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25. Adam Cifu, MD: On Ending Medical Reversals and Reimagining Medical Education

Adam Cifu

In this conversation, Daniel Belkin and Mitch Belkin speak with Adam Cifu, MD, about how to improve medical education, the importance of evidence-based medicine, and medical reversals. We discuss his collaboration with Vinay Prasad, MD, why we should swap the order of medical school curricula, and landmark trials that changed his clinical practice.

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Who is Adam Cifu?

Adam Cifu a general internist and professor of medicine at the University of Chicago. He is a clinical educator, a podcast host, and the author of over 100-peer reviewed articles as well as two books: Ending Medical Reversal: Improving Outcomes, Saving Lives (2015) and Symptom to Diagnosis: An Evidence Based Guide (4th Edition, 2019).

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Podcast

24. Sekar Kathiresan, MD: Pioneering Single Dose Medications to Cure Cardiovascular Disease

Sekar Kathiresan

In this conversation, Daniel Belkin and Mitch Belkin speak with Sekar Kathiresan, MD, about using gene editing medications to treat cardiovascular disease. We discuss Dr. Kathiresan’s company Verve Therapeutics, which has pioneered a lipid nanoparticle delivery system of a CRISPR-based gene editing technology. We delve into the pathophysiology of cardiovascular disease, the role played by LDL and the LDL receptor in atherosclerosis, the genetics underlying monogenic and polygenic risk for myocardial infarction, CRISPR and the future of gene editing technologies, and Verve’s ongoing phase I trial of a PCSK9 gene editing medication (VERVE-101) in humans.

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Who is Sekar Kathiresan?

Dr. Sekar Kathiresan, a cardiologist, geneticist, and the CEO and co-founder of Verve Therapeutics. Verve Therapeutics is a company pioneering a new approach to the treatment of cardiovascular disease with single-dose gene editing medications. Prior to co-founding Verve, he served as the director of the Massachusetts General Hospital Center for Genomic Medicine and was a Professor of Medicine at Harvard Medical School. 

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23. Joel Topf, MD: Acute Kidney Injury, Contrast-Associated Nephropathy, and Precious Bodily Fluids

Joel Topf

In this conversation, Daniel Belkin and Mitch Belkin speak with Joel Topf, MD, about contrast-associated nephropathy. We discuss Acute Kidney Injury (AKI), the value of creatinine as a marker for AKI, how to evaluate volume status, the evidence around contrast-induced/contrast-associated nephropathy, recommendations on fluids to prevent AKI in patients with Chronic Kidney Disease, and comparing venous and arterial contrast with respect to the risk of AKI.

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Who is Joel Topf?

Dr. Topf is a clinical nephrologist in Detroit, who is a partner and medical director at St Clair Nephrology and an assistant professor at Oakland University William Beaumont School of Medicine. He is the co-creator of NephMadness and NephJC. He hosts multiple podcasts, blogs at pbfluids.com, and tweets @Kidney_boy. 

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22. John Cochrane, PhD: The Economics of Affordable Healthcare

John Cochrane

In this conversation, Daniel Belkin and Mitch Belkin speak with Professor John Cochrane about the economics of the American healthcare system. We discuss the lack of clarity around US healthcare pricing, as well as how employer-sponsored health insurance and the persistence of massive cross subsidies contribute to dysfunction in the US healthcare market. Professor Cochrane argues that the best way to solve these problems is to simplify regulation and remove regulatory hurdles which prevent innovative entrants from improving healthcare and making it more affordable.

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Who is John Cochrane?

Professor John Cochrane is an economist specializing in finance and macroeconomics. Formerly a professor at the University of Chicago, Cochrane is now the Rose-Marie and Jack Anderson Senior Fellow at the Hoover Institution at Stanford University. He blogs regularly as The Grumpy Economist at https://johnhcochrane.blogspot.com/.

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21. Christy Chapin, PhD: Bad Incentives, the AMA, and How US Healthcare Became Dysfunctional

Christy-Chapin

In this conversation, Daniel Belkin and  Mitch Belkin speak with Professor Christy Chapin, who is an Associate Professor of History at University of Maryland Baltimore County. We discuss how the American insurance company-based model of healthcare developed in the first half of the 20th century. Specifically, we explore the role of some of the major actors who created the fragmentary and expensive US healthcare landscape: the American Medical Association (AMA), Blue Cross and Blue Shield, as well as private insurance companies.

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In this episode, Professor Chapin defines what she terms the “insurance company model” of healthcare. We explore various competing models at the turn of the 20th century, including prepaid physician groups, which were an early multi-specialty group practice. (This model of healthcare delivery, which Professor Chapin argues, could have become the dominant model of US healthcare, was effectively banned by the American Medical Association in 1938).

We discuss the organizational history of the AMA, its rise to prominence, and how it influenced the development of American healthcare. While the AMA attempted to maintain physician autonomy in the 1920s, concerns of government involvement prompted a 1938 deal with insurance companies that produced our current model of 3rd party financed healthcare. By insisting on a fee-for-service payment structure, this led to vast increases in the cost of care. Overtime, increasing insurance company regulation and government involvement (Medicare, the ACA, etc.) have attempted to reduce costs with limited success.

Professor Chapin argues that the US healthcare system is not a free market. Rather, it is a product of warped incentives brought about by historical negotiations between insurance companies, hospitals, government agencies, and special interest groups. Cost containment measures instituted by insurance companies to reduce costs have led insurers to effectively control the practice of medicine.

Who is Christy Chapin?

In addition to being an Associate Professor of History at UMBC, Professor Chapin is a visiting scholar at Johns Hopkins. Her professional interests include 20th century U.S. political, business, and economic history. She’s also the author of Ensuring America’s Health: The Public Creation of the Corporate Health Care System, which was published in 2015.

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