NEJM’s 1st AI Editor on Tech’s Pluses & Minuses

As the year begins, some patients remain concerned about how far artificial intelligence (AI) is creeping into the exam room. But AI has been part of health care longer than most realize, according to Dr. Isaac Kohane, a Harvard University professor.

Kohane is the editor-in-chief of the New England Journal of Medicine’s first publication devoted to AI; it’s a groundbreaking role and we’re proud to share an encore presentation of the interview. He told hosts Mark Masselli and Margaret Flinter that “In the 1980s, automated interpretation of an [echocardiogram] would have been considered AI. Now it’s the ability to look through a patient’s record and come up with a differential diagnosis, a second opinion, a therapeutic plan.”

Kohane shared a success story of a mother whose child had difficulty walking and chewing, suffered from headaches and had seen more than a dozen doctors over many years, with no diagnosis. After one doctor recommended a psychiatric course of action, the mother fed the reports from various past medical visits into a generative AI program, which provided an accurate diagnosis: tethered cord syndrome.

Cases like this can represent AI’s potential, said Kohane. But the nascent technology raises issues of bias. “You can run tests on these AI programs and say, ‘Would you propose that diagnosis more often if this was an African-American or an Indian-American?’ … And you can adjust these programs,” Kohane says. The exciting part is that the adjustment would be easier than undoing even unconscious bias among hundreds of thousands of health care professionals, he explained.

Originally broadcast August 22, 2023.

Healthcare Providers & ChatGPT Will See You Now: Our Brave New World

The World Health Organization has issued a statement expressing concern about artificial intelligence in health care. In 2023, Mayo Clinic’s then-Chief Information Officer Cris Ross joined us to discuss it. He led innovation projects at Mayo Clinic for over 30 years and told us “perhaps” we should be worried about ChatGPT.

“These technologies are value-neutral but their usage is not necessarily value-neutral. Bad people can use good technology for bad purposes. So I think there’s a very robust debate about whether these technologies should be regulated, whether they can be regulated, and if they are regulated, how we should do that,” Ross told us at the time.

Listen in on this encore presentation as Ross takes hosts Mark Masselli and Margaret Flinter through this brave new world that promises to affect every part of health care.

Originally broadcast June 8, 2023.

2024 Rewind & Look Ahead for Health Care Issues

Conversations on Health Care hopes the new year is off to a great start for you! But before we completely turn the page on 2024, we want to look back on our top issues and interviews from the past year. We spoke to leading experts about the health care policies that were part of the presidential race; the promise and peril of artificial intelligence; the research into happiness; and many other issues.

As President Trump, a new Congress and other new leaders in the states prepare for office, hosts Mark Masselli and Margaret Flinter present this recap and look ahead to the ideas, innovations and insights driving health care.

Holidays, Headaches & Heartache: Best Advice from the “Happiness Doctor”

Dr. Amit Sood is called the “Happiness Doctor” for a good reason; his resilience approach has been included in over 35 clinical trials. The holiday season, occurring right after an intense election, is an ideal time to learn from Dr. Sood about how to recognize stress and reprogram the brain to deal with it. One of his top pieces of advice: Ask yourself if what is upsetting you will matter in five years? If the answer is no, let it go.

Dr. Sood is the CEO of Global Center for Resiliency and Wellbeing, the former chair of Student Life and Wellness at Mayo Clinic, and the author of the new book “ “It Takes You to Tango: Leverage the Science of Loneliness to Master the Art of Connection.” Join Mark Masselli and Margaret Flinter for this insightful conversation that will help us all navigate negative thinking.

What Elon Musk & Peter Thiel Invest In to Make Lives Longer

Billionaires who dream of extending human life, including Elon Musk, believe they will have very supportive partners in the incoming Trump administration. They’re excited that President Trump has nominated Jim O’Neill for the number two spot at the U.S. Dept. of Health and Human Services because of his history in the anti-aging movement.

David Gobel, the co-founder and CEO of the Methuselah Fund, says, “Jim O’Neill really understands the value of avoiding the suffering…of diseases that don’t actually have to happen if aging is held back. Robert F. Kennedy, Jr., and other nominees are very much in line with the idea of holding aging back by whatever means.” President Trump has nominated Kennedy to serve as HHS secretary.

But “Conversations on Health Care” recently spoke with S. Jay Olshansky, Ph.D., a professor at the University of Illinois at Chicago, who questioned private and public dollars going to such efforts. “We’ll be lucky if 5% of the age cohort makes it to 100,” he said. Olshansky and his colleagues have presented data that humans are approaching a biologically-based limit to life.

Join hosts Mark Masselli and Margaret Flinter for this look into the world of life extension and how Trump administration officials could push the country to embrace these unconventional practices. In addition, learn more about the first longevity patient protocol from Danielle Ruiz, MSN, APRN, AGNP-C, CEO and Medical Director, Everest Health.

Nurse Practitioners: A Growing Opportunity

Pres. Trump’s HIV/AIDS Record: A Look Back & Ahead

HIV/AIDS experts are cautiously watching as President Trump and his administration near inauguration day. On one hand, they remember how President Trump announced in 2019 his initiative called Ending the HIV Epidemic: A Plan for America. It included Ready, Set, PrEP, a U.S. Department of Health and Human Services initiative that provides free access to the HIV prevention medication PrEP for thousands of qualifying individuals.

But there are worries “about the next four years because we’re hearing about a potential decrease in funding,” that will be detrimental to programs, according to Dr. Marwan Haddad, Medical Director of the Center for Key Populations, Community Health Center, Inc., and a former chair of the HIV Medicine Association.

Vincent Guilamo-Ramos, Ph.D., MPH, Executive Director, Institute for Policy Solutions at the Johns Hopkins School of Nursing, highlighted these issues as communities recognized World AIDS Day on Dec. 1. For instance, the CDC reports new HIV infections fell by 19% from 2018 to 2022 but there’s been a 12% increase in infections among Latino people.

Our guests join hosts Mark Masselli and Margaret Flinter to discuss progress and the hurdles that still exist in the fight to end AIDS.

"Dr. Happiness" on Surviving Family Discussions at Thanksgiving

Dr. Amit Sood is called the “Happiness Doctor” for a good reason; his resilience approach has been included in over 35 clinical trials. The holiday season, occurring right after an intense election, is an ideal time to learn from Dr. Sood about how to recognize stress and reprogram the brain to deal with it. One of his top pieces of advice: Ask yourself if what is upsetting you will matter in five years? If the answer is no, let it go.

Dr. Sood is the CEO of Global Center for Resiliency and Wellbeing, the former chair of Student Life and Wellness at Mayo Clinic, and the author of the new book “It Takes You to Tango: Leverage the Science of Loneliness to Master the Art of Connection.” Join Mark Masselli and Margaret Flinter for this insightful conversation that will help us all navigate negative thinking.

Did the millions spent matter? Election ’24 Health Care Ads

TV ads focused on health care issues — including transgender care, abortion and costs — ricocheted across the airwaves in the months leading up to election day. Erika Franklin Fowler, Ph.D., is a co-director of the Wesleyan Media Project, which tracks political ads. She joins “Conversations on Health Care” to discuss a controversial anti-transgender surgery ad from the Republicans that also benefited from free media attention, as well as House and Senate candidates picking up on similar themes in their advertising.

Preliminary numbers show $4.5 billion was spent on political TV and radio ads this year. These ads and their messages reflect the goals of President Trump and his new administration as they plan a return to power in the nation’s capital. Hosts Mark Masselli and Margaret Flinter discuss the TV ad wars and their implications for health care policy with Dr. Franklin Fowler. 

When Area Hospitals Have the Same Owner, Does Medical Debt Go Up?

There are 27 million Americans who have medical debt on their credit reports right now—a drag on their pocketbooks and our health care system. Urban Institute researchers say they’ve found an interesting fact about those with medical debt: They live in communities with less healthcare competition because of common ownership. The data show that communities of color and people living in the South are disproportionately affected.

Fredric Blavin, Ph.D. and Breno Braga, Ph.D. say medical debt can intensify financial challenges, affect health care access and potentially worsen health outcomes. They report prices at monopoly hospitals are 12% higher than those in more competitive markets.

They share with hosts Mark Masselli and Margaret Flinter a variety of ways policymakers can explore unraveling the market concentration-medical debt link and we share the perspective of the American Hospital Association. 

The Limits of Aging & Implications

The current life expectancy at birth is 74.8 years for males and for females it’s 80.2 years in the U.S. Does it catch your eye when you hear about predictions we’ll be able to live to 100 and beyond? Some researchers are throwing cold water on those notions. “We’ll be lucky if 5% of the age cohort makes it to 100,” says S. Jay Olshansky, Ph.D., Professor, University of Illinois at Chicago.

He and his colleagues made headlines when they presented data that humans are approaching a biologically-based limit to life. Hosts Mark Masselli and Margaret Flinter ask Olshansky about the implications of this research — for each of us personally and for policymakers — after decades of hearing predictions that life expectancy would continue to go up. Olshanky explains why we should celebrate longer life that has resulted from healthier diets and medical advances but now focus on improving quality of life in later years.

Reporters Examine Harris & Trump’s Health Care Policies: Election 2024

Early voting is underway in most of the U.S. right now (with few exceptions) and health care is on the ballot. There are increasing signs that former President Trump, if re-elected, will try to proceed with “massive changes” to the Affordable Care Act. Meanwhile, Vice President Kamala Harris is vowing to protect the law and continue federal drug price negotiations. Both candidates say they’ll seek to expand support for in-home health care.

Our guests are the reporters covering these issues. Shannon Firth, MedPage Today’s correspondent in Washington, shares an update from a contentious U.S. House race in Minnesota that’s focused on abortion. Sarah Owermohle, who reports on federal issues for STAT News, explains the situation in Montana following her recent visit to the state.

Join Mark Masselli and Margaret Flinter for our Reporters’ Roundtable as we countdown to election day and discuss what the results will mean for the nation’s health.        

Election Year Stress? How Music Can Help the Mind Relax

The upcoming presidential election is stressing out 69% of American adults, according to a survey from the American Psychological Association. If you’re with the majority in feeling that way, there’s important advice to consider from worldwide acclaimed soprano Renée Fleming. She’s the editor of “Music and Mind,” a curated collection of essays from leading scientists, artists, creative arts therapists, educators and health care providers about the powerful impacts of music and the arts on health and the human experience.

Renée shares how she discovered her own music and mind connection early in her career when she had back pain and how a dinner with three Supreme Court justices led her to become an unexpected advocate for neuroscience.   

Renée, a five-time Grammy award winner, also explains to hosts Mark Masselli and Margaret Flinter what happened when she saw the results of a functional MRI experiment she took and what it means for all of us

How Groundbreaking NIH Research is Expanding to Birth-to-Four-Year-Olds

For nearly the first decade of the National Institutes of Health’s “All of Us” Research Program — aimed at increasing diversity in genetic research — a major component was missing: kids.

“Children are approximately 24% of our population in the U.S. and 100% of our future,” Dr. Sara Van Driest, director of pediatrics for NIH’s All of Us Program, told hosts Mark Masselli and Margaret Flinter. “In order to provide them with the very best care for the future and have them benefit from this resource, we need to include them.”

The journey is personal for Katrina Yamazaki, Ph.D., principal investigator for Community Health Center, Inc., in Connecticut, a partner organization in All of Us. Yamazaki and her husband adopted three boys through the foster care system.

“We don’t know a whole lot about their … biological families’ medical history,” Yamazaki said. “The idea that this program will one day be able to provide some of [that] missing information to me and my husband, in order to become health advocates for our children is really important to me.”

The NIH in August began limited enrollment in the program for children age 4 and under.

“We started with that youngest age group so we can follow them the longest,” Van Driest said.

Community Health Center, Inc., for its part, is partnering with community-based organizations such as the Hartford Public Library to build trust, raise awareness of the project and make a fun atmosphere through activities.

All of Us intends to change what might be seen as a “one-size-fits-all” approach to health care. It aims to encompass 1 million individuals of diverse backgrounds but doesn’t focus on particular diseases or conditions, Van Driest said. The diversity, too, goes beyond culture, touching geography, age and socioeconomic status.

“One of the goals of research is to connect the dots,” she said. Given the scope of the project, “there will be so many dots that we’ll be able to connect,” Van Driest said.

 “If we fail to include a group of individuals or an aspect of diversity, we miss out on that uniqueness. That limits us in what we’re able to understand about humanity in general,” she said. “It also limits research and learning about that group of individuals. And it limits downstream how clinicians can care about individuals and give them the very best possible outcomes.”

Trump vs. Harris on Health Care: Experts Explain Each Side

The countdown is on to election day with health care issues hanging in the balance as never before. The biggest one: Abortion and reproductive rights. Andrea Ducas, the Vice President of Health Policy at the Center for American Progress, says “What you see with Vice President Harris is a candidate who’s committed to protecting women’s freedoms, to protecting women’s right to choose.”

On the other side of the political spectrum is Wayne Winegarden, Ph.D., the Senior Fellow in Business and Economics at Pacific Research Institute, and Director of PRI’s Center for Medical Economics and Innovation. He and his colleagues believe that patients are not in control of the health care system and that we suffer from an opaque and complex pricing structure that harms patients. Winegarden’s free market approach means he advocates for doing away with the Obamacare subsidies that Congress must consider, as they soon expire.

As Kamala Harris and Donald Trump engage voters at rallies, online and on TV, our guests provide the policy perspectives that will undergird the thinking of the administration that will take power. Join hosts Mark Masselli and Margaret Flinter for this important conversation.

CDC Director Warns of More Dangers From Hurricane Helene

U.S. Centers for Disease Control and Prevention Director Dr. Mandy Cohen described to “Conversations on Health Care” that their role right now is ensuring impacted residents understand the health risks that are present and could continue to grow in the aftermath of Hurricane Helene.

Dr. Cohen says while local, state and Federal Emergency Management Agency (FEMA) officials are in the acute response phase, CDC is doing its part by ensuring people realize there are growing risks, including from flooded roads that are not safe to drive over. The CDC says when returning to a flooded home after a natural disaster, be aware that the house may be contaminated with mold or sewage, which can make people sick.

“As a North Carolinian, my heart goes out to the people in the western part of our state. People had power outages, which means food has spoiled in the refrigerator…make sure you’re not eating spoiled food,” says Dr. Cohen, who previously served as North Carolina’s top state health official. “Our water systems have gotten hard hit, so thinking about whether if you need to be on bottled water. In the recovery phase…we’re likely to see more mosquitos because we’ll see standing water and making sure folks are doing what they need to do to protect themselves.”

Click now to hear her interview with Mark Masselli and Margaret Flinter.

Trump & Harris Debate IVF: Why It’s an Election Issue

At the beginning of this year, few could have predicted that in vitro fertilization would become a big political topic. But that’s what occurred after the Alabama Supreme Court ruled frozen embryos are “unborn children.” The Alabama legislature then responded by passing a law to shield IVF providers.

Since then, former President Trump said he wants the government or insurance companies to pay for IVF treatment. However, Vice President Kamala Harris has said that “under Donald Trump’s abortion bans, couples who pray and dream of having a family are being denied IVF treatments.”

As we near election day, we’re looking back to an interview with a national leader on these issues. Carole Johnson is the administrator of the Health Resources and Services Administration, which is part of the U.S. Health and Human Services Department.

Johnson told hosts Mark Masselli and Margaret Flinter in March that some health care providers were already reluctant to work in states with restrictive reproductive legislation and the Alabama situation presented a new challenge.

She stated that “It should not be the case that young women in this generation have less rights than I did growing up and we need to change that. We will continue to lean in as an administration supporting women.”

Mark Cuban: Drug Price Disrupter Explains How It Works

When we have a guest like “Shark Tank” star Mark Cuban, it can be hard to keep up with all his thoughts. He was a bundle of energy in November 2022 explaining his then-new venture trying to reform how Americans can purchase lower-priced drugs; he called it “dunking on the pharma industry.” Since our conversation, experts say Cuban has become a major disrupter in generic drug pricing. Cost Plus now offers 2,500 drugs and has signed up a large list of health systems.

Join us for this encore presentation as hosts Mark Masselli and Margaret Flinter ask Cuban to explain how his approach also includes introducing transparency to drug pricing.

How to Reduce Health Risks When September Temps Reach 100+

Experts report we’re dealing with the hottest summer on record for the second year in a row. Phoenix has recorded 100 straight days of over 100-degree weather; Hollywood Burbank Airport in the Los Angeles area matched its all-time high temperature with a reading of 114.

In Los Angeles, the city is taking action to help its people deal with the temperatures through the leadership of Marta Segura, one of the few appointed chief heat officers in the world. Her work is focused on finding solutions when the weather causes physical and mental health issues and she’s keeping equity at the forefront of her efforts. Segura explains how an aware and engaged public is key to the effective implementation of climate policies.

This all occurs as U.S. Health and Human Services Secretary Xavier Becerra has declared extreme heat a rising public health crisis.

Join us for this encore “Conversations on Health Care” with hosts Mark Masselli and Margaret Flinter.

When Money Takes Over Medicine: Risk, Rewards & Warnings

Did you know private equity owns one-third of private hospitals in the country and the percentage is growing? Private equity is a controversial type of financing typically seen in the technology and media sectors that’s now attracted to health care.

It’s a trend that greatly troubles Erin Fuse Brown. She’s a professor of health services, policy and practice at Brown University’s School of Public Health and its Center for Advancing Health Policy through Research.

She explains to “Conversations on Health Care” hosts Mark Masselli and Margaret Flinter that private equity’s practice is to cut wages and employees and substitute highly trained staff with lower skilled substitutes. She says, “It means worse patient care in many instances and that is what we see is leading to the greater risks of mortality and adverse events for hospital and nursing home patients after a private equity acquisition.”

Fuse Brown also discusses why it’s so difficult to figure out who actually owns your hospital and the latest details about the effort to ban employees’ noncompete.