So, now we're going to be talking about transparency in medicine, and I want to bring our panel
up now.
So, come on up, everybody.
We've got Kat Lindley, who has been introduced before.
Welcome back, Kat.
Dr. Rutherford.
Welcome.
Welcome.
Welcome, welcome.
Come on up.
Jordan Vaughn, who's been up here before, and Tim Clark, hey, welcome, buddy.
Come on up.
Everybody else who's been introduced so far, except for, I think, Molly, so far, Dr. Rutherford
here, who is an IMA Senior Fellow, Family Medicine and Addiction Medicine, founder of
Bluegrass Family Wellness, Direct Care Practice for Primary and Addiction Care, expert in
family medicine, in addiction medicine with a focus on functional medicine, and MD, MPH
in Epidemiology and Health Policy from Johns Hopkins.
So welcome.
All right, Cat, Transparency in Medicine.
It's kind of a big, vague title.
It's one of our pillars.
How do we begin this one?
What does this really imply here?
So the way I think of transparency in medicine
is we need to empower the patient
to be able to make good decisions.
we need to strengthen the patient-physician relationship.
We have to have fully informed consent.
We have to have pharma stop advertising to everyone.
So there's so much to cover.
All right, well, let's start to break it down.
I said yesterday, the day before last week,
that I lost my trust in the system.
I'm in a very regulated business,
so I have a registered investment advisory.
And if I said even, I can't even say it here,
If I said the name of a stock and then failed to disclose
that I was invested in that stock, I get in trouble.
Molly, what happens to a doctor who fails to disclose
that they're getting money for a bonus structure as we saw
on the Blue Cross Blue Shield to put vaccines into children?
Nothing happens to the doctor, but I want to educate people
Those doctors often don't even know about those incentives.
I think it's 75, greater than 75% of physicians are now employed,
usually by a hospital system or some government entity.
So they don't have any autonomy.
And I worked inside the system before I started my direct care practice
in 2015, so I was very aware of meeting
with an administrator once a month, for example.
and they would tell me, oh, you didn't see enough patients,
you didn't bill correctly, you didn't, and it got worse during,
when the ACA was passed because they, there are boxes
that these doctors have to check.
So were they pressured, are they pressured to give vaccinations?
Yes, absolutely, but it's, the money is going to the system
and they're not really, it's not like they're getting a,
cut a check for the most part.
They are just, they're checking boxes that then lead
to them meeting these standards according to the administrator
of the hospital so that they can get bonuses perhaps on their salary.
So, nothing happens to them but they, if they don't meet those,
so it's not, I guess they're not being dishonest
in not disclosing it because it's not a direct, it's very indirect
where that pressure is coming from.
Well, I guess that complexity helps sort of hide it a little bit
but the point is it's, it is part of the pay.
Absolutely, but I think physicians gave the power away decades ago
and we have to own it.
Our organizations did that.
The AMA helped with that and it started back when,
it started with Medicare and Medicaid especially,
but it started when doctors agreed to submit a bill
to an insurance company instead of to the customer, the patient.
So once they did that, they gave the power over to them
and then every year reimbursement gets cut and most physicians have no power
in any of it.
Yeah, understood.
Dr. Vaughn, what's your take on this?
So my honest opinion is actually the first area that needs
to be transparent is the day a student walks into medical school and realize
that the charter for this medical school that originally was
to actually provide care to the citizens of the state is now actually just a
pre-employment program for a multi-billion dollar medical system
that the state benefits from.
And until that is changed, because again, I mean, University of Alabama,
actually it wasn't even UAB Medical School now, it's UAB Medical School,
But before that, the hospital attached
to the medical school was just a function of education.
It was not a function of generating immense power
and money for employment for state,
well just people in the state.
The problem is, is most medical students step
into medical school thinking that they're going to be a doctor
for the citizens of the state and they are actually going
to help those people.
But what they really don't realize is you're actually
stepping into a almost Fortune 500 type training program for you
to be a peon and another cog in a wheel for a system that continues
to grow like a leviathan with worse and worse outcomes
but more and more money spent.
And most people, if they knew that when they were stepping
into medical school, probably wouldn't go.
Well, it almost sounds like the education system in general, right,
which is we're getting worse outcomes so I guess we're going
to spend more money and then we end up getting worse outcomes
so I guess we need to spend more money.
And nobody's ever backing up and saying, wait a minute,
this is broken model here.
Yeah, and again, the medical school has no incentive
to teach physicians how to think,
because that would mean they wouldn't work for them.
And they have no incentive to teach them actually
how to run a business either,
because they don't want them to know that,
because they want them to be beholden to them
for a basic salary.
Interesting, yeah.
So Warren Buffett's right-hand man, Charlie Munger,
said, show me the incentive, I'll show you the outcome.
We have to talk about the incentives in this.
Tim, ACA got mentioned, that's Obamacare, and it clearly,
I had one senator describe it to me as the largest giveaway
to health insurance companies in the history of America.
And second, we learned just the other day, I believe from you,
35 cents of every tax dollar, or every, no, expenditure dollar,
which is a bigger number, flows through health,
or what we call health.
Just how, what are we up against here?
First of all, happy Sunday morning.
And.
Let's all pray.
Yes.
All I know is when I went to bed last night, Duke was up by five points.
And.
By condolences.
And my bracket was a disaster afterwards.
So I can just, you know, I can't speak to the medical schools or anything
like that, I can just speak to my own experience coming
into Health and Human Services as an outsider.
And a true outsider because I was a Californian.
You're not really allowed to go back to D.C. from California.
And as the White House liaison representing the President
of the United States walking into every single meeting
in every square inch of HHS with the, basically,
with the President's authority, with the President's ring,
the King's ring, I was shocked at how much happens at NIH, FDA,
CDC trying to get the vaccine injury data out of CDC and actually talking to our CDC director saying we really want to make this
a priority. And four years later finding that it just wasn't possible. I think it's that kind of transparency we need from the
top because that restores trust. Right. And and of course the ACA did some fantastic things to hide the ball. But I can just
tell you the story when I called up Francis Collins. So Francis Dr. Collin I'm coming out to NIH the White House liaison.
When I come tour, I want to see what you guys do.
When I come see what you do.
And I don't want a guitar song.
And Francis liked to play the guitar.
And when I showed up, you know, here I am with all my clearances
and everything else, I was greeted by Francis Collins, Dr. Fauci,
and like this row of five doctors.
And they wouldn't let me see anything or go anywhere.
And I'm like, well, no, no, I want to go see that.
Oh, no, no, we have this whole program for you, Tim.
You just stay here.
And it was that way.
And you can't come out of that and help, but feeling like you're
in a system that doesn't want you to see what they do and feels
like they know better than you.
And we were just in a room talking about how do we bring America together
on this, on this healthcare stuff.
And I think transparency is the key.
You just, you blow open the data and you say, look, here's the good,
here's the bad, but it's got to start at HHS.
Now, Bobby Kennedy has got a lot to do.
And going in and blowing open the boxes
for transparency is a tough job.
So, you know, let's see how he does over the next year.
but I believe that's where it has to start.
And blowing open those boxes would be, I'm going
to guess, jealously guarded bureaucratic fiefdoms
that are going to do what they can to keep it hidden?
You can't walk in NIH and not walk out feeling
like they all feel like they know what's going on.
You just sit tight because they'll take good care of you.
You don't need to know because they've got this.
And that doesn't serve anybody well.
It certainly hasn't.
That's why we have, I mean, Maha is a movement of moms.
Moms are the frontline health providers in every family.
And they're saying, no, no, no, you haven't gotten this
and I want to know.
And so the more we can promote that out of HHS without,
I mean, that's the holy grail.
Can you do that without losing your secretary?
Because there's a lot of people that just don't want you
to see what's going on.
And there's a lot of money that flows.
FDA, you can't walk into FDA without saying,
oh my gosh, this place is plush.
That's one of the plushes that's got the best cafeteria
of all of DC, it just does.
So, the cafeteria model, that's all you need to know,
how well-funded it is.
I like it.
So, Kat, it sounds to me like we're talking about,
there was this, the power sat with doctors
and their patient relationship for a while,
and then these other incentives came in,
started dragging that away.
Perhaps now we've lost the plot a little bit,
and the idea now is how do we begin to reconcile that?
But I almost feel like the patient is the complete afterthought in this entire story
so far.
So how do we begin correcting that?
I shared a little bit yesterday.
I worked for a medical school.
I worked for a huge healthcare system.
I was a medical director of rural health clinic with five outside clinics.
And I don't know if I shared this story with this group site, well, anyway, there was an
elderly veteran who had diabetes, always controlled everything great, saw him every three months,
did labs, you know, everyone's happy, we had a great relationship.
He comes one time and his hemoglobin A1c that measures diabetes is sky high, and I'm like,
why?
I haven't changed anything, he hasn't changed anything, so, you know, I kind of started
talking to him and he was really embarrassed to tell me that he couldn't
afford his insulin. I was like, why? I've always given you the same exact insulin.
I haven't changed the brand or anything. Well, you know, the pharmacist benefit
managers changed the formulary and this insulin is not covered. He can't afford it.
And that's when I truly understood, I never really understood until that
moment, when I have this elderly veteran who cannot afford to pay for his
insulin that he's always had. And that's kind of when I had like come to Jesus
moment and realized this is really broken and I kind of transitioned into
direct primary care and went on my own. Only 1% of physicians are independent
physicians and only independent physician can be a true advocate for
their patient. We have no conflict of interest. The insurance man is not in my
office watching what I'm doing. Blood work is really cheap. Complete blood count
you can get it anywhere from 250 to 325. How much does insurance charge for it?
150. MRIs I get it for 425 in Florida is even cheaper sometimes you can get for
250 or something. How much does it cost with your deductible? $2,500. So this is
why it's broken because you have these people in the middle. They're making
these decisions on how much things are going to cost. Then they have discussions
with Medicare, with CMS, Medicare, Medicaid, and then you have to check all
these boxes to actually get paid. And until we realize that the only power in
in healthcare is between patient and physician and no one else.
Things are not going to get better.
So now I'm curious of that 35 cents, does anybody have a sense
of that 35 cents of all dollars, all federal expenditures?
How much of that actually landed in a doctor's pocket and a lab,
which I will call the direct unit of expenditure?
How much of that 35 cents went there versus to the middle folks?
Do we know?
Somebody ask Grok real quick.
Very slow amount.
In Kentucky, we're able to dispense medicines as well.
I know Kat's not able to do that in Texas because of laws.
But in Kentucky, I dispense medicines.
So when people ask me, well, what
do you do for Medicare patients, they're
not going to join your practice.
They have Medicare, everything's covered.
I have Medicare patients who they
save so much money on their medicines that it pays for their membership. Yeah, so we
have a 90-day supply of metformin, for example, is under $5. My mother-in-law lives with me.
She has Medicare. If she were to get her medications at Kroger through her insurance, it would
be over $50. So she gets them from me. It's less than $10. So many people are not aware.
caught in this trap, oh, I need my insurance
because healthcare is so expensive.
Well, healthcare is so expensive because of the insurance.
Right.
Well, Dr. Vaughan, I was talking with you this morning
and you have this incredible finding about the iliac vein
and just how transformative it is for some people.
And what I took from that, at least in part, was this idea
that here you have an outcome that's rock solid
And, you know, so I asked the next question is,
well, how many other people know about this?
And you've got a few other people out there.
But I get the sense you're going to have to fight hard to sort
of spread a better outcome that's better for the patient.
And so that feels like a system that's not about the outcome.
Yeah. One thing I will say is that, you know,
my biggest critique is, well, why don't you publish?
And first of all, I'm saying patients.
It takes a lot of publish.
But even the mechanisms from the expense of biostatisticians
to IRB to other stuff. It's not like the insurance is giving me that to do it. First of all they don't want me to publish it. So
a lot of times it's self financing because a lot of the other thing I think one of the more important things even though it just
got held up in court this morning is how the NIH is changing indirect funding. But the reason that you can't battle the
little Lathia Leviathan is because they have this 50 percent slush fund that actually allows them to not have to deal
with how payments actually are in reality. Meaning in the typical person if you get an NIH grant for a million dollars if
you're UAB that got 50 percent indirect funding that would mean about six hundred and sixty six thousand dollars would go
to the researcher. But about three hundred and thirty thousand would go to pay for the dean's salary and whatever the
heck he else wants. And that is not what we get when we're running practices as independent people. Does that make sense.
And in a sense, that gives them the flexibility to hire people
to put out their findings and actually get them out quicker and easier.
It is not easy to publish because it requires,
if you want to publish well, it requires a lot of people
that have a lot of expertise that we don't have that are expensive.
I know this sounds like I'm, you know,
but that's why the Leviathan continues to feed on all
of the smaller people out in the world.
And so I think Jay already at NIH trying to get this flat indirect fee
where that slush fund goes away and you better line item the reason you need
this money is going to mean that we're going to have good outcomes
and the dean may not have as great an office
or he can't depreciate his building, which the state paid for anyway.
But that I think is part of the change that needs to happen.
The other thing at the NIH is the Bayh-Dole Act.
Okay? And what that actually, I think intent, you know,
in terms of its intent was in the 80s, again,
it was actually passed before I was born to just kind
of give you an idea of how old it is.
But at the time, they were kind of frustrated
with the universities not commercializing
or getting this information out to the public
because there was no incentive.
Well, the problem was as the pendulum swing,
all of a sudden the incentive now is to only push out things
that have patentable commercial abilities.
And then when you think about it, actually I think it was 2022
or 2023, I think there was over $500 million in royalties paid
to the scientists at NIH.
Well, I would remind you that there's probably,
I think at the time there was only 386 scientists that were
in line for that royalty.
Well, you do the math.
That's a lot more than I make.
And these people are supposedly public servants.
I mean, I'm just, again,
I'm not saying they have ill intent here.
But if I was a public servant scientist at the NIH,
Would I research things that were repurposed drugs,
knowledge we already had, or would I research things
that I had the potential to have, you know,
perpetuity royalties on?
And those are the perverse
and non-transparent incentives that are going on.
And actually, if you want to know the truth,
I have no question that's why mRNA was the chosen technology
for addressing this pandemic.
So it goes back to a bill that was passed by Bob Dole
and By's father, Evan By's father, back in the 80s.
But it sounds crazy that that's it.
But that is what the incentives drove us to.
Yeah, indeed.
And you know, I did work in pharma for three years
right out of business school.
And that was in around the year 2000.
And even then their return on equity was cratering.
They were down to very small drugs.
They were orphaned.
You know, it's just, you could see the business model dying.
So MRNA must have been this excite, oh we can cure everything
and we can sell it and get it in everybody's arms
and it was an exciting moment for people who look
at their spreadsheets in pharma offices.
So as at least in part, but we're talking about incentives.
Tim, ouch, so we're talking about 4.8 trillion in spend
on healthcare last GDP cycle.
We're up against a multi-trillion dollar industry
that doesn't want any of this to change.
Likes it complicated, opaque.
What's the political battle?
What would that look like if somebody really wanted
to try and change that?
Well, ugly.
Well, first of all, so when it comes to publishing,
I recommend this guy James Lindsay.
You may have heard of him.
He sat on the panel yesterday.
He's published a few things about, well, they.
I don't want to trick people.
I actually went real silent.
Anyway, I had the opportunity to interview James yesterday
for we do a podcast behind the scenes for this conference
that we have lots of material for social media later on.
And it was amazing to me the circular thinking that goes on. That's part of it. Right. Is is I mean as a as a political
strategist I would love to be able to confirm my own work. You know two or three sources that are me. That would be fantastic.
But so yeah. What does it take. Well of course there's a lot of money to interest. So I am a one of the things that we're
pushing and this is why this is a pillar for us in this is that we're actually pushing for HHS to open everything up and to
show everything. It's going to be tough. You know in politics you have to disclose where your funding comes from. But in health
care you don't. And in and in health care you don't have to disclose that this drug that you're recommending is one that you're
actually making a royalty on. And so I can only say that this is a major push. And again it's a unifying push because it's not
ideological, it's good process.
And that's, a lot of Maha transcends ideology
and just goes after good, right process.
And that's why HHS is so different
versus other agencies.
And that's why Bobby's got opportunity
and that's why he's also got threats
because he's not a straight ideological thing.
So all I can say is that with IMA, we're pushing for that.
I don't know that it's a top priority for them,
But I know that it's a it's a win that they would like to get. But it's going to be expensive in terms of the battle against
any time you expose who's making how much what percent or whatever you're talking about people's paycheck. You know and then
that's when the knives come out in D.C. I once learned one time we we were running a bill to stop Congress from raising their
own pay. And I got so many calls from Congressmen saying you can do whatever you want with taxes and regulations. Don't you
dare touch my pay. And that's D.C. them in that shell. So anyway. So that's I mean
that's it. It's going to be an epic battle if they can do it. But if they can
do it it transcends ideology. It's not Democrat it's not Republican. It's
unifying. It's everybody show us show us. Right.
Was the Upton Sinclair quote never expect a man to understand something if
the salary requires him not to.
So Kat, how do we begin, a sense I have is that HHS sort of
and the whole industry became about treatments.
How do we get outcomes back in the mix as something
that has a seat at the table?
And what does the role of patient transparency play in that?
So I think the biggest advocate for their own health
are patients.
So we need to engage patients to actually care
about what's happening in DC as well.
We need to empower them to be in charge of their own health.
And you can do that through different initiatives,
whether it's expanding HSAs that Chip Roy and Ted Cruz
like to do, whether it's asking for more transparency
from the HHS.
but we actually need every voice up there.
We need every mom up there.
You know, one of the things, there's a lot of things
that I don't like about what's happening in HHS,
but one of the good one is this new office
of looking at vaccine injury.
They want transparency, and that's really transparent,
for lack of a better word.
But we just need to be the power behind the initiatives
that they're trying to accomplish.
And we need every mom and dad out there and grandparents
and everyone to get involved.
From our perspective, I think three of us are here independent.
We are trying to show that the only way to return trust
in medicine is to get back to this art of being the physician,
being the servant leader.
That's what our profession is meant to be.
We need to become mentors to our medical students.
We need to teach them there.
It's a better thing than.
The problem is like if you go to medical school,
you have like quarter million dollars of debt, and then the,
okay, it's a hard word to say this morning.
Anyway, you know what I mean.
And then the hospital comes along, and it's like, oh,
if you join my practice, you're going to start making this much money,
and you're going to be able to pay off your medical school loans,
and that's how they get them.
So we need actually the administration to,
I'm a big proponent of small business loans
for people who want to go into private practice of medicine.
We need to open this venue of actually
empowering doctors to be doctors.
And at the same time, we need to,
and I think the good thing about COVID is
people have woken up to the fact that
we are not the masters of the universe you are.
So claim that, claim your own power back.
and demand better of us.
Nice. I love that.
So.
I will. So, Dr. Rutherford, I love the ability of a story
to sort of encapsulate the larger, the fractal nature of it.
The opioid epidemic, you're an addiction specialist.
What's that story?
I feel like it has an instructive lesson for us here.
Well, that was one of the early awakenings that I had
after medical school I moved out to Kentucky in the middle
of the opioid epidemic and really saw how the pharmaceutical industry was
coming in and pressuring doctors to treat pain more, you know,
more aggressively and we were taught that in medical school as well.
And I think some people, doctors got blamed for all of it
but it really was coming down from the top.
So there were, it came down, there were pain is the fifth vital sign
that came from ultimately government.
And it was all based on a lie.
One paragraph in the New England Journal of Medicine saying
that if you treat, that addiction is very rare
if you treat somebody with opioids.
Well, we all know that's false.
So that's how I ended up in direct care, really.
I was treating addiction.
I decided to become certified to prescribe buprenorphine in Kentucky
and help people with opioids.
And I loved the work so much.
And part of the reason I loved it was
substance use disorders, they were not covered
by insurance or Medicare and Medicaid.
So it was all cash-based.
So I had the opportunity to sit with a patient
for an hour and listen to their story.
And it was so rewarding when somebody is in recovery,
they're just completely different
from what they're like when they're in active addiction.
So it was extremely rewarding work.
And then I just loved the fact
that I didn't have to worry about checking these boxes and deciding
if it was an ENM code four or ENM code five
and doctors know what I'm talking about with that.
It's just annoying side stuff that has nothing to do with medicine.
And so that was when I decided I want to do this for primary care
as well and I happened to learn about direct primary care.
But yeah, the opioid epidemic was a big fraud and it killed,
It still is killing millions of people.
I have to ask, where did that paragraph in NEJM come from?
It was a letter.
I don't remember the author, but it wasn't a study.
It was a brief letter, and it was based on hospitalized patients.
So they weren't even being followed.
You can't know if somebody becomes addicted
to opioids based on a hospitalization.
And if you're in a hospital, you're probably in severe acute pain.
So it would make sense to prescribe opioids for acute pain.
But chronic pain is completely different.
So it was all based on a big lie and then pharma capitalized on it.
And, you know, some doctors really did bad things.
You know, there were doctors
who were feeding their own addiction by giving out pills to everyone.
But for the most part, we were blamed for something
that was not necessarily all our fault.
We did over-rescribe, but it was, there were all these forces
on the outside pressuring us to do that.
Because in Kentucky, actually, doctors were being sued
for under-treating pain when I moved out there.
Sued for under-treating pain.
It was one of the CMS markers.
If you didn't address the pain, then your performance went down,
so your pay went down.
So it's all these indirect pressures that are put down.
And it wasn't pushed by us because none of us, I would say,
like to treat chronic pain because it's, you know,
it's one of those things that's very complex and needs
to be addressed from many points of view.
Well, the CDC came out with recommendations back in 2014
that made panicked all of the primary care doctors
so that they just cut everybody off of their pain pills.
And then I was on the HHS task force on pain management.
And so we kind of revised, CDC came back
and revised those recommendations, thank goodness.
But it was, our recommendations
in the pain task force were not really widely distributed
for some reason.
I'm not sure what happened there.
Maybe Tim knows.
Well, the incentives, again, seem to be driving a lot of this.
And when I was at the Brownstone retreat a while ago,
there was a guy there, Ralph, who talked about the difficulty
of speaking of transparency of how there are all these disconnected
medical record systems so that part of the problem with some
of the outcomes is that a patient might go
to four different specialists
who don't actually see each other's records, really.
Or it's in PDF form, and who's going to read 1,000 pages of PDFs
of labs to get to something. Jordan you had a way of getting better transparency inside your own practice. I feel it would be
important to share. Yeah I mean just in vaccine injury and long cover it. A lot of these patients are probably I mean I think
probably the record might be 170 doctors before they got to me over a three year time period. Again these people a lot of them
were just like they're the guys that became people who ran sub four minute mile. So meaning they have the go with all to want
to find an answer that's not hey your brain is you know like oh you're just thinking right. Meaning so a lot of these people will
spend out of pocket. I mean I think probably the highest of somebody spent probably two hundred thousand dollars but they have gone
to every specialist all over the country. A lot of these people I don't know how they get to me probably because they're you know keep
trying and wanting an answer. But they're also wealthy. I mean some of the patients I've taken care of are in the top 50 people in
terms of wealth and the whole world. And they have spent more money than you would ever imagine. But they also have 170 doctors
opinions. And interestingly enough I think the again I don't want to get outside of my lane here a little bit. But A.I. that might
be the opportunity for it. And so what I'm able to do is I wrote my own large language model that actually analyzes all you know
you know, I'd get a stack of 2,000 pages, and it's like,
hell, I'm not going to read all that.
But I can write a large language model to go look
for how I would look at records.
And what it does is actually allow me to get a two-piece summary
of their chronological history over four years,
which actually makes it really easy, not easy, but when I go in
and talk to the patient, they're like,
how do you already know this all about me?
And it's actually not because I spent seven hours reading it,
but because I had something run through the large language model
in about one minute, and it spit out what I was looking for.
Now, this sounds very like, I know AI, as it's,
we talked about this morning, is AI now reasoning,
but I think that is actually one of the things
that might be a great help to these complex patients,
because there is such huge disconnect.
But if I already kind of know what I want to look at the totality
of the 10 neurologists and the 10 cardiologists
and the 10 whatever have seen, and I can run something
to actually review those records quickly.
It is a huge, huge help.
So those are efficiencies that I think we're on the precipice of,
which as independent physicians make us a powerful tool
because the hospital is creating this massive documentation
and it makes us as confused as possible.
But in a sense, actually, we can have something do that for us
without blowing our heads off at the end of the day.
But that's one of the things that's actually helped me
because in a sense, I would say the negative of that is
I don't ever look at the subjective, by the way.
I look at the objective because the subjective,
most of these patients when they come through
have been told that it's not real,
it's not vaccine injury, it's not whatever.
And then that gets kind of tagged to their record.
And then all that doctor who has two minutes to review
One note before you walk in the room, they just say, oh, I'm dealing with the crazy person. Does that make sense? And so what we have to get back to is the totality of objective data being able to actually look at that over a time period very quickly, which ai is going to allow us to do. I'm not an advocate for ai, but I just think it's a cool thing. And the other thing is, as I was telling Chris, it learns what I care about, which is even weirder and actually makes almost better recommendations than I have. Sometimes at the end of it, it's one of the parts of the large language model.
And then some of the recommendations it makes, it says,
I actually get a, well, that's not a bad idea.
So it just shows you that there is, you know,
because it read the record too.
And it, anyway, it allows these very complex patients,
not to make them easier, but to not feel like you're, like,
when you get that manila envelope full of this to be like, oh my gosh.
Anyway, I know this is not transparency in medicine, but anyway,
we need to have a talk on AI, good uses of AI for complex patients.
That should be a talk next time.
But anyway.
I'll show my age, but do you remember
when the specialist would send you a letter
after they saw your patient and tell you what they did?
Now we just get this gobbledygook
from the electronic medical record.
It's so frustrating.
It makes no sense.
So that's great that you figured out a way to translate it.
And Jordan, but you could write your large language model
like you would, meaning, so I feed the papers and some
of the foundational things that I think
about when I see patients to it.
And then it actually, I also write a script that says,
these are the things I care about.
And then it goes and finds it all for me.
And you got training to do that very specialized thing
from the AMA?
Oh no, HHS gave you money to do that?
I actually, my incentive was a personal incentive
to say there's got to be a better way to do that.
Right. Well, it's exceedingly valuable knowledge because, I mean,
that's part of the transparency.
The system we have is incentivized
to give you 170,000 pages of junk.
And it doesn't have an incentive to synthesize it, so you have to do it.
There is good data in there.
There's no question.
It's like you don't need to redo the echo and all this stuff,
but you're always like, did they get an echo?
But, I mean, but it's so convoluted if you don't have a system
to actually analyze it, that you're going to be in trouble.
Not in trouble.
you're going to have blind, not that we don't all have blind spots,
but the blind spots also create inefficiencies in medicine
because then you're like, well, you're going to go,
you need to go get this done again.
And then you've, well, I've already had five, you know, MRIs.
I'm like, well, I don't, I don't have access to, you know, so it's, anyway,
I think that's one of the cool things.
Now, I can almost guarantee this probably, this, what I'm talking about,
eventually probably some, there'll be some policy paper
that says you can't do it, but whatever.
Because it's, because it's making medicine too efficient
and you're having good outcomes which means you don't need our stinking drugs. But it. But right now it's kind of cool on the
precipice to be able to use that. Yeah. Excellent story. So hunt him down. Hear more about it if that applies to you. Question here
from Shirley says if corporate doctors in the system are being given incentives for checking the boxes is this not an anti kickback
statute problem. Tim is can we can we write a law. Does it do laws already exist.
Wait, wait.
I want to say something.
Groc, how is Dr. Von's elf?
I'm so sorry.
Just kidding.
I will say, if you ever get a chance with Groc,
me and Chris were doing that this morning.
Ask it to roast you.
Oh, it's hysterical.
I got roasted.
Okay. It is.
It'll look at your tweets and roast you
like a comedian will roast you, and it like hits you right here.
Well so. So there's there's laws there's regulations there's rules. And I think we should we should strengthen the rules at a
minimum. That's where the secretary can act quickly. I want to go back to this this opioid thing is you know the health care
has taken a huge hit in trust. Right. Especially our agencies have taken a huge hit in trust. Doctors have taken a huge hit in
trust which I thought what I'd never see. I mean in campaigns if you want to elect someone you haven't stand next to a firefighter
a doctor. Well that's not the case anymore. Yeah I'm standing next to a doctor. You're going to lose more boats and you win. And
and so hopefully I am a can help push this restoration of trust because in the Sackler case and the whole opioid thing that they
got teams and guys like me that are saying no no no no. This is the doctor's fault. We gave them a very sophisticated tool to
used and doctors misused it right. And the blame game in the PR game because nowadays truth is relative to what you hear. And we
have to get through that too. And it used to be that the HHS was the gold standard as President Trump has said several times
the last return to the gold standard. It used to be that you could trust what came out of there. So in terms of transparency we
have to restore that too. And I know that's why IMA is pushing so hard. And we would like IMA to be a place where people can
come in and check against what they've heard and say oh yeah. I am a says this. We know this is true. But right now there's no
entity out there that does that. And that's the problem. And I will I will say I mean that is to have the 70 percent down to
sub 40 percent in respect. People to blame for that who pissed your profession away are the people over the last four years
that had the microphones and we should be angry about it. Yeah indeed. I always say that if your doctor works for a hospital
system or for the government they don't work for you. It sounds harsh but it's true. And I and I have sympathy for or empathy
for doctors who you know their specialty won't allow them to be independent right now. But hopefully we can move to where they
take that back more as a consultant role instead of being employed by the
hospital. I always use the you know when Obama said you can keep your doctor then
what actually he was saying was you can keep that person that you that that
that doctor person the difference is your doctor is not your doctor anymore
actually instead of working for you he's working for the system that is now
employing him. So he may be the same person but the incentive structure to
actually care about you and how much he cares about you since 2010 I guess as is
drastically changed. And the results are obvious.
Well indeed if you want to really get angry about things which it's Sunday
morning so we all do you know just go and look at the CEO pay for just a
regional hospital or a mid sized hospital. It's in the millions. You look at the C
suite play it pay for all the health insurance companies tens if not hundreds
of millions but usually typically tens and tens of millions. You have to ask what are these people doing that justifies pay that
large. Not only that I mean half of them don't even know. I mean they're not the smartest people in the book because in business
they all would have been out of business but they get they get bailed out every time every little county hospital is about to go out
of business. They never say hey let's cut the CEO pay. Yeah. And why do we have an idiot running it. It's and they're
or non-profits?
Yes.
That's not good.
Not-for-profits?
Yeah.
Whose profits?
Right, exactly.
So, question here from Anonymous who's been very active
over this weekend.
Does the insurance system play the biggest role
in prohibiting transparency in medicine overall, including CMS,
along with publicly traded insurance companies?
Biggest role.
Biggest role.
I don't know that, you know, even I think Bobby, one of the things
that he's actually said was when he tried to go get the data from CMS,
they said he had to purchase it, if I remember this.
I couldn't believe that.
Like, you're now the, you're the head of HHS
and CMS is still telling you to get that data.
He still, within HHS, has to purchase that data.
I'm like, aren't you all on the same, maybe Tim can talk about this,
but I was like, I was dumbfounded.
Yeah I I don't know. But on that I just I know the free market is the biggest regulator of pricing and and the insurance
company that completely warped the free market and health care system. And that's why we get a lot of what we get. So you
know a restoration of that would would go a long way in making sure we're no longer paying for 120 dollar aspirins. So you
have many lobby groups. You have pharma, you have hospital associations, you have
insurance, you have pharmacy benefit managers, you have all these people who
have a huge role and no one wants to share their data because data is money,
data is power. So there are many players in this game but biggest one is actually
CMS. Center for Medicare Services. It's one of the biggest ones and that's our
own government. Well we saw that maybe the hopefully the pinnacle of that but
we had the execution on the streets of New York of the UNH CEO right United
Health Care by Luigi and what was astonishing to me going out to Reddit and
seeing things there were a lot of people out there who were openly saying yeah
that was a good thing right so you could feel like the frustration the anger in
this system we're talking about and a lot of other people sort of took the
Chris Rock approach which was like I don't condone it but I understand it. You know. And it's amazing. So that's the anger built
up in the system is that broken. It feels like there should be some fuel to help fix it. And I don't think it's going to get
better. I mean as much as I'm doing the A.I. stuff to help the patient that's what the insurance companies are using it to deny
care. And it is. And so that's actually that guy what he was known for was actually utilizing A.I. and United Health had the
biggest denial compared to other health insurance companies. But he had just instituted the last two years a way to get denials
written without actually having to pay people to write them. I don't think we're going to fix it from the top down. I think it's
going to take patients demanding doctors like us independent doctors. And I think it's going to take training or educating the
the young doctors, the medical students
on what they're getting themselves into.
Because doctors are not happy.
They're very burnout.
People are retiring early.
And so I think I'm optimistic
because I'm seeing that movement within my practice.
I have people wanting to join my practice.
Just it's a blessing.
However, if I want to hire a doctor
I have to compete with the local hospital systems
and I can't match their salaries.
I can't provide a doctor, a young doctor with a signing bonus,
for example, or loan repayment, but I do have some hope just
because patients are seeking out independent doctors.
Good. All right.
In our final time, last question,
in the payment incentive structure,
and this could be a single word if you want.
Kat, starting with you, is it reformable?
Can I go last, I'll think about it?
You can.
The payment incentive structure.
In business you often have to make the decision, we either reform this culture or we blow it
up.
We have to just start over.
We have to blow it up, and people are.
The Surgery Center of Oklahoma, Keith Smith, there's people out there who are.
Yep.
Yeah, actually I think you have to get rid of third party payers.
I mean third party payers make the market economy not work.
There is the fact that the interaction is between you and the patient and the person that decides is hasn't has as only
financial or financial perspective in the game and they're disconnected from the interaction makes it something that will
never be never be. I don't think you could ever solve that. Meaning it has to be blown up. Why is our insurance tied to our
employment. That's a huge flaw as well. Right. These guys. So I I think the
health share movement is very interesting because it's exposed a lot of
the pricing differences. You walk into a doctor's office and you say I'm I'm
self-paid. They're like OK it's seventy five dollars or if you walk in you say
I'm with insurance. OK well it's you know X or Y or Z five hundred dollars. So
maybe it resolves itself a little bit through that mechanism. I don't know but
I think the health care system has exposed a lot of the pricing issues and
incentive issues. Yeah. And that's only growing. So great. Thank you. Cat. Last word. Well you don't know how I feel about
the world organization. So this is kind of the same thing. And I was waiting to see what they will say. They will be a
little bit more optimistic than I am because I tend to be quite negative. I don't think these things can be reformed. They
need to be blown up. But the only way they can be blown up is if people take their power back. And how do you do that. You
You do it with your money, you know, you walk out.
How do you, you know, you don't have to take what your healthcare professional, I was going
to do provider, but then I remembered provider is a bad word, yeah, yeah, yeah.
Healthcare professional tells you, right, you don't have to buy what they're selling
you.
But you're the only one that has that power, we don't have it.
You know, we try to do our best and we are, and we are seeing the movement of doctors
but even young residents who want to go into direct primary care
or direct specialty care.
So the movement is there, but we need you to back us up,
and you need to do it by walking out of that office
that you don't agree with.
There are many solutions.
There are different policies that can help you do that,
but you're the one that's in charge, not the system.
And this is exactly why.
So when you hear about the transparency pillar in IMA, it's about this.
It's about restoring that trust at the foundation that requires that transparency.
It's about restoring that dynamic between the doctor and the patient, not the provider.
And it's about understanding that we have a perverse system of incentives that have
been carefully layered up over time that have stolen the power from all of us and also our
money.
So that's why all of this has to be exposed and there's nothing like the disinfectant
of sunlight.
So this all has to just be pulled right out in the open.
So thank you, everybody.
Thank you.
Thank you.
