The Accad and Koka Report
By Michel Accad and Anish Koka
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This is a show for all those who love medicine but have grown weary of this vast boondoggle called the health care system. We produce an episode once a week and we regularly bring in guests that we put on the hot seat. We discuss current topics in medical science, policy, economics, and ethics, always with an eye toward safeguarding the doctor-patient relationship. We bring fresh, provocative insights that resonate with physicians in the trenches who are determined not to let their passion for medicine be ground to a pulp.
||CleanEp. 50 Thieves of Virtue: How Bioethics Stole Medicine||Did bioethics emerge to defend the interests of patients or to rationalize the needs and actions of the state and its corporate allies? Are bioethicists too complacent about their grasp of economics? Do they have sufficient understanding of the comp||12/13/2018||Free||View in iTunes|
||CleanEp. 49 Why Are We Insuring Primary Care? Lee Gross on the DPC Movement||"We're not going to ask permission to take care of our patients." It is with this epiphany, that our guest on this episode became one of the pioneers and leaders of the most hopeful trend in health care today: the direct primary care or DPC movement.||12/9/2018||Free||View in iTunes|
||CleanEp. 48 Many Statisticians, Many Answers: The Methodological Factor in the Replication Crisis||In 550 BC, the Greek philosopher Heraclitus famously declared: “No man ever steps in the same river twice, for it's not the same river and he's not the same man.” In this episode, we learn from our guest whether scientists can step into the same||12/4/2018||Free||View in iTunes|
||CleanEp. 47 Drug Dosing: One Size Does Not Fit All||Patients come in all sizes and shapes, and with varying tolerance for complications and risk. Is it plausible that a single dosing regimen can optimize treatment for everybody? If not, what is keeping the pharmaceutical industry from endorsing a mor||11/30/2018||Free||View in iTunes|
||CleanEp. 46 Reforming Medical Education: Beyond the Usual Platitudes||The reform of medical education is a usually boring conversation that needs its own reform. The discussion we have on this episode does just that. It goes far beyond the usual proposals to tweak the curriculum and directly addresses the question of||11/27/2018||Free||View in iTunes|
||CleanEp. 45 Brain Death at the Bedside||We revisit the question of brain death, this time with a more practical focus. What should doctors tell families of patients who fulfill neurological criteria for brain death? Joining us on this program is Fred Rincon, MD,||11/21/2018||Free||View in iTunes|
||CleanEp. 44 Economic vs. Political Means to Healthcare: A Conversation with Jeff Deist||Economic knowledge should not be the sole province of technical experts, but it is—and we seem to accept the way it is. The price we pay for this ignorance is that most people—including doctors—can easily fall prey to the political class and to||11/18/2018||Free||View in iTunes|
||CleanEp. 43 Doctors and Guns: Where Is the Lane?||Should doctors have something to say about guns? If so, what should they say? A position paper by the American College of Physicians, followed by a blog post and a tweet from the National Rifle Association,||11/15/2018||Free||View in iTunes|
||CleanEp. 42 The Tyranny of Metrics: A Historian Weighs In||Bureaucratic appeal to measurement as a check on personal judgment rules the medical field but also permeates our entire culture. Our guest is the author of a new book that comprehensively treats this unique phenomenon of modern life and brings a valu||11/12/2018||Free||View in iTunes|
||CleanEp. 41 Healthcare Policy in the Crosshairs: The Hospital Readmissions Reduction Program||The Hospital Readmission Reduction Program is a recent policy designed to save the government money by imposing large financial penalties on hospitals whose readmission rates for certain medical conditions are found to be higher than the national avera.||11/8/2018||Free||View in iTunes|
||CleanEp. 40 Practicing Medicine in Canada: Promises and Realities||What's the professional life of Canadian doctors really like? Does the safety and stability of a single-payer system free them from business concerns and allow them to concentrate on patient care? Or do the realities of central planning produce unex||11/3/2018||Free||View in iTunes|
||CleanEp. 39 Freedom of speech regained: How NIFLA v. Becerra could impact medical practice||A recent US Supreme Court decision has struck down the "professional speech doctrine" which was elaborated by lower courts to justify restricting or regulating the activities of anyone offering advice or counsel to another individual.||10/29/2018||Free||View in iTunes|
||CleanEp. 38 Sally Pipes: The case against single-payer healthcare||Support for a single-payer healthcare system in the United States seems to be growing inexorably. Before we resign ourselves to the inevitable fate of "Medicare-4-All," it may be prudent to remind ourselves or understand better the arguments against a||10/25/2018||Free||View in iTunes|
||CleanEp. 37 Hospital sham peer review: what doctors need to know||Peer review by colleagues is an important process by which doctors who misbehave or malpractice can be held accountable and, if necessary, prevented from harming patients. Unfortunately, the process can also be used in bad faith,||10/20/2018||Free||View in iTunes|
||CleanEp. 36 Conversation with a clinical trialist||The life of a clinical trialist involves juggling multiple demands. Beyond the purely scientific questions are the clinical interests of the patient and the personal demands on the physician. - Our guest on this episode is Ajay Kirtane, MD,||10/16/2018||Free||View in iTunes|
||CleanEp. 35 Why brain dead isn’t dead: An introduction to “Shewmon’s Challenge”||One of the most fundamental questions that a doctor may be asked to answer is the following: Is this man or is that woman dead? And one would think that any substantial controversy regarding the determination of death would feature prominently in th||10/10/2018||Free||View in iTunes|
||CleanEp. 34 Free-market solutions in a world of third-party payers||The arcane procedure patients must follow to file out-of-network claims is an important obstacle for a more widespread embrace of a third-party free medical practice. Could that process be made less daunting? - Our guest is Vatsal G. Thakkar, MD,||10/7/2018||Free||View in iTunes|
||CleanEp. 33 Moving mountains: The folly of population medicine||In a matter of a couple of decades, the concepts of population health and population medicine have taken center-stage in healthcare, displacing the traditional aim of medicine and distorting the doctor-patient relationship. -||10/2/2018||Free||View in iTunes|
||CleanEp. 32 Sexual harassment and bias in medicine: Will metrics help?||In the wake of the #MeToo movement, a sweeping report was recently published by the National Academies of Science, Engineering, and Medicine detailing 30 years of research on the sexual harassment of women in academia. In addition,||9/29/2018||Free||View in iTunes|
||CleanEp. 31 Is moral injury the cause of physician burnout?||Physician burnout has attained epidemic proportions. It is highest among all professions and new research indicates that doctors commit suicide at a rate that is twice that of the general population, leading to a loss of approximately one physician pe||9/22/2018||Free||View in iTunes|
||CleanEp. 30 Beyond EBM: Case-based reasoning and the integration of clinical knowledge||Can anyone question evidence-based medicine and not be considered some kind of fringe lunatic? Fortunately it's possible, as will be demonstrated by our guest, Mark Tonelli, professor of medicine from the University of Washington,||9/19/2018||Free||View in iTunes|
||CleanEp. 29 Why Hippocrates still matters||For most doctors, Hippocrates is a quaint figure of the past with hardly any relevance to the modern practice of medicine. We may label him as the “father of medicine,” but we have no idea what really connects us to him.||9/15/2018||Free||View in iTunes|
||CleanEp. 28 Jeanne Lenzer: The case for tougher medical device regulation||Are doctors patsies for the medical device industry? Are patients put in harm's way for lack of tough standards on new device approvals? We examine the question with Jeanne Lenzer, award-winning investigative journalist and author of The Danger With||9/13/2018||Free||View in iTunes|
||CleanEp. 27 The coronary heart disease pandemic: a medical historian’s perspective||Coronary heart disease remains shrouded in mystery as to its causes and natural history. Our guest is Dr. William Rothstein, Professor Emeritus of Sociology at the University of Maryland, who has just published The Coronary Heart Disease Pandemic of t||9/8/2018||Free||View in iTunes|
||CleanEp. 26 Scientific gatekeepers in the age of Twitter: A journal editor’s perspective||Are medical journals still needed in the age of the internet and social media? Our guest is Brahmajee Nallamothu, editor of the journal Circulation Cardiovascular Quality and Outcomes. We have a wide ranging conversation,||9/4/2018||Free||View in iTunes|
||CleanEp. 25 Exposing medical students to free market ethics and principles||US medical schools overwhelmingly support centralization of healthcare and health care decision-making. That is not a surprise since, over the decades, academic institutions have greatly benefited from healthcare policy. -||9/1/2018||Free||View in iTunes|
||CleanEp. 24 Making the case for Medicare-4-All||For an increasing number of Americans today, a single payer system seems to be the only conceivable next step in the cataclysmic and ruinous history of our healthcare system. Our guest today is Adam Gaffney, MD,||8/29/2018||Free||View in iTunes|
||CleanEp. 23 Buying doctors with lunches: fact or fiction?||Do medical journals apply scientific standards selectively? On the subject of the effect of pharmaceutical lunch gifts on physician behavior, all that may be required from a paper is that the conclusions drawn be compatible with the expected narrative||8/26/2018||Free||View in iTunes|
||CleanEp. 22 Free markets in healthcare: Objecting to the objections||Many ardent supporters of free markets still believe that healthcare is an exception where government intervention is, for some reason, necessary. Our guest on this episode is Roman Zamishka, a financial analyst and medical school applicant who author||8/22/2018||Free||View in iTunes|
||CleanEp. 21 Inside the Swiss healthcare system with Dr. Fouradoulas||The Swiss healthcare system is frequently proposed as a model for the rest of the world to emulate. Our guest is Marc Fouradoulas who practices medicine in Zurich, Switzerland. He is a board-certified internist who holds a Master’s degree of advanc||8/17/2018||Free||View in iTunes|
||CleanEp. 20 How healthcare systems scapegoat physicians: the Bawa-Garba case||Hadiza Bawa-Garba was convicted of involuntary manslaughter by a British court for her role in the care of a patient in a hospital setting fraught with system failures. Our guest is Dr. Saurabh Jha who returns on the show to share his insights on this||8/12/2018||Free||View in iTunes|
||CleanEp. 19 Public reporting: necessary evil or harmful fake news?||Public reporting of outcomes aims at improving quality but has also harmed patients and doctors alike. Can any good come out of it? Our guest on this episode is Dr. Robert W. Yeh, Associate Professor of Medicine at Harvard Medical School and Direct||8/10/2018||Free||View in iTunes|
||CleanEp. 18 A doctor fights against CON laws||Our guest on this episode is Dr. Gajendra Singh, a well-respected surgeon who decided to provide affordable ultrasound, CT, and MRI imaging to his community. A few months into his endeavor, he was confronted by his state's "certificate of need" laws t||8/3/2018||Free||View in iTunes|
||CleanEp. 17 Hope in the fight against MOC||Our guest this week is Dr. Wes Fisher who is leading the fight against the American Board of Internal Medicine and its self-serving tactics to force thousands of physicians to comply with the onerous Maintenance of Certification Program.||7/28/2018||Free||View in iTunes|
||CleanEp. 16 The EHR will see you now||Our guest is Twila Brase, RN, PHN, Executive Director of the Citizen's Council for Health Freedom. We discuss her freshly released book that reveals the ugly truths about the electronic health records and what can be done to escape from this modern d||7/21/2018||Free||View in iTunes|
||CleanEp. 15 Lethal regulation: The 1962 FDA amendments||Our guest is Dr. Mary Ruwart, scientist, ethicist, and author of a new book that examines the history of the last 6 decades of drug regulation and highlights the unintended consequences on the 1962 amendments to the FDA.||7/14/2018||Free||View in iTunes|
||CleanEp. 14 EBM “India-style,” with Dr. Anupam Singh||We took the EBM controversies to India and consulted with Dr. Anupam Singh, Assistant Professor of Medicine at SMC in Ghaziabad. He offered a very sound and intelligent perspective on the proper role of clinical trials and clinical judgment in medical||7/10/2018||Free||View in iTunes|
||CleanEp. 13 A buffet of blood pressure guidelines||We have fun discussing the controversies about blood pressure guidelines with our guest, Dr. Swapnil Hiremath, Assistant Professor of Medicine at the University of Ottawa and Co-founder of NephJC, a highly successful Twitter-based journal club. Dr.||6/30/2018||Free||View in iTunes|
||CleanEp. 12 John Mandrola: The case for “Less-Is-More”||We explore the "less-is-more" movement with Dr. John Mandrola, one of its most articulate and popular champions. We discuss the problem of practices that have no scientific justification and the conundrum of out-of-control costs.||6/24/2018||Free||View in iTunes|
||CleanEp. 11 The case against shared decision-making||Shared decision-making (SDM) has become a sacred cow of medical ethics almost overnight. What's more, doctors are now being forced to practice it in order to get paid for certain procedures. We review the history of this concept and why it is contra||6/16/2018||Free||View in iTunes|
||CleanEp. 10 Free-market medicine is unstoppable||We have a terrific interview with G. Keith Smith, co-founder of the Surgery Center of Oklahoma and of the Free Market Medical Association. Keith gives us an overview of his pioneering experience and clearly makes the case that free markets are ethical||6/9/2018||Free||View in iTunes|
||CleanEp. 9 Jade eggs and Francis Bacon||We discuss a blog post by obesity therapy guru Jason Fung in which he pushes back against "debunkers" and self-appointed guardians of "science-based medicine." We look at the question of science and pseudo-science and how it bears on actual medical ca||6/2/2018||Free||View in iTunes|
||CleanEp. 8 The dangerous business of public reporting||We discuss the background policies the effects of public reporting of outcomes on the behavior of physicians and the reactions to a paper that was just published on this topic. Anish shares a real life experience of a patient of his who was a tragic||5/25/2018||Free||View in iTunes|
||CleanEp. 7 “No tears for you!” say the pharmascolds||We discuss a tweet and a paper claiming that pharmaceutical companies don't even need to produce effective drugs anymore. All they need is "an effective marketing campaign" and billions of dollars in annual sales soon follow.||5/18/2018||Free||View in iTunes|
||CleanEp. 6 “Real ACOs have never been tried!”||We take to task healthcare policy wonks who lament that the government can no longer mandate hospital systems to participate in new "value-based" payment schemes. These alternative payment plans have been a disaster from the get-go,||5/11/2018||Free||View in iTunes|
||CleanEp. 5 Saurabh Jha: Normal is fuzzy||We have a free-wheeling and fun conversation with Dr. Saurabh Jha on the philosophical question of "what is normal." The conversation was prompted by an editorial by John Ioannidis who thinks that "Big Data" could help clinicians get a handle on the v||5/5/2018||Free||View in iTunes|
||CleanEp. 4 The Alfie Evans case: lessons for doctors||There precise rationale invoked by the courts to prevent Alfie Evans' parents from transferring the child out of the UK is widely misunderstood. In many ways it worse than what many people imagine. We discuss this chilling case and the ethical doctr||4/27/2018||Free||View in iTunes|
||CleanEp. 3 Should doctors protect their turf?||We discuss a “white paper” jointly written by Jeffrey Flier, former dean at Harvard Medical School, and Jared Rhoads, from the Dartmouth Institute, calling for some deregulation of the apparatus that rules the supply of physicians and their scope of||4/24/2018||Free||View in iTunes|
||CleanEp. 2 Francis and Accad on EBM||We have a fun chat with Professor Darrel Francis, from Imperial College in London and the UK's National Heart and Lung Institute. Dr. Francis takes the "pro" side and Michel the "con" side in regards to evidence-based medicine. GUEST: -||4/21/2018||Free||View in iTunes|
||CleanEp. 1 Confessions of a pharma-fed doctor||After an opinion piece in JAMA Internal Medicine once again showed the influence of drug company payments on physician practices, Anish comes clean about his relationship with Big Pharma. We discuss that potential conflict of interests but place it in||4/14/2018||Free||View in iTunes|
Finally, and interesting medical podcast
Let’s face it—there are a LOT of medical podcasts out there, and most are unlistenable: narrow topics, boring hosts, unreasonable duration, etc. The Accad & Koka report is different.
The hosts are opinionated and interesting, the topics are of interest to docs & laypeople alike, and the presentations are generally focused.
As a physician, one would think that medical podcasts would be my catnip. True—but only good ones. This is one of them.
Amazing (true) side of healthcare
This is amazing. An alternative and more accurate view on medicine which flies in the face of what we learn from academia, government, and of course, the BUCA cartel (third party payers).
A thoughtful, in-depth analysis of current issues in healthcare.
These doctors are the forefront of an evolving healthcare system and they are leading the charge. If you are looking to be informed about healthcare from the perspective of healthcare professionals, you should subscribe and listen.