18-17 Segment 1: Medicare Tackles the Opioid Epidemic

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With the opioid epidemic continuing to take many lives every year, people are concerned with how to stop it. In order to help counter this epidemic, Medicare has taken steps to implement limits on the prescriptions of opioids. However, the Medicare proposal has left doctors wondering if these new limits will do more harm than good for patients.

Currently, the United States is experiencing the second wave of the opioid epidemic. Dr. Anna Lembke, Associate Professor and Chief of Addiction Medicine at Stanford University School of Medicine, explains that opioid addiction arises from the prescription of these medications as a go-to for doctors even if the medical condition does not necessarily call for it. Furthermore, Dr. Sally Satel, an addiction psychiatrist and lecturer at Yale University School of Medicine and Resident Scholar at American Enterprise Institute, states that another issue is not just the prescribing of opioid medications, but the over-prescribing. In many cases, a doctor will prescribe a patient an unnecessary amount of opioids, but this often leads to leftover medication that tends to get into the hands of people who are likely to abuse it. So, one way that Medicare is working to counteract this is by regulating the quantity and overall dose of opioids that are allowed to be prescribed to a patient. Dr. Satel explains that by limiting the number of pills allowed when refilling a prescription, not only will it decrease the number of leftover pills, but it will also guarantee that those who benefit from opioids continue to take them appropriately. Along with this, Dr. Lembke states that this limit on the number allowed to be prescribed is important because doctors most likely would not limit their prescriptions enough to a point that would allow for a decrease in the epidemic. With this regulation, the number of leftover pills being circulated outside of who they were prescribed to will decrease which will allow for a drop in the number of people addicted to prescription opioids.

The proposed Medicare regulations also came with a second leg to it. This other guideline would cut-off any doctor from prescribing a high-dose of opioid medications. However, Dr. Satel explains that many pain physicians had problems with this regulation because it would make it extremely difficult for patients who do benefit from these prescriptions, and use them properly, to have access to them. So, when the final Medicare proposal was released, this second guideline was altered to allow physicians to prescribe high-doses of opioid medications, but it gave pharmacists the power to override a high-dose request that seemed unnecessary.

While these Medicare limits are a step in the right direction for managing the opioid epidemic, there is still much that can be done to improve it. For instance, other medical treatments should be made more accessible through Medicare, explains Dr. Lembke. It’s important to reduce the access to opioids. However, it is also important to facilitate the use of other medical treatments to help with pain. Improvements are being made in the healthcare system to stop the opioid epidemic, but those who benefit from opioid prescriptions should not have to suffer.

Guests:

  • Dr. Anna Lembke, Associate Professor and Chief of Addiction Medicine at Stanford University School of Medicine
  • Dr. Sally Satel, addiction psychiatrist and lecturer at Yale University School of Medicine, and Resident Scholar at American Enterprise Institute

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18-17 Segment 2: Curing Chronic Sinusitis

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Common colds, allergies, and sinus infections have similar symptoms that make it very difficult to identify which malady a person is suffering from. However, for some people who constantly feel sick, knowing what their symptoms mean could allow them to receive better healthcare. So, how can you tell the difference between a cold, allergies, and a sinus infection?

Dr. Lisa Liberatore, an otolaryngologist specializing in sinus and sleep issues at Totum Health, New York, explains the differences between these three maladies. If a patient has body aches, fevers, and other systemic symptoms, she states that these are not usually symptoms of allergies and can be indicative of an infection. Along with these symptoms, Dr. Liberatore explains that the longevity of the symptoms can further indicate if the infection is viral or bacterial. Some infections can start off as viral, but once seven to ten days pass, a patient may begin to have fits of heavy coughing or notice yellow or green mucus. Dr. Liberatore says that this is an indication that the infection has become bacterial. Despite being a bacterial infection, antibiotics tend to do little to help the patient. The best way to get over a cold or cold-like symptoms is often to just wait out the course of the infection, consume lots of fluids, and get lots of rest.

But, for some people, these cold-like symptoms never seem to go away. Dr. Liberatore explains that if the cold lasts for a long time, or tends to progress to something worse, that can be an indication of a structural problem. This structural problem is related to chronic sinusitis which affects a person’s quality of life tremendously, causing symptoms such as severe nasal congestion to lack of productivity. Dr. Liberatore states that many primary care physicians often provide their patients with two treatment options–antibiotics or surgery. However, she explains that there are many smaller treatments present today that can provide relief to the patient without having to undergo an intense surgery.

Guest:

  • Dr. Lisa Liberatore, otolaryngologist specializing in sinus and sleep issues at Totum Health, New York

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18-16 Segment 1: Diagnosing Perinatal Depression

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Imagine going to the doctor with your newborn baby because you are interested in receiving help for symptoms of depression only to be taken to the emergency room by the police. This is what happened to new mother Jessica Porten who had been experiencing symptoms of perinatal depression–previously known as postpartum depression–when she attempted to seek medical treatment. While this sounds like an overreaction in this situation, Dr. Darby Saxbe and Dr. Tiffany Moore Simas both agree that the healthcare provider was just attempting to protect the mother and the child by avoiding any harm. In any situation like this, Dr. Moore Simas, Associate Professor of Obstetrics and Gynecology, Pediatrics, Psychiatry and Quantitative Health Sciences at the University of Massachusetts Medical School and co-chair of Maternal Mental Health Expert Work Group at the American College of Obstetricians and Gynecologists, explains that either way a physician will face scrutiny by overreacting or underreacting, so it is best to overreact when there are safety concerns. Yet, symptoms similar to Porten’s are common in new mothers, so why do these situations continue to happen?

Dr. Saxbe, Assistant Professor of Psychology at the University of Southern California, explains that one in seven women are affected by perinatal depression, with some populations being more highly affected. But, it still remains massively undertreated because of the stigmatization of mental illness. Dr. Saxbe states that many new moms feel it is wrong to not feel overjoyed by the birth of their child, so they do not feel comfortable seeking treatment. Furthermore, Dr. Moore Simas explains that the symptoms of perinatal depression are often times not associated with depression, but instead, they are attributed to being apart of pregnancy or postpartum.

While stigmatization and confusion of the symptoms do decrease the likelihood of diagnosing perinatal depression, there appears to be another problem with the lack of training given to OBGYN’s. Dr. Saxbe explains that they often have little to no training in psychiatry, and remain unqualified in properly screening and diagnosing perinatal depression. But, Dr. Moore Simas states, recently schooling to become an OBGYN  has started to introduce mental health training as a component in order to improve the care provided to women experiencing perinatal depression. With increased knowledge on psychiatry and increased accessibility to psychiatric care, women with perinatal depression will be able to receive better treatment and many of these cases will no longer go undiagnosed.

Guest:

  • Jessica Porten, new mother diagnosed with depression
  • Dr. Darby Saxbe, Assistant Professor of Psychology at the University of Southern California
  • Dr. Tiffany Moore Simas, Associate Professor of Obstetrics and Gynecology, Pediatrics, Psychiatry and Quantitative Health Sciences at the University of Massachusetts Medical School, and co-chair of Maternal Mental Health Expert Work Group at the American College of Obstetricians and Gynecologists

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18-16 Segment 2: Foreign Accent Syndrome

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In a medical emergency that results in a brain injury, such as a stroke, there are a number of health complications that can affect the patient afterward. One of the more well-known subsequent results is aphasia which is the impairment of speech and language. However, many people do not know that once the aphasia wears off, the patient may still be left with an accent. This sudden change in speaking is actually a syndrome known as foreign accent syndrome. However, Dr. Jack Ryalls, Professor of Communication Sciences and Disorders at University of Central Florida, explains that research has proven that these patients’ new way of speaking is actually not an accent. Furthermore, Dr. Sheila Blumstein, Albert D. Mead Professor of Cognitive Linguistics and Psychological Sciences at Brown University, states that people will perceive these as foreign accents, but in actuality, people who suffer from foreign accent syndrome have only developed slight variations in how they pronounce words which indicates to those listening to them that they have an accent.

So, what happens to those who suffer from foreign accent syndrome? Dr. Ryalls explains that chances of recovery are very slim–only about 30% are able to recover their old accent because therapy has been proven to not be beneficial. Along with this, people with foreign accent syndrome are likely to experience distress. Dr. Blumstein states that how an individual sounds and speaks contributes a lot to their self-identity, so it can affect a person’s perception of oneself. This distress can be furthered, too, by a change in how they are identified in the world. Dr. Blumstein explains that foreign accent syndrome can be isolating because many people will view this person as being from a foreign country. While many people do not recover, some are able to regain their old accents. Researchers have been looking into cases of recovery in order to improve the chances of recovery for others who suffer from foreign accent syndrome.

Guest:

  • Dr. Sheila Blumstein, Albert D. Mead Professor of Cognitive Linguistics and Psychological Sciences at Brown University
  • Dr. Jack Ryalls, Professor of Communication Sciences and Disorders at the University of Central Florida

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18-15 Segment 1: Adventures of a Paramedic

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Have you ever wondered what it is like to be a first responder? We talk with Kevin Hazzard, former paramedic and author of A Thousand Naked Strangers: A Paramedic’s Wild Ride to the Edge and Back, who tells us about his experiences as a paramedic and what it takes to be able to deal with emergency situations.

As a first responder, paramedics must enjoy the chaos and must be able to adjust to any situation. Hazzard explains that the practices of medicine that are taught during training are not always the most effective way to approach an emergency situation because EMTs and paramedics tend to be outmatched. Furthermore, he states that being a paramedic is often like being a detective because first responders must be attentive to the details surrounding them in order to figure out what happened and how to best treat the victim. An EMT or paramedic must be capable of listening to the victim and the bystanders, as well as making observations about the environment, because they are incapable of running tests that can provide them with answers. Hazzard describes the care provided by first responders as a primitive form of medicine because they are not able to use a lot of advanced medical techniques that medical practices have access to.

Along with these skills, first responders rely on a certain level of emotional capability in these emergency situations. Hazzard explains that it is important to be able to be detached from the victims because if not, many would be incapable of doing the job. He states that a first responder cannot think about the pain of the victim because it will hinder their ability to perform vital tasks. However, in certain situations, empathy provides the most effective care. Hazzard explains that some people call 911 because they are frightened or unsure of what is going on, and the best way to help them in this situation is to simply talk to them. Furthermore, he expresses that paramedics must be able to cope with the fact that they are almost always going to be put into compromising situations.

In the end, first responders must be dedicated to their jobs. Hazzard explains that as a tax funded field, they are not given the best supplies, and are often told to made do with what they have. Some even spend their own income to purchase better equipment. Despite the tough circumstances and compromising situations, most first responders continue to be committed to saving the lives of the American people that need their help.

Guest:

  • Kevin Hazzard, former paramedic and author of A Thousand Naked Strangers: A Paramedic’s Wild Ride to the Edge and Back

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18-15 Segment 2: The Mystery of Meniere’s Disease

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Imagine waking up and no longer being able to hear in one of your ears. And, after losing the ability to hear, you are suddenly affected by bouts of vertigo attacks that can last anywhere from a few minutes to a few hours. This is what happened to James Raath, business consultant and author of Love Mondays, who suffers from Meniere’s disease which is a disease that is caused by a fluid imbalance in the inner ear that forces the membrane separating the chambers to rupture.

Dr. David Friedland, Professor and Vice Chair of Otolaryngology and Communication Sciences at Medical College of Wisconsin, explains that this disease is commonly diagnosed, however, it is an uncommon disease to have. While the main symptoms, tinnitus and vertigo, are experienced by many people, the presence of both does not necessarily imply that the person has Meniere’s. Furthermore, Dr. Friedland explains that it is unknown whether the rupturing of the membrane is caused by the endolymphatic sac absorbing too little or too much fluid. But, the sufferer will be relieved of the symptoms once the membrane fixes itself. However, regular occurrences of this rupturing can have long term effects. Dr. Friedland explains that a person may suffer from progressive loss of hearing and increased weakness in the balance system.

So, what can be done to stop the progression of this disease? Dr. Friedland explains a few ways in which physicians can go about treating Meniere’s disease. The first, he says, is allergy medicine because allergies appear to be a trigger that can set off the fluid imbalance. Another way that he suggests to counteract the disease is to consume a low salt diet and water pills. In some cases, Dr. Friedland states some patients may get a shot that can drain excess fluid in the ear and improve the hearing loss. A final treatment that he explains is ablation which destroys the balance cells within the inner ear. The goal of this procedure is to reduce vertigo by making it so that an imbalance of fluid in the ear does not affect the balance system that causes vertigo. However, he warns that this procedure does not change the disease process, but instead, only changes the balance system so it cannot be stimulated by the disorder. While there is no cure to Meniere’s disease, there are many ways in which those who suffer from the disease can work to counteract or slow down the process.

Guests:

  • James Raath, business consultant and author of Love Mondays
  • Dr. David Friedland, Professor and Vice Chair of Otolaryngology and Communication Sciences at Medical College of Wisconsin

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18-14 Segment 1: The Price Consequences of Doctor Consolidation

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In some areas, it has become almost impossible to find independent physician practices. Many of these smaller practices have opted into being bought by hospitals and other large medical groups. So, what has prompted the increase of consolidation in the medical field? And what does this mean for patients?

The incentives of consolidation have been researched, but the results do not point to one reason. Dr. Laurence Baker, Professor of Health Research and Policy at Stanford University School of Medicine, explains that physicians running smaller practices might benefit from no longer having their own business. Another possibility, Dr. Christopher Ody, Research Assistant Professor at Kellogg School of Management at Northwestern University, explains, is that some hospitals may view consolidation as a way to improve the quality of healthcare and decrease the costs to help physicians and their patients. However, data has indicated that the factor with the largest role in consolidation has to do with increasing the amount that hospitals are getting paid, and decreasing the amount paid to pharmaceutical companies. Even though research has not provided an overarching incentive that drives consolidation, the data seems to point to increasing income for hospitals rather than providing patients with better care. Furthermore, hospital consolidation has not been shown to benefit the patient. Dr. Baker explains that data indicates that the cost of healthcare has not gone down for patients with consolidation. Since the cost of healthcare has increased for patients, many have started to wonder how consolidation has been able to continue and what is being done to control it.

In the medical field, it is important to maintain consistency in market concentration and ensure that the markets are still competitive. One way in which authorities in the medical field work to maintain market concentration is by regulating transactions that reach a price threshold. However, Dr. Ody explains that hospitals have been able to avoid these regulations by partaking in multiple smaller transactions that invest in a small number of physicians at a time in order to ensure that the cost is below the threshold for evaluation. By avoiding regulations, hospitals have been able to grow into much larger entities that generate a lot of power and income from smaller practices. Since consolidation has prompted increased healthcare costs, it currently appears to be detrimental to the medical field rather than helpful. Yet, it could be worth it if hospitals were able to determine a method of consolidation that decreases healthcare costs and improves the quality of care that is provided to patients.

Guests:

  • Dr. Laurence Baker, Professor of Health Research and Policy at Stanford University School of Medicine
  • Dr. Christopher Ody, Research Assistant Professor at Kellogg School of Management, Northwestern University

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