Healthy Skeptic, MD

Older adults often have a more holistic perspective on the world than younger people. In today’s episode, Geriatrician Dr. Laura Mosqueda – a Professor of Family Medicine and the former Dean of the Keck School of Medicine of USC – talks about why she loves caring for older adults. She also discusses policy changes that could improve the aging experience in the U.S.

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Dr. Michael Hochman gives a rundown of the week's medical news and announces an exciting new partnership with Scan Health Plan!

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Policymakers across the nation have recently pledged billions to fund housing for the homeless. In Los Angeles, a federal judge even ordered city and county officials to offer all homeless individuals in the Skid Row neighborhood shelter by October. But will these “housing first” efforts work? Or will it prove necessary to concurrently address the health issues – such as mental illness and substance use – that are intertwined with homelessness. In today’s episode, Dr. Steven Hochman, a primary care doctor at the JWCH health clinic on Skid Row provides his perspective.

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This year, the Nobel Prize in Chemistry went to two scientists – Jeniffer Doudna at Berkley and French Scientist Emmanuelle Charpentier – who played key roles in developing a gene editing tool known as CRISPR. Just a few years later, gene editing – with the aid of the CRISPR tool – began being used for treating genetic disorders in real patients. We are just beginning to get the initial results. In today’s episode, one of the leading scientists using gene therapy talks with us about this frontier, both the opportunities and the real risks.

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Just when we thought the end was in sight, there are signs that COVID-19 variants – such as the B117 strain first found in the UK – are popping up across the U.S. Worryingly, this B117 strain appears to be more contagious among children. But according to today’s guest, Pediatrician Dr. Jessica Hochman, we should take it all in stride. The miraculous immune systems of children handle the SARS-Co-2 virus very well, and if we can continue rapidly distributing the vaccines to high risk adults, the overall benefits of getting children back in schools outweigh the risks.

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Many of us assume that the dietary supplement products that we purchase in pharmacies, grocery stores and nutrition outlets – as well as on the internet – are carefully regulated for safety. Unfortunately, this is far from the truth. In today’s episode, supplement expert Dr. Pieter Cohen from Harvard Medical School and the Cambridge Health Alliance explains that supplement makers have a very low bar for demonstrating the safety of new products, and that there are many loopholes from circumventing the existing lax restrictions. According to Pieter, the FDA needs much greater authority to oversee supplement safety as well as resources to enforce the regulations.
 
See also Pieter’s new study this week on weight loss and exercise supplements and an article about the legal challenges he faced as a result of his work.

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Some may dismiss the idea of a national health insurance program due to concerns and skepticism about “big government.” But as Drs. Steffie Woolhandler and David Himmelstein from Hunter College explain, a national health insurance program could greatly simplify health insurance for patients and doctors, while ensuring that everyone in the U.S. is covered. Their data – which has been verified by the Congressional Budget Office and other sources – show significant financial savings from a national health insurance approach. Steffie and David also explain how and why such a system would lead to better, more equitable care for patients.

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For patients experiencing a heart attack, stents can be lifesaving, restoring blood flow to a blocked coronary artery feeding the heart. But hundreds of thousands of cardiac stents (as well as cardiac bypass surgeries) are performed in the U.S. each year for patients with stable blockages. According to Dr. David Maron, the Director of Preventive Cardiology at Stanford, many of these procedures – particularly those performed for patients without severe symptoms – are unnecessary. According to Dr. Maron, patients, with guidance from their doctors, should drive the decision about when to perform these procedures. Yet too often it is the doctors pushing these procedures.

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The question of whether or not schools should reopen this spring has taken center stage. Proponents argue that the benefits of reopening outweigh the risks while opponents fear it could trigger another surge. Today, we hear from Dalia Hochman, PhD, the Head of School at Gann Academy, a Massachusetts high school, which has remained open for in-person instruction throughout the academic year. Dalia will explain the protocols and policies her team has used to ensure her community’s safety. She also offers inspiring words for other school leaders hoping to get their students back in the classroom.

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Opioid overdoses lead to nearly 70,000 deaths each year in the U.S., and for this reason the medical community has significantly curtailed their use for treating pain in adults. But what about in children? In today’s episode, Pediatric surgeon and researcher Dr. Lorraine Kelley-Quon, from Children’s Hospital Los Angeles, explains that treating pain in children requires a nuanced approach. Dr. Kelley-Quon recently authored the first national guidelines about the role of opioids in children undergoing surgery, and makes the case that we need to find a “sweet spot” in which we treat pain aggressively but without using opioids recklessly. Often this involves maximizing the role of comfort mechanisms to minimize the need for medications.  

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