1 00:00:01,760 --> 00:00:02,880 Speaker 1: CAUs Media. 2 00:00:05,200 --> 00:00:08,479 Speaker 2: Hello and welcome to the podcast. It's me James. Today 3 00:00:08,600 --> 00:00:12,080 Speaker 2: we have a very special episode in which everyone is 4 00:00:12,119 --> 00:00:14,440 Speaker 2: a doctor. I will believe in discussion, of course, as 5 00:00:14,480 --> 00:00:17,239 Speaker 2: a doctor of modern European history. But I'm joined today 6 00:00:17,440 --> 00:00:22,560 Speaker 2: by venktash Ramnath, who is a practicing pullmanologist, a professor 7 00:00:22,600 --> 00:00:26,200 Speaker 2: at UC San Diego Health, a medical director of several 8 00:00:26,200 --> 00:00:29,160 Speaker 2: it use in royal and urban settings, and also the 9 00:00:29,200 --> 00:00:32,800 Speaker 2: author of the substack be a health architect. Welcome to 10 00:00:32,840 --> 00:00:34,440 Speaker 2: the Shoving Test. Thanks for joining us. 11 00:00:34,440 --> 00:00:35,200 Speaker 3: Great to be here. 12 00:00:35,400 --> 00:00:38,640 Speaker 2: I'm also joined by doctor Carve Holder, a gastro enterologist 13 00:00:39,120 --> 00:00:43,600 Speaker 2: and the host of our favorite medical podcast, The House 14 00:00:43,640 --> 00:00:44,040 Speaker 2: of Pod. 15 00:00:44,240 --> 00:00:46,920 Speaker 3: Of the many you listen to, I'm sure yeah. 16 00:00:46,920 --> 00:00:48,839 Speaker 2: What they might call a super user in a medical 17 00:00:48,880 --> 00:00:53,239 Speaker 2: podcast space you listen to more than most importantly Cave 18 00:00:53,400 --> 00:00:57,720 Speaker 2: of course, our friend, our resident doctor with a useful doctorate. 19 00:00:58,200 --> 00:01:03,280 Speaker 2: So what we want to talk about today is Medicare 20 00:01:03,840 --> 00:01:07,240 Speaker 2: and specifically some of the cuts to medicare. More broadly, 21 00:01:08,200 --> 00:01:12,120 Speaker 2: the I don't know really have to put this challenges 22 00:01:13,080 --> 00:01:15,399 Speaker 2: for people working in healthcare and the Trump administration right. 23 00:01:15,400 --> 00:01:19,600 Speaker 2: We addressed specifically gender affirming care in a previous episode, 24 00:01:19,680 --> 00:01:22,399 Speaker 2: but it doesn't start and end there, right, That might 25 00:01:22,440 --> 00:01:24,399 Speaker 2: be the thing that sort of the culture wars have 26 00:01:24,440 --> 00:01:27,160 Speaker 2: been focusing on recently. But I want to talk more 27 00:01:27,200 --> 00:01:30,959 Speaker 2: broadly about the challenges facing healthcare. So first of all, 28 00:01:31,520 --> 00:01:35,679 Speaker 2: would one of you care to explain medicare for people 29 00:01:35,680 --> 00:01:38,000 Speaker 2: who are not familiar And some listeners might not be 30 00:01:38,160 --> 00:01:40,520 Speaker 2: living in the United States, or they might just not 31 00:01:40,560 --> 00:01:42,880 Speaker 2: have encountered this yet in their life, So could one 32 00:01:42,920 --> 00:01:46,120 Speaker 2: of you explain what this particular sort of type of 33 00:01:46,160 --> 00:01:48,960 Speaker 2: health insurance is and how it's maybe more vulnerable than 34 00:01:49,000 --> 00:01:52,120 Speaker 2: other types to federal government changes. 35 00:01:52,960 --> 00:01:54,440 Speaker 3: I could take a stab at it. 36 00:01:54,800 --> 00:01:58,080 Speaker 4: I'm not a health policy want but I am a 37 00:01:58,080 --> 00:02:00,920 Speaker 4: physician that has to deal with Medicare all the time. 38 00:02:01,040 --> 00:02:04,880 Speaker 4: So Medicare, in sort of general terms, is a type 39 00:02:04,880 --> 00:02:08,359 Speaker 4: of health insurance that is provided by the federal government. 40 00:02:08,840 --> 00:02:11,880 Speaker 4: It is almost exclusively for individuals above the age of 41 00:02:11,960 --> 00:02:15,320 Speaker 4: sixty five, as it dates back to the nineteen sixties 42 00:02:15,360 --> 00:02:19,640 Speaker 4: with Lyndon Johnson's Great Society Program, and so since that 43 00:02:19,800 --> 00:02:25,160 Speaker 4: time there has been this blanket coverage for any individuals 44 00:02:25,160 --> 00:02:29,840 Speaker 4: above that age, such that all their medical services or products, 45 00:02:30,280 --> 00:02:33,760 Speaker 4: whatever they need for their healthcare is actually covered by 46 00:02:33,880 --> 00:02:34,440 Speaker 4: the government. 47 00:02:34,480 --> 00:02:35,760 Speaker 3: This is the federal government. 48 00:02:36,040 --> 00:02:38,080 Speaker 4: Now, the interesting thing about Medicare is that there are 49 00:02:38,080 --> 00:02:41,960 Speaker 4: different parts to it. There's Part A, which is primarily 50 00:02:42,400 --> 00:02:47,520 Speaker 4: for some essential services and includes hospital care. There's Part B, 51 00:02:47,800 --> 00:02:53,000 Speaker 4: which includes whatever physicians fees go into that healthcare. And 52 00:02:53,040 --> 00:02:56,520 Speaker 4: then there's Part D, which relates to pharmaceutical prices, so 53 00:02:56,600 --> 00:02:59,920 Speaker 4: your drug costs. It's not comprehensive in the sense that 54 00:03:00,400 --> 00:03:04,720 Speaker 4: there's always something more that individuals need, but Medicare, for 55 00:03:04,760 --> 00:03:08,959 Speaker 4: all intents and purposes, is the sort of standard and 56 00:03:09,000 --> 00:03:14,120 Speaker 4: it should cover most of individual's needs. Now that said, 57 00:03:14,680 --> 00:03:18,280 Speaker 4: the commercial payers, that is, the other insurance companies that 58 00:03:18,360 --> 00:03:22,840 Speaker 4: are not federally government sponsored, take their lead from Medicare. 59 00:03:22,919 --> 00:03:26,440 Speaker 4: So a lot of the different payment rates or coverages 60 00:03:26,480 --> 00:03:30,040 Speaker 4: and services they all look to what the centers of 61 00:03:30,080 --> 00:03:34,079 Speaker 4: Medicare and Medicaid services dictate as far as what is 62 00:03:34,120 --> 00:03:38,640 Speaker 4: an acceptable reimbursement rate, what are the rules around what 63 00:03:38,680 --> 00:03:41,880 Speaker 4: should be covered and what should not. So that's why 64 00:03:42,000 --> 00:03:46,120 Speaker 4: Medicare is such an important entity for the United States. 65 00:03:46,240 --> 00:03:47,920 Speaker 3: Yeah, I'll add to that. 66 00:03:48,320 --> 00:03:51,560 Speaker 5: They set the lead of importance here too, because if 67 00:03:51,560 --> 00:03:55,440 Speaker 5: we're talking about telemedicine telehealth, how important that is to 68 00:03:56,120 --> 00:03:59,640 Speaker 5: medicare patients to everyone in the country at this point. 69 00:04:00,440 --> 00:04:03,320 Speaker 5: Then if they are to cut it, if that happens, 70 00:04:03,360 --> 00:04:05,200 Speaker 5: as I think we're probably going to discuss. If that 71 00:04:05,240 --> 00:04:09,320 Speaker 5: goes away, then the other private insurance companies are going 72 00:04:09,360 --> 00:04:09,720 Speaker 5: to follow. 73 00:04:09,800 --> 00:04:10,200 Speaker 3: That's right. 74 00:04:10,240 --> 00:04:14,280 Speaker 5: It could be across the board changes led by these 75 00:04:14,360 --> 00:04:15,200 Speaker 5: changes of medicare. 76 00:04:15,400 --> 00:04:17,960 Speaker 2: Yeah, so let's talk about those changes. Then, as you 77 00:04:18,000 --> 00:04:21,280 Speaker 2: mentioned right, there's this telemedicine it's a waiver right that 78 00:04:21,320 --> 00:04:26,400 Speaker 2: has allowed telemedicine to be funded through this for the 79 00:04:26,480 --> 00:04:29,760 Speaker 2: last five years. I suppose it's going to expire by 80 00:04:29,760 --> 00:04:32,680 Speaker 2: the end of this month, which is March twenty twenty five. 81 00:04:32,720 --> 00:04:37,279 Speaker 2: If if you're listening later, explain like why telemedicine has 82 00:04:37,320 --> 00:04:41,920 Speaker 2: been such a positive step like in healthcare since if 83 00:04:41,920 --> 00:04:45,279 Speaker 2: you could since twenty twenty and then what we're facing 84 00:04:45,600 --> 00:04:47,520 Speaker 2: if it's no longer funded federally. 85 00:04:48,040 --> 00:04:50,680 Speaker 5: May I'll start this one, but Venkesh definitely want you 86 00:04:50,720 --> 00:04:53,400 Speaker 5: to weigh in on it as well. Does give a little background. 87 00:04:53,839 --> 00:04:56,400 Speaker 5: Over the past five years that's grown quite a bit 88 00:04:56,520 --> 00:05:00,360 Speaker 5: and it's gone from being kind of this emergency stop 89 00:05:00,400 --> 00:05:05,080 Speaker 5: gap to a real cornerstone of what we consider modern healthcare, 90 00:05:05,520 --> 00:05:09,040 Speaker 5: and now it's exceedingly common, like over seventy five percent 91 00:05:09,240 --> 00:05:13,120 Speaker 5: of hospitals in the US connect at a distance via 92 00:05:13,279 --> 00:05:20,200 Speaker 5: video conference or some technology to patients. And it's been 93 00:05:20,240 --> 00:05:22,840 Speaker 5: popular on both sides. It's been popular on both sides 94 00:05:22,839 --> 00:05:26,440 Speaker 5: of the aisle. When it first was done, as you mentioned, 95 00:05:26,560 --> 00:05:31,880 Speaker 5: during COVID, when they said, Okay, we're gonna peel back 96 00:05:31,920 --> 00:05:36,200 Speaker 5: some of the restrictions on Medicare coverage for these telehealth things, 97 00:05:36,760 --> 00:05:39,440 Speaker 5: it was considered like a victory, like one of the 98 00:05:39,480 --> 00:05:41,320 Speaker 5: few good things that come out of COVID. 99 00:05:41,800 --> 00:05:43,120 Speaker 3: Both sides liked it. 100 00:05:43,120 --> 00:05:47,200 Speaker 5: It was popular amongst patients, it was popular amongst medical providers. 101 00:05:47,760 --> 00:05:51,840 Speaker 5: It was good for Republicans and Democrats alike. And as 102 00:05:51,839 --> 00:05:55,520 Speaker 5: you mentioned, it's been kept going through being put in 103 00:05:55,560 --> 00:05:57,720 Speaker 5: some bill or another since it was initially put in 104 00:05:58,320 --> 00:06:01,320 Speaker 5: I think as they called twenty two, and it's been 105 00:06:01,320 --> 00:06:03,800 Speaker 5: put in one bill or another to go with a funding. 106 00:06:04,120 --> 00:06:07,520 Speaker 5: But then came this last December when Congress was going 107 00:06:07,520 --> 00:06:10,360 Speaker 5: through their spending. It was only given this three month 108 00:06:10,440 --> 00:06:12,279 Speaker 5: reprieve which is going to be up as you mentioned, 109 00:06:12,320 --> 00:06:14,680 Speaker 5: at the end of this month, and if it goes away, 110 00:06:14,800 --> 00:06:16,480 Speaker 5: there's a lot of factors will go into a lot 111 00:06:16,480 --> 00:06:20,880 Speaker 5: of them. But there's a lot of people, older patients, 112 00:06:21,080 --> 00:06:23,400 Speaker 5: you know, compromise patients who don't want to come into office, 113 00:06:23,480 --> 00:06:27,040 Speaker 5: people with disabilities, people can't get around that well, people 114 00:06:27,080 --> 00:06:30,239 Speaker 5: in rural areas, which is you know, really how it started. 115 00:06:30,640 --> 00:06:33,440 Speaker 5: People who are going to be hurt all across this country. 116 00:06:33,640 --> 00:06:36,440 Speaker 5: And at this point, the majority of people have had 117 00:06:36,720 --> 00:06:41,040 Speaker 5: at least one experience or more in a year with telemedicine. 118 00:06:41,080 --> 00:06:43,040 Speaker 5: It's become a part of a lot of people's lives. 119 00:06:43,320 --> 00:06:46,400 Speaker 5: And if it goes away, you know, there's still going 120 00:06:46,440 --> 00:06:48,360 Speaker 5: to be health care as it is. I mean, it 121 00:06:48,360 --> 00:06:50,719 Speaker 5: doesn't mean health care is going away, but it is 122 00:06:50,760 --> 00:06:54,800 Speaker 5: going to put a tremendous burden on patients and hospitals 123 00:06:54,920 --> 00:06:56,960 Speaker 5: for that matter, across the country. 124 00:06:57,279 --> 00:06:58,400 Speaker 3: Yeah, let me let me add to that. 125 00:06:58,520 --> 00:07:02,520 Speaker 4: So, you know, telemedicine has been around for a very 126 00:07:02,640 --> 00:07:05,200 Speaker 4: long time, at least technically speaking, right, I mean, you 127 00:07:05,240 --> 00:07:08,240 Speaker 4: can go back to the nineteen seventies. Even when you 128 00:07:08,400 --> 00:07:10,920 Speaker 4: talk about the intensive cared it which is where the 129 00:07:10,960 --> 00:07:13,880 Speaker 4: sickest people in the hospital are. There are studies that 130 00:07:13,920 --> 00:07:18,080 Speaker 4: come out of the nineteen seventies. However, Ever, since people 131 00:07:18,080 --> 00:07:21,040 Speaker 4: have had iPhones and been on Airbnb and everything else. 132 00:07:21,040 --> 00:07:25,520 Speaker 4: Since two thousand and seven, that inflection point actually had 133 00:07:25,560 --> 00:07:29,720 Speaker 4: a wave of opportunity that washed right into medicine, and 134 00:07:29,760 --> 00:07:33,560 Speaker 4: as Cave is saying, you know, we have such a 135 00:07:33,640 --> 00:07:37,480 Speaker 4: fragmented healthcare system that has you know, folks living in 136 00:07:37,560 --> 00:07:42,040 Speaker 4: rural areas, suburban areas, and urban areas, all of whom 137 00:07:42,480 --> 00:07:45,520 Speaker 4: are at the mercy of what specialists may be. They're 138 00:07:45,720 --> 00:07:50,960 Speaker 4: contracted at any given time for any given specialty. Now telemedicine, 139 00:07:51,360 --> 00:07:54,280 Speaker 4: as it's gotten more and more popular, has kind of 140 00:07:54,840 --> 00:07:57,240 Speaker 4: leveled the playing field. I mean, you can be in 141 00:07:57,680 --> 00:08:00,160 Speaker 4: a rural place like where I'm sitting right now on 142 00:08:00,200 --> 00:08:03,080 Speaker 4: the US Mexico border, or you can be in New 143 00:08:03,160 --> 00:08:06,160 Speaker 4: York City, you know, one of the densest populations, but 144 00:08:06,280 --> 00:08:12,240 Speaker 4: you may might not have access to specialty expertise without telemedicine. 145 00:08:12,400 --> 00:08:16,000 Speaker 4: With telemedicine, you can now have access and I've seen 146 00:08:16,080 --> 00:08:18,800 Speaker 4: patients love it. You can deal with the sickest of 147 00:08:18,840 --> 00:08:21,600 Speaker 4: the sick, like I said, intensive care units, but you 148 00:08:21,640 --> 00:08:24,080 Speaker 4: can also have outpatient experiences. And we've seen a number 149 00:08:24,080 --> 00:08:27,520 Speaker 4: of different you know, commercial opportunities that have leveraged that. 150 00:08:27,680 --> 00:08:30,280 Speaker 4: But the point is that as as we're hearing on this, 151 00:08:30,680 --> 00:08:35,160 Speaker 4: you know, it's become sort of a standard operating procedure 152 00:08:35,200 --> 00:08:37,760 Speaker 4: for how we deliver healthcare. And if you just pull 153 00:08:37,840 --> 00:08:40,880 Speaker 4: the rug out from that, there can be some you know, 154 00:08:41,040 --> 00:08:44,120 Speaker 4: unintended consequences to that that are not insignificant. 155 00:08:44,520 --> 00:08:46,719 Speaker 2: Yeah, and like it makes a lot of sense to 156 00:08:46,720 --> 00:08:48,080 Speaker 2: a lot of people, right, Like I think about my 157 00:08:48,120 --> 00:08:51,240 Speaker 2: own experience with it. I was traveling recently and got 158 00:08:51,280 --> 00:08:53,720 Speaker 2: COVID like a couple of months ago, and there was 159 00:08:53,760 --> 00:08:55,360 Speaker 2: no need for me to go to a clinic and 160 00:08:55,480 --> 00:08:57,720 Speaker 2: be around other people, right, I just needed to contact 161 00:08:57,760 --> 00:09:01,240 Speaker 2: my doctor and get some prescriptions check in, And like 162 00:09:01,280 --> 00:09:02,880 Speaker 2: it was so much better that I could do it 163 00:09:02,920 --> 00:09:06,559 Speaker 2: in my pajamas from a bed rather than like having 164 00:09:06,600 --> 00:09:08,920 Speaker 2: to get out. And I'm lucky to have access to 165 00:09:08,960 --> 00:09:11,040 Speaker 2: a car. It can drive to the doctor's surgery is 166 00:09:11,040 --> 00:09:13,400 Speaker 2: not that far away. Have a job that accommodates my schedule. 167 00:09:13,440 --> 00:09:16,040 Speaker 2: But there are a million reasons way it might be 168 00:09:16,120 --> 00:09:20,120 Speaker 2: very beneficial to people. So let's talk about you. You 169 00:09:20,160 --> 00:09:23,240 Speaker 2: mentioned this before, but we have commercial insurers, and like 170 00:09:23,320 --> 00:09:26,720 Speaker 2: people might think that this is limited to older folks, 171 00:09:26,800 --> 00:09:29,440 Speaker 2: or it doesn't affect them, or it's something that only 172 00:09:29,480 --> 00:09:33,240 Speaker 2: impacts people who have Medicare. But as you said, Medicare 173 00:09:33,360 --> 00:09:36,400 Speaker 2: kind of sets the standard for what is covered and 174 00:09:36,440 --> 00:09:38,440 Speaker 2: what isn't covered, right, So can you explain how this 175 00:09:38,559 --> 00:09:41,680 Speaker 2: might end up resulting in it in just a massive 176 00:09:41,800 --> 00:09:44,280 Speaker 2: like a cliff. I've seen it described as a telehealth cliff. 177 00:09:44,679 --> 00:09:48,559 Speaker 4: Yeah, So, I mean basically, the sort of this convoluted 178 00:09:48,600 --> 00:09:52,240 Speaker 4: way that we pay for services is it looks to 179 00:09:52,480 --> 00:09:55,960 Speaker 4: one standard, even though some may argue how did that 180 00:09:56,000 --> 00:10:00,320 Speaker 4: standard come about? But regardless of that, Medicare is the 181 00:10:00,360 --> 00:10:04,920 Speaker 4: central authority that basically tells everyone this is what we 182 00:10:04,960 --> 00:10:06,880 Speaker 4: should be doing, and this is how much we should 183 00:10:06,880 --> 00:10:10,480 Speaker 4: be paying for it. Now, the commercial insurers can decide 184 00:10:10,520 --> 00:10:13,839 Speaker 4: to exceed that if they wish. If they say, have 185 00:10:13,880 --> 00:10:18,600 Speaker 4: an employer who's employees they want to have a special 186 00:10:19,000 --> 00:10:22,760 Speaker 4: contract with, that's fine, that's not restricted. But the bottom 187 00:10:23,120 --> 00:10:27,280 Speaker 4: of what is considered a reimbursable amount is really set 188 00:10:27,280 --> 00:10:30,200 Speaker 4: by Medicare, and so they move the bottom. And so 189 00:10:30,360 --> 00:10:33,160 Speaker 4: if you drop the bottom, you can pretty much well 190 00:10:33,200 --> 00:10:35,280 Speaker 4: assured in this, you know, in a capitalist you know 191 00:10:35,360 --> 00:10:38,280 Speaker 4: sort of mentality that the cost should go down, right, 192 00:10:38,320 --> 00:10:39,479 Speaker 4: I mean, why should. 193 00:10:39,240 --> 00:10:39,880 Speaker 3: You pay more? 194 00:10:40,360 --> 00:10:43,280 Speaker 4: For something that you don't need to write, and we 195 00:10:43,360 --> 00:10:46,880 Speaker 4: see that. We see that every year. Okay, every year 196 00:10:47,320 --> 00:10:50,960 Speaker 4: there's new technology, but the slightly older technology, which is 197 00:10:51,040 --> 00:10:55,640 Speaker 4: again covered by Medicare, they move those reimbursements down. So 198 00:10:55,760 --> 00:10:58,960 Speaker 4: whether it's a sleep study, you know, for someone with 199 00:10:59,320 --> 00:11:02,400 Speaker 4: obstructives leap babner, a difficulty sleeping at night, or it's 200 00:11:02,440 --> 00:11:07,040 Speaker 4: some ophthalmology technology, or it's some ultrasound machine, it doesn't really. 201 00:11:07,000 --> 00:11:07,760 Speaker 3: Matter what it is. 202 00:11:08,320 --> 00:11:12,080 Speaker 4: Medicare is always trying to minimize costs, which is understandable. 203 00:11:12,080 --> 00:11:14,400 Speaker 4: They want to make it cost effective, but they are 204 00:11:14,440 --> 00:11:18,920 Speaker 4: setting the lead so everyone will follow what they do. 205 00:11:19,200 --> 00:11:21,839 Speaker 4: That's kind of the way that our system is sort 206 00:11:21,880 --> 00:11:22,320 Speaker 4: of set up. 207 00:11:22,920 --> 00:11:26,079 Speaker 5: Yeah, you know, I might just add to that that 208 00:11:26,840 --> 00:11:29,079 Speaker 5: aside from all the things we mentioned about it, how 209 00:11:29,440 --> 00:11:32,360 Speaker 5: you know it helps people in rural areas, people with 210 00:11:32,400 --> 00:11:35,880 Speaker 5: difficulty getting places are just really busy schedules. It also 211 00:11:36,280 --> 00:11:39,160 Speaker 5: you know, helps free of hospital beds, helps prevent emergency 212 00:11:39,240 --> 00:11:43,160 Speaker 5: rooms from being overwhelmed, It leads to faster testing, it 213 00:11:43,240 --> 00:11:46,040 Speaker 5: leads to a higher number of people that we can see, 214 00:11:46,400 --> 00:11:49,640 Speaker 5: and in terms of its quality, we know it works 215 00:11:49,760 --> 00:11:53,760 Speaker 5: well and about ninety percent of cases of telemedicine to 216 00:11:53,800 --> 00:11:56,760 Speaker 5: get the same outcomes if the patient was there in clinic, 217 00:11:57,200 --> 00:11:59,199 Speaker 5: and that ten percent that's not it's not clear that 218 00:11:59,240 --> 00:12:00,760 Speaker 5: they're getting in fear your care. 219 00:12:00,600 --> 00:12:01,680 Speaker 3: In most of those cases. 220 00:12:02,160 --> 00:12:06,679 Speaker 5: So it's an effective treatment, and you could make an 221 00:12:06,760 --> 00:12:09,360 Speaker 5: argument that it is cost effective in some ways too, 222 00:12:09,679 --> 00:12:14,040 Speaker 5: particularly clearly for like things like dermatology, pediatrics. These are 223 00:12:14,040 --> 00:12:16,280 Speaker 5: things where it's clearly cost effective to have it, but 224 00:12:16,840 --> 00:12:20,199 Speaker 5: even beyond that, it's not even necessarily I think a 225 00:12:20,240 --> 00:12:23,480 Speaker 5: strong argument that we'll be losing money from it and 226 00:12:23,520 --> 00:12:26,120 Speaker 5: that cutting it would help us in the long run. 227 00:12:26,160 --> 00:12:28,560 Speaker 5: I feel like we're being smart about how to manage 228 00:12:28,600 --> 00:12:32,719 Speaker 5: American healthcare system and how to keep it afloat. TELL 229 00:12:32,800 --> 00:12:34,480 Speaker 5: the Medicine is going to be an important part of 230 00:12:34,480 --> 00:12:35,319 Speaker 5: that going forward. 231 00:12:36,400 --> 00:12:38,560 Speaker 4: I do want to add something here, and I do 232 00:12:38,679 --> 00:12:42,200 Speaker 4: want to be careful about the term, because telemedicine and 233 00:12:42,240 --> 00:12:45,920 Speaker 4: telehealth are not only sort of a catch all, but 234 00:12:45,960 --> 00:12:49,360 Speaker 4: they're sort of used interchangeably, right, and just like anything, 235 00:12:49,760 --> 00:12:51,440 Speaker 4: you have to be specific about the term. So I 236 00:12:51,480 --> 00:12:55,880 Speaker 4: think what we're talking about this on this podcast is 237 00:12:56,320 --> 00:12:59,360 Speaker 4: tell a medicine in terms of a two way audio 238 00:12:59,520 --> 00:13:03,400 Speaker 4: visual interface where you can have a direct face to 239 00:13:03,480 --> 00:13:10,000 Speaker 4: face consultation or interaction with a practicing practitioner. Usually that's 240 00:13:10,040 --> 00:13:11,959 Speaker 4: going to be a physician, but it may be a 241 00:13:12,040 --> 00:13:15,640 Speaker 4: nurse practitioner or other physician extender we call them. But 242 00:13:15,960 --> 00:13:18,680 Speaker 4: just to be clear, you know, telemedicine also extends to 243 00:13:19,440 --> 00:13:23,480 Speaker 4: other types of devices, like wearables, those things that they're 244 00:13:23,520 --> 00:13:26,040 Speaker 4: either you know, trackers that you can wear as your fitbit, 245 00:13:26,559 --> 00:13:29,560 Speaker 4: or a sleep device you know that you can wear around. 246 00:13:30,120 --> 00:13:32,520 Speaker 4: Those kinds of things are kind of put into the 247 00:13:32,520 --> 00:13:37,040 Speaker 4: telemedicine bucket and it's not clear to me at least 248 00:13:37,440 --> 00:13:40,600 Speaker 4: how that is going to change. I think April first 249 00:13:40,840 --> 00:13:44,720 Speaker 4: is when the face to face coverage from a professional 250 00:13:44,800 --> 00:13:49,120 Speaker 4: fee standpoint that is slated to end because they did 251 00:13:49,559 --> 00:13:53,880 Speaker 4: liberalize it during the COVID pandemic and it's been extended. 252 00:13:53,920 --> 00:13:56,720 Speaker 4: I think another year around that and that will that 253 00:13:56,760 --> 00:14:00,320 Speaker 4: will definitely change the dynamic here, but it's not clear 254 00:14:00,320 --> 00:14:03,440 Speaker 4: how much of it extends to other types of remote 255 00:14:03,440 --> 00:14:06,760 Speaker 4: physiologic monitoring services and products. 256 00:14:06,960 --> 00:14:09,520 Speaker 2: Right, Yeah, so something like a glucose monitor or like 257 00:14:10,160 --> 00:14:12,600 Speaker 2: some other yeah, which could be catastrophic for people, right 258 00:14:12,840 --> 00:14:15,280 Speaker 2: if they don't get those those funded. Right, we're going 259 00:14:15,320 --> 00:14:17,480 Speaker 2: to take a little break for advertisements here. Maybe you'll 260 00:14:17,480 --> 00:14:20,160 Speaker 2: get an advertisement for a gluecose monitor or even. 261 00:14:19,960 --> 00:14:21,240 Speaker 3: Insulin can only hope. 262 00:14:21,360 --> 00:14:25,520 Speaker 2: Yeah, Yeah, I'm glad they're taking some of that money 263 00:14:25,720 --> 00:14:27,880 Speaker 2: that they've made me bleed out of my wallet over 264 00:14:27,920 --> 00:14:30,240 Speaker 2: the years and returning it to me in the form 265 00:14:30,280 --> 00:14:46,040 Speaker 2: of podcast advertisements. All right, we're bank Let's talk more 266 00:14:46,120 --> 00:14:49,960 Speaker 2: broadly about I guess the changes in the legislative environment 267 00:14:50,000 --> 00:14:52,440 Speaker 2: for healthcare might be a good way to put it. Like, 268 00:14:52,720 --> 00:14:55,720 Speaker 2: I think if you were an excellent op ed recently 269 00:14:55,760 --> 00:14:58,560 Speaker 2: where you discussed you you were one of the many 270 00:14:58,600 --> 00:15:01,800 Speaker 2: recipients of the five useful things you did at work 271 00:15:01,840 --> 00:15:04,920 Speaker 2: this week email, and I thought you wrote like a 272 00:15:05,000 --> 00:15:09,600 Speaker 2: really good piece about about the varied and critical work 273 00:15:09,640 --> 00:15:13,600 Speaker 2: that you do. Can you talk about, like, what is 274 00:15:13,640 --> 00:15:18,640 Speaker 2: the feeling among healthcare professionals, physicians who have you sort 275 00:15:18,640 --> 00:15:22,800 Speaker 2: of like to speak speak as going into four years 276 00:15:22,840 --> 00:15:28,760 Speaker 2: of possibly vastly reduced government spending and a sort of 277 00:15:28,840 --> 00:15:33,040 Speaker 2: bizarre and haphazard cutting of the federal bureocracy that we're seeing. 278 00:15:33,360 --> 00:15:36,480 Speaker 4: Yeah, it's a tough time, certainly, and coming out of 279 00:15:36,520 --> 00:15:40,120 Speaker 4: the pandemic, this is not what really anybody expected. But 280 00:15:40,240 --> 00:15:43,440 Speaker 4: you know, the stresses have been mounting for quite a 281 00:15:43,440 --> 00:15:48,440 Speaker 4: while right. Healthcare professionals are seeing and feeling more stress 282 00:15:48,480 --> 00:15:52,000 Speaker 4: at work, whether it's you know, the demands of the 283 00:15:52,120 --> 00:15:56,320 Speaker 4: job meaning that there are fewer resources to spend on 284 00:15:56,920 --> 00:16:01,640 Speaker 4: a heightened number of patients with you know, increasingly complex diseases, 285 00:16:02,640 --> 00:16:06,080 Speaker 4: or even just the questions that we are getting from patients. 286 00:16:06,400 --> 00:16:09,080 Speaker 4: You know, a lot of patients now are asking me 287 00:16:09,440 --> 00:16:12,880 Speaker 4: really financial questions. I mean literally, the other day, I 288 00:16:12,960 --> 00:16:16,920 Speaker 4: had a woman who was unfortunately having septic shock and 289 00:16:17,160 --> 00:16:20,920 Speaker 4: was faced with having to amputate her leg, and I 290 00:16:21,000 --> 00:16:23,280 Speaker 4: was speaking with her husband because she was becoming more 291 00:16:23,320 --> 00:16:27,080 Speaker 4: and more delirious, and he was just asking me about, well, 292 00:16:27,840 --> 00:16:29,960 Speaker 4: I'm going to have to sell my house in order 293 00:16:30,000 --> 00:16:34,120 Speaker 4: to fund what might come down the pike as far 294 00:16:34,160 --> 00:16:36,400 Speaker 4: as being at home with services, and I was trying 295 00:16:36,440 --> 00:16:38,960 Speaker 4: to I was trying to kind of get an understanding 296 00:16:39,000 --> 00:16:43,080 Speaker 4: of how he viewed his wife actually going through the 297 00:16:43,120 --> 00:16:46,680 Speaker 4: thing that we're watching in the moment. But it's a 298 00:16:46,680 --> 00:16:49,640 Speaker 4: preoccupation that has taken up a lot of space in 299 00:16:49,680 --> 00:16:52,680 Speaker 4: the room, and it's now coming on to physicians to 300 00:16:52,880 --> 00:16:56,920 Speaker 4: sort of navigate at least some questions and answer those. 301 00:16:56,840 --> 00:16:59,640 Speaker 3: Questions around it. So that's a long way of saying that. 302 00:16:59,800 --> 00:17:04,120 Speaker 4: You know, so physicians and nurses and other healthcare professionals 303 00:17:04,160 --> 00:17:06,800 Speaker 4: are feeing more and more stress in a system that's 304 00:17:06,840 --> 00:17:10,679 Speaker 4: just buckling, right, And the last thing anybody needs is 305 00:17:11,240 --> 00:17:14,240 Speaker 4: to be having to do more without really a clear 306 00:17:14,880 --> 00:17:18,480 Speaker 4: understanding of the purpose around it, right, And we are 307 00:17:18,560 --> 00:17:21,359 Speaker 4: all for a cost effectiveness. We want that to work. 308 00:17:21,400 --> 00:17:25,840 Speaker 4: We also want to provide care irrespective of someone's religious, political, 309 00:17:25,960 --> 00:17:28,600 Speaker 4: or other beliefs. And yet you know, we have to 310 00:17:28,800 --> 00:17:32,119 Speaker 4: work within a system that we kind of are not 311 00:17:32,280 --> 00:17:35,879 Speaker 4: really understanding how they're approaching this issue. Are they are 312 00:17:35,880 --> 00:17:37,960 Speaker 4: they with us or against us or somewhere in between. 313 00:17:38,400 --> 00:17:40,560 Speaker 4: It's it's sort of a it's a moving target, and 314 00:17:40,600 --> 00:17:43,159 Speaker 4: so I think that's what's that's what's kind of sandwiched 315 00:17:43,240 --> 00:17:45,320 Speaker 4: a lot of healthcare professionals and we don't really know 316 00:17:46,080 --> 00:17:49,000 Speaker 4: where to turn for some of the answers that we 317 00:17:49,119 --> 00:17:50,520 Speaker 4: ourselves are looking for. 318 00:17:51,160 --> 00:17:54,080 Speaker 5: I would add also, you know, we're seeing this active 319 00:17:54,119 --> 00:17:58,880 Speaker 5: dismantling of the US healthcare infrastructure, and our friends in 320 00:17:58,960 --> 00:18:02,480 Speaker 5: the academic world in particular, it's a very stressful time 321 00:18:02,480 --> 00:18:05,720 Speaker 5: for them. Who knows if their studies are going to 322 00:18:05,760 --> 00:18:08,120 Speaker 5: go through. Who knows if they're going to get their funding, 323 00:18:08,760 --> 00:18:10,800 Speaker 5: who knows what's going to stay, what's going to go 324 00:18:10,840 --> 00:18:12,399 Speaker 5: in the next couple of years. There's a lot of 325 00:18:12,400 --> 00:18:16,560 Speaker 5: concern over that, obviously, But even in the medical world 326 00:18:16,640 --> 00:18:19,639 Speaker 5: outside of the academic centers, I know a lot of 327 00:18:19,720 --> 00:18:23,280 Speaker 5: doctors right now are concerned and they're concerned about what's 328 00:18:23,320 --> 00:18:27,000 Speaker 5: going to happen to the state of our scientific community 329 00:18:27,040 --> 00:18:31,359 Speaker 5: that helps us with new advancements in medical technology in 330 00:18:31,400 --> 00:18:34,159 Speaker 5: the coming years. And it seems like, as Ventecha was 331 00:18:34,160 --> 00:18:38,720 Speaker 5: alluding to, we're dismantling all our ability to follow to 332 00:18:38,840 --> 00:18:43,879 Speaker 5: study to really closely track infectious disease in a time 333 00:18:44,440 --> 00:18:48,919 Speaker 5: that is exceedingly dangerous across the world, with rising disease, 334 00:18:49,000 --> 00:18:52,840 Speaker 5: tuberculosis in this country, measles in this country, in Uganda, 335 00:18:52,880 --> 00:18:54,080 Speaker 5: there's ebola again. 336 00:18:55,160 --> 00:18:56,679 Speaker 3: There's threats all over the world. 337 00:18:56,680 --> 00:18:58,520 Speaker 5: And this is one of the worst times I could 338 00:18:58,520 --> 00:19:02,919 Speaker 5: think of to be in this moment of austerity, and 339 00:19:02,960 --> 00:19:05,719 Speaker 5: particularly because so much of it seems unclear to us 340 00:19:05,720 --> 00:19:09,119 Speaker 5: why why these things are being done, you know, is 341 00:19:09,600 --> 00:19:12,800 Speaker 5: it all because of this ridiculous gender ideology? Do they 342 00:19:12,840 --> 00:19:14,920 Speaker 5: actually think they're saving money with some of these things. 343 00:19:15,359 --> 00:19:17,680 Speaker 5: It's a very unclear time. And of course there are 344 00:19:17,720 --> 00:19:20,600 Speaker 5: a lot of people in the medical world, doctors included, 345 00:19:20,640 --> 00:19:25,800 Speaker 5: that are conservative or Republican voters. Getting into conversations with 346 00:19:25,840 --> 00:19:28,640 Speaker 5: them about this is sort of a tough thing to 347 00:19:28,680 --> 00:19:33,000 Speaker 5: do because, like Fintesha mentioned, they, like a lot of us, 348 00:19:33,040 --> 00:19:34,600 Speaker 5: want to make sure we're doing this in a cost 349 00:19:34,640 --> 00:19:37,239 Speaker 5: effective manner, something we talk about and we have been 350 00:19:37,280 --> 00:19:40,240 Speaker 5: talking about in medicine for a long time, particularly academic medicine, 351 00:19:40,280 --> 00:19:42,920 Speaker 5: interestingly enough, which is really on the cutting board. It's 352 00:19:42,960 --> 00:19:46,359 Speaker 5: academic medicine that usually talks about, you know, trying to 353 00:19:46,359 --> 00:19:48,720 Speaker 5: be cost effective. What tests are we going to order, 354 00:19:49,000 --> 00:19:50,919 Speaker 5: what labs do we need to get, how we do 355 00:19:50,960 --> 00:19:53,239 Speaker 5: in this in the most cost effective way. These are 356 00:19:53,280 --> 00:19:57,560 Speaker 5: important things that are discussed and across the political spectrum 357 00:19:57,840 --> 00:20:01,560 Speaker 5: in medicine. I think there is some concern even amongst 358 00:20:01,600 --> 00:20:04,800 Speaker 5: some of the more right leaning doctors. But again it's 359 00:20:04,800 --> 00:20:07,600 Speaker 5: hard because they've gone this far down the road, it's 360 00:20:07,640 --> 00:20:10,000 Speaker 5: hard to know, you know, when they're going to pull back. 361 00:20:10,040 --> 00:20:11,879 Speaker 5: What's the line in the stand for them about what 362 00:20:12,000 --> 00:20:13,600 Speaker 5: is maybe too far for this administration. 363 00:20:14,400 --> 00:20:17,679 Speaker 2: Yeah, and certainly like an area where we're seeing that 364 00:20:17,800 --> 00:20:22,440 Speaker 2: right now is in like public health, right, we don't 365 00:20:22,480 --> 00:20:25,560 Speaker 2: really know. Like I'm going to Texas next week where 366 00:20:25,600 --> 00:20:29,320 Speaker 2: there's currently a measles outbreak. Yeah, and the things that 367 00:20:29,359 --> 00:20:31,240 Speaker 2: we didn't think that we might be seeing in this 368 00:20:31,320 --> 00:20:34,360 Speaker 2: country again, we're seeing again. And like, as you say, 369 00:20:34,400 --> 00:20:37,919 Speaker 2: it's coming at a time when like not just funding 370 00:20:38,680 --> 00:20:43,720 Speaker 2: is unstable, but also like the I guess, like the 371 00:20:43,720 --> 00:20:48,199 Speaker 2: basics of science have been somewhat politicized right to a degree, 372 00:20:48,240 --> 00:20:49,919 Speaker 2: and like people, I don't know if that's something you 373 00:20:49,960 --> 00:20:53,159 Speaker 2: see in your practice, but like certainly, like I was 374 00:20:53,160 --> 00:20:55,320 Speaker 2: talking to a doctor friend who said half their clients 375 00:20:55,320 --> 00:20:59,359 Speaker 2: are now like declining vaccinations as I was there to get, 376 00:20:59,640 --> 00:21:02,439 Speaker 2: you know, every disease that I could get. I have 377 00:21:02,440 --> 00:21:04,920 Speaker 2: a lot of travel vaccinations, so I'm always getting new 378 00:21:04,920 --> 00:21:08,920 Speaker 2: and exciting vaccinations. But I'm making up for some of 379 00:21:08,960 --> 00:21:12,040 Speaker 2: the gap, I guess. But it's uh, it's it's a 380 00:21:12,080 --> 00:21:15,280 Speaker 2: really challenging time right from that perspective as well, like 381 00:21:15,359 --> 00:21:16,320 Speaker 2: the culture around it. 382 00:21:16,440 --> 00:21:17,240 Speaker 3: Yeah, that's right. 383 00:21:17,280 --> 00:21:19,600 Speaker 5: I mean even here in the San Francisco Bay area, 384 00:21:20,160 --> 00:21:23,200 Speaker 5: you know, I've seen more vaccine hesitation than I remember 385 00:21:23,240 --> 00:21:24,560 Speaker 5: ever seen before in the past. 386 00:21:24,880 --> 00:21:28,040 Speaker 4: It's sort of a vaccine question because I think some 387 00:21:28,119 --> 00:21:30,840 Speaker 4: of this is, let's be clear, some of this is 388 00:21:30,960 --> 00:21:34,360 Speaker 4: on our messaging, you know, as healthcare professionals. I mean, 389 00:21:34,720 --> 00:21:37,879 Speaker 4: there are more and more articles. In fact, there the 390 00:21:37,960 --> 00:21:40,720 Speaker 4: Wall Street Journal piece a couple of weeks ago that 391 00:21:40,880 --> 00:21:44,199 Speaker 4: was saying how patients you know, are increasingly not trusting 392 00:21:44,240 --> 00:21:47,520 Speaker 4: their doctors, and there are data to say that we 393 00:21:47,520 --> 00:21:50,320 Speaker 4: don't communicate very well. Right, So there is that, and 394 00:21:50,359 --> 00:21:53,320 Speaker 4: that's on us. And you know, another op ed piece 395 00:21:53,359 --> 00:21:55,679 Speaker 4: in the Boston Globe by Ash's Jaw, you know, did 396 00:21:55,720 --> 00:21:58,399 Speaker 4: a mea culpa around some of the things that public 397 00:21:58,440 --> 00:21:59,399 Speaker 4: health we did wrong. 398 00:21:59,520 --> 00:22:00,399 Speaker 3: We got we got it. 399 00:22:00,400 --> 00:22:03,480 Speaker 4: Wrong in COVID where we didn't you know, deal with 400 00:22:03,560 --> 00:22:07,520 Speaker 4: some of the doubts and lack of evidentiary base for 401 00:22:07,680 --> 00:22:11,320 Speaker 4: masking and some of these other things that basically hurt 402 00:22:11,359 --> 00:22:15,119 Speaker 4: us in the end. So there's definitely that. However, you know, 403 00:22:15,440 --> 00:22:20,399 Speaker 4: restoring the trust in healthcare professionals is sort of like 404 00:22:20,440 --> 00:22:23,239 Speaker 4: a basic step to anyone getting their healthcare. I mean, 405 00:22:23,280 --> 00:22:26,440 Speaker 4: I think people still go to their doctors, Most people 406 00:22:26,680 --> 00:22:30,560 Speaker 4: still trust their doctor to some degree, and I think 407 00:22:30,600 --> 00:22:34,960 Speaker 4: that that's at least a bright spot in where we are, 408 00:22:35,080 --> 00:22:39,280 Speaker 4: because when we've lost that, I think we're really in trouble. 409 00:22:39,320 --> 00:22:41,919 Speaker 4: I mean, that's slipping. But I think that there is 410 00:22:42,119 --> 00:22:45,320 Speaker 4: a way to restore that trust. But it starts so 411 00:22:45,400 --> 00:22:47,800 Speaker 4: that it just starts with a conversation. You know, if 412 00:22:47,800 --> 00:22:52,120 Speaker 4: someone has a vaccine hesitancy or they don't understand what's 413 00:22:52,200 --> 00:22:57,000 Speaker 4: going on, that's the opportunity to open the doors to 414 00:22:57,240 --> 00:23:00,680 Speaker 4: a dialogue. And I think maybe that's you know, maybe 415 00:23:00,680 --> 00:23:03,680 Speaker 4: that's the starting point for any of this. We all 416 00:23:03,720 --> 00:23:08,439 Speaker 4: want cost effectiveness, we all want, you know, transparency. We 417 00:23:08,520 --> 00:23:11,080 Speaker 4: also want to have choices that make sense to us. 418 00:23:11,480 --> 00:23:14,800 Speaker 4: But let's not make it an adversarial confrontation. And I 419 00:23:14,800 --> 00:23:17,880 Speaker 4: think that that goes for both sides. I would add, 420 00:23:17,920 --> 00:23:20,800 Speaker 4: though I agree with you on pretty much all of that. 421 00:23:20,800 --> 00:23:22,840 Speaker 4: I agree that we need to have those conversations, you know, 422 00:23:22,840 --> 00:23:25,720 Speaker 4: if they're difficult. We need to be able to look 423 00:23:25,760 --> 00:23:29,320 Speaker 4: back objectively about things that worked and didn't work. But 424 00:23:29,440 --> 00:23:31,480 Speaker 4: a lot of these sort of mia culpas that have 425 00:23:31,520 --> 00:23:35,320 Speaker 4: come out about like you know, this is where we 426 00:23:35,359 --> 00:23:37,920 Speaker 4: went wrong and why we lost trust, if I'm being honest, 427 00:23:37,960 --> 00:23:41,000 Speaker 4: including that one from Ashishyad, has a lot of in 428 00:23:41,040 --> 00:23:43,880 Speaker 4: my opinion pick me energy. A lot of people who 429 00:23:43,880 --> 00:23:48,200 Speaker 4: are trying to appeal to the incoming administration and be like, hey, look, 430 00:23:48,240 --> 00:23:52,280 Speaker 4: I'm cool too. I'm not always about vaccines, and to me, 431 00:23:52,400 --> 00:23:55,399 Speaker 4: that's just as bad too. And I do think we 432 00:23:55,440 --> 00:23:57,239 Speaker 4: need to have an honest conversation, and I do think 433 00:23:57,280 --> 00:23:59,639 Speaker 4: we need to be clear about how we do scigns. 434 00:23:59,680 --> 00:24:02,280 Speaker 4: Something we need to be able to explain, and you're 435 00:24:02,359 --> 00:24:05,800 Speaker 4: absolutely right, which we didn't do very well is Look, 436 00:24:05,840 --> 00:24:08,040 Speaker 4: we are working with information we have at hand. 437 00:24:08,440 --> 00:24:11,520 Speaker 5: We're doing everything we can. This information may change. When 438 00:24:11,520 --> 00:24:14,439 Speaker 5: it changes, our recommendations aren't going to change too. And 439 00:24:14,520 --> 00:24:17,480 Speaker 5: that is tough. That is a tough message to get 440 00:24:17,480 --> 00:24:20,879 Speaker 5: across because people don't like nuance like that. People don't 441 00:24:20,920 --> 00:24:24,120 Speaker 5: like the uncertainty of that. People want to know yes 442 00:24:24,240 --> 00:24:27,119 Speaker 5: or no absolutely, and sometimes it's hard. It's hard to 443 00:24:27,200 --> 00:24:30,639 Speaker 5: find good communicators and science to do that. But that 444 00:24:30,680 --> 00:24:34,400 Speaker 5: you're exactly right is incumbent upon us as doctors who 445 00:24:34,440 --> 00:24:37,760 Speaker 5: have a sub stack like yours, of a podcast like mine, 446 00:24:38,119 --> 00:24:42,639 Speaker 5: who are academics who have a reach to students and 447 00:24:42,680 --> 00:24:46,480 Speaker 5: beyond to communicate these things. And even though it would 448 00:24:46,520 --> 00:24:51,000 Speaker 5: be awesome if for the next four years my podcast 449 00:24:51,119 --> 00:24:54,720 Speaker 5: was just about farts and poop. I know I have 450 00:24:54,800 --> 00:24:57,119 Speaker 5: to do a lot of this stuff because I know 451 00:24:57,160 --> 00:25:00,399 Speaker 5: how important this is now more than ever. So I 452 00:25:00,440 --> 00:25:03,680 Speaker 5: totally agree it's going to start with conversations. 453 00:25:04,080 --> 00:25:07,199 Speaker 2: I think there's a big difference between this is the 454 00:25:07,200 --> 00:25:09,040 Speaker 2: information we have available and we're doing our best with it. 455 00:25:09,080 --> 00:25:11,320 Speaker 2: When we get new information, we'll do something different if 456 00:25:11,840 --> 00:25:14,760 Speaker 2: that's what that information points to. And these people are 457 00:25:14,760 --> 00:25:17,719 Speaker 2: acting out of malice to deprive you of your rights 458 00:25:17,800 --> 00:25:21,080 Speaker 2: or you know, to which is sometimes what's been suggested 459 00:25:21,119 --> 00:25:23,520 Speaker 2: by some people, and like, I think a good way 460 00:25:23,560 --> 00:25:26,080 Speaker 2: to defeat that, as you say, it's communicating around it. 461 00:25:26,080 --> 00:25:28,879 Speaker 2: It is very sad that, Like when I was doing 462 00:25:28,920 --> 00:25:32,960 Speaker 2: the research for my PhD dissertation, I wrote about first 463 00:25:32,960 --> 00:25:35,240 Speaker 2: I wrote about violence and the Anarchist Builders Union for 464 00:25:35,280 --> 00:25:38,080 Speaker 2: my masters and then I wrote about public health and 465 00:25:38,119 --> 00:25:40,960 Speaker 2: popular sport in the nineteen thirties in Barcelona, and a 466 00:25:41,040 --> 00:25:43,960 Speaker 2: lot of what you saw anarchists doing in Barcelona in 467 00:25:43,960 --> 00:25:47,360 Speaker 2: the nineteen thirties was talking to people about tuberculosis, educating 468 00:25:47,400 --> 00:25:51,680 Speaker 2: people about tuberculosis and explaining what tuberculosis was and where 469 00:25:51,680 --> 00:25:55,560 Speaker 2: it came from. And like that was in nineteen thirty 470 00:25:55,640 --> 00:25:57,440 Speaker 2: one and how. 471 00:25:57,280 --> 00:25:59,600 Speaker 3: Far we've come baby, wow. 472 00:25:59,520 --> 00:26:02,679 Speaker 2: Wow, Yeah, it's great. There were some other things from 473 00:26:02,720 --> 00:26:05,159 Speaker 2: the nineteen thirties which have also made an unwelcome return. 474 00:26:05,480 --> 00:26:08,560 Speaker 2: Juberculosis is not the only one. There's also the Nazi 475 00:26:08,600 --> 00:26:14,639 Speaker 2: salute in large public gatherings in the United States, which, yeah, 476 00:26:14,840 --> 00:26:16,440 Speaker 2: I don't know, and I guess i'd answer for them 477 00:26:16,440 --> 00:26:18,480 Speaker 2: both in the nineteen thirties, and they're the same answers 478 00:26:18,560 --> 00:26:33,119 Speaker 2: that apply now. I think people like people will be 479 00:26:33,240 --> 00:26:35,840 Speaker 2: distressed by this, right, like a lot of people of 480 00:26:35,960 --> 00:26:38,640 Speaker 2: my age and younger I guess folks a bit younger 481 00:26:38,640 --> 00:26:41,679 Speaker 2: than me for the larger part, like the pandemic was 482 00:26:41,720 --> 00:26:45,040 Speaker 2: a life defining event for a lot of younger folks, right, 483 00:26:45,119 --> 00:26:47,520 Speaker 2: and it was a scary thing. It still is a 484 00:26:47,560 --> 00:26:50,720 Speaker 2: scary thing, Like getting COVID still really sucks. And I 485 00:26:50,760 --> 00:26:53,080 Speaker 2: know people who have long COVID and the thought of 486 00:26:53,119 --> 00:26:57,480 Speaker 2: that is petrifying to me. People will be genuinely anxious 487 00:26:57,560 --> 00:27:02,000 Speaker 2: now right at this potential dismantling of public health apparatus, 488 00:27:02,040 --> 00:27:07,200 Speaker 2: like a rise in vaccine hesitancy, less funding for research, 489 00:27:07,400 --> 00:27:11,119 Speaker 2: such that if we enter another pandemic with some novel 490 00:27:11,200 --> 00:27:14,479 Speaker 2: infectious disease, we won't be able to respond as fast. Right, 491 00:27:14,720 --> 00:27:17,439 Speaker 2: the response to COVID for the criticisms of it, like 492 00:27:17,480 --> 00:27:20,320 Speaker 2: the speed with which we had vaccines was amazing. Some 493 00:27:20,400 --> 00:27:23,600 Speaker 2: of that came from like Vancousha's college at UCSD actually, 494 00:27:23,920 --> 00:27:26,480 Speaker 2: or right like salt I guess which is next door 495 00:27:27,200 --> 00:27:31,920 Speaker 2: with free parking, which is nice? So like, what would 496 00:27:31,920 --> 00:27:33,560 Speaker 2: you say to people because this is a thing I 497 00:27:33,600 --> 00:27:35,760 Speaker 2: see more and more among folks who you know, who 498 00:27:35,760 --> 00:27:38,479 Speaker 2: are friends of mine, right, is like real worry about 499 00:27:38,600 --> 00:27:44,399 Speaker 2: infectious disease, real concern about new variants of COVID or 500 00:27:44,600 --> 00:27:47,879 Speaker 2: about you know, the bird flu is one, right with 501 00:27:48,000 --> 00:27:50,640 Speaker 2: these other infectious diseases. I saw fifty people have died 502 00:27:50,680 --> 00:27:54,600 Speaker 2: of it as yet unexplained disease in Congo recently. What 503 00:27:54,600 --> 00:27:57,240 Speaker 2: would you say to those people? Because there concerns are 504 00:27:57,240 --> 00:27:59,760 Speaker 2: somewhat legitimate, right, Like, if we go into another pandemic, 505 00:27:59,760 --> 00:28:03,240 Speaker 2: when going to be anywhere near as effective as we 506 00:28:03,240 --> 00:28:06,399 Speaker 2: were in twenty twenty because of all these combination of 507 00:28:06,440 --> 00:28:07,160 Speaker 2: reasons we've. 508 00:28:06,960 --> 00:28:09,800 Speaker 4: Discussed, that's a hard question to answer. I would say, 509 00:28:10,040 --> 00:28:12,479 Speaker 4: let me back up. You know I think that the 510 00:28:12,480 --> 00:28:15,760 Speaker 4: COVID pandemic, Yes, there are a lot of things that 511 00:28:15,800 --> 00:28:19,439 Speaker 4: went well. The vaccine development was phenomenal, I mean a revolutionary. 512 00:28:19,440 --> 00:28:22,520 Speaker 4: I mean, who would have expected that to happen. However, 513 00:28:22,760 --> 00:28:26,560 Speaker 4: it also just revealed how shattered our public health system 514 00:28:26,600 --> 00:28:31,480 Speaker 4: really is in terms of messaging, even detection, spreading information. 515 00:28:31,560 --> 00:28:37,639 Speaker 4: Even the vaccine distribution was completely chaotic. Right, So, so 516 00:28:38,000 --> 00:28:40,400 Speaker 4: I don't want to say that, you know, the public 517 00:28:40,400 --> 00:28:42,920 Speaker 4: health response during COVID was some sort of paragon to 518 00:28:42,960 --> 00:28:47,600 Speaker 4: be emulated or replicated, right So that said, though, absolutely, 519 00:28:47,680 --> 00:28:50,240 Speaker 4: I mean, you know, how are we going to handle 520 00:28:51,200 --> 00:28:54,800 Speaker 4: a new era of this what if you know scenario 521 00:28:54,880 --> 00:28:57,280 Speaker 4: where we don't know what virus is coming next? I mean, 522 00:28:57,320 --> 00:29:00,320 Speaker 4: I'm seeing these days, I'm even seeing virus is that 523 00:29:00,480 --> 00:29:03,760 Speaker 4: never caused the kind of respiratory failure in the past, 524 00:29:04,000 --> 00:29:06,400 Speaker 4: they're doing it now, whether it's RSV or a respiratory 525 00:29:06,440 --> 00:29:11,040 Speaker 4: sensitial virus or even non COVID coronavirus which should just 526 00:29:11,040 --> 00:29:14,560 Speaker 4: give you a cold the sniffles, and yet it's causing devastating, 527 00:29:14,960 --> 00:29:17,600 Speaker 4: you know, pneumonias. So we're in a new era and 528 00:29:17,720 --> 00:29:22,600 Speaker 4: you know, antibiotic resistance is not getting any less you know, problematic. 529 00:29:22,920 --> 00:29:25,400 Speaker 4: So what do we do in this era. Well, I 530 00:29:25,440 --> 00:29:30,040 Speaker 4: think awareness is the first thing, okay, awareness around. Yes, 531 00:29:30,160 --> 00:29:33,480 Speaker 4: I mean these diseases are transmitted from person to person. 532 00:29:33,920 --> 00:29:37,320 Speaker 4: You know, we all know somebody who doesn't want to 533 00:29:37,320 --> 00:29:39,720 Speaker 4: take a vaccine. I mean, I don't think there's that's 534 00:29:39,720 --> 00:29:42,520 Speaker 4: a surprise to say we know of somebody or directly 535 00:29:42,680 --> 00:29:46,040 Speaker 4: or maybe one degree of separation, right, And I think 536 00:29:46,200 --> 00:29:48,720 Speaker 4: you need to have those community conversations. You need to 537 00:29:48,760 --> 00:29:51,240 Speaker 4: have one on one conversations. Yes, it's going to be uncomfortable, 538 00:29:51,240 --> 00:29:54,200 Speaker 4: but we got to talk about it and talk to 539 00:29:54,240 --> 00:29:57,200 Speaker 4: your healthcare provider about it. I mean, yes, you can 540 00:29:57,240 --> 00:29:59,280 Speaker 4: look up stuff on TikTok. Yes, you could look up 541 00:29:59,320 --> 00:30:03,400 Speaker 4: stuff on Google or or you name your online resource. 542 00:30:03,960 --> 00:30:07,640 Speaker 4: But you want to have a person that can actually 543 00:30:07,720 --> 00:30:12,680 Speaker 4: understand from years of living and living and breathing this stuff, 544 00:30:13,200 --> 00:30:15,760 Speaker 4: and also who listens to you as a human being 545 00:30:16,160 --> 00:30:20,040 Speaker 4: in the same community or somewhere nearabouts right to put 546 00:30:20,080 --> 00:30:23,360 Speaker 4: together what the science says in some sort of meaningful 547 00:30:23,520 --> 00:30:27,480 Speaker 4: way to you, uh, and not some anonymous you know 548 00:30:27,880 --> 00:30:31,280 Speaker 4: resource that may or may not have all the you know, 549 00:30:31,400 --> 00:30:34,120 Speaker 4: all the data their fingertips, you know. So so I 550 00:30:34,200 --> 00:30:37,480 Speaker 4: guess it still goes back to how does anyone find 551 00:30:37,600 --> 00:30:41,440 Speaker 4: reliable information? Where do you go when you've got questions? 552 00:30:41,560 --> 00:30:44,920 Speaker 4: Most people want a human being who's lived and breathed 553 00:30:45,440 --> 00:30:48,840 Speaker 4: this with experience to help them navigate. I I certainly 554 00:30:48,920 --> 00:30:51,120 Speaker 4: see that, not just as a doctor, but as a friend, 555 00:30:51,760 --> 00:30:55,480 Speaker 4: as a family member. I'm constantly you know, they're asking 556 00:30:55,520 --> 00:30:57,880 Speaker 4: me these things, and I would suggest that you know 557 00:30:57,960 --> 00:31:03,560 Speaker 4: your audience may have both personally but also professionally to 558 00:31:03,680 --> 00:31:05,320 Speaker 4: those folks that can help them navigate. 559 00:31:05,840 --> 00:31:08,040 Speaker 5: You know, and to answer your question from my perspective, 560 00:31:08,120 --> 00:31:11,800 Speaker 5: is a challenge. I because I think people should be concerned. 561 00:31:12,280 --> 00:31:14,520 Speaker 3: In fact, I just did two parter. 562 00:31:14,480 --> 00:31:18,360 Speaker 5: With one of the world's best virologists talking about the 563 00:31:19,040 --> 00:31:22,479 Speaker 5: possible bird flu pandemic that could arise and all the 564 00:31:22,520 --> 00:31:25,360 Speaker 5: threats that are out there, and so I do think 565 00:31:25,400 --> 00:31:29,640 Speaker 5: there are some really significant, serious risks to be worried about. However, 566 00:31:29,960 --> 00:31:32,120 Speaker 5: I'm never gonna say there's nothing that can be done 567 00:31:32,120 --> 00:31:34,480 Speaker 5: about it. There's plenty that can still be done about it. 568 00:31:34,960 --> 00:31:37,760 Speaker 5: I still maintain hope in the medical community for what 569 00:31:37,760 --> 00:31:40,320 Speaker 5: we're able to do and what we're able to accomplish. 570 00:31:40,360 --> 00:31:42,680 Speaker 5: And to echo what I think both of you guys 571 00:31:42,800 --> 00:31:44,440 Speaker 5: have said or would at least agree with. 572 00:31:44,880 --> 00:31:46,920 Speaker 3: There's a lot of changes that we can make locally 573 00:31:47,320 --> 00:31:48,720 Speaker 3: amongst our small. 574 00:31:48,520 --> 00:31:51,200 Speaker 5: Sphere of influence, and then growing out from there in 575 00:31:51,280 --> 00:31:55,960 Speaker 5: terms of getting vaccinated, in terms of wearing masks when needed, 576 00:31:56,040 --> 00:31:57,760 Speaker 5: or at least looking at the data with an open 577 00:31:57,800 --> 00:32:02,200 Speaker 5: mind and sharing good resources. Is because one thing that 578 00:32:02,360 --> 00:32:05,840 Speaker 5: the younger population is good about, and what some of 579 00:32:05,840 --> 00:32:10,120 Speaker 5: the people you're mentioning, James, is they're good at detecting 580 00:32:10,240 --> 00:32:13,720 Speaker 5: bullshit online and that's a skill that needs to be 581 00:32:13,920 --> 00:32:18,960 Speaker 5: honed for medical literacy as well, and I'm hopeful that 582 00:32:18,960 --> 00:32:23,040 Speaker 5: that's going to continue to improve. Maybe stupid optimism, but 583 00:32:23,080 --> 00:32:25,320 Speaker 5: I do believe the younger generation is going to continue 584 00:32:25,360 --> 00:32:28,040 Speaker 5: to be better at that than the older generation, and 585 00:32:28,280 --> 00:32:30,080 Speaker 5: I think that will help battle a lot of the 586 00:32:30,080 --> 00:32:32,840 Speaker 5: misinformation that's out there. But there are things that they 587 00:32:32,840 --> 00:32:35,240 Speaker 5: can do in fact, for getting back to the telehealth thing, 588 00:32:35,680 --> 00:32:40,280 Speaker 5: for example, talking about telemedicine slash telehealth as venteche sort 589 00:32:40,280 --> 00:32:43,239 Speaker 5: of broke down in terms of it being cut at 590 00:32:43,240 --> 00:32:45,320 Speaker 5: the end of the month. There are people that are 591 00:32:45,320 --> 00:32:50,320 Speaker 5: really pushing against that, including Rocanna, who's here a legislator 592 00:32:50,400 --> 00:32:53,760 Speaker 5: here in California who's proposed a new bill. I haven't 593 00:32:53,760 --> 00:32:55,440 Speaker 5: been able to see any of the details of it, 594 00:32:55,720 --> 00:32:58,560 Speaker 5: but there are a lot, including Amazon. By the way, 595 00:32:58,600 --> 00:33:01,160 Speaker 5: Amazon is one of like three hundred and fifty companies 596 00:33:01,600 --> 00:33:06,520 Speaker 5: that have written a letter to Congress to help push 597 00:33:06,760 --> 00:33:10,960 Speaker 5: for this funding. So if you can call a congress person, 598 00:33:11,000 --> 00:33:13,400 Speaker 5: if you can do that, if you can keep bothering 599 00:33:13,440 --> 00:33:16,480 Speaker 5: them telling them how important it is, I think those 600 00:33:16,480 --> 00:33:18,320 Speaker 5: are things that can help. So I think that's a 601 00:33:18,320 --> 00:33:19,680 Speaker 5: good place to start. 602 00:33:20,920 --> 00:33:22,480 Speaker 2: Yeah, that's a really get piece of advice. 603 00:33:22,720 --> 00:33:25,040 Speaker 4: If I could just follow up with that. I think 604 00:33:25,120 --> 00:33:28,800 Speaker 4: part of what will help with the support for some 605 00:33:28,840 --> 00:33:31,920 Speaker 4: of these programs is to take you know, take us 606 00:33:32,040 --> 00:33:34,720 Speaker 4: take a few minutes to think about what the other 607 00:33:34,840 --> 00:33:37,160 Speaker 4: side is worried about, right. I mean, we all know 608 00:33:37,280 --> 00:33:42,760 Speaker 4: about the excesses of certain online bad actors, who are 609 00:33:43,440 --> 00:33:48,440 Speaker 4: they use telemedicine to promote you know, ADHD medications or 610 00:33:48,480 --> 00:33:53,160 Speaker 4: other types of psychotropic medications, which was not it was 611 00:33:53,200 --> 00:33:56,080 Speaker 4: not supported, and it actually caused harm. Right, So so 612 00:33:56,480 --> 00:34:01,200 Speaker 4: there are things out there that are excesses and somewhat harmful, 613 00:34:01,680 --> 00:34:04,600 Speaker 4: and if we could as a community sort of help 614 00:34:05,040 --> 00:34:08,600 Speaker 4: frame the approach to dealing with some of those things 615 00:34:08,680 --> 00:34:11,840 Speaker 4: and preventing some of those problems, then I think some 616 00:34:12,000 --> 00:34:15,600 Speaker 4: of the support will kind of sort of show itself. 617 00:34:15,640 --> 00:34:17,440 Speaker 4: I think the worry is if you open up the 618 00:34:17,480 --> 00:34:21,000 Speaker 4: floodgates too wide, you know, human nature being what it is, 619 00:34:21,000 --> 00:34:24,319 Speaker 4: it's going to encourage bad behavior. Not that anybody wants that, 620 00:34:24,440 --> 00:34:27,360 Speaker 4: but there is something to be said about some scrutiny. 621 00:34:27,440 --> 00:34:28,680 Speaker 3: Right, So if. 622 00:34:28,560 --> 00:34:31,480 Speaker 4: We're the ones, and I completely support the use of 623 00:34:31,520 --> 00:34:35,000 Speaker 4: TELL medicine, but I also want to be careful about 624 00:34:35,200 --> 00:34:39,200 Speaker 4: how to promote its thoughtful and safe use and wed 625 00:34:39,320 --> 00:34:41,640 Speaker 4: that in the proposal and not just leave it for 626 00:34:41,680 --> 00:34:44,879 Speaker 4: others to figure out that That I think would potentially 627 00:34:45,640 --> 00:34:49,520 Speaker 4: change the conversation around while you just want this and 628 00:34:49,600 --> 00:34:50,840 Speaker 4: we're not going to give it to you, like the 629 00:34:50,880 --> 00:34:53,880 Speaker 4: standoff will will subside when you try to work it, 630 00:34:54,000 --> 00:34:56,600 Speaker 4: work a partnership out as opposed to a give it 631 00:34:56,600 --> 00:34:58,880 Speaker 4: to me or else kind a scenario. 632 00:34:59,000 --> 00:35:01,120 Speaker 5: I don't disagree with that, but I also think you're 633 00:35:01,120 --> 00:35:06,080 Speaker 5: giving those more credit than I would, which is to 634 00:35:06,120 --> 00:35:08,920 Speaker 5: say that they actually really, they really would focus or 635 00:35:08,920 --> 00:35:11,600 Speaker 5: listen to. I think what they've just done is literally, 636 00:35:12,040 --> 00:35:16,480 Speaker 5: you know, take a chainsaw and cut away at major 637 00:35:16,800 --> 00:35:20,160 Speaker 5: federal funding and then kind of seeing what was really 638 00:35:20,200 --> 00:35:23,120 Speaker 5: bad about that and what wasn't and being like, oh, okay, 639 00:35:23,320 --> 00:35:26,080 Speaker 5: maybe we do need people in charge of nuclear security. 640 00:35:26,320 --> 00:35:28,799 Speaker 3: Oh maybe this is popular. We'll put it back. You know. 641 00:35:28,880 --> 00:35:30,799 Speaker 3: I kind of think that. 642 00:35:30,719 --> 00:35:33,600 Speaker 5: They're not taking as much attention or care, But I 643 00:35:33,920 --> 00:35:36,319 Speaker 5: also do agree that the point is is valid. I mean, 644 00:35:36,360 --> 00:35:39,880 Speaker 5: sure there is there fraud in some telemedicine. Yeah, I'm sure, 645 00:35:40,239 --> 00:35:43,560 Speaker 5: probably small, very small percentage. But if we can specify 646 00:35:43,600 --> 00:35:47,160 Speaker 5: its use, if we can be better about that, I agree, 647 00:35:47,400 --> 00:35:48,160 Speaker 5: I'm all for it. 648 00:35:48,600 --> 00:35:51,120 Speaker 2: Yeah, especially right now. I was just thinking, as you're 649 00:35:51,160 --> 00:35:54,120 Speaker 2: talking about, like how important is people that accessing reproductive 650 00:35:54,120 --> 00:35:57,520 Speaker 2: healthcare and being able to access reproductive healthcare wherever they are, 651 00:35:57,640 --> 00:36:02,160 Speaker 2: and like how much more difficult that would be, right 652 00:36:02,160 --> 00:36:04,319 Speaker 2: if people didn't have telemedicine appointments. So I think we've 653 00:36:04,360 --> 00:36:06,960 Speaker 2: spoken about before on this show. But yeah, I'm sure 654 00:36:06,960 --> 00:36:08,480 Speaker 2: there are some school cases. I'm sure there are a 655 00:36:08,480 --> 00:36:12,640 Speaker 2: bunch of sis gender guys getting gender affirming hormonal care 656 00:36:12,960 --> 00:36:18,240 Speaker 2: through telemedicine who probably could go without and be Okay, guys, 657 00:36:18,239 --> 00:36:21,360 Speaker 2: I'd like to wrap up there, but I want to 658 00:36:21,360 --> 00:36:23,239 Speaker 2: give you a chance both to you talked a lot 659 00:36:23,280 --> 00:36:27,240 Speaker 2: about like science communication. So where can people find you online? 660 00:36:27,280 --> 00:36:30,200 Speaker 2: Where can they see you communicating your medical knowledge? 661 00:36:30,360 --> 00:36:33,880 Speaker 4: Okay, well, so I thanks James. I have a substack 662 00:36:33,960 --> 00:36:36,799 Speaker 4: it's called be a Health Architect. You can book me 663 00:36:36,880 --> 00:36:39,759 Speaker 4: up at be a Health Architect, and you know, I 664 00:36:39,800 --> 00:36:43,640 Speaker 4: have a conversation there around an issue that certainly affects 665 00:36:43,680 --> 00:36:46,000 Speaker 4: me and those around me, which is physician burnout. But 666 00:36:46,480 --> 00:36:49,160 Speaker 4: in the larger sphere of healthcare professionals, it really touches 667 00:36:49,200 --> 00:36:54,319 Speaker 4: everybody in healthcare. So that's where I'm posting actively. I'm 668 00:36:54,360 --> 00:36:58,319 Speaker 4: also sharing that, you know, through various other avenues such 669 00:36:58,360 --> 00:37:01,600 Speaker 4: as X and Blue Sky and other places, so you 670 00:37:01,400 --> 00:37:04,920 Speaker 4: can you can find me there. Look forward to seeing 671 00:37:04,920 --> 00:37:05,279 Speaker 4: you there. 672 00:37:05,680 --> 00:37:05,879 Speaker 3: Yeah. 673 00:37:05,880 --> 00:37:09,400 Speaker 5: I would also recommend Vintechha's substack. If you're in the 674 00:37:09,400 --> 00:37:13,560 Speaker 5: medical field in particular, I think you'll appreciate it. A 675 00:37:13,600 --> 00:37:17,719 Speaker 5: focus on burnout is as important as it's ever been, 676 00:37:17,800 --> 00:37:20,160 Speaker 5: if not much much more. I mean, we were talking 677 00:37:20,160 --> 00:37:24,879 Speaker 5: about burnout moral injury in doctors before COVID, and now 678 00:37:25,320 --> 00:37:27,200 Speaker 5: you know, down a couple of years down the road, 679 00:37:27,239 --> 00:37:29,279 Speaker 5: it's only worse. So I think it's really important and 680 00:37:29,320 --> 00:37:31,799 Speaker 5: I do recommend it, or you know, check out his 681 00:37:31,960 --> 00:37:35,240 Speaker 5: latest article in the Los Angeles Times. As you mentioned before. 682 00:37:35,600 --> 00:37:38,960 Speaker 5: As for me, find me on Blue Sky at Cave MD. 683 00:37:39,120 --> 00:37:42,279 Speaker 5: But more importantly, just listen to the podcast The House 684 00:37:42,320 --> 00:37:45,040 Speaker 5: of Pod. If you are a fan of this show, 685 00:37:45,120 --> 00:37:47,400 Speaker 5: I think you're gonna like The House of Pod if 686 00:37:47,400 --> 00:37:49,040 Speaker 5: you haven't already given it a try. 687 00:37:49,440 --> 00:37:51,839 Speaker 3: It's a lot of the same people that you hear 688 00:37:51,880 --> 00:37:53,719 Speaker 3: on this show. On the House of Pod. 689 00:37:54,080 --> 00:37:56,680 Speaker 5: James included he's gonna be coming back to talk about 690 00:37:56,719 --> 00:37:59,480 Speaker 5: the measles and with an author of a new book 691 00:37:59,520 --> 00:38:03,600 Speaker 5: down there about the measles outbreak. And you know, we 692 00:38:03,640 --> 00:38:06,600 Speaker 5: take a look at grifters, medical grifters, We take a 693 00:38:06,640 --> 00:38:10,200 Speaker 5: look at some people that would be considered medical contrarians. 694 00:38:10,600 --> 00:38:13,440 Speaker 5: We take a look at some of the quackery and 695 00:38:13,520 --> 00:38:17,680 Speaker 5: medicine as well. So I think you'll appreciate this show. 696 00:38:17,719 --> 00:38:20,799 Speaker 5: If you like the whole behind the Bastards verse, I 697 00:38:20,840 --> 00:38:23,120 Speaker 5: think you'll get into the House of Podso so check 698 00:38:23,200 --> 00:38:25,480 Speaker 5: us out wherever you get your podcasts. 699 00:38:25,680 --> 00:38:27,799 Speaker 2: Yeah, great, Thank you so much for joining us. Guys 700 00:38:27,800 --> 00:38:28,520 Speaker 2: really appreciate it. 701 00:38:28,520 --> 00:38:29,279 Speaker 3: Thanks, thank you. 702 00:38:32,280 --> 00:38:34,800 Speaker 1: It could happen here is a production of cool Zone Media. 703 00:38:34,960 --> 00:38:38,040 Speaker 1: For more podcasts from Cool Zone Media. Visit our website 704 00:38:38,120 --> 00:38:41,680 Speaker 1: coolzonmedia dot com, or check us out on the iHeartRadio app, 705 00:38:41,760 --> 00:38:45,319 Speaker 1: Apple podcasts, or wherever you listen to podcasts. You can 706 00:38:45,360 --> 00:38:47,680 Speaker 1: now find sources for it could happen here listened directly 707 00:38:47,719 --> 00:38:50,000 Speaker 1: in episode descriptions. Thanks for listening.