soprano, Denyce Graves. Get ready for a wild journey of an episode. With said, let’s get started.

Barbara Tuchman, the Pulitzer Prize winning author of the WWI classic, “The Guns of August,” once observed, “The unrecorded past is none other than our old friend, the tree in the primeval forest which fell without being heard.” Not only must history be recorded, it must also be examined and retold. For most of us, who are not professional historians, we approach history through the curation and re-telling of the past, mainly via books and documentaries. Perhaps we are not so different from our ancestors, and their oral traditions. History may be written by the victors, but it’s kept alive through the story tellers. Today we are heading to London to meet with journalist and author, Wendy Moore. Like Tuchman, Wendy was also drawn to the period of “The Great War,” but in search of story many of you have likely never heard of. In a time when women in the UK, the US and most democratic nations were not even allowed to vote, there was a hospital called Endell Street. A hospital with women surgeons, women nurses, women administrators, and women staff. A hospital almost completely run by and run with women! A 573 bed hospital that performed over 7000 surgical operations and treated some 26,000 wounded soldiers, many with unprecedented battlefield trauma. A hospital led by two active suffragette doctors, one with a criminal record, having been sentenced to six weeks in prison for her protests. A hospital that also treated Spanish Flu patients before being shut down and nearly lost to history…until now.

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

In January of 2018, Warren Buffett, Jeff Bezos and Jamie Dimon announced the creation of a new, co-venture, to tackle the rising costs of healthcare for their company’s employees. They immediately picked famous writer and surgeon, Atul Gawande to lead it. Short on details but big on promise, just the simple announcement of this venture sent shock waves through the media and the markets. Billions of dollars in stock value for insurance companies and other health sector players vanished over night. Two years later, we have a name for this venture (Haven Health) but little else. What they’re up to, and what they’re planning, is still a big mystery. Whatever ultimately happens here, it will matter, simply because names like Amazon and Warren Buffet are behind it. The question is, how much will it matter for the rest of us? How much can anyone (even powerful billionaires) really change the American healthcare system? Today’s guest is Christopher Robertson, Associate Dean for Research and Innovation and Professor of Law at the University of Arizona. His background and research interests overlap many academic disciplines, including bioethics, health law, incentives, behavioral economics and more. His CV includes a PhD in philosophy and a law degree from Harvard. Unfortunately, Chris doesn’t have behind the scenes access to Haven Health (we know, we asked him). But, he does have a new book exploring some unique ideas and research that should certainly be on their radar, and yours. The book, “Exposed: Why Our Health Insurance is Incomplete and What can be Done About,” also includes a historical overview of our modern American health system, a history often forgotten and overlooked in today's political debates. This was great conversation and we really enjoyed having Christopher on. With that said, let’s get started…

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

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

All right, welcome back. If you're still around in the year 2061, two things will be true. You'll enjoy seeing the next passing of Halley's Comet, and your life insurance company will enjoy having collected four more decades of your life insurance premiums, without a payout. Standing there that day you and your insurance company can be grateful for the work of one man, the exact same man that comet is named for. The English astronomer, mathematician and physicist, Edmond Halley. Why you ask? Well, not only did Halley develop the calculations to predict the comet's periodicity, he is also developed the early mathematical tools for predicting human longevity, known very well to your insurance company as actuarial science. Today's guest, like Halley is also a physicist, a theoretical physicist to be exact. And like Halley he sees no need to limit his research interests to one academic domain. Laurence Jacobs began is career at MIT pursuing some of the broader mysteries of our universe. Today he's pursuing another ambitious project, quantifying all of the measures, signs, risk models, data sets, bio-wearable monitoring outputs, health history, genomics and more into (perhaps) one single accessible number. Something you may have heard called a health score. Something that promises to refine our ability to predict longevity, and even improve it. This was an amazing conversation and not a short one. The potential benefits of developing these tools are huge, but so are the challenges and dizzying complexities. Many of the answers will likely come from surprising and unexpected places. To quote one of our past guests, Dr. Robert Gale, the American physician at Chernobyl, “Progress is often made by those who investigate the boundaries of several areas, instead of having laser-like focus on a single discipline. That’s where many of the answers in science reside.” That's exactly where we find Laurence Jacobs today, in Zurich Switzerland where he continues to develop the main concepts and the risk models that underlie the Dacadoo Health Score and the remote disease monitoring and management system, remsmed / EMMA Care. With that said, let's get started..

It's no mystery to most of you that poor health behaviors such as smoking, substance abuse, poor nutrition, lack of exercise and patient non-compliance account for a substantial portion of the disease burden, not to mention costs, in the US. Some recent estimates by the CDC and other researchers suggest behaviors account for 40-50% of increased risk associated with deaths before age 75. The problems are clear. What to do about them isn't. There's no “will power” medication to prescribe, and most public health efforts thus far have barely made a dent. But what if old fashioned will power really isn't the issue? What if something researchers call “introspection illusion,” is causing us to overestimate our own will power, and underestimate the capacities of others? Today's guest is psychologist and behavioral scientist, Wendy Wood. She is currently a professor of psychology and business at the University of Southern California, and a visiting professor at the INSEAD Business School in Paris. Wendy has spent much of her career studying what she considers the very building blocks of behavioral change, something we all know as habits. Angela Duckworth describes her as “the world's foremost expert in the field.” And according to Adam Grant, she is “widely recognized as the authority on the science of habits,” We'll explore her research and recent book, “Good Habits, Bad Habits.” Our conversation also touches on what's commonly called, the replication and reproducibility crisis. Wendy has a unique lens on this issue, having served as one of fifteen distinguished scientists chosen by the American Academy of Sciences to study the problem. This was a fun episode with a lot of ground covered. With that said, let's get started...

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

We've all heard the bad news about rural hospitals in the U.S. 60 million of our fellow citizens rely on these small hospitals, often known by their designation as critical access facilities. According to a recent analysis conducted by the consulting firm, Navigant, 21% of rural hospitals today are at a severe risk of closure. That includes 430 hospitals across 43 states, representing 21,000 staffed beds, 150,000 employees and $21 billion in revenue. When one of these hospitals closes (and 95 have so far since 2010) critical access to care isn't the only casualty. These hospitals are often largest employers and drivers of economic activity in their communities. The ripple effects are felt wide and deep every time a hospital shuts its doors. OK, that's the bad news. How about some good news? Today we're making the trip to a remote town in Idaho, known as Arco. With a population of only 900, Arco is small. You won't find many restaurants, you won't even find a Walmart but you will find a hospital. A small 14 bed hospital called Lost Rivers (by the way, what a cool name for a hospital, right). Its existence and survival in the face of overwhelming odds is the story of today's episode. When our guest, CEO Brad Huerta, took over in 2013, he wasn't there to save Lost Rivers, he was there to shut it down. With over three million dollars in debt, pending bankruptcy, and only seven thousand dollars of cash in the bank, the situation was beyond grim. Today this same hospital is cash positive, free of every dime of debt, running six years with a yearly profit, and getting ready to open a new surgery center. How is this possible and what happened after Brad arrived? Well, it's one heck of a ride and one hell of a story. So buckle in and get ready. With that said, let's get started.

Today we're heading to the front-lines of research testing and challenging one of the most basic truths of the human experience...we all get older and we all eventually die. Today's guest doesn't buy this. In fact, he actually views aging as a diagnosable disease, a disease that can be managed today, and one day fully treated. Now, before you start rolling your eyes, let's meet today' guest. David Sinclair is a professor of genetics at Harvard Medical School and co-director of the Paul Glenn Center Biological Mechanisms of Aging. He is widely considered one the world's foremost experts on longevity research. A co-founder of the journal Aging and several biotech companies, he also holds 35 patents. A recipient of more than 25 awards and honors, including being knighted in the Order of Australia, and Time Magazine's top 100 most influential people. Besides his peer-reviewed research, his work is featured in five books, two documentary movies, 60 Minutes, Morgan Freeman’s, “Through the Wormhole,” and other media. David's newest book, “Lifespan, Why We Age and Why We Don't Have To,” is to quote the blurb on the cover, “an elegant and exciting book that deserves to be read broadly and deeply." That comes from Siddhartha Mukherjee, the famous Columbia University oncologist, and winner of the Pulitzer prize. Not bad! It was a rare treat to have David with us today. Our conversation is also a great reminder that these really are incredible and exciting times we're living in. With that said, let's get started.

All right welcome back. Here's a quick trivia question, which group of US patients are constitutionally guaranteed access to free medical care? And no this is not a trick question. The answer...prisoners. Today we're jumping into an area of medicine few, if any of us, know much about. Let's be honest, how many of you out there have even seen the inside of a prison of jail? Not many, we guess. Criminal records and professional medical licensing don't mix well. For those of you who've been with us for awhile, you know this isn't a political program. I say this because I'm going to read a few stats here. Don't worry, we're not gearing up for a policy discussion on prison reform. It is an important issue, but outside the scope of our conversation today. As of 2016, there were 2.1 million people incarcerated in the US. That makes us the world leader both in the total number incarcerated and a per-capita incarceration rate (655 per 100,000). That rate beats everyone, even places like China, North Korea, Russia, Kazakhstan and Saudi Arabia. As of 2015, the US population represented only 4.4% of the global population, while we held a whopping 21% of the global prison population. We're reading these stats to show just how big US prison medicine is. That's over two million people who are constitutionally guaranteed free medical care. Just imagine how many doctors, nurses and other medical professionals it takes to deliver that amount of care. Today's guest is one of them. [Read more…] Dr. Jeffery Keller is emergency medicine physician. After 23 years working in a busy trauma center, Keller got a call from the local jail. They needed help. Working in prison didn't sound very appealing, so he politely declined. Six months later they called again. This time he reluctantly agreed, but only temporarily. Then a funny thing happened, Keller actually started to enjoy his work seeing and treating inmates. So began a new path in Keller's career. A path through a largely unknown area of medicine that we're going to explore today. With that said, let's get started.

All right welcome back. If you could pick the ideal patient population, armed with the best knowledge, fluent in medical jargon, generally healthy and willing to comply with recommended treatments, who would you pick? How about doctors? Doctors may not be perfect patients but at least they should outperform similar non-clinicians, right? Surprisingly, little to no research has actually been done comparing the care, compliance and outcomes of doctors to comparable groups of non- physicians. For reasons we'll soon see, this is actually a difficult question to tackle, but it's a very important question with broader implications. Today's guest is MIT economist, Jonathan Gruber. He recently co-authored a study using a unique data source to examine just how good doctors and their family members are when they find themselves in the patient seat. Spoiler alert, obviously if the results aren't surprising, we probably would not be here talking about it. That's for the first part of this episode. In the second, we'll explore some of Jonathan's other work. Besides his 160 researcher papers, seven books, numerous awards and prestigious appointments, there's also something else Jonathan is known for. He was one of key advisors (come have even called architects) of Romney-care and Obamacare. Perhaps you've forgotten so let's see if this jogs your memory: www.youtube.com/watch?v=tLOV4oUXawg So if you've been listening to us long enough, you know PeerSpectrum, unlike CNN, is not your home for politics. There are plenty of other places to go for that. Not that Keith and I don't have our opinions, we just recognize our limitations. We aren't journalists and we don't pretend to be. We'll leave the politics to them. Did we bring up Gruber's history and talk about it? You bet. There was no way we could skip it completely. In his own words, Gruber became a virtual proxy for the intense debates taking place during the lead up the passage of the ACA. Whatever you think about Obamacare, or Gruber personally, he's important figure and someone worth talking with. With that said, let's get started.

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

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

Today's guest is Dr. Devi Shetty, a cardiac surgeon, entrepreneur and one of the most famous physicians in India. What's he famous for? Well, he performed the very first neonatal heart surgery in India, and actually served as Mother Teresa's personal physician after operating on her following a heart attack. Obviously, we weren't missing the opportunity to explore these unusual stories, but they are far from the main focus of our conversation. Dr. Shetty is best known for the unique and innovative health system he created. A system so revolutionary, the Wall Street Journal has nicknamed him the "Henry Ford of Medicine." We'll uncover what it takes to perform an advanced cardiac procedure, with western trained doctors, state of the art equipment, comparably lower complication rates than most US hospitals, for only $2,000 with a profit. The same procedure that would cost over $100,000 in the US with higher complication rates and additional OR time. Make no mistake, their model isn't simply about cheaper overseas labor and this isn't a story about medical tourism. We'll see how Naryana Health functions as a working laboratory for testing and implementing new techniques, technologies, models, and training allowing them to be more agile, efficient and safer than any hospital you have likely yet encountered. We'll see how Naryana Health has become a profitable publicly traded company while adhering to a policy of never refusing care to a patient regardless of their ability to pay. Yes, you heard that right! A profitable private hospital system that also provides free medical care. An hour just wasn't enough here. It was incredible conversation that only just scratches the surface of what's going on. It's also a forward look at what's coming whether we like it or not. With that said let's get started.

Keith and I have long considered doing an episode on meditation. What held us back was our goal (as it is with every episode) to answer these two questions: how would the episode specifically benefit you, the physicians and medical professionals in our audience, and how would we avoid simply rehashing a well worn topic explored elsewhere? As you know, we're not big on chasing trends here. So we tabled it, until just recently, when we came across today's guest. Dr. Patrick Codd earned his M.D. in the Harvard Medical School/MIT Health Science & Technology Program. He then completed his residency in Neurosurgery at the Massachusetts General Hospital/Harvard Medical School. Patrick then served as the Director of the North Neurosurgical Service at Massachusetts General Hospital, and an Instructor in Surgery at Harvard Medical School before joining the neurosurgery staff at Duke University Medical Center where we find him today. [Read more…] Not only is Patrick a solidly credentialed neurosurgeon at a world class institution, he's also, get ready for this, an ordained Buddhist priest. Not a combination you find everyday but just the kind of person we knew we had to invite on the program. We'll explore Patrick's uncommon path and his unique perspective on meditation. After-all, the brain isn't just the focal point of Patrick's meditative practice, it's also something he actually operates on every week. We'll learn how meditation initially helped him manage the daily encounters with stress and patient suffering he experienced as a resident. Then we'll see how a busy neurosurgeon fits meditation into his daily workflow, becoming a critical element of his life and practice. Maybe you already have a meditation routine, maybe you've tried it but found little benefit, or maybe you're still highly skeptical of the whole thing. Wherever you're coming from, this episode will have something for you. With that said, let's get started...

Most of you know the quote, “If you cannot measure it, you cannot improve it.” It's often attributed, incorrectly, to the famous nineteenth century physicist, Lord Kelvin. Wherever it came from, it's sounds about right. Same goes for this familiar quote from a popular business book author, “What gets measured gets done.” Well, in today's episode were going to talk about what's getting measured and what's actually getting done. What's getting measured are thousands of performance and quality indicators. What's getting done is docking our medical system billions of dollars every year in costs and lost productivity. Nothing new to all of you out there. But what if this “metric fixation,” is doing more than just wasting time and money? Used correctly, metrics and big data analysis offer incredible promise for research, visibility and improvement. Used incorrectly, they can steer us off course, devalue professional judgment, manipulate, encourage fraud, and possibly cause real harm to physicians, hospitals and patients. As you know, every so often we like to venture outside the medical tent for unique perspectives. That's certainly true of today's guest, historian Jerry Muller. Author of many books and a regular contributor to The New York Times, The Wall Street Journal and Foreign Affairs. His recent book, “The Tyranny of Metrics,” arose from his initial frustrations with metric fixation in higher education. As he dug deeper, he soon realized these fixations weren't' limited to universities, and they weren't new. They were already prevalent in business, law enforcement, the military, philanthropy, and of course medicine. What he found was a growing obsession with rankings, scores and a belief that all aspects of human performance and judgment can ultimately be deconstructed, demystified and quantified. This was a fascinating discussion with a rare thinker and scholar, we hope you'll enjoy. With that said let's get started.

Today's episode is about money, specifically your money. Now, if we're going to take a break from interviewing astronauts, Navy SEAL's, NFL surgeons and cutting edge researchers to do an episode on investing, you can bet we we have a very specific reason for doing so. You can also bet we have a rare and unique guest. That guest is renowned Economist, Burton Malkiel. You can google him later but here's a quick CV highlight reel: PhD from Princeton, Harvard MBA, author of 12 books and more than 150 articles, dean of the Yale School of Management, member of the President's Council of Economic Advisers, corporate board memberships including Prudential Financial , the American Stock Exchange, and the Vanguard Group. At 86 years of age he isn't stopping and currently serves as chief investment officer at Weathfront. All very impressive you say, but what does this have to do with me? Well, Burton is also the author of one the most influential investment books of all time. First published over 45 years ago, “A Random Walk Down Wall Street,” has sold over 1.5 million copies and is now (as of Jan 2019) in its 12th edition. When it was first published in 1973, Burton called B.S. on the performance and excessive fees charged by professional money managers and other experts. He imagined a better, low cost investment tool that did not yet exist. Three years later that changed and today this simple investment tool is the vehicle of choice for 40% of the total invested stock market. Even Warren Buffet (the oracle of Omaha and one of the extremely rare few to actually outperform the market) now recommends this tool for investors. What is this tool and how did Burton Malkiel's ideas transform the financial world? How have his ideas become a sort of placebo control virtually no one can beat over the long run? How can an 86 year old economist help you avoid the time and money wasting decisions so many have, and will continue to make? Let's find out, and with that said, let's get started...

Clinical research with Psychedelic compounds like psilocybin, LSD and MDMA have gotten a lot of press recently. Major institutions such as Johns Hopkins, UCLA and Yale are leading the charge with dramatic results in drug addiction, PTSD, end of life care, depression and other mental illness that is simply breathtaking. When we think back to the psychedelic sixties, it’s hard to imagine that legitimate clinical research was taking place with psychedelics then, too; although much of it (think Timothy Leary) wouldn’t pass even the most lenient institutional review boards today. Much of this early research in the US came to a screeching halt with the passage of the Controlled Substances Act of 1970. Only now are we beginning to reawaken to the incredible healing and trans-formative effects these compounds can offer. Today it’s our distinct privilege to speak with the researcher who carried the torch through a time when psychedelic research was nearly non-existent. When it comes to the mechanisms of action, biochemistry and pharmacology of psychedelics, David Nichols is arguably the world’s foremost expert. He’s spent over 40 years researching and producing these compounds. And yes, all legally, as Nichols held one of the very few DEA licenses granted during this time. If you’re skeptical about all this, hang in there. We’ll see how psychedelic tools can open new pathways to understanding neuroscience, mental illness and even perhaps change who we are and how we see the world. A majority of those who experience a psychedelic trip consider it among the most meaningful experiences of their entire lives. How is that possible? We’re going to find out. With that said, let’s get started…

Today we have award winning science journalist, Laura Beil with us. Her investigative podcast series on the notorious former neurosurgeon, Christopher Duntsch is what brings her here today. Since its release last month, "Dr. Death," as it is called is now one of top 5 ranked podcasts in the country. You've probably heard about this story but just a quick recap before we get started:In 2011, neurosurgeon Christopher Duntsch began his first practice in Dallas, TX. Through the next two years, he operated on 37 patients. Of those 37, 33 suffered severe injuries and complications. Several were left permanently paralyzed, and two left dead from what all should have been fairly routine, elective procedures.It's an appalling story, later described by a surgeon (testifying at Duntsch's trial) as a "complete and utter failure of the entire system of checks and balances for patient safety.” A failure that likely would have continued were it not for the heroic efforts of other doctors in the Dallas community who battled to stop him. This episode covers a lot of ground in a short time, including followup information that has come to light since the podcast's release. There's nothing enjoyable about this story. But it's also too important to ignore. With that said, let's get started. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit peerspectrum.substack.com

On this episode's release, we find ourselves in week 3 of the 2018 NFL season. So what could be a better time than now to talk with a surgeon who's spine practice has treated more NFL, and other professional athletes, than any in the world. Patients such as Dan Marino, Tony Romo, Peyton Manning, Wayne Gretzky, Reggie Jackson and Rob Gronkowski, just to name a few. If you like stats, check out this patient roster: 173 NFL players, 21 Superbowl Champions, 43 NBA players, 60 Pro Hockey Players, 8 Stanley Cup Champions, 112 Major League Baseball players, 30 World Series Champions, 12 Olympic Gold Medalists...and the list goes on and on. Today's guest is Orthopedic surgeon, Dr. Robert Watkins, IV. Along with his father, Dr. Robert Watkins, III and their partner, Dr. David Chang; they together run the world renowned Watkins Spine Center in Marina Del Rey, California. We'll go behind the scenes to discover what's involved with the treatment of these elite high profile athletes. We'll separate what really happens from all the noise and misconceptions out there. And we'll explore how modern surgical techniques can return many elite athletes, (with what were once career ending injuries) to a highly competitive level of play. This episode was a blast so sit back and enjoy. With that said let's get started...

All right, welcome back. Steve Jobs once said,"If Henry Ford had asked his customers what they want, they would have said a faster horse...[you see, he said] It's not the customer's job to know what they want." When you create a trillion dollar company and the iPhone, you get to say stuff like that. How would your life be different if Steve Jobs designed your EHR? Could a dream team from Apple design a perfect hospital without any input from the physicians and nurses who will work there? What if they said,” it's not the doctors job to know what they want because we know what's best for them.” Yeah, probably not. Medical space design is something we take for granted everyday, often only crossing our minds when we're frustrated about it. And sometimes it's really frustrating. Much of this frustration originates from the gulf between those who design these spaces and those of us who actually work in them. It effects our work, our mood and as research is now showing even patient outcomes. As a trained physician and architect, Dr. Diana Anderson (the docitecht as she is known) understands this better than most. She has worked on hospital design projects in the US Canada and Australia, and is widely published in both architectural and medical journals, books and the popular press. She's currently a Fellow at the Harvard Medical School Center for Bioethics. Just the kind of unique perspective we love to find on the show. When it comes to problems in design and medicine in general, perhaps we're all looking for faster horses when what we actually need requires a different perspective. With that said, let's get started

Name: Mona Hanna-Attisha, MD Specialty: Pediatrician and public health advocate Location: Hurley Medical Center: Flint, MI Today it's our distinct privilege to have Dr. Mona Hanna-Attisha on the show. Before her best selling book, her countless TV interviews, before Time magazine named her one of the 100 most influential people in the world, "Dr. Mona" (as she is known) was just another pediatrician taking care of children in one of the poorest cities in the country. If you're like us, you probably think you know the Flint story pretty well. This episode may change your mind. Here's some things we didn't know: Flint Michigan was once one of America's most prosperous cities. Many historians say the middle class was born there. The crisis began when the city switched its water source to the Flint river. This river was once so polluted it caught on fire twice. The entire crisis was completely avoidable, like 80 bucks a day avoidable! Lead poisoning may be one of the largest threats to American children today. It's literally everywhere around us. The first abortion pill was made of lead The same thing happened that happened in Flint happened in Washington DC in 2004. Thousands of adults and children were exposed to high levels of lead contamination and we still have really no idea what the long term effects will be. Choosing to be a whistleblower carries tremendous risk. We only hear of the success stories. We never hear of about the whistleblowers who lose their jobs, go bankrupt, get divorced and even commit suicide. This is an amazing and heroic story, but also a haunting one. You really have to wonder...what would have happened to Flint if there wasn't a Dr. Mona to stand up and fight? We really don't know. The best we can hope for is that by sharing her story, others may find the tools and the inspiration to do the same. With that said let's get started...

The opening you just heard was the actual footage of STS- 133, the final launch of the Space Shuttle Discovery, and the second to last launch of the US space shuttle program. One of the astronauts aboard that day was Dr. Michael Barratt: A career astronaut, a physician by training and today's guest on the podcast. I can't even begin to tell you how excited we were to do this interview. NASA gets literally thousands of requests every year for astronaut interviews, speaking engagements and visits. They can only accept so many. Thanks to the growing popularity of our podcast, and to all of you who are listening, we're now getting more opportunities like this to speak with some really unique and incredible people. Put yourself in our shoes for a minute. Michael Barratt someone who's been to space twice, lived on the International Space Station for 200 hundred days, conducted two space walks (EVA's), he's one of the world's experts in space and aviation medicine, and we got to sit down with him for over an hour and ask him anything we wanted. It was a rare and unforgettable privilege and we want to thank all of you out there for making it possible. With that said, let's get started...

If you fly often, it's only a matter of time before you hear those not so welcome words over the intercom: "Is there a doctor or medical professional aboard?" So, do you hit your flight attendant button, or wait for someone else to do it first? When you're stuck at 30,000 feet, options are limited. You might even feel a little like our past guest, Dr. Gavin Francis, serving as the only doctor available in a remote Antarctic research base. So what are your options? Who can you call for assistance? Is there medical equipment available? What are your legal risks and ethical responsibilities? How often does this stuff actually happen? Today we're going behind the scenes with Dr. Paulo Alves, global medical director for Medaire, a company contracted with most the world's commercial airlines to provide real-time medical assistance from their emergency command center in Phoenix, Arizona. If that's not exciting enough, they also specialize in emergency medical evacuations, crew training, and medical and security preparations for private jets, yachts and even cruise ships. It's a fascinating world many of us know very little about. With that said let's get started...

All right, welcome back for round two with former Navy SEAL, Dr. Robert Adams. If you missed part one, go back and check it out. In Part II we move forward to Bob's career as an army physician. We're going to learn what it's like being a physician attached to the Army's elite counter terrorism and hostage rescue unit, known as Delta Force. A unit so secretive that even family members of Delta operators are treated by separate physicians. Next we'll move to post-invasion Iraq and Bob's early efforts to train and equip Iraqi physicians who, because of Saddam Hussein's onerous travel restrictions, were practicing medicine in a virtual time capsule, unchanged over the previous twenty five years. We'll discover a close call that nearly ended the lives of 700 Iraqi physicians, in a terrorist plot uncovered just in the nick of time. It's an incredible conversation for part II of our series. With that said, let's get started....

Today we’ve got a pretty awesome guest for you. What was once a secret, and very much unknown group of elite US military soldiers, has now become a virtual household name inspiring countless books, news stories and even movies. While all of you have certainly heard of Navy SEAL’s, very few of you have likely met one. They’re a small, select and rare group. Even rarer are the handful of Navy Seals who have gone on become physicians. Today’s guest is one of these few. To become a SEAL requires one to pass one of (if not the) most difficult, grueling and selective training processes in the world. This includes a crucible called Hell Week where recruits face six torturous days of physical tests, no sleep, freezing cold water, hazardous elements and (for those who make it through) watching each day as most of your fellow classmates ultimately quit the process. The stresses and physiological impacts to the human body are very real, leaving many graduates presenting with the same signs and symptoms seen in POWs, or even victims of torture. It’s what we’re going to talk about today and who better to explore it with us than physician who went through it himself. Today Dr. Robert Adams is family physician with the UNC health system. He entered medical school after serving as an elite Navy SEAL for 12 years. His recently published book, “Six Days of the Impossible,” is the first ever exploration of this process from a medical perspective. It’s an unbelievably fascinating story for part I of our conversation with Bob. Part II is the result of our regrets for all the questions and topics we didn’t get to in that first conversation. So we asked Bob to come back for another round. After this episode we’ll continue the journey in part II with Bob’s time as a command surgeon for the Army’s elite Delta Force, and his experiences as army physician in post invasion Iraq. Get ready for an exciting ride. With that said, let’s get started…

Welcome back. During our last episode we had an incredible conversation with the founders of Experiment.com, a very novel and exciting platform for crowd funding scientific research. If you missed this episode, definitely check it out. Keith and I came away so impressed with their venture, we decided to take a deeper look at some of the current research. One experiment really jumped out, so we invited the lead researcher to join us. That researcher is today's guest, Dr. Susan Culican, professor of Ophthalmology and residency directory at the Washington University School of Medicine, and the St. Louis Children's Hospital. We covered a lot of ground in this episode: alternatives to traditional grant funding, resident education and best of all... Susan's current research that ...get ready... actually challenges the long held assumption that only surgeons have the expertise to reliably assess surgical skill. Her experiment seeks to prove that non-clinicians (i.e. the public) while viewing surgical videos can assess surgical skill just as accurately as highly skilled attendings. Not a chance, you say! Well, see how you feel at the end of this episode. You might just change your mind. With that said, let's get started.

How do you feel about funding scientific research, particularly medical research? How efficient, effective and fair is the grant system in deploying billions of taxpayer dollars? Are funds targeted towards diseases proportional to their occurrence in patient populations? Are the influences of disease specific non-profit groups helpful or hurtful? Are the interests and activities of biomedical companies aligned with the needs of you, and your patients? Well, if you think there's room for some serious improvement, today's episode is for you. Cindy Wu was a young undergraduate student at the University of Washington, working on a way to modify an enzyme treatment for anthrax, using a videogame. (which, by the way, is a heck of a lot more than I was doing in college) Eager to find funding for her idea, Cindy approached her professor. “Cindy, [he responded] the system doesn’t fund people like you...It only funds tenured professors.” Although he ended up helping her by sharing money from one of his own research grants, Cindy had taken her first glance at the huge world of underfunded, and undiscovered science. Cindy wanted to do something, but she needed help. She discussed the problem with her friend, Denny Luan, a fellow student with a software background. The amazing solution they came up with was pitched to silicon valley investors in 2013, at Y Combinator. That three minute pitch brought in 1.2 million dollars in initial startup funds, and Experiment.com, a unique crowd funding platform for scientific research was born. Like early stage investing, it's easy to see this space as early stage research. Bill Gates has described Experiment as a, "solution [that] helps close the gap for potential and promising, but unfunded projects." Most research in gap can be funded by as little as 5 to 10 thousand dollars! We know what you're thinking. 5-10 grand? Maybe for a university science fair, but certainly not for legitimate medical research. As we're seeing though, technologies such as CRISPR gene editing, 3D printing and artificial intelligence are already lowering the costs and barriers to researchers in ways that would have been unimaginable just a few years ago. This will only continue, and companies like Experiment are leading the way into this undiscovered country. With that said, we're happy to bring you the founders of Experiment, Cindy Wu and Denny Luan....

Today we're exploring the future of PA's and NP's. Many of you listening work very closely with them, and in-fact many of you listening are PA's and NP's. As the roles, responsibilities and autonomy of PA's and NP's continue to grow, an interesting question comes up. Can we actually compare the effectiveness of PA's and NP's to doctors? To help us tackle this question is today's guest, Dr. Ellen Kurtzman. Ellen is a professor of nursing at George Washington University and she has made nurses, nurse practitioners and physician assistants a major focus of her research. She's held several senior leadership roles in organizations such as the American Health Care Association, American Red Cross, and The Partnership for Behavioral Healthcare. She is also a Fellow of the American Academy of Nursing. Ellen's recently published research compares the practice patterns and quality of care of NP's/PA's vs. family physicians, in a very specific setting. As you'll see, this paper is just the beginning of some really interesting forthcoming research and debate related to our question. With that said, let's get started...

All right, welcome back. Imagine a world where patients can access their medical records anytime, anywhere with immutable security. Imagine every instance along a patient's continuum of care recorded and easily searchable. Imagine the opportunity to meta search millions of health records and data points, and even outcomes, without compromising an individual patient's personal identity. Imagine patients using these resources to evaluate and choose their hospitals, and even you. Folks, this isn't science fiction or wishful thinking. It's a technology called block-chain and if you've heard of bitcoin, you've heard of block-chain. Today we have Dr. William Gordon with us to unpack this technology and help us separate the hype from the real (and very exciting) promise. While in Medical School at Cornell, Will also had a side gig as a software developer. Will became involved with several technology start ups, including serving as director of clinical products at one after residency. Today Will is a clinical informatics fellow at Partners Healthcare while also serving as a hospitalist at Mass General, and clinical instructor with Harvard Medical College. His research and recent papers focus on Blockchain and the unique promise it holds for medicine. Obviously, with his background, Will is uniquely qualified to help us explore this exciting new technology. With that said let's get started...

Name: Alan Levinovitz, PhD Location: James Madison University: Harrisburg, VA Specialty: Professor of Religion and Philosophy “Although scientific training can inoculate against the power of nutritional myths, by no means does it guarantee immunity.” -Alan Levinovitz, “The Gluten Lie” All right, welcome back. Do a quick search on Amazon for books about gluten and over three thousand results show up. Everything from cooks books, diet guides and even childrens' books show up. If you're a listener to this podcast, and you don't have celiac disease, these are not the books likely found in your home library. Happily there's one book, on the first page of results, that you should own though. Called “The Gluten Lie”, it's well researched, backed up with peer-reviewed data and it's about much more than just Gluten. Who wrote this book you ask? An MD out there who was fed up with latest irrational diet craze. No, this book was written by our guest today, Alan Levinovitz, a professor of Religion and Philosophy at James Madison University. As we'll soon explore with Alan, many of these diet crazes, pseudo science myths and other crazy beliefs are nothing new. They've popped up again and again throughout history, and if we don't learn from history, well, you can guess what happens. This was a unique conversation and probably one of the funnest yet. Alan is fighting the good fight, writing for The Atlantic, Time, Fortune and NPR just to name a few. He's also a great guy to talk with and the kind of professor you wish you had had in college. With that said, let's get started....

Name: Gavin Francis, MD Location: Edinburgh Scotland Specialty: General Practitioner, Emergency Medicine Dr. Gavin Francis is a general practitioner based in Edinburgh Scotland. He's also a prolific traveler and an incredibly talented writer. Today we're going the explore the 15 months Gavin served as the sole physician at Halley, the British research station in Antarctica. Gavin was it. With no medical team, no back up and pretty limited equipment, Gavin had to be ready for any medical emergency, large or small. During the winter months, Halley is completely cut off from the rest of the world. Ships can't enter, planes can't land and you won't see the sun until spring. It's hard to imagine being farther off the grid than this. Even the international space station has a Soyuz spacecraft ready for an emergency escape. His book, “Empire Antarctica” is an account of those 15 months spent at Halley. It's a fascinating story, and a beautifully written book for which he received the prestigious Scottish national book award. We all know plenty of doctors who also write. After reading his book, you may find that Gavin is a writer, who also practices medicine. Either way it was a real privilege to have him on. With that said, let's get started....

Norman Beck has been profiled in the New Yorker, he's shared his story on the stage of TED, he has breakfast with Warren Buffett and Bill Gates every year, and yet, there's a good chance you've never heard of him...until today. Norman Beck searches for data in hard to reach places. Because he looks where no one else looks, he knows what no one else knows. Norman's experience and skills were put to the test one day in a doctors office, when he found himself on the receiving end of a life threatening diagnosis. He knew his life depended on the answer to a very serious question: “who is the best surgeon I can find?” The answer to that question saved Norman's life, and led to his wildly popular Ted Talk. It's what leads him here today. With that said, let's get started...

Today we're going to take a brief departure from our normal routine for a smaller, mini episode. In just one week, the moon's shadow will be passing over the continental US . If you've never seen a solar eclipse, and you're still not sure if it's worth all the hype, stay tuned. Our guest, Dr. Gordon Telepun is a plastic surgeon in Decatur Alabama. That's his day job. Gordon is also a passionate amateur astronomer. He's traveled to the middle of the ocean, and as far as the plains of southern Africa to see a solar eclipse. His knowledge of eclipses would probably give Neil deGrasse Tyson a run for his money. Gordon has even developed a geo-location app (for viewing the eclipse) that's being used by NASA next week at two of their observation sites. This episode was fascinating and lot of fun. With that said, let's get started...

How many of you feel like your patients consider you the 2nd opinion after first consulting Dr. Google? How much of your time is spent fighting through a jungle of pseudo science and misinformation just to reach your patients? Why is it so hard to earn their trust? With all the talk today of fake news, the erosion of journalism and the shallow miasma of modern media things look pretty grim. But this is Peerspectrum. Lamenting over the state of affairs is not what we do here. Despite the circumstances, there are some out there (particularly physicians) engaging these problems head on. Today's guest is one of them. Dr. Alok Patel is a Pediatrician and associate professor at Columbia University, in New York City. He's also rising voice among physicians using modern media to defend and advance medicine. Alok is a regular contributor to Medscape, and he has recurring segment on ABC News. While he rubs shoulders with people like Katie Couric and Whoopi Goldberg, he's not afraid to get his hand dirty, even dodging attacks and personally fighting it out on social media. This is great episode here folks and one of real importance today. Let's get started...

So, where do the Air Force's elite bomber crews, fighter jet pilots and even drone navigators go when they need to see a doctor? They go see a guy like today's guest, Dr. Ryan Gray. Ryan is an aerospace medicine physician, also known as a flight surgeon. As a flight surgeon, Ryan treated some Air-force's most elite fliers. He was also responsible for evaluating their flight readiness, sometimes having to ground pilots and crew members who were not medically cleared to fly. As you can imagine, not everyone was eager to find themselves in Ryan's clinic, fearing a medical disqualification that could literally ground their careers. We're going to learn how Ryan navigated this challenging dynamic, and the tactics he used to build trust with his patients. We're also going to learn how a young airman's question sparked a new mission for Ryan, the mission he now pursues as an educator and physician entrepreneur. Today, Ryan is the founder and CEO of the MedicalSchool Headquarters, an incredibly successful enterprise dedicated to helping students enter and succeed in medical school. He is also a fellow podcast host, with not one, but four very popular podcasts all dedicated to helping the next generation of physicians. This was a fun and fascinating episode I think you're really going to enjoy. With that said, let's get started.

Today we're happy to welcome Mara Howard Williams to the show. Mara has traveled extensively throughout the US, and around the world supporting critical medical mission work. She currently works as a Graduate Research Assistant at America's Health Rankings while also pursing her masters in the School of Global Public Health at UNC, Chapel Hill.Mara is a special guest for us because she's also one of Keith's former patients. Diagnosed in her early teens with advanced scoliosis, Mara underwent corrective deformity surgery (by Keith) when she was just fifteen years old. Following her recovery, Mara was asked to offer advice and help to several other young patients facing similar paths. Mara was happy to help, wishing she had had someone (her age) to talk with before her surgery. It didn't take long for Mara to recognize that more than just a few kids needed help. She took the initiative and started an incredibly successful support network called BalkTalk. This was a place where kids could talk with, and ask questions of, peers just like themselves.We're going to learn more about Mara's efforts and what it was like to be a young patient facing major surgery. We'll also explore Mara's medical mission work abroad. We covered the cultural dynamics of patient treatment, what medical NGO's do well (and what they do not), how you can get involved, and the mistakes and legal oversights many physicians make when going on medical missions abroad. This was a fascinating episode we hope you enjoy listening to Mara as much as we did. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit peerspectrum.substack.com

Today we're going to explore a topic that (while not always fun to discuss) is critically important to you and your patients. To help us out, we're joined by Dr. Gerald Hickson. Dr. Hickson is one of the world's leading experts on medical malpractice risk and patient safety. In over 150 peer reviewed articles and chapters, Dr. Hickson has explored questions such as:Why do patients and families choose to file suit?Why do most malpractice claims originate from a very small number of physicians?What can you do to reduce medical malpractice claims risk?Is there a link between physician behavior and patient outcomes?The last question is a very interesting. It's the focus of Dr. Hickson's most recent co-authored article, recently published in JAMA surgery.Dr. Hickson is a pediatrician who served as Chief of Pediatric Outpatient Services at Vanderbilt. He currently serves as Senior VP of Quality, Safety and Risk Prevention, and Joseph C. Ross Chair of Medical Education and Administration at Vanderbilt University School of Medicine. Dr. Hickson is also known for developing PARS® (Patient Advocacy Reporting System), a program that uses unsolicited patient complaint data to improve patient safety. It's used in more than 70 hospitals and health systems nationwide.This was a fascinating episode with numerous references to peer reviewed research and data. It's all here in the show notes so you can explore for yourself. With that said, let's get started. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit peerspectrum.substack.com

Imagine yourself as a patient, free to schedule visits any time you wish. During those visits, you can expect to spend an average of 45 minutes, face to face with your doctor. You can also call your doctor anytime, even on nights and weekends. Now imagine yourself as that doctor. Today, the average family physician sees 35-40 patients a day, averaging only seven minutes with each. It's no surprise that many GPs today report feeling over worked, underpaid and even burned out. But not you. You enjoy an average of 45 minutes with each of your patients. You see, at most, five or six patients per day. Your patients can call you anytime, but surprising they rarely do. You love your job and your lifestyle. You know your patients and they know you. Your practice model enables huge health-care cost savings but your income still matches or exceeds that of your traditional family practice colleagues. So what's the catch? Is this a concierge practice limited to wealthy patients? A Utopian practice model existing only in theory? No, it's real, it's simple and its called, simply enough, Direct Primary Care (or DPC). Also, for those of you who aren't family physicians, stay tuned because this is a dynamic model, not limited to just family medicine. Dr. Staci Benson is an expert who knows her stuff about DPC practice. She's also a family physician with her own DPC practice. Her practice model (and financials) are completely transparent, so we'll take a look under the hood. Is the DPC model too good to be true? This is one of those episodes that may challenge your traditional thinking, your practice, and your future.

Today we have a fun episode for you. Dr. Gregory Lopez is orthopedic spine surgeon in Chicago with Midwest Orthopedics at Rush. He's a former collegiate and minor league baseball player who's experienced his fair share of injuries. It's those experiences that inspired his path toward medicine. He's also an innovator and that's where are story gets fun. As a baseball player, Greg recognized the critical importance of regular practice. During residency, Greg uncovered a real need for more hands on surgical practice. Unfortunately, time was limited and cadavers and bone models are expensive. So Greg decided to build his own surgical simulator to help his peers (and himself) improve basic psychomotor skills. Surgical simulators are complex and expensive, so where did Greg go to start his project? A large medical device company, a sawbones manufacturer, kick-starter maybe? Nope, Greg headed right over to his local Home Depot and started shopping. As we'll learn, Greg (along with several colleagues) created a simple, yet elegant system for practicing basic surgical hand skills, all for about $350 bucks! Today this system is used in teaching hospitals around the country and around the world. We're going to learn all about it and we're going to explore the broader challenges related to medical education and maintenance of skills.

As we find her today, in February of 2017, Suzanne Watson is medical student finishing up her final year at Wake Forest School of Medicine. She's also a mother of four, a former minister, a widow, and she is 54 years old. With a growing family, Suzanne voluntarily left medical school in her twenties but never gave up on her dream of becoming a physician. The dream never flickered, even through her career as an Episcopalian minister, all while raising her four children alone after the tragic death of her husband. We're going to talk with Suzanne about what happened to her husband (a Neurologist) 15 years ago. We're going to see how that experience impacted her and her family. We're going to see how it guides her current mission to become a healer, and an advocate for those suffering with mental illness. If I had to pick one word to describe Suzanne, it would have be resilience. As you'll see though, that one word alone really isn't enough to describe Suzanne. She's someone with incredible kindness, an inspiring mission, and someone, we predict, you'll be hearing more from in the future. It was a real privilege to speak with her at the beginning of this next journey in her life.

Scientific animations are powerful visual tools that can significantly reduce the time it takes to communicate and conceptualize complex scientific ideas and models. Today we're happy to have Quintin Anderson with us. Quintin is a recognized expert in scientific and industrial animations. After completing, not one, but two masters degrees at Harvard, Quintin began his career in animations, eventually starting his own company that he manages today. You're going to find real practical applications you can take away from this episode. We'll learn how you can use animations to reach a larger and more targeted audience for published research. We'll learn about a family physician who used animations to explain complex pathologies and treatments to his patients, before they came into the exam room. This resulted in tremendous time savings in clinic, and more productive time with each patient.

How many of you feel that your patients, hospital administrators, and even some of your own colleagues really understand and appreciate what you do every day? How much of your work and effort goes unseen? Today we're excited to welcome David Zweig. David is the author of "The Invisibles," a deep dive exploration of the quiet professionals who are indispensable to our modern life. David is a familiar face to many of you, he's written for publications such as the New York Times, The Wall Street Journal, The Atlantic and the Harvard Business Review. We have a link to his Ted Talk in the show notes that's definitely worth checking out. So, what does a Structural engineer, a Perfume tester, a UN Translator, a Sound engineer for Led Zeppelin, an anesthesiologist, a cinematographer and a Guitar Tech for Radiohead all have in common? They are the elite professionals who work quietly and meticulously behind to scenes in ways that are often both indispensable and invisible. Many of us have no idea who they are or what they do...unless of course, something goes wrong.

Medicine is a career that can take you anywhere. How do consider an incredible job offer in less than incredible place? What are the most important variables to you and your family? What if you're already there and you feel stuck? Every city and town in America needs doctors. No every city or town has incredible restaurants, a great nightlife, great schools, a symphony orchestra, or an NFL team. We don't all live close to the beach or mountains, either. [Read more…] Our guest today is author, Melody Warnick. In her book, "This Is Where You Belong: The art and science of loving the place you live,” Melody explores why we Americans move so much and the effect that has on our careers, happiness and even health. She should know because she's relocated six times in the last fifteen years. We're going to explore her research and data that can help you make better decisions. Most importantly, we're going to explore her strategies for making a place your home even if you don't really like it. We covered a lot during this episode so check out show notes after you listen. It was a great episode and we really enjoyed talking with Melody. With that said, let's get started...

Ever come up with an idea for a new medical device or a way to improve a problem area, but you have no idea how or where to go with it? Medical innovation is a massive, multi-billion dollar business. Think you have to start a company yourself or work for the Mayo or Cleveland Clinic? Wrong. Medical innovation is happening in ways and in places you may not have even realized. Our guest today is Dr. Arlen Meyers. He's an ENT surgeon and professor emeritus at the University of Colorado School of Medicine. He is an inventor, a former Harvard-Macy fellow, and a Fulbright scholar. Dr. Meyers was named by Modern Health-care as one of the 50 Most Influential Physician Executives in the US. He has experienced both success... and failures with several medical devices and digital health start-ups. Today Dr. Meyers is CEO of the Society of Physician Entrepreneurs (SoPE). This an international medical innovation network with thousands of members worldwide. Soap, as it's called provides education, resources and a powerful peer network accessed through local innovation chapters. It's a pretty cool organization and we're going to learn all about it. With that said, let's get started... Show Notes: -Medicine and innovation. Dr. Meyer's path. -”Entrepreneurial Attending.” Why Dr. Meyers wants to help physician entrepreneurs today. -The many ways of being a physician entrepreneur. It isn't just about starting a company. -Do I really want to start a company myself? -Having the entrepreneurial mindset. -Does medical training, and medical school admissions selection, encourage or discourage the entrepreneurial mindset. "Sending fighters to the front with blanks in their rifles." -Can entrepreneurship/creativity be taught? Entrepreneurial DNA? -”You can't teach someone how to be a surgeon, only how to do surgery.” -Do innovative ideas always come from the front lines? What does Dr. Meyers think? -"The confluence of a problem solver and a problem seeker." --"Innovation polarized lenses." Mindset let's you see the opportunities. -Are doctors better able to identify medical problems and solutions? What about innovators outside of medicine? -Selling hospital administration. Dr. Meyer's advice for dealing effectively with hospital administration and advancing your ideas. -Does your institution have an "innovation learning system?" How is this different from an "innovation center." -"Patient defined value." What is the most important value? -I'm at a smaller community hospital. I'm not in Silicon Valley or the Cleveland Clinic. Do I stand a chance? -Why Dr. Meyers believes ANYONE can innovate, not matter who you are. -How can I start a SOPE chapter? If you are willing to, "show up," SOPE is ready to help you. -PALs "Partners and alliances." Benefits of joining SOPE. Membership directory gives you a huge network connect with. This includes 1300 members and over 26 thousand linked-in followers -How do I protect my idea? Patent law, intellectual property and legal resources. -Business education. Is the MD/MBA a good idea? Dr. Meyers has an MD/MBA and helped create one of the first programs in the US, but that doesn't mean he thinks you should. -Involvement in K-12. STEM+Arts= STEAM. How the arts can contribute to creativity and innovation. -Dr. Meyer's mentor: Dr. Ben Eiseman: http://www.ucdenver.edu/academics/colleges/medicalschool/departments/surgery/News/Pages/Ben-Eiseman-tribute.aspx -Dr. Meyer's daily habits and routines. "Habitology." -How practice and repetition relate to neuroscience. -Write every day.

Marni Jameson is the Executive Director of the Association of Independent Doctors. It's a national organization with over 1000 physicians members, dedicated to defending and supporting independent practitioners. e talked with Marni about health care consolidation and the impact it has, not only on you and your practice but also your patients. We're going to learn more about what Marni and her team are doing for you, even if you are currently employed with a hospital. We're also going to learn more about Marni's background and experience. It's pretty impressive. She was only 22 when she founded her own health care public relations firm. After ten successful years, she sold the firm to pursue her passion for journalism, becoming a health reporter for the Los Angeles Times, and later, the Orlando Sentinel. She also has a passion for design. Even with all the demands of running the AID, she manages to find time to write a nationally syndicated column on home design. "At Home With Marni Jameson," appears in more than 30 newspapers across North America, reaching 7 million readers. She's also the author of two best-selling books. Marni has quite a story and Keith and I really enjoyed our conversation with her. We know you will too. So let's get started... Show Notes: -Marni's path through health care and journalism. -“Somebody needs to do something about this.” How AID (Association of Independent Doctors) got started. -The trend towards consolidation and physician employment: In 2000, 57% of US doctors were independent. Today only 33% are. -The pressures on independent physicians. Monopoly health care, gov't regulation, payer networks, etc. -How larger hospital systems use their leverage to control the market and negotiate higher payments from insurance carriers. -Which specialists are most likely to become hospital employees? -Why should patients care? The negative impact on patient care. -How independent practitioners help keep medical costs down. -The Stark Law. How do hospital systems use their influence to keep patients “in-house?” Why they pay close attention to “patient leakage.” Data and quotas. -Don't give in yet! Why Marni says to interdependent doctors, “it is hard...hold on, help is coming.” -”AID Save:” Discounts on medical supplies. -How AID is working with other independent physician groups. Two sides of the same coin. -How AID is working through Washington and the media to fight for independent physicians. -What you need to know before signing a hospital employment contract: -Responsibilities. -Performance standards. -Physician autonomy. -Office hours. -Call coverage. -Office space and resources. -Outside activities. -Restrictive clauses. -...and more. -Want to get out of your contract? Legal resources available for AID members. -MACRA and bundled payments. -Three victories where AID has lobbied the FTC to block anti-competitive mergers. Links and Resources: MACRA: https://www.ama-assn.org/practice-management/understanding-medicare-payment-reform-macra http://obroncology.com/imshealth/content/IMSH_Oncology_Trend_Report_020514F4_screen.pdf Hospital Prices Increase in California, Especially Among Hospitals in the Largest Multi-hospital Systems: https://www.ncbi.nlm.nih.gov/pubmed/?term=27284126 http://www.aid-us.org/media amicus-brief-advocate-northshore-7_22 aid-helps-ftc-win-appeal-in-illinois-press-release-10312016aid-helps-ftc-win-appeal- press-release-09282016aid-amicus-hershey-pinnacle aid-helps-ftc-win-appeal-press-release-09282016

Rachel Koster earned her Master's Degree in Interior Architecture from Kansas State University. She is an expert in what's called 3-D visualization technology. She is also an expert in commercial real estate , particularly health care space design and development. We picked her brain and covered everything from how medical space design affects a patient mood to how it affects work flow and staff morale. How can elements such as colors, hallway width and lighting make a huge impact on your practice?We covered leasing, negotiations and location selection. Have you considered getting into the commercial real estate arena? It's a tricky business and you're going to want to hear what Rachel has to say. We really covered a lot of ground and this is definitely an episode you don't want to miss. So let's get started...Show Notes:-What is Internal Architecture? How does space affect your mood?-3D Visualization Software. Sketchup.com.-2nd Generation Spaces vs. New construction.-Knowing what your goals are. How many exam rooms will you need? How much administration space do you need? Meeting room?-Opening a new office? Who do you need to speak with first? What are the steps to making a successful transition.-The elements of Internal Architecture. The reception desk. Open spaces. Hallway widths. Work flow. Colors-How do you use the medical office to reflect the personality of the medical provider?-The importance of collaboration between the design team, the provider and the medical team.-Where to go to get ideas and stratifies for your office design.-Existing Office: What can you do in a day or weekend to transform your medical practice space? What are some quick fixes?-Traffic choke points. Focusing on patient flow and efficiency. Making sure your patients don't get "lost in a maze" on the way out!-Measuring your patients' experience. The importance of first impressions.-Each area can be a different experience. The waiting area is a different experience than the exam room.-Location, Location, Location! Retail vs. Medical office park. Parking, highway proximity and ease of access.-Commercial real estate.-You need help. How to qualify and assess a real estate professional.-Negotiating a lease. Remember, all leases are written for the landlord, not you.-What to look for and what to avoid in a lease agreement. Exclusivity clauses.-Thinking about getting into the commercial real estate business? Should you lease or purchase office space? Assessment fees. Your legal rights. Flood plains.-Dealing with practice partners as it relates to real estate. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit peerspectrum.substack.com