Podcasts about CHS

In an effort to persuade lawmakers to focus on animal welfare bills this session, the Connecticut Humane Society went to the capitol and they brought furry friends too! We spoke with executive director of CHS, Jame Bias, about the bills being debated and the impact on rescue animals. Image Credit: Getty Images 

Coach Millar has had quite the journey in his track career. From it being his second choice to throwing in college and becoming the CHS head coach, he has had his fair share of experience. He gives insight on building character, strength, and speed. This podcast was a great learning experience! Produced by All Sports Best Filmed by Isaiah Galindo Presented by CNB Bank

积极心理学中，有个有趣的看法：虽然「幸运」常常被视为是偶然或外部因素，但它其实更是一种可以被主动塑造的生活状态。保持积极快乐的心情，会更容易感觉到幸运；还能增加自我效能感，会更容易有主动的行动、开放的心态，这些特质，都能够增加遇到幸运的可能性。只是在各种压力越来越大的社会氛围之下，维持积极情绪并不容易——这种时候，「音乐」就变得更加重要了。对我来说，邂逅幸运的最小单位，就是一首歌。在这期节目，我想把这种幸运分享给你，希望能在轻盈的初夏来临之际，通过音乐，来唤醒浪漫或者快乐，让人更加积极主动地去生活、去抓住机会和属于你的幸运。

In this episode, Dr. Courtney Herring talks with Dr. Nadia Maccabee-Ryaboy about cannabinoid hyperemesis syndrome (CHS), a malevolent downstream condition related to cannabis use being seen in a growing uptrend of adolescent emergency department visits and hospital admissions. Listen in on the discussion that circles around clinical practice guidelines addressing how best to identify, manage, and support patients with CHS as public policy and public health collide. 

This episode of the Coast Highway Shuffle Show features our tribute to the amazing 'Q', Mr. Quincy Jones.  Mainly as a producer and arranger, Mr. Jones was truly one of the most impactful figures in popular music over the past 60 years. As clear evidence, we share songs by artists like Lesley Gore, Frank Sinatra, Michael Jackson, George Benson, and The Brothers Johnson, along with songs Mr. Jones recorded directly.Add in another 10 group of songs by various artists and you have yet another memorable edition of the CHS! Enjoy!    

THIS edition of the CHS is 2 days after Christmas, which explains why there is NO Christmas themed music in it! INSTEAD, there IS great music from artists like ELP, The Who, Ambrosia, The Meters, Billy Strings, Dave Edmunds, KT Tunstall, Larkin Poe, Black Sabbath and MANY more! Enjoy!! {and an early Happy New Year 2025!} 

This first episode of CHS in 2025 includes an important interview with Laguna Beach Fire Chief Niko King {at the 11mn. 45 sec mark}.Chief King has joined us on air for important fire safety updates as Laguna Beach watches both the Palisades and Altadena fires burning up in LA County and works to ensure our own fire readiness. Following this interview, the rest if the show features 13 songs with "Wind" in their title, given the proornounced effect of heavy winds tonight in Laguna.THANK YOU, Chief King. Be safe everyone!!!

4-29-25 FM 4-CHS 0 by MBC Grand, Inc.

4-22-25 GJ 5-CHS 2 by MBC Grand, Inc.

In this episode, hosts Drs. Peter Lu and Temara Hajjat talk to Dr. Thangam Venkatesan about cannabinoid hyperemesis syndrome (CHS).  Dr. Venkatesan is an adult gastroenterologist and Professor of Internal Medicine at The Ohio State University Wexner Medical Center, where she leads the Neurogastroenterology and Motility section.  She is a world-renowned expert in CHS and cyclic vomiting syndrome (CVS).  In this episode, we discuss the diagnosis of CHS, its relationship with CVS, and the management of the adolescent with CHS. Learning Objectives:Understand the diagnostic criteria for cannabinoid hyperemesis syndrome (CHS).Recognize the similarities and differences between CHS and cyclic vomiting syndrome.Review the management of the adolescent with CHS.Links:Venkatesan T, et al. Guidelines on management of cyclic vomiting syndrome in adults by the American Neurogastroenterology and Motility Society and the Cyclic Vomiting Syndrome Association. Neurogastroenterol Motil. 2019 Jun;31 Suppl 2(Suppl 2):e13604. PMID: 31241819Support the showThis episode may be eligible for CME credit! Once you have listened to the episode, click this link to claim your credit. Credit is available to NASPGHAN members (if you are not a member, you should probably sign up). And thank you to the NASPGHAN Professional Education Committee for their review!As always, the discussion, views, and recommendations in this podcast are the sole responsibility of the hosts and guests and are subject to change over time with advances in the field.Check out our merch website!Follow us on Bluesky, Twitter, Facebook and Instagram for all the latest news and upcoming episodes.Click here to support the show.

Cannabinoid Hyperemesis Syndrome (CHS), also known as "scromiting," is a debilitating condition characterized by severe nausea, vomiting, and abdominal pain that affects heavy cannabis users. Dr. Casey Grover explains this increasingly common syndrome caused by high-potency cannabis products, which paradoxically improves with hot showers and proves challenging to treat with conventional medications.• First identified in 2009 and named "scromiting" to reflect the combined screaming and vomiting patients experience• Cannabis potency has increased dramatically from 1% THC in the 1970s to 25-30% THC in today's products• Patients experience cyclical episodes of diffuse abdominal pain, nausea, and vomiting lasting 24-48 hours• Compulsive hot bathing is a hallmark symptom, with patients focusing hot water on their abdomen for relief• Standard anti-nausea medications like Zofran don't work well; psychiatric medications like Haldol often provide better relief• Many patients question the diagnosis because cannabis is thought to help nausea rather than cause it• Treatment requires cannabis cessation, though symptoms may persist for months after quitting• Multiple theories explain CHS, including nerve hypersensitivity and paradoxical stress responses from high-dose THCTo contact Dr. Grover: ammadeeasy@fastmail.com

4-15-25 PHS 10-CHS 4 by MBC Grand, Inc.

Brian talks with Michael Honeycutt, CFA about how tariffs will locally affect the real estate market here in Charleston, SC!  Have a real estate need or question? Book a consult with us today! ☎️ (843) 800-0065

Brian gives a market update plus talks about how to get your house ready to sell this Spring! Thinking about renovating your home to sell? Text the word REMODEL to 843-800-0065 to recieve a guide on how to maximixe your investment and learn what renovations are actually worth the hassle.  Have a real estate need or question? Book a consult with us today! ☎️ (843) 800-0065

Every Thursday Connecticut Humane Society joins the show to tell us about another pet that needs a home.  This week meet Reiki! She's a super cute 1-year-old domestic shorthair mix who came to CHS from local animal control. She's a shy girl, but once she warms up to you she's super playful and cuddly. It'll be important for her new family to be nice and patient with her.  Here are some more specifics about the type of home she should go to:  ~ I have not had much experience with children but am willing to consider sharing my home with kids who can be gentle and respectful of pets. ~ I have not had much experience with cats or dogs but am willing to consider sharing my home with a furry friend. ~ I am a quiet and reserved kitty. I would prefer a peaceful home. If you're interested in learning more about adopting Reiki head to cthumane.org/adopt

Brian talks about the Short Term Rental market and how times are changing! With new laws, fees and interest rates, does a STR make sense right now? And with more STRs hitting the market how does that effect Charleston home sales? Find out NOW on the Brian Beatty Real Estate Show! Have a real estate need or question? Book a consult with us today! ☎️ (843) 800-0065

Tuesday on AOA, powered by Cenex, we start the show with a check of the cattle markets and a recap of the USDA data from Monday with Kyle Bumsted from Allendale. In Segment Two, we discuss the latest surrounding 2026 RFS Volumes with Paul Winters from Clean Fuels Alliance America. In Segment Three, we have a conversation with Verity Ulibarri, Chairwoman of the U.S. Grains Council. Then we close the show with some equipment lubrication tips ahead of spring fieldwork with Jon Woetzel, Quality Assurance Manager, CHS.

In October 2024 Cranford Radio featured its first AI-hosted podcast. It was amazing and scary. As the technology continues to evolve, there's a new experimental program by a company called Sesame. In a demo available online you can chat live with one of two voices; Maya and Miles. Both have distinct personalities. In this week's episode I have Maya as my guest. I wanted to not only demonstrate the technology but to show what this particular AI program knows about Cranford. We talk about topics such as the Rahway River, Downtown Cranford and CHS. The interview is only lightly edited to show some of the challenges of talking to a computer in real time. 

In this episode of This Comic Cooks, we sit down with the ultimate Green Lantern fan, Ralph D. Apel! From his first exposure to Hal Jordan in Super Friends to collecting comics and launching Lanterns Live, Ralph shares his journey as a lifelong Green Lantern enthusiast. We discuss everything from Kyle Rayner's impact, Blackest Night's rise in popularity, and even the upcoming Lanterns TV series.Want to know the history, legacy, and future of the Green Lantern mythos? This is the episode for you!

Brian talks about the Dockside Condo Crisis currently happening in downtown Charleston and how you can avoid similar HOA disasters when purchasing a condo! He also talks about the current market in Charleston, SC and dives into why you NEED title insurance when buying a property. Plus, COMMISSION! How to make sure you get the value you pay for! Have a real estate need or question? Book a consult with us today! ☎️ (843) 800-0065

Solomon sends his limo with an armed security detail to pick up his bride. His ride is full of symbolism for us today. His request to behold her man invites us to behold the glory and majesty of our Savior.

Brian talks about current market trends, how buyers are doing in the current market and how to make sure your home is being marketed correctly! Listen Now! Have a real estate need or question? Book a consult with us today!  ☎️ (843) 800-0065

This week please join author Michael Zhang and Guest Editor Paul Gurbel as they discuss the article "Association of Coagulation Factor XI Level With Cardiovascular Events and Cardiac Function in Community-Dwelling Adults: From ARIC and CHS." For the episode transcript, visit: https://www.ahajournals.org/do/110.1161/podcast.20250210.487047

2 - 7-25 B DHS 74 - CHS 68 by MBC Grand, Inc.

2 - 7-25 G DHS 57 - CHS 29 by MBC Grand, Inc.

Send us a textOn episode 127 of Funny in Theory we are joined by the legend, Dr. Chuck Ells. Learn a little bit about what he does on 45TV and reminisce on old memories of Dr. Chuck visiting CHS field. From being the bat boy for the Saints to interviewing Philadelphia Eagles players at the Super Bowl. Listen to get all the in between. As always, thank you for listening and make sure to follow us on socials @funnnyintheory. 

Every Thursday Kathryn from Connecticut Humane Society joins the show to tell us about another pet that needs a home.  This week we have Adelaide! An adorable Domestic Shorthair / Mix MEET ADELAIDE Age: 1 year Gender: Spayed Female Spayed/Neutered: Yes Size: Small Color: Brown / Black Declawed: No Location: Westport Branch Area: Free Roam 2 ABOUT ADELAIDE ~ I have not had much experience with children but am willing to consider sharing my home with kids who can be gentle and respectful of pets. ~ I would prefer to be the only pet in the home. ~ I am a cuddle bug! My love language is physical touch! I am the kind of cat who wants to be with you at all times and as close as possible for cuddling! The Westport Branch is completing adoptions by appointment only in order to best serve the pets in care and the community. CHS is currently accepting adoption applications for pets at this location. Applications are reviewed in the order in which they are received. CHS looks forward to helping you find your best match. The online adoption application is available at CThumane.org/AdoptionApp.

2 - 4-25 B MHS 59 - CHS 25 by MBC Grand, Inc.

2 - 4-25 G MHS 47 - CHS 35 by MBC Grand, Inc.

BREEDERS SYNDICATE LINKS: https://linktr.ee/riotseeds--------NOTES FOR THIS EPISODEAlso, I'm ready for the goofballs who are going to tell me i'm a propagandist, however there's documentation of me having it and he effects on this channel over a 2 year period.  Here is a great short video on the syndrome discussed in the episode:https://www.youtube.com/watch?v=Rx-urUi0mnA&t=6sAnother really in depth and amazing article but VERY science heavyhttps://pmc.ncbi.nlm.nih.gov/articles/PMC7347072/A 6 Year study done in Australia (where the syndrome was first noted and discovered) - REALLY fascinating results especially as it pertains to Male Vs Femalehttps://pmc.ncbi.nlm.nih.gov/articles/PMC9545654/A recent article by PBS - when it comes to CHS, so little is truly known except cause and effect that the most current data is pricelessLhttps://www.pbs.org/newshour/health/what-is-cannabinoid-hyperemesis-syndrome-heres-what-to-know-and-why-experts-say-its-on-the-riseA really good sound clip discussing it as well:https://soundcloud.com/bmjpodcasts/cannabinoid-hyperemesis-syndrome?utm_source=clipboard&utm_campaign=wtshare&utm_medium=widget&utm_content=https%253A%252F%252Fsoundcloud.com%252Fbmjpodcasts%252Fcannabinoid-hyperemesis-syndrome---------------------------Join this channel to get access to perks:https://www.youtube.com/channel/UCp9mauDnr-JxOiG_ek4BWag/joinOr check out our Patreon here:https://www.patreon.com/breederssyndicateWe are also available on ALL audio podcast platforms - here's a link to our favorite, Spreaker - https://www.spreaker.com/podcast/breeders-syndicate-2-0--5630034Breeders Syndicate website: http://www.breederpodcast.comCheck out our STRAIN DATABASE aka CODEX: https://codex.thebreederssyndicate.com/Visit our friend Troy and Bagel's  "I  LOVE WEED LIVE" show for more great weed content mostly related to concentrates and smoking: https://www.youtube.com/@UCRFUMCugvdcroxq_fpjix-g Copyright Disclaimer: The material contained herein is used under the doctrine of 'fair use' pursuant to Section 107 of the U.S. Copyright Act, allowing for limited use of copyrighted material for criticism, comment, news reporting, teaching, scholarship, and research. All rights reserved to the originalBecome a supporter of this podcast: https://www.spreaker.com/podcast/breeders-syndicate-3-0--5630034/support.

Charles Hugh Smith discusses civilization's crumbling status quo and the hydrocarbon industrial age or current world system which some view as superabundant due to technology while others question whether we've used up the easy energy and are facing resource constraints. He comments on cycles, empire, financialization, consumption, true wealth, how the future will go to those who can get the most out of the resources they extract, and why a new mythology and revolution in social and cultural values is needed. We're faced with a Kafkaesque digital neofeudalism or digital gulag, one solution is reducing our dependency on their systems as much as possible. Watch on BitChute / Brighteon / Rokfin / Rumble / Substack Geopolitics & Empire · Charles Hugh Smith: Anti-Progress, Resource Constraints, & Digital Neofeudalism #511 *Support Geopolitics & Empire! Become a Member https://geopoliticsandempire.substack.com Donate https://geopoliticsandempire.com/donations Consult https://geopoliticsandempire.com/consultation **Visit Our Affiliates & Sponsors! Above Phone https://abovephone.com/?above=geopolitics easyDNS (use code GEOPOLITICS for 15% off!) https://easydns.com Escape The Technocracy course (15% discount using link) https://escapethetechnocracy.com/geopolitics PassVult https://passvult.com Sociatates Civis (CitizenHR, CitizenIT, CitizenPL) https://societates-civis.com Wise Wolf Gold https://www.wolfpack.gold/?ref=geopolitics Websites Blog https://www.oftwominds.com/blog.html Substack https://charleshughsmith.substack.com X https://x.com/chsm1th Books https://www.oftwominds.com/CHS-books.html About Charles Hugh Smith Charles Hugh Smith is the author of the oftwominds.com blog, #7 in CNBC's top alternative financial sites, and 18 books on our economy and society, including "A Radically Beneficial World: Automation, Technology and Creating Jobs for All," "Global Crisis, National Renewal: A (Revolutionary) Grand Strategy for the United States," "Burnout: Reckoning and Renewal" and "Self-Reliance in the 21st Century." His work is published on a number of popular financial websites including Zero Hedge, Financial Sense and Seeking Alpha and has been featured on numerous podcasts. Smith has also written nine novels, including "The Adventures of the Consulting Philosopher" and "The Asian Heroine Who Seduced Me." Sample chapters of his books are available on his sites www.oftwominds.com/blog.html and https://charleshughsmith.blogspot.com *Podcast intro music is from the song "The Queens Jig" by "Musicke & Mirth" from their album "Music for Two Lyra Viols": http://musicke-mirth.de/en/recordings.html (available on iTunes or Amazon)

Charles Hugh Smith discusses civilization's crumbling status quo and the hydrocarbon industrial age or current world system which some view as superabundant due to technology while others question whether we've used up the easy energy and are facing resource constraints. He comments on cycles, empire, financialization, consumption, true wealth, how the future will go to those who can get the most out of the resources they extract, and why a new mythology and revolution in social and cultural values is needed. We're faced with a Kafkaesque digital neofeudalism or digital gulag, one solution is reducing our dependency on their systems as much as possible. Watch on BitChute / Brighteon / Rokfin / Rumble / Substack Geopolitics & Empire · Charles Hugh Smith: Anti-Progress, Resource Constraints, & Digital Neofeudalism #511 *Support Geopolitics & Empire! Become a Member https://geopoliticsandempire.substack.com Donate https://geopoliticsandempire.com/donations Consult https://geopoliticsandempire.com/consultation **Visit Our Affiliates & Sponsors! Above Phone https://abovephone.com/?above=geopolitics easyDNS (use code GEOPOLITICS for 15% off!) https://easydns.com Escape The Technocracy course (15% discount using link) https://escapethetechnocracy.com/geopolitics PassVult https://passvult.com Sociatates Civis (CitizenHR, CitizenIT, CitizenPL) https://societates-civis.com Wise Wolf Gold https://www.wolfpack.gold/?ref=geopolitics Websites Blog https://www.oftwominds.com/blog.html Substack https://charleshughsmith.substack.com X https://x.com/chsm1th Books https://www.oftwominds.com/CHS-books.html About Charles Hugh Smith Charles Hugh Smith is the author of the oftwominds.com blog, #7 in CNBC's top alternative financial sites, and 18 books on our economy and society, including "A Radically Beneficial World: Automation, Technology and Creating Jobs for All," "Global Crisis, National Renewal: A (Revolutionary) Grand Strategy for the United States," "Burnout: Reckoning and Renewal" and "Self-Reliance in the 21st Century." His work is published on a number of popular financial websites including Zero Hedge, Financial Sense and Seeking Alpha and has been featured on numerous podcasts. Smith has also written nine novels, including "The Adventures of the Consulting Philosopher" and "The Asian Heroine Who Seduced Me." Sample chapters of his books are available on his sites www.oftwominds.com/blog.html and https://charleshughsmith.blogspot.com *Podcast intro music is from the song "The Queens Jig" by "Musicke & Mirth" from their album "Music for Two Lyra Viols": http://musicke-mirth.de/en/recordings.html (available on iTunes or Amazon)

1 - 16 - 25 G MHS 43 - CHS 13 by MBC Grand, Inc.

1 - 16 - 25 B MHS 52 - CHS 44 by MBC Grand, Inc.

2GG Best Of: Tanya Wants Kids to Move Back to CHS by Two Girls and a Guy

Brian is joined by special guest Derek Goulette of Fairway Independent Mortgage. Brian and Derek talk about interest rates and what changing rates could mean for the future of Charleston, SC. Brian also gives his predictions for 2025 including if the market will slow down or pick up speed! ** GET OUR FREE GUIDE** Text 'GUIDE' to 843-800-0065 for a FREE copy of The Most Comprehensive Home Seller Guide in Charleston. Have a real estate need or question? Book a consult with us today!  ☎️ (843) 800-0065

Chris Finn is a Licensed Physical Therapist, Certified Strength and Conditioning Specialist, Titleist Performance Institute (TPI) Certified Medical Professional, Certified Precision Nutrition Coach and a Golf Digest Top 50 Golf Fitness Professional. He is also the Founder of Par4Success - a Golf Performance and Direct Pay Physical Therapy industry leader. He and his team work with golfers of all abilities and ages to swing faster, play better and hurt less. Chris joins #OntheMark to talk about health, wellness, injury prevention, and habits for better golf, and MORE clubhead speed. In Part 2. of 2, Chris is joined by Kirk Coburn, a golfer in his 50's, who is a successful businessman who travels a lot for work. Kirk had experienced a deteriotation in mobility and flexibility, a subsequent loss in form and consistency, and some lower back pain.  He resolved to connect with P4S to rediscover his best health and his best golf. Kirk talks about how with an improvement in Hip Mobility reduced his lower back pain and how gym-work focussing on "Power Numbers" helped him improve clubhead speed (CHS) and overall golf-swing consistency. Kirk and Chris also address:  Improving longevity in golf Goal-setting for the body and the game Building a body that supports your particular golf-swing This podcast is also available as a vodcast. Go to youtube.com and seach for, and subscribe to Mark Immelman.  Also use Code "OntheMark" to get a free physical assessment with Par4Success.

Chs.6 and 7: Iyov's response to Eliphaz. Text here: https://www.sefaria.org/Job.6?lang=bi, https://www.sefaria.org/Job.7?lang=bi

Episode 181: Cannabinoid Hyperemesis SyndromeFuture Dr. Johnson explains the pathophysiology, assessment, and management of Cannabinoid Hyperemesis syndrome. Dr. Arreaza adds some insights on the topic.  Written by Tyler Johnson, MSIV, Western University of Health Sciences, College of Osteopathic Medicine of the Pacific-Northwest. Editing and comments by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Definition Cannabinoid hyperemesis syndrome (CHS) is a syndrome of cyclic abdominal pain, vomiting, or nausea in older adolescents and adults who have chronic ϲаnոаbis use.The term “marijuana” is considered racist by some people. In the 1930s, American politicians popularized the term “marijuana” in the U.S. to portray the drug as a “Mexican vice” and to have a justification to persecute Mexican immigrants. Epidemiology The overall prevalence of cannabinoid hyperemesis syndrome is unknown due to a lack of definitive criteria or diagnostic tests. It occurs in a population that may not disclose substance use. One study conducted in 2015 in a United States urban emergency department not named, found one-third of patients with near-daily cannabis use met criteria for having had CНЅ in the prior six months.Why are rates of CHS increasing?Between 2005-2014 hospitalizations cyclic vomiting syndromes increased by 60 %. concurrent cannabis use in hospitalized patients increasing from 2 to 21 percent. 7 years after the commercialization of cannabis in Canada, the Canadian health services found a 13-fold increase in cyclic vomiting syndromesPotential correlations for the increase in CHS are increased legalization and commercialization of cannabis, higher tetrahydrocannabinol concentrations in cannabis products, and increased recognition of the syndrome.Legal status of Cannabis in the USCannabis is legal in 24 states: Alaska, Arizona, California, Colorado, Connecticut, Delaware, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nevada, New Jersey, New Mexico, New York, Ohio, Oregon, Rhode Island, Vermont, Virginia, and Washington. It is also legal in Washington, D.C. Cannabis is approved for medical use in 38 states.Federal level: Cannabis is a Schedule I drug, under the Controlled Substance Act (added in 1970) in the group of Hallucinogenic or psychedelic substances. Tetra-hydro-cannabinol (THC, a “mind-altering substance in cannabis”) is on the same list. However, cannabidiol (CBD, derived from hemp or non-hemp plants) was removed from the Controlled Substances Act in 2018. CBD is FDA-approved (under the name of Epidiolex®) to treat rare seizure disorders. CBD is still on the list of controlled substances in some states. I see THC as a problem.THC increased concentration As recreational Cannabis becomes more normalized, innovators look to find new ways to differentiate their product and increasing THC has become a common way to perform this similar to alcohol content in the beer, wine, and liquor industry. An article by Yale School of Medicine titled “Marijuana: Rising THC Concentrations in Cannabis Can Pose Health Risks” states, “In 1995, the average THC content in cannabis seized by the Drug Enforcement Administration was about 4%. By 2017, it had risen to 17% and continues to increase. Beyond the plant, a staggering array of other cannabis products with an even higher THC content like dabs, oils, and edibles are readily available—some as high as 90%.”Recently, cannabis-infused water started to be sold in some grocery stores.Pathophysiology of CHSIt is not entirely understood. Some suggest multifactorial involving cannabinoid metabolism, exposure dose and tolerance modifying receptor regulation, complex pharmacodynamics at Cannabinoid receptors, and even changes in genetics and cannabinoid variation in plants. CB1 receptors are involved in gastric secretion, sensation, motility, inflammation, and lipogenesis. The activation of CB1 and CB2 receptors has been suggested as the possible cause of CHS.Risk FactorsCHS can occur after acute or acute on chronic use but many report daily 3-5x cannabis use cannabis use over one year and many over at least two years. Median age 24 years. Interesting factsMedical visits for inhaled cannabis are more likely associated with CHS while edibles are more likely for acute psychiatric reactions.Also, CHS is a paradoxical effect since cannabis and cannabinoid receptor agonists are known antiemetics (as seen in nabilone and dronabinol (synthetic analogs of THC)) and prescribed by some physicians to combat chemotherapy effects.Clinical Features of CHSCyclical pattern with abdominal pain, severe nausea, and vomiting up to 30 episodes daily. Pain is intense and even referred to as “scromiting” due to its intense nature, causing patients to scream and vomit concurrently.Typically, it presents with 2 or more episodes over a 6-month period with no symptoms in between. It starts within 24 hours of last cannabis use (differentiating from cannabis withdrawal) and occurs at day or night. There is a gradual symptom resolution of nausea and vomiting after several days of cannabis cessation. Some patients had symptoms 2 days to 2 weeks after cessation. Diagnosis of CHSClinical diagnosisRule out neurological symptoms such as migraine headaches, acute abdomen, motion sickness, and medications, such as recent antibiotics and chemotherapy.Often the diagnosis is discovered with a thorough history reporting a decrease in symptoms with hot showers/baths.Management of CHS AcuteRehydrate with Fluids Dopamine Antagonists– Droperidol (0.625 or 1.25mg) /Haloperidol (0.05 to 0.1mg/kg with max dose of 5mg initially) favored over typical antiemetics like Zofran or Reglan.If needed, combine with an antiemetic like metoclopramide IM or ondansetron IV and consider patients' dehydration status likely requiring US-guided IV.Topical capsaicin cream 0.025 – 0.1% on the abdomen. Long term97% resolution of symptoms completely in a systematic review of patients who stopped cannabis use.Reinforce it may take several weeks of abstinence for symptoms to resolve and symptoms can worsen if cannabis is resumed. It is unknown if a reduction in use can prevent recurrence.Approaches in the clinicEducate patients on the etiology of their symptoms with complete cessation of cannabis use.Consider referral to counseling for cannabis use disorder and abstinence support for treatment-seeking cannabis users. Approach topics such as changing one's environment, seeking social support, and using self-help techniques to non-treatment-seeking individuals.Consider referring patients with polysubstance use and significant comorbidities to a supervised withdrawal management setting. Conclusion: Cannabis use is increasing with legalization and commercialization across the United States. With increased use, Cannabinoid hyperemesis syndrome incidence increases. Often it can be diagnosed with a thorough history including chronic cannabis consumption and symptomatic relief by showers. Physicians will need to develop counseling approaches to better understand CHS patients and how to approach an often-difficult topic.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Angulo MI. Cannabinoid Hyperemesis Syndrome. JAMA. 2024;332(17):1496. doi:10.1001/jama.2024.9716. Link: https://jamanetwork.com/journals/jama/fullarticle/2824833#:~:text=Cannabinoid%20hyperemesis%20syndrome%20(CHS,last%20less%20than%201%20week.Backman, Isabella, Marijuana: Rising THC Concentrations in Cannabis Can Pose Health Risks, Yale School of Medicine, August 30, 2023. https://medicine.yale.edu/news-article/not-your-grandmothers-marijuana-rising-thc-concentrations-in-cannabis-can-pose-devastating-health-risks/Buchanan, Jennie A and George Sam Wang, Cannabinoid Hyperemesis Syndrome, Up To Date, updated July 17, 2024. https://www.uptodate.com/contents/cannabinoid-hyperemesis-syndromeTheme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/.

American healthcare is well known for its extreme cost and worst outcomes among industrialized (such as the 38 OECD member) countries, and beyond that to be remarkably opaque. The high cost of prescription drugs contributes, and little has been done to change that except for the government passing the Affordable Insulin Now Act at the end of 2022, enacted in 2023. But in January 2022 Mark Cuban launched Cost Plus Drugs that has transformed how many Americans can get their prescriptions filled at a fraction of the prevailing prices, bypassing pharmacy benefit managers (PBMs) that control 80% of US prescriptions. That was just the beginning of a path of creative destruction (disruptive innovation, after Schumpeter) of many key components American healthcare that Cuban is leading, with Cost Plus Marketplace, Cost Plus Wellness and much more to come. He certainly qualifies as a master disrupter: “someone who is a leader in innovation and is not afraid to challenge the status quo.” Below is a video clip from our conversation dealing with insurance companies. Full videos of all Ground Truths podcasts can be seen on YouTube here. The current one is here. If you like the YouTube format, please subscribe! The audios are also available on Apple and Spotify.Transcript with External links to Audio (00:07):Hello, it's Eric Topol with Ground Truths, and I have our special phenomenal guest today, Mark Cuban, who I think you know him from his tech world contributions and Dallas Mavericks, and the last few years he's been shaking up healthcare with Cost Plus Drugs. So Mark, welcome.Mark Cuban (00:25):Thanks for having me, Eric.Eric Topol (00:27):Yeah, I mean, what you're doing, you've become a hero to millions of Americans getting them their medications at a fraction of the cost they're used to. And you are really challenging the PBM industry, which I've delved into more than ever, just in prep for our conversation. It's just amazing what this group of companies, namely the three big three CVS Caremark, Optum of UnitedHealth and Express Scripts of Cigna with a market of almost $600 billion this year, what they're doing, how can they get away with all this stuff?Inner Workings of Pharmacy Benefit ManagersMark Cuban (01:03):I mean, they're just doing business. I really don't blame them. I blame the people who contract with them. All the companies, particularly the bigger companies, the self-insured companies, where the CEO really doesn't have an understanding of their healthcare or pharmacy benefits. And so, the big PBMs paid them rebates, which they think is great if you're a CEO, when in reality it's really just a loan against the money spent by your sickest employees, and they just don't understand that. So a big part of my time these days is going to CEOs and sitting with them and explaining to them that you're getting ripped off on both your pharmacy and your healthcare side.Eric Topol (01:47):Yeah, it's amazing to me the many ways that they get away with this. I mean, they make companies sign NDAs. They're addicted to rebates. They have all sorts of ways a channel of funds to themselves. I mean, all the things you could think of whereby they even have these GPOs. Each of these companies has a group purchasing organization (I summarized in the Table below).Mark Cuban (02:12):Yeah, which gives them, it's crazy because with those GPOs. The GPO does the deal with the pharmacy manufacturer. Then the GPO also does the deal with the PBM, and then the PBM goes to the self-insured employer in particular and says, hey, we're going to pass through all the rebates. But what they don't say is they've already skimmed off 5%, 10%, 20% or more off the top through their GPO. But that's not even the worst of it. That's just money, right? I mean, that's important, but I mean, even the biggest companies rarely own their own claims data.Mark Cuban (02:45):Now think about what that means. It means you can't get smarter about the wellness of your employees and their families. You want to figure out the best way to do GLP-1s and figure out how to reduce diabetes, whatever it may be. You don't have that claims data. And then they don't allow the companies to control their own formularies. So we've seen Humira biosimilars come out and the big PBMs have done their own version of the biosimilar where we have a product called Yusimry, which is only $594 a month, which is cheaper than the cheapest biosimilar that the big three are selling. And so, you would think in a normal relationship, they would want to bring on this new product to help the employer. No, they won't do it. If the employer asks, can I just add Cost Plus Drugs to my network? They'll say no, every single time.Mark Cuban (03:45):Their job is not to save the employer money, particularly after they've given a rebate. Because once they give that loan, that rebate to the employer, they need to get that money back. It's not a gift. It's a loan and they need to have the rebates, and we don't do rebates with them at all. And I can go down the list. They don't control the formula. They don't control, you mentioned the NDAs. They can't talk to manufacturers, so they can't go to Novo or to Lilly and say, let's put together a GLP-1 wellness program. All these different things that just are common sense. It's not happening. And so, the good news is when I walk into these companies that self-insured and talk to the CEO or CFO, I'm not asking them to do something that's not in their best interest or not in the best interest of the lives they cover. I'm saying, we can save you money and you can improve the wellness of your employees and their families. Where's the downside?Eric Topol (04:40):Oh, yeah. Yeah. And the reason they can't see the claims is because of the privacy issues?Mark Cuban (04:46):No, no. That's just a business decision in the contract that the PBMs have made. You can go and ask. I mean, you have every right to your own claims. You don't need to have it personally identified. You want to find out how many people have GLP-1s or what are the trends, or God forbid there's another Purdue Pharma thing going on, and someone prescribing lots of opioids. You want to be able to see those things, but they won't do it. And that's only on the sponsor side. It's almost as bad if not worse on the manufacturer side.Eric Topol (05:20):Oh, yeah. Well, some of the work of PBMs that you've been talking about were well chronicled in the New York Times, a couple of major articles by Reed Abelson and Rebecca Robbins: The Opaque Industry Secretly Inflating Prices for Prescription Drugs and The Powerful Companies Driving Local Drugstores Out of Business. We'll link those because I think some people are not aware of all the things that are going on in the background.Mark Cuban (05:39):You see in their study and what they reported on the big PBMs, it's crazy the way it works. And literally if there was transparency, like Cost Plus offers, the cost of medications across the country could come down 20%, 30% or more.Cost Plus DrugsEric Topol (05:55):Oh, I mean, it is amazing, really. And now let's get into Cost Plus. I know that a radiologist, Alex Oshmyansky contacted you with a cold email a little over three years ago, and you formed Cost Plus Drugs on the basis of that, right?Mark Cuban (06:12):Yep, that's exactly what happened.Eric Topol (06:15):I give you credit for responding to cold emails and coming up with a brilliant idea with this and getting behind it and putting your name behind it. And what you've done, so you started out with something like 110 generics and now you're up well over 1,200 or 2,500 or something like that?Mark Cuban (06:30):And adding brands. And so, started with 111. Now we're around 2,500 and trying to grow it every single day. And not only that, just to give people an overview. When you go to www.costplusdrugs.com and you put in the name of your medication, let's just say it's tadalafil, and if it comes up. In this case, it will. It'll show you our actual cost, and then we just mark it up 15%. It's the same markup for everybody, and if you want it, we'll have a pharmacist check it. And so, that's a $5 fee. And then if you want ship to mail order, it's $5 for shipping. And if you want to use our pharmacy network, then we can connect you there and you can just pick it up at a local pharmacy.Eric Topol (07:10):Yeah, no, it's transparency. We don't have a lot of that in healthcare in America, right?Mark Cuban (07:15):No. And literally, Eric, the smartest thing that we did, and we didn't expect this, it's always the law of unintended consequences. The smartest thing we did was publish our entire price list because that allowed any company, any sponsor, CMS, researchers to compare our prices to what others were already paying. And we've seen studies come out saying, for this X number of urology drugs, CMS would save $3.6 billion a year. For this number of heart drugs at this amount per year, for chemotherapy drugs or MS drugs this amount. And so, it's really brought attention to the fact that for what PBMs call specialty drugs, whether there's nothing special about them, we can save people a lot of money.Eric Topol (08:01):It's phenomenal. As a cardiologist, I looked up a couple of the drugs that I'm most frequently prescribed, just like Rosuvastatin what went down from $134 to $5.67 cents or Valsartan it went down from $69 to $7.40 cents. But of course, there's some that are much more dramatic, like as you mentioned, whether it's drugs for multiple sclerosis, the prostate cancer. I mean, some of these are just thousands and thousands of dollars per month that are saved, brought down to levels that you wouldn't think would even be conceivable. And this has been zero marketing, right?Mark Cuban (08:42):Yeah, none. It's all been word of mouth and my big mouth, of course. Going out there and doing interviews like this and going to major media, but it's amazing. We get emails and letters and people coming up to us almost single day saying, you saved my grandma's life. You saved my life. We weren't going to be able to afford our imatinib or our MS medication. And it went from being quoted $2,000 a month to $33 a month. It's just insane things like that that are still happening.Eric Topol (09:11):Well, this is certainly one of the biggest shakeups to occur in US healthcare in years. And what you've done in three years is just extraordinary. This healthcare in this country is with its over 4 trillion, pushing $5 trillion a year of expenditure.[New CMS report this week pegs the number at $4.867 trillion for 2023]Mark Cuban (09:30):It's interesting. I think it's really fixable. This has been the easiest industry to the disrupt I've ever been involved in. And it's not even close because all it took was transparency and not jacking up margins to market. We choose to use a fixed margin markup. Some choose to price to market, the Martin Shkreli approach, if you will. And just by being transparent, we've had an impact. And the other side of it is, it's the same concept on the healthcare side. Transparency helps, but to go a little field of pharmacy if you want. The insane part, and this applies to care and pharmacy, whatever plan we have, whether it's for health or whether it's for pharmaceuticals, there's typically a deductible, typically a copay, and typically a co-insurance.Insurance CompaniesMark Cuban (10:20):The crazy part of all that is that people taking the default risk, the credit risk are the providers. It's you, it's the hospital, it's the clinics that you work for. Which makes no sense whatsoever that the decisions that you or I make for our personal insurance or for the companies we run, or if we work for the government, what we do with Medicare or Medicare Advantage, the decisions we all make impacts the viability of providers starting with the biggest hospital systems. And so, as a result, they become subprime lenders without a car or a house to go after if they can't collect. And so, now you see a bunch of people, particularly those under the ACA with the $9,000, the bronze plans or $18,000 out-of-pocket limits go into debt, significant medical debt. And it's unfortunate. We look at the people who are facing these problems and think, well, it must be the insurance companies.Mark Cuban (11:23):It's actually not even the insurance companies. It's the overall design of the system. But underneath that, it's still whoever picks the insurance companies and sets plans that allow those deductibles, that's the core of the problem. And until we get to a system where the providers aren't responsible for the credit for defaults and dealing with all that credit risk, it's almost going to be impossible to change. Because when you see stories like we've all seen in news of a big healthcare, a BUCA healthcare (Blue Cross Blue Shield (BCBS), UnitedHealth, Cigna, and Aetna/CVS) plan with all the pre-authorizations and denials, typically they're not even taking the insurance risk. They're acting as the TPA (third party administrator) as the claims processor effectively for whoever hired them. And it goes back again, just like I talked about before. And as long as CMS hires or allows or accepts these BUCAs with these plans for Medicare for the ACA (Affordable care Act), whatever it may be, it's not going to work. As long as self-insured employers and the 50 million lives they cover hire these BUCAs to act as the TPAs, not as insurance companies and give them leeway on what to approve and what to authorize and what not to authorize. The system's going to be a mess, and that's where we are today.Academic Health System PartnershipsEric Topol (12:41):Yeah. Well, you've been talking of course to employers and enlightening them, and you're also enlightening the public, of course. That's why you have millions of people that are saving their cost of medications, but recently you struck a partnership with Penn Medicine. That's amazing. So is that your first academic health system that you approached?Cost Plus MarketplaceMark Cuban (13:00):I don't know if it was the first we approached, but it was certainly one of the biggest that we signed. We've got Cost Plus Marketplace (CPM) where we make everything from injectables to you name it, anything a hospital might buy. But again, at a finite markup, we make eight and a half percent I think when it's all said and done. And that saves hospital systems millions of dollars a year.Eric Topol (13:24):Yeah. So that's a big change in the way you're proceeding because what it was just pills that you were buying from the pharma companies, now you're actually going to make injectables and you're going to have a manufacturing capability. Is that already up and going?Mark Cuban (13:39):That's all up and going as of March. We're taking sterile injectables that are on the shortage list, generic and manufacturing them in Dallas using a whole robotics manufacturing plant that really Alex created. He's the rocket scientist behind it. And we're limited in capacity now, we're limited about 2 million vials, but we'll sell those to Cost Plus Marketplace, and we'll also sell those direct. So Cost Plus Marketplace isn't just the things we manufacture. It's a wide variety of products that hospitals buy that we then have a minimal markup, and then for the stuff we manufacture, we'll sell those to direct to like CHS was our first customer.Eric Topol (14:20):Yeah, that's a big expansion from going from the pills to this. Wow.Mark Cuban (14:24):It's a big, big expansion, but it goes to the heart of being transparent and not being greedy, selling on a markup. And ourselves as a company, being able to remain lean and mean. The only way we can sell at such a low markup. We have 20 employees on the Cost Plus side and 40 employees involved with the factories, and that's it.Eric Topol (14:46):Wow. So with respect to, you had this phenomenal article and interview with WIRED Magazine just this past week. I know Lauren Goode interviewed you, and she said, Mark, is this really altruistic and I love your response. You said, “how much f*****g money do I need? I'm not trying to land on Mars.” And then you said, “at this point in my life, it's just like more money, or f**k up the healthcare industry.” This was the greatest, Mark. I mean, I got to tell you, it was really something.Mark Cuban (15:18):Yeah.Eric Topol (15:19):Well, in speaking of that, of course, the allusion to a person we know well, Elon. He posted on X/Twitter in recent days , I think just three or four days ago, shouldn't the American people be getting their money's worth? About this high healthcare administration costs where the US is completely away from any other OECD country. And as you and I know, we have the worst outcomes and the most costs of all the rich countries in the world. There's just nothing new here. Maybe it's new to him, but you had a fabulous response on both X and Bluesky where you went over all these things point by point. And of course, the whole efforts that you've been working on now for three years. You also mentioned something that was really interesting that I didn't know about were these ERISA lawsuits[Employee Retirement Income Security Act (ERISA) of 1974.] Can you tell us about that?ERISA LawsuitsMark Cuban (16:13):Yeah, that's a great question, Eric. So for self-insured companies in particular, we have a fiduciary responsibility on a wellness and on a financial basis to offer the members, your employees and their families the best outcomes at the best price. Now, you can't guarantee best outcomes, but you have to be able to explain the choices you made. You don't have to pick the cheapest, but again, you have to be able to explain why you made the choices that you did. And because a lot of companies have been doing, just like we discussed earlier, doing deals on the pharmacy side with just these big PBMs, without accounting for best practices, best price, best outcomes, a couple companies got sued. Johnson and Johnson and Wells Fargo were the first to get sued. And I think that's just the beginning. That's just the writing on the wall. I think they'll lose because they just dealt with the big pharmacy PBMs. And I think that's one of the reasons why we're so busy at Cost Plus and why I'm so busy because we're having conversation after conversation with companies and plenty of enough lawyers for that matter who want to see a price list and be able to compare what they're paying to what we sell for to see if they're truly living up to that responsibility.Eric Topol (17:28):Yeah, no, that's a really important thing that's going on right now that I think a lot of people don't know about. Now, the government of the US think because it's the only government of any rich country in the world, if not any country that doesn't negotiate prices, i.e., CMS or whatever. And only with the recent work of insulin, which is a single one drug, was there reduction of price. And of course, it's years before we'll see other drugs. How could this country not negotiate drugs all these years where every other place in the world they do negotiate with pharma?Mark Cuban (18:05):Because as we alluded to earlier, the first line in every single pharmaceutical and healthcare contract says, you can't talk about this contract. It's like fight club. The number one rule of fight club is you can't talk about fight club, and it's really difficult to negotiate prices when it's opaque and everything's obfuscated where you can't really get into the details. So it's not that we're not capable of it, but it's just when there's no data there, it's really difficult because look, up until we started publishing our prices, how would anybody know?Mark Cuban (18:39):I mean, how was anybody going to compare numbers? And so, when the government or whoever started to negotiate, they tried to protect themselves and they tried to get data, but those big PBMs certainly have not been forthcoming. We've come along and publish our price list and all that starts to change. Now in terms of the bigger picture, there is a solution there, as I said earlier, but it really comes down to talking to the people who make the decisions to hire the big insurance companies and the big PBMs and telling them, no, you're not acting in your own best interest. Here's anybody watching out there. Ask your PBM if they can audit. If you can audit rather your PBM contract. What they'll tell you is, yeah, you can, but you have to use our people. It's insane. And that's from top to bottom. And so, I'm a big believer that if we can get starting with self-insured employers to act in their own best interest, and instead of working with a big PBM work with a pass-through PBM. A pass-through PBM will allow you to keep your own claims, own all your own data, allow you to control your own formulary.Mark Cuban (19:54):You make changes where necessary, no NDA, so you can't talk to manufacturers. All these different abilities that just seem to make perfect sense are available to all self-insured employers. And if the government, same thing. If the government requires pass-through PBMs, the price of medications will drop like a rock.Eric Topol (20:16):Is that possible? You think that could happen?Mark Cuban (20:19):Yes. Somebody's got to understand it and do it. I'm out there screaming, but we will see what happens with the new administration. There's nothing hard about it. And it's the same thing with Medicare and Medicare Advantage healthcare plans. There's nothing that says you have to use the biggest companies. Now, the insurance companies have to apply and get approved, but again, there's a path there to work with companies that can reduce costs and improve outcomes. The biggest challenge in my mind, and I'm still trying to work through this to fully understand it. I think where we really get turned upside down as a country is we try to avoid fraud from the provider perspective and the patient perspective. We're terrified that patients are going to use too much healthcare, and like everybody's got Munchausen disease.Mark Cuban (21:11):And we're terrified that the providers are going to charge too much or turn into Purdue Pharma and over-prescribe or one of these surgery mills that just is having somebody get surgery just so they can make money. So in an effort to avoid those things, we ask the insurance companies and the PBMs to do pre-authorizations, and that's the catch 22. How do we find a better way to deal with fraud at the patient and provider level? Because once we can do that, and maybe it's AI, maybe it's accepting fraud, maybe it's imposing criminal penalties if somebody does those things. But once we can overcome that, then it becomes very transactional. Because the reality is most insurance companies aren't insurance companies. 50 million lives are covered by self-insured employers that use the BUCAs, the big insurance companies, but not as insurance companies.Eric Topol (22:07):Yeah, I was going to ask you about that because if you look at these three big PBMs that control about 80% of the market, not the pass-throughs that you just mentioned, but the big ones, they each are owned by an insurance company. And so, when the employer says, okay, we're going to cover your healthcare stuff here, we're going to cover your prescriptions there.Mark Cuban (22:28):Yeah, it's all vertically integrated.Mark Cuban (22:36):And it gets even worse than that, Eric. So they also own specialty pharmacies, “specialty pharmacies” that will require you to buy from. And as I alluded to earlier, a lot of these medications like Imatinib, they'll list as being a specialty medication, but it's a pill. There's nothing special about it, but it allows them to charge a premium. And that's a big part of how the PBMs make a lot of their money, the GPO stuff we talked about, but also forcing an employer to go through the specialty mail order company that charges an arm and the leg.Impact on Hospitals and ProceduresEric Topol (23:09):Yeah. Well, and the point you made about transparency, we've seen this of course across US healthcare. So for example, as you know, if you were to look at what does it cost to have an operation like let's say a knee replacement at various hospitals, you can find that it could range fivefold. Of course, you actually get the cost, and it could be the hospital cost, and then there's the professional cost. And the same thing occurs for if you're having a scan, if you're having an MRI here or there. So these are also this lack of transparency and it's hard to get to the numbers, of course. There seems to be so many other parallels to the PBM story. Would you go to these other areas you think in the future?Mark Cuban (23:53):Yeah, we're doing it now. I'm doing it. So we have this thing called project dog food, and what it is, it's for my companies and what we've done is say, look, let's understand how the money works in healthcare.Mark Cuban (24:05):And when you think about it, when you go to get that knee done, what happens? Well, they go to your insurance company to get a pre-authorization. Your doctor says you need a knee replacement. I got both my hips replaced. Let's use that. Doctor says, Mark, you need your hips replaced. Great, right? Let's set up an appointment. Well, first the insurance company has to authorize it, okay, they do or they don't, but the doctor eats their time up trying to deal with the pre-authorization. And if it's denied, the doctor's time is eaten up and an assistance's time is eaten up. Some other administrator's time is eaten up, the employer's time is eaten up. So that's one significant cost. And then from there, there's a deductible. Now I can afford my deductible, but if there is an individual getting that hip replacement who can't afford the deductible, now all of a sudden you're still going to be required to do that hip replacement, most likely.Mark Cuban (25:00):Because in most of these contracts that self-insured employers sign, Medicare Advantage has, Medicare has, it says that between the insurance company and the provider, in this case, the hospital, you have to do the operation even if the deductibles not paid. So now the point of all this is you have the hospital in this case potentially accumulating who knows how much bad debt. And it's not just the lost amount of millions and millions and billions across the entire healthcare spectrum that's there. It's all the incremental administrative costs. The lawyers, the benefits for those people, the real estate, the desk, the office space, all that stuff adds up to $10 billion plus just because the hospitals take on that credit default risk. But wait, there's more. So now the surgery happens, you send the bill to the insurance company. The insurance company says, well, we're not going to pay you. Well, we have a contract. This is what it says, hip replacement's $34,000. Well, we don't care first, we're going to wait. So we get the time value of money, and then we're going to short pay you.Mark Cuban (26:11):So the hospital gets short paid. So what do they have to do? They have to sue them or send letters or whatever it is to try to get their money. When we talk to the big hospital systems, they say that's 2%. That's 2% of their revenue. So you have all these associated credit loss dollars, you've got the 2% of, in a lot of cases, billions and billions of dollars. And so, when you add all those things up, what happens? Well, what happens is because the providers are losing all that money and having to spend all those incremental dollars for the administration of all that, they have to jack up prices.Eric Topol (26:51):Yeah. Right.Mark Cuban (26:53):So what we have done, we've said, look for my companies, we're going to pay you cash. We're going to pay you cash day one. When Mark gets that hip replacement, that checks in the bank before the operation starts, if that's the way you want it. Great, they're not going to have pre-authorizations. We're going to trust you until you give us a reason not to trust you. We're not short paying, obviously, because we're paying cash right there then.Mark Cuban (27:19):But in a response for all that, because we're cutting out all those ancillary costs and credit risk, I want Medicare pricing. Now the initial response is, well, Medicare prices, that's awful. We can't do it. Well, when you really think about the cost and operating costs of a hospital, it's not the doctors, it's not the facilities, it's all the administration that cost all the money. It's all the credit risks that cost all the money. And so, if you remove that credit risk and all the administration, all those people, all that real estate, all those benefits and overhead associated with them, now all of a sudden selling at a Medicare price for that hip replacement is really profitable.Eric Topol (28:03):Now, is that a new entity Cost Plus healthcare?Mark Cuban (28:07):Well, it's called Cost Plus Wellness. It's not an entity. What we're going to do, so the part I didn't mention is all the direct contracts that we do that have all these pieces, as part of them that I just mentioned, we're going to publish them.Eric Topol (28:22):Ah, okay.Mark Cuban (28:23):And you can see exactly what we've done. And if you think about the real role of the big insurances companies for hospitals, it's a sales funnel.Getting Rid of Insurance CompaniesEric Topol (28:33):Yeah, yeah. Well, in fact, I really was intrigued because you did a podcast interview with Andrew Beam and the New England Journal of Medicine AI, and in that they talked about getting rid of the insurers, the insurance industry, just getting rid of it and just make it a means test for people. So it's not universal healthcare, it's a different model that you described. Can you go over that? I thought it was fantastic.Mark Cuban (29:00):Two pieces there. Let's talk about universal healthcare first. So for my companies, for our project dog food for the Mark Cuban companies, if for any employee or any of the lives we cover, if they work within network, anybody we have the direct contract with its single-payer. They pay their premiums, but they pay nothing else out of pocket. That's the definition of single-payer.Eric Topol (29:24):Yeah.Mark Cuban (29:25):So if we can get all this done, then the initial single-payers will be self-insured employers because it'll be more cost effective to them to do this approach. We hope, we still have to play it all through. So that's part one. In terms of everybody else, then you can say, why do we need insurance companies if they're not even truly acting as insurance companies? You're not taking full risk because even if it's Medicare Advantage, they're getting a capitated amount per month. And then that's getting risk adjusted because of the population you have, and then there's also an index depending on the location, so there's more or less money that occurs then. So let's just do what we need to do in this particular case, because the government is effectively eliminating the risk for the insurance company for the most part. And if you look at the margins for Medicare Advantage, I was just reading yesterday, it's like $1,700 a year for the average Medicare Advantage plan. So it's not like they're taking a lot of risk. All they're doing is trying to deny as many claims as they can.Eric Topol (30:35):Deny, Deny. Yeah.Mark Cuban (30:37):So instead, let's just get somebody who's a TPA, somebody who does the transaction, the claims processing, and whoever's in charge. It could be CMS, can set the terms for what's accepted and what's denied, and you can have a procedure for people that get denied that want to challenge it. And that's great, there's one in place now, but you make it a little simpler. But you take out the economics for the insurance company to just deny, deny, deny. There's no capitation. There's no nothing.Mark Cuban (31:10):The government just says, okay, we're hiring this TPA to handle the claims processing. It is your job. We're paying you per transaction.Mark Cuban (31:18):You don't get paid more if you deny. You don't get paid less if you deny. There's no bonuses if you keep it under a certain amount, there's no penalties If you go above a certain amount. We want you just to make sure that the patient involved is getting the best care, end of story. And if there's fraud involved as the government, because we have access to all that claims data, we're going to introduce AI that reviews that continuously.Mark Cuban (31:44):So that we can see things that are outliers or things that we question, and there's going to mean mistakes, but the bet was, if you will, where we save more and get better outcomes that way versus the current system and I think we will. Now, what ends up happening on top of that, once you have all that claims data and all that information and everybody's interest is aligned, best care at the best price, no denials unless it's necessary, reduce and eliminate fraud. Once everybody's in alignment, then as long as that's transparent. If the city of Dallas decides for all the lives they cover the 300,000 lives they cover between pharmacy and healthcare, we can usually in actuarial tables and some statistical analysis, we can say, you know what, even with a 15% tolerance, it's cheaper for us just to pay upfront and do this single-pay program, all our employees in the lives we cover, because we know what it's going to take.Mark Cuban (32:45):If the government decides, well, instead of Medicare Advantage the way it was, we know all the costs. Now we can say for all Medicare patients, we'll do Medicare for all, simply because we have definitive and deterministic pricing. Great. Now, there's still going to be outlier issues like all the therapies that cost a million dollars or whatever. But my attitude there is if CMS goes to Lilly, Novo, whoever for their cure for blindness that's $3.4 million. Well, that's great, but what we'll say is, okay, give us access to your books. We want to know what your breakeven point is. What is that breakeven point annually? We'll write you a check for that.Eric Topol (33:26):Yeah.Mark Cuban (33:27):If we have fewer patients than need that, okay, you win. If we have more patients than need that, it's like a Netflix subscription with unlimited subscribers, then we will have whatever it is, because then the manufacturer doesn't lose money, so they can't complain about R&D and not being able to make money. And that's for the CMS covered population. You can do a Netflix type subscription for self-insured employers. Hey, it's 25 cents per month per employee or per life covered for the life of the patent, and we'll commit to that. And so, now all of a sudden you get to a point where healthcare starts becoming not only transparent but deterministic.Eric Topol (34:08):Yeah. What you outline here in these themes are extraordinary. And one of the other issues that you are really advocating is patient empowerment, but one of the problems we have in the US is that people don't own their data. They don't even have all their data. I expect you'd be a champion of that as well.Mark Cuban (34:27):Well, of course. Yeah. I mean, look, I've got into arguments with doctors and public health officials about things like getting your own blood tested. I've been an advocate of getting my own blood tested for 15 years, and it helped me find out that I needed thyroid medication and all of these things. So I'm a big advocate. There's some people that think that too much data gives you a lot of false positives, and people get excited in this day and age to get more care when it should only be done if there are symptoms. I'm not a believer in that at all. I think now, particularly as AI becomes more applicable and available, you'll be able to be smarter about the data you capture. And that was always my final argument. Either you trust doctors, or you don't. Because even if there's an aberrational TSH reading and minus 4.4 and it's a little bit high, well the doctor's going to say, well, let's do another blood test in a month or two. The doctor is still the one that has to write the prescription. There's no downside to trusting your doctor in my mind.Eric Topol (35:32):And what you're bringing up is that we're already seeing how AI can pick up things even in the normal range, the trends long before a clinician physician would pick it up. Now, last thing I want to say is you are re-imagining healthcare like no one. I mean, there's what you're doing here. It started with some pills and it's going in a lot of different directions. You are rocking it here. I didn't even know some of the latest things that you're up to. This seems to be the biggest thing you've ever done.Mark Cuban (36:00):I hope so.Mark Cuban (36:01):I mean, like we said earlier, what could be better than people saying our healthcare system is good. What changed? That Cuban guy.Eric Topol (36:10):Well, did you give up Shark Tank so you could put more energy into this?Mark Cuban (36:16):Not really. It was more for my kids.Eric Topol (36:19):Okay, okay.Mark Cuban (36:20):They go hand in hand, obviously. I can do this stuff at home as opposed to sitting on a set wondering if I should invest in Dude Wipes again.Eric Topol (36:28):Well, look, we're cheering for you. This is, I've not seen a shakeup in my life in American healthcare like this. You are just rocking. It's fantastic.Mark Cuban (36:37):Everybody out there that's watching, check out www.costplusdrugs.com, check out Cost Plus Marketplace, which is business.costplusdrugs.com and just audit everything. What I'm trying to do is say, okay, if it's 1955 and we're starting healthcare all over again, how would we do it? And really just keep it simple. Look to where the risk is and remove the risk where possible. And then it comes down to who do you trust and make sure you trust but verify. Making sure there aren't doctors or systems that are outliers and making sure that there aren't companies that are outliers or patients rather that are outliers. And so, I think there's a path there. It's not nearly as difficult, it's just starting them with corporations, getting those CEOs to get educated and act in their own best interest.Eric Topol (37:32):Well, you're showing us the way. No question. So thanks so much for joining, and we'll be following this with really deep interest because you're moving at high velocity, and thank you.**************************************************Thank you for reading, listening and subscribing to Ground Truths.If you found this fun and informative please share it!All content on Ground Truths—its newsletters, analyses, and podcasts, are free, open-access.Paid subscriptions are voluntary. All proceeds from them go to support Scripps Research. Many thanks to those who have contributed—they have greatly helped fund our summer internship programs for the past two years. I welcome all comments from paid subscribers and will do my best to respond to each of them and any questions.Thanks to my producer Jessica Nguyen and to Sinjun Balabanoff for audio and video support at Scripps Research.FootnoteThe PBMS (finally) are under fire—2 articles from the past week Get full access to Ground Truths at erictopol.substack.com/subscribe

Chris Finn is a Licensed Physical Therapist, Certified Strength and Conditioning Specialist, Titleist Performance Institute (TPI) Certified Medical Professional, Certified Precision Nutrition Coach and a Golf Digest Top 50 Golf Fitness Professional. He is also the Founder of Par4Success - a Golf Performance and Direct Pay Physical Therapy industry leader. He and his team work with golfers of all abilities and ages to swing faster, play better and hurt less.  Chris joins #OntheMark to talk about health, wellness, injury prevention, and habits for better golf, and MORE clubhead speed. In Part 1. of 2, Chris is joined by 62 year-old Brent Rebus from Ottawa, Canada. Brent is an elite golfer who played at the National Level.  Brent had experienced a slump in play and a loss in power and so he connected with P4S to rediscover his best golf. Brent talks about how with an improvement in Hip Mobility and Rotational Ability he increased his CHS from 102mph average to 115mph: They address: The moment that spurred the action The 4 key areas identified for improvement The discipline and mindset required The ease of working with a remote coach, and Examples of exercises for mobility and speed gains. This podcast is also available as a vodcast.  Go to youtube.com and seach for, and subscribe to Mark Immelman.    

[SEGMENT 1-1[ DEI Divorce: Biden-Harris   Move over, Hatfields and McCoys—America's got a new feud to gawk at. Except this time, there are no moonshine stills, shotgun standoffs, or Appalachian drama. Sadly for Democrats, this is the modern age, where political pettiness is played out on camera; with forced applause and awkward grins as the soundtrack. The players? Joe and Jill Biden vs. Kamala Harris and her “Second Gentleman” (because nothing says modern marriage like giving your husband a title that sounds like a rejected superhero name). The scene? The Kennedy Center Honors, where the Bidens pulled a move so cold Frosty the Snowman had to put on a sweater. Newsbreak reported: "President Joe Biden and first lady Jill Biden gave a cold shoulder to Vice President Kamala Harris and her husband, second gentleman Doug Emhoff, as they entered the 47th Kennedy Center Honors to an applauding crowd. The president and first lady were seen on video not making eye contact or acknowledging the vice president and her husband as they walked past them and waved alongside them. The vice president and second gentleman remained effusive and applauded the Bidens during the standing ovation despite the first couple ignoring them." First of all, can we take a moment to appreciate the power of passive aggression? The Bidens basically perfected the art of the social snub. No glares, no side comments—just pure, unadulterated “I don't see you, Kamala” energy. That takes skill, or maybe just years of marriage practice. Still, when Joe and Jill Biden were announced, Kamala and hubby clapped like trained seals. Nevertheless, let's hit rewind. This tension didn't start at the Kennedy Center. It's been brewing since at least Veteran's Day, when Jill Biden gave Kamala the cold shoulder so sharp it could've sliced through steel. What's the beef? The plot to get rid of Joe. During the period where Democrats contemplated dumping Joe Biden, Harris quietly circled the Oval Office like a hawk eyeing a wounded rabbit. Everybody knows that she had been "read in" on the coup conspiracy". Remember, this partnership wasn't exactly built on a solid foundation of trust and camaraderie. Biden and Harris weren't teammates; they were co-workers forced into the same cubicle. And just like in any dysfunctional office, one person inevitably starts plotting their takeover the moment the boss trips over his own shoelaces—metaphorically or otherwise. Kamala's mistake? She forgot to be subtle. Harris was to Brutus as Biden was to Caesar. And on the Ides of July, Harris lured Biden into the chambers and it was knives out. This feud isn't just personal—it's deeply ironic. These two were supposed to be the ultimate DEI power couple, the living embodiment of “diversity, equity, and inclusion.” [SEGMENT 1-2] Democracy on the rise? Subscribers and BSC I did my first podcast for Subscribers and I must say it is one of my best. Thanks Bill for reminding me that we needed to kick that off. Talk about a special broadcast. Only 14 people will get to hear it. But it's 14 of the finest people on the planet. I had a BLAST putting that together for you. For members of The Back Stage Club, get ahold of me, and we will make the broadcast available to you as well. I will do at least one of those every couple of weeks (minimum), and on BSC, we post things as we develop them. They come more in batches, but I will work on more consistency there too. I have observations from Japan, Mexico, and soon to be Thailand along with pictures and videos. Also, I found the video I made with Justice Thomas, so expect me to post that soon.     We Saved the Republic: The Fragile Triumph Over Chaos The last election preserved the constitutional republic we hold dear, narrowly steering the nation away from the precipice of destruction. Over the past 16 years, Democrats have spent 12 tearing at the fabric of the nation, creating cultural and political divides so wide that chaos seemed inevitable. A Harris presidency would have only accelerated this unraveling. Thankfully, we avoided that scenario. But the specter of such leadership reminds us how close we came to disaster. A Nation at Rest—or at Least at Pause Despite the dire warnings from the left, America hasn't plunged into chaos since Trump's return to the political arena. Recent events suggest a marked shift in the national climate. Consider Daniel Penny's recent exoneration—a moment that could have ignited protests led by Black Lives Matter. Yet, the country remained calm, unmoved by the provocations that once would have led to streets filled with unrest. This shift raises an interesting question: Are we finally moving past the endless state of cultural panic? Can figures like Darren Wilson reclaim their careers in law enforcement, or could Derek Chauvin see his conviction re-evaluated under a new climate of fairness? Perhaps, just perhaps, white America can finally lower the metaphorical "RED ALERT."Democracy vs. Republic: Are They What They Seem? According to a Pew Research report, as of 2017, 57% of the world's nations were considered democracies. But does this mean democracy is flourishing? By that measure, it may seem like global democracy is at a modern-day high. Yet, appearances can be deceiving. Many of these so-called democracies lack the principles that Americans associate with the term.   [SEGMENT 1-3] FBI at J6 1 J6 is unraveling for the Left. A Capitol Comedy: The FBI's J6 Revelations Newly revealed testimony confirms what skeptics of the January 6 narrative have long suspected: the FBI's involvement wasn't just passive oversight but an active participation, complete with paid informants and undercover agents. According to disclosures during congressional hearings, there were so many FBI confidential human sources (CHS) at the Capitol that the agency had to “poll” its offices afterward to figure out how many were on-site. The cherry on top? At least three of these informants were specifically directed to attend by their handlers.. If this sounds like the punchline to a poorly executed spy thriller, that's because it is. The Numbers Game: More Agents than We're Told? The FBI claims only three informants were actively encouraged to attend. But as a former Capitol Police chief has testified, there were at least 18 undercover FBI agents mingling in the crowd, in addition to an estimated 20 undercover operatives from the Department of Homeland Security. Defense attorneys in Proud Boys trials also revealed that eight CHSs had infiltrated their group, and at least one was physically inside the Capitol during the breach​. This raises the question: if we were told it was a spontaneous “insurrection,” why did federal agencies embed dozens of operatives in advance? Was this infiltration an attempt to mitigate violence—or to stoke it? FBI operations, including infiltrating groups or rallies, typically require meticulous planning and oversight. [SEGMENT 1-4] FBI at J6 2   [X] SB – Kamala Harris on J6 [X] SB – Paid protester on J6 [X] SB – Congressman speaks on the number of agents at J6   The FBI's focus on January 6 highlights a troubling pattern. While the bureau assigns agents to monitor political rallies, it seems conspicuously less effective at preventing other, more tangible threats. We've seen this pattern before—mass shooters who were already on FBI watchlists, an open southern border exploited by known terrorists, and even whistleblowers within the agency alleging systemic dysfunction​ If the FBI's resources were deployed to prevent violence, they failed spectacularly. If the goal was to justify the post-election crackdown on Trump supporters, well, they've done a bang-up job.Become a supporter of this podcast: https://www.spreaker.com/podcast/the-kevin-jackson-show--2896352/support.

Today's show is a big one before heading into the weekend. We start off, as we always do on Friday's, with a run through the news you may have not heard about on Legacy/mainstream media as we dive into Tara's Top 10. On the heels of that, my good friend Kerry Sloan from “We the Female” made an interesting observation about the assassination of the United Healthcare CEO. Where is the usual cry from the Left to ban guns and infringe on the 2A? As the show started, we got breaking news that Rep. Nancy Pelosi (D-CA) had been injured on a trip to Europe in honor of the anniversary of the Battle of the Bulge. She is in a hospital, but a spokesperson said she was working, just unable to attend the rest of the events. Then I remind you of an exchange between Rep. Clay Higgins (D-LA) and FBI Director Christopher Wray. Higgins wanted to know if there were an Confidential Human Sources embedded in the J6 protesters? Wray would not answer, but indicated there were none and if there were, they didn't do anything wrong. This leads to the just released DOJ IG report on J6. It is confirmed that at least 26 CHS's were in the protest. So, I remind you about the psychology of the mob. Mayor Eric Adams (D-NY) says he is going to work with Trump because we are now missing 500,000 children since the Biden-Harris regime opened our border. He said he must protect everyone, including children and citizens from crime. Tom Homan agrees and says Trump will likely pull Federal funds from cities/states that refuse to follow the law. What a difference two days can make. Suddenly, Rep. Bennie Thompson (D-MS) is interested in taking a pardon if Joe Biden offers. So we remind you again, this time from Rep. Adam “Crybaby” Kinzinger (R-IL) that you aren't offered a pardon unless you did something wrong. The ProPublica heat-piece that blew up earlier this week is now the subject of a piece in The Federalist. They came to the same conclusion I did, that smear just landed Pete in the seat of Secretary of Defense. Sen. Lisa Murkowski (R-AS) is worried that elected Republicans are feeling pressure to do what the voters want when it comes to Donald Trump's nominees and agenda. Well, imagine that! She's upset that she is supposed to represent, not rule. The Biden Administration is trying to auction off all the border materials for pennies to thwart Trump's plan to get back to building the wall. Lt. Gov. Dan Patrick (R-TX), in a brilliant move, is willing to buy them up to have them ready. Finally, Leslie Stahl laments that Legacy/mainstream media is dying and she's not sure how to save it. I offer some suggestions to include no longer being the propaganda wing of the Democrat Party. I'm not worried about them taking my advice. That sentiment is also echoed by the Editor-in-Chief of The Federalist, Mollie Hemingway. Please take a moment to rate and review the show and then share the episode on social media. You can find me on Facebook, X, Instagram, GETTR and TRUTH Social by searching for The Alan Sanders Show. You can also support the show by visiting my Patreon page!!

Brian talks about what to expect this year in Real Estate. How will the new administration change the Real Estate climate? How will interest rates be effected? Plus, insurance rate increases are a major problem in the Charleston, SC area. Listen now to find out more! ** GET OUR FREE GUIDE** Text 'GUIDE' to 843-800-0065 for a FREE copy of The Most Comprehensive Home Seller Guide in Charleston. Have a real estate need or question? Book a consult with us today!  ☎️ (843) 800-0065

Want a business built on creativity, community & individuality? My conversation with Mimi Striplin of the Tiny Tassel is LIVE! A few highlights of what we cover: The origin story of Tiny Tassel How what sets you apart can be your superpower What it looks like for faith to be part of your work Her Charleston favorites (I've been visiting CHS for 10 years now and a few of these were new to me!) A couple holiday promos for the Tiny Tassel - you'll want to scoop something fun up! This conversation is one of my favorites. We touch on high moments in owning a small business, low ones too, and how faith in God is an absolute 'it' factor through it all. Watch our conversation via YouTube or listen in via the podcast. And while you're there, don't forget to subscribe... more of these conversations are to come so that you can be supported so well in your entrepreneurship journey. Watch on YouTube: https://www.youtube.com/watch?v=bIl3QYp9uiI&t=44s Apply to work with Alexandra: https://alexandra443.typeform.com/to/ngAu0h

In this week's episode of Agri-Biz, Rusty Halvorson and Sarah Heinrich talk about end-of-year tax planning for farmers and ranchers, the farm bill logjam that is showing signs of breaking after the elections, and a proposed merger between CHS and West Central Ag Services that attracted attention from The Arthur Companies.See omnystudio.com/listener for privacy information.

Dance and cheer at Carlsbad High School is serious business. Each member works hard to learn each choreographed move and technique for the betterment of the team. Brooke Parrish is a senior captain for the dance team at CHS and has been doing it for a long time. Her leadership has kept her team sharp throughout the fall semester. Emilee Good does both dance and cheer so getting breaks are a foreign concept for her. This was a fun episode.   #cheerleading #dance #danceteam #newmexico #carlsbadnm

John Mara commits to Joe Schoen and Brian Daboll through the season. Grayson McCall calls it a career because of concussions. A look ahead to week 8 on Picks Against the Spread. Plus, wedding songs, CHS tapes, training in progress and much more!See omnystudio.com/listener for privacy information.

Cannabinoid Hyperemesis Syndrome (CHS): Yep, this is definitely an issue and has been in recent print. This was just covered in an expert commentary in J Gastroenterology in May 2024, and CMS was featured as a JAMA Patient Page on October 10, 2024 in JAMA Network. PLUS, we actually covered this back in Feb 10th, 2020! Yep…M-O-R-E information just keeps coming, including a new study in the OCT 2024 Green Journal, which shows that rates of THC in pregnancy are still increasing. This study, again from THIS MONTH, tells us that the prevalence of prenatal cannabis use increased from 5.5% in 2012 to 9.0% in 2022 among pregnant individuals, at least according to the database from Northern California ( Kaiser Permanente Northern California). In this episode, we will update our previous discussion on CHS (from back in 2020) based on these new publications.

In this episode, Scott Becker highlights eight major healthcare stories, including the rise in for-profit hospital mergers, Florida hospitals bracing for a hurricane, and the growth of AI tools at CHS. He also covers the expansion of digital care platforms, a large prescription drug fraud case, and new members joining the Becker's Healthcare CEO Advisory Board.