Are You Up to Date on Health Care Policy & Innovation as 2024 Kicks Off? We Can Help.

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Mark Masselli ( 00:04 ):
We start the new year with the promise that the next 12 months can help bring clarity to our most
complex healthcare issues, including misinformation about vaccines, the continued fight over abortion
rights, and the record high suicide rate in 2023. We talked to leading experts on these topics.
Margaret Flinter ( 00:25 ):
We've captured the key parts of these interviews and have important updates to share since our original
discussions took place. Where have we been? Where are we going? This is Conversations on Healthcare.
Mark Masselli ( 00:45 ):
Welcome to Conversations on Healthcare. Each interview we conduct captures a moment in time. We
know our guests strive to share the latest details they have in our conversations. That started with our
very first guest, and you remember it, Margaret.
Margaret Flinter ( 00:59 ):
I do.
Mark Masselli ( 01:00 ):
14 years ago, I think it was early in September, we had the then Speaker of the House, Nancy Pelosi on.
Margaret Flinter ( 01:08 ):
That's right.
Mark Masselli ( 01:09 ):
And just think about that. That was six months before the Affordable Care Act passes in March of the
following year. And we really wanted to come together and share new information and developments
that occurred each month and week after we talked to them.
Margaret Flinter ( 01:26 ):
We started off with the speaker and things only got more interesting from there. Years later, as we
review some of our most consequential interviews in 2023, we'll update you on where things stand now.
Take for instance, our interview in October with Dr. Mandy Cohen, the relatively new director of the
Centers for Disease Control and Prevention. At that time, COVID, Flu, RSV vaccination seasons had all
begun in earnest.
Dr. Mandy Cohen ( 01:55 ):
Well, first, more than 10 million Americans have already gotten the updated COVID vaccine. We're
continuing to see millions of Americans get their updated flu shot. RSV again is only for our older adults,
and we have an immunization for our babies, and that's historic. We've never had that before. But I do
think that folks need to hear from trusted partners, trusted folks in their lives. Often that is their doctor,
or maybe it is a nurse practitioner or a nurse that they see. We know from our research, those continue
to be the most trusted messengers related to this information.
( 02:37 ):

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The most common reason that someone did not get vaccinated is that their doctor didn't offer it to
them and they didn't talk to them about it. So those are really powerful moments and conversations. So
we are doing a lot of talking to our physician community, to our nurse practitioner community and
nursing and others to talk about the importance of just bringing it up with your patients. And look, we've
looked at this data very closely. I think these vaccines have been studied extensively by independent
bodies and the safety of them has been reviewed.
( 03:11 ):
I wouldn't recommend vaccines for the American people that I wouldn't recommend for my own family.
So I've gotten my updated COVID vaccine. Got it last week. I got my updated flu shot. My kids who are
nine and 11 just got their updated COVID vaccine yesterday, in fact. My husband's been vaccinated, my
parents who are over 65. So again, this is something I'd recommend for my own family to keep them
safe.

Mark Masselli ( 03:37 ):
Well, just a few days after that interview, Margaret, the country learned there was a shortage of RSV
immunizations and in fact, Dr. Cohen and the CDC had led the efforts to provide hundreds of thousands
of additional doses. In the better news for the CDC, Dr. Cohen correctly predicted it would be a late flu
season. Correct?

Margaret Flinter ( 04:01 ):
Mm-hmm.

Mark Masselli ( 04:03 ):
And we also heard from Dr. Anthony Fauci who helped lead the nation's COVID response early in the
year. He's expected to testify before the House committee. That will be a must watch interview. I think
he's doing two private transcripts and one live interview, so I know Americans will be tuned into that. He
explained to us the importance of maintaining good ties to that country, and that country being China,
which is so important in all of the issues in public health.

Dr. Anthony Fauci ( 04:36 ):
The situation right now with the enmity that we have towards China is very counterproductive. The
more we make accusations and the more we push against them, the more they pull back. And in order
to be able to have the kind of broad global surveillance, global cooperation, global collaboration, you've
got to have a relationship the way we had before COVID, which was a relationship of exchange of
scientific information, supporting each other. And a lot of very good science has come out of China,
particularly in the field of infectious diseases, but other diseases.
( 05:18 ):
We've had collaborations with the Chinese for decades and decades. Now if you ask somebody, it looks
like we're at war with them, which is really very nonproductive.

Margaret Flinter ( 05:28 ):
The anti-vaxxer movement also was part of our conversation with Food and Drug Administration
Commissioner Dr. Robert Califf. He explained the impact that the continuing falsehoods about vaccines
is having on the United States.

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Dr. Robert Califf ( 05:41 ):
I think misinformation is actually the leading cause of death in America now because so many people
who die could have done things to change it had they gotten better information in a way which
motivated them to act in very simple things like taking proven medications to prevent cardiac events, for
example. And certainly vaccination is another example of the same thing. But this is a very complex and
difficult issue. We're in such a different environment now with the advent of the internet and the use of
algorithms and social media.
( 06:26 ):
It's just an article last week that really got my attention that demonstrated, a social science article, that
if the headline of an article has a negative word in it gets more clicks than exactly the same headline
without a negative word. And so there's also an article that shows that physicians are just as affected in
their recommendations by which news outlets they watch as lay people are. So these things are telling
us that if we believe that a federal agency like FDA can just make a determination and put out one
statement and things will happen, that's a very naive perspective.
( 07:07 ):
On the other hand, we highly value the First Amendment and the right to free speech. So finding where
that appropriate middle ground is, is really difficult. And I'm not arguing that we know that right now,
but we've got to be constantly working on trying to get accurate, reliable information to people.

Mark Masselli ( 07:31 ):
Margaret, we touched on so many important issues this year, and one of the most important was
women's reproductive health rights, which continued to make headlines and affect election outcomes in
2023. We asked the United States Department of Health and Human Services Secretary Xavier Becerra
to speak out about what has happened since the Supreme Court decision, the Dobbs decision to
overturn a woman's constitutional right to an abortion.

Xavier Becerra ( 08:00 ):
Well, first, we're going to do everything under the sun to protect the health of every American, certainly
a woman and her reproductive rights and access to abortion. You have to remember that a woman is
three times more likely to die of a complication during pregnancy if she happens to reside in a state that
restricts her access to abortion care services than if she lives in a state that gives her a full set of the
reproductive services that she needs. And so we are seeing women and their health harmed simply
because of the politics in that state.
( 08:36 ):
So we at the federal level, are doing everything we can continue to protect a woman's right to access
the care she needs, including abortion care. So that means if she's got an emergency, under federal law,
any provider, a hospital has to give her the services she needs for that emergency, including abortion
care. We're going to make sure that we protect the privacy, not just of the patient, but of the providers
as well. They're entitled to privacy. We're going to make sure that if there's a medication that's available
for any American that's prescribed because it is safe and effective, that a woman has access to it.
( 09:12 ):
So medication abortion, Mifepristone, everybody hears about the drug. That is safe and effective. We're
going to do everything we can to make sure every woman continues to have access to Medicaid

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abortion. And so we're going to continue to work with those who are trying to protect a woman's rights
as much as we can because no American should have to go without their healthcare.

Margaret Flinter ( 09:30 ):
Since our interview, new data have provided a clearer picture about abortion in America. A report from
the Society of Family Planning showed the number of abortions fell to nearly zero in states with the
strictest bans since the Supreme Court decision. However, abortions rose in other states, especially
those states located close to those with the bans. We can expect abortion to play a prominent role in
the 2024 presidential election. It will be the first presidential vote since the Supreme Court's ruling.

Mark Masselli ( 10:03 ):
In addition to abortion rights, mental health news remains a critically important issue. The government
stated that the number of suicides in the United States has reached a record number. The American
Psychiatric Association President, Dr. Petros Levounis, is at the center of the efforts to prevent suicides
with substance use addiction, a key part of their work. He and his fellow APA members have launched a
campaign with the hope that more people can benefit in the new year.

Dr. Petros Levounis ( 10:36 ):
Yes. Our campaign has one major goal to open up the conversation. Way in the past, we thought that
when you talk about suicide, you may be making things worse. We know that it's not true. The more we
talk about these matters, the better off we are. So opening up the conversation, having that first
openness with a loved one or with anyone whom you trust is just so essential. Of course, seeing a
professional, seeing your primary care physician, seeing a psychiatrist is a great idea. But the majority of
people who start feeling depressed or anxious or sometimes even suicidal, they would prefer to talk to
someone other than a psychiatrist at first.
( 11:29 ):
So this is what the campaign's strength is all about, to not just say there's one and only one path to
finding help.

Margaret Flinter ( 11:41 ):
Well, Dr. Levounis, anxiety, of course, is a big contributor to distress that may get people to that state.
And the US Preventive Services Task Force has now recommended for the first time, I believe, that
physicians screen all adult patients under age 65 for symptoms of anxiety. Are you and your members
seeing, or are you hearing reports of an uptick in referrals coming from primary care and other physician
and other healthcare provider practices? Do you think this is going to be helpful?

Dr. Petros Levounis ( 12:13 ):
It is going to be helpful. It is going to be to raise awareness about anxiety disorders. But we have not
really seen the effect that you mentioned yet. Maybe too early. This has just happened this summer, so
we haven't seen the uptick that maybe we will experience in the future. But more than the specific
referrals, it's once again in the spirit of opening up the conversation and making this diagnosis much less
fearsome than they used to be.

Margaret Flinter ( 12:50 ):

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Dr. Shereef Elnahal, the Undersecretary for Health in the US Department of Veteran Affairs says their
most important clinical care and public health issue right now is preventing veteran suicides. The data
show that 17 vets a day die by suicide.

Dr. Shereef Elnahal ( 13:08 ):
Thank you for asking about that because it is my most important clinical priority for veteran care and
also our most important public health priority to really reduce veteran suicide to the lowest extent
possible. Even one veteran dying by suicide is one too many. Every single veteran suicide is a tragedy
that we have to learn from, and we are doing that to the extent possible every single day. And we really
have three prongs to our approach in reducing veteran suicide. The first is to make sure that crisis care is
available to any veteran who needs it no matter where they are.
( 13:42 ):
And our veteran's crisis line is on first with that. It's a much easier number to remember now. It's 988,
and if you're a veteran, press one. You get connected to a professional on the other end who can help
you through that crisis and help you understand that there's a reason to keep going and the reason to
live, and then connect you to VA care that's needed after that. On top of that, our emergency rooms,
our clinicians and medical centers across the country are there for you. It is okay not to be okay. There's
a stigma around mental health.
( 14:13 ):
For veterans, it could be lifesaving to encourage a battle buddy or if you're a caregiver, loved one, to
encourage that veteran to seek healthcare. We also have really important community coalitions that we
are funding across the country. We've now given out more than $50 million in grants this year alone to
community organizations that help fortify a veteran's social and support network to be protective
against the risk of suicide. And finally, and very importantly, the work we are doing on gun safety and
lethal means safety. We hand out gun locks with every opportunity we have.
( 14:47 ):
This isn't us wading into any type of political debate on guns. It's just allowing for a few extra seconds to
minutes to help save that veteran's life. If they need to reach out for something to unlock their gun, or if
their gun lock is with their caregiver or loved one, that could be a life-saving situation where they would
not use that firearm to die by suicide. And so between all of those initiatives, we're working as hard as
we can on this very important public health priority.

Mark Masselli ( 15:14 ):
On another a front, this is the time when many of us make our New Year's resolution. Have you made
one yet?

Margaret Flinter ( 15:20 ):
I have. Same as last year's and the year before.

Mark Masselli ( 15:23 ):
If your goal is to lose weight, you have the help in that battle. FDA Commissioner Dr. Califf shared his
perspective.

Dr. Robert Califf ( 15:33 ):

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You know that we more than almost any other country is suffering from this enormous amount of
obesity, type two diabetes, hundreds of thousands of teenagers now with type two diabetes. And the
biology of the weight gain that we've experienced as a country has been poorly understood. And I think
as much as anything else, these new classes of drugs are giving us insight into something that a few
scientists knew about, but most of us were oblivious to, which is that the connection between the gut
and the brain that affects our appetite is a complex neurohormonal connection.
( 16:14 ):
And so these drugs intervene in those pathways. And what I would say is that obviously the FDA has
found one of the drugs to be safe and effective, not only for diabetes, but also obesity. And there's
another one, which the data will come in soon from large trials that'll give us the insight that we need to
have. I feel like this is going to be the beginning of a revolution in the way that we control weight, not
just with the pills, but because we'll understand the biological mechanisms better.
( 16:50 ):
There'll probably be multiple therapeutic approaches, including better use of the integration of digital
technologies and medicines. So would I prescribe it now safe and effective for the intended population?
I think the biggest issue in front of us is going to come from very large trials that are underway about
people that have obesity but don't have diabetes. And in that population, the results of those trials will
tell us what we need to do. If you have a reduction in death, a reduction in disability due to orthopedic
conditions or cardiovascular events, then by all means, on average, the benefits will outweigh the risk.
( 17:38 ):
But like all drugs, all interventions, there are side effects and toxicities. We have to be aware of those as
clinicians and we need to inform patients. The good thing about these drugs, like many others, is that
most of the side effects are symptomatic. And so if someone's having symptoms of side effects, you can
stop the treatment. That's kind of a nice quality of this kind of intervention.

Margaret Flinter ( 18:03 ):
We also heard from Dr. Jamie Ard, the President-elect of the Obesity Society. We talked with him about
research that shows that Black patients already receive less obesity treatment than white patients,
despite facing a higher prevalence of obesity. He and other physicians are looking for insurance to pick
up more of the costs of some of the revolutionary medications now available.

Dr. Jamie Ard ( 18:28 ):
I think we're at a watershed moment. This is really sort of an inflection point, if you will, in thinking
about the potential change in the landscape and how we conceptualize treatment of obesity. For the
longest, a lot of the basic thinking about how we treat obesity was rooted in the idea that, well, it's just
a calorie imbalance and people are typically eating too much and exercising too little. And obviously if
we reverse that, then that will solve the problem. And as we know that that clearly has not worked, and
it doesn't absolve us from continuing to focus on how we prevent excess weight gain and modify our
environments in a way that make healthy living more easily attainable for a larger portion of people.
( 19:20 ):
But those of us who have developed obesity and live with obesity, that mantra and that idea of eat less,
move more just doesn't work. And we have to have a biological process that actually helps to deal with
the core issue. And so this is, at its core, an issue at the brain level where the brain is not responding to
this environment appropriately in terms of helping us to manage the energy dysregulation that has

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happened in this environment. So medications actually really do get at that core issue, and they help the
individual better respond to this environment and reduce intake in a way that allows for that individual
to lose weight.
( 20:11 ):
And as our understanding has changed and evolved over time, we think that yeah, our policies and the
way we identify treatment and take care of patients should evolve with that. And so this is why these
types of conversations are so important because it helps us to highlight where our biased thinking in the
past continues to have an impact on policy and influences decision-making around resource allocation
currently.

Mark Masselli ( 20:42 ):
Well, revolutionary medicine really describes this. A new study has added to our understanding, it found
that the diabetes drug Mounjaro is more effective for weight loss than Ozempic for overweight or obese
adults. The Mounjaro user also saw larger reductions in body weight over a longer period of time.

Margaret Flinter ( 21:06 ):
Really quite remarkable. Innovations with artificial intelligence are also bringing excitement as well as
anxiety to the healthcare sector. The World Health Organization issued a statement expressing concern
about artificial intelligence in healthcare. Mayo Clinic's Chief Information Officer Cris Ross laid out the
issues at play.

Cris Ross ( 21:28 ):
These technologies are value neutral, but their usage is not necessarily value neutral. Bad people can
use good technology for bad purposes. So I think there's a very robust debate about whether these
technologies should be regulated, whether they can be regulated, and if they are regulated, how would
you do that? To a large degree, these are being managed at this time in a coalition of the willing, if you
will. Now there's different regulatory and even statutory regimes that are emerging in different places,
and we'll see what happens.
( 22:11 ):
But at the moment, this is a bit of a we're being governed by our good conscience kind of world.

Mark Masselli ( 22:17 ):
Margaret, a day doesn't go by where AI isn't in the front page of the paper.

Margaret Flinter ( 22:21 ):
Or our conversations.

Mark Masselli ( 22:22 ):
Or our conversations. At the time of that interview, the Biden Administration was working on a new AI
regulation, which unveiled in late October. The regulation covers safety and security, but some critics
say they still do not go far enough. On our program, innovation is always part of our focus. This summer,
we were part of the Aspen Ideas Health. We had such a wonderful time there. They run such a great
initiative. We were able to hear from leaders of the Advanced Research Project Agency for Health, it's

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known as ARPA-H, and is backed by nearly three billion in federal money with a mandate to accelerate
better health outcomes for everyone.
( 23:11 ):
The initiative aims to work out outside of traditions with a range of performers and a variety of
approaches to solve healthcare's biggest hurdles. We talked with Renee Wegrzyn, the director of the
initiative,

Renee Wegrzyn ( 23:25 ):
Yeah. And this is really the vision of President Biden. So a little over a year ago, he announced and call
on Congress to fund ARPA-H to be a place that we can take these really big bets on health, big audacious
ideas to work towards cures in cancer and Alzheimer's, but actually be agnostic and be an agency that
could launch a multitude of moonshots for health moving forward. And so a really special part about
ARPA-H is there's not a single one of our dollars is aligned to a single disease or technology. But instead,
we want to really address these big problems in health.
( 23:58 ):
And we do that in a really special way through our program managers that come in for short-term
appointments to really take that shot on goal to solve that problem, and then rinse and repeat. We bring
a lot through to address those problems going forward.

Mark Masselli ( 24:13 ):
So, that's a radical approach, right? That's new to-

Renee Wegrzyn ( 24:15 ):
Yes.

Mark Masselli ( 24:15 ):
... Maybe NIH. I'm not sure. Maybe it will be as part of an independent agency within NIH. But who came
up with that concept of how to manage new projects?

Renee Wegrzyn ( 24:26 ):
So it's not a brand new concept. DARPA, the Defense Advanced Research Projects Agency, has really
developed the business model of being able to pursue, in their case, breakthrough technologies for
national security in a problem-based approach, but really taking that business model where you give a
lot of autonomy to those program managers to pursue those goals. But it's really the Congress that gave
us our authorities to do special things like have direct hiring authorities so we can hire the experts who
want to solve these problems very quickly, that we can bring in house and a lot of autonomy in decision
making.
( 25:00 ):
So while we have been stood up within NIH and we have a wonderful relationship, especially with the
technical world-class experts that work there, we bring in their insights to ARPA-H, but we're the
ultimate decision makers. We set the timelines, we set those really aggressive milestones because that's
our unique role in the ecosystem, to take these big risks that NIH, that the private sector can't take, and
then we de-risk it, and then it leaves the agency. So, that's really this new piece for us.

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Mark Masselli ( 25:29 ):
Margaret, since our interview, ARPA-H has made investments in radical new ways to detect and treat
cancers, improvements to clinical trials, advances in vaccines, and cutting edge data security
technologies.
Margaret Flinter ( 25:42 ):
There's a lot at stake, and we look forward to sharing the developments when they're ready. As we
leave you, we send our best wishes for peace and health in 2024. As always, go online to chcradio.com
to sign up for email updates. You can also share your thoughts and comments about this program. But
most of all, Mark and I thank you for joining us, and we look forward to even more conversations in and
about healthcare in the year ahead.
Mark Masselli ( 26:10 ):
Happy New Year.
Margaret Flinter ( 26:11 ):
Happy New Year.
( 27:42 ):
This copyrighted program is produced by Conversations on Healthcare and cannot be reproduced or
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