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2 Docs Talk: Medicine | Health | Healthcare Policy | Evidence Based Medicine

Welcome to 2 Docs Talk, the podcast about healthcare, the science of medicine and everything in between. Join cohosts Kendall Britt, MD and Amy Rogers, MD for a 15 minute check-up on current issues in medicine and health policy. The doctor is always in.
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2 Docs Talk: Medicine | Health | Healthcare Policy | Evidence Based Medicine
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Now displaying: Category: healthcare policy
Aug 28, 2017

Medicaid is the subject of a lot of talk in today's political environment. Sadly much of what is said isn't based in fact, or it focuses on parts of the program that represent a tiny portion of its cost. 

Today, 2 Docs Talk about Medicaid, who it serves, and how it was affected (or, rather, supposed to be affected) by the Affordable Care Act.

Aug 7, 2017

If you've had many conversations about healthcare reform, it is likely you've heard some variation on this theme: 

"Hospitals have to provide care for people who show up. So everyone can get healthcare when they need it. So when people say that can't get healthcare, that isn't true."

Is there any merit to that argument? Spoiler: NO. But if you want to hear more about where that idea comes from, take a listen. 

Resources:

https://www.cms.gov/Regulations-and-Guidance/Legislation/EMTALA/

http://www.kff.org/medicaid/state-indicator/medicaid-income-eligibility-limits-for-parents/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

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Apr 3, 2017

Kendall and Amy are in agreement that hospice care is an important, compassionate aspect of healthcare that humanizes what can be a very clinical, impersonal process. We've both experience with hospice - personally and professionally. 

Sadly, like most aspects of healthcare, the potential for profit has introduced some ugly practices into what should be focused solely on the needs of dying patients and their families.

Today, Kendall and Amy talk about the good and the bad of hospice as it exists in 2017.

Resources:

 

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Mar 27, 2017

Ever since Sarah Palin famously accused Obamacare of promoting death panels, the idea remains a fixture for some politicians to fall back on to impugn the healhcare law. 

But were death panels ever a part of the original healthcare law? And more importantly, how should patients and their physicians be approaching the topic of death, if at all?

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Mar 20, 2017

In this follow up episode to last week, we dig in to how the American Healthcare Act, aka Trumpcare, will affect Medicaid, and who will benefit from all the tax breaks. 

We recorded this episode before the Congressional Budget Office came out with their evaluation of the plan. We weren't too far off, if anything we may have been generous with Trumpcare. We've linked the CBO report in the resources below in case you want to check it out for yourself.

Also, I mistakenly credited the Vox article to Ezra Klein, but it was Sarah Kliff who wrote the excellent summary of the AHCA. It's also linked below.

Resources:

Health Affairs Blog on AHCA

Kaiser’s side-by-side comparison of Obamacare and AHCA

Obamacare Essential Healht Benefits

Vox Article by Sarah Kliff

Summary of Congressional Budget Office Report

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Mar 13, 2017

UPDATE: Since the episode aired (like the very next day) the Congressional Budget Office came out with their assessment of the American Healthcare Act. It was not positive. Stay tuned to the second part of this episode coming out on Monday, March 20, where we will discuss what they had to say.

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Over the past week, we've finally gotten to take a look at the elusive Republican healthcare plan, the proposed replacement for Obamacare.

In this episode we talk about the faults opponent found with Obamacare, and how the proposed plan, which we call Trumpcare, attempts to address those issues.

This is the first installment of a two-part episode on Trumpcare, so be sure to listen this week and next week to get our full analysis.

Resources:

Health Affairs Blog on AHCA

Kaiser's side-by-side comparison of Obamacare and AHCA

Obamacare Essential Healht Benefits

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Feb 20, 2017

Physician burnout is a big issue in the medical community. According the the Medscape Lifestyle Report 2017, over half of physicians report burnout. But physician burnout isn't just a problem for physicians. It is a problem for patients, for other medical staff, and for the health care economy. 

Today we dig into the causes of physician burnout and how it can be addressed. Here's a hint: It doesn't involve meditation or counseling.

Resources:

Medscape Lifestyle Report 2017

2 Docs Talk About Pricing Transparency

2 Docs Talk About Medicare for All

2 Docs Talk About Drug Pricing

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Jan 23, 2017

The 21st Century Cures Act was passed by both bodies of Congress and signed into law by President Obama on December 7, 2016. The bill received overwhelming bipartisan support, with only a small number (of notable) exceptions.

On the surface, the law sounds like a triumph for healthcare and medical research. But a closer look at funding for the act brings its staying power into question. The only provisions of the law that don't require further action to maintain funding benefit one lucky group. 

Here's a hint: it's not patients. 

So today, 2 Docs Talk about what the 21st Century Cures Act accomplishes and what it doesn't accomplish. Buckle up. 

Resources:

Legislative history and text of 21st Century Cures Act

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Nov 14, 2016

November 8, 2016 has come and gone and no matter what box you checked you are probably a little surprised by the outcome. Donald Trump will be the 45th POTUS. 

This has the potential to shake things up in a lot of areas of American life, but we want to focus today on the healcare ramifications of a  Donald Trump presidency. What did he say he would do? Will he do it? And what will it look like if he does.

We refer to a couple of our previous podcasts in this show and they are worth a listen as you evaluate the plans Donald Trump is offering up:

Episode 10: What Does Planned Parenthood Actually Do?

Episode 6: Pricing Transparents in Medicine and Healthcare

Nov 7, 2016

The process of drug approval is long and expensive. To complicate matters, pharmaceutical companies, patients, an the FDA are all invested in the process, for different reasons - and they aren't always the same.

Today we discuss the story of how a new drug came to market and the unusual circumstances around its approval. 

Resources:

FDA grants accelerated approval to first drug for Duchenne muscular dystrophy

CDC on Duchenne Muscular Dystrophy

Right to Try

Compassionate Use

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Oct 24, 2016

If you've paid any attention to the news over the past year or so, you've likely seen stories of greedy capitalists gouging the vulnerable by hiking up the prices of their life-saving drugs.

But are the prices hikes all that bad?

Yes. Yes, they are. And we talk about that to day on 2 Docs Talk.

Resources:

JAMA on Drug Pricing

Our episode on Hep C

Our episode on Alzheimers

Our episode on Pricing Transparency

Sep 19, 2016

If there is a hot button issue in politics these days, it's abortion. But abortion is the result of a long line of issues that are being inadequately addressed in this country. Today we take a look at contraception - what it is, how it works, its history and its future. 

We also offer a look at an innovative program that has the potential to help both pro-choice and pro-life groups happy. 

 

Resources:

Details on various types of birth control

The Choice Project

Use of LARCs in Colorado

Slang for using a condom (adult humor - you've been warned)

 

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Jul 25, 2016

In this episode, we dig into the terms being bandied about by politicians this year. Medicare for all, single-payer, socialized medicine. What do they all mean? Are they all the same or are there differences between these systems. 

And what would we do, today, to start making healthcare work a little better?

Resources:

Per Capita Health Spending by Country

Gallup Poll on Healthcare Satisfaction by Country

 

Jun 20, 2016

 

If you watch any tv at all, it's likely you've seen a drug ad. These ads generally show seemingly healthy people living normal lives, the message being the drug did this for them.

But are the drug ads telling the whole story? And should they even be advertising directly to consumers to begin with? We discuss this issue on today's episode.

 

Resources:

Nivolumab Research from New England Journal of Medicine

What the FDA has to say about drug ads

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May 23, 2016

In a world when concerns about healthcare costs, access to care, and medical complications create significant barriers to medical care, telemedicine has an obvious role to fill. 

But what are the potential downsides of a technology that is being adopted faster than we can track? Is it effective? Is it safe? Is it a door for the unscrupulous ot take advantage of the unsuspecting?

We discuss these and other issues of the growing field of telemedicine. 

Resources:

AMA policy on telemedicine

AAFP debate on telemedicine policy

AAP on telemedicine and the "medical home"

Hospital at Home

Use of telemedicine to prevent preterm labor

Mar 28, 2016

In this episode, we dig into the terms being bandied about by politicians this year. Medicare for all, single-payer, socialized medicine. What do they all mean? Are they all the same or are there differences between these systems. 

And what would we do, today, to start making healthcare work a little better?

Resources:

Per Capita Health Spending by Country

Gallup Poll on Healthcare Satisfaction by Country

Feb 15, 2016

Opioid abuse is at an ever increasing high in the U.S. with overdose being a significant cause of death. 

What role do physicians, pharmaceutical companies, and the drug users themselves play in this epidemic. We examine these questions and more in this episode on the opioid problem in the United States.

Resources:

Drug Overdose Deaths by State

Draft CDC Guidelines for Prescribing Opioids for Chronic Pain

Specific Populations and Prescription Drug Misuse and Abuse

Feb 1, 2016

If you live anywhere but under a rock, you know that Planned Parenthood has been the center of controversy in recent months. In this episode, we discuss the history of the organization and its founder Margaret Sanger. Then we dig into Planned Parenthood as it exists today and the controversy surrounding it.

The coverage of the controversy in the media is filled with innuendo and half-truths from both sides of the political spectrum. We wanted to know the facts, so we did a little searching. Since we recorded this episode, the courts in Houston did too, and found no evidence that they were profiting from the sale of fetal tissue or organs.

But, what role does Planned Parenthood play in healthcare today?

Do they provide needed services? What are those services? Is abortion their primary business? Should Medicaid funds cover their services? And finally, is there anything that can be done to curb the number of abortions performed today? (Hint: yes there is, and it has nothing to do with Roe v. Wade.)

Resources:

Where are Planned Parenthood Clinics Located?

Texas Tribune Articles on Planned Parenthood

Planned Parenthood Services by the Numbers

CDC Abortion Surveillance Report - 2012

New England Journal of Medicine on Planned Parenthood

Long Acting Reversible Contraception in Colorado

The Choice Project - LARCs in Colorado

Jan 25, 2016

As we enter primary season for this election year, gun violence and control is a hot topic. However, much of the discussion lives in one of two extremes, and little of it is based on actual evidence. 

With over 30,000 gun deaths each year, and over 20,000 of those death from suicide, the reality is that gun violence is a public health issue. This means we need to treat this issue from the point of view of the medical evidence. 

Today we look at the scope of the problem, what has and hasn't worked, and some thougths about what lies ahead. 

Resources:

CDC All Injuries Statistics

CDC Accidental Death Statistics

CDC Homicide and Assault Statistics

CDC Suicide and Self-Inflicted Injury Statistics

CDC Depression Statistics

Discussion of Australia's Gun Laws in the New York Times

Discussion of Missouri's Gun Laws in the New York Times

Survey of Defensive Gun Use Cited Frequently by NRA 

Methodological issues with Defensive Gun Use Survey

Jan 4, 2016

If you've ever tried to figure out the price of a medical procedure, you know it's not that easy. In fact, research shows that complete pricing for medical procedures is unavailable when requested over one-third of the time. 

As healthcare deductibles rise and indidviduals are affected more and directly by these costs, the issue of pricing transparency is growing. In this episode we talk about the problem posed by opaque medical pricing practices. We also dig into two innovative practice models that solve this transparency problem, as well as a few other issues in the delivery of healthcare and medicine.

Resources:

Surgery Center of Oklahoma

Turntable Health

Iora Health

JAMA: Availability of Consumer Prices from US Hospitals for a Common Surgical Procedure

Dec 10, 2015

Since March 2010, health care in the U.S. has been subject to the Affordable Care Act, also known as Obamacare.

There is a significant amount of confusion about what exactly this law does or does not do. In this episode, we talk about the key provisions of the law and how it affects the delivery of healthcare in the U.S.

We cover:

  • the effect of the law on insurance
  • subsidies
  • the pre-exisiting conditions clause
  • the mandatory coverage provision
  • pharmaceutical pricing
  • and other key requirements of the law.

In this episode we refer to the following information:

Insurance companies requesting rate reviews under Obamacare

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