Common Sense Medicine

Welcome back to Common Sense Medicine! This is a great interview with a physician who is working in the intersection of the care navigation space. Patient-centered care can mean a lot of things to a lot of people. For me, it means that patients are heard in their care journeys and feel as though they have agency in a system which is often confusing and not at all “human-centered.” My guest today is trying to change that through providing a better solution care navigation in cancer care. Dr. Hillary Lin is a Stanford-trained, board-certified internal medicine physician and the Co-founder and CEO of Curio, a HealthTech startup addressing health equity and outcomes via Al-enabled navigation. Dr. Lin has contributed to neuroscience and oncology with her peer-reviewed research work. She is a frequent speaker and advisor for programs, including Headstream Innovation and Cornell BioVenture eLab. In her personal life, she enjoys immersive experiences and has completed over 200 escape rooms worldwide.Video Version[00:59] Hillary's background in medicine, and Curio's start * She entered medicine because she was passionate about the “human experience,” she knows how complicated life can be and how important health is * It's about all of the aspects around health that you also have to manage when you are sick and not just the disease itself* There's too much focus on the facts of medicine and the facts of biology and it sucked out the “soul” of medicine for her * We're asked as physicians to remember more facts and be computers rather than a person to help guide the journey (AI can help here)* Drove her to specialize in oncology because she wanted to be deep in the process of answering existential questions, but when she got there she found out it's mostly running in and out of bedrooms and clinic rooms. She was trained in internal medicine at Stanford and then went to Columbia for a brief time in an Oncology fellow role* You don't get time to sit down with the patient that much* She found that she wasn't answering the existential questions she wanted to, so she went to digital health innovation and sampled the smorgasbord of what she could be doing, and finally she landed on cancer care navigation[06:16] What is so compelling about care navigation for patients? * Took her a long time, she was seeking for years to land in a field to innovate in* In the beginning, as a relatively new founder, like many founders, she went straight to where the problem was—when founders do this, they try and create a tech-enabled clinical platform for whatever they want to solve quickly. She thinks this is the first-order solution, rather than the final state* They found that with more serious healthcare concerns, a lot of it comes down to navigation problems / concerns. Health literacy, access, and equity are prevalent in the U.S. where we have a convoluted system. It's very hard for them to get optimal treatment and care[08:44] All about Curio—what is it & how does it help their end customers? * Problem they're solving: Help patients get the resources they need in order to optimize their health * The tooling behind that (which is growing) is vast, and it's growing in real time Shree's note: the tooling now may be different then when we recorded this podcast in November 2023* One example of a tool is a natural language parsing tool to provide the opportunity to explain a problem and can connect to a in-person navigator to find those services, or use the AI to find them a personalized service which can help them find the solution for their specific issue * The next level of that is to guide them through the steps to get the resources that they need. Instead of having a case manager or a social worker on the line, they can use the AI to navigate the next level * The key thing to understand is a B2B company which works with health delivery platforms, non-profits, patient support services, and similar entities. 80-90% of the time, there is a human in the loop, such as a social worker or another personnel* Rather than focusing on just a patient assistance program in a specific zip code, you can use Curio to add additional parameters (i.e., age, family members, etc.) to add greater “precision level resourcing” for cancer patients* There's also a level of communicative support which uses generative AI to help individualize to the patient's health literacy level in an SMS or email communication[14:35] What are patients most using Curio for? * Financial assistance is by far the largest problem which patients face with a cancer diagnosis, and financial toxicity is the main focus of Biden's Cancer X initiative* It takes up to 80% of people's bandwidth and mindshare. Cancer care is so incredibly expensive that people max out their deductible pretty quickly. There's also legal type of concerns especially with their employers (i.e., leaves of absences)* In an earlier rendition, Curio was a mental healthcare company. They found that for cancer care, mental health is a secondary concern, after people are able to pay for their medications and their base needs. There are a lot more resources to tackle mental health than other issues though[18:12] Curio's business model * They sell to intermediaries, navigation and utilization discovery services. The ecosystem has become very bloated with point solutions for digital health that benefits administrators get burned out* Shree's take: Curio is really trying to differentiate their navigation solution based on its personalization through partnerships. For example, if you have a MSK issue, Curio will basically tell you which piece of education you need to read for your particular issue* They use both human / automated version of finding those resources, but they prefer a partnership because then it is more intricately tied to the experience of navigating care* They use a tiered utilization pricing model for Curio's care navigation solutions. They align well for utilization based pricing model because sometimes there's very low utilization of those benefits [27:16] What do oncologists think about this tool? * Trust is key to get buy-in from various providers. They are trying to establish strong relations with patient advocacy groups—this is not to just have their logo on their website, but to have relationships with them * Hospitals don't reimburse for care navigation services, so it's pretty awesome to see that patients are getting these services outside the hospital. Doctors don't get paid (RVUs) based on them helping the patient navigate the system; social workers are strapped for their time. If patients find Curio or another tool, it can be a real game changer for them* They are also working on the pharma side where they are focused on getting patients more adherent onto their treatment, and focusing on patient engagement. Pharma companies want to know why patients aren't continuing on their treatment (i.e., copay, adverse events, etc.) so it's actually pretty helpful for them to understand where in the patient journey they are losing the consumer[32:49] Does Curio help with finding second opinions? * They work with advocacy groups to help find second opinions for their patients. In fact, in Hillary's opinion, a lot of doctors do value second opinions and look to get them from academic institutions (i.e., you have one oncologist at an academic institution and one in a community setting) * They are working on getting a database for clinical trials so patients can use that to find trials which are very helpful to them. Patients are very skeptical of trials, so according to her, getting patients there is 90% of the issue* A lot of the convincing happens at the education level and the risks and benefits of the trial[40:16] What is different about Curio? * Shree's note: I read an market map of the Generative AI in healthcare space, where they talked about how the care navigation space is becoming crowded—so I asked Hillary about her opinions in the care navigation nicheNavigation companies, such as Navvi Health, Collective Health, Auxa, and Talktomira, focus on helping employees and patients navigate their healthcare benefits and options. However, these companies face challenges like overcoming vendor fatigue and budget constraints in the current economic climate. Interestingly, these companies have the largest amount of funding in this category and the lowest amount of median funding per company, which implies the category is more saturated and less capital intensive then other patient-facing categories. We're excited to see how generative AI can streamline user experiences, interpret health information, and guide patients more holistically, potentially reducing readmissions and encouraging proactive care.* Curio is good at patient engagement, which a lot of digital health companies have not been successful at (according to Hillary)* Each product / feature release has to be laser-focused on that particular use case—they are trying to solve problems with technology rather than with humans * A lot of care navigation companies are human first, with technology enablement, where she thinks it has to be reversed—tech first, with human enablement at points, so that it can scale* Now with generative AI, this scalable solution is now possible[45:48] What is the future of Curio? * They are trying to provide a broader layer of tech for the vision of healthcare—a human person is more than their disease, so they have to have a broad way to access that care * Rather than becoming verticalized, they want to go more horizontal—focus on nutrition, wellness, or other places[47:04] Why go into Digital Health? * It took her years to get her legs underneath her as an entrepreneur. She believes we're living in a world where healthcare is stuck in an outdated mode of manual labor* Looking very closely at other industries, all other industries are moving towards this idea of personalization, but why can't we focus that on scaling up healthcare for a lot more people? This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.shreenadkarni.com

Welcome back to Common Sense Medicine! This is the last post of the year, moving into the holidays, so wishing you happy holidays and a happy new year. In this episode, I'm joined by Stuart Blitz, who is the Co-Founder and Chief Operating Officer at Hone Health, a men's optimization clinic that offers at-home blood tests, tele-health consultations, and medication delivery. Prior to this, Stuart held the position of Chief Business Officer at Seventh Sense Biosystems (now YourBioHealth), where they played a key role in designing and developing the world's first push-button blood collection device. Before that, they worked at AgaMatrix, where they served as the Executive Director of Business Development and Strategy, as well as the Director of Worldwide Commercial Development. Stuart's experience spans over several years and includes a focus on improving healthcare systems and providing convenient solutions for consumers.Check out the episode on Spotify, iTunes, or YouTubeIf you've been forwarded this email and are just getting this for the first time— thanks for reading! I publish podcasts monthly and I'd love for you to subscribe using the link below.Video Version[1:00] Stuart's origin in HealthTech, and how he created the first-ever medical device for the original iPhone* Started his career and joined two founders who started AgaMatrix in the diabetes space* He had done Biomedical Engineering in college at Johns Hopkins, and he was sort of the “black sheep” there because people didn't want to go to health startups in 2002, but rather medical school or government or research* AgaMatrix made glucometers with test strips for diabetes and then launched a medical device company * They ended up getting to retail pharmacies, and 15 years later the device that they made is still on the shelves at CVS, Krogers, etc. * They started working with Apple in 2007, right around the release of the first iPhone, to create a smart glucometer which was cleared by the FDA* They were able to partner with Sanofi, and distributed their product in 20-30 countries[4:22] Why he decided to stay at AgaMatrix for 10+ years* Every 2-3 years, he did something new, so it didn't feel like that long * The first couple years were core startup mode to figure out product-market fit and raise capital. * The first idea was to make software to make glucometers work better. This was a stupid idea because people make money on the glucose test strips and not the glucometer themselves* The next few years were about growing and selling, and they signed a bunch of deals to distribute their products. One was Liberty Medical, which provided products to people on Medicaid* The last few years were about distribution, building around new partnerships like the international one with Sanofi and scaling their sales team to get into more patients' daily routines[7:07] How did he pivot to SeventhSense Bio? * He had a lot of experience in HealthTech and diagnostics, and had met SeventhSense Bio before joining them* They had an interesting angle on at-home testing, which would require an easy device to get that blood from the patient without the assistance of a healthcare professional* Met many founders (ex. Hims, Romans, and also the much-maligned Theranos) and saw the D2C angle for medications* Key insight was they haven't gotten to mass adoption because of cost angle, usability angle, and lab compatibility angle* Most important is the usability angle, because at-home diagnostic has to function 99% of the time, the first time (there are no “re-dos” because it isn't like the patient has another tube or a professional to help them at home). The devices that are on the market right now aren't there yet, but might get there* His thesis was that there are going to be way more D2C, cash-pay, access companies started but they're going to get started around high-niche customers who aren't getting serviced already by the system[11:39] Founding Hone Health* He met his current co-founder, Saad, and liked his story. Saad had turned 35 and he had all the symptoms of Low Testosterone (Low T)* Saad approached Stuart in his role at SeventhSense Bio and thought that his at-home device could help measure low T in his customers* Stuart said it might not work that way, but he was intrigued by the business model and decided to join Saad at Hone Health 4 years ago[13:23] What does he think was core to build Hone? * Shree's take: With D2C companies, I see three issues — the patient needs to know that they have the disease, they need to know where to go to treat it, and they need to make sure that the provider also knows how to treat this under-serviced condition* Something that was core to the offering that they built was through building their physician network. A lot of HealthTech companies would use Wheel or SteadyMD provider networks to get started, but the specialty care that Hone provides prevented them from doing this* Stuart can tell if the physician is knowledgable about treatment for male hormonal health in 1 minute — do they (1) know the patient population, (2) do they know the protocols around dosing testosterone, (3) are they committed to the clinic by responding frequently / giving this the seriousness that it deserves, (4) can you use technology well to treat patients, and (5) do they pass the vibe check. Below is a video of his real time reaction when a doctor says they don't know the correct dosing of testosterone* Hone's business model is that a physician meets with a patient after they get labs via a tele-medicine consult, and then they determine based on AUA guidelines whether a patient needs to get low T. Then, the patient gets on a subscription plan to pay for the treatment and has a consult every 90 days[21:54] Risks to Hone's business model by using telemedicine with controlled substances* Context: The Ryan Haight law prevents providers from using telehealth from prescribing controlled substances. It was temporarily waived during the pandemic, when people needed them to continue on treatment (think Suboxone for opioid dependance, or Testosterone like in this case)* Stuart doesn't think it will be a big risk because the law originally was meant to prevent people from googling “Vicodin” to buy it online. This law came out 15 years ago when telemedicine was far from prevalent* The DEA had a proposal (summarized by Stuart) that said that a patient should see a provider in person at least once in 90 days to continue on that prescription for the controlled substance. Hone's patient population would be OK seeing a practitioner, Stuart thinks, because they go to LabCorp every 90 days for a lab test to continue being on Testosterone* The DEA held sessions in September 2023 to learn more about what to do about this restriction, and they decided to make a special registration process to make sure that providers could be able to continue to prescribe controlled substances via a telemedicine pathway which (he thinks) will be finished by the end of next year (2024)[27:11] Surprising things that Stuart learned about the patient population at Hone* Patients want options, it's not about either getting labs taken at-home or in the clinic, but it's the option of getting it at one or the other. You could have a patient in a city who has LabCorp 10 minutes away from them, or a rural area where they have one 150 miles away [29:01] Hone Health's Unit Economics* Stuart thinks that Unit Economics have to work from day one, and that VC-backed companies cannot stay afloat if this basic tenet is not met because simply relying on growth will not outpace profitability* They want to expand to longevity, thyroid care, obesity, etc. Right now, they don't serve that and their providers will send them elsewhere to get that care[31:20] Stuart's hot takes on Twitter * Stuart thinks that there are many players in the space who are making money off of the “bad things” that are happening in healthcare. If you insert X thing here, and you ask “why isn't anyone disrupting this? It's terrible for patients,” there's probably someone profiting off of that* Hone Health might have some competition as more clinics pop up, and there is a “race to the bottom” as they compete on pricing, but they can compete on the value that they provide to the consumer* One of the key learnings that they had on Hone Health was that in order to keep OpEx low, they have to be scrappy. Stuart mentioned if you're starting out, just “use Google Sheets.” Then you can figure out how to get your first customers, and then build from there* Those learnings are very critical and they can serve the business [38:53] Building their own HIPAA compliant EMR * They are not serving a population which requires Meaningful Use metrics (i.e., Medicare), since they are out-of-pocket / cash pay for all of their costs, but if they were then they will add on compliance after the fact * They first got one off-the-shelf, but it was pretty bad and wasn't helpful. The off-the-shelf EMR was fine for doctors who were writing notes, but the problems came in from a product standpoint, where there weren't meaningful ways to onboard patients and have a good patient journey* This was complemented because each of the founders had their own expertise, so they were able to build a better company by having a lot of synergies (marketing, finance, ops, marketing, brand, etc.) [43:48] Stuart's vision for the future of Hone Health * At a minimum, they want to be able to network with payers. They want to reduce out-of-pocket costs for patients, and they want to expand the amount of benefits which they can tackle using Hone (i.e., longevity, etc.) This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.shreenadkarni.com

Welcome back to Common Sense Medicine! In this episode, we're joined by Dr. Jimmy Turner, an academic anesthesiologist, self-proclaimed money nerd, and host of "Money Meets Medicine" podcast. He's also the author of "The Physician Philosopher's Guide to Personal Finance" Dr. Turner's mission is to empower doctors to find work-life balance and financial freedom. We delve into his journey from burnout to empowerment and discuss his involvement with Attend, a groundbreaking startup that redefines how physicians navigate financial challenges. For more insightful discussions, be sure to follow him on Twitter (@TPP_MD) and check out his book, and visit Attend's website for valuable resources and support. Join me as I explore the intersection of medicine and finance and discover practical solutions for physicians seeking a better quality of life.Again, if you've been forwarded this email and are just getting this for the first time— thanks for reading! I publish podcasts monthly and I'd love for you to subscribe using the link below. Video version[0:00] Introduction[0:34] Jimmy's story and learning more about the startup world* He did anesthesiology residency and fellowship at Wake Forest, and stayed on faculty there * Really started getting involved in learning about how to manage his money during fellowship — read the blogs, the books, and dove deep into the podcasts around personal finance* He really liked teaching others and he stayed in academic medicine and students, residents, and fellows used to ask his tips about money management* He married burnout with financial wellness, and his first business, The Physician's Philosopher (TPP) was around combating this idea about financial wellness* There is an intrinsic link between financial wellness and specialty choice / when you start a family / how you practice* He started a couple of podcasts, wrote a book, and became a top 5 name for physician blogger with TPP* That led to him starting a business with his co-host for Money Meets Medicine podcast, Dr. Lisha Taylor* Attend's north star - “Legitimately do what's good for doctors using technology”* Jimmy's mission is trying to put people over profit, and Attend's mission of being the comprehensive solution which is best for doctor's financial wellness was too good to pass up and was highly appealing to him [5:00] How do financial incentives impact physicians? * Jimmy would get told not to make a formal curriculum for students and residents around personal finance, both of which he does now* Nobody wanted to talk about money because they didn't want to cause any trouble * In fact, higher student loan burdens are linked with lower in-training exam scores. In-training exams in an internal medicine cohort (n = 16,394) showed that scores decreased as educational debt increased, with a mean difference of 5 points (IM-ITEs are scored as a percentage of total questions answered, only 260 out of the 300 items are scored).* This suggested to Jimmy that as a residency program, they should be ethically bound to teach their residents the ins and outs of personal finance wellness * Conflicts of interests are important to consider, but physicians already have conflicts when they have relationships with device manufacturers[07:15] Jimmy's experience with entrepreneurship and lessons learned* There are 2 schools of thought around entrepreneurship — (1) hustle as hard as you can or (2) take some time for yourself and make sure you can have a sustainable life outside of your business* He started out on the first camp, and now he's squarely on the second. He first started out with 60 hours / week with his main job as an anesthesiologist, and 20 hours / week on the business. It transitioned to more hours in the busines and less hours in anesthesiology until he arrived at his current split of 2 days / week as an anesthesiologist and the rest is on the business.* By the end of the first year, he hadn't made any money. By month eighteen, he might have broken even in the $5,000 he put in to make the website* He realized that in order to help people, he had to make his business grow, which in turn required revenue* He sold the personal finance business of TPP to Attend, where he became the Chief Medical OfficerFear is by far and the way the biggest lesson. Doctors are usually afraid of failure, and we haven't experienced much of it. However, in entrepreneurship, you're going to have a product, or a service line, which doesn't bring any profit to you. And you're going to have to take those learnings and improve. [11:12] How does Attend make money? * Attend makes money on consults for student loans / disability insurance. From their website, they can work with you in defining a plan for you post medical school how to manage your loans and how to pick a good disability insurance* Jimmy said that their consults usually cost around $200-500 per consult, and they are framing it as a way to save hundreds of thousands of dollars in the long term with your student loan burden* Jimmy mentions that his friend decided to refinance his student loans with a private loan lender, and it cost him $400,000 in student loans because he doesn't qualify for the public loan forgiveness program (PSLF)* Shree's research: I found that their products include $199.00 per student loan consult and can split it up over a few months, and they serve as a point person for good insurance disability quotes. I think that they have some sort of relationship with the brokers that they use for disability insurance, to either get a flat fee paid out to be part of their “trusted broker” list or some other revenue sharing arrangement. * Jimmy mentions that all of their employees earn a flat salary so they are not incentivized to push any larger policies to earn a larger commission; they are trying to design incentives so they don't screw people over by preventing them from being eligible for disability insurance[13:38] Jimmy's story about disability insurance / his journey to personal finance * When Jimmy was a fourth-year medical student, he had his first child, and wanted to get life insurance* He sat with a brother of a friend who was an insurance salesman and bought a private disability insurance policy which was fully underwritten and involved a deep dive into his medical history* Jimmy takes propranolol for essential tremor and has an ADHD diagnosis which he takes medication for, and this prevented him from getting disability insurance* Most residency programs have a Guaranteed Standard Issue (GSI) policy which is available to trainees if they haven't been denied or haven't been disabled. If you don't have an income, this none of the rest of personal finance matters* He thinks that disability insurance is the #1 financial task for physicians in residency because you'll never be more insurable than you are now* You have to be able to tell the insurance agent everything, because they can't go to the medical boards. If they find something in the medical underwriting piece, you're toast * Most insurance agents won't tell you about the GSI plan* GSI plan is only available during training and three months, usually, out of training. It locks in your rate in training and then, when you're out of training, allows you to buy more insurance as your income increases* A fully underwritten policy isn't bad if you're healthy, but make sure that you get a benefits rider to make sure your health history is “locked-in” at this current time because most people develop a medical problem during residency[18:53] What are some financial lessons which residents and students should know as they're starting their career? * When you're graduating medical school, the name of the game is preventing debt* When you get to residency, get disability insurance and make a student loan plan and see how you're going to join PSLF. Avoid revolving credit card debt like the plague* Work on the smaller tasks during residency — make an emergency fund ($1,000 as a resident, 3-6 months of living expenses as an attending physician)* Doctors are really bad at backcasting, and don't reverse engineer when they want to retire * The Diderot Effect, AKA lifestyle creep - obtaining a new possession often creates a spiral of consumption which leads you to acquire more new things. As a result, we end up buying things that our previous selves never needed* If you have extra money, you will spend that money. You have to know that it is coming as an attending physician[22:05] Discussion around Roth IRA / 401K and investing* You would rather pay the taxes and then invest as a Resident in a Roth IRA, and when you're in your Peak earning years, you put it in a Pre-tax vehicle (401K) (RR, PP)* The only caveat is that as a trainee, in an income-driven repayment program, your loan payments are based on your post-tax income (Adjusted gross income - discretionary income). If you contribute to a 401K, your student loan payments will be smaller* If you have a 401K match in residency, then you should definitely use it (“It's free money!”), but be careful about the vesting period — you don't want the money that you earned during the match to evaporate if you sign a job offer at a different institution[26:09] Refinancing student loans — why are doctors so bad at decision making? * The savings from Attend are often immediate — long term, there is always a return for these consults* When refinancing, you don't want to do it with a private lender. Jimmy thinks that every single company should have the disclaimer that “If you refinance your student loans, then you can never do PSLF ever!” * Every company which recommends a particular lender to refinance with gets a kickback to do so* PSLF is public service loan forgiveness program, which is a program which lets you get your loans forgiven tax-free. * In order to qualify for this program, you have to be enrolled in an income-driven repayment program (IDR) administered by the federal government, where loan payments are driven by your income* The two IDR programs are SAVE (formerly REPAYE) and IBR (income-based repayment). SAVE is a great plan for a majority of people — it allows for a cap on interest for your loans and can exclude your spouse's income. * Right now, there are four IDR programs, but they are consolidating into two (SAVE and IBR) in 15 months and you have to be in one of them to get PSLF* You have to make 120 non-consecutive qualifying payments on a federal loan, have to be in an income-driven repayment program (IDR) and work at least 30 hours a week for a qualifying employer (80% of hospitals are qualified state organization, federal organization, non-profits which allow for this) to get your loans forgiven. Residency payments which are low qualify for this program[33:10] Non-clinical careers — what do you tell people about making the switch?* You can still be an entrepreneur in medicine — a private practice doc, etc. Entrepreneurship allows for autonomy and allows Jimmy to control his schedule in a holistic way, more than medicine does * Also, burnout is a big problem for physicians and people are tired of it* If you can find a coach who can accelerate your journey for what you want to do, it's easier to achieve your goals. It is an uphill battle to found your own practice, but lean on people who have done the work before[40:11] Jimmy reflects on the most valuable advice he was given* He had a coach walk him through the process of why his business was failing. He wasn't trained as well to manage a business. The coach mentioned that he didn't have to do it all by himself* He was initially worried about the cost of running a business, but bringing more people into the business was helped him to improve the business * The best process improvement that happened during his business-building experience was the onboarding process for customers and building out the customer relationship management (CRM) system[43:40] What are the biggest failures that you've faced? * Ryan Holiday's “Obstacle is the Way” really helped him contextualize the process of failure into a stepping stone rather than a final destination* You have to experience the failure in order to learn the lesson* He was scared of offending people, and he had to realize that he was going to offend someone when he picked up a mic or typed something on a keyboard* Getting over the fear of being perceived as a failure was a big hurdle for him as well, and he was scared of being judged* Jimmy thinks that sales is a service, and it's not sleazy. You're trying to provide them a service which makes that [47:29] What's Jimmy's favorite car? * It would have to have manual transmission, and it would have to have a lot of horsepower * There aren't that many cars left like this: You have the CT4 Blackwing (which he drives), or a CT5, or the M3 / M5 BMWs [49:23] Which books would you recommend? * From a business perspective, “Never Split the Difference” by Chris Voss, “Think Again” by Adam Grant, “Leaders eat Last” by Simon Sinek, and “The Hard Thing about Hard Things” by Ben Horowitz This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.shreenadkarni.com

Welcome back to Common Sense Medicine! For the post, skip down ~2 scrollsLong time, no see, you say. Well, that's true. I've been busy and not-so-busy these past few years, and the long overdue post about “where have you been, Shree?” is coming—I promise. But first, a reflection. Since 2018, when I started this show, the world of healthcare, and my own perspective about it, has changed tremendously. However, there is one constant: talking to people who are “in the weeds” (to borrow a corporate phrase) of the work is the best way to get up to speed in the space. There is so much happening in the world of healthcare like Generative AI, electronic health records, and biotech, and I want to write more about all of it. As I'm in a more “chill” part of medical school, I've been taking the time to talk to founders of interesting HealthTech startups to build a framework about where the industry is headed.When can I expect more posts?, you say. First of all, I'm not sure anyone is asking for more emails in their mailbox, but I hope that if you're subscribed, I'm providing some value. I'm not trying to clutter your email—I think there's a space for interesting conversations about healthcare around 1 time a month. Plus, most people just skim anyway so I'll try and keep the show notes and insights on the shorter side. Alright, now that I've gotten the niceties over with, here are the show notes.Forwarded this email? Subscribe below for musings about healthcare conversations with people who are much smarter than me.What is Anja Health? Anja Health is a health and technology company that provides cord blood, cord tissue, and placenta banking. They are one of the few companies in the world that offer these services. Anja Health's services include: * Freezing umbilical cord and placenta stem cells* Sending a kit to soon-to-be parents in preparation for their birth experience* Safely collecting and storing your baby's stem cells for future cell treatments* Providing an easy to use collection kit with FDA-approved materials* Manual lab processing for maximum stem cell volume* 20 years of secure cryogenic storage at -180°C* Personal support from a banking or birth expertAnja Health's mission is to create one more treatment option through the power of stem cells. Anja Health was founded by Kathryn Cross, just over a year after graduating from Wellesley. Kathryn shared her personal story of founding the company in memory of her brother Andrew, who was diagnosed with cerebral palsy after a near-death accident with me on Common Sense Medicine, and below is a summary of our conversation. Show Notes (with timestamps)* [00:02:18] Cord blood stem cell space.* Kathryn talks about a Duke University study which was a randomized, double-blind crossover trial on cerebral palsy (CP) treatment with autologous cord blood (CB). It didn't show statistically significant results between the study and control groups, but a significant difference was found between the group that received infusions with a higher dose of (>2.5 * 10^7 cells) versus those who did not. * Providers historically have not been educated about giving information about cord blood banking, and social media is easier to go direct to the customer to educate them about the cord blood banking. She spoke about creator-led businesses, which have greater trust (especially in the beginning) when they have relatability and value capture on their side. This was the enabling factor to gaining and acquiring their first few customers. * [00:07:45] Lessons from team members.* She was a younger founder, and she needed to read a lot of material around management to “learn the ropes.” She touches each part of business, but she has been decreasing her involvement with ops to focus on growth and marketing. She tried to find someone who is better than she is at parts of the business, and then aligning with them to achieve the goals which she has for Anja. * [00:11:19] Fundraising process and mistakes.* Kathryn talked about using a process to fundraise for a startup using Ryan Breslow's book Fundraising. He recommends to only fundraise for 3 months, and make sure that you don't fundraise too early before you have product-market fit because the growth will be very painful if so. Kathryn thought that she fundraised too early, and this was partly because she didn't have a process going into her fist fundraising round. * [00:15:17] Private blood banking - why should parents use it? * Kathryn says that most pregnant people should be using cord blood banking because the placenta and the cord blood bank can act as a sort of “insurance” against a worst case scenario. Physicians can use stem cells to prepare treatment and then Anja Health is able to release a patient's units to the provider, and then it's used to give the patient the stem cell treatment. * Shree's take: I'm not convinced that doing this by way of a private blood bank vs. a public blood bank is still reasonable in this day and age, because the cost doesn't justify the evidence which is currently available. If you're bullish on storing on a private blood bank, look for one which is AABB accredited (by the FDA, like Anja is). The one drawback from a public bank which I had noticed is that you might not get your cells if someone else had already used it, but looking at the Duke University study and others in the space, the blood collected might not be useful if you only have one child to do an autologous stem cell transplant—as most of the research is done in preclinical models. However, that's part of Anja's allure, because you might be able to use it in the next 20 years for therapies which haven't been discovered today. * [00:24:24] Using placenta stem cells.* When someone actually donates a blood bank sample, they can increase the density by first sorting it manually. Anja Health mentions that they can do it manually but other companies say that the automatic sorting helps them get rid of contaminants.* Shree's take: I think that this is a function of marketing—if Anja Health is able to capture more of the market and convince their buyers that automatic sorting = bad, and that manual sorting = personalized, then they can effectively control the narrative that their method is better. Kathryn also mentions that she doesn't have any statistics about how many people actually use their stem cells, which gives me pause. How useful could this be if people aren't using it and it's mostly a function of marketing? In fact, one paper shows that automatic sorting actually increases the yield of the cord blood separation. * [00:28:05] Stem cell research in pregnancy.* She's excited about more general parts of women's health related work — infertility and PCOS which came to mind. She also thinks that you shouldn't consume your placenta, ya nasty. * [00:29:24] Scaling content and creator burnout.* It's really hard to scale content because there's a threshold to how much content you can produce. She batches a lot of content, but it's hard to scale them. She had a consigliere who fed her research about content, but now she just does her own thing. She also interviews a lot of people in the space, like doulas, midwives, and lactation consultants. Kathryn thinks that now, she's more able to do speak about her interests “off the cuff” because she's just had so much experience in the space. * [00:34:07] Consuming information and deciphering.* Interestingly she says that lower-income families do a lot more research, read everything, and are more anxious with childbirth rather than those who come from a higher-income family. So, she tries to recommend evidence-based organizations to help families distinguish signal from noise. * [00:36:00] Recruiting. * She's still figuring out how to best recruit, but one of the things that she has to do in order to really put herself in a position for recruiting the best talent is to interview the person and make sure they gel with everyone on the team, whether they have the skills for the particular role that she's hiring for, and gradually hiring into the role (contractor to employee)* Another book from Ryan Breslow which she recommends is Recruiting* [00:45:57] Favorite guest and learning experiences.* Kathryn's question for me! Listen to the podcast to learn more. Thank you for subscribing to Common Sense Medicine! If you have any comments / questions, please reply to this email to let me know what you think. Also, I'm also on the hunt for new podcast guests. If you know anyone who you think would be a good fit (think people in healthtech or healthcare doing interesting, innovative things) feel free to let me know. That's all folks! Remember, it's just common sense. — Shree “I will never eat a placenta” Nadkarni This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.shreenadkarni.com

Dr. Sutterer is a 4th year physical medicine and rehabilitation resident physician and will begin a sports medicine fellowship this summer. He is also a YouTuber with nearly 450,000 subscribers on his channel where he provides educational videos about sports medicine and injury analysis. You'll want to listen if you'd like to hear about his experience starting a YouTube channel focused on sports medicine, his opinion on performance enhancing drugs and how physicians should think about them, and how he makes his videos while also being a full time resident physician of physical medicine and rehabilitation.

Today, I’m interviewing Brett and Jared Dashevsky. They’re brothers, and a dynamic duo who run a media company called Healthcare Huddle. If that’s not enough for you, Brett is also a project manager at Capital One, and Jared has a Masters in Healthcare Systems Engineering and is a current medical school student. Jared used his foundations in healthcare innovation to build his weekly newsletter which he runs with Brett and his medical school classmate, Harrison Kaplan. Since its inception in 2019, Healthcare Huddle has grown it's audience to around 15,000 health professionals and students. I’m excited to have them on because, well, I am one of those 15,000 readers. It’s important to stay informed about healthcare and they do it with bite sized pieces that you can read in 5 minutes. Even in medical school, I am able to keep in front of the news cycle about the COVID-19 updates because Brett, Jared, Harrison, and the whole team at Healthcare Huddle has me covered. If you want to learn more go to shreenadkarni.com/hchuddle to register and become part of the “Huddlers!”

Dr. Patel is on faculty at the Penn Medicine Center for Health Care innovation and the Center for Health Incentives and behavioral economics, and a Staff Physician at the Crescenz VA Medical Center in Philadelphia, and a Senior Fellow at the Leonard Davis Institute of Health Economics. His research focuses on combining insights from behavioral economics with scalable technology platforms to improve health and health care. He has led more than 25 clinical trials in partnership with health systems, insurers, employers, and community organizations that tested ways to design nudges, incentives, and gamification to change clinician and patient behavior. This work includes digital health interventions using wearable devices and smartphones, and health system interventions using the electronic health record.

Today's podcast is with Shailin Thomas (@shailinthomas), who is a fifth-year student (and third year medical student) in a joint MD/JD program between Harvard Law School and the New York University School of Medicine. He received his B.S. from Yale University where he stuied cognitive neuroscience—exploring the anatomy and hysiology behind social phenomena. His interests lie at the intersection of clinical medicine and the legal forces that shape it. Prior to graduate school, Shailin worked on both the administrative and clinical sides of health care, and as a research associate at the Berkman Klein Center for Internet & Society. While in graduate school, he has served as a Student Fellow at Harvard Law School’s Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics, and as an Admissions Ambassador with the NYU School of Medicine Office of Admissions — helping to recruit the next generation of physician leaders. His writing has been published in a number of outlets, including the Journal of the American Medical Association. Podcast Episode Summary 1:16 - How he's every Asian-American immigrant's dream for their son (going to Harvard, becoming a doctor and a lawyer...need I say more?) 2:12 - Why he decided to go into an eternity of schooling (and is deciding to go through with residency) 8:36 - How he took his gap years and why he worked at Harvard before he became a medical student 10:16 - How he reasons through topics in health law and how he finds topics to write about 22:54 - The origins of health law and how we can design a better liability penalties and design framework for the healthcare system 31:00 - How to balance deregulation in the healthcare industry with a legal solace for patients to get the right treatment 34:51 - His opinions on healthcare coverage and how they impact patient care; how he addresses my devil's advocate comments about shielding cost from consumers and the implications of moral hazard and more!

Today's guest is Dan Munro, who is, in his own words, "not a clinician or an economist," but he is interested in how healthcare is broken in the United States and how technology innovation and policy can solve that. He first started writing about healthcare starting as a Forbes Contributor in 2011, and Dan has since appeared in a wide range of publications. We talked about his first book, called Casino Healthcare, and many other topics. We talk about 1:48 - His background as an system engineer, and how that helped him get into healthcare and how it operates from a software engineering perspective 9:08 - How the AMA meets behind closed doors in order to price healthcare via CMS 13:09 - How uncompensated care can lead to higher premium rates, and tiered care (case study: Hahnemann shut down) 23:59 - Why he thinks that medical Education should be free from a systems level perspective 28:03 - Why healthcare can never be a consumer product like in other parts of our life 34:27 - Telemedicine and the advent of telehealth (point of care technologies, digital health technologies)

Peter A. Ubel M.D. is the Madge and Dennis T. McLawhorn University Professor of Business, Public Policy and Medicine at Duke University. A physician and a behavioral scientist, he uses the tools of decision psychology and behavioral economics to explore topics like informed consent, shared decision making and health care cost containment.  He has authored over 300 academic publications, the majority of which involve empirical explorations of decision psychology as it pertains to health care. He has written for the New York Times, the Los Angeles Times, the Atlantic, the New Yorker, and is a regular contributor at Forbes. His books include Pricing Life (MIT Press 2000), Free Market Madness (Harvard Business Press, 2009) and Critical Decisions (HarperCollins, 2012). His newest book, Sick to Debt, is scheduled for release in 2019 (Yale University Press). You can find his blogs and other information at http://www.peterubel.com/. 

Professor Forman is a Professor of Diagnostic Radiology (and faculty director for Finance),  Public Health (Health Policy), Economics and Management.  Professor Forman directs the Health Care management program in the Yale School of Public Health and teaches healthcare economics in the Yale College Economics Department. He is the faculty founder and director of the MD/MBA program as well as the faculty director of the healthcare focus area in the School of Management’s MBA for Executives program. As a practicing emergency/trauma radiologist, he is actively involved in patient care and issues related to financial administration, healthcare compliance, and contracting. His research has been focused on improving imaging services delivery through better access to information. He has worked as a health policy fellow in the U.S. Senate, on Medicare legislation.

Dr. Kumar is is an Assistant Professor in the Department of Interventional Radiology at Rutgers New Jersey Medical School.  He completed his fellowship training in Vascular and Interventional Radiology  at the Mount Sinai system in NYC. He is an Assistant Professor in the Department of Interventional Radiology at Rutgers New Jersey Medical School. He mentors many residents and students interested in IRHis treats a wide spectrum of diseases using minimally invasive procedures include Peripheral Arterial Disease, venous disease, dialysis , women’s health/Uterine Fibroid Embolization, Liver cancer. He grew up in Houston, Texas and moved to New York City for residency after medical school. He has lived in NYC for 10 years. In his free time he enjoys trying new restaurants in the city, sports, traveling. 

Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in 1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident. In 1992 Dr. Balentine started practicing Emergency Medicine at St. Barnabas Hospital in the Bronx where he served as Residency Director and Department Co-Director. Dr. Balentine served as Chief Medical Officer and Executive Vice President of St. Barnabas Hospital and Healthcare System in the Bronx until 2014. He is Past-President of the New York Chapter of the American College of Emergency Physicians and Vice Chair of the New York State Board of Medicine. He has authored and edited many web and textbook chapters and was the founding medical editor of newyorkmedicaljournal.org. Dr. Balentine is currently Dean, College of Osteopathic Medicine; Vice President, Health Sciences and Medical Affairs at the New York Institute of Technology.  

Kevin is currently a postdoctoral associate the laboratory of David D. Moore, PhD, focusing on the role of lipids and one carbon metabolism-related nutrients on nuclear receptor signaling with broad relevance to both physiological and pathophysiological states. Kevin additionally is a primary collaborator for NCT03194659, a randomized, controlled trial of choline supplementation during pregnancy.

We are four medical students attending the University of Utah School of Medicine. We love Anki but found it very difficult to use at first. We originally made a few videos to help our classmates and eventually decided to keep making tutorials so we could share with all Anki users worldwide. The four of us are members of The Church of Jesus Christ of Latter-day Saints and believe that serving others is what brings true happiness. We hope you enjoy everything we have put together for you! My name is Tyson Burnham. I'm a second-year medical student at the University of Utah. I am originally from Arizona but have lived in Utah for the better part of 8 years. I did my undergraduate studies in neuroscience at Brigham Young University. During my studies at BYU, I took 2 years off of school to serve a mission in Argentina for the Church of Jesus Christ of Latter-day Saints. I come from a family of physicians and have known since childhood I wanted to be a doctor. After medical school, I plan on pursuing a residency in Internal Medicine followed by additional training in Cardiology and Electrophysiology, but I understand that at this point in my career nothing is set in stone. I have always been passionate about mentorship and teaching, so when I had the opportunity to join the AnKing team, I jumped on it. 

Dara Kass, MD is an Assistant Professor of Emergency Medicine at Columbia University Medical Center, where she also serves as the director of Equity and Inclusion for the Emergency Department. After completing her residency at SUNY Downstate Medical School and Kings County Hospital, she served as faculty of Staten Island University Hospital, where she facilitated the start of their EM residency program. She previously served as the director of undergraduate medical education at NYU. As director, she introduced longitudinal career advising, innovative educational modalities, and numerous clinical experiences. She is the founder of FemInEM, an organization dedicated to the achievement of gender equity in emergency medicine. FemInEM serves as an open access resource for women in EM, a community focused on career development, physician support, and seeing women in medicine thrive. What began as a blog is now a movement, a multi-faceted community comprised women in medicine all over the world. 

Varun and Shree sit down to talk about some viewer questions that we got from Instagram and Twitter @csmedicine. We also talk about mini-medical interviews, research for high school students, and how to write a good personal statement. If you're interested in more topics like these, definitely leave a comment about what you want to hear about next!

Dr. Gopal Desai is a resident physician at the NYU School of Medicine specializing in Anesthesiology.  

Varun and Shree talk about Biases against IMGs in Residency, Activism in Medicine, and why we need more rural doctors in the US.

Tricia Rae Pendergrast is a medical student at Northwestern Feinberg School of Medicine and is interested in Pediatric intensive care and critical care medicine. She joins me to talk about medical school, and how we can dismantle barriers in medicine for people who identify as LGBTQ+. You can find her @traependergrast

Dr. Bryan Carmody writes a blog at the Sheriff of Sodium. He is a pediatric nephrologist, and an EVMS associate professor. He is an advocate for medical students and common sense. You can find him @jbcarmody

#58 - Medical School in the Time of Corona, STEP 1 Woes, and Doctor Drama. Find us on @csmedicine, and commonsensemd.com

Robert Croyle, PhD, was appointed director of the Division of Cancer Control and Population Sciences (DCCPS) at the National Cancer Institute (NCI) in July 2003. You can learn more at https://cancercontrol.cancer.gov/od/director_rc.html

Dr. Adam Biener is an Assistant Professor of Economics at Lafayette College. Previously, he was employed as an economist at the Agency for Healthcare Research and Quality in the US Department of Health and Human Services. Dr. Biener's research focuses on medical care use and expenditures in the US. Specific areas of his research include the medical care costs of obesity, how the affordable care act has affected physician payments and the use of primary care, as well as racial and ethnic disparities in healthcare use. Dr. Biener received his PhD in Economics from Lehigh University in 2015. 

Louise Aronson is a physician, writer, and person. Learn more about her at https://louisearonson.com/about/

Priya Kantesaria is a fourth-year medical student at Rutgers New Jersey Medical School. Priya graduated from Rutgers University – New Brunswick, where she completed her bachelors in Genetics with minors in public health and health & society. At NJMS, Priya has focused on improving healthcare at a variety of levels. Priya has a passion for legislative advocacy. As an active member of the American Medical Association, Priya serves as the Committee on Long Range Planning Vice Chair where she works on studies & programming related to medical student debt & burnout. She serves as the NJ delegate to the House of Delegates where she represents NJ medical students. As the AAMC-OSR Northeast Legislative Chair, she focuses on developing the relationship between student-led advocacy and medical school administration. At her institution, she increases student access to pre-clinical resources by running academic support for first years and developing curriculum to teach students bleeding control. She active in the fight against sexual harassment & domestic violence through her work with the Title IX committee & the Domestic Violence Intervention Program. She believes strongly in preparing the next generation of physicians and has created curriculum for the Mini-Med School. As a future physician, she hopes to encourage physicians and patients to be active and empowered members in healthcare, whether that be through legislative action or everyday clinical care.

Travis Benson is an M1 at Harvard Medical School. Prior to medical school, Travis worked as a pipe welder for nine years. Motivated by the experience of being the child of a transgender parent and seeing the discrimination that the trans community faces in a clinical setting, Travis quit his job in 2015 to return to school to become a physician. He attended the Oregon Health & Science University-Portland State University School of Public Health and majored in Health Sciences as a non-traditional first-generation student. During undergrad, Travis was heavily involved in research. At OHSU, he conducted research on voice masculinization in transmasculine patients, created a health needs assessment study of the transgender and gender non-conforming community in Portland, and worked as a clinical researcher in a circadian rhythm lab. He also spent some time as a research fellow at the NIH as part of the Amgen Scholars program where he studied immunology. He has been heavily involved in mentoring students. As an undergrad, he founded a chapter of Phi Delta Epsilon at his school and tutored for the Louis Stokes Alliance for Minority Participation and athletic department. Currently, he serves as a non-resident tutor for Harvard University where he helps pre-med students navigate the application process. Currently, he is involved in phalloplasty research at Boston Children’s Hospital and cutaneous T cell lymphoma research at Brigham & Women’s Hospital. He is part of the Derm Scholars program at HMS. He is one of the co-founders and moderators of the twitter chat, @MedStudentChat. He is interested in transgender health, dermatology, and bioethics, and one day hopes to combine those three interests in his career.

Dr. Jason Ryan is the creator of the website Boards and Beyond. Thousands of students from around the globe use his online videos and practice questions to prepare for the USMLE Step 1 exam. Dr. Ryan trained in internal medicine and cardiology at Harvard’s Beth Israel Deaconess Medical Center, where he also served as a chief resident. In addition to his MD, he holds a Master of Public Health degree and a Bachelor of Science degree in Chemical Engineering. He has been a faculty member at the University Of Connecticut School Of Medicine in Farmington, Connecticut for over 10 years.

Dr. Michael L. Barnett is Assistant Professor of Health Policy and Management at the Harvard T.H. Chan School of Public Health and a primary care physician at Brigham and Women’s Hospital. Dr. Barnett received his MD from Harvard Medical School and completed a residency and fellowship in primary care and general internal medicine at Brigham and Women’s Hospital. Dr. Barnett’s research focuses on understanding and improving the health care delivery system with specific interests in the role of physicians in the opioid epidemic as prescribers and providers of treatment for opioid use disorder as well as studying innovative models for health care payment and care delivery. His research has been published in the New England Journal of Medicine, JAMA, British Medical Journal and Annals of Internal Medicine and has received best research of the year awards from the Society of General Internal Medicine and AcademyHealth. His research has also been featured or cited in the New York Times, Washington Post, National Public Radio, CNN and The Economist. He is the recipient of a Career Development Award from the National Institute on Aging.

Professor Mamas trained in Medicine at the University of Oxford, undertaking an MA in Physiological Sciences in 1994 and a DPhil in Physiological sciences from 1994-1997. He completed his clinical training at the University of Oxford in 2000. Professor Mamas was appointed as Clinical Lecturer in Cardiology at the University of Manchester (2006) and completed his specialist training in Interventional Cardiology in 2012 and was appointed as a Senior Clinical Lecturer and Honorary Consultant Interventional Cardiologist at the University of Manchester. In 2015 he was appointed as Professor of Interventional Cardiology at Keele University. Professor Mamas is an Associate Editor of Circulation Cardiovascular Interventions and a member of the E-Cardiology working group of the European Society of Cardiology. He is also a member of the NIHR interventional procedures review panel as well as sitting on several safety endpoint committees of several national randomized controlled trials. He is the Clinical Director of the Centre for Prognosis Research at Keele University, and leads a group of clinicians, data scientists and statisticians whose research interests focus around the use of routinely collected electronic healthcare data to inform the diagnosis, treatment and clinical outcomes of real-world patients with cardiovascular disease. His group uses national audit data derived from the national cardiovascular societies at the National Institute of Cardiovascular Outcomes Research (NICOR; https://www.ucl.ac.uk/nicor), data derived from primary care (Clinical Practice Research Datalink; https://www.cprd.com/intro.asp) as well as large datasets from the US such as the Nationwide Inpatient Sample and National Readmissions Dataset to study outcomes in patients with cardiovascular diseases. His work focuses around studying clinical outcomes, complications and assessment of treatment efficacy of interventions / medical treatments using real world data derived from the national electronic healthcare records of patients with cardiovascular disease, as well as prognostic modeling leading development of risk stratification tools used for national reporting in PCI and TAVR. He has published over 300 peer-reviewed papers using big data in populations with cardiovascular disease.

Cedric Dark, MD, MPH, FACEP is Founder and Executive Editor of Policy Prescriptions. A graduate of Morehouse College, Dr. Dark earned his medical degree from New York University School of Medicine and holds a master’s degree from the Mailman School of Public Health at Columbia University. He completed his residency training at George Washington University. Currently, Dr. Dark is an Assistant Professor in the Department of Emergency Medicine and a Health Policy Scholar in the Center for Medical Ethics & Health Policy at Baylor College of Medicine. He produces a health policy podcast for the American Academy of Emergency Medicine and a column for ACEP Now.

Today, we talk with Dr. Gwen Quinn, the Livia Wan M.D. Endowed Chair and Vice-Chair of Research in Obstetrics and Gynecology and Professor in the departments of Population Health and the Center for Medical Ethics at NYU School of Medicine. She is the chair of the departments promotion and tenure committee. Dr. Quinn received her Ph.D. in educational psychology from Florida State University and did a post-graduate fellowship in public health and has post-graduate certification in Program Evaluation and Biomedical Ethics. Her research focuses on improving patient/family/physician communication through understanding the barriers and benefits of health care use from a mutli- stakeholder perspectives. Her current research and training efforts are in the areas of : Reproductive Health, Sexuality, and Fertility Preservation, Quality of Life issues in Pediatric, Adolescent & Young Adult and LGBTQ+ Cancer Populations, and Cancer Clinical Trials (including minority barriers to participation); and training researchers to conduct research with high risk populations.

Today, we sit down with Dr. Talal Hilal, a physician who is originally from Syria. He completed his medical school training at the Royal College of Surgeons in Ireland (RCSI) campus in Bahrain in 2012. He applied for residency training as an IMG in 2013. He did his residency in Internal Medicine at the University of Kentucky, and graduated in 2016. At the time of this interview, he was chief fellow in the Hematology/Oncology fellowship at Mayo Clinic in Phoenix, AZ and graduated in the summer of 2019. His clinical interests are hematology (specifically lymphoproliferative disorders), application of evidence-based medicine in clinical practice, and pragmatic trial designs.

In this podcast, Dr. Richard Frankel stops by and we talk about a varied number of sociological factors that physicians have to face - in terms of their training, their eventual job, and other factors outside their job. Dr. Frankel is a professor of medicine and geriatrics at the Indiana School of Medicine, and he researches organizational culture change, face-to-face communication, and the role of technology and its effect on the human dimensions of healthcare, especially empathy.  In addition to his research interests he has been a medical educator for the past 35 years. He was the co- director of the internal medicine residency program at Highland Hospital/University of Rochester and also served as co-director of the Program and Fellowship in Advanced Biopsychosocial Medicine. From 2003-2013, he was the statewide director of Indiana University School of Medicine’s professionalism competency and responsible for both curriculum and remediation in this arena. We talked about his experiences in academia and his interests around medicine, and how I could learn from different perspectives outside of just the clinical aspects of medicine.

On this episode of Vital Signs, Varun and I talk about the book When Breath Becomes Air by Paul Kalanithi as well as our personal experiences up close and personal with death and dying.

My friend Varun and I talk about our journey in the BS/MD Program and how we got to medical school. Enjoy the next episode of Vital Signs!

A new co-host, Varun, and I talk about our experiences in our medical school program, compassion tests, and medical education. Email us at contact@commonsensemedic.com if you have any questions, comments, or concerns! Articles discussed in this episode: https://news.aamc.org/medical-education/article/med-school-3-years-future-medical-education/?fbclid=IwAR0YHj28mmIVMoUnK1O7cf15W3ag0b0TJk2cgPRGmcY2wcs5HinirPzttzo https://khn.org/news/oregon-medical-students-face-tough-test-talking-about-dying/ https://www.kevinmd.com/blog/2019/07/our-medical-training-has-been-outsourced.html

Today on the show we are very glad to welcome Dr. Nina Shapiro, ENT specialist and author of Hype!  In our conversation we chat about her book and what inspired a general and popular publication of its kind before getting into some of our guest's experiences and opinions on the medical field at present. We discuss confirmation bias, common health concerns and the attitudes of parents towards health in the modern climate. Dr. Shapiro opens up about e-cigarettes, vaccines, online information and gender bias in medicine too. She shares some of the challenges that come with writing a book, and particularly a medically focused one, why mentorships are so important to young doctors and the troubling advice she offers encounters in her work. We finish off the episode with a few fun questions about wishes, her mission and a question that Dr. Shapiro wants to ask Shree! For all this and more, tune in today!   Key Points From This Episode:   Confirmation bias, the influence of Google and the inspiration behind the book. Surprising beliefs that are widely held to be true. Reformulating the pyramid of health concerns. E-cigarettes, JUUL products and the effects that Dr. Shapiro has noted. The evolving attitude of parents about their children's wellbeing. The unrealistic debate around vaccines and legal and ethical concerns. Close-knit communities, the speed of outbreak and the importance of education. Lay press, battling fake information and Dr. Shapiro's attitude towards these. The most challenging elements of writing the book. Medical education and mentorships within any program. Shapiro's experience of gender bias in the medical profession. The professional advice Dr. Shapiro disagrees with the most. Shapiro's mission and what gets her out of bed in the morning. The three things Dr. Shapiro would wish from a genie! And much more!   Tweetables:   “I work in healthcare, I work with patients, I work with families, we’re exposed to a lot of information, all of us, not just doctors, all of us on a daily basis.” — @drninashapiro [0:01:04]   “I really felt that there was a dire need to write a book that was as evidence based and as non-biased as possible.” — @drninashapiro [0:01:29]   “I take care of very elective problems and I take care of severely emergency, life and death problems and everything in between. And no two days are the same.” — @drninashapiro [0:34:56]   Links Mentioned in Today’s Episode:   Common Sense Medicine — http://commonsensemedic.com/ Hype — https://www.amazon.com/Hype-Doctors-Understanding-Personal-Decisions/dp/1250149304/ Dr. Nina Shapiro — http://drninashapiro.com Dr. Nina Shapiro on Twitter — https://twitter.com/drninashapiro Dr. Peter Attia — https://peterattiamd.com/ When Breath Becomes Air — https://www.goodreads.com/book/show/25899336-when-breath-becomes-air The Spirit Catches You and You Fall Down — https://www.goodreads.com/book/show/25589791-the-spirit-catches-you-when-you-fall-down How Millennials Became The Burnout Generation — https://www.buzzfeednews.com/article/annehelenpetersen/millennials-burnout-generation-debt-work Digital Minimalism — https://www.goodreads.com/book/show/40672036-digital-minimalism

On the podcast today, I interview Dr. Joyce Kahng, a dentist practicing in Costa Mesa, California. She teaches classes in dentistry at USC and also owns a private practice called Orange + Magnolia dentistry studio. We open up with how she got interested in dentistry, to be like her mom.    She didn’t really know what she wanted to do with dentistry until she completed school, she explains, like a lot of other people in medicine. She came to the General practice residency to talk to people about routine things (because she did not want to specialize) and focus on building relationships with people.    Building Relationships Through Social Media   This brought her to Instagram. Starting it as a tool to grow her business, she was able to more readily disperse knowledge about dentistry, like how to floss correctly.  She explains that it was more authentic to her to make sure that she was able to talk about the topics that would help people on their journey throughout dentistry. We talk about how memorable moments like patient cases impacted her decisions along the way to becoming a practicing dentist as well.    How Dentistry is Going to Change   Although business practices are changing, Dr. Kahng is optimistic for the future. She believes that she should have had more fun during school (who doesn’t?) but she is optimistic for her future as well. The insurance companies, while they charge more for “elective” procedures, have the ability to change through advocacy in the dental community. 

Today, I had the great pleasure of talking to Dr. Andrea Tooley. She is a fellow in ophthalmic plastic surgery in New York City. She is active on Instagram with the handle @dr.andreatooley. We were able to talk about how she got interested in ophthalmology, her struggles in medical school, and how she was able to use YouTube, Instagram, and other social media outlets in her professional life as an advocate for the American Academy of Ophthalmology.    Something cool that I learned about Dr. Tooley on the podcast was that she earned her pilot’s license at age 16, and was exposed to ophthalmology through a trip in her senior year with Orbis International, a foundation which flies to underserved nations and carries out eye surgeries on planes.    As she progressed through her education, she was able to find a routine in medical school and hit the ground running as she knew that she wanted to specialize in ophthalmology from the get go.    Finding a Mentor   Throughout her journey, Dr. Tooley found a mentor who was willing to help her focus her passion through doing research while in medical school, and this led to other opportunities which helped her stand out. I also asked her about how she was able to study for USMLE STEP 1 while managing other projects on the side.    She was able to find time by being very active when she learned; she couldn’t just re-read and highlight the books that she had to study with. Also, by writing information on the whiteboard was another method she used to get through a lot of facts in a small amount of time.    Holding Doctors To a Standard    Some bad recommendations that Dr. Tooley hears in the wards is that people give too much resources to study. If you are pulled in too many directions, then you are not able to focus when you are studying. Also, if you try and act like any one else, then you will not succeed - being yourself is more important than living someone else’s life.    Also, getting over challenges is more about introspection and reaching out to the support systems that you have (your family and friends) rather than a specific routine. Each challenge brings adversity, and Dr. Tooley is no stranger to that fact. 

My guest today is Dr. R. Peter Manes. We talk a lot about work-life balance as a doctor, how to become an ENT, and what excites him about surgery. Something that really amazes me about being a doctor is how specialized people become and how they are able to be just a handful of people in the world who know how to do the things that they do. For example, Dr. Manes is able to do endoscopic and rhinology skull base surgery, something that he had to train years to accomplish. And it is because of his efforts that people can live comfortably even though they have chronic sinusitis. Something that I haven’t had the ability to appreciate in making these podcasts is the journey that I have had talking to different professionals, and Dr. Manes is right that it is a good time to reflect on my own journey and move ahead as I’m starting medical school.

Dr. Shannon Tapia stops by the podcast, and we talk about relationships, stand up comedy, and when to get married. It's a real talk which shows how life can take different turns when you least expect it. We started talking about how she was able to get into stand-up, and how she was able to turn bad experiences into good learning moments and her advice for women in medicine. Something that I learned about Dr. Tapia during this podcast is her ability to not let things faze her. In a world where there is a culture of instant gratification, there is solace in the fact that she is adamant about not letting the outside world define her view of how things are going in her professional life. Also, we talked about how she planned around a family during her time in medical school, and how she planned around her boards (Step 1 and Step 2). Dr. Tapia also explained to me how "if you're a physician and a Mom, you're pretty much working 190% of the time" Although I'm not a female pre-med student, I do understand that there are experiences that I won't ever get. However, that's the goal of this podcast: to gain perspectives that I wouldn't have gained otherwise. In this world, as Dr. Tapia says, you have to take any advice with a grain of salt -- the narrow perspective by which we see the world is limited, however, that's equally as true for other people. One of the goals of this podcast is to make sure that I am able to think, read, and write. That's not going to change as I make these podcasts and go through medical school. If you are interested in learning more about Dr. Tapia, definitely check out her blog: http://medicineontap.net/

Have you ever wondered how to speak better and communicate more effectively? It's something that we do every day but it's getting harder and harder to do as we forget the core principles of communication and become lonelier and lonelier due to our focus on technology. I set out to search for people who could help me understand how to communicate better on the podcast or otherwise, and I stumbled into New York Speech and Vocal Coaching. My guest today is a Voice Teacher Associate, and he specializes in teaching a singing voice and is a rehabilitation specialist, which enables him to provide healing to injured singers and proper technique to avoid injury in healthy singers. One thing that Brendan focused on was the "urgency pulse" which is getting anxiety when there is a need to speak. Speech coaching, the cognitive issues which arise when there is a need to speak is different than speech pathology, which is more of reducing a clinical condition. Brendan explained to me that my verbal ticks were because of this urgency pulse and reducing this by controlling my breathing would be helpful in future podcasts to communicate my point more clearly. This urgency pulse is due to the fight-or-flight response which we are ingrained with in an evolutionary sense. He was able to rehabilitate his voice by taking part in the NYVC Voice Teacher Training and Certification under the teaching of Justin Stoney. In doing so, he has learned invaluable information to assist him in his voice teaching. The Voice Teacher Training has been the highlight of his career as a voice teacher and musician. In addition to being a voice teacher, Brendan is also a licensed and certified speech-language pathologist. He is a Speech Coaching Associate at New York Speech Coaching and the Head of New York Speech Pathology. Brendan holds a Master of Arts degree in Speech-Language Pathology from Hofstra University as well as Bachelor of Arts degrees in Speech Communications and Philosophy/Religious Studies from St. Joseph’s College, where he also minored in music. We also talked about his own journey and some of the injuries that he saved himself from.

What is an endodontist? I was curious as to what dentistry entails and how I could learn more about the part of our body that physicians don't often treat, the teeth and how they connect to the whole body. My guest was Dr. Stephanie Tran, who is a New York based endodontist. She's a big game of thrones fan, something which we talk about in the podcast, but it led her to make her instagram title and bio, which is @her_holiness_the_pulp. If you're a dental student and want to learn more, message @csmedicine and we can arrange a quick Q+A! An endodontist is basically someone who focuses on the apex of the tooth where the pulp meets the blood vessels of the gum. She works on very cool procedures which help save the teeth and reconstruct the surrounding structures of the tooth. We talked about the craziest cases she has seen in oral maxillofacial trauma, and other tooth trauma when teeth also came out of the socket! There are a lot of specialties in dentistry as well, and so we talked about her journey in endodontics, and how she chose this one over other specialties like periodontics. However, she also appreciates these specialties and tries to learn from them as she practices. She also accelerated her training, so something that we also go into is how she was able to manage all of her studying as a college student -- some advice that I definitely needed and am going to apply as I go through my journey! Furthermore, we talk about newer technology that's popping up in the world of dentistry. Have you ever heard of teeth being replaced using 3D technology? It's actually crazy to hear from someone in the forefront of technology in dentistry on how to make dentistry better. It's really cool to see someone who's so passionate about her work and it was a great conversation. I love to see what Dr. Tran does in the future!

Stoked to have @aliabdaal on the podcast. We were able to talk about lots of things, including his businesses and some advice for starting on YouTube. I have been following Ali for quite some time, so it was a great time to have him on the podcast to talk about some things that I see Common Sense Medicine becoming throughout my journey in medicine. First, we talked about the video aspects of medical education. He thought it would be fun, and it would be a cool thing to start the podcast. We also talked about optimizing his productivity in medical school and tech, which he covers in his YouTube channel. We also talked about how the UK and US differ in their structure of medical school. He was able to use his passion for coding to start a business based on his score on the BMAT (the medical entrance exam in the UK).

How often do you take care of your ears? Hearing hygiene is a thing, I learned through Dr. Marjorie C. McCullagh from the University of Michigan School of Medicine. She studies hearing loss in farmers, and gave me some tips on learning about how to put in my earplugs properly.  Something that we don’t think about often is how concerts and other sounds can affect our health down the line. Hearing is something that we take for granted, and I know that I’m definitely going to think twice when I go to a concert without earplugs after hearing what Dr. McCullagh told me can happen when you don’t take proper precautions! We also talk about how the sound level of even common place sounds can be too much if its an “impact” vs a “continuous” noise, and other advances in hearing research and behavioral incentives for helping rural health.

Prerak is a second year medical student at Yale School of Medicine. Currently, he is in his clerkship year, where he is rotating at multiple sites and getting a better idea of what each specialty entails. Outside of school, Prerak also enjoys sharing his experiences and what he has learned through his YouTube channel! YouTube gives Prerak a way to reflect on his journey while also assists others in theirs.

Rick Pescatore is the Director of Clinical Research for the Department of Emergency Medicine at CKHS. 

Dr. Kevin Jubbal is a physician, innovator, and educator. Find him on Instagram @KevinJubbalMD or @MedSchoolInsiders, or at KevinJubbal.com

Kateryna is a first generation immigrant that focuses on empowering those around her to reach a higher level of education. She grew up in a medically and educationally underserved community and would like to introduce a new perspective on medicine. Aside from medicine, she is a micro influencer and model for various companies. 

Robin O. Winter, MD, MMM has been Director of the JFK Family Medicine Residency Program since 1989. Board certified in both Family Medicine and Geriatric Medicine, Dr. Winter earned a Master of Medical Management degree at Carnegie Mellon University. He is Medical Director of JFK Hartwyck Nursing, Convalescent and Rehabilitation Centers, and sits on their Board. Dr. Winter is Professor and Founding Chair of the Department of Family Medicine for Hackensack Meridian School of Medicine at Seton Hall University. He is also a Clinical Professor in the Department of Family Medicine and Community Health at Rutgers Robert Wood Johnson Medical School and an Associate Professor at St. George’s University School of Medicine.