healthcare reform

Chronic stress can be at the root of everything from mental health struggles to digestive problems to heart disease.  Today on Raise the Line, we’re going to learn about a wearable device made by Apollo Neuroscience that uses gentle vibrations to help the body adjust to stress. “Apollo is based on all the same principles that music is based on. It's wearable music for your body,” explains the company’s co-founder and chief medical officer Dr. David Rabin, a neuroscientist, psychiatrist, health tech entrepreneur and inventor who has been studying the impact of chronic stress in humans for over fifteen years.  A close reading of non-Western medical practices led him to realize that, generally speaking, the focus was on reducing the “fight or flight” response and increasing our parasympathetic rest and recovery system. With that in mind, the Apollo device acts on the vagal nervous system with a gentle vibration that delivers safety signals to your skin in the form of low frequency music that you can't really hear, but you can feel. In this revealing conversation with host Shiv Gaglani, you’ll learn more about how and why Apollo works and its connection to Rabin’s interests in psychedelic-assisted therapy, the importance of safety in the provider-patient relationship, and how to effectively blend Western, Eastern and tribal approaches to medicine and healing. 

Mentioned in this episode: https://apolloneuro.com/

You may have seen today’s guest, Dr. Raj Dasgupta, on Chasing the Cure, The Doctors, CNN or ABC News and if so, you’ll understand why he is an award-winning medical educator and a force in the field. His irrepressible enthusiasm for patient care and teaching pours out in every moment of this fun and illuminating conversation with host Shiv Gaglani. “I really have this desire to make my teaching engaging and educational at the same time. To be a good teacher, you have to change your style with the times and for who your audience is,” Dasgupta says. Beyond his work with students, residents and fellows at the Keck School of Medicine of USC and the many attendees at his USMLE exam prep classes around the world over the past twenty years, Dr. Raj has touched a multitude of others through a series of books published by Elsevier that include the popular Morning Report: Beyond the Pearls and Case Reports: Beyond the Pearls. It’s a wide-ranging discussion -- he is quadruple board certified in pulmonary, critical care, sleep, and internal medicine, after all -- that offers insight on everything from licensing exams to AI to mentorship to battling burnout to the power of a smile. Don’t miss this whirlwind wisdom drop from the kind of teacher you always wish you had. 

Mentioned in this episode: The Dr. Raj Podcast

Something as complicated as starting a medical school is bound to include unanticipated obstacles, but few schools can match the roller coaster ride of the American Canadian School of Medicine in the Commonwealth of Dominica which just welcomed its first class of students. Our Raise the Line guest, Dr. Ramin Ahmadi, along with colleagues from Yale and Penn State medical schools, had worked for years to design an innovative curriculum and train faculty for a new medical school in Kazan, Russia. Then came Russia’s invasion of Ukraine. “Because of the war, we had to pull out. That was the end of the project at that point and we were all very sad,” Ahmadi tells host Shiv Gaglani. Tune in to learn how the project was given new life and how Ahmadi and his team are meeting the needs and preferences of modern students with a flipped-classroom, case-based approach to education. You’ll also hear about ACSOM’s different approach to clinical training, new model for residency programs and other innovations. And be sure to stay tuned to hear about his remarkable experiences in global health and human rights, and gain from his insights on how physicians can protect themselves from burnout.

Mentioned in this episode: https://www.acsom.edu.dm

Of the many hopeful developments in psychedelic research in recent years, perhaps the most important is that FDA approval of MDMA-assisted therapy for treating post-traumatic stress disorder appears likely within the next year. That prospect is due in no small part to our Raise the Line guest, Dr. Michael Mithoefer, who has spearheaded clinical trials of MDMA-assisted therapy for more than twenty years and is a senior leader at the Multidisciplinary Association for Psychedelic Studies Public Benefit Corporation which has led this groundbreaking research. Although he notes that FDA approval isn’t guaranteed, Mithoefer is contemplating what the practicalities will be of implementing this multi-stage therapy regimen, and he has cause for concern. “I think now the question is going to be, if it's approved, how does it fit into this medical system we have, which I think is quite dysfunctional, especially with mental health. To me, the challenge is going to be not to try to distort the treatment to fit the system,” he tells host Shiv Gaglani. In this enlightening conversation, Shiv and Dr. Mithoefer discuss the need for specialized therapist training, the importance of making the therapy available regardless of ability to pay, and other potential therapeutic uses for MDMA. This is a great opportunity to hear from an important voice about the current and future state of psychedelics as a treatment modality. 

Mentioned in this episode: https://mapsbcorp.com/

On this episode of Raise the Line, we’ll introduce you to a relatively new company in the digital health space focused on treatment-resistant mental health patients, which constitute about 30% of people in the US with a mental health diagnosis. Our guest is Jimmy Qian, the co-founder and president of Osmind, who believes mental health practitioners could benefit from a more data-driven approach. “We can't understand the biology of neuropsychiatry unless we get more and more multimodal data and work together as a scientific community to really understand how mental health even works, and that requires rethinking diagnosis and treatments from the ground up using data,” says Qian. As he tells host Shiv Gaglani, Osmind is sharing its data with researchers to help improve scientific understanding of hard-to-treat conditions and has already published two studies with Stanford, including the largest ever real-world analysis of ketamine as a treatment for depression.  Check out this informative conversation to learn how Osmind’s platform is also giving patients the opportunity to provide real-time information on how they're doing between visits and helping providers smooth out their workflow.

Mentioned in this episode: https://www.osmind.org/

If you were to name one thing that could simultaneously increase patient satisfaction and reduce provider burnout, would empathy come to mind? Well, based on research published in peer-reviewed journals, it should, as we’ll learn from our Raise the Line guest Dr. Helen Riess, a clinical professor at Harvard Medical School and author of the book, The Empathy Effect. Trained as a psychiatrist, Riess has built a training program based on the neuroscience of emotion that bucks the prevailing wisdom that empathy is an inborn trait that can’t be taught. “I feel your pain is not just a figure of speech. We actually do feel other people's pain and our very survival depends on it,” Riess explains to host Shiv Gaglani. The company Riess founded and leads, Empathetics, has put thousands of clinicians and frontline staff through its e-learning courses with impressive results including major increases in patient experience scores and improvements in staff retention with the longest follow-up case study showing an 82.9% decrease in turnover among participating clinicians. In a nutshell, the training builds perception of emotion and fosters a deeper understanding of what Riess calls ‘the whole person.’ “You know, not just the broken wrist, but what does the broken wrist mean for a sixty-five-year-old woman who is the only caretaker for her grandchild?” Join us for a fascinating look at the neuroscience of empathy and its role in transforming the culture of healthcare.

Mentioned in this episode: https://www.empathetics.com/

The value of early detection is perhaps greater for cancer than many other diseases because it remains the second leading cause of death worldwide. On this episode of Raise the Line we're going to learn about a new testing approach that leverages genomic technology and machine learning to detect signals circulating in the blood across more than 50 types of cancers -- far beyond the number currently screened for -- and helps physicians target locations for diagnostic evaluation. “We can look at this epigenetic pattern on very specific regions of the DNA and say this is only seen in cancer, and make a call,” says Dr. Josh Ofman, the president of GRAIL, a spinoff of the genomic sequencing company Illumina. “We have an opportunity now to dramatically improve the number of cancers found in the population through early detection. We could reduce the death rate over the next five years by almost forty percent,” he tells host Shiv Gaglani. Tune in to find out who qualifies for the test, what obstacles lie ahead and how GRAIL is working to educate physicians about this potentially powerful new option 

Mentioned in this episode: https://grail.com/

On this episode of Raise the Line, we have the privilege of hearing from one of the nation's top healthcare leaders, Dr. Joshua Gordon, who is the director of the National Institute of Mental Health. In that role, he oversees an extensive portfolio of basic and clinical research that seeks to transform the understanding and treatment of mental illnesses, paving the way for prevention, recovery and cure. “Our main role is in trying to make sure that good science is conducted in the service of furthering public mental health,” he tells host Shiv Gaglani. One area of NIMH research that gets less attention than breakthrough medicines is how to make it easier for healthcare systems and practices to adopt best practices and proven treatments. This not only helps improve patient outcomes, but Gordon says it is one element in addressing feelings of a lack of effectiveness that contribute to provider burnout. “If we can increase individuals’ efficacy by ensuring that they are trained in evidence-based approaches, and continue to make new treatments available to help those who aren't responding to the old ones, that's one way we can do that.” This is a rare opportunity to hear from a federal agency executive on some of the most pressing and interesting issues in healthcare including the shortage of providers, health equity, social determinants of health, telemedicine and the potential for psychedelics to treat mental health problems.   

Mentioned in this episode: https://www.nimh.nih.gov/

The Crucial Role of Psychedelic Therapy Guides - Mary Cosimano, Former Director of Guide and Facilitator Services at The Johns Hopkins Center for Psychedelic and Consciousness Research

All of the promising research into the potential benefits of psychedelics in mental health treatment depends on having skilled professionals who can create a therapeutic alliance with participants and guide the sessions in which the compounds are administered. We could not have a betterRaise the Line guest for understanding this role than Mary Cosimano, LMSW, former director of Guide and Facilitator Services at the Johns Hopkins Center for Psychedelics & Consciousness Research. Since the genesis of psychedelic research there two decades ago, she has conducted over 500 sessions herself as well as serving as a research coordinator.  In this fascinating conversation with host Shiv Gaglani, Cosimano discusses how she prepares for and processes the often-taxing sessions, the common themes that emerge from participants, and what qualities effective guides need to have. On that point, she thinks the role needs to be open to chaplains, nurses, hospice care workers, and others with the right combination of experience and personal qualities, not just to licensed medical personnel.  “What’s as important is who they are, what they've done in their life and career, how much work have they done on themselves, do you feel comfortable with them?” This is a fascinating look into the heart of psychedelic-assisted therapy and the meaningful experiences participants can have when they are in the right hands.  

Mentioned in this episode: https://hopkinspsychedelic.org/

Caring for the Caregivers- Renee Panec, BSN, RN, HWNC-BC, CCM, CPHQ Highlights

"It brings up a lot of feelings, too, in caregivers in terms of not only overwhelm, but they may be sad about their current situation. They may experience feelings of... really of grief, of that loss of the life that they anticipated living. And now it's going to be a very different kind of life.

And it's often unacknowledged.  From whatever kind of life they've been living, whether they were professionals and had a professional job, or if they were a mom home with the kids, it's still huge." ~Renee Panec, BSN, RN, HWNC-BC, CCM, CPHQ

Ah-ha Moments

• What happens to the caregiver when a patient is discharged home, and they must do everything else they were doing AND care for their loved one?
• Are you pouring from an empty cup? What can you do to love and support yourself? What can you do for you?
• It’s ok to ‘bloom where you’re planted’ and use your skills exactly where you are, without feeling you need to change anything.
• Not sure where to begin, or who you want to work with?  Begin where you are. You have experience with something that others may not have.
• What stories have you been telling yourself that hold you back?  How could those stories be shifted to support you and what you want today?
• How can you nurture yourself to grow into who you want to be?
• Embrace your power Nurse… you have healing abilities filled with love, give it to yourself and then share it with others.

Links and Resources

Join Caring 4 Caregivers Facebook Group here

Integrative Nurse Coach Certificate Program

Listening with HEART blog

Bloom Where you’re Planted Nurse Coach blog

Whole Health Nursing, Inc.

Email: Renee@wholehealthnursing.com

*****

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Integrative Nurse Coach Academy I Integr 
Our mission is to provide nurses with a global community for learning, networking, and reconnecting 

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“We're really heading to a cliff when it comes to those expressing interest in healthcare careers,” cautions today’s Raise the Line guest Geoffrey Roche, director of Workforce Development in North America for Siemens Healthineers. Unfortunately, this drop-off in interest is happening as statistics on the current and future shortage of healthcare workers seemingly get worse by the day. One strategy the veteran hospital administrator and educator advocates is partnering with the K-12 system to provide early exposure to healthcare careers. “We have to show young people what the possibilities are. We've got to visually help an individual understand ‘this is what your career ladder could be.’ It could also help, he tells host Rishi Desai, if young people understood how much healthcare technology is powered by the same type of systems as video games. Citing the concerns that other industries do a better job of recruiting young people, Roche urges all healthcare organizations to have deep working relationships with educators. “If you’re not working with an academic institution to look at your needs of today and tomorrow proactively, strategically and tactically, then you're behind.” The good news is Roche sees examples of community partnerships and creative approaches to certification and apprenticeships that could yield results. Tune in to find out how bringing healthcare and education together at all levels can help fill the daunting gap in clinical and non-clinical staff that confronts our healthcare system. 

Mentioned in this episode: www.siemens-healthineers.com

Active and fun are rarely the first words associated with medical education, but today’s Raise the Line guest, Dr. Amin Azzam, contends learners get the most value when they can engage with their education rather than passively receive knowledge. As Azzam relates to host Hillary Acer, the vice president of Strategic Operations at Osmosis, he remembers first seeing the power of active learning while observing a class of med students as a psychiatry resident. “I sat behind a one-way mirror and watched these students leading their own small-group learning and it was just palpably infectious how excited they were to learn medicine.” In the ensuing years, Azzam has happily been utilizing and developing active learning strategies as a professor at three Bay Area universities and in his role as Faculty Engagement Coordinator at Osmosis, one of many key roles he has played as a longtime team member. One of his most impactful creative strokes was creating the first medical school course dedicated to improving the quality of health information on Wikipedia, both providing a unique learning experience and improving health content that has been viewed 88 million times by people around the world. Speaking of global impact, he’s also been instrumental in Osmosis initiatives to facilitate learning by medical students in war-torn Syria and refugees seeking medical care. Check out this lively and fascinating look at learner-centric education and the power of providing opportunities for students to do social good while learning. 

Mentioned in this episode:

Osmosis OMEF-ONSA Program

Wikipedia Education Foundation

“When we say ‘treatment for menopause,’ it implies that menopause is a disease, when really it’s a normal and expected time of life,” says Dr. Anna Barbieri, an integrative medicine physician and specialist in menopause certified by the North American Menopause Society. That attentiveness to word choice is reflective of a new perspective that’s driving Dr. Barbieri and her peers to see menopause more holistically than in the past and to forge new approaches to the care they provide. "Menopause care is not checkbox medicine. We have to work with our patients individually," Barbieri shares with special guest host Dr. Deborah Enegess, herself a practicing gynecologist as well as a clinical content writer for Osmosis. A personalized approach involves tailoring care plans that take exercise, nutrition, sleep, stress management and other lifestyle and psychological factors into account in an effort to help patients feel better in the short term and longer term.  Providers also have to contend with a shift in long-held thinking about the use of hormone therapy and a bewildering array of supplements that are touted as effective remedies for various symptoms.  To help sort through all of this complexity, new resources have come on the scene in recent years, including the digital platform Elektra Health -- of which Barbieri is the founding physician -- that describes its mission as “smashing the menopause taboo.” Check out this engaging exploration of what looks to be a promising time for women in search of individualized, integrated and informed care during their menopause journey.

Mentioned in this episode: https://www.elektrahealth.com/

We've been careful on Raise the Line to use the term psychedelic-assisted therapy because, as we've heard from previous guests, these compounds are best administered in the context of a therapeutic relationship in a safe, controlled setting. Today, we're going to focus on the therapy part of the equation with Dr. Mary “Bit” Yaden, an assistant professor of Psychiatry and Behavioral Sciences at Johns Hopkins University. Yaden contends that administering a two-to-three-month course of psychedelic-assisted therapy will be vastly different for professionals used to conventional mental health treatments that involve taking medications daily and which might or might not include long-term courses of talk therapy. “This is taking a pill twice, and participating in psychotherapy is integral to its success. This is not ‘maybe I feel better today taking an SSRI, but I'm not quite sure.’ This is deliberately taking a medicine that changes your mental state in a way that is not ordinary,” she tells host Shiv Gaglani. And while she’s encouraged by growing evidence that psilocybin and other compounds are showing therapeutic promise, she’s concerned about history repeating itself, as reflected in a 2021 article in JAMA Psychiatry she co-authored entitledPsychedelics and Psychiatry, Keeping the Renaissance from Going Off the Rails.  “I think a great tragedy could be if there is so much overblown hype that we become disenchanted too early or that we start allowing for practices that are not safe.” Don’t miss this highly engaging and instructive conversation on the full picture of psychedelic-assisted therapy.

Mentioned in this episode: https://hopkinspsychedelic.org/

“I really have challenged the students that have graduated from Duke the last couple of years to consider being ambassadors for science and for communication of what is good science,” says Dr. Mary Klotman, executive vice president for Health Affairs and dean of the School of Medicine at Duke University.  She notes that the stakes of disinformation are too high to do otherwise, as up to 300,000 COVID-19 deaths can be attributed to unfounded fears about one of the safest vaccines ever produced. It's just one of many educational imperatives Klotman is pursuing to prepare future clinicians for a constantly changing healthcare landscape. Others include helping students put new tools such as AI in the context of patient care, creating more opportunities to learn in ambulatory settings where 90% of healthcare is now delivered, and more multidisciplinary training to reflect a growing team approach to medical care. To help develop those interprofessional habits, Klotman has championed a “One Duke” approach. “Whether you're a student, senior investigator or a clinician, take advantage of the broad expertise here to solve a problem whether it's engineering in medicine, or it's data science. That is the nature of scientific problem solving today.” Join host Shiv Gaglani on this episode of Raise the Line for a wide-ranging look at how a leading academic center is innovating to adjust to dynamic changes in society, technology and healthcare.

Mentioned in this episode: 

Duke University School of Medicine

Duke's Program on Medical Misinformation

Instead of fretting about AI replacing jobs humans currently do, Dr. Nigam Shah is urging people to adopt a perspective about the technology that echoes President John Kennedy’s famous charge in his inaugural address: ‘ask not what this technology can do to you, ask what you can do with this technology.’ “If medicine simply automated everything we were doing 200 years ago, we’d have a machine that would do bloodletting. But we didn't fall into that trap,” says Shah, the chief data scientist at Stanford University. Instead, he suggests, people in the healthcare arena should think about what a human and a computer can do together that neither of them could do alone. In this fascinating episode of Raise the Line with host Shiv Gaglani, Shah also issues a call to action to the medical community about training AI for medical purposes. “If you really want to use these things, we have to create the instruction-tuning data so that they produce the output that we expect.” As for predictions of AI being the author of our salvation or doom, count him as skeptical. “I'm quite sure both sides are overblowing it for different reasons, and the truth will land somewhere in the middle. We’ve got to proactively pick the amazing and stay away from all the fearmongering.” There is much to be learned in this engaging conversation about the history of AI hype cycles, how to use AI to maximize productivity and the challenges inherent in AI-human interaction. 

“What's really exciting and scary in medical education right now is we're seeing large language models enter the scene,” says today’s Raise the Line guest Dr. Adam Rodman, who is well-placed to make such an assessment. As co-director of the Innovations in Media and Education Delivery Initiative (iMED) at the Beth Israel Deaconess Medical Center, Rodman is witnessing, and influencing, how new technologies are shaping both medical education and the future of healthcare.  In his view, AI can’t replace a doctor right now, but it can make remarkable insights into how humans think. “We need to start to grapple with what it means when a lot of these cognitive processes that medical education is designed to train for get offloaded to a machine,” he tells host Shiv Gaglani. He summarized his thoughts on AI, with co-author Dr. Avraham Cooper, in a piece for the August issue of the New England Journal of Medicineentitled “AI and Medical Education: A 21st-Century Pandora's Box” and invokes another concept rooted in ancient Greece as he describes AI as a ‘pharmakon.’ “There really is a way these technologies could dramatically improve what it means to be a patient -- and hopefully what it means to be a physician -- but the same technologies could be used to make things worse.” The ancient references are not surprising coming from Rodman, a medical historian who enjoys exploring the roots and evolution of the field on his long-running podcast Bedside Rounds. Don’t miss this richly informed conversation on how humans perform when interacting with AI, the advent of virtual tutors, and how AI might be used to improve student assessments and enhance the doctor-patient relationship.

When Munjal Shah and his colleagues chose to use Hippocratic in the name of their new AI-based company, it wasn’t just about signaling their product was involved with healthcare, it was also intended to leverage the ‘do no harm’ philosophy associated with the term. After all, formerly fanciful fears of ‘robots’ replacing doctors have become more realistic since the advent of generative AI last year.  Shah addresses that issue up front in this revealing Raise the Line episode with host Shiv Gaglani. “We're going to be restricting the product when it comes out. It's not going to be able to do diagnoses.” Instead, the platform will focus on serving the needs of patients after their diagnosis, especially for those with chronic conditions.  Shah sees his healthcare-specific chatbots answering questions about symptoms, medications, post-op care and other routine matters as a vast, virtual and low-cost expansion of the healthcare workforce. “What would happen in the world if we could have 30 million nurses? How much would America's health improve? That's the vision we're after.” And he argues that healthcare expertise available in every home in every language, 24-7 would be a major factor in improving access. “We want to really solve health equity for everybody.” Tune in to find out how Hippocratic AI plans to establish itself as a trusted source of accurate healthcare information, how they intend to manage AI’s ‘hallucination’ problem and how his system could actually improve patient engagement.  

Mentioned in this episode: https://www.hippocraticai.com/