How to Reduce Health Risks When September Temps Reach 100+

Experts report we’re dealing with the hottest summer on record for the second year in a row. Phoenix has recorded 100 straight days of over 100-degree weather; Hollywood Burbank Airport in the Los Angeles area matched its all-time high temperature with a reading of 114.

In Los Angeles, the city is taking action to help its people deal with the temperatures through the leadership of Marta Segura, one of the few appointed chief heat officers in the world. Her work is focused on finding solutions when the weather causes physical and mental health issues and she’s keeping equity at the forefront of her efforts. Segura explains how an aware and engaged public is key to the effective implementation of climate policies.

This all occurs as U.S. Health and Human Services Secretary Xavier Becerra has declared extreme heat a rising public health crisis.

Join us for this encore “Conversations on Health Care” with hosts Mark Masselli and Margaret Flinter.

When Money Takes Over Medicine: Risk, Rewards & Warnings

Did you know private equity owns one-third of private hospitals in the country and the percentage is growing? Private equity is a controversial type of financing typically seen in the technology and media sectors that’s now attracted to health care.

It’s a trend that greatly troubles Erin Fuse Brown. She’s a professor of health services, policy and practice at Brown University’s School of Public Health and its Center for Advancing Health Policy through Research.

She explains to “Conversations on Health Care” hosts Mark Masselli and Margaret Flinter that private equity’s practice is to cut wages and employees and substitute highly trained staff with lower skilled substitutes. She says, “It means worse patient care in many instances and that is what we see is leading to the greater risks of mortality and adverse events for hospital and nursing home patients after a private equity acquisition.”

Fuse Brown also discusses why it’s so difficult to figure out who actually owns your hospital and the latest details about the effort to ban employees’ noncompete.

Trump, Harris on Abortion: Reporters’ Roundtable Examines Their Records

Gallup reports that a record-high 32% of U.S. voters say they will only vote for a candidate for major office who shares their views on abortion. Indeed, the upcoming November presidential election will be the first one since the Supreme Court ended the constitutional right to abortion. The Washington reporters who cover health care policy and political maneuverings join us on “Conversations on Health Care” to discuss how Vice President Kamala Harris highlighted the contrasts between the parties as former President Donald Trump has issued statements that appear to muddy the issue.

Discussing reproductive rights and other issues are:

• Shannon Firth with MedPage Today

• Ben Leonard with POLITICO

• Sarah Owermohle with STAT News

Hosts Mark Masselli and Margaret Flinter also ask them about gun violence, medical debt, Medicaid, and the future of the Affordable Care Act and its subsidies. Be sure to listen to what health-related question each of these journalists would like to ask the presidential candidates if given the chance—some of their questions may surprise you!

NEJM’s First AI Editor: Yes, AI is Here to Stay

Some patients are concerned about how far artificial intelligence (AI) is creeping into the exam room. But AI has been part of health care longer than most realize, according to Dr. Isaac Kohane, a groundbreaking Harvard University professor.

Kohane is the editor-in-chief of the New England Journal of Medicine’s first publication devoted to AI. He tells hosts Mark Masselli and Margaret Flinter that “In the 1980s, automated interpretation of an [echocardiogram] would have been considered AI. Now it’s the ability to look through a patient’s record and come up with a differential diagnosis, a second opinion, a therapeutic plan.”

Kohane shares a success story of a mother whose child had difficulty walking and chewing, suffered from headaches and had seen more than a dozen doctors over many years, with no diagnosis. After one doctor recommended a psychiatric course of action, the mother fed the reports from various past medical visits into a generative AI program, which suggested tethered cord syndrome.

Cases like this can represent AI’s potential, says Kohane. But the nascent technology raises issues of bias. “You can run tests on these AI programs and say, ‘Would you propose that diagnosis more often if this was an African-American or an Indian-American?’ … And you can adjust these programs,” Kohane says. The exciting part is that the adjustment would be easier than undoing even unconscious bias among hundreds of thousands of health care professionals, he explains.

Nuance can help health field regain public trust: AcademyHealth CEO

Dr. Aaron Carroll raises eyebrows with statements that highlight contradictory health advice: “‘Eggs are going to kill you because of cholesterol’ — ‘oh, it actually doesn’t matter. Eat as many eggs as you like.’ ‘Red meat will kill you.’ ‘Oh no, read meat can be part of a diet.’ ‘Drink no alcohol’ … ‘Oh, no no. Drinking red wine is perfectly healthy.’”

Dr. Carroll has devoted his career to advocating for scientific and research communities need to improve how they discuss nuance, especially in health. Dr. Carroll, serving as CEO of the AcademyHealth, says “science is portrayed as binary — positive or negative — and that can breed mistrust from the public.”

“The way that we discuss nutrition and food [can] burn people’s belief in science, in that it feels like people are told one or the other,” Dr. Carroll tells “Conversations on Health Care” hosts Mark Masselli and Margaret Flinter.

For most people, ramping up or cutting out consumption of one particular food “can add a tiny bit of risk here or there. But the extremes that we are often sold, one way or the other, about what you should and should not eat are often not really well-supported by science,” he says.

It’s not that new data disproves old research, he says. But both add up to a more complex picture. “When you describe things in absolute terms … it creates a climate where people don’t trust exactly what you’re saying.”

Despite the constantly changing nature of science, nurses and doctors are still consistently held in high trust, Dr. Carroll says. One way to add nuance to public discourse is to use trusted voices to help people understand what questions to ask when they hear new information: Pre-buttal, as opposed to rebuttal, as he puts it. “[That] is much more powerful than trying to change their minds after they’ve heard things that are just not true.”

Self-healing joints? Perfect surgeries? Your tax $$ could make it happen

The director of the Advanced Research Projects Agency for Health (ARPA-H) knows the eyes of the nation are on her. Renee Wegrzyn, Ph.D., leads the billion-dollar effort charged with leveraging research advances for real-world impact.

Wegrzyn talked with hosts Mark Masselli and Margaret Flinter at Aspen Ideas: Health about the agency’s initiatives, including a $100 million sprint for women’s health and creating tissue-specific delivery of therapies.

“How can we pursue some of these breakthroughs — in our case, for health — by empowering the scientists…the program managers…that have these really big ideas that are so risky that the technical sector, the private sector can’t address because there’s no proof of concept?”

She explained the process: Hire program managers with big ideas in health and give them a time frame to find solutions.

Wegrzyn said the time limit ensures they bring a sense of urgency to solving problems. In return, participants get resources to focus on technical risks.

Many of ARPA-H’s missions are cancer-centered, aimed at issues through what-if questions such as: “What if cancer surgeries were one-and-done?” “What if clinical trials evolved in the same way tumors do?”

She said, “The investments that we’ve made in cancer [include] our precision surgical interventions program. Think about reimagining the operating room suites, when a surgeon is looking into a surgical cavity and trying to remove a tumor.”

95 Days to Election ’24: Analyzing the Health Care Issues

The defining health care issues in this year’s election are crystalizing with reproductive rights remaining at the top of the list. Julie Rovner, chief Washington correspondent for KFF Health News, has covered health policy fights for nearly four decades. She said, “I think this may be the first time that abortion rights drive people out to vote. The anti-abortion movement has always been the one that has been able to gin up their base, and the people who are sort of on the most extreme of the anti-abortion movement are the ones who are most devoted and…one of the reasons Republicans have courted them so assiduously is they show up and they vote.”

Rovner also weighed in on the 15 states or more states with abortion-related ballot initiatives and efforts to restrict the abortion pill mifepristone and end in vitro fertilization.

Rovner spoke to hosts Mark Masselli and Margaret Flinter on location at Aspen Ideas: Health. While the presidential race is in flux (including a change in the Democratic candidate), the core issues have remained consistent.

The hosts asked Rovner which health care question she’d most like to pose to former President Trump in a debate. “I don’t mean this in a negative way, I’d like to ask him if he knows the difference between Medicare and Medicaid, and whether he feels as strongly about preserving Medicaid as he said he does about Medicare.” She also analyzed the hurdles the Biden-Harris administration has had to date in communicating about what it sees as its health policy victories.

JAMA’s Editor: Rebuilding Trust & Reaching More Readers

The Journal of the American Medical Association (JAMA), which was first published 141 years ago, is grappling with modern challenges as the most widely circulated general medical journal in the world. At the forefront is Dr. Kirsten Bibbins-Domingo, its relatively new editor-in-chief.

Dr. Bibbins-Domingo took the helm at a tumultuous time and has a clear vision for how JAMA should deal with equity in medicine and the public’s lack of trust in health care.

She told hosts Mark Masselli and Margaret Flinter at Aspen Ideas: Health that “I am not the keeper of trust for the journal. I am not the keeper of our focus on equity.” But she said she has installed new processes “so that we could collectively have those conversations, be more transparent around them, think about the processes that help us make sure that we are always trying to be the best that we can be.” That includes giving JAMA employees and authors a voice in discussions about equity and increasing transparency with readers.

Dr. Bibbins-Domingo also focused on how to keep JAMA connected to its current audience while attracting new audiences using an omnichannel approach, especially social media.

“I think about what JAMA and the JAMA Network have to do right now is do the core functions the same way we’ve always done it…vetting the science, making sure this is science you can trust, putting the stamp of approval in that way on it, and then publishing it. And then we have to do something that I think all journals need to do better… and that is being a modern communication vehicle,” she said.

HHS’ Admiral Rachel Levine: Managing Her History-Making Role While Focused on the Nation’s Health

With most of the country suffering through a sweltering heat wave, the U.S. Dept. of Health and Human Services has found the right time to unveil its nationwide Heat and Health Index (HHI).

“Conversations on Health Care” learned all about it from Admiral Rachel Levine, M.D., the department’s assistant secretary for health. “We are seeing heat-related injury and health impacts globally,” says Levine, particularly in vulnerable populations, such as children, seniors and people who work outside.

HHI combines historic temperature data and Emergency Medical Services (EMS) data on heat-related emergency responses from the past three years, as well as data on community characteristics, including pre-existing health conditions, socio-demographic information, and characteristics of the natural and built environment, to provide a final heat and health index ranking by ZIP code.

Levine is used to being in the hot seat on a variety of issues, from worries about bird flu to the latest on Long COVID. During June, she helped lead efforts to celebrate LGBTQ+ Pride, as the nation’s highest-ranking openly transgender official.

Hosts Mark Masselli and Margaret Flinter, well aware that Levine serves at the president's pleasure, asked her about future plans. She said she would absolutely be willing to go through another intense Senate confirmation process depending on what happens on Election Day. “I firmly believe in the Biden-Harris Administration and the principles they advocate for and represent.”

Biden Gun Prevention Leader at Aspen Ideas: Health to Make Their Case

“Conversations on Health Care” went on the road to Aspen Ideas: Health. We start this series with Gregory Jackson, A White House official with one of the toughest assignments: tackling gun violence, Gregory is deputy director of the White House Office of Gun Violence Prevention.

Helping Community Health Workers Succeed: Ideas From an Innovative Program

Experts praise community health workers as the keys to building a more equitable and fair health care system in America. Is there a way to unlock more success for hiring and retaining them?

Dr. Shreya Kangovi thinks so; she developed the IMPaCT Care program, which is saving money and quickly growing. We’re proud to share this encore “Conversations on Health Care” interview. Hosts Mark Masselli and Margaret Flinter talked to Dr. Kangovi about how it’s a standardized, scalable program that transforms the effectiveness of the community health workforce by reimagining each step.

Dr. Fauci Talks About His New Book: 7 Presidents & the Challenges of COVID, AIDS

Five times during the COVID pandemic Dr. Anthony Fauci took time out of his incredibly busy schedule to share with “Conservations on Health Care” his latest insights. Now, he returns to reflect not only on COVID but also on the entire scope of his career, including his efforts to bring attention and resources to the AIDS fight in the 1980s.

Dr. Fauci explains he had to speak truth to power during the pandemic in order “to preserve…professional integrity and to fulfill my responsibility to the American public.” He continues to focus on sharing “just the facts.” In terms of the current COVID situation, he says the virus persists and “has an uncanny capability of continuing to evolve…there’s a new variant now…that evades some of the protection from vaccines and prior infection.”

Dr. Fauci’s New York Times best-selling autobiography, “On Call: A Doctor's Journey in Public Service,” takes readers through his life from growing up in Brooklyn to advising seven presidents through some of the world’s most harrowing health crises.

Join hosts Mark Masselli and Margaret Flinter for this important conversation with the most renowned and acclaimed physician and public health leader of our era, Dr. Fauci.

The Urgent Need to Rethink Suicide: Lessons for Veterans & All Americans

Is the way we're going about suicide prevention all wrong? And how are those misperceptions affecting efforts to stop veteran suicides? Clinical psychologist Craig Bryan is an Iraq War veteran and studies the issue.

He's the author of “Rethinking Suicide: Why Prevention Fails, and How We Can Do Better” and says we need a better focus on firearm safety. In 2021, 72% of veteran suicides involved firearms.

The veteran suicide rate is currently 1.5 times the rate of the general population and the U.S. Department of Veterans Affairs says its top clinical priority is preventing suicide among all those who have served.

America’s Record-High Deaths by Suicide: APA Pres. Outlines Prevention Steps

More than 50,000 Americans died by suicide in 2023, the highest number on record. Data from 2021 found that over 12 million American adults thought about suicide and 1.7 million attempted it.

American Psychiatric Association President Dr. Petros Levounis, who’s finishing his term, is at the center of efforts to prevent suicides. His focus continues to be on substance use addictions. He and the 38,000 APA members have launched a campaign called “Confronting Addiction: From Prevention to Recovery.”

Dr. Levounis also talked about vaping, opioids, alcohol and the rapidly growing addiction to tech.

Join hosts Mark Masselli and Margaret Flinter for this encore presentation of the interview with Dr. Levounis.

Nurses & Moms Partnering for Health Success: How Babies Benefit

What if we say there’s a way to have healthier pregnancies, improve children’s health and create better economic outcomes? And it all begins with a knock on the door? That’s the way Nurse-Family Partnership works. It’s an evidence-based, community health program with 45 years of research showing significant improvements in the health and lives of first-time moms and their children affected by social and economic inequality.

The initiative succeeds by having specially educated nurses regularly visit first-time moms, starting early in the pregnancy and continuing until the child’s second birthday. Research consistently proves that the partnership between a nurse and the mom is a winning combination that makes a measurable, long-term difference for the whole family.

Nurse-Family Partnership’s Sharon Sprinkle, co-director of nursing practice, and Jenny Harper, government affairs director, join hosts Mark Masselli and Margaret Flinter to discuss its founding, funding and how expectant moms sign up.

Meet America's Hidden Health Heroes

You know about the Army and Navy, but have you heard about the USPHS Commissioned Corps?

It is one of the nation’s uniformed services — a branch committed to the service of health. Its over 6,000 officers advance the nation’s public health, serving in agencies across the government, as physicians, nurses, dentists, veterinarians, scientists, engineers and other professionals.

President of the Public Health Service Commissioned Officers Foundation Gene Migliaccio spoke to “Conversations on Health Care” hosts Mark Masselli and Margaret Flinter about the role the Corps played in combatting the pandemic.

The fight against COVID-19 was the largest deployment in the 223-year history of the United States Public Health Service Commissioned Corps. At the beginning of the pandemic, “I think what we did right was the mobilization,” Migliaccio said.

“When Covid hit, we didn’t have testing centers. It started slowly, and then all of the sudden there were hundreds of them. It took a tremendous amount of effort and some of the best and brightest minds within the Department of Health and Human Services” to accomplish that, he said.

The Public Health Service Commissioned Officers Foundation is part of a new documentary titled “Invisible Corps,” narrated by the actress Ali McGraw. The piece is trying to raise awareness about the Corps and also how public health has become politicized.

Sharing Best Practices: Lessons from Community Health Centers Coast to Coast

This week we’ve brought together some of the brightest minds who run many of the best and most innovative community health centers across the country. From Long Island to San Francisco, community health centers served over 31 million patients last year. How are they keeping pace with their success while always working to improve the quality of the care?

The guests are part of the Community Health Best Practices network and serve as CEOs of their nonprofits:

--Gloria Amador from Salud Integral en la Montaña in Puerto Rico;

--Eddie Chan with North East Medical Services in San Francisco;

--Nieves Gomez with Columbia Basin Health Association in Connell, Washington;

--Ann Kauffman Nolon with Sun River Health in New York City, Long Island and the Hudson Valley; and

--Greg Wilmot with East Boston Neighborhood Health Center.

“Conversations on Health Care” co-hosts Mark Masselli and Margaret Flinter explore how they navigated the COVID pandemic, deal with employee engagement and tackle funding challenges.

Black Women Taking Steps to Health: Funder & Nonprofit Explain How

Join us for a unique conversation with an innovative nonprofit leader and the grantmaker who’s helping support her efforts. Morgan Dixon is the co-founder and CEO of GirlTREK, which she calls a “life-saving sisterhood.” Their campaign seeks to heal intergenerational trauma, fight systemic racism, and transform Black lives by organizing women walking teams. While participants walk, they also mobilize community members to support advocacy efforts and lead a Civil Rights-inspired health movement.

How Could Medical Racism Fuel Soaring Black Youth Suicide Rate? Answers and Solutions

Black children ages 5 to 12 are twice as likely to die by suicide as their white counterparts, and the rate of suicides among Black teens is rising faster than any other racial/ethnic group.

Those statistics are alarming to most people, but they’re not surprising to Yale Child Study Center (YCSC) Chief Resident and Child Psychiatry Fellow Dr. Amanda J. Calhoun.

“Experiences of anti-Black racism affect kids before they are even born,” says Dr. Calhoun.

The stress of anti-Black racism on Black mothers, including experiencing inferior care by health care providers, has been linked to low birthweight babies, putting Black infants at greater risk for developing depression and other mental health disorders.

In addition, racist beliefs start to become ingrained in children as young as four years old, which means that Black children start to experience racism from their peers and teachers as early as preschool.

“It’s not the school-to-prison pipeline. It’s the preschool-to-prison pipeline,” says Calhoun. Black children are more likely to be suspended from or arrested in school than their peers.

When they seek help, Black children are the most likely to be physically restrained in emergency departments. And they are more likely to be diagnosed with disruptive mood disorders than white children with comparable symptomatology.

“You have people who are traumatized, who are being traumatized, by people who are supposed to help them,” says Dr. Tichianaa Armah, Chief Psychiatry Officer and Vice President of Behavioral Health at Community Health Center, Inc.

“Of course, they are going to have poor mental health outcomes,” says Dr. Calhoun.

Dr. Armah and Dr. Calhoun tell “Conversations on Health Care” hosts Mark Masselli and Margaret Flinter that they have seen the effects of this early trauma up close in their work and are exploring what measures can be taken to protect young Black lives.

Dr. Calhoun is leading a Black Youth Mental Health Clinical Case Conference Series at Yale University where experts will weigh in on complex clinical cases involving Black youth presented by YCSC trainees, please learn more here: https://medicine.yale.edu/news-article/black-youth-mental-health-series-yale/

But she is doing things a bit differently. “In a typical case conference, we talk about the problematic behavior of patients,” says Dr. Calhoun. None that she has seen have asked “What if one of the primary causes that has led to the lapses in care of this Black child is the medical racism of the team?” 

Can Health Care Policy Take a Page from Recent Bipartisan Efforts?

In the wake of recent bipartisan policy wins in Washington, can health care policy follow suit?

Dr. Anand Parekh, chief medical advisor at the Bipartisan Policy Center (BPC), spoke with hosts Mark Masselli and Margaret Flinter about how the best solutions emerge from a solid understanding of the issues and the eventual give-and-take of political opponents.

For example, The Milbank Memorial Fund’s 2024 Scorecard Report of The Health of U.S. Primary Care declared that the state of “primary care is in crisis.” The report made clear the systemic lack of support for primary care is harming people’s health and weakening the U.S. health system.

Dr. Parekh agrees the issue is dire. “As a primary care physician…this is the most important health care issue in America,” he says. “A strong primary care system needs to be the foundation of our health care system. So much of what is ailing us is because we haven’t put in the resources into our primary care system infrastructure.”

How can a bipartisan approach help?

Dr. Parekh points to the recent effort by the BPC to relaunch the Congressional House Primary Care Caucus, which had been dormant for years. They began by identifying bipartisan co-chairs to lead the caucus (two Democrats and two Republicans) who will be educating members about the importance of primary care before they begin to discuss policy solutions.

Dr. Parekh’s interview this week on “Conversations on Health Care” highlights how ensuring that both parties are working together from the beginning on an issue lays the foundation for mutual understanding and agreement down the line.