Dr. Dennis Charney, Dean of the Icahn School of Medicine at Mount Sinai

(Music)

Mark Masselli : This is a Conversation on H ealth Care. I’m Mark Masselli .

Margar et Flinter: And I am Margaret F linter.

Mark Masselli : Well , Margaret , the rollercoaster ride in Washington is over , they have
pas sed continuing resolution and address the budget crisis at least for now, but it’s had
a big impact on millions of Americans across this country .

Margaret Flinter: Mark , I think we have manage d to avoid disaster but done with the
tactic just too familiar too often kicking the cane do wn the road to be dealt with at
another time .

Mark Masselli : You know t he women of the senate came together both bipartisan
democratic side and the republican side and they put together a proposal that ’s
th
accepted to push the temporary budget out till Jan uary 15 in (0:46 inaudible)
th
February 7 my hope is that this is a lesson for both the House and the Senate , that
they have to come together in a bipartisan way to move the agenda forward.

Margaret Flinter: Mark, I do understand that there were some compromises made and
is part of the deal conservatives and ho use to mend that additional income verif ication
for folks and rolling in the online insurance marketplaces under Obama C are. But really
income verification was already part of the law’s requirements and part of the exchange
applications.

Mark Masselli : It really was and w e’ll see how old these gets carried out over the next
few months.

Margaret Flinter: And speaking of the A ffordable C are A ct in the exchanges does
exchanges have been up in running for a few weeks now kind of a tale of two nations
the states that set up their own exchanges at least on a tactical level have reported a
much smoother process but in the S tates 36 of them th at are re lying on the federal
exchange they ’ve really been be develop ed by IT problems since the beginning.

Mark Masselli : There’s going to be autopsy in all of these at some point where people
will look critically at it there already are some as you said some ve ry good acti vities
going on in differ ent states and hopefully that will spread across the country.

Margaret Flinter: And people out there who’ve been train ed to help people one group is
E nroll America that’s a national volunt eer organization that deployi ng people to assist in
the online application processes especially in the states that haven’t developed as much
support as they may need.

Mark Masselli : And you can find out more about E nroll America by going to
enrollamerica .org .

Margaret Flinter: And in spite of all the focus on enrollment in the Affordable Care Act
dramatic chang e is h appening everyday in H ealth Care and out guest today kn ows a lot
about that, that’s Dr. Dennis Charney the Dean of the Icahn school of Medicine at
Mount Sinai in New York C ity , where they are undergoing a massive transformation in
their health system as well as in the medical school that train the health professional of
the next generation .

Mark Masselli : You know they are making B ig D ata a central player in their restructur ed
medical school program as well as in their health system Dr. Charney w ill tell us about
the changes going underway that are transform ing their approach to train ing the next
generation of medi cal professional . It looks like it interesting m odel for other medical
training institution s to learn from.

Margaret Flinter: And we will also hear from Lori Robertson managing editor of
FactCheck.org who will be looking into some false claims about health reform that have
been spoken recently in the public domain.

Mark Masselli : No matter what the topic you can hear all of our shows by goggling CHC
Radio . And as always if you have comments please emails u s at chcradio .com or find
us on Face book or Twitter we ’d love to hear from you .

Margaret Flinter: Now we ’ll get to our interview with Dr. Dennis Charney in just a
moment.

Mark Masselli : But first here is our producer Marianne O ’ Hare with this week’s headline
news .

(Music)

Marianne O ’ Hare: I am Marianne O ’ Hare with these health care headlines.
Government is back in business after a weeks long shut down and what did it cause the
American economy about 24 billion dollars according to estimate from standard in poor
rating agency. Wall Street analyze predict dire consequences if congress doesn’ t get
act together soon C hina has already downgraded its rating of the Americans treasury
bond s due to the shut down new default and un resolve d ebt ceiling issues. What didn’t
make it pass to shut down was a GOP attempt to repeal the medical device tax , it’s part
of the A ffordable C are A ct design to help raise funds to pay for the l aw . Meanwhile
things are turning along slowly o n the federal health exchanges while they remain open
some predict many wee ks or even months of round the clocks troubleshooting before
that system wraps up to full s peed. And while they’re running more smoothly for the
most part they are glitches and hanging up s on the state base exchanges and number
of states are re porting pro blems with their list of doctors procedure and medication s
shown to be covered by each of the plan s , covered California had remove their doctor
list entirely because it was s o problematic .

On the w hole states are doing a fairly good job of assisting residen ce in signing up for
coverage. Meanwhile mark et calendar is spending authority only continues to January
th th
15 , and the federal borrowing privileges extended through February 7 the budget
debate and accompanying wows are far from over. And simult aneously it’s time again
for open enrollment for Medicare coverage seniors are be ing urge to really re define
prints this year, a num ber of plans may have different coverage than the previous year,
senior s being told not to assume their coverage will remain the same. Mirror, mirror o n
the wall what city is the largest drug consumer of all, when it come to Medicare
prescription drug consumption the winner is Miami. The average senior in Miami spen t
close to 5 , 000 dollars per year on prescription drugs, many in high risk category in
national averages about half that there are couple of reasons according to Dr. Jeffr e y
Munson lead author of the Dartmouth report, one reason was simply that Miami ha s
t raditionally been a high use region another reason higher per centage of specialist there
more likely to prescribe more targeted drug regiments. And want to get little Johnny to
sleep better ant night and behave better doing the day it’s not in the pills it’s in the
discipline it seems recent studies in Great Britai n showed a direct correlation between
later bedtime hours for children and less well behave kids during the days . That’s
nothing new but what the study did find out was those kids was variable bed times each
night f e are d far worse across the board . So early to bed at same time every night
make s a child chipper mindful and bright. I am Marianne O ’ Hare with this health care
headline .

Mark Masselli : We ’re speaking today with Dr. Dennis Charney, Dean of the Icahn
S chools of M edicine at Mount Sinai in New York and President for A cademic A ffairs .
Dr. Charney is a professor of psychiatry in neuroscience and system s therapeutics and
he’s a world expert on neurobiology in the treatment of mood and anxiety disorder s. Dr.
Charney has several patens to his name and he’s author of over 700 publish ed articles
in several books including the neurobiology of mental illness and resilien ce the science
of master in life’s greatest challenges. Dr. Charney is a form er scientific direct or at the
National Institute of mental health and a member of the institute o f medicine of the
national academy of science. Dr. Charney welcome to conversation on health care.

Dr. Charney : I’m happy to join you to day .

Mark Masselli : Well the A ffordabl e C are A ct has been keeping you and your
organization quite busy, the M ount Sinai health systems in New York C ity recently going
under a significant transformation including the creation about affordable care
organization you ’ve also been thinking hard abo ut training that next generation of health
care professionals as a necessary approach to preparing your organization in the
country for its future challenges . T ell us about your vision fo r the re design ed health
care system in the age of the A ffordable C ar e A ct coupled with significant technological
advances ?

Dr. Charney : I’m happy to . As you may know about two weeks ag o we concluded an
agreement to emerge with the continuum health partner’s system to form the Mount
Sinai h ealth system . Which now consist of seven hospitals, a large am bula tory care

network associated with a single medical school and that’s the Icahn school of Medicine
at Mount Sinai. The Health care system will be responsible for two and a half million
outpatient visit s almost 40% of the discharges in Manhattan here . And it allows us to
develop new method s innovative methods of delivering outstanding health care to a
large population , in other words p opulation management of health . W hich is a key
component of the A ffo rdable C are A ct , and as you mention we also have a n
Accountable Care Organization an A C O which looks almost like an experiment al way
in the beginning to determine how can we lower the cost of health care while improving
quality . And so, through these tw o processes one is now having one of the largest
health care system s in the nation with a single medical school and the ACO we ’ re
developing noble methods to deliver health care.

Margaret Flinter: Well Dr. Charney , it certainly sounds like you are breaking some new
ground and breaking it in a very big and significant way . And I ’d like to ask about the
work that you’re doing with assembling data for population management I understand
that you ’re investing significan tly in a Data Hub that you ’ve hire d the original or one of
the original data scientist from F acebook and a growing team to figure th is out and at
the sometime also are building a biobank at M ount Sinai where genetic information can
be store d and then incor porate into a data stream to get better insight into e ffective
treatments and I imagine personalize d treatment as well. Maybe you could share with
us , you have s o much going on simultaneously where are you in the process of setting
up these massive data i nfrastructure and when do you th ink you’ll begin to see impact
either on teaching or patient outcomes.

Dr. Charney : So, all those these are happening here at Mount Sinai . One of the key
elements of being able to provide gr eat car e in a large health care system is that you
must be data driven so that you know what practice relate to patient wellness what
practice relate to readmission . And how do you create an approach to wellness and
primary care that ultimately enhances to help of your community. In o rder to be able do
that you need to have expertise and what is now call ed B ig D ata analytic s and how that
m ight relate to delivering health care. So, we ’ve been investing a lot in that area as you
allude to. Eric S c had t is the head of our D epartment of G enomics and Multiscale
B iology , he is one of the pioneer s in B ig D ata analytic s and he help ed us recruit Jeff
H ammerbacher who you alluded to -- who used to work for F acebook and help ed
develop the large data analytic platform for F acebook and Jeff Hammerb acher who is
now an assistant professor here and is working with Eric Schadt’s teams, has decided
to take his skills that he develop ed at F acebook and devote that to biomedical research
and health care delivery.

In order to accomplish this we’ve had to in vest a lot in high performance computing
system and, apparently when you invest enough you can name your computer. So, we
have a computer and now it’s called Minerva which is the goddess of wisdom . A nd that
computer is the infrastructure that is required to analyze a really enormous amount s of
data from our electronic medical record , from our genomic s program , imaging program ,
and to especially put it all together and help us make ultimately clinical decision for the
better for our patients and -- I’ll ju st give you one example of how that actually work s .

As many of you listen ers may know , the ability to sequence the human genome has
gone down enormous ly i n course so that shortly the cause of sequencing one’s genetics
will be at the level of the lab test. In order to make that work in delivering health care
we now take genomic data we put it together with one ’s c linical data and so that at the
point of care our doctors can now be -- have information that enables them to make
decision s base d on the patient ’s genetic s in terms of what drugs they are given to at the
best outcome s .

Mark Masselli : Well that is exciting and I certainly would like to talk a little more about
B ig D ata and what is good actionable data for clinicians. But first and we’ve heard from
a lot of folks who ’ve come on our show about the difficulty of dealing with the silos in
health care . A nd it ’ s taking a long time to bui ld them and deconstructing the system
while continuing to deliver care can be a real challenge sort of the proverb ial flying in
the jet and changing out the engines at the same time. And you are not only breaking
down Silos within your system , you’re also partnering with some exciting external
partners like R ensselaer P olytechnic I nstitute to seek outside assistance and system
transformation . So how are you achieving this transformation on such a large scale
while M ount Sinai continues to treat 2.5 millions outpatient visits 40%of the discharges
in Manhattan that’s a lot balls to keep up in New York -- tell u s how yo u ’re doing that?

Dr. Charney : Well, you know, first -- in analyzing you know whether or not the merger
c ontinuum health partner s system may tends to -- you know, we spent about a year in
developing plans to integrate the systems and determine that you had to achieve
excellen ce throughout a seven hospital system. And so, even though we only recently
actually merge d the planning ha d been going on , you know , for a year and just like you
said we had to continue to deliver outstanding care while we m erg e the systems. So,
we had figured out ways how to do that, we have had lots of meeting s the leaders of our
different department s and institute s and ultimately what we’re going to develop is
clinical cent ers of excellence throughout the M ount Sinai health care system , such as
diabetes, HIV, pulmonary disease and primary care . And in fact one of the key
ingredients with achieving wellness in the population i s to have a very strong primary
care of network . So all these ini ti ative s began before w e completed the merger and
now we are hitting the ground running to literally change heath care in Manhattan and
around the rest of New York C ity and the tri state area.

We are also investing a lot in innovation and that’s where the partnership with
R ensselaer P olytechnic I nstitute comes in. More and more digital medicine is going to
be important in how we deliver health care so, that more care can happen literally in the
home and not in the hospital or outpatient clinic or doctors office or in the hospitals
its elf . And we can do that because of the advances in digital medicine it allows us to
take blood pressure and measure glucose level s and to do E KGs literally in the home.
We can communicate in a very robust way with our patients , you know, while the y’re in
the home setting and so that offers a lot of advantages because literally what’s
important about achieving health is being healthy in your community your -- in your
home. So, we ’re going to take advantage impart w ith our partnership with RPI which is

-- has a lot of expertise in digital health to literally have a health care system that start s
in one ’s home.

Margaret Flinter: Well Dr. Charney you’re obviously doing a really remarkable work in
delivery system redesign and technology advances . But I know that, there is a very
core focus also on your m ission of training and teaching and training that next
generation to be the provider and the scientist and the leaders in this transform system
and I understand that you’re committing really quite a massive i nvestment two billion
dollars toward s the plan to thoroughly transform that medical training program to focus
o n some of these changes to focus on transitional medicine , utilizing the emerging tools
in b io - medic s and genomics and other technolog ies as you ’ve describe to create better
solution s to treatment in patient care . Maybe you could share with us some about this
new train ing approach how you’re doing that, and I wonder i f also -- although the focus
here I think it ’ s on your medical training and I kn ow you’re there in New York with the
Macy Foundation and have the same push for inter collabor ative professional practices
and education that all institution s are trying to achieve . So maybe share with us a little
bit about that training mission .

Dr. Cha rney : Yeah as you mention ed we are in the middle of implementing a two billion
dollars plus strategic plan that goes from conducting very basic research that ultimately
we hope only to cures for a serious medical diseases through the kind of care we
curre ntly deliver to patient. And so, it’s -- in a sense delivering care now and
discovering care for the future is part of our st rategic plan. And the ultimate goal of th is
strategic plan is to make discoveries that change the way medicine is practice whether it
through novel approaches to digital health as I mention ed or the discovering of new
medicines for cancer or heart diseases or a serious mental illness or new medical or a
surgical devices to improve surgical outcomes . Th at’s all part of our pla n to achieve
that though we ha ve to be training literally the best and the brightest medical students
graduates students and other trainees.

And we want to have a culture of entrepreneurship t hat our students think out of the box
almost like a Silicon Val ley approach to a training and discov ery. So, in order to do that
we have revamp our medical training curriculum and even the way we admits student to
our medical school. We are actively recruiting medical students from discipline s th at
typically have no t thought of going to medical schools like students with expertise in
computer science and mathematics engineering and physic s , we are teaching our
students how to be entrepreneur and innovative and literally think that they can change ,
you know, medicine early in their career. So, what that’s done is a lead to a culture of
you know excitement and innovation here at Mount Sinai starting with our students and
ending with the patient’s experience.

Mark Masselli : We’re speaking today with Dr. Dennis Charney, Dean of the Icahn
School of M edicine at Mount Sinai in New York and P resident for A cademic A ffairs. Dr.
Charney is a world expert on neurobiology in the treatment of mood and anxiety
disorder s and over seas one of the largest collections of nation al institute of health
studies among the nation ’s medical schools . Dr. Charney significant focus of your work

is in conducting research in your specific area of expertise is in p sychiatr y and
neuropharmacology . But you seem to have a dysfunctional patien t In Washington that
is impacting everyone’s health the sequester obviously had an enormous impact on the
NIH budget and to the shut down completely. Tell us first of all about some of the
exciting research that you are doing but also the impact on the la ck of adequate funding
fir NIH and the shutdown is having on your larger plans.

Dr. Charney : Ye ah, you know it was Dickens wrote this it’s the best in time s and the
worst of times. It’s the best of time in that we ’ve never had so many tools to discover
the causes of serious medical diseases and base d on that to develop new treatments.
We’re making rapid progress in discovering new approaches to the treatment of cancer
now it’s becoming more of a chronic disease with certain cancer. In m ental illnesses
our scientist have discovered a new approaches for the treatment of depression and are
working very hard at developing better treatments for serious diseases early in life like
autism and late in life like A lzheimer's disease or a micr o - biologist have discover ed a
new methods to develop a universal flu of vaccine so, you won’t have to get a f lu shot
ultimately every year but may be every you know, ten years .

There’s just so many you know, exciting thing s now happening but the problem is that
we’r e not getting the funding we need to accomplish what we know we can now
accomplish. The sequester resulted in it you know, literally a decrease in NIH funding in
real dollars and when yo u take into account inflations it was a substantial decrease and
the nation ’s health depends on research funded by the NIH and with the shut down and
the government all new applications stop being evaluated . And so we’re making zero
progress and its very important for your listeners to make contact with their
representativ es to get them to fund the NI H The N ational S cience F oundation so , that
we can achieve the potential that we currently have and that is to change medicine a n d
t he practice of medicine in a very rapid way like never before.

Margaret Flinter: Dr. Charney I know you’re your own personal clinical and scholarly
and research focus has been in the field s of p sychiatry and neuroscience . You’ve
written extensively on the subject and authored many seminar works including the
n euro biology of mental illness and la st year ’s critically acclaim ed resilie nce the science
of maste r ing life ’s greatest challenges ai m ed at the general population . I think there is a
inc rease understanding in the population both on the impact and the outcome s of
adverse childhood events and certainly with our re turning veterans from the w a rs of the
affects of p ost traumatic stress disorder on people’s life I wonder if you could share with
our listeners what you see as breakthroughs in th ese areas of dealing with problems
like post traumatic stress disorder?

Dr. Charney : Yeah thank you for saying that the -- my own research has focused on
discovering new treatment s for depression and anxiety disorder s. A nd in addition and
more recently over the past ten years or so with a colleague Steven S outhwick from
Yale university we have been studying res ilience a nd that is the ability to overcome a
serious trauma s in one’s life that we all experience it at some point a nd to literally
experience a growth from overcoming a challenges . And the way we st udy that is we

identified people who were resilient who had overcome very difficult things in their life,
we studied p risoners of war , victims of earthquake s in Pakistan and poverty and abuse
in the intercity, women who had overcome the ravages of rape and through all that work
and literally interviewing and getting to know hundreds of people we develop what we
consider a bit of a prescription o r a road map to become a more resilient person . And
we have also come to the conclusion that anybody can become m ore resilient we’re all
going to face loss of a love d one so, that ’s going to happen and so you want to develop
the psychological tool box to be able to handle those stress in your life and that’s been
the results of our work on resil ience to develop up pr escription for resili ence so that you
can literally train yourself to become a more resilient person.

Mark Masselli : Well Dr. Charney you have a conferen ce coming up the second annual
Sinai In novation s C onference that will focus entirely on emerging notion of team science
not just in health care but across all the discipline s and you have a pre -- a great and
diver se p ane l of experts attending from health care technology art , sport I believe you
have a Yankee’s manager Joe Torre is participating veter an Yankee man a ger Jo e To r r e
is participating . T ell us about the -- this new approach to team science in the impact it’s
poised to have on the future of health care.

Dr. Charney : You know it’s -- so we’re (23:32 Inaudible) a village to accomplish great
t hings a nd that certainly now true in b iomedical research in innovation and health care
delivery you can’t do it by yourself you literally can ’t make major dis coveries in a single
web any more you need teams of people working together to make discover ies that
make a difference . G eneticist need to work with biologist the biologist need to work with
physician scientist and physician scientist need to work with clinicians so you do have to
work to really make fundamental progress you need to function as a gr eat group where
you synergize. And one of the reasons we ask Joe Torre to participate is you know he
did win four World Championships with the Yankees.

Margaret Flinter: Right it’s a good reason .

Dr. Charney : We hope that happen -- starts happening again, you know, with the Yanks
and we, you know, we thought we can get advice from, you know, other areas in how
they -- you bring people together to achieve greatness.

Margaret Flinter: We are speaking today with Dr. Dennis Charney, Dean of the Icahn
S chools of M edicine at Mount Sinai in New York and President for A cademic A ffairs at
the Mount Sinai S chool of M edicine . Y ou can learn more about his work by going to
mountsinai.org , Dr. Charney thank you so much for joining us on Conver sation on
Health C are today .

Dr. Charney : You’re welcome.

(Music )

Mark Masselli: At Conversations on Health Care we want our audience to be truly in the
know when it comes to the facts about health care reform and policy, Lori Robertson is
an award wi nning journalist and Managing Editor of FactCheck.org a non partisan, non
profit consumer advocate for voters that aim to reduce the level of deception in US
politics. Lori, what have you got for us this week?

Lori Robertson: Well the medical device exc ise tax that ’s part of the A ffordable C are
A ct got some a ttention recently. A day after the house of representative voted to repeal
it as part of the budget resolution . H ouse S peaker John Boehner said that the medical
device tax quote is costing us tens of thousands of job that are been shift overse as .
The excise tax is 2.3% and falls on clinical medical devices, things like CAT scan
machine s, stents and other devices -- both the hospital s and health providers it doesn’t
apply to consumer devices purchas e directly by the public. The tax w ent into e ffect in
January of these years and since businesses can deduct excise taxes the net effect is
about 1.5% as estimated by Moodys. It’s true that some compan ies have announce d
the elimination of several thousan d positions not just in the U nited S tates but around the
world. But we found no evidence that the number has reach the tens of thousands as
Boehner said or that all th ose jobs are going overseas. The R epublican N ational
C ommittee and a lobbying group cal led (26:15 inaudible) have compile d quip s of
medical device companies announcing job elimination . The list show twelve company’s
announcing the elimination of at most 8 7 25 positions most companies didn’t blame the
reduction entirely on the medical device tax and a few made no mention of the tax at all .
Medical device companies are also making large investment overseas but those are
driven in large part by gro ws in emerging markets including C hina , India, Brazil and
Russia. The repeal o f the tax was not part of the final legislation that end ed the
government shutdown and that ’s my FactCheck for these weeks I am Lori Robertson
M anaging E ditor of FactCheck.org .

Margaret Flinter: FactCheck.org is committed to factual accuracy from the cou ntry’s
major political players, and is a project of the Annenberg Public Policy Center at the
University of Pennsylvania. If you have a fact that you’d liked checked, email us at
CHCradio.com we’ll have FactCheck.org’s Lori Robertson check it out for you here on
Conversations on Health Care.

(Music)

Margaret Flinter: Each week conversations highlight’s a bright idea about how to make
wellness a part of our communities and to everyday lives . W alking sound simple but it ’ s
tricky business when you ’ve lost a limb and with the proliferation by IED explosion s in
our recent wars in Iraq and Afghanistan we seen the devasta ting e ffects of these
injuries too frequently. But all of these amputees have sp urred a new Russian science
to build a better prostheti c traditional artificial feet and limbs do a pretty good job of
g etting amputees on their feet again, but they have limitation s and on average
amputees take a fall at least once a year because of a lack of proficiency of the artificial
limb to function nat urally. Scientist at Michigan Tech had develop ed a computerize d

b ionic limb that pivots and rotates just like a natural ankle would allowing for better
balance while in motion.

Professor Mo Rastgaar : The anchor has it can move more than just to up and t o down,
and it allows the foot to roll side to side . It allows the w earer to turn more naturally .

Margaret Flinter: Professor Mo Rastgaar lead developer on the team says that would
really makes all the difference here ’s that their bionic limb has computer sensor s on the
bottom of the foot that a lerts the limb to potential changes and gait .

Professor Mo Rastgaar : When we walk the ankle adapts to different train for example if
there is a pebble and you walk on top of it the ankle roll s , right ? So , i f you have the
same kind of mechanism in the procedure in the ankle that we have eventually it allows
better stability for the amputees it prevents them from falling often .

Margaret Flinter: He team ed up with researches at the male clinic who are helpi ng to
refine the processes and test its reliability .

Professor Mo Rastgaar : It has cable so it allows us to move the electrical motors that
are in the device to virtually any where that we want. This is a good flexibility because it
prevents the focusing all the weight i n the area of the lost limb . There is a good
flexibility in distributing the weight of a device that ’s a feature that I hope that someone
help amputees in order to increase their mobility

Margaret Flinter: A biotic artificial limb that that uses advance micro processor to
facilitate more natural walking for amputees improving their safety as well as their
dignity and quality of life . Now that’s a bright idea

(Music)

Margaret Flinter: This is conversation on health care I’m Margaret Flinter .

Mark Masselli: A nd I’m Mark Masselli , peace and health.

Conversations on Health Care , broadcast from the campus of WESU, at Wesleyan
University, streaming live at WESUFM.org and brought to you by the Community Health
Center .