In Dobbs v. Jackson Women’s Health Organization, the Supreme Court in June 2022 reversed the court’s previous 1973 Roe v Wade decision, and 20 related cases, wiping out a half century of constitutional protections for women’s reproductive rights.  In Dobbs, the court found the Constitution now excludes a woman’s control over her body as well as the possible continuation of her life.  Compelled pregnancy, involuntary childbirth and forced parenthood is not, the court ruled, an essential part of the “liberty” protected under the 14th amendment - or presumably even the freedom of “involuntary servitude” protected under the 13th amendment.  Dobbs effectively demotes women to the status of an involuntary vessel entitled to no more respect than other forms of collectively-owned property.  Since some have termed the Dobbs decision a “break the glass” moment, Ms. Hoffman has published her “post-Roe abortion rights manifesto,” that leverages her five decades of reproductive rights work to shed light on the repercussions of overturning Roe and work she believes now needs to be done, or redone, to ensure the safety and legality of reproductive rights. 

Ms. Merle Hoffman is an American author, activist, feminist health care innovator who established one the first abortion clinics in the US, CHOICES Women’s Medical Center in Queens, New York. CHOICES also provides prenatal care, all-options counseling, GYN visits, mental health services, and trans health services.  Ms. Hoffman was the publisher and editor-in-chief of On the Issues magazine (1983–99) and is also the author of Intimate Wars (Feminist Press, 2012). She is the cofounder of the National Abortion Federation.

Information on Ms. Hoffman’s book is at: https://www.skyhorsepublishing.com/9781510776951/choices/.

Over the past 12 years this podcast has discussed increasing corporate dominance of healthcare delivery, made evident in part by the fact the healthcare market is highly concentrated and highly leveraged, e.g., over the past decade private equity has spent roughly $1 trillion to acquire physician practices.  The corporate practice of medicine (CPOM) is problematic because allowing for corporate medicine can compromise a physicians’ independence and/or creates a conflict between physicians’ ethical duty to their patients and corporate interests in maximizing profits.  While states have historically prohibited corporate medicine, enforcement has both been limited and every state has created CPOM exceptions.  In part because the Biden administration has given priority implementing regulatory policies to promote market competition, there is renewed interest in revising corporate medicine statutes.   This past fall the AMA considered a resolution seeking a federal ban on CPOM informed in part by a 70-page report published last October by Take Medicine Back.  AMA delegates voted to refer the resolution to the AMA Bd of Trustees for further study. 

Dr. Mitchell Louis Judge Li is a practicing board certified emergency physician in North Carolina and founder of Take Medicine Back. Dr. Li has been an invited speaker to represent physicians to the FTC on the effects of mergers and acquisitions on healthcare, has spoken as a panelist at the Capitol Forum’s Conference on Healthcare Competition, and currently serves as the only physician-advisor to the Robert Wood Johnson Foundation’s committee on healthcare financialization. Dr. Li earned his MD at the University of Massachusetts and completed his emergency medicine residency at St. John Hospital in Detroit.

Information on Take Medicine Back is at: https://takemedicineback.net/. Their 70-page working paper discussed during this interview is at: https://qrco.de/beUEJm.

Sen. Warren’s Take Medicine Back video noted during the discussion is here.

Research published last month in Advances in Atmospheric Sciences by Prof. Abraham and his colleagues once again show ocean temperatures, more specifically ocean heat content (OHC), once again dramatically increased in 2023.  (As I noted last year, many believe OHC is the best way of measuring anthropocentric warming because it is comparatively less variable on a year-to-year basis.)  Oceans, that cover over 70% of the earth’s surface, absorb roughly 90% of the sun’s heat trapped by an increasing Earth Energy Imbalance (EEI) due to our continuing inability to meaningfully curb our greenhouse gas emissions.  Oceans also serve as immense carbon sinks. Oceans determine the Earth’s energy, water and carbon cycles and increasingly warming oceans have an increasingly deleterious effect on the Earth’s climate and weather. Think: human survival, i.e., warming ocean water (and rising ocean acidification) disrupts marine life that in turn substantially threatens the availability of food we eat and the oxygen we breathe. 

John Abraham, Ph.D., is a Professor and Program Director in the Mechanical Engineering Department at the University of St. Thomas in Minnesota.  His studies largely concern geophysical science related to the climate crisis that includes the rate at which the planet is warming, particularly oceans.  His team’s warming measurements provide insights on future climate crisis effects over the coming decades.  Professor Abraham also studies the impact of increasing heat on the human body - information that has important health consequences particularly for at risk and minority populations.   Professor has conducted approximately 400 published scientific studies.  He is a frequent television and radio guest having participated in over 100 TV and radio interviews.   Professor Abraham earned his BS, MS and Ph.D. in  mechanical engineering at the University of Minnesota.

Prof. Abraham and his colleagues’ January Advances in Atmospheric Sciences article, titled “Another Year of Record Heat for the Oceans” is at: https://link.springer.com/article/10.1007/s00376-023-2385-2.

In his soon-to-be-published book, Dr. Chaudhary argues the climate crisis or the Anthropocene era is the political product of rightwing climate realism - what he terms the “Rex Tillerson Position.”  Listeners should be aware politics, not technology or economics, explains why the US continues to emit an enormous amount of CO2e pollution. (The US healthcare industry contributes approximately 550 MT CO2e annually or roughly 9% of the nation’s total.) The politics of functional climate denialism, or the belief business-as-usual can mitigate global warming, has resulted in economic, ecological and social despair, disenchantment or in sum socioecological exhaustion.  What capitalism has built, Dr. Chaudhary argues, is an exhausted world.  Any workable solution or any effort to create a sustainable environmental niche requires a new climate realism.  Real ecomodernism he argues must be in sum grounded in decolonization - that essentially means the Global North no longer exploits the Global South.

Ajay Singh Chaudhary is the Executive Director of the Brooklyn Institute for Social Research and a core faculty member specializing in social and political theory. He holds a PhD from Columbia University and an MSc from the London School of Economics. His research focuses on social and political theory and economy, political ecology, media, religion, and post-colonial studies. He has written for The Guardian, The Nation, The Baffler, n+1, Los Angeles Review of Books, Quartz, Social Text, Dialectical Anthropology, The Hedgehog Review, Filmmaker Magazine, and 3quarksdaily, among others.

Information on the book is at: https://www.penguinrandomhouse.com/books/736324/the-exhausted-of-the-earth-by-ajay-singh-chaudhary/.

Sepsis presents an enormous public health threat. There are for approximately 1.7 million hospital cases and 270,000 deaths per year. Sepsis is consistently in the top five for hospital case volumes and is the most expensive and resource intensive medical inpatient condition, representing approximately 15% of total hospital costs despite accounting for less than 4% of hospital stays.  Various studies estimate sepsis is present in 30% to 50% of hospitalizations that culminate in death.  Because two-thirds of sepsis cases are paid for by Medicare, beginning this January 1, HHS will add sepsis care Medicare’s Value-Based Purchasing/VBP program. Meaning, Medicare hospital reimbursement will be determined in part on adherence in meeting a multi-step sepsis treatment protocol focused on timely diagnosis and treatment.  Dedicated listeners of this podcast may recall ten years ago this week I interviewed Dr. Jim Palmer regarding the use of heart rate variability to identify the onset of infection.

During this 23-minute interview Dr. Scoggins begins by explaining why timely diagnosis of sepsis has remained challenging and why the Medicare program will now tie reimbursement to meeting a sepsis quality measure or protocol. He explains the SEP-1 measure, addresses concerns regarding the sepsis measure driving antibiotic overuse and administrative burden, whether paying for sepsis performance will unduly penalize hospitals serving poorer communities, how the Medicare rule will impact his program, comments on emerging technology improving sepsis diagnosis, the extent to which commercial payers will adopt a similar sepsis pay for value payment rule and finally why we are seeing more sepsis infections and mortality.

Robert Scoggins, MD, PhD, has been a practicing medicine for over twenty years as a pulmonary and critical care physician. He currently is Chief of Staff and ICU Medical Director at Kootenai Health in Northern Idaho. He earned his undergraduate degree in Molecular Biology from Vanderbilt University and his MD and a Ph.D. in Microbiology at the University of Virginia. Dr. Scoggins completed his residency in Internal Medicine and a fellowship in Pulmonary and Critical Care at Vanderbilt University.

In part because there are over 10,000 known human diseases and symptoms thereof may have numerous possible explanations, frequently diagnostic tests can be in-determinative or less informative than observing (termed: watchful waiting) a suspected disease’s clinical course over time.  Because of diagnostic complexities population level diagnostic errors represent a significant public health problem.  Nevertheless, despite the progress made in treating cancer - as Ropeik writes in his introduction two-thirds of nearly 200 types of cancer are either treatable as chronic diseases or entirely curable - cancer today remains the emperor of nosophobias that in turn leads to over-screening, over diagnosis and false positives, over treatment, potentially harmful side effects, death and excessive healthcare budgeting and wasteful spending.  As one reviewer of the book wrote, “Ropeik details how the gravity force of cancerphobia warps risk perception, leading to personal and societal harms and legislative misdirection.” 

During this interview Mr. Ropeik begins by clarifying the book’s discussion is at the population level, disputes the belief cancer always needs be diagnosed as soon as possible and describes the US Preventive Services Taskforce’s (USPSFT’s) work upon which his book is based. He next discusses USPSTF’s (evolving) mammography screening recommendations for breast cancer, the prevalence of associated false positive diagnoses particularly related to DCIS (ductal carcinoma in situ). He discusses his chapter regarding environmental agents as cancer agents or contributing to the fear of cancer, the lack of a relationship between federal funding and the burden of disease, e.g., breast v pancreatic cancer funding. He concludes by discussing policy solutions that can simultaneously reduce cancer phobia and improve the effectiveness and cost cancer care.

Mr. David P. Ropeik is a retired Harvard University Instructor, author, and international consultant on risk perception, risk communication, and risk management. He worked as a television reporter for WCVB-TV in Boston from 1978 – 2000 specializing on environment and science issues, wrote a science column for The Boston Globe, taught journalism at Boston University, Tufts University, and MIT, was a Knight Science Journalism Fellow at MIT and a member of the Board of Directors of the Society of Environmental Journalists. Mr. Ropeik previously published “How Risky Is It, Really? Why Our Fears Don’t Always Match the Facts,” (2010, McGraw Hill), and co-author of “RISK, A Practical Guide for Deciding What’s Really Safe and What’s Really Dangerous in the World Around You,” (2002, Houghton Mifflin). Mr. Ropeik has also authored more than 50 articles, book chapters, and other essays on risk perception and risk communication published in The New York Times, The Washington Post, The Los Angeles Times, USA Today, Scientific American, The Atlantic Monthly, Health Affairs, Issues in Science and Technology and elsewhere. He writes a blog for Psychology Today and blogged at Big Think and The Huffington Post. Among numerous awards Mr. Ropeik is a two time winner of the DuPont-Columbia Award and seven regional EMMY awards.

Information on “Curing Cancer-Phobia” is at: https://www.press.jhu.edu/books/title/12956/curing-cancerphobia.

According to the non-profit Mapping Police Violence, since 2013 when experts first starting tracking police shootings, last year was the deadliest year on record with 1,176 law enforcement gun deaths, or more than three people per day and nearly 100 per month.  In 2022 Blacks were three three times more likely to be killed by police than Whites.  However in, for example, MPLS and Chicago, Black shooting deaths were respectively 28 and 25 times more likely than White.   In her recently published book by Viking Press, Prof. Schwartz explains how the corruption of the 4th amendment and Civil Rights law, the creation of the legal fiction “qualified immunity” and other reasons make it nearly impossible to police the police.  

During this 38-minute interview, Prof. Schwartz begins by discussing the case of Ornee Norris. She in turn explains the courts’ undermining of 4th amendment’s protection from unreasonable searches, civil rights protections, specifically section 1983 of the 1871 Civil Rights Act, and the Supreme Courts 1967 creation of, in Pierson v. Ray, of qualified immunity, discusses the case of systematic violence by Vellejo, CA, police, the failure by governments to learn from these cases, efforts by states to pass laws ending qualified immunity, notes the value of Freedom of Information Act (FOIA) requests, and finally comments on the issue of the militarization of the police.

Joanna Schwartz is Professor of Law at UCLA School of Law and the Faculty Director of the David J. Epstein Program in Public Interest Law and Policy.  She was a recipient of UCLA's Distinguished Teaching Award in 2015 and served as Vice Dean for Faculty Development from 2017-2019. Beyond Shielded, her recent scholarship has been published in the Yale Law Journal, Stanford Law Review, University of Chicago Law Review, Columbia Law Review, New York University Law Review, Michigan Law Review, Northwestern Law Review, Georgetown Law Journal, UCLA Law Review, and elsewhere. She has also written for The New York Times, The Washington Post, The Los Angeles Times, USA Today, The Atlantic, The Boston Review, and Politico, and has appeared on NPR’s Fresh Air, CBS Sunday Morning, PBS NewsHour, ABC News, CNN, MSNBC, and elsewhere. Professor Schwartz is also co-author with Stephen Yeazell and Maureen Carroll of a leading casebook, Civil Procedure (11th Edition). Professor Schwartz was graduated from Brown University and Yale Law School. She clerked for Judge Denise Cote of the Southern District of New York and Judge Harry Pregerson of the Ninth Circuit Court of Appeals.  

US healthcare emits a massive amount of carbon pollution at approximately 600 million tons annually or roughly 9% of total US greenhouse gasses.  Because of the rapid increase in climate crisis-related harms projected economic losses worldwide over the next few years are estimated in the trillions.  Consequently, the US is beginning to follow Brazil, Canada, France, Japan, Switzerland and the UK in mandating GHG emission and climate-risk disclosures.  Most noteworthy, in April 2022 the Security Exchange Commissions (SEC) issued a proposed rule, anticipated to go final this month, that will require publicly traded companies to disclose information about climate-related financial risks and financial metrics to inform investors in making corporate investment and voting decisions.  Just recently the California governor signed a “Climate Accountability Package,” the White House in late September charged the OMB to work with fed agencies to measure GHG emissions in order to calculate impacts on fed programs and the European Union has moved related reporting regulations that will impact American companies doing business overseas.

During this 34 minute interview Ms. Hanawalt begins by outlining the proposed SEC climate disclosure rule. She next outlines CA’s “Climate Accountability Package (S253 and S261) that address CA reporting for different sized private and public companies and discusses related European Union regulatory rules.

Ms. Cynthia Hanawalt is the Director of the Sabin Center’s financial regulation practice. Her work supports regulatory and policy responses to climate-related financial risk at the federal and state level and includes a focus on the complex intersections of ESG and antitrust law with sustainability goals and climate resiliency measures. Ms. Hanawalt is affiliated with Columbia Climate School and the Initiative for Climate Risk & Resilience Law. Prior to joining the Sabin Center, Ms. Hanawalt served as Chief of the Investor Protection Bureau for the New York State Office of the Attorney General and was a litigation partner at the firm Bleichmar Fonti & Auld. She was graduated from Columbia Law School where she was a Harlan Fiske Stone Scholar and Duke University where she received the William J. Griffith University Service Award.

For more information regarding climate disclosure see these Sabin Center writings:

https://blogs.law.columbia.edu/climatechange/2023/08/08/new-california-legislation-would-be-a-major-step-forward-for-climate-disclosure/

https://blogs.law.columbia.edu/climatechange/2023/03/28/global-consensus-is-emerging-on-corporate-scope-3-disclosures-will-the-sec-lead-or-lag/

US healthcare spending is extreme currently at approximately $4.3 trillion.  The single largest payer of healthcare services is Medicare at roughly $900 billion annually or 21% of total healthcare spending.   In this edited volume, recently published by Johns Hopkins University Press, Dr. Moffit along with eleven other contributors including Joe Antos, Douglas Holtz-Eakin, Brian Miller, Mark Pauly and Gail Wilensky, lay out the conservative version of Medicare reform.  In sum, the authors argue federal policymakers reinvent Medicare as a defined contribution or premium support program or at minimum substantially expand the Medicare Advantage program (Medicare Part C), or Medicare coverage provided by private insurance companies. 

The interview begins by Dr. Moffit commenting on whether healthcare services can be defined as a market commodity. He discusses the problem of healthcare pricing, measuring for value in healthcare, improving Medicare Advantage benchmarking, remedying Medicare Advantage coding intensity via retrospective risk adjustment and risk transfer pools and competing fee for service Accountability Care Organizations (ACOs) against Medicare Advantage.

Dr. Robert Moffit is a Senior Fellow in Domestic Policy Studies at The Heritage Foundation specializing in health care and entitlement programs, moreover Medicare. Dr. Moffit also serves on the Maryland Health Care Commission as an appointee of Gov. Larry Hogan and he is a member of the advisory board of the Buckley School of Public Speaking in Camden, South Carolina. He brings to the reform effort experience as a senior official of the U.S. Department of Health and Human Services (HHS) and the Office of Personnel Management (OPM) during the Reagan administration. Dr. Moffit is a co-author of “Why Obamacare Is Wrong for America,” (Harper Collins, 2011). He was a contributor to “A Time for Governing: Policy Solutions From the Pages of National Affairs” (Encounter Books, 2012) and “Controversial Issues in Social Policy” (Allyn and Bacon, 2003), a university textbook on public policy. He has published in numerous professional and specialty journals among them Health Affairs, Health Systems Review, Harvard Health Policy Review, Inquiry, Journal of Law, Medicine and Ethics, National Affairs, New England Journal of Medicine, Postgraduate Medicine, and Journal of Medicine and Philosophy. His analysis and commentary have been cited or published by The New York Times, The Wall Street Journal, The New York Post, The Washington Post and The Washington Times. He holds a master's degree and a doctorate in Political Science from the University of Arizona. He received his bachelor's degree in Political Science from LaSalle University in Philadelphia.

Information on “Modernizing Medicare,” is at: https://www.press.jhu.edu/books/title/12839/modernizing-medicare.

Over the past several decades healthcare has increasingly defined patients as medical consumers.  For example, healthcare advertising is today a $22 billion annual business; federal policymakers have over the past few years instituted regulations requiring both hospitals and commercial health plans to make pricing information public; and, provider quality performance information is increasingly publicly reported.   The question begged is to what extent have efforts to define patients as medical care consumers been successful - or even legitimate.  In “Remaking the American Patient,” winner of the prestigious Bancroft Prize, Prof. Tomes explains how over the past century the public or patients have increasingly been defined as medical consumers and evaluates whether medical consumerism, or medicine as a commercial product, has served the public or patients’ interests and/or has transformed American healthcare for the better.

During this 37-minute discussion Prof. Tomes begins by explaining what prompted her to write the book. She discusses the inherent problems with defining patients as consumers and medicine as a commodity, what explains the origin of patient/medical consumerism (largely uniquely American), discusses the 1973 Patients Bill of Rights as an exemplary patient empowerment effort and the ongoing or never-ending tension between medical professionalism and patient consumerism. She concludes by summarizing her findings and what capacity there is to resolve the conflict between professionalism and consumerism or change the paradigm.

Prof. Nancy Tomes is Professor History at Stony Brook University. Her publications include: Madness in America: Cultural and Medical Perceptions of Mental Illness Before 1914, with Lynn Gamwell (Cornell, 1995), The Gospel of Germs: Men, Women and the Microbe in American Life (Harvard, 1998), and Remaking the American Patient: How Madison Avenue and Modern Medicine Turned Patients into Consumers (UNC, 2016); plus two co-edited collections, Medicine's Moving Pictures, with Leslie Reagan and Paula Treichler (Rochester, 2007), and Patients as Policy Actors, with Beatrix Hoffman, Rachel Grob, and Mark Schlesinger (Rutgers, 2011); and a website, "Medicine and Madison Avenue," on the history of health-related advertising, developed in collaboration with Duke University Library's Special Collections.  Prof. Tomes was graduated from the U. of Pennsylvania with a Ph.D. in History.

Information on “Remaking the American Patient,” is at: https://uncpress.org/book/9781469622774/remaking-the-american-patient/.

Professors Albritton Jonsson and Wennerlind’s recently published book, “Scarcity” by Harvard University Press, offers interpretations of a key concept in economic theory: scarcity, or the belief we live in a world of limited resources and therefore must master the natural world to meet desired needs.   The authors state, “the book does not offer a critique of the usefulness of the neoclassical concept of scarcity, instead, the problem we highlight is that it has been far too successful,” that is “by promoting optimal use of resources and maximum economic growth, it has fostered a world in which the economy and nature are on a collision course.”  As a result our economic success has endangered both our health and survival via the use of fossil fuels to power our economy.  

This 37-minute interview begins with brief descriptions of two umbrella categories of scarcity the authors define: Cornucopian; and, Finitarian. They identify subcategories within these two categories and thinkers throughout history who can be categorized into sub-categories of scarcity of, e.g., enlightened, capitalist and neoclassical and neo-Aristotelian, Utopian, Malthusian, Romantic, Socialist and Planetary. The authors comment on Diamandis and Kotler’s argument regarding negativity bias. They discuss the benefit of taking a long view, here 500 years, to free today’s thinkers of taking alternative views of the world to challenge current dominate neoclassical view of scarcity and economics and discuss the book concluding on the the concept of repair.

Frederik Albritton Jonsson is an Associate Professor of History at the University of Chicago and Carl Wennerlind is a Professor of History and Chair of the History Department at Barnard College at Columbia University.

The authors bios are at: https://history.uchicago.edu/directory/fredrik-albritton-jonsson and and https://history.barnard.edu/profiles/carl-wennerlind.

Information on the book can be found at: https://www.hup.harvard.edu/catalog.php?isbn=9780674987081.