On this episode of the Health Policy Podcast, Jeffrey Smith, resident senior fellow at the R Street Institute, discussed tobacco harm reduction, vaping policy, nicotine products and the role of science in shaping FDA regulation.

Smith explained how his background in neuroscience and neuroplasticity led him to study nicotine and reduced-risk tobacco products, including vaping devices and nicotine pouches. Smith said combustible cigarettes remain the most dangerous nicotine delivery system and argued that reduced-risk products such as electronic nicotine delivery systems (ENDS), nicotine pouches and Swedish-style snus may help adult smokers move away from smoking-related disease. He discussed the FDA's evolving approach to vaping regulation, public confusion around nicotine products and the debate over flavored vaping products.

The conversation also explored declining youth smoking rates, the political controversy surrounding vaping policy and why Smith believes policymakers should focus on scientific evidence and consumer behavior when crafting tobacco harm reduction regulations. Smith said the United States still sees roughly 500,000 smoking-related deaths annually and argued that innovation and consumer choice could play a role in reducing those numbers over time.

Terry Wilcox, Co-founder and CEO of Patients Rising, discusses the critical gap between FDA approval and patient access for new early-onset Alzheimer's treatments. She shares personal insights from her experience as a caregiver and explains how the ASAP Act aims to fix the policy hurdles preventing families from accessing life-changing innovation.

Phil Kerpen, President of American Commitment, joins the show to discuss why hospitals often escape public blame for rising healthcare costs despite vertical price increases. He explains how tax-exempt status, "facility fees," and the consolidation of independent physician groups have eroded competition. The conversation also explores the massive lobbying power of health systems and how federal regulations like the medical loss ratio inadvertently incentivize higher spending.

Dr. Jeremy Levin, author of 'Biotech in the Balance,' explains why small biotech firms—not Big Pharma—are the true engines of medical discovery. He discusses the sector's unique capital risks and the growing public distrust that threatens the future of American innovation.

Economist Wayne Winegarden joins the podcast to expose how the 340B Drug Discount Program evolved from a small safety net for rural clinics into a \$100 billion revenue engine for massive hospital systems. He explores how misaligned incentives drive up drug spending, fuel hospital consolidation, and why transparency is the first step toward reform.

Treatment-resistant depression (TRD) affects millions of Americans and carries significant personal, clinical, and economic consequences. In this episode of the Health Policy Podcast, host Bryan Hyde speaks with Dr. William Sauvé, Chief Medical Officer of Osmind, and Mark Desmarais, Principal at Health Management Associates, about new research examining the impact of TRD on patients and the healthcare system.

Drawing on a comprehensive analysis of Medicare claims data, Desmarais explains how patients with TRD generate approximately $8,000 more in annual healthcare costs than patients whose depression is effectively managed. The discussion explores the reasons behind these costs, including higher rates of physician visits and hospitalizations, as well as their impact on both individuals and caregivers.

Dr. Sauvé, a psychiatrist with extensive experience treating complex depression cases in both military and civilian settings, discusses TRD, the challenges patients face after multiple unsuccessful medication trials, and the importance of identifying effective treatments. The conversation also examines workforce shortages in mental health care, barriers posed by prior authorization requirements, and how delaying effective treatment can worsen patient outcomes and increase healthcare spending.

Drug policy analyst Layal Bou Harfouch discusses the unintended consequences of New Mexico's SB 42, which allows the state to mandate treatment or remove newborns based on substance exposure. She explores how centralized, one-size-fits-all mandates bypass clinical assessments and create dangerous disincentives for mothers seeking prenatal care.

Dr. Gail C. Christopher, Executive Director of the National Collaborative for Health Equity, discusses the "Momnibus" Act and the multi-decade effort to eliminate racial disparities in maternal health. She shares promising policy shifts, including the expansion of Medicaid coverage for doula services and the bipartisan momentum behind comprehensive birth equity.

Pete Sepp, President of the National Taxpayers Union, joins the show to discuss why healthcare costs remain high, unpredictable, and opaque. Sepp breaks down the perverse incentives across the industry—from site-neutrality issues and "pay and chase" government models to the bureaucratic overhead that consumes up to 30% of expenditures.

On the Health Policy Podcast, attorney and mental health reform advocate Ellen Lubensky discusses her concerns about the use of psychiatric medications and the lack of informed consent in mental health care. Drawing from personal experience, she argues that patients are often prescribed medications during brief appointments without a full understanding of potential risks, including dependency and withdrawal effects. Lubensky calls for greater transparency from physicians, longer consultation times, and systemic changes in funding that would prioritize therapy and patient education before medication. She also highlights barriers within insurance and disability systems that may discourage alternative treatments. Her core message to listeners is to advocate for themselves, ask questions, and seek providers who take the time to explain treatment options thoroughly.