JAMA’s Editor: Rebuilding Trust & Reaching More Readers

The Journal of the American Medical Association (JAMA), which was first published 141 years ago, is grappling with modern challenges as the most widely circulated general medical journal in the world. At the forefront is Dr. Kirsten Bibbins-Domingo, its relatively new editor-in-chief.

Dr. Bibbins-Domingo took the helm at a tumultuous time and has a clear vision for how JAMA should deal with equity in medicine and the public’s lack of trust in health care.

She told hosts Mark Masselli and Margaret Flinter at Aspen Ideas: Health that “I am not the keeper of trust for the journal. I am not the keeper of our focus on equity.” But she said she has installed new processes “so that we could collectively have those conversations, be more transparent around them, think about the processes that help us make sure that we are always trying to be the best that we can be.” That includes giving JAMA employees and authors a voice in discussions about equity and increasing transparency with readers.

Dr. Bibbins-Domingo also focused on how to keep JAMA connected to its current audience while attracting new audiences using an omnichannel approach, especially social media.

“I think about what JAMA and the JAMA Network have to do right now is do the core functions the same way we’ve always done it…vetting the science, making sure this is science you can trust, putting the stamp of approval in that way on it, and then publishing it. And then we have to do something that I think all journals need to do better… and that is being a modern communication vehicle,” she said.

HHS’ Admiral Rachel Levine: Managing Her History-Making Role While Focused on the Nation’s Health

With most of the country suffering through a sweltering heat wave, the U.S. Dept. of Health and Human Services has found the right time to unveil its nationwide Heat and Health Index (HHI).

“Conversations on Health Care” learned all about it from Admiral Rachel Levine, M.D., the department’s assistant secretary for health. “We are seeing heat-related injury and health impacts globally,” says Levine, particularly in vulnerable populations, such as children, seniors and people who work outside.

HHI combines historic temperature data and Emergency Medical Services (EMS) data on heat-related emergency responses from the past three years, as well as data on community characteristics, including pre-existing health conditions, socio-demographic information, and characteristics of the natural and built environment, to provide a final heat and health index ranking by ZIP code.

Levine is used to being in the hot seat on a variety of issues, from worries about bird flu to the latest on Long COVID. During June, she helped lead efforts to celebrate LGBTQ+ Pride, as the nation’s highest-ranking openly transgender official.

Hosts Mark Masselli and Margaret Flinter, well aware that Levine serves at the president's pleasure, asked her about future plans. She said she would absolutely be willing to go through another intense Senate confirmation process depending on what happens on Election Day. “I firmly believe in the Biden-Harris Administration and the principles they advocate for and represent.”

Biden Gun Prevention Leader at Aspen Ideas: Health to Make Their Case

“Conversations on Health Care” went on the road to Aspen Ideas: Health. We start this series with Gregory Jackson, A White House official with one of the toughest assignments: tackling gun violence, Gregory is deputy director of the White House Office of Gun Violence Prevention.

Helping Community Health Workers Succeed: Ideas From an Innovative Program

Experts praise community health workers as the keys to building a more equitable and fair health care system in America. Is there a way to unlock more success for hiring and retaining them?

Dr. Fauci Talks About His New Book: 7 Presidents & the Challenges of COVID, AIDS

Five times during the COVID pandemic Dr. Anthony Fauci took time out of his incredibly busy schedule to share with “Conservations on Health Care” his latest insights. Now, he returns to reflect not only on COVID but also on the entire scope of his career, including his efforts to bring attention and resources to the AIDS fight in the 1980s. Dr. Fauci explains he had to speak truth to power during the pandemic in order “to preserve…professional integrity and to fulfill my responsibility to the American public.” He continues to focus on sharing “just the facts.” In terms of the current COVID situation, he says the virus persists and “has an uncanny capability of continuing to evolve…there’s a new variant now…that evades some of the protection from vaccines and prior infection.” Dr. Fauci’s autobiography, “On Call: A Doctor's Journey in Public Service,” takes readers through his life from growing up in Brooklyn to advising seven presidents through some of the world’s most harrowing health crises. Join hosts Mark Masselli and Margaret Flinter for this important conversation with the most renowned and acclaimed physician and public health leader of our era, Dr. Fauci.

The Urgent Need to Rethink Suicide: Lessons for Veterans & All Americans

Is the way we're going about suicide prevention all wrong? And how are those misperceptions affecting efforts to stop veteran suicides? Clinical psychologist Craig Bryan is an Iraq War veteran and studies the issue.

He's the author of “Rethinking Suicide: Why Prevention Fails, and How We Can Do Better” and says we need a better focus on firearm safety. In 2021, 72% of veteran suicides involved firearms.

The veteran suicide rate is currently 1.5 times the rate of the general population and the U.S. Department of Veterans Affairs says its top clinical priority is preventing suicide among all those who have served.

America’s Record-High Deaths by Suicide: APA Pres. Outlines Prevention Steps

More than 50,000 Americans died by suicide in 2023, the highest number on record. Data from 2021 found that over 12 million American adults thought about suicide and 1.7 million attempted it.

American Psychiatric Association President Dr. Petros Levounis, who’s finishing his term, is at the center of efforts to prevent suicides. His focus continues to be on substance use addictions. He and the 38,000 APA members have launched a campaign called “Confronting Addiction: From Prevention to Recovery.”

Dr. Levounis also talked about vaping, opioids, alcohol and the rapidly growing addiction to tech.

Join hosts Mark Masselli and Margaret Flinter for this encore presentation of the interview with Dr. Levounis.

Nurses & Moms Partnering for Health Success: How Babies Benefit

What if we say there’s a way to have healthier pregnancies, improve children’s health and create better economic outcomes? And it all begins with a knock on the door? That’s the way Nurse-Family Partnership works. It’s an evidence-based, community health program with 45 years of research showing significant improvements in the health and lives of first-time moms and their children affected by social and economic inequality.

The initiative succeeds by having specially educated nurses regularly visit first-time moms, starting early in the pregnancy and continuing until the child’s second birthday. Research consistently proves that the partnership between a nurse and the mom is a winning combination that makes a measurable, long-term difference for the whole family.

Nurse-Family Partnership’s Sharon Sprinkle, co-director of nursing practice, and Jenny Harper, government affairs director, join hosts Mark Masselli and Margaret Flinter to discuss its founding, funding and how expectant moms sign up.

Meet America's Hidden Health Heroes

You know about the Army and Navy, but have you heard about the USPHS Commissioned Corps?

It is one of the nation’s uniformed services — a branch committed to the service of health. Its over 6,000 officers advance the nation’s public health, serving in agencies across the government, as physicians, nurses, dentists, veterinarians, scientists, engineers and other professionals.

President of the Public Health Service Commissioned Officers Foundation Gene Migliaccio spoke to “Conversations on Health Care” hosts Mark Masselli and Margaret Flinter about the role the Corps played in combatting the pandemic.

The fight against COVID-19 was the largest deployment in the 223-year history of the United States Public Health Service Commissioned Corps. At the beginning of the pandemic, “I think what we did right was the mobilization,” Migliaccio said.

“When Covid hit, we didn’t have testing centers. It started slowly, and then all of the sudden there were hundreds of them. It took a tremendous amount of effort and some of the best and brightest minds within the Department of Health and Human Services” to accomplish that, he said.

The Public Health Service Commissioned Officers Foundation is part of a new documentary titled “Invisible Corps,” narrated by the actress Ali McGraw. The piece is trying to raise awareness about the Corps and also how public health has become politicized.

Sharing Best Practices: Lessons from Community Health Centers Coast to Coast

This week we’ve brought together some of the brightest minds who run many of the best and most innovative community health centers across the country. From Long Island to San Francisco, community health centers served over 31 million patients last year. How are they keeping pace with their success while always working to improve the quality of the care?

The guests are part of the Community Health Best Practices network and serve as CEOs of their nonprofits:

--Gloria Amador from Salud Integral en la Montaña in Puerto Rico;

--Eddie Chan with North East Medical Services in San Francisco;

--Nieves Gomez with Columbia Basin Health Association in Connell, Washington;

--Ann Kauffman Nolon with Sun River Health in New York City, Long Island and the Hudson Valley; and

--Greg Wilmot with East Boston Neighborhood Health Center.

“Conversations on Health Care” co-hosts Mark Masselli and Margaret Flinter explore how they navigated the COVID pandemic, deal with employee engagement and tackle funding challenges.

Black Women Taking Steps to Health: Funder & Nonprofit Explain How

Join us for a unique conversation with an innovative nonprofit leader and the grantmaker who’s helping support her efforts. Morgan Dixon is the co-founder and CEO of GirlTREK, which she calls a “life-saving sisterhood.” Their campaign seeks to heal intergenerational trauma, fight systemic racism, and transform Black lives by organizing women walking teams. While participants walk, they also mobilize community members to support advocacy efforts and lead a Civil Rights-inspired health movement.

How Could Medical Racism Fuel Soaring Black Youth Suicide Rate? Answers and Solutions

Black children ages 5 to 12 are twice as likely to die by suicide as their white counterparts, and the rate of suicides among Black teens is rising faster than any other racial/ethnic group.

Those statistics are alarming to most people, but they’re not surprising to Yale Child Study Center (YCSC) Chief Resident and Child Psychiatry Fellow Dr. Amanda J. Calhoun.

“Experiences of anti-Black racism affect kids before they are even born,” says Dr. Calhoun.

The stress of anti-Black racism on Black mothers, including experiencing inferior care by health care providers, has been linked to low birthweight babies, putting Black infants at greater risk for developing depression and other mental health disorders.

In addition, racist beliefs start to become ingrained in children as young as four years old, which means that Black children start to experience racism from their peers and teachers as early as preschool.

“It’s not the school-to-prison pipeline. It’s the preschool-to-prison pipeline,” says Calhoun. Black children are more likely to be suspended from or arrested in school than their peers.

When they seek help, Black children are the most likely to be physically restrained in emergency departments. And they are more likely to be diagnosed with disruptive mood disorders than white children with comparable symptomatology.

“You have people who are traumatized, who are being traumatized, by people who are supposed to help them,” says Dr. Tichianaa Armah, Chief Psychiatry Officer and Vice President of Behavioral Health at Community Health Center, Inc.

“Of course, they are going to have poor mental health outcomes,” says Dr. Calhoun.

Dr. Armah and Dr. Calhoun tell “Conversations on Health Care” hosts Mark Masselli and Margaret Flinter that they have seen the effects of this early trauma up close in their work and are exploring what measures can be taken to protect young Black lives.

Dr. Calhoun is leading a Black Youth Mental Health Clinical Case Conference Series at Yale University where experts will weigh in on complex clinical cases involving Black youth presented by YCSC trainees, please learn more here: https://medicine.yale.edu/news-article/black-youth-mental-health-series-yale/

But she is doing things a bit differently. “In a typical case conference, we talk about the problematic behavior of patients,” says Dr. Calhoun. None that she has seen have asked “What if one of the primary causes that has led to the lapses in care of this Black child is the medical racism of the team?” 

Can Health Care Policy Take a Page from Recent Bipartisan Efforts?

In the wake of recent bipartisan policy wins in Washington, can health care policy follow suit?

Dr. Anand Parekh, chief medical advisor at the Bipartisan Policy Center (BPC), spoke with hosts Mark Masselli and Margaret Flinter about how the best solutions emerge from a solid understanding of the issues and the eventual give-and-take of political opponents.

For example, The Milbank Memorial Fund’s 2024 Scorecard Report of The Health of U.S. Primary Care declared that the state of “primary care is in crisis.” The report made clear the systemic lack of support for primary care is harming people’s health and weakening the U.S. health system.

Dr. Parekh agrees the issue is dire. “As a primary care physician…this is the most important health care issue in America,” he says. “A strong primary care system needs to be the foundation of our health care system. So much of what is ailing us is because we haven’t put in the resources into our primary care system infrastructure.”

How can a bipartisan approach help?

Dr. Parekh points to the recent effort by the BPC to relaunch the Congressional House Primary Care Caucus, which had been dormant for years. They began by identifying bipartisan co-chairs to lead the caucus (two Democrats and two Republicans) who will be educating members about the importance of primary care before they begin to discuss policy solutions.

Dr. Parekh’s interview this week on “Conversations on Health Care” highlights how ensuring that both parties are working together from the beginning on an issue lays the foundation for mutual understanding and agreement down the line.

An Environmental Psychiatrist Explains Climate Anxiety As We Celebrate Earth Day

As we mark Earth Day, we have just experienced the hottest March on record. But climate change’s impact isn’t stopping with the weather; it’s also affecting our mental health, says Dr. Gary Belkin, director of the Billion Minds Project at Columbia University’s Mailman School of Public Health.

Climate anxiety, which refers to having distressing feelings related to climate change impacts, is increasingly prevalent in communities where the impact is the most severe.

And the problem is only getting worse.

Dr. Belkin says it is important to ask, “What happens when there is mass hopelessness?” From individuals to politicians to society as a whole, feelings of hopelessness can hamper people’s ability to problem solve and result in people giving up and retreating from the issue.

A solution? Start small in communities, Dr. Belkin says.

He’s putting this idea into practice through his work as chair of COP², an organization that curates coalitions of experts, advocates, care providers, decision-makers and funders to support projects that are co-created with local communities living on the front lines of the climate crisis.

“What I think is really exciting,” he tells hosts Mark Masselli and Margaret Flinter, “is that the climate pressures have generated some powerful forms of local organizing and intersecting actions.”

Why NIH’s Dr. Collins Accompanies Opera’s Renee Fleming in Highlighting Music & Mind’s Power

What happens when music therapists and neuroscientists team up? Patients win, says Dr. Francis Collins. From adults with Parkinson’s disease to children with autism, music has the power to help people walk, talk, ease pain and so much more.

Dr. Collins recently stepped down from his role as the longest-serving director of National Institutes of Health. As he faces a personal battle against prostate cancer, he’s exploring the promising impact that music and art therapy could hold for patients with health challenges.

Dr. Collins is hoping to develop a deeper understanding of music’s influence on brain circuitry. The goal? To help patients ease the symptoms of conditions like chronic pain, post-traumatic stress disorder and dementia.

His interview with hosts Mark Masselli and Margaret Flinter is a follow-up to a conversation with opera singer Renée Fleming about her new book “Music and Mind: Harnessing the Arts for Health and Wellness,” for which Dr. Collins wrote the foreword.

Opera Superstar Renée Fleming & Experts Reveal How Music Can Make Us Healthier in New Book

She’s received worldwide praise for singing at the Super Bowl, during a presidential inauguration and regularly for The Metropolitan Opera, but Renée Fleming is stretching her voice in new ways. 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.

This special edition of “Conversations on Health Care” will continue on April 18 with guest Dr. Francis Collins, the former National Institutes of Health director, who’s written the foreword to Renée’s book.

Reporters' Roundtable: Why Health Care Will Impact the Election—But To Whose Advantage?

It’s about seven months to election day and our regular panel of health care journalists sees a lot of divisions in the electorate. Joyce Frieden, who’s in charge of MedPage Today's coverage of Washington and health policy, says the debate over abortion is driving voter interest. Yet Ben Leonard, a health care reporter at POLITICO, notes that Republican voters place issues such as immigration ahead of health care.

Meanwhile, Nathaniel Weixel, a health policy reporter for The Hill, says the health care sector should consider itself a winner for avoiding the chopping block during the recent federal budget showdown. This trio of journalists joins hosts Mark Masselli and Margaret Flinter to share their insights about their news stories including Washington’s take on artificial intelligence in health care and efforts to get federal dollars for the new obesity drugs.

Expanded Coverage of Weight Loss Drugs? Diabetes Advocates Say Yes

Medicare just announced that it will pay for weight loss drugs if patients using them also have heart disease and need to reduce the risk of future heart attacks and strokes. Medicare has already been covering the costs of the GLP-1 class of drugs to treat diabetes problems. However, Medicare Part D plans are still restricted by law from covering obesity medications used for chronic weight management alone.

It’s a decision the American Diabetes Association would like to see overturned. “It really is important that we try to get upstream of diseases…we know that obesity is a disease and it’s a bigger driver to the increasing number of people developing diabetes…it’s important that people have access to treatments that are effective. Medicare isn’t covering that [obesity] treatment and that’s something we’ve been advocating for,” says Dr. Robert Gabbay, chief scientific and medical officer for the American Diabetes Association

Dr. Gabbay also tells hosts Mark Masselli and Margaret Flinter that anybody with diabetes on insulin should have access to a continuous glucose monitor and the ADA is proud that it helped secured Medicare coverage for such monitors.

Young Deaths from Colorectal Cancer Skyrocket as New Research Emerges

The recent death of former college football player Craig Roh from colon cancer at age 33 has brought attention to the “alarming” increase of colorectal cancer in young people. The American Cancer Society reports colon cancer is now the most common cause of cancer deaths in men under 50 and second for women under 50.

Dr. Alan Venook at the University of California-San Francisco is one of the nation’s leading colorectal cancer researchers. March is Colorectal Cancer Awareness Month and Dr. Venook explains to “Conversations on Health Care” hosts Mark Masselli and Margaret Flinter how to stem the rise in cases among young people.

Dr. Venook also talks about his research that found there’s no compromise in colorectal cancer patient survival or the risk of recurrent cancer over time with less radiation—a finding that goes against conventional wisdom.

Super Sperm Donors - America’s Underground Surrogacy Movement: Author Explains Her Journey

The family planning revolution has a new chapter and journalist Valerie Bauman is both documenting it and participating in it. She and others pursuing alternatives say they’re frustrated with fertility clinics because of the cost, what they call the discriminatory nature of the system and the lack of insurance coverage. Bauman explains how she met her sperm donor and why others like her say it makes sense for them.

Hosts Mark Masselli and Margaret Flinter interview Bauman about her upcoming book “Inconceivable: Super Sperm Donors, Off-the-Grid Insemination, and Unconventional Family Planning.”