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GOOD AFTERNOON, I'M
ELISEO

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STABLE-PEREZ, DIRECTOR OF

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NATIONAL INSTITUTE ON MINORITY

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HEALTH AND HEALTH DISPARITIES.

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THANK YOU FOR JOINING US FOR THE

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NIMHD DIRECTOR'S SEMINAR SERIES.

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THIS NIMHD DIRECTOR'S SEMINAR

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LECTURE WILL BE UNIQUE FOR

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SEVERAL REASONS.

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FIRST, THE FOURTH AND FINAL

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LECTURE OF 2023, SECOND WE'RE

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CO-SPONSORING WITH THE NIH

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OUTCOMES AND EFFECTIVE RESEARCH

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INTEREST GROUP.

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WE'LL ALSO HAVE THE NCI DIVISION

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OF CANCER CONTROL AND POPULATION

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SCIENCES DIRECTOR, WHO WILL

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SERVE AS MY CO-MODERATOR AND

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MONICA WEBB HOOPER WHO WILL JOIN

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US ON THE PANEL AND BE A

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CO-MODERATOR, DEPUTY DIRECTOR OF

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NIMMED.  -- NIMHD.

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OUR SPEAKER IS MARTIN SHAPIRO,

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PROFESSOR OF MEDICINE AT WEILL

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CORNELL MEDICAL COLLEGE,

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PRACTICED GENERAL INTERNAL

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MEDICINE FOR MANY YEARS AT UCLA,

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ORIGINALLY FROM CANADA, ATTENDED

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MCGILL UNIVERSITY FOR COLLEGE

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AND MEDICAL SCHOOL, OBTAINED A

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MASTER'S IN PUBLIC HEALTH,

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Ph.D. IN HISTORY FROM UCLA.

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HE'S ALSO A DEDICATED RESEARCHER

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WHO STUDIED MANY TOPICS, ACCESS

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TO CARE, HEALTH DISPARITIES,

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SCIENTIFIC MISCONDUCT,

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PHARMACEUTICAL ADVERTISING,

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SCIENTIFIC AUTHORSHIP, AMONG

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MANY OTHERS.

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PRIOR TO JOINING CORNELL, MARTIN

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SPENT THE BULK OF HIS CAREER AT

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UNIVERSITY OF CALIFORNIA LOS

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ANGELES, WHERE HE WAS

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DISTINGUISHED PROFESSOR AT

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MEDICINE AND PUBLIC HEALTH,

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CHIEF OF THE DIVISION OF GENERAL

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INTERNAL MEDICINE, AND HEALTH

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SERVICES RESEARCH, AND FOUNDER

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OF THE UCLA T32 TRAINING PROGRAM

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IN PRIMARY CARE RESEARCH.

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MOST NOTABLY HE WAS THE

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PRINCIPAL INVESTIGATOR OF THE

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HIV COST AND SERVICES

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UTILIZATION STUDY, ENROLLED A

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PROBABILITY SAMPLE, NATIONAL

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SAMPLE OF PERSONS WITH HIV,

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WIDELY RECOGNIZED AS AFFECTING

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POLICY IN HIV CARE THROUGH

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STUDIES OF ACCESS, MENTAL

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HEALTH, DRUG USE, RISK BEHAVIOR,

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BIORESISTANCE, HEALTH OUTCOMES,

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CLINICIANS PROVIDING HIV CARE,

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AND IMPACT OF THE RYAN WHITE

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CARE ACT ON PATTERNS OF CARE FOR

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HIV.

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MARTIN IS AN ELECTED MEMBER OF

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THE AMERICAN SOCIETY FOR

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CLINICAL INVESTIGATION AND

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ASSOCIATION OF AMERICAN

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PHYSICIANS, A PAST PRESIDENT OF

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THE SOCIETY OF GENERAL INTERNAL

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MEDICINE, WHICH IS AWARDING HIM

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HIGHEST HONORS IN AWARDS.

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PUBLISHED 200 PEER  PEER

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REVIEWED PAPERS AND AUTHORED

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SEVERAL BOOKS.

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HE HAS BEEN A TERRIFIC MENTOR OF

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STUDENTS, RESIDENTS, FELLOWS,

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JUNIOR FACULTY MEMBERS.

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HE SERVES AT CORNELL AS

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ASSOCIATE DIRECTOR OF THEIR T32 

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TRAINING PROGRAM AND STUDENT

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RESEARCH PROGRAM.

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HE'S AN AUTHOR, , HIS TALK ABOUT

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BE A BROKEN SYSTEM, AMERICAN

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HEALTH CARE NEEDS COMBINATION

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THERAPY.

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PLEASE JOIN ME IN GIVING A

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VIRTUAL WELCOME TO MARTIN

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SHAPIRO.

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>> I'M THRILLED TO BE
HERE.

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I'M GOING TO SHARE MY SCREEN, IF

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I CAN DO IT CORRECTLY. 

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THAT SHOULD BE MY SCREEN NOW.

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CAN YOU SEE IT?

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>> NOT YET, MARTIN.

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>> SO I DID SOMETHING
WRONG, DID

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I?

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I DIDN'T -- DID I NOT SUCCEED?

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SHARING MY SCREEN.

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>> DID NOT, MARTIN, DID
NOT.

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>> OKAY.

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HOW DO I GET OUT OF THIS THEN?

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SORRY.

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I DID NOT GET ANY ACCOLADES FOR

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MY TECHNOLOGICAL STRENGTHS ON

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COMPUTERS. 

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SHARE SCREEN, DID THAT HAPPEN?

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NO? 

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>> NO.

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>> THERE WE GO, I THINK.

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YES.

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>> OKAY.

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>> PRESENTATION MODE.

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>> YES, OKAY.

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I HAD TO DOUBLE CLICK.

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>> IT'S PERFECT NOW.

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THANK YOU.

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>> OKAY.

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GOD IS STILL WORKING ON ME.

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THE GOD SUCH TECHNOLOGY.

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THANK YOU VERY MUCH, ELISEO, AND

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ALL OF YOU FOR INVITING ME HERE.

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IN 2017, I MOVED TO NEW YORK.

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I DETERMINED TO USE A GOOD PART

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OF MY TIME WRITING A BOOK ABOUT

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THE PROBLEMS OF HEALTH CARE IN

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AMERICA.

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AS I WORKED THROUGH, IT BECAME

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CLEAR THE MAIN QUESTION TO BE

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ANSWERED WAS WHY WE HAVE NOT

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MANAGED TO FIX THE VERY OBVIOUS

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PROBLEMS IN AMERICAN HEALTH

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CARE.

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MY EFFORT TO FULLY UNDERSTAND

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THE PROBLEMS, PROCESSES, THE

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PHENOMENA THAT STAND IN THE WAY

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TOOK ME ON A JOURNEY INTO

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SOCIOLOGY, PHILOSOPHY, HISTORY,

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AND OTHER DISCIPLINES IN THE

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SOCIAL SCIENCES AND HUMANITIES,

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ESSENTIAL TO UNDERSTANDING THE

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MESS THAT WE'RE IN.

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I WON'T DWELL LONG ON THE

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WELL-CHARACTERIZED

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MANIFESTATIONS OF OUR HEALTH

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CARE SYSTEM'S DREADFULNESS.

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LACK OF INSURANCE FOR MANY, EVEN

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AFTER PASSAGE OF THE ACA,

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UNDERINSURANCE FOR EVEN MORE.

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OUR HEALTH EXPENDITURES FAR

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EXCEED THOSE IN OTHER COUNTRIES 

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AS A PERCENTAGE OF G.D.P.

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BACK BEFORE 1970 THE U.S. WAS

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NOT SUCH A SPEND THRIFT,

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EXPENDITURES WERE RELEVANT TO

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CANADA, THAT CHANGED AROUND THE

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TIME IT ADOPTED NATIONAL HEALTH

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PLAN.

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OVER THE SAME PERIOD OF TIME AND

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OMINOUSLY THE U.S. HAS FALLEN

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BEHIND OTHER COUNTRIES WITH

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ADVANCED ECONOMIES AND LIFE 

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EXPECTANCY.

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WE LIVE 78.9 YEARS, AND NOW

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TRAIL OTHER COUNTRIES WITH

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ADVANCED ECONOMIES IN THIS

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METRIC BY 5 TO 6 YEARS.

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AS YOU ARE ALL AWARE THERE'S

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CONSIDER  CONSIDERABLE

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DIFFERENCE ARE RACE AND

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ETHNICITY.

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IT GOES BEYOND PROPOSALS AND

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HEALTH SERVICES RESEARCH.

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RATHER, THE WAYS IN WHICH THE

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VARIOUS GROUPS OF ACTORS

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CONCEPTUALIZE HEALTH AND HEALTH

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CARE PURSUE THEIR INTERESTS AND

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PERCEIVE NEEDS, AND INTERACT

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BASED ON THESE

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CONCEPTUALIZATIONS, CREATING

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IMPEDIMENTS TO A SYSTEM THAT'S

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RATIONAL, JUST, EFFICIENT.

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LET'S LOOK AT THE GROUPS OF

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ACTORS, I ARGUE ALL STAND IN THE

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WAY OF EQUITABLE, EFFICIENT,

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EFFECTIVE CARE, THESE ARE

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PHYSICIANS, MEDICAL SCHOOLS,

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CORPORATIONS, INCLUDING

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HOSPITALS AND HEALTH SYSTEMS,

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DIALYSIS, NURSING, HOME AND

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PHARMACY COMPANIES,

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MANUFACTURERS OF MEDICINES,

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MACHINES, MEDICAL RECORDS,

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INSURERS, INVESTORS, ALSO

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SCIENTISTS AND THE NIH,

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GOVERNMENT, EMPLOYERS AND

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EMPLOYEE GROUPS, AND, YES, ALSO

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PATIENTS, FAMILIES, AND MANY

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COMMUNITY ORGANIZATIONS.

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I BELIEVE THREE PHENOMENA SHAPE

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THE CIRCUMSTANCES AND EXPERIENCE

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OF HEALTH CARE IN CONTEMPORARY

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SOCIETY.

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THE TREATMENT OF HEALTH CARE AND

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HEALTH AS COMMODITIES BY ACTORS

212
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WITHIN AND WITHOUT THE SYSTEM.

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THE CONSCIOUSNESS OF THESE

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GROUPS OF ACTORS, MEANING THEIR

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ATTITUDES, VALUES, PERCEIVED

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NEEDS AND EXPECTATIONS,

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INTERESTS AND CAPACITIES WHICH

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SHAPE ATTITUDES AND BEHAVIOR, IN

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RELATION TO HEALTH CARE, AND THE

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COMMUNICATION AND RELATIONSHIPS

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AMONG THESE ACTORS WHICH

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REINFORCE EXISTING ARRANGEMENTS.

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FIXING HEALTH CARE IS SO VERY

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DIFFICULT BECAUSE OF THESE

225
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PHENOMENA.

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LET'S CONSIDER THESE GROUPS OF

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ACTORS IN TURN.

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MAJOR HEALTH SYSTEMS INCLUDE

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ACADEMIC AND NON-ACADEMIC ONES,

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THOSE FOR PROFIT AND THOSE

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SUPPOSEDLY NOT FOR PROFIT,

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BEHAVIORAL DISTINCTIONS BETWEEN

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THEM IS FAR FROM CLEAR.

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THEY CONTRIBUTE TO THE PROBLEM

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IN A NUMBER OF WAYS.

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EARLY IN MY CAREER AT UCLA, MY

237
00:08:58,721 --> 00:08:59,788
DEPARTMENT HAD A RETREAT.

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00:08:59,788 --> 00:09:01,957
THE KEYNOTE SPEAKER WAS A SENIOR

239
00:09:01,957 --> 00:09:03,892
EXECUTIVE AT HENRY FORD HOSPITAL

240
00:09:03,892 --> 00:09:11,667
IN DETROIT. 

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00:09:11,667 --> 00:09:14,503
HE SAID WHAT YOU REFER TO AS

242
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HOSPITAL ADMISSION AND

243
00:09:16,171 --> 00:09:18,674
OUTPATIENT VISITS, SALES, WAS

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00:09:18,674 --> 00:09:19,375
CLARIFIED.

245
00:09:19,375 --> 00:09:21,543
THESE SYSTEMS ARE INDEED

246
00:09:21,543 --> 00:09:22,945
INTERESTED IN SALES, MAXIMIZING

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MARKET SHARE OF COVERED LIVES,

248
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MAXIMIZING REIMBURSEMENT AND

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MINIMIZING RISK MEANING POOR

250
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PEOPLE WITH MEDICAID OR NO

251
00:09:31,887 --> 00:09:32,254
INSURANCE.

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CONTRACTING WITH HEALTHY

253
00:09:33,989 --> 00:09:34,523
POPULATIONS AND PROMOTING

254
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LUCRATIVE PRODUCT LINES AND

255
00:09:37,092 --> 00:09:37,393
PROCEDURES.

256
00:09:37,393 --> 00:09:40,029
THEY SEEK NINE FIGURE SURPLUSES,

257
00:09:40,029 --> 00:09:42,898
PAY EXECUTIVES SEVEN TO EIGHT

258
00:09:42,898 --> 00:09:45,301
FIGURE SALARIES WHICH NATIONALLY

259
00:09:45,301 --> 00:09:48,504
30% ARE FINANCIAL PERFORMANCE

260
00:09:48,504 --> 00:09:50,239
BASED.

261
00:09:50,239 --> 00:09:52,841
COULD WE ALTER THE INCENTIVES

262
00:09:52,841 --> 00:09:54,043
FOR THESE CLINICAL CORPORATIONS

263
00:09:54,043 --> 00:09:55,377
AND THEIR LEADERS?

264
00:09:55,377 --> 00:09:57,346
NOT EASILY.

265
00:09:57,346 --> 00:09:59,548
BUT SOME STARTING GESTURES MIGHT

266
00:09:59,548 --> 00:10:02,084
BE TO NOT PAY CEOS SALARIES UP

267
00:10:02,084 --> 00:10:05,354
TO 50 TIMES WHAT SOME DOCTORS,

268
00:10:05,354 --> 00:10:08,324
TO END BONUS PAYMENTS BASED ON

269
00:10:08,324 --> 00:10:10,159
FINANCIAL PERFORMANCE, REQUIRE

270
00:10:10,159 --> 00:10:11,794
FULL PARTICIPATION OF ALL

271
00:10:11,794 --> 00:10:13,762
CLINICIANS IN MEDICAID, FOR

272
00:10:13,762 --> 00:10:16,432
HEALTH SYSTEMS TO MAINTAIN

273
00:10:16,432 --> 00:10:17,733
NON-PROFIT STATUS.

274
00:10:17,733 --> 00:10:19,034
AS FOR OTHER CORPORATE

275
00:10:19,034 --> 00:10:20,102
INTERESTS, THEY TOO ARE

276
00:10:20,102 --> 00:10:22,538
INTERESTED IN SALES AND ARE IN

277
00:10:22,538 --> 00:10:24,940
THE BUSINESS OF INDUCING DEMAND,

278
00:10:24,940 --> 00:10:26,475
PHARMA AND BIOLOGICS ADVERTISE

279
00:10:26,475 --> 00:10:30,746
SHAMELESSLY TO PATIENTS AND

280
00:10:30,746 --> 00:10:31,947
PROVIDERS TRYING TO CONVINCE

281
00:10:31,947 --> 00:10:34,550
FORMER PRODUCTS WILL EXTEND LIFE

282
00:10:34,550 --> 00:10:36,051
OR IMPROVE QUALITY WITHOUT

283
00:10:36,051 --> 00:10:40,155
REGARD TO HOW MUCH OR WHAT COST,

284
00:10:40,155 --> 00:10:41,690
RAISE PRICES AND RECRUIT

285
00:10:41,690 --> 00:10:45,394
ECONOMISTS TO JUSTIFY PRICE

286
00:10:45,394 --> 00:10:52,067
POINTS, EXTEND PATENTS WITH 

287
00:10:52,067 --> 00:10:52,968
MINOR MODIFICATIONS CALLED

288
00:10:52,968 --> 00:10:53,702
EVERGREENING, AND PREVENT

289
00:10:53,702 --> 00:10:56,138
NEGOTIATION OF PRICES.

290
00:10:56,138 --> 00:10:57,906
EQUIPMENT MANUFACTURERS HAVE THE

291
00:10:57,906 --> 00:10:58,640
SAME STRATEGY.

292
00:10:58,640 --> 00:11:04,480
THE MARKET FOR INFORMATION 

293
00:11:04,480 --> 00:11:08,283
SYSTEMS IS AN OLIGO PATHY,

294
00:11:08,283 --> 00:11:09,618
INCREASE COST OF PRIMARY CARE

295
00:11:09,618 --> 00:11:11,887
PROVIDERS FOR BENEFITS THAT MAY

296
00:11:11,887 --> 00:11:13,555
NOT BE FORTHCOMING.

297
00:11:13,555 --> 00:11:16,625
HEALTH INSURANCE INDUSTRY SEES

298
00:11:16,625 --> 00:11:17,926
SINGLE PAYER AS EXISTENTIAL THE

299
00:11:17,926 --> 00:11:21,764
THREE AND EXISTS EXPANSION OF

300
00:11:21,764 --> 00:11:25,134
PUBLIC COVERAGE AND PROD ALLIES

301
00:11:25,134 --> 00:11:30,506
TO PRIVATIZE  LUCRATIVE PUBLIC

302
00:11:30,506 --> 00:11:32,141
PROGRAM.

303
00:11:32,141 --> 00:11:33,909
THEY SEEK TO MINIMIZE RISK OFTEN

304
00:11:33,909 --> 00:11:35,644
BY DENYING COVERAGE FOR

305
00:11:35,644 --> 00:11:38,046
PROCEDURES, OFFERING PRODUCTS

306
00:11:38,046 --> 00:11:42,651
WITH LARGE CO-PAYMENTS AND 

307
00:11:42,651 --> 00:11:45,087
DEDUCTIBLES, M AN ENORMOUS

308
00:11:45,087 --> 00:11:48,791
BURDEN ON MANY AND SADDLE FAR

309
00:11:48,791 --> 00:11:49,491
TOO MANY WITH INSURMOUNTABLE

310
00:11:49,491 --> 00:11:50,659
MEDICAL DEBT.

311
00:11:50,659 --> 00:11:54,530
OTHER CORPORATIONS SUCH AS

312
00:11:54,530 --> 00:11:55,164
NURSING HOMES, PHARMACIES,

313
00:11:55,164 --> 00:11:56,498
DIALYSIS COMPANIES ARE

314
00:11:56,498 --> 00:12:00,969
INTERESTED IN MAINTAINING OR

315
00:12:00,969 --> 00:12:02,938
VASTLY INCREASING REVENUE

316
00:12:02,938 --> 00:12:03,272
STREAMS.

317
00:12:03,272 --> 00:12:07,743
HEDGE FUNDS MOVE INTO THE MELT

318
00:12:07,743 --> 00:12:11,046
SECTOR, THEY SEEK TO INFLATE

319
00:12:11,046 --> 00:12:14,550
VALUE THROUGH UPCODING REVENUE

320
00:12:14,550 --> 00:12:16,084
AND CUTTING CORNERS AND SELLING

321
00:12:16,084 --> 00:12:18,253
AT PROFIT, SOME TALK ABOUT

322
00:12:18,253 --> 00:12:18,720
VALUE-BASED CARE.

323
00:12:18,720 --> 00:12:21,890
WHEN ONE WAS RECENTLY ACQUIRED

324
00:12:21,890 --> 00:12:24,660
BY CVS, THEY SPOKE OF, QUOTE,

325
00:12:24,660 --> 00:12:28,263
OFFERING SIGNIFICANT VALUE TO

326
00:12:28,263 --> 00:12:30,432
OUR SHAREHOLDERS, UNQUOTE.

327
00:12:30,432 --> 00:12:31,633
LEGENDARY COMEDIAN AND PRODUCER

328
00:12:31,633 --> 00:12:32,734
MEL BROOKS LIKES TO TELL THE

329
00:12:32,734 --> 00:12:34,837
STORY ABOUT A MAN WHO GOES INTO

330
00:12:34,837 --> 00:12:39,741
A DELI TO BUY BAGELS, PLACES HIS

331
00:12:39,741 --> 00:12:43,045
ORDER AND STOPS AND SAYS, SALT,

332
00:12:43,045 --> 00:12:44,580
ALL OF YOUR SHELVES ARE COVERED

333
00:12:44,580 --> 00:12:45,747
WITH RED BOXES SALT.

334
00:12:45,747 --> 00:12:47,282
YOU SELL A LOT OF SALT?

335
00:12:47,282 --> 00:12:47,950
THE OWNER RESPONDS.

336
00:12:47,950 --> 00:12:50,285
IF I SELL A BOX OF SALT A WEEK

337
00:12:50,285 --> 00:12:52,454
I'LL THROW A PARTY, IT'S A

338
00:12:52,454 --> 00:12:52,688
MIRACLE.

339
00:12:52,688 --> 00:12:53,889
I DON'T SELL A LOT OF SALT.

340
00:12:53,889 --> 00:12:56,425
BUT THE GUY WHO SELLS ME THE

341
00:12:56,425 --> 00:13:02,998
SALT, BOY, CAN HE SELL SALT.

342
00:13:02,998 --> 00:13:05,167
THESE GROUPS OF CORPORATIONS ARE

343
00:13:05,167 --> 00:13:07,569
VERY GOOD AT SELLING BOXES OF

344
00:13:07,569 --> 00:13:12,107
SALT, AND POLICIES ARE UNLIKELY 

345
00:13:12,107 --> 00:13:13,609
TO HAVE MUCH IMPACT.

346
00:13:13,609 --> 00:13:19,114
WHAT ABOUT DOCTORS?

347
00:13:19,114 --> 00:13:20,048
PRACTICINGCLINICIANS AND

348
00:13:20,048 --> 00:13:22,050
PROFESSIONAL SOCIETIES HAVE

349
00:13:22,050 --> 00:13:31,793
ECONOMIC INTERESTS, PAYMENT 

350
00:13:31,793 --> 00:13:32,761
SYSTEMS REIMBURSES, PROCEDURAL

351
00:13:32,761 --> 00:13:35,831
SPECIALTY SOCIETIES APPLY 70% OF

352
00:13:35,831 --> 00:13:39,134
SEATS ON RVU UPDATE COMMITTEE

353
00:13:39,134 --> 00:13:40,435
THAT ADVISES MEDICARE PRODUCE

354
00:13:40,435 --> 00:13:42,304
GUIDELINES THAT JUSTIFY THEIR

355
00:13:42,304 --> 00:13:44,373
ACTIVITY, MINIMIZE RISK BY

356
00:13:44,373 --> 00:13:45,841
OPTIMIZING INSURANCE TYPE, WHEN

357
00:13:45,841 --> 00:13:47,342
THEY RUN THE TILL AS LONG AS

358
00:13:47,342 --> 00:13:49,311
THEY CAN.

359
00:13:49,311 --> 00:13:52,848
AT UCLA THE RESIDENTS USED TO

360
00:13:52,848 --> 00:13:56,018
JOKE THE CARDIOLOGIST HAD TWO

361
00:13:56,018 --> 00:14:01,957
INDICATIONS FOR HEART 

362
00:14:01,957 --> 00:14:02,591
CATHETERIZIZE, LUB AND DUB, THE

363
00:14:02,591 --> 00:14:03,525
HEART SOUNDS.

364
00:14:03,525 --> 00:14:08,096
THE WAYS THE SYSTEM PAYS FOR 

365
00:14:08,096 --> 00:14:09,464
SERVICES SHAPES PHYSICIAN

366
00:14:09,464 --> 00:14:09,865
BEHAVIOR.

367
00:14:09,865 --> 00:14:11,700
THE INCOME DIFFERENCES BETWEEN

368
00:14:11,700 --> 00:14:12,801
PROCEDURAL AND COGNITIVE FIELDS

369
00:14:12,801 --> 00:14:13,669
ARE STARK.

370
00:14:13,669 --> 00:14:17,406
IN FACT HAVE GROWN SINCE THE RVS

371
00:14:17,406 --> 00:14:19,241
WAS IMPLEMENTED IN MEDICARE.

372
00:14:19,241 --> 00:14:21,310
AT THE SAME TIME, DOCTORS

373
00:14:21,310 --> 00:14:23,412
WEREN'T SELECTED INTO MEDICAL

374
00:14:23,412 --> 00:14:25,280
SCHOOL PRIMARILY TO BE EMPATHIC

375
00:14:25,280 --> 00:14:27,015
AND CARING.

376
00:14:27,015 --> 00:14:28,317
MANY PHYSICIANS HANDLE

377
00:14:28,317 --> 00:14:30,185
UNCERTAINTY POORLY, ARE NOT WELL

378
00:14:30,185 --> 00:14:32,721
TRAINED TO LIMIT CARE, ARE MORE

379
00:14:32,721 --> 00:14:34,122
COMFORTABLE WITH NARROW TASKS

380
00:14:34,122 --> 00:14:35,657
LIKE PROCEDURES THAN BUILDING

381
00:14:35,657 --> 00:14:37,292
RELATIONSHIPS WITH PATIENTS.

382
00:14:37,292 --> 00:14:38,493
ACCORDINGLY THE CHOICES MANY

383
00:14:38,493 --> 00:14:48,370
MAKE OF SPECIAL  SPECIALTIES ARE

384
00:14:48,370 --> 00:14:50,205
DRIVEN BY INCOME GENERATION.

385
00:14:50,205 --> 00:14:53,709
DAVID WAS A THIRD YEAR MED

386
00:14:53,709 --> 00:14:55,344
STUDENT WHO I SUPERVISED IN

387
00:14:55,344 --> 00:14:56,445
INTERNAL MEDICINE CLERKSHIP.

388
00:14:56,445 --> 00:14:58,246
HIS KNOWLEDGE OF DISEASE AND

389
00:14:58,246 --> 00:15:00,048
TREATMENT WAS AT HIGH LEVEL.

390
00:15:00,048 --> 00:15:01,149
HE RELATED EXTREMELY WELL TO

391
00:15:01,149 --> 00:15:03,318
MEMBERS OF HIS TEAM AND NURSING

392
00:15:03,318 --> 00:15:03,752
STAFF.

393
00:15:03,752 --> 00:15:05,754
WITH PATIENTS HE WAS SENSITIVE,

394
00:15:05,754 --> 00:15:09,491
OPEN, CARING AND COMMITTED. 

395
00:15:09,491 --> 00:15:13,195
I TOLD DAVID HE WOULD BE AN

396
00:15:13,195 --> 00:15:14,262
OUTSTANDING RESIDENT AND HE

397
00:15:14,262 --> 00:15:17,199
COULD IMAGINE HIMSELF IN

398
00:15:17,199 --> 00:15:18,166
INTERNAL MEDICINE BUT HAD BEEN

399
00:15:18,166 --> 00:15:19,668
ADVISED NOT TO DO THAT.

400
00:15:19,668 --> 00:15:20,769
QUOTE, YOUR TEST SCORES AND

401
00:15:20,769 --> 00:15:23,271
GRADES ARE TOO GOOD, IT WOULD BE

402
00:15:23,271 --> 00:15:23,872
A WASTE, UNQUOTE.

403
00:15:23,872 --> 00:15:25,907
THEY WERE SAYING HE WAS IN LINE

404
00:15:25,907 --> 00:15:27,442
FOR A HIGH-PAYING SPECIALTY.

405
00:15:27,442 --> 00:15:29,544
NONETHELESS HE PROMISED TO THINK

406
00:15:29,544 --> 00:15:31,279
ABOUT WHAT I SAID.

407
00:15:31,279 --> 00:15:34,349
THE PROPORTION OF RESIDENCY

408
00:15:34,349 --> 00:15:35,884
PHYSICIANS FILLED BY USMGs

409
00:15:35,884 --> 00:15:38,487
BEARS A LINEAR RELATIONSHIP TO

410
00:15:38,487 --> 00:15:39,454
SPECIALTY INCOMES.

411
00:15:39,454 --> 00:15:41,023
SEVERAL MONTHS LATER DAVID CAME

412
00:15:41,023 --> 00:15:42,891
BY MY OFFICE AND ASKED IF I'D

413
00:15:42,891 --> 00:15:44,660
WRITE A LETTER OF RECOMMENDATION

414
00:15:44,660 --> 00:15:45,827
FOR HIM FOR RESIDENCY.

415
00:15:45,827 --> 00:15:48,363
I WAS HAPPY TO PROVIDE ONE BUT

416
00:15:48,363 --> 00:15:50,565
DISAPPOINTED TO LEARN HE CHOSE

417
00:15:50,565 --> 00:15:51,767
TO GO INTO ANESTHESIOLOGY.

418
00:15:51,767 --> 00:15:54,469
IT'S LIKELY HE WILL BE A

419
00:15:54,469 --> 00:15:58,840
TERRIFIC ANESTHESIOLOGIST BUT

420
00:15:58,840 --> 00:16:00,175
AWARENESS FINANCIALLY WAS A

421
00:16:00,175 --> 00:16:01,043
CORRUPTING INFLUENCE ON HIS

422
00:16:01,043 --> 00:16:02,144
CAREER DECISION.

423
00:16:02,144 --> 00:16:07,582
WHY DOESN'T SOCIETY VALUE COG

424
00:16:07,582 --> 00:16:08,383
ANITY SPECIALTIES?

425
00:16:08,383 --> 00:16:10,686
IT'S NO LESS COMPLEX AND

426
00:16:10,686 --> 00:16:13,088
DEMANDING AND LIFE ALTERING FOR

427
00:16:13,088 --> 00:16:13,622
PATIENTS.

428
00:16:13,622 --> 00:16:15,624
I CAN RELATE STORIES FROM MY

429
00:16:15,624 --> 00:16:16,692
EXPERIENCE.

430
00:16:16,692 --> 00:16:19,661
A PATIENT WHO NEEDED CONSTANT

431
00:16:19,661 --> 00:16:22,731
COACHING AND REPEATED DISCUSSION

432
00:16:22,731 --> 00:16:23,832
OF THE EVIDENCE, EMOTIONAL

433
00:16:23,832 --> 00:16:26,101
SUPPORT TO STICK WITH TREATMENT

434
00:16:26,101 --> 00:16:27,869
FOR HODGKIN'S DISEASE.

435
00:16:27,869 --> 00:16:29,971
A PATIENT WITH SEVERE

436
00:16:29,971 --> 00:16:30,806
HYPERTENSION, SERIOUS MENTAL

437
00:16:30,806 --> 00:16:32,040
ILLNESS THAT MADE IT HARD FOR

438
00:16:32,040 --> 00:16:34,342
HER TO ADHERE TO TREATMENT AND

439
00:16:34,342 --> 00:16:35,544
SHOW UP FOR APPOINTMENTS, BUT

440
00:16:35,544 --> 00:16:36,978
NEEDED A DOC WHO WOULD STICK

441
00:16:36,978 --> 00:16:39,514
WITH HER AND KEEP HER ALIVE IN

442
00:16:39,514 --> 00:16:41,016
SPITE OF ALL THAT.

443
00:16:41,016 --> 00:16:42,984
A PATIENT WHO WAS DISSPIRITTED

444
00:16:42,984 --> 00:16:44,720
BY MULTIPLE MORBIDITIES AND

445
00:16:44,720 --> 00:16:47,255
NEEDED A DOCTOR NOT ONLY TO

446
00:16:47,255 --> 00:16:48,557
MANAGE HER COMPLEX REGIMEN BUT

447
00:16:48,557 --> 00:16:50,859
ALSO TO KEEP HER SPIRITS UP.

448
00:16:50,859 --> 00:16:52,828
SOME DOCTORS DO ATTEND THESE

449
00:16:52,828 --> 00:16:54,429
VITAL ISSUES, THE PROBLEM IS

450
00:16:54,429 --> 00:16:56,431
THERE'S A DISINCENTIVE IN THE

451
00:16:56,431 --> 00:16:58,633
CURRENT SYSTEM TO SPEND TIME

452
00:16:58,633 --> 00:16:59,835
DOING THAT.

453
00:16:59,835 --> 00:17:03,438
WELL, CAN WE CHANGE CLINICIANS'

454
00:17:03,438 --> 00:17:04,005
PRIORITIES?

455
00:17:04,005 --> 00:17:05,674
HERE ARE SOME IDEAS.

456
00:17:05,674 --> 00:17:07,843
PAY DOCTORS FOR THEIR TIME, NOT

457
00:17:07,843 --> 00:17:12,414
FOR PIECE WORK. 

458
00:17:12,414 --> 00:17:13,715
SPECIALLY PAY SHOULD DIFFER

459
00:17:13,715 --> 00:17:17,119
MODESTLY TO ACCOUNT FOR TIME AND

460
00:17:17,119 --> 00:17:17,686
TRAINING ONLY.

461
00:17:17,686 --> 00:17:18,887
INCENTIVIZE TO SEEK

462
00:17:18,887 --> 00:17:19,755
PSYCHOTHERAPY TO HELP THEM

463
00:17:19,755 --> 00:17:21,523
BETTER RELATE TO PATIENTS' NEEDS

464
00:17:21,523 --> 00:17:22,624
AND VALUES.

465
00:17:22,624 --> 00:17:25,460
ALL PHYSICIANS SHOULD HAVE

466
00:17:25,460 --> 00:17:27,229
PERIODIC TRAINING IN

467
00:17:27,229 --> 00:17:30,065
COMMUNICATION, NEGOTIATION WITH

468
00:17:30,065 --> 00:17:32,267
PATIENTS, ETHICS, MORALS, SOCIAL

469
00:17:32,267 --> 00:17:33,001
RESPONSIBILITY.

470
00:17:33,001 --> 00:17:34,569
AND MANDATE PROCEDURALLISTS AND

471
00:17:34,569 --> 00:17:40,041
ADMINISTRATORS  MEET AND SET

472
00:17:40,041 --> 00:17:43,879
TARGETS RATHER THAN THE

473
00:17:43,879 --> 00:17:47,282
OPPOSITE.

474
00:17:47,282 --> 00:17:48,350
WHAT ABOUT EDUCATIONAL

475
00:17:48,350 --> 00:17:48,683
INSTITUTIONS?

476
00:17:48,683 --> 00:17:49,985
UNIVERSITIES AND MEDICAL SCHOOLS

477
00:17:49,985 --> 00:17:52,220
ARE PART OF THE PROBLEM.

478
00:17:52,220 --> 00:17:56,424
MEDICAL SCHOOL ADMISSIONS ARE

479
00:17:56,424 --> 00:17:58,527
LIMITED WITH THOSE WITH GREAT

480
00:17:58,527 --> 00:18:00,162
SCORES AND PAY LITTLE ATTENTION

481
00:18:00,162 --> 00:18:02,464
TO VALUES, ABILITY TO EMPATHIZE

482
00:18:02,464 --> 00:18:03,431
AND COMMUNICATE EFFECTIVELY, NOT

483
00:18:03,431 --> 00:18:05,400
SURPRISINGLY THE GREAT MAJORITY

484
00:18:05,400 --> 00:18:07,602
OF THOSE ADMITTED STUDIED THE

485
00:18:07,602 --> 00:18:10,305
BIOLOGICAL AND PHYSICAL SCIENCES

486
00:18:10,305 --> 00:18:11,540
AND RELATED DISCIPLINES AND

487
00:18:11,540 --> 00:18:15,143
OVERWHELMINGLY REPRESENT THOSE 

488
00:18:15,143 --> 00:18:16,912
FROM PRIVILEGED BACKGROUNDS

489
00:18:16,912 --> 00:18:18,613
WHILE UNDERREPRESENTING BLACKS

490
00:18:18,613 --> 00:18:21,950
AND HISPANICS, SCHOOLS DO A POOR

491
00:18:21,950 --> 00:18:24,686
JOB OF IDENTIFYING STUDENTS WITH

492
00:18:24,686 --> 00:18:26,555
COMMITMENT TO SOCIETAL

493
00:18:26,555 --> 00:18:26,855
BETTERMENT.

494
00:18:26,855 --> 00:18:30,258
THE UNDERGRADUATE CURRICULUM IS

495
00:18:30,258 --> 00:18:31,026
SCIENCE BASED, BIOLOGICALLY

496
00:18:31,026 --> 00:18:32,527
REDUCTIONIST, HUMANITIES AND

497
00:18:32,527 --> 00:18:36,531
SOCIAL SCIENCES WHICH SHOULD BE

498
00:18:36,531 --> 00:18:38,400
A CORE REQUIRED COMPONENT OF

499
00:18:38,400 --> 00:18:41,670
MEDICAL EDUCATION IS AT BEST AN

500
00:18:41,670 --> 00:18:43,271
AFTERTHOUGHT.

501
00:18:43,271 --> 00:18:44,506
THE WHITE COAT CEREMONIESY ARE

502
00:18:44,506 --> 00:18:51,079
EXERCISE IN TRIUMPHALISM BUT

503
00:18:51,079 --> 00:18:51,746
PEOPLE THAT ACCOMPLISHED NOTHING

504
00:18:51,746 --> 00:18:54,349
YET AND GO THROUGH A NEGATIVE

505
00:18:54,349 --> 00:18:56,451
SOCIALIZATION AND LOSS OF ANY

506
00:18:56,451 --> 00:18:57,853
IDEALISM THAT MEDICAL SCHOOLS

507
00:18:57,853 --> 00:19:03,091
DON'T SHOW  INTEREST IN

508
00:19:03,091 --> 00:19:05,293
ARRESTING AND DON'T LEARN HOW TO

509
00:19:05,293 --> 00:19:07,028
RELATE TO PATIENTS AND NEXT TO

510
00:19:07,028 --> 00:19:09,364
NOTHING ABOUT ETHICAL

511
00:19:09,364 --> 00:19:11,633
OBLIGATIONS AND SOCIAL

512
00:19:11,633 --> 00:19:12,033
RESPONSIBILITIES.

513
00:19:12,033 --> 00:19:15,704
SOME WHO ARRIVE INTENDING TO

514
00:19:15,704 --> 00:19:19,441
FOLLOW IN FOOT STEPS OF MOTHER

515
00:19:19,441 --> 00:19:20,542
TERESA DECIDE TO PURSUE HIGH

516
00:19:20,542 --> 00:19:21,610
PAYING SPECIAL TILs.

517
00:19:21,610 --> 00:19:25,347
DEBT IS SUBSTANTIAL DID YOU NOT

518
00:19:25,347 --> 00:19:27,249
PRECLUDE LIVING IN COMFORT BUT

519
00:19:27,249 --> 00:19:28,016
PROVIDES RATIONALIZATION FOR

520
00:19:28,016 --> 00:19:29,718
THOSE DECISIONS.

521
00:19:29,718 --> 00:19:30,852
WHEN I ENTERED MEDICAL SCHOOL,

522
00:19:30,852 --> 00:19:32,153
MY UNCLE COMMENTED THAT I WOULD

523
00:19:32,153 --> 00:19:33,688
HAVE A CHOICE BETWEEN FIGURING

524
00:19:33,688 --> 00:19:35,123
OUT HOW TO MAKE A LOT OF MONEY

525
00:19:35,123 --> 00:19:37,192
OR HOW TO BEST SERVE HUMANITY.

526
00:19:37,192 --> 00:19:39,494
ON THE BASIS OF MY CHOICE PEOPLE

527
00:19:39,494 --> 00:19:41,630
COULD JUDGE MY WORTH AS A HUMAN

528
00:19:41,630 --> 00:19:42,464
BEING.

529
00:19:42,464 --> 00:19:53,008
THAT WAS A PROVOCATION AND GIFT.

530
00:19:56,444 --> 00:19:57,145
IN POST-GRADUATE, AND CLINICAL

531
00:19:57,145 --> 00:20:04,486
TRAINING IT'S THE EXCEPTION, NOT

532
00:20:04,486 --> 00:20:06,154
THE RULE, COMMITMENT TO

533
00:20:06,154 --> 00:20:07,222
DIVERSITY POPULATIONS, THAT

534
00:20:07,222 --> 00:20:09,858
MIGHT MAKE AMERICA LESS

535
00:20:09,858 --> 00:20:10,492
EXCEPTIONAL.

536
00:20:10,492 --> 00:20:12,928
AGAIN, AS LITTLE EXPOSURE TO

537
00:20:12,928 --> 00:20:16,131
HUMANITIES AND SOCIAL SCIENCES,

538
00:20:16,131 --> 00:20:17,632
FEW OPPORTUNITIES TO ADDRESS

539
00:20:17,632 --> 00:20:18,533
PERSONAL CHALLENGES OF DOCTORS,

540
00:20:18,533 --> 00:20:21,069
STAND IN THE WAY OF EFFECTIVE

541
00:20:21,069 --> 00:20:22,003
RELATIONSHIPS WITH PATIENTS,

542
00:20:22,003 --> 00:20:23,872
LITTLE EFFORT TO ASSURE THEY ARE

543
00:20:23,872 --> 00:20:26,274
ABLE TO COMMUNICATE EFFECTIVELY

544
00:20:26,274 --> 00:20:27,475
WITH PATIENTS, SOME INSTITUTIONS

545
00:20:27,475 --> 00:20:29,344
TRY TO PROVIDE POSITIVE

546
00:20:29,344 --> 00:20:30,946
OUTPATIENT EXPERIENCES, BUT IN

547
00:20:30,946 --> 00:20:32,614
MANY PROGRAMS THEY ARE AWFUL.

548
00:20:32,614 --> 00:20:36,117
RESIDENTS WHO ARE PRESSED FOR

549
00:20:36,117 --> 00:20:36,952
TIME ARE ASSIGNED PATIENTS THE

550
00:20:36,952 --> 00:20:46,294
FACULTY DON'T WANT TO SEE

551
00:20:46,294 --> 00:20:47,462
THEMSELVES.

552
00:20:47,462 --> 00:20:49,597
PROMOTE CHOICES OF PROCEDURAL

553
00:20:49,597 --> 00:20:49,965
CAREERS.

554
00:20:49,965 --> 00:20:51,433
CLINICALLY, MEDICAL SCHOOLS ARE

555
00:20:51,433 --> 00:20:52,968
NO LESS INTERESTED IN THE

556
00:20:52,968 --> 00:20:54,235
PRIVATE SECTOR IN GENERATING

557
00:20:54,235 --> 00:20:55,003
REVENUE, THE HEALTH OF THE

558
00:20:55,003 --> 00:20:58,340
PUBLIC IS NOT MUCH OF A PRIORITY

559
00:20:58,340 --> 00:20:59,774
BEYOND THE OCCASIONAL LECTURE ON

560
00:20:59,774 --> 00:21:02,077
SOCIAL ASPECTS OF MEDICINE.

561
00:21:02,077 --> 00:21:04,245
PRACTICES ARE OFTEN SEGREGATED

562
00:21:04,245 --> 00:21:05,780
BY INSURANCE TYPE, BUSINESS

563
00:21:05,780 --> 00:21:09,617
PLANS REFLECT PRIORITY OF

564
00:21:09,617 --> 00:21:12,220
REVENUE GENERATION, MARKET

565
00:21:12,220 --> 00:21:14,289
SHARE, MAXIMIZED REIMBURSEMENT,

566
00:21:14,289 --> 00:21:18,493
MINIMIZED RISK, RUN THE TILL,

567
00:21:18,493 --> 00:21:19,361
THE HIDDEN CURRICULUM.

568
00:21:19,361 --> 00:21:21,096
STUDENTS GROW UP TO EMULATE THE

569
00:21:21,096 --> 00:21:22,964
PRACTICE PATTERNS AND VALUES OF

570
00:21:22,964 --> 00:21:23,531
THE FACULTY.

571
00:21:23,531 --> 00:21:26,468
WHAT CAN WE DO ABOUT MEDICAL

572
00:21:26,468 --> 00:21:27,302
EDUCATION?

573
00:21:27,302 --> 00:21:30,839
THERE ARE LOTS OF POTENTIAL

574
00:21:30,839 --> 00:21:32,007
STRATEGIES.

575
00:21:32,007 --> 00:21:36,644
REPLACE PRE-MEDICAL SCIENCE 

576
00:21:36,644 --> 00:21:40,615
REQUIREMENTS IN TOTO WITH

577
00:21:40,615 --> 00:21:41,049
ETHICS.

578
00:21:41,049 --> 00:21:44,753
THIS WAS PROPOSED BUT IT HASN'T

579
00:21:44,753 --> 00:21:45,620
HAPPENED.

580
00:21:45,620 --> 00:21:46,855
SELECT APPLICANTS ALTRUISTIC,

581
00:21:46,855 --> 00:21:47,489
EMPATHIC, PSYCHOLOGICALLY OPEN

582
00:21:47,489 --> 00:21:51,192
AND HAVE SOUND MORAL AND ETHICAL

583
00:21:51,192 --> 00:21:51,893
FOUNDATIONS.

584
00:21:51,893 --> 00:21:53,194
MEMBERS OF UNDERSERVED

585
00:21:53,194 --> 00:21:54,129
COMMUNITIES SHOULD NOMINATE

586
00:21:54,129 --> 00:22:02,737
MEDICAL SCHOOL MA TRICULUM, AND

587
00:22:02,737 --> 00:22:05,106
SHOULD PROVIDE HALF OF THE

588
00:22:05,106 --> 00:22:09,144
CURRICULUM AND BE INTEGRATED

589
00:22:09,144 --> 00:22:11,112
INTO CLINICAL TRAINING.

590
00:22:11,112 --> 00:22:13,081
WHAT ABOUT MEDICAL RESEARCH?

591
00:22:13,081 --> 00:22:14,182
THINKING ABOUT SCIENCE IT'S

592
00:22:14,182 --> 00:22:20,655
WORTH CONSIDERING ROBERT

593
00:22:20,655 --> 00:22:21,389
MURTON'S CHARACTERIZATION, LET'S

594
00:22:21,389 --> 00:22:23,391
LOOK AT THE SECOND ONE.

595
00:22:23,391 --> 00:22:23,958
COMMUNALISM.

596
00:22:23,958 --> 00:22:27,762
THE FINDINGS OF SCIENCE ARE

597
00:22:27,762 --> 00:22:28,329
PRODUCTS OF COLLABORATION,

598
00:22:28,329 --> 00:22:30,832
ASSIGNED TO THE COMMUNITY.

599
00:22:30,832 --> 00:22:33,535
THIS ETHOS IS INCOMPATIBLE WITH

600
00:22:33,535 --> 00:22:35,403
TECHNOLOGY DEFINED AS PRIVATE

601
00:22:35,403 --> 00:22:35,937
PROPERTY.

602
00:22:35,937 --> 00:22:38,139
DOES THAT CHARACTERIZE MEDICAL

603
00:22:38,139 --> 00:22:40,809
RESEARCH TODAY?

604
00:22:40,809 --> 00:22:42,677
CERTAINLY NOT ENTIRELY.

605
00:22:42,677 --> 00:22:44,612
BASIC SCIENTISTS TEND TO BE

606
00:22:44,612 --> 00:22:46,448
EXCITED ABOUT DISCOVERY, GET

607
00:22:46,448 --> 00:22:50,051
LITTLE EDUCATION ABOUT SOCIAL

608
00:22:50,051 --> 00:22:54,456
RESPONSIBILITIES OF SCIENTISTS, 

609
00:22:54,456 --> 00:22:56,524
PATENTS CAN BE LUCRATIVE TO

610
00:22:56,524 --> 00:23:00,895
SCIENTISTS AND THEIR EMPLOYERS

611
00:23:00,895 --> 00:23:02,330
AND FOR SOME THESE PRIORITIES

612
00:23:02,330 --> 00:23:05,733
ARE APPARENT TO THEIR STUDENTS.

613
00:23:05,733 --> 00:23:07,268
AND AFFECT THEIR ATTITUDES TO

614
00:23:07,268 --> 00:23:09,471
WHAT'S IMPORTANT IN SCIENCE.

615
00:23:09,471 --> 00:23:10,738
CLINICAL RESEARCH IS ESSENTIAL.

616
00:23:10,738 --> 00:23:13,575
BUT WHEN IT'S FUNDED BY

617
00:23:13,575 --> 00:23:15,710
INDUSTRY, PAYMENTS CAN BE

618
00:23:15,710 --> 00:23:16,778
GENEROUS BUT THE PRIORITIES MAY

619
00:23:16,778 --> 00:23:19,147
BE THOSE OF INDUSTRY.

620
00:23:19,147 --> 00:23:21,349
THERE CAN BE LIMITATIONS ON

621
00:23:21,349 --> 00:23:22,650
INTELLECTUAL READING.

622
00:23:22,650 --> 00:23:24,752
AS FOR LATE TRANSLATIONAL POLICY

623
00:23:24,752 --> 00:23:29,457
RESEARCH SUCH AS I'VE DONE IN MY

624
00:23:29,457 --> 00:23:30,892
CAREER AND ELISEO TOO, MOST

625
00:23:30,892 --> 00:23:41,402
SCIENTISTS TEND TO GENUFLECT, 

626
00:23:43,304 --> 00:23:45,440
MOST FOCUS ON SMALL CHANGES.

627
00:23:45,440 --> 00:23:47,609
LET'S LOOK AT THE NIH MISSION

628
00:23:47,609 --> 00:23:48,910
STATEMENT IN PART.

629
00:23:48,910 --> 00:23:50,145
TO SEEK FUNDAMENTAL KNOWLEDGE

630
00:23:50,145 --> 00:23:52,213
ABOUT THE NATURE AND BEHAVIOR OF

631
00:23:52,213 --> 00:23:54,182
LIVING SYSTEMS AND APPLICATION

632
00:23:54,182 --> 00:23:56,918
OF THAT KNOWLEDGE TO ENHANCE

633
00:23:56,918 --> 00:24:07,462
HEALTH, LENGTHEN LIFE,  REDUCING

634
00:24:08,997 --> 00:24:09,330
ILLNESS.

635
00:24:09,330 --> 00:24:12,567
THEY DO NOT TREAT ALL ASPECTS OF

636
00:24:12,567 --> 00:24:14,969
THIS MISSION STATEMENT EQUALLY.

637
00:24:14,969 --> 00:24:16,838
SCIENTIFIC ORGANIZATIONS AND

638
00:24:16,838 --> 00:24:19,674
FUNDERS SUCH AS NIH OVERPROMISE

639
00:24:19,674 --> 00:24:22,510
BENEFITS OF BASIC RESEARCH.

640
00:24:22,510 --> 00:24:23,278
THE RELENTLESS PURSUIT OF

641
00:24:23,278 --> 00:24:24,812
MOLECULAR SOLUTIONS TO HEALTH

642
00:24:24,812 --> 00:24:26,447
PROBLEMS AFFECTS PRACTICE AND

643
00:24:26,447 --> 00:24:28,550
ENCOURAGES PROFESSIONAL AND

644
00:24:28,550 --> 00:24:31,152
PUBLIC ATTITUDES TOWARDS

645
00:24:31,152 --> 00:24:33,555
DISEASES BEING LARGELY A SOCIAL,

646
00:24:33,555 --> 00:24:37,091
PRODUCING NARROW VISION OF WHAT 

647
00:24:37,091 --> 00:24:39,827
SIGNS COULD BE TO KEEP MONEY

648
00:24:39,827 --> 00:24:40,562
FLOWING THROUGH THEIR

649
00:24:40,562 --> 00:24:41,563
PRIORITIES, CERTAINLY NOT

650
00:24:41,563 --> 00:24:42,664
TOWARDS OTHER KINDS OF RESEARCH

651
00:24:42,664 --> 00:24:45,166
THAT MIGHT HAVE A LARGER IMPACT

652
00:24:45,166 --> 00:24:49,370
ON POPULATION HEALTH SUCH AS

653
00:24:49,370 --> 00:24:50,138
STUDIES, PROGRAM TO IMPROVE

654
00:24:50,138 --> 00:24:53,074
BLOOD PRESSURE CONTROL, WEIGHT

655
00:24:53,074 --> 00:24:54,342
MANAGEMENT, SMOKING CESSATION

656
00:24:54,342 --> 00:24:55,043
AND THE LIKE.

657
00:24:55,043 --> 00:24:59,280
WHEN I WROTE MY FIRST R01 GRANT

658
00:24:59,280 --> 00:25:01,482
PROPOSAL, HIV OUTSOME STUDY, I

659
00:25:01,482 --> 00:25:04,319
GOT EXCELLENT SCORE BUT WASN'T

660
00:25:04,319 --> 00:25:04,886
FUNDED.

661
00:25:04,886 --> 00:25:07,422
THE PROJECT OFFICER WAS

662
00:25:07,422 --> 00:25:08,623
ENTHUSIASTIC ABOUT MY PROPOSAL

663
00:25:08,623 --> 00:25:10,692
BUT TOLD ME NOT TO RESUBMIT

664
00:25:10,692 --> 00:25:12,760
THERE BECAUSE THE DIRECTOR DID

665
00:25:12,760 --> 00:25:15,830
NOT CONSIDER SUCH RESEARCH TO BE

666
00:25:15,830 --> 00:25:18,366
HIS RESPONSIBILITY.

667
00:25:18,366 --> 00:25:20,902
REDIRECTED ME TOWARD WHAT IS NOW

668
00:25:20,902 --> 00:25:21,336
AHRQ.

669
00:25:21,336 --> 00:25:24,973
YOU CAN SEE THE BREAKDOWN OF THE

670
00:25:24,973 --> 00:25:26,908
2021 NIH BUDGET ALONG WITH AHRQ

671
00:25:26,908 --> 00:25:28,676
AND PCORI.

672
00:25:28,676 --> 00:25:29,978
SOME LARGE INSTITUTES DO SUPPORT

673
00:25:29,978 --> 00:25:32,080
SOME HEALTH SERVICES AND

674
00:25:32,080 --> 00:25:33,248
BEHAVIORAL RESEARCH.

675
00:25:33,248 --> 00:25:42,890
IN MANY, YOU THE FLUCTUATES OR

676
00:25:42,890 --> 00:25:44,525
WITH CHANGE OF DIRECTORSHIP SOME

677
00:25:44,525 --> 00:25:46,160
YEARS AGO THE LEVEL OF SUPPORT

678
00:25:46,160 --> 00:25:48,796
FOR THIS KIND OF RESEARCH

679
00:25:48,796 --> 00:25:49,063
PLUMMETS.

680
00:25:49,063 --> 00:25:51,332
OTHERS ESSENTIALLY NEVER SUPPORT

681
00:25:51,332 --> 00:25:53,401
SUCH RESEARCH, A FEW

682
00:25:53,401 --> 00:25:56,104
CONSISTENTLY DO, BUT MOST OF

683
00:25:56,104 --> 00:25:58,339
THOSE HAVE BUDGETS THAT ARE LESS

684
00:25:58,339 --> 00:26:04,145
THAN 1% OF THE BUDGET OF THE

685
00:26:04,145 --> 00:26:04,812
OVERALL NIH.

686
00:26:04,812 --> 00:26:08,650
SO, HOW DO WE MAKE SCIENCE MORE

687
00:26:08,650 --> 00:26:10,251
RESPONSIVE TO SOCIETAL NEEDS?

688
00:26:10,251 --> 00:26:11,152
TRAINING IN SOCIAL

689
00:26:11,152 --> 00:26:13,554
RESPONSIBILITY SHOULD BE A

690
00:26:13,554 --> 00:26:14,422
SUBSTANTIAL FEATURE OF

691
00:26:14,422 --> 00:26:15,823
SCIENTIFIC EDUCATION.

692
00:26:15,823 --> 00:26:17,258
REVENUE FROM INVENTIONS FUNDED

693
00:26:17,258 --> 00:26:18,593
BY FEDERAL GRANTS SHOULD ACCRUE

694
00:26:18,593 --> 00:26:22,096
LARGELY TO THE GOVERNMENT AND

695
00:26:22,096 --> 00:26:26,367
NOT TO SCIENTISTS, INSTITUTIONS

696
00:26:26,367 --> 00:26:27,468
OR CORPORATIONS.

697
00:26:27,468 --> 00:26:28,336
RESEARCH ON BRINGING EFFECTIVE

698
00:26:28,336 --> 00:26:30,204
CARE SHOULD HAVE THE NIH HIGHEST

699
00:26:30,204 --> 00:26:33,141
PRIORITY, HALF OF THE MEMBERS OF

700
00:26:33,141 --> 00:26:34,876
ADVISORY COUNCILS OF INSTITUTES

701
00:26:34,876 --> 00:26:40,481
SHOULD BE NOMINATED BY MEMBERS

702
00:26:40,481 --> 00:26:41,683
OF DIVERSE COMMUNITIES.

703
00:26:41,683 --> 00:26:43,017
GOVERNMENT CAN BE PART OF THE

704
00:26:43,017 --> 00:26:44,986
SOLUTION BUT IT'S OFTEN PART OF

705
00:26:44,986 --> 00:26:45,286
THE PROBLEM.

706
00:26:45,286 --> 00:26:47,722
THE U.S. GOVERNMENT AVOIDS

707
00:26:47,722 --> 00:26:51,225
POLICIES THAT NECESSITATE

708
00:26:51,225 --> 00:26:56,464
RAISING TAXES. 

709
00:26:56,464 --> 00:27:02,503
SUSCEPTIBLE TO CORPORATE

710
00:27:02,503 --> 00:27:05,139
PRESSURE, THEY FAIL AS

711
00:27:05,139 --> 00:27:06,674
WASHINGTON POST REPORTED TODAY,

712
00:27:06,674 --> 00:27:10,378
THEY FAIL TO EXERCISE MARCH-IN

713
00:27:10,378 --> 00:27:13,348
RIGHTS TO CONTROL THE

714
00:27:13,348 --> 00:27:14,549
EXTRAORDINARILY EXTRAVAGANT COST

715
00:27:14,549 --> 00:27:16,851
OF NEWER DRUGS.

716
00:27:16,851 --> 00:27:18,720
THEY OVERPAY FOR PROCEDURES

717
00:27:18,720 --> 00:27:22,290
RELATIVE TO COGNITIVE SERVICES.

718
00:27:22,290 --> 00:27:23,091
THEY PROMOTE OVERSPECIALIZATION

719
00:27:23,091 --> 00:27:25,159
IN TECHNICAL FIELDS THROUGH THE

720
00:27:25,159 --> 00:27:32,166
DISTORTED FEE SCHEDULE AND 

721
00:27:32,166 --> 00:27:35,903
EDUCATIONAL SUBSIDIES AND PREFER

722
00:27:35,903 --> 00:27:38,406
MOONSHOTS THAT ARE ASOCIAL.

723
00:27:38,406 --> 00:27:45,012
OUR PATIENTS, ARE THEY INNOCENT

724
00:27:45,012 --> 00:27:45,246
VICTIMS?

725
00:27:45,246 --> 00:27:47,014
I THINK NOT.

726
00:27:47,014 --> 00:27:49,117
JUST AS SCIENTISTS, CLINICIAN,

727
00:27:49,117 --> 00:27:50,084
PHARMACEUTICAL COMPANY, HEALTH

728
00:27:50,084 --> 00:27:53,388
SYSTEM SEE HEALTH CARE AS A

729
00:27:53,388 --> 00:27:58,326
COMMODITY, SO DO MANY PATIENTS.

730
00:27:58,326 --> 00:28:00,361
THEY WANT THEIR SHARE.

731
00:28:00,361 --> 00:28:02,864
18 TO 19% OF GDP, WHO WANTS TO

732
00:28:02,864 --> 00:28:04,966
WORK 7 1/2 HOURS A WEEK TO PAY

733
00:28:04,966 --> 00:28:06,401
FOR MEDICAL CARE BUT THEY WANT

734
00:28:06,401 --> 00:28:10,438
BLOOD TEST, SCAN, BED IN ICU AND

735
00:28:10,438 --> 00:28:12,640
MANY TREAT LIFE ITSELF AS A KIND

736
00:28:12,640 --> 00:28:14,609
OF COMMODITY WANTING MORE DAYS

737
00:28:14,609 --> 00:28:17,145
AND WEEKS AND MONTHS OF LIFE,

738
00:28:17,145 --> 00:28:18,646
WHATEVER THE COST OR CONSEQUENCE

739
00:28:18,646 --> 00:28:19,447
TO OTHERS.

740
00:28:19,447 --> 00:28:21,616
THERE'S NO MORE THOUGHT OF THE

741
00:28:21,616 --> 00:28:22,717
COMMON GOOD AMONG MUCH OF THE

742
00:28:22,717 --> 00:28:24,252
PUBLIC THAN AMONG THOSE WORKING

743
00:28:24,252 --> 00:28:25,987
IN THE HEALTH SECTOR.

744
00:28:25,987 --> 00:28:26,988
WHY WOULD THAT BE?

745
00:28:26,988 --> 00:28:30,258
WELL IN PART IT REFLECTS A WORLD

746
00:28:30,258 --> 00:28:38,666
IN WHICH ALMOST EVERYTHING IS

747
00:28:38,666 --> 00:28:39,767
COMMODIFIED, SOME PEOPLE FEEL

748
00:28:39,767 --> 00:28:41,536
ENTITLED TO GET WHATEVER THEY

749
00:28:41,536 --> 00:28:44,839
WANT, AND MANY WHO ARE NOT

750
00:28:44,839 --> 00:28:46,240
WELL-CONNECTED TO OTHERS,

751
00:28:46,240 --> 00:28:47,108
REPLETE WITH LONELINESS, BEATEN

752
00:28:47,108 --> 00:28:50,411
DOWN BY THE WORLD, THEY COME TO

753
00:28:50,411 --> 00:28:52,814
HEALTH CARE LOOKING FOR COMFORT,

754
00:28:52,814 --> 00:28:53,915
COMPANIONSHIP, A HEART OPEN TO

755
00:28:53,915 --> 00:28:56,517
THEM IN THE WAY THE LARGER WORLD

756
00:28:56,517 --> 00:28:57,752
IS NOT.

757
00:28:57,752 --> 00:28:59,620
UNLIKE THOSE DEMANDING CARE OUT

758
00:28:59,620 --> 00:29:02,323
OF ENTITLEMENT, WHO GET WHAT

759
00:29:02,323 --> 00:29:04,625
THEY WANT, THESE INDIVIDUALS

760
00:29:04,625 --> 00:29:05,426
ENCOUNTER PROFESSIONALS NOT

761
00:29:05,426 --> 00:29:07,061
EQUIPPED TO GIVE THEM WHAT THEY

762
00:29:07,061 --> 00:29:07,695
NEED.

763
00:29:07,695 --> 00:29:08,696
BELIEFS AND ATTITUDES MAY BE

764
00:29:08,696 --> 00:29:09,831
SHAPED BY A MEDICAL PROFESSION

765
00:29:09,831 --> 00:29:13,835
THAT DOESN'T KNOW HOW TO SET

766
00:29:13,835 --> 00:29:15,703
LIMITS, SCIENTIFIC ESTABLISHMENT

767
00:29:15,703 --> 00:29:19,740
THAT HOLDS UP CONQUEST, LACK OF

768
00:29:19,740 --> 00:29:21,509
CLARITY ABOUT WHAT LIMITS

769
00:29:21,509 --> 00:29:23,377
REASONABLE AND DOGMA FROM SOME

770
00:29:23,377 --> 00:29:24,345
RELIGIOUS LEADERS ABOUT WHEN

771
00:29:24,345 --> 00:29:27,081
LIFE BEGINS AND HOW IT SHOULD

772
00:29:27,081 --> 00:29:27,415
END.

773
00:29:27,415 --> 00:29:29,817
I COMMEND TO YOU THE WONDERFUL

774
00:29:29,817 --> 00:29:31,252
BOOK BY ROBERT BELLA AND

775
00:29:31,252 --> 00:29:34,422
COLLEAGUES, HABITS OF THE HEART,

776
00:29:34,422 --> 00:29:36,624
WHICH PROVIDES INSIGHTS.

777
00:29:36,624 --> 00:29:39,460
THEY WRITE IN PART, AMERICAN

778
00:29:39,460 --> 00:29:41,095
INDIVIDUALISM HAS BECOME

779
00:29:41,095 --> 00:29:43,397
AUTONOMY DISASSOCIATED FROM

780
00:29:43,397 --> 00:29:44,832
MEANINGFUL SOCIETAL INTEGRATION,

781
00:29:44,832 --> 00:29:46,033
THERE'S BEEN A DESTRUCTION OF

782
00:29:46,033 --> 00:29:47,568
SUBTLE TIES THAT BIND PEOPLE

783
00:29:47,568 --> 00:29:50,104
LEAVING THEM FRIGHTENED AND

784
00:29:50,104 --> 00:29:50,404
ALONE.

785
00:29:50,404 --> 00:29:53,040
MANY ABANDON ANY NOTION OF

786
00:29:53,040 --> 00:29:54,008
FINDING MEANING IN RELATION TO

787
00:29:54,008 --> 00:29:57,311
SOCIETY AND THE IDEA OF THE

788
00:29:57,311 --> 00:29:57,745
COMMON GOOD.

789
00:29:57,745 --> 00:29:59,614
EDUCATION BECOMES AN INSTRUMENT

790
00:29:59,614 --> 00:30:01,582
FROM INDIVIDUAL CAREERISM AND

791
00:30:01,582 --> 00:30:06,554
THERE'S A FRACTURED IMBALANCE

792
00:30:06,554 --> 00:30:08,389
BETWEEN INDIVIDUALISM AND

793
00:30:08,389 --> 00:30:08,923
COMMUNITYISM.

794
00:30:08,923 --> 00:30:12,426
UNDERLYING ACTIONS ARE VALUES

795
00:30:12,426 --> 00:30:16,264
AND CONSCIOUSNESS OF SOCIETY,

796
00:30:16,264 --> 00:30:18,966
LACK OF COMMUNAL CONCERNS,

797
00:30:18,966 --> 00:30:21,168
MISTRUST, GREED IS GOOD, POVERTY

798
00:30:21,168 --> 00:30:22,470
IS WEAKNESS, DECLINE OF RELIGION

799
00:30:22,470 --> 00:30:25,239
IS A SOURCE OF SUPPORT, FAILURE

800
00:30:25,239 --> 00:30:27,875
OF PUBLIC DISCOURSE TO ADDRESS

801
00:30:27,875 --> 00:30:29,176
THESE ISSUES, HEALTH CARE

802
00:30:29,176 --> 00:30:31,045
MANIFESTS IN ECONOMIC AND

803
00:30:31,045 --> 00:30:33,147
POLITICAL BEHAVIOR OF ACTORS AND

804
00:30:33,147 --> 00:30:41,222
IN THEIR INNER LIVES. 

805
00:30:41,222 --> 00:30:44,625
HEALTH CARE IS COMMODIFIED.

806
00:30:44,625 --> 00:30:46,360
SOME SEEK GREATER MARKET SHARE,

807
00:30:46,360 --> 00:30:48,996
STILL OTHERS RUN THE TILL AND

808
00:30:48,996 --> 00:30:51,399
NEVER SAY KNOW TO PATIENTS AND

809
00:30:51,399 --> 00:30:55,202
FAMILY MEMBERS.

810
00:30:55,202 --> 00:31:03,311
SOME INTERESTED IN INVENTIONS.

811
00:31:03,311 --> 00:31:06,147
AL OF THESE GROUPS ARE PUSHING

812
00:31:06,147 --> 00:31:07,682
FOR HEALTH SYSTEM DO MORE, SPEND

813
00:31:07,682 --> 00:31:08,249
MORE.

814
00:31:08,249 --> 00:31:11,953
ON THE OTHER HAND, INSURERS, THE

815
00:31:11,953 --> 00:31:13,054
GOVERNMENT, LAWYERS, EACH WITH

816
00:31:13,054 --> 00:31:15,056
THEIR OWN REASONS TO LIMIT CARE

817
00:31:15,056 --> 00:31:18,092
AND COST, COVERAGE IN A WAY NOT

818
00:31:18,092 --> 00:31:27,702
NECESSARILY CONSISTENT WITH

819
00:31:27,702 --> 00:31:28,936
OPTIMAL HEALTH.

820
00:31:28,936 --> 00:31:35,309
(INDISCERNIBLE)

821
00:31:35,309 --> 00:31:37,044
WHEN CARE IS COMMODIFIED THERE'S

822
00:31:37,044 --> 00:31:42,283
DISINCENTIVE TO KNOW THEM, TO DO

823
00:31:42,283 --> 00:31:46,554
MORE PROCEDURES, GREATER 

824
00:31:46,554 --> 00:31:47,788
CO-PAYS, EXACERBATING

825
00:31:47,788 --> 00:31:49,457
DISPARITIES, CONSUMPTION OF

826
00:31:49,457 --> 00:31:57,298
RESOURCES, LIMITING ACCESS TO

827
00:31:57,298 --> 00:31:59,567
NEEDED CARE, AS WELL AS

828
00:31:59,567 --> 00:32:02,737
DIVERSION OF RESOURCES FROM

829
00:32:02,737 --> 00:32:04,739
SOCIAL SERVICES AND EDUCATION

830
00:32:04,739 --> 00:32:07,475
AND INFRASTRUCTURE.

831
00:32:07,475 --> 00:32:13,280
CAN HEALTH CARE EVEN BE 

832
00:32:13,280 --> 00:32:15,449
OPTIMIZED IN A COMMODIFIED

833
00:32:15,449 --> 00:32:15,983
MARKETPLACE?

834
00:32:15,983 --> 00:32:18,085
PELLEGRINO OFFERS PUTTING

835
00:32:18,085 --> 00:32:19,487
PHYSICIANS AT FINANCIAL RISK CAN

836
00:32:19,487 --> 00:32:23,424
(INDISCERNIBLE) WHICH HAS GRAVE

837
00:32:23,424 --> 00:32:24,625
CONSEQUENCES IN MEDICINE AND

838
00:32:24,625 --> 00:32:26,594
ONLY THE GOVERNMENT WILL PLACE

839
00:32:26,594 --> 00:32:28,663
PUBLIC GOOD ABOVE PRIVATE

840
00:32:28,663 --> 00:32:29,363
INTEREST.

841
00:32:29,363 --> 00:32:29,964
ECONOMIST KENNETH ARROW WROTE

842
00:32:29,964 --> 00:32:33,300
HEALTH CARE CAN'T BE A PERFECTLY

843
00:32:33,300 --> 00:32:34,268
FUNCTIONING MARKET BECAUSE OF

844
00:32:34,268 --> 00:32:36,137
UNCERTAINTY ABOUT QUALITY OF

845
00:32:36,137 --> 00:32:37,238
PRODUCTS THAT PATIENTS PURCHASE,

846
00:32:37,238 --> 00:32:39,006
INJURY TO SOME CAUSED BY

847
00:32:39,006 --> 00:32:40,741
UNCONSTRAINED MARKET MAY NOT BE

848
00:32:40,741 --> 00:32:48,315
OFFSET BY BENEFIT TO OTHERS.

849
00:32:48,315 --> 00:32:51,052
WE KNOW MARKET-BASED U.S. SYSTEM

850
00:32:51,052 --> 00:32:54,522
IS PERHAPS THE LEAST EFFICIENT 

851
00:32:54,522 --> 00:33:02,163
WHILE PRODUCING POORER OUTCOMES.

852
00:33:02,163 --> 00:33:08,235
HOWEVER,  CONSCIOUSNESS OF

853
00:33:08,235 --> 00:33:10,538
ACTORS IS NO LESS POTENT.

854
00:33:10,538 --> 00:33:12,506
CLINICIANS DOING THINGS CONCRETE

855
00:33:12,506 --> 00:33:14,241
AND SHORT TERM HAVE TROUBLE

856
00:33:14,241 --> 00:33:16,210
RELATING TO PATIENTS, SAYING NO,

857
00:33:16,210 --> 00:33:18,646
AREN'T GOING TO LIMIT CARE AND

858
00:33:18,646 --> 00:33:21,348
CHANGE PRIORITY.

859
00:33:21,348 --> 00:33:24,085
MEDICAL SCHOOLS CAN'T TRAIN MORE

860
00:33:24,085 --> 00:33:25,086
SUBSPECIALISTS, THEY DON'T KNOW

861
00:33:25,086 --> 00:33:33,961
HOW TO BREAK WITH PROPENSITY FOR

862
00:33:33,961 --> 00:33:36,597
MERIT RATHER THAN CAPACITY TO

863
00:33:36,597 --> 00:33:40,401
CARE, LACKING INTEREST TO

864
00:33:40,401 --> 00:33:42,036
PRODUCE SOCIETAL OBLIGATIONS,

865
00:33:42,036 --> 00:33:45,339
SCIENTISTS LIKE IT FIGURE THINGS

866
00:33:45,339 --> 00:33:47,208
OUT, OBLIVIOUS TO PROBLEMS.

867
00:33:47,208 --> 00:33:48,609
POLITICIANS HAVE MOONSHOTS AND

868
00:33:48,609 --> 00:33:52,346
PROGRAMS BUT DON'T WANT TO

869
00:33:52,346 --> 00:33:53,781
OFFEND THOSE THAT MIGHT DRIVE

870
00:33:53,781 --> 00:33:54,749
THEM FROM OFFICE.

871
00:33:54,749 --> 00:33:57,818
PATIENTS RUN DOWN BY LIFE WITH

872
00:33:57,818 --> 00:33:59,587
PAIN LITERAL AND FIGURATIVE,

873
00:33:59,587 --> 00:34:00,755
DON'T TRUST MEDICAL AUTHORITIES

874
00:34:00,755 --> 00:34:04,258
FROM WHOM THEY ARE DISTANT,

875
00:34:04,258 --> 00:34:05,793
CONFUSED BY MISINFORMATION ABOUT

876
00:34:05,793 --> 00:34:07,928
WHAT MEDICAL SCIENCE HAS TO

877
00:34:07,928 --> 00:34:12,066
OFFER, LOOK TO MEDICINE FOR THE

878
00:34:12,066 --> 00:34:14,468
HEALING TOUCH.

879
00:34:14,468 --> 00:34:17,004
DISCOURSE IS DISAPPOINTING,

880
00:34:17,004 --> 00:34:19,740
DOCTORS SELLING PROCEDURES,

881
00:34:19,740 --> 00:34:21,375
PROVIDERS ADVERTISING MIRACLES,

882
00:34:21,375 --> 00:34:23,244
PROFESSIONAL SOCIETIES GUARDING

883
00:34:23,244 --> 00:34:24,545
THEIR INTERESTS, MEDICAL

884
00:34:24,545 --> 00:34:27,081
EDUCATORS PROMULGATING VALUES OF

885
00:34:27,081 --> 00:34:29,784
THE STATUS QUO, SCIENTISTS AND

886
00:34:29,784 --> 00:34:32,753
NIH MAKING EXTRAVAGANT PROMISES,

887
00:34:32,753 --> 00:34:35,389
CORPORATIONS INDUCE DEMAND AND

888
00:34:35,389 --> 00:34:37,591
BLOCK PROGRESS, POLITICIANS

889
00:34:37,591 --> 00:34:39,560
PRIORITIZE MOONSHOTS, MEDIA

890
00:34:39,560 --> 00:34:41,328
SENSE TAIGSALLIZE REPORTS OF

891
00:34:41,328 --> 00:34:42,763
LATEST ADVANCES, NOT REPORTING

892
00:34:42,763 --> 00:34:44,298
VERY OFTEN ON SYSTEMIC PROBLEMS

893
00:34:44,298 --> 00:34:45,499
IN CARE.

894
00:34:45,499 --> 00:34:47,802
HEALTH POLICY RESEARCHERS DON'T

895
00:34:47,802 --> 00:34:50,938
THREATEN THE STATUS QUO, PUBLIC

896
00:34:50,938 --> 00:34:53,040
INTELLECTUALS WHO MIGHT TRY TO

897
00:34:53,040 --> 00:34:58,379
BALANCE DISCOURSE ARE DROWNED

898
00:34:58,379 --> 00:34:58,846
OUT.

899
00:34:58,846 --> 00:35:00,581
ACOURTING TO THEORY OF

900
00:35:00,581 --> 00:35:02,683
COMMUNICATEIVE ACTION PROGRESS

901
00:35:02,683 --> 00:35:04,418
IN SOCIETY DEPENDS ON COMMON

902
00:35:04,418 --> 00:35:06,253
UNDERSTANDING ACROSS THOSE WHO

903
00:35:06,253 --> 00:35:08,789
CONTROL CAPITAL, THOSE WHO MAKE

904
00:35:08,789 --> 00:35:09,890
POLICY, INDIVIDUALS AND GROUPS

905
00:35:09,890 --> 00:35:11,725
WHO SEEK TO HAVE INFLUENCE, AND

906
00:35:11,725 --> 00:35:14,461
VALUES AND BELIEFS THAT MEMBERS

907
00:35:14,461 --> 00:35:17,331
OF SOCIETY, ARGUES IN GENERAL

908
00:35:17,331 --> 00:35:18,299
CAPITALISTS AND POLICYMAKERS

909
00:35:18,299 --> 00:35:20,401
COMMUNICATE VERY WELL WITH

910
00:35:20,401 --> 00:35:22,269
ELEMENTS SHUT OUT IN HEALTH

911
00:35:22,269 --> 00:35:27,641
CARE, CAPITALISTS HAVE THE

912
00:35:27,641 --> 00:35:30,044
POWER, AND ABSENT COMMON

913
00:35:30,044 --> 00:35:31,445
UNDERSTANDING ADVERSARIAL

914
00:35:31,445 --> 00:35:32,546
SITUATIONS LIKE MALPRACTICE

915
00:35:32,546 --> 00:35:35,182
SUITS, INSURANCE DENIALS,

916
00:35:35,182 --> 00:35:36,684
COLLECTION AGENCIES, MISDIRECTED

917
00:35:36,684 --> 00:35:39,987
PRIORITIES IN RESEARCH, CLINICAL

918
00:35:39,987 --> 00:35:41,288
PROGRAMS, MEDICAL EDUCATION,

919
00:35:41,288 --> 00:35:46,227
POOR COMMUNICATION AND CLINICAL

920
00:35:46,227 --> 00:35:48,929
ENCOUNTERS ALL ENSUE.

921
00:35:48,929 --> 00:35:51,165
SO, WHAT CAN WE DO?

922
00:35:51,165 --> 00:35:53,000
POLICY CHANGE CAN'T BE SUSTAINED

923
00:35:53,000 --> 00:35:57,504
WHEN ALMOST EVERY ACTOR WANTS IT

924
00:35:57,504 --> 00:35:59,473
TO FAIL.

925
00:35:59,473 --> 00:36:00,674
PHILOSOPHERS AND OTHERS,

926
00:36:00,674 --> 00:36:06,814
SOCIOLOGISTS WHO THOUGHT ABOUT

927
00:36:06,814 --> 00:36:10,217
THIS, LUKACS, KORSCH, CONTEND

928
00:36:10,217 --> 00:36:14,588
PURSUING SOCIETAL CHANGE JUST BY

929
00:36:14,588 --> 00:36:15,222
POLICY WITHOUT ADDRESSING

930
00:36:15,222 --> 00:36:16,991
CONSCIOUSNESS WILL LEAD TO

931
00:36:16,991 --> 00:36:18,292
FAILURE IN THE END.

932
00:36:18,292 --> 00:36:20,828
IN HEALTH CARE THERE ARE SO MANY

933
00:36:20,828 --> 00:36:24,999
MATERIAL GOODS AT STAKE AND

934
00:36:24,999 --> 00:36:26,533
NON-MATERIAL FACTORS THAT ALL

935
00:36:26,533 --> 00:36:29,270
GROUPS OF ACTORS ARE INCLINED TO

936
00:36:29,270 --> 00:36:31,005
BEAR THOSE ILLS WE HAVE THAN FLY

937
00:36:31,005 --> 00:36:37,912
TO OTHERS THAT WE KNOW NOT OF.

938
00:36:37,912 --> 00:36:40,114
SO, THE CHARACTERS IN THE

939
00:36:40,114 --> 00:36:42,249
PAINTING OF THE ASSASSINATION OF

940
00:36:42,249 --> 00:36:43,817
CAESAR COULD BE ALL THE ACTORS

941
00:36:43,817 --> 00:36:47,221
IN HEALTH CARE WHO SEEK TO KILL

942
00:36:47,221 --> 00:36:47,454
REFORM.

943
00:36:47,454 --> 00:36:53,794
A MODEST INTERVENTION SUCH AS

944
00:36:53,794 --> 00:36:54,561
INCENTIVIZING CASSPISA AND

945
00:36:54,561 --> 00:36:55,629
BRUTUS WOULDN'T HAVE CHANGED THE

946
00:36:55,629 --> 00:36:58,065
OUTCOME ON THE IDES OF MARCH NOR

947
00:36:58,065 --> 00:37:01,769
WILL THAT BE ENOUGH IN HEALTH

948
00:37:01,769 --> 00:37:02,036
CARE.

949
00:37:02,036 --> 00:37:03,103
MEANINGFUL CHANGE, IS IT

950
00:37:03,103 --> 00:37:03,370
POSSIBLE?

951
00:37:03,370 --> 00:37:08,876
THERE ARE SO MANY ACTORS CAUGHT

952
00:37:08,876 --> 00:37:18,085
IN THIS MAELSTROM OF

953
00:37:18,085 --> 00:37:20,721
COMMODIFICATION OF CARE.

954
00:37:20,721 --> 00:37:21,922
IT'S A DAUNTING CAST, WE CAN'T

955
00:37:21,922 --> 00:37:22,456
IGNORE CHALLENGES.

956
00:37:22,456 --> 00:37:29,129
WE NEED TO TAKE THEM ON.

957
00:37:29,129 --> 00:37:31,131
WE NEED TO THINK HOW MANY

958
00:37:31,131 --> 00:37:32,766
PROBLEMS CAN BE TAKEN ON IN

959
00:37:32,766 --> 00:37:36,270
THEIR INSTITUTIONS AND IN THEIR

960
00:37:36,270 --> 00:37:37,137
OWN BEHAVIOR.

961
00:37:37,137 --> 00:37:41,642
GOVERNMENT CAN'T COUNT ON

962
00:37:41,642 --> 00:37:46,914
MINIMALIST INCENTIVES TO CLEAR

963
00:37:46,914 --> 00:37:47,982
THE WRECKAGE, SCIENTISTS CAN'T

964
00:37:47,982 --> 00:37:49,550
BURY HEADS IN SCIENCE AND TRIALS

965
00:37:49,550 --> 00:37:50,684
IF THEY ARE COMMITTED TO

966
00:37:50,684 --> 00:37:52,486
IMPROVING THE HEALTH OF THE

967
00:37:52,486 --> 00:37:52,720
PUBLIC.

968
00:37:52,720 --> 00:37:55,556
THEY NEED TO FUND STUDIES NEEDED

969
00:37:55,556 --> 00:37:57,324
TO DEVELOP AND EVALUATE

970
00:37:57,324 --> 00:38:01,895
INTERVENTIONS THAT ADDRESS THE

971
00:38:01,895 --> 00:38:02,997
MANY PROBLEMS AND PERHAPS

972
00:38:02,997 --> 00:38:06,467
POTENTIAL STEPS THAT I'VE

973
00:38:06,467 --> 00:38:07,401
SUGGESTED TODAY.

974
00:38:07,401 --> 00:38:09,670
CHANGING POLICY WON'T BE ENOUGH.

975
00:38:09,670 --> 00:38:12,740
WE NEED TO TRANSFORM

976
00:38:12,740 --> 00:38:14,608
CONTEMPORANEOUSLY POLICY

977
00:38:14,608 --> 00:38:16,276
CONSCIOUSNESS AND COMMUNICATION,

978
00:38:16,276 --> 00:38:17,344
POWER RELATIONSHIPS, COMBINATION

979
00:38:17,344 --> 00:38:22,683
THERAPY IS NEEDED, OTHERWISE

980
00:38:22,683 --> 00:38:24,118
INNOVATIONS WHICH REPRESENT REAL

981
00:38:24,118 --> 00:38:25,786
PROGRESS ARE LIKE TREATING

982
00:38:25,786 --> 00:38:28,188
LYMPHOMA OR HIV WITH ONE DRUG,

983
00:38:28,188 --> 00:38:29,623
WILL MAKE SOME DIFFERENCE BUT

984
00:38:29,623 --> 00:38:33,427
WILL BE UNDONE BY THE UNDERLYING

985
00:38:33,427 --> 00:38:33,927
MALADY.

986
00:38:33,927 --> 00:38:35,295
IN ADDITION TO WHAT WE'VE

987
00:38:35,295 --> 00:38:37,164
DISCUSSED OTHER CHANGES ARE

988
00:38:37,164 --> 00:38:37,765
ESSENTIAL.

989
00:38:37,765 --> 00:38:39,033
EVERYONE NEEDS THE SAME

990
00:38:39,033 --> 00:38:41,335
INSURANCE, SEPARATE IS NEVER

991
00:38:41,335 --> 00:38:42,169
EQUAL.

992
00:38:42,169 --> 00:38:46,040
NEW TREATMENT SHOULD BE APPROVED

993
00:38:46,040 --> 00:38:47,007
AFTER ONLY CAREFUL ASSESSMENT

994
00:38:47,007 --> 00:38:48,108
AND COST.

995
00:38:48,108 --> 00:38:49,843
THE NATIONAL ACADEMY ALSO SHOULD

996
00:38:49,843 --> 00:38:53,480
CONVENE A PANEL TO PROPOSE A

997
00:38:53,480 --> 00:38:54,481
RADICALLY REVISED BUDGET

998
00:38:54,481 --> 00:38:57,184
PRIORITY FOR NIH THAT GIVES FAR

999
00:38:57,184 --> 00:38:59,920
MORE EMPHASIS TO POPULATION

1000
00:38:59,920 --> 00:39:00,487
HEALTH.

1001
00:39:00,487 --> 00:39:05,059
IF WE CAN'T DISBAND THE FEE FOR

1002
00:39:05,059 --> 00:39:07,561
SERVICE SYSTEM, WE SHOULD

1003
00:39:07,561 --> 00:39:09,997
DISBAND THE RUC, WHICH POISONS

1004
00:39:09,997 --> 00:39:13,367
IT AND RADICALLY REVISE THE

1005
00:39:13,367 --> 00:39:15,903
MEDICARE FEE SCHEDULE.

1006
00:39:15,903 --> 00:39:17,104
IN TERMS OF COMMUNICATION, FIND

1007
00:39:17,104 --> 00:39:19,606
A WAY TO LIMIT HEALTH SYSTEM

1008
00:39:19,606 --> 00:39:21,041
ADVERTISING TO PROMOTION OF

1009
00:39:21,041 --> 00:39:25,012
PUBLIC HEALTH, NOT THEIR PRODUCT

1010
00:39:25,012 --> 00:39:25,512
LINES.

1011
00:39:25,512 --> 00:39:28,515
STOP OVERSELLING IMPLICATIONS.

1012
00:39:28,515 --> 00:39:29,583
STOP SELLING PATIENTS WITH

1013
00:39:29,583 --> 00:39:31,218
THINGS THEY DON'T NEED.

1014
00:39:31,218 --> 00:39:33,320
PROVIDE GREATER TRANSPARENCY

1015
00:39:33,320 --> 00:39:35,155
ABOUT ALL MEDICAL DEVICES

1016
00:39:35,155 --> 00:39:36,824
INCLUDING AN INDIVIDUAL

1017
00:39:36,824 --> 00:39:37,891
DOCTOR/PATIENT ENCOUNTER AND

1018
00:39:37,891 --> 00:39:41,295
ESTABLISH MEDIA STANDARDS FOR

1019
00:39:41,295 --> 00:39:42,296
MORE BALANCED REPORTING ON

1020
00:39:42,296 --> 00:39:45,132
IMPLICATIONS OF NEW RESEARCH.

1021
00:39:45,132 --> 00:39:46,767
FINALLY, FOR PATIENTS AND PUBLIC

1022
00:39:46,767 --> 00:39:49,069
PROVIDE THE SOCIAL SERVICES AND

1023
00:39:49,069 --> 00:39:50,704
FINANCIAL AND PSYCHOLOGICAL

1024
00:39:50,704 --> 00:39:51,338
RESOURCES NEEDED TO ADDRESS

1025
00:39:51,338 --> 00:39:54,408
PROBLEMS BEST DEALT WITH IN

1026
00:39:54,408 --> 00:39:55,943
THOSE CONTEXTS, EDUCATE THE

1027
00:39:55,943 --> 00:39:58,879
PUBLIC AND PATIENTS ABOUT THE

1028
00:39:58,879 --> 00:40:00,948
C█OMMON GOOD, FAIR DISTRIBUTION

1029
00:40:00,948 --> 00:40:02,182
OF LIMITED MEDICAL RESOURCES,

1030
00:40:02,182 --> 00:40:03,650
LIMITS ON WHAT MEDICINE CAN

1031
00:40:03,650 --> 00:40:05,486
ACCOMPLISH, TRAIN CLINICIAN WHO

1032
00:40:05,486 --> 00:40:07,654
IS CAN RELATE TO DIVERSE

1033
00:40:07,654 --> 00:40:08,722
COMMUNITIES AND INCORPORATE

1034
00:40:08,722 --> 00:40:10,591
COMMUNITIES INTO ALL LEVELS OF

1035
00:40:10,591 --> 00:40:13,026
DECISION MAKING AND RESEARCH

1036
00:40:13,026 --> 00:40:15,329
EDUCATION AND CLINICAL CARE.

1037
00:40:15,329 --> 00:40:16,930
SO, SOME WOULD SAY YOU CAN'T

1038
00:40:16,930 --> 00:40:19,032
SOLVE THIS IN HEALTH CARE ALONE.

1039
00:40:19,032 --> 00:40:20,234
I AGREE.

1040
00:40:20,234 --> 00:40:22,536
ACTORS IN HEALTH CARE WON'T

1041
00:40:22,536 --> 00:40:28,242
UNILATERALLY DISARM IN TERMS OF

1042
00:40:28,242 --> 00:40:36,416
COMMON  -- COMMON FUNDED.

1043
00:40:36,416 --> 00:40:42,122
WE MUST ACT IN PROFESSIONAL

1044
00:40:42,122 --> 00:40:44,391
CAPACITIES AS CITIZENS TO

1045
00:40:44,391 --> 00:40:46,393
PROMOTE CHANGES.

1046
00:40:46,393 --> 00:40:48,228
SILENCE IS ASSENT, AS WAS

1047
00:40:48,228 --> 00:40:48,662
WRITTEN.

1048
00:40:48,662 --> 00:40:52,599
SO, WHAT NEEDS TO HAPPEN IS THAT

1049
00:40:52,599 --> 00:40:54,234
EVERY ORGANIZATION INCLUDING

1050
00:40:54,234 --> 00:40:54,935
INVOLVED IN MEDICAL EDUCATION

1051
00:40:54,935 --> 00:40:56,336
RESEARCH AND PRACTICE NEEDS TO

1052
00:40:56,336 --> 00:40:58,205
ADDRESS THESE PROBLEMS WITH

1053
00:40:58,205 --> 00:41:00,507
UTMOST URGENCY IN THEIR OWN

1054
00:41:00,507 --> 00:41:03,777
ACTIVITIES IN BROADER SOCIETY,

1055
00:41:03,777 --> 00:41:04,878
CHANGE CONSCIOUSNESS, TRANSFORM

1056
00:41:04,878 --> 00:41:05,746
DISCOURSE, PURSUE A CONSENSUS

1057
00:41:05,746 --> 00:41:08,081
WE'RE IN THE SAME BOAT, AND

1058
00:41:08,081 --> 00:41:10,884
PRODUCE THE EVIDENCE NEEDED TO

1059
00:41:10,884 --> 00:41:12,986
OPTIMIZE POPULATION HEALTH.

1060
00:41:12,986 --> 00:41:14,955
WE SURELY SHOULDN'T GIVE UP WITH

1061
00:41:14,955 --> 00:41:19,459
EACH FAILED EFFORT AT REFORM.

1062
00:41:19,459 --> 00:41:20,527
TWO MILLENNIAL AGO IT WAS

1063
00:41:20,527 --> 00:41:21,728
WRITTEN IT'S NOT YOUR DUTY TO

1064
00:41:21,728 --> 00:41:23,263
FINISH THE WORK BUT NEITHER ARE

1065
00:41:23,263 --> 00:41:26,466
YOU AT LIBERTY TO NEGLECT IT.

1066
00:41:26,466 --> 00:41:28,635
WE DIDN'T TALK ABOUT ALL THESE

1067
00:41:28,635 --> 00:41:29,369
BALLOONS TODAY.

1068
00:41:29,369 --> 00:41:32,239
BUT THERE IS A LOT WE NEED TO

1069
00:41:32,239 --> 00:41:32,673
DO.

1070
00:41:32,673 --> 00:41:35,409
THANK YOU VERY MUCH.

1071
00:41:35,409 --> 00:41:41,448
 

1072
00:41:41,448 --> 00:41:43,417
 

1073
00:41:43,417 --> 00:41:47,354
>> THANK YOU, MARTIN.

1074
00:41:47,354 --> 00:41:50,624
I'M GOING TO REACT AND PASS TO

1075
00:41:50,624 --> 00:41:55,362
EITHER KATRINA OR MONICA TO HAVE

1076
00:41:55,362 --> 00:41:55,862
COMMENTS.

1077
00:41:55,862 --> 00:41:59,299
SO, YOU PRESENT A RATHER I WOULD

1078
00:41:59,299 --> 00:42:02,069
SAY PESSIMISTIC VIEW OF WHERE WE

1079
00:42:02,069 --> 00:42:04,037
ARE, MAYBE THAT'S NOT YOUR

1080
00:42:04,037 --> 00:42:05,906
INTENT BUT THAT'S CERTAINLY THE

1081
00:42:05,906 --> 00:42:07,407
MESSAGE I HEAR.

1082
00:42:07,407 --> 00:42:10,477
YOU KNOW, A LOT OF WHAT YOU

1083
00:42:10,477 --> 00:42:13,013
COMMENTED ON, YOU KNOW,

1084
00:42:13,013 --> 00:42:14,648
RESONATES WITH MY OWN VIEWS, AS

1085
00:42:14,648 --> 00:42:16,283
TO WHERE WE ARE.

1086
00:42:16,283 --> 00:42:18,452
BUT IT MAKES IT ALMOST SO

1087
00:42:18,452 --> 00:42:19,920
DAUNTING THAT YOU SAY, WELL,

1088
00:42:19,920 --> 00:42:21,221
WHERE DO WE START?

1089
00:42:21,221 --> 00:42:22,856
WHAT DO WE DO?

1090
00:42:22,856 --> 00:42:25,259
I MEAN, ONE OPTION IS TO, YOU

1091
00:42:25,259 --> 00:42:27,094
KNOW, QUOTE/UNQUOTE BLOW

1092
00:42:27,094 --> 00:42:28,528
EVERYTHING UP AND START OVER BUT

1093
00:42:28,528 --> 00:42:31,164
THAT WE KNOW IS NOT VERY

1094
00:42:31,164 --> 00:42:31,665
PRACTICAL.

1095
00:42:31,665 --> 00:42:34,668
SO, YOU KNOW, WHERE DO WE GET

1096
00:42:34,668 --> 00:42:36,103
STARTED WITH INCREMENTAL CHANGE?

1097
00:42:36,103 --> 00:42:37,838
>> WELL, YOU KNOW, I THINK
ALL

1098
00:42:37,838 --> 00:42:40,607
OF THESE THINGS NEED TO HAPPEN.

1099
00:42:40,607 --> 00:42:42,242
AND THERE'S NO ONE ENTITY OR

1100
00:42:42,242 --> 00:42:43,310
INDIVIDUAL WHO CAN WORK ON ALL

1101
00:42:43,310 --> 00:42:45,946
OF THEM.

1102
00:42:45,946 --> 00:42:48,782
BUT WE NEED TO RECOGNIZE THEM

1103
00:42:48,782 --> 00:42:49,883
ALL.

1104
00:42:49,883 --> 00:42:56,023
MY VERY FIRST SLIDE, I QUOTED

1105
00:42:56,023 --> 00:42:57,357
MAX WHO SAID THAT THE

1106
00:42:57,357 --> 00:42:59,426
DENUNCIATION OF EVERYTHING THAT

1107
00:42:59,426 --> 00:43:02,262
MUTILATES MANKIND AND IMPEDES

1108
00:43:02,262 --> 00:43:03,130
ITS PRE-DEVELOPMENT RESTS ON

1109
00:43:03,130 --> 00:43:04,464
CONFIDENCE IN MAN.

1110
00:43:04,464 --> 00:43:07,634
I WOULD HOLD THAT LAYING ALL OF

1111
00:43:07,634 --> 00:43:11,038
THIS OUT, ALTHOUGH, YES, IT'S A

1112
00:43:11,038 --> 00:43:14,541
LOT OF STUFF, IS AN OPTIMISTIC

1113
00:43:14,541 --> 00:43:15,842
VIEW BECAUSE WHY WOULD WE DO

1114
00:43:15,842 --> 00:43:23,817
THAT IF WE DIDN'T THINK WE COULD

1115
00:43:23,817 --> 00:43:24,418
SOLVE PROBLEMS?

1116
00:43:24,418 --> 00:43:27,888
SO, WHERE WOULD WE START?

1117
00:43:27,888 --> 00:43:29,056
I THINK INSURING EVERYONE AND

1118
00:43:29,056 --> 00:43:31,792
GIVING THE SAME INSURANCE IS ONE

1119
00:43:31,792 --> 00:43:32,059
ITEM.

1120
00:43:32,059 --> 00:43:33,560
CHANGING MEDICAL EDUCATION BOTH

1121
00:43:33,560 --> 00:43:35,429
BY CHANGING WHOM WE SELECT INTO

1122
00:43:35,429 --> 00:43:38,432
MEDICAL SCHOOL AND WHAT GOES ON

1123
00:43:38,432 --> 00:43:39,666
IN MEDICAL SCHOOL WOULD BE

1124
00:43:39,666 --> 00:43:42,436
ANOTHER KEY THING TO DO.

1125
00:43:42,436 --> 00:43:44,104
AND CHANGE THE INCENTIVES AND

1126
00:43:44,104 --> 00:43:44,438
PRACTICE.

1127
00:43:44,438 --> 00:43:46,373
AS I SUGGESTED, PAYING DOCTORS

1128
00:43:46,373 --> 00:43:48,241
FOR THEIR TIME AND PAYING PEOPLE

1129
00:43:48,241 --> 00:43:50,010
ONLY A LITTLE BIT MORE IF THEY

1130
00:43:50,010 --> 00:43:52,045
HAVE TAKEN AN EXTRA YEAR OR TWO

1131
00:43:52,045 --> 00:43:52,779
OF TRAINING.

1132
00:43:52,779 --> 00:43:59,453
ALL OF WHOM WOULD BE QUITE

1133
00:43:59,453 --> 00:43:59,786
HELPFUL.

1134
00:43:59,786 --> 00:44:05,559
AND I THINK THAT WOULD BE A GOOD

1135
00:44:05,559 --> 00:44:07,361
STARTING TRIPLE REGIMEN.

1136
00:44:07,361 --> 00:44:08,195
>> ALL RIGHT.

1137
00:44:08,195 --> 00:44:10,063
THREE AREAS AT LEAST.

1138
00:44:10,063 --> 00:44:11,965
KATRINA, DO YOU HAVE --

1139
00:44:11,965 --> 00:44:14,534
>> YES, THANK YOU SO MUCH
FOR

1140
00:44:14,534 --> 00:44:17,170
THIS PRESENTATION.

1141
00:44:17,170 --> 00:44:19,139
IT'S ABSOLUTELY FANTASTIC.

1142
00:44:19,139 --> 00:44:22,209
AND I THINK WE'RE SPEAKING TO AN

1143
00:44:22,209 --> 00:44:24,511
AUDIENCE OF PEOPLE AT NIH TODAY,

1144
00:44:24,511 --> 00:44:26,947
AND SO I'D REALLY BE INTERESTED

1145
00:44:26,947 --> 00:44:30,784
IN DIVING A BIT DEEPER INTO SOME

1146
00:44:30,784 --> 00:44:36,056
OF THE CHALLENGES THAT YOU THINK

1147
00:44:36,056 --> 00:44:37,124
SPECIFICALLY HOW SCIENTISTS ARE

1148
00:44:37,124 --> 00:44:37,991
CONTRIBUTING TO THESE PROBLEMS

1149
00:44:37,991 --> 00:44:40,761
AND WHAT WE CAN DO AT NIH.

1150
00:44:40,761 --> 00:44:45,899
AND YOU HAVE A CHAPTER IN YOUR

1151
00:44:45,899 --> 00:44:48,101
BOOK ABOUT SCIENTISTS AND OUR

1152
00:44:48,101 --> 00:44:49,703
CONTRIBUTIONS TO THE PROBLEMS.

1153
00:44:49,703 --> 00:44:55,041
AND SOME OF THE THINGS THAT YOU

1154
00:44:55,041 --> 00:45:00,447
MENTIONED ARE BIASES IN PEER 

1155
00:45:00,447 --> 00:45:02,082
REVIEW, LOBBYING, OVERSTATEMENT

1156
00:45:02,082 --> 00:45:05,819
OF THE BENEFITS OF OUR RESEARCH

1157
00:45:05,819 --> 00:45:09,122
THAT WE OFTEN SELECT RESEARCH

1158
00:45:09,122 --> 00:45:12,392
THAT HAS MARGINAL OR INCREMENTAL

1159
00:45:12,392 --> 00:45:20,267
ADVANCES VERSUS HIGH RISK

1160
00:45:20,267 --> 00:45:20,767
ADVANCES.

1161
00:45:20,767 --> 00:45:25,439
AND REALLY WAYS THAT WE

1162
00:45:25,439 --> 00:45:25,972
PRIORITIZE BIOLOGICAL

1163
00:45:25,972 --> 00:45:29,910
REDUCTIONISM AND KINDS OF

1164
00:45:29,910 --> 00:45:32,979
RESEARCH AND HOW WE SELECT

1165
00:45:32,979 --> 00:45:35,182
RESEARCH TOPICS WERE SOME AREAS

1166
00:45:35,182 --> 00:45:37,284
WAY WE CONTRIBUTE AS RESEARCHERS

1167
00:45:37,284 --> 00:45:38,218
AND SCIENTISTS AT NIH.

1168
00:45:38,218 --> 00:45:40,887
I'D LIKE TO HEAR MORE YOUR

1169
00:45:40,887 --> 00:45:42,823
THOUGHTS ON WHAT CAN WE BE DOING

1170
00:45:42,823 --> 00:45:46,026
FROM OUR NECK OF THE WOODS.

1171
00:45:46,026 --> 00:45:48,228
>> WELL, AS I IMPLIED AT
ONE

1172
00:45:48,228 --> 00:45:50,096
POINT IN MY TALK, I THINK THAT

1173
00:45:50,096 --> 00:45:52,199
THE IDEAS THAT WE HAVE ON HOW WE

1174
00:45:52,199 --> 00:45:55,101
FIX THINGS ALL NEED TO BE

1175
00:45:55,101 --> 00:45:55,368
EVALUATED.

1176
00:45:55,368 --> 00:45:59,172
AND THE NIH SHOULD BE INVESTING

1177
00:45:59,172 --> 00:46:01,975
SERIOUSLY IN -- CERTAINLY I MEAN

1178
00:46:01,975 --> 00:46:04,744
IN I THINK THE NIH ISN'T OFTEN

1179
00:46:04,744 --> 00:46:06,279
INTERESTED IN STUDYING MEDICAL

1180
00:46:06,279 --> 00:46:07,214
EDUCATION BUT MEDICAL EDUCATION

1181
00:46:07,214 --> 00:46:09,649
IS ONE OF THE POISONS IN THE

1182
00:46:09,649 --> 00:46:11,518
WATERS OF HEALTH CARE IN

1183
00:46:11,518 --> 00:46:12,052
AMERICA.

1184
00:46:12,052 --> 00:46:13,487
AND NEEDS TO BE STUDIED AND

1185
00:46:13,487 --> 00:46:16,990
ADDRESSED AND IMPROVED AND

1186
00:46:16,990 --> 00:46:17,390
CHANGED.

1187
00:46:17,390 --> 00:46:19,593
A LOT OF OTHER ISSUES THAT I'VE

1188
00:46:19,593 --> 00:46:20,360
TALKED ABOUT SIMILARLY.

1189
00:46:20,360 --> 00:46:23,763
BUT WHEN YOU THINK ABOUT WHAT

1190
00:46:23,763 --> 00:46:25,298
THE NIH INVESTS IN, FORMER

1191
00:46:25,298 --> 00:46:28,034
DIRECTOR OF NIH JUST WRITING

1192
00:46:28,034 --> 00:46:29,236
THIS PAST WEEKEND IN THE

1193
00:46:29,236 --> 00:46:34,541
"WASHINGTON POST" I THINK WROTE

1194
00:46:34,541 --> 00:46:36,409
ABOUT HEPATITIS C, WROTE THAT

1195
00:46:36,409 --> 00:46:38,044
THE CORRECT NUMBER OF DEATHS

1196
00:46:38,044 --> 00:46:39,446
FROM HEPATITIS C IN A YEAR IN

1197
00:46:39,446 --> 00:46:43,183
THE U.S. RIGHT NOW SHOULD BE

1198
00:46:43,183 --> 00:46:43,483
ZERO.

1199
00:46:43,483 --> 00:46:44,818
YOU KNOW, BUT THERE ISN'T A

1200
00:46:44,818 --> 00:46:49,623
SYSTEM IN PLACE TO GET US THERE

1201
00:46:49,623 --> 00:46:50,690
WITH UNDOING ONE PROJECT, YOU

1202
00:46:50,690 --> 00:46:52,692
KNOW, THERE ARE A FEW OTHER

1203
00:46:52,692 --> 00:46:53,793
PROJECTS WHERE PEOPLE ARE

1204
00:46:53,793 --> 00:46:54,761
LOOKING AT ACCESS AND

1205
00:46:54,761 --> 00:46:57,397
DISPARITIES AND WHAT DO YOU DO

1206
00:46:57,397 --> 00:46:58,865
AND SO ON IN THIS DISEASE.

1207
00:46:58,865 --> 00:47:05,805
BUT IF -- YOU KNOW, IF 16,000

1208
00:47:05,805 --> 00:47:07,474
PEOPLE WERE DYING FROM A

1209
00:47:07,474 --> 00:47:08,108
TERRORIST ATTACK, YOU KNOW,

1210
00:47:08,108 --> 00:47:09,543
THERE WOULD BE A LOT THAT WOULD

1211
00:47:09,543 --> 00:47:11,611
HAPPEN TO TRY TO MAKE SURE THAT

1212
00:47:11,611 --> 00:47:13,813
DOESN'T HAPPEN AGAIN.

1213
00:47:13,813 --> 00:47:16,349
BUT IN MY CAREER, MY FIRST

1214
00:47:16,349 --> 00:47:19,519
PROJECT IN MONTREAL WAS STUDY OF

1215
00:47:19,519 --> 00:47:20,420
PROBLEMS IN CONTROLLING

1216
00:47:20,420 --> 00:47:22,155
HYPERTENSION IN THE COMMUNITY.

1217
00:47:22,155 --> 00:47:25,025
THEN I SPENT A LOT OF MY CAREER

1218
00:47:25,025 --> 00:47:26,326
STUDYING HIV AND ITS CARE.

1219
00:47:26,326 --> 00:47:27,427
WE HAVE TREATMENTS THAT CAN

1220
00:47:27,427 --> 00:47:30,363
ALLOW PEOPLE TO LIVE A NORMAL

1221
00:47:30,363 --> 00:47:32,098
LIFE WITH HIV BUT THERE'S STILL

1222
00:47:32,098 --> 00:47:33,767
15,000 A PEOPLE YEAR DYING FROM

1223
00:47:33,767 --> 00:47:38,572
HIV IN THE UNITED STATES.

1224
00:47:38,572 --> 00:47:43,843
WHY ISN'T THE NIH INVESTING SOME

1225
00:47:43,843 --> 00:47:45,912
OF -- MUCH MORE OF ITS $50

1226
00:47:45,912 --> 00:47:47,414
BILLION LOOKING AT THESE

1227
00:47:47,414 --> 00:47:49,149
DISORDERS AND THESE POPULATIONS

1228
00:47:49,149 --> 00:47:51,585
AND THESE PROBLEMS, AND THEN THE

1229
00:47:51,585 --> 00:47:53,553
UPSTREAM STUFF THAT LEADS TO

1230
00:47:53,553 --> 00:47:54,020
THAT.

1231
00:47:54,020 --> 00:47:55,422
IT'S NOT ENOUGH TO SAY, WELL,

1232
00:47:55,422 --> 00:47:57,490
LET'S DEVELOP A BETTER DRUG.

1233
00:47:57,490 --> 00:47:57,924
YEAH, SURE.

1234
00:47:57,924 --> 00:47:59,459
SOMETIMES IT'S GOOD TO HAVE A

1235
00:47:59,459 --> 00:48:00,327
BETTER DRUG.

1236
00:48:00,327 --> 00:48:01,528
MAYBE IT'S GOOD IF SOMEONE CAN

1237
00:48:01,528 --> 00:48:06,132
TAKE AN INJECTION INSTEAD OF

1238
00:48:06,132 --> 00:48:10,937
GETTING A PILL EVERY DAY.

1239
00:48:10,937 --> 00:48:16,843
BUT THERE IS SO MUCH NEGLECT OF

1240
00:48:16,843 --> 00:48:18,278
POPULATION HEALTH.

1241
00:48:18,278 --> 00:48:19,913
I REALLY THINK THE PRIORITIES,

1242
00:48:19,913 --> 00:48:23,016
SURE, WE NEED BASIC SCIENCE, WE

1243
00:48:23,016 --> 00:48:24,184
NEED TO DEVELOP VACCINES AND,

1244
00:48:24,184 --> 00:48:26,586
YES, IT'S GREAT TO HAVE DRUGS

1245
00:48:26,586 --> 00:48:28,254
THAT ARE GOING TO GIVE PEOPLE

1246
00:48:28,254 --> 00:48:32,092
ANOTHER TWO OR THREE MONTHS OF

1247
00:48:32,092 --> 00:48:34,794
DISEASE-FREE SURVIVAL, YOU KNOW,

1248
00:48:34,794 --> 00:48:36,296
WITH THEIR LUNG CANCER, AS

1249
00:48:36,296 --> 00:48:38,098
REPORTED IN THE NEW ENGLAND

1250
00:48:38,098 --> 00:48:39,399
JOURNAL THIS WEEK.

1251
00:48:39,399 --> 00:48:41,267
BUT THERE'S SO MUCH MORE THAT WE

1252
00:48:41,267 --> 00:48:42,469
NEED TO DO.

1253
00:48:42,469 --> 00:48:45,171
THERE'S SO MANY PEOPLE THAT ARE

1254
00:48:45,171 --> 00:48:46,306
DYING EARLY.

1255
00:48:46,306 --> 00:48:48,274
IT IS A CATASTROPHE.

1256
00:48:48,274 --> 00:48:51,211
YEARS AGO, I REMEMBER READING AN

1257
00:48:51,211 --> 00:48:53,313
ARTICLE ABOUT DECLINE OF LIFE

1258
00:48:53,313 --> 00:48:55,281
EXPECTANCY IN THE SOVIET UNION,

1259
00:48:55,281 --> 00:48:56,049
IN THE 1980s.

1260
00:48:56,049 --> 00:48:59,019
I SAW THAT AND SAID MY GOD, HOW

1261
00:48:59,019 --> 00:49:02,522
CAN THAT COUNTRY SURVIVE?

1262
00:49:02,522 --> 00:49:05,458
WELL, THIS IS A FIVE-ALARM FIRE.

1263
00:49:05,458 --> 00:49:08,928
LIFE EXPECTANCY IS DECLINING,

1264
00:49:08,928 --> 00:49:10,196
PEOPLE ARE DYING OF DISEASES

1265
00:49:10,196 --> 00:49:11,598
THEY SHOULDN'T DIE OF.

1266
00:49:11,598 --> 00:49:13,233
PEOPLE ARE GOING INTO MEDICAL

1267
00:49:13,233 --> 00:49:14,534
SCHOOL, 10% OF STUDENTS IN THE

1268
00:49:14,534 --> 00:49:16,870
FIRST YEAR OF CLASS HAVE ALREADY

1269
00:49:16,870 --> 00:49:18,038
SELECTED ORTHOPEDIC SURGERY NOT

1270
00:49:18,038 --> 00:49:19,372
BECAUSE OF LOVE OF BONES, THEY

1271
00:49:19,372 --> 00:49:21,007
MIGHT TELL YOU THAT'S WHY THEY

1272
00:49:21,007 --> 00:49:22,442
ARE DOING IT, BUT BECAUSE THEY

1273
00:49:22,442 --> 00:49:26,446
CAN MAKE SO MUCH MONEY DOING IT.

1274
00:49:26,446 --> 00:49:30,617
OUR MEDICAL STUDENTS, SOME ARE

1275
00:49:30,617 --> 00:49:31,384
VERY IDEALISTIC.

1276
00:49:31,384 --> 00:49:34,020
WHEN YOU GET A COMMUNICATION

1277
00:49:34,020 --> 00:49:36,423
LETTER A LOT HAVE A SIGNATURE

1278
00:49:36,423 --> 00:49:37,524
BLOCK THAT LISTS PREFERRED

1279
00:49:37,524 --> 00:49:40,927
PRONOUNCE, WHICH IS GREAT, AN

1280
00:49:40,927 --> 00:49:41,995
ACKNOWLEDGMENT OF DIVERSITY.

1281
00:49:41,995 --> 00:49:45,098
BUT SOME YEARS FROM NOW, THEY

1282
00:49:45,098 --> 00:49:47,701
WILL HAVE -- MAY STILL HAVE

1283
00:49:47,701 --> 00:49:49,569
PLEASED PRONOUNS BUT WILL HAVE

1284
00:49:49,569 --> 00:49:51,471
PREFER INSURANCE AND IT WON'T BE

1285
00:49:51,471 --> 00:49:53,173
THE INSURANCE 90 MILLION

1286
00:49:53,173 --> 00:49:54,140
AMERICANS HAVE, MEDICAID.

1287
00:49:54,140 --> 00:49:57,677
WE GOT TO SOLVE THESE PROBLEMS.

1288
00:49:57,677 --> 00:50:03,883
THE NIH SHOULD GO ALL IN WITH

1289
00:50:03,883 --> 00:50:04,851
POPULATION HEALTH.

1290
00:50:04,851 --> 00:50:10,590
SOMETIMES WHEN I GIVE TALKS

1291
00:50:10,590 --> 00:50:12,692
PURSUANT TO MY BOOK, I QUOTE

1292
00:50:12,692 --> 00:50:14,227
JOHN DUNN.

1293
00:50:14,227 --> 00:50:15,762
ANY MAN'S DEATH DIMINISHES ME

1294
00:50:15,762 --> 00:50:17,897
BECAUSE I'M INVOLVED IN MANKIND.

1295
00:50:17,897 --> 00:50:20,233
THAT SHOULD BE THE MANTRA OF THE

1296
00:50:20,233 --> 00:50:20,433
NIH.

1297
00:50:20,433 --> 00:50:23,536
ANY MAN'S DEATH, ANY PERSON'S

1298
00:50:23,536 --> 00:50:25,505
DEATH, ANY PERSON'S DEATH.

1299
00:50:25,505 --> 00:50:26,406
AND THEY SHOULD INVEST ACCORDING

1300
00:50:26,406 --> 00:50:28,875
TO WHAT'S GOING TO DO THE MOST

1301
00:50:28,875 --> 00:50:31,978
TO PREVENT THOSE DEATHS THAT CAN

1302
00:50:31,978 --> 00:50:35,682
BE PREVENTED.

1303
00:50:35,682 --> 00:50:36,216
 

1304
00:50:36,216 --> 00:50:38,952
>> ELISEO, YOU'RE ON MUTE.

1305
00:50:38,952 --> 00:50:41,287
>> I WANT TO TURN TO A
QUESTION

1306
00:50:41,287 --> 00:50:42,822
IN THE CHAT.

1307
00:50:42,822 --> 00:50:44,023
ALTHOUGH I DO THINK THERE'S MORE

1308
00:50:44,023 --> 00:50:46,092
BEING DONE AT THE NIH THAN YOU

1309
00:50:46,092 --> 00:50:47,327
GIVE US CREDIT FOR, MARTIN,

1310
00:50:47,327 --> 00:50:51,331
WE'LL COME BACK TO THAT.

1311
00:50:51,331 --> 00:50:52,732
REGARDING YOUR PROPOSAL FOR

1312
00:50:52,732 --> 00:50:53,867
MEDICAL SCHOOL ADMISSIONS HOW DO

1313
00:50:53,867 --> 00:50:55,835
YOU SCREEN FOR THINGS LIKE

1314
00:50:55,835 --> 00:50:57,137
MORALS, ETHICS, SOCIAL

1315
00:50:57,137 --> 00:50:58,238
RESPONSIBILITY AND ALTRUISM AND

1316
00:50:58,238 --> 00:51:01,074
HOW DO YOU ENSURE THAT

1317
00:51:01,074 --> 00:51:02,842
APPLICANTS ACTUALLY BELIEVE IN

1318
00:51:02,842 --> 00:51:04,577
THESE THINGS, IN THESE VALUES,

1319
00:51:04,577 --> 00:51:06,446
RATHER THAN SIMPLY LEARNING THE

1320
00:51:06,446 --> 00:51:08,848
CORRECT THING TO SAY OR TREATING

1321
00:51:08,848 --> 00:51:11,351
THEM LIKE, YOU KNOW, BOX

1322
00:51:11,351 --> 00:51:12,786
CHECKING EXERCISE FOR THE

1323
00:51:12,786 --> 00:51:14,120
PURPOSE OF THEIR APPLICATION?

1324
00:51:14,120 --> 00:51:15,622
SEEMS LIKE THERE'S A RISK THAT

1325
00:51:15,622 --> 00:51:17,590
THOSE WHO ALREADY HAVE THE LEG

1326
00:51:17,590 --> 00:51:19,259
UP COULD JUST ADAPT BUT NOT

1327
00:51:19,259 --> 00:51:21,694
TRULY GROW AND FIX THE PROBLEM.

1328
00:51:21,694 --> 00:51:25,698
>> I WOULD AGREE BUT
SOCIAL

1329
00:51:25,698 --> 00:51:27,867
PSYCHOLOGISTS SPEND THEIR

1330
00:51:27,867 --> 00:51:30,537
CAREERS DEVELOPING MEASURES OF

1331
00:51:30,537 --> 00:51:31,037
THINGS LIKE THIS.

1332
00:51:31,037 --> 00:51:33,006
OF COURSE THEY HAVE TO BE TESTED

1333
00:51:33,006 --> 00:51:34,174
FOR THESE PURPOSES.

1334
00:51:34,174 --> 00:51:37,310
BUT WE INVEST A LOT IN PEOPLE

1335
00:51:37,310 --> 00:51:38,711
DEVELOPING MEASURES OF QUALITY

1336
00:51:38,711 --> 00:51:40,380
OF LIFE, THIS, THAT, AND THE

1337
00:51:40,380 --> 00:51:41,014
OTHER.

1338
00:51:41,014 --> 00:51:46,953
WHY NOT INVEST IN DEVELOPING 

1339
00:51:46,953 --> 00:51:48,488
RELIABLE WAYS OF MEASURING OR

1340
00:51:48,488 --> 00:51:50,023
DETECTING THE VALUES OF PEOPLE?

1341
00:51:50,023 --> 00:51:51,758
NOW, MEMBERS OF THEIR

1342
00:51:51,758 --> 00:51:52,392
COMMUNITIES, I SUGGESTED

1343
00:51:52,392 --> 00:51:55,028
COMMUNITY MEMBERS SHOULD BE ABLE

1344
00:51:55,028 --> 00:51:56,229
TO NOMINATE.

1345
00:51:56,229 --> 00:51:57,764
THAT COULD GET POLITICIZED TOO

1346
00:51:57,764 --> 00:51:58,631
AND COULD GET DISTORTED.

1347
00:51:58,631 --> 00:52:03,469
THEY WOULD HAVE TO THINK ABOUT 

1348
00:52:03,469 --> 00:52:06,105
HOW TO NOT HAVE THAT HAPPEN.

1349
00:52:06,105 --> 00:52:07,841
WHAT HAPPENS WHEN PEOPLE COME DO

1350
00:52:07,841 --> 00:52:08,608
MEDICAL SCHOOL, THE ETHOS IS NOT

1351
00:52:08,608 --> 00:52:10,376
WHAT IT SHOULD BE.

1352
00:52:10,376 --> 00:52:17,584
I TALKED ABOUT THE WHITE COAT

1353
00:52:17,584 --> 00:52:18,685
CEREMONY, CELEBRATING WITH

1354
00:52:18,685 --> 00:52:20,019
FAMILIES, REFERENCE TO ETHICAL

1355
00:52:20,019 --> 00:52:23,723
RESPONSIBILITY, MIGHT BE BETTER 

1356
00:52:23,723 --> 00:52:28,995
TO DO WHAT POPE FRANCIS DID ON

1357
00:52:28,995 --> 00:52:30,096
HIS FIRST DAY, WASHING THE FEET

1358
00:52:30,096 --> 00:52:31,431
OF THE POOR REMINDER WHAT HE WAS

1359
00:52:31,431 --> 00:52:33,299
SUPPOSED TO BE ABOUT.

1360
00:52:33,299 --> 00:52:34,901
NOW, THERE COULD BE ANALOGOUS

1361
00:52:34,901 --> 00:52:41,474
THINGS THAT ONE CAN DO.

1362
00:52:41,474 --> 00:52:43,243
AND I THINK WE COULD GET THERE.

1363
00:52:43,243 --> 00:52:45,979
I THINK WE COULD GET THERE.

1364
00:52:45,979 --> 00:52:49,782
BUT, YOU KNOW, DANIEL MARKOWITZ

1365
00:52:49,782 --> 00:52:52,518
WROTE A GREAT BOOK ON

1366
00:52:52,518 --> 00:52:54,587
MERITOCRACY, BASICALLY THE

1367
00:52:54,587 --> 00:52:57,457
CURRENT PATTERN OF SELECTION

1368
00:52:57,457 --> 00:52:58,324
JUST PROVIDES MORE EQUITY TO

1369
00:52:58,324 --> 00:52:59,626
THOSE PEOPLE AND THEIR FAMILIES

1370
00:52:59,626 --> 00:53:02,495
WHO ALREADY HAVE LOTS OF IT.

1371
00:53:02,495 --> 00:53:05,298
>> ALL RIGHT. 

1372
00:53:05,298 --> 00:53:05,865
MONICA, ARE YOU ON?

1373
00:53:05,865 --> 00:53:07,967
DO YOU HAVE A COMMENT OR

1374
00:53:07,967 --> 00:53:09,602
QUESTION FOR MARTIN?

1375
00:53:09,602 --> 00:53:11,004
>> I AM.

1376
00:53:11,004 --> 00:53:11,237
HI.

1377
00:53:11,237 --> 00:53:13,873
THANK YOU, ELISEO.

1378
00:53:13,873 --> 00:53:14,741
I DO.

1379
00:53:14,741 --> 00:53:16,276
I APPRECIATE THE THINGS YOU

1380
00:53:16,276 --> 00:53:18,111
BRING TO THE TABLE IN YOUR

1381
00:53:18,111 --> 00:53:20,313
DISCUSSION BECAUSE IT'S VERY

1382
00:53:20,313 --> 00:53:21,748
THOUGHT PROVOKING.

1383
00:53:21,748 --> 00:53:23,917
I THINK MANY PEOPLE HAVE TALKED

1384
00:53:23,917 --> 00:53:25,885
ABOUT THIS TO SOME DEGREE.

1385
00:53:25,885 --> 00:53:28,955
YOU BRING IT TOGETHER IN

1386
00:53:28,955 --> 00:53:31,124
INTERESTING AND, YEAH, THOUGHT

1387
00:53:31,124 --> 00:53:31,491
PROVOKING WAYS.

1388
00:53:31,491 --> 00:53:33,226
MY QUESTION, SOME PEOPLE REFER

1389
00:53:33,226 --> 00:53:34,761
TO THE U.S. HEALTH CARE SYSTEM

1390
00:53:34,761 --> 00:53:37,063
AS REALLY MORE OF A SICK CARE

1391
00:53:37,063 --> 00:53:39,032
SYSTEM VERSUS HEALTH CARE.

1392
00:53:39,032 --> 00:53:40,033
YOU KNOW, IT'S INCREASINGLY

1393
00:53:40,033 --> 00:53:42,201
DIFFICULT TO GET AN APPOINTMENT

1394
00:53:42,201 --> 00:53:43,836
TO SEE YOUR DOCTOR FOR MONTHS

1395
00:53:43,836 --> 00:53:45,805
SOMETIMES AND AS YOU SAID, TIME

1396
00:53:45,805 --> 00:53:47,874
WITH CLINICIANS IS JUST VERY

1397
00:53:47,874 --> 00:53:48,675
LIMITED.

1398
00:53:48,675 --> 00:53:50,843
I THINK OTHER THINGS,

1399
00:53:50,843 --> 00:53:51,511
PREVENTION, MENTAL AND

1400
00:53:51,511 --> 00:53:54,681
BEHAVIORAL HEALTH ARE JUST NOT

1401
00:53:54,681 --> 00:53:56,182
PRIORITIZED IN FAVOR OF THE

1402
00:53:56,182 --> 00:53:57,750
BIOMEDICAL MODEL.

1403
00:53:57,750 --> 00:53:59,585
AND RESEARCH HAS SHOWN THAT

1404
00:53:59,585 --> 00:54:01,020
ATTENTION TO THESE ASPECTS OF

1405
00:54:01,020 --> 00:54:03,756
HEALTH ARE NOT ONLY CRITICAL FOR

1406
00:54:03,756 --> 00:54:05,158
REDUCING PREVENTIBLE DEATH AND

1407
00:54:05,158 --> 00:54:07,460
DISEASE BUT ALSO REALLY COST

1408
00:54:07,460 --> 00:54:08,461
EFFECTIVE.

1409
00:54:08,461 --> 00:54:09,329
SO FROM YOUR EXPERIENCE, WHAT

1410
00:54:09,329 --> 00:54:12,398
ARE SOME OF THE MOST EFFECTIVE

1411
00:54:12,398 --> 00:54:14,167
STRATEGIES TO BRIDGE THE GAP

1412
00:54:14,167 --> 00:54:16,235
BETWEEN RESEARCH FINDINGS AND

1413
00:54:16,235 --> 00:54:17,870
THEIR IMPLEMENTATION IN CLINICAL

1414
00:54:17,870 --> 00:54:19,305
PRACTICE FOR THESE AND OTHER

1415
00:54:19,305 --> 00:54:21,708
CLINICAL PRACTICE KINDS OF

1416
00:54:21,708 --> 00:54:21,941
ISSUES?

1417
00:54:21,941 --> 00:54:28,514
>> WELL, I'M NOT A GREAT

1418
00:54:28,514 --> 00:54:29,248
IMPLEMENTATION SCIENTIST.

1419
00:54:29,248 --> 00:54:31,217
I WOULD DEFER TO OTHERS.

1420
00:54:31,217 --> 00:54:32,652
BUT I THINK INVESTING IN LOTS OF

1421
00:54:32,652 --> 00:54:35,722
EFFORTS TO FIGURE OUT HOW TO DO

1422
00:54:35,722 --> 00:54:38,224
THIS, PUTTING LOTS AND LOTS OF

1423
00:54:38,224 --> 00:54:39,659
RESOURCES INTO DOING IT IN

1424
00:54:39,659 --> 00:54:42,695
PRIORITY AREAS IS GOING TO

1425
00:54:42,695 --> 00:54:45,298
IDENTIFY THE STRATEGIES FOR

1426
00:54:45,298 --> 00:54:48,167
DOING SO THAT ARE MOST

1427
00:54:48,167 --> 00:54:48,968
EFFECTIVE.

1428
00:54:48,968 --> 00:54:51,904
I THINK JUST SAYING, OH WELL,

1429
00:54:51,904 --> 00:54:53,106
THIS IS A PRIORITY, LET'S MAKE

1430
00:54:53,106 --> 00:54:54,974
THIS A PRIORITY AND GO OUT AND

1431
00:54:54,974 --> 00:54:57,810
DO STUFF, WE WOULDN'T DO THAT

1432
00:54:57,810 --> 00:54:58,711
WITH MEDICATIONS.

1433
00:54:58,711 --> 00:55:02,615
WE NEED SCIENCE AND WE NEED MORE

1434
00:55:02,615 --> 00:55:02,949
SCIENCE.

1435
00:55:02,949 --> 00:55:04,183
ELISEO, I KNOW THERE'S STUFF

1436
00:55:04,183 --> 00:55:05,485
GOING ON AT NIH.

1437
00:55:05,485 --> 00:55:10,056
I'M ARGUING THAT IT'S NOT NEARLY

1438
00:55:10,056 --> 00:55:11,824
ENOUGH.

1439
00:55:11,824 --> 00:55:13,359
WHY CAN'T $20 BILLION OF THE $50

1440
00:55:13,359 --> 00:55:14,894
BILLION BE DEVOTED TO THESE

1441
00:55:14,894 --> 00:55:17,764
KINDS OF THINGS?

1442
00:55:17,764 --> 00:55:18,498
 

1443
00:55:18,498 --> 00:55:22,668
>> CAN I ASK A FOLLOW-UP

1444
00:55:22,668 --> 00:55:26,739
QUESTION ABOUT HOW WE SHOULD BE

1445
00:55:26,739 --> 00:55:29,342
THINKING ABOUT WHAT HAS THE MOST

1446
00:55:29,342 --> 00:55:30,777
POPULATION HEALTH IMPACT AT NIH

1447
00:55:30,777 --> 00:55:35,581
AND SO JUST AS AN EXAMPLE, ONE

1448
00:55:35,581 --> 00:55:41,187
OF THE AREAS I STUDIED IN MY

1449
00:55:41,187 --> 00:55:43,356
PAST IS PEDIATRIC HEREDITARY

1450
00:55:43,356 --> 00:55:44,690
CONDITIONS, WHICH ARE FAIRLY

1451
00:55:44,690 --> 00:55:46,325
RARE.

1452
00:55:46,325 --> 00:55:48,928
SO IF YOU'RE THINKING ABOUT

1453
00:55:48,928 --> 00:55:50,229
THESE CONDITIONS OUT OF

1454
00:55:50,229 --> 00:55:51,864
POPULATION IMPACT LEVEL IN TERMS

1455
00:55:51,864 --> 00:55:54,200
OF THE NUMBERS OF INDIVIDUALS

1456
00:55:54,200 --> 00:55:56,702
WHO HAVE EACH OF THESE

1457
00:55:56,702 --> 00:55:59,338
CONDITIONS, THERE AREN'T THAT

1458
00:55:59,338 --> 00:56:02,175
MANY PEOPLE.

1459
00:56:02,175 --> 00:56:04,043
HOWEVER, THESE CONDITIONS ARE

1460
00:56:04,043 --> 00:56:06,913
RESPONSIBLE FOR A SUBSTANTIAL

1461
00:56:06,913 --> 00:56:08,748
FRACTION OF HOSPITALIZATIONS

1462
00:56:08,748 --> 00:56:11,384
AMONG CHILDREN, AS WELL AS A

1463
00:56:11,384 --> 00:56:15,188
SUBSTANTIAL FRACTION OF THE COST

1464
00:56:15,188 --> 00:56:16,089
FOR PEDIATRIC CARE.

1465
00:56:16,089 --> 00:56:20,259
AND SO I'M JUST WONDERING, YOU

1466
00:56:20,259 --> 00:56:24,964
KNOW, HOW WE PRIORITIZE, WHAT IS

1467
00:56:24,964 --> 00:56:30,336
THE MOST IMPACTFUL PUBLIC

1468
00:56:30,336 --> 00:56:32,071
HEALTH-RELATED TOPIC NIH SHOULD

1469
00:56:32,071 --> 00:56:33,172
BE STUDYING, MERELY BASED ON THE

1470
00:56:33,172 --> 00:56:34,607
NUMBER OF PEOPLE IMPACTED OR

1471
00:56:34,607 --> 00:56:36,876
WHAT MEASURES WOULD WE USE?

1472
00:56:36,876 --> 00:56:38,945
>> THAT'S A GREAT WAY OF
FRAMING

1473
00:56:38,945 --> 00:56:41,180
THE QUESTION.

1474
00:56:41,180 --> 00:56:44,150
I WOULD SAY IT'S NOT FOR ME TO

1475
00:56:44,150 --> 00:56:44,450
SAY.

1476
00:56:44,450 --> 00:56:47,186
BUT WE CAN'T BE IGNORING THE BIG

1477
00:56:47,186 --> 00:56:49,155
THINGS THAT ARE KNOCKING OFF

1478
00:56:49,155 --> 00:56:49,922
LOTS OF PEOPLE.

1479
00:56:49,922 --> 00:56:51,657
BUT THERE OUGHT TO BE ROOM TO

1480
00:56:51,657 --> 00:56:53,493
STUDY THE KINDS OF THINGS THAT

1481
00:56:53,493 --> 00:56:56,028
YOU ARE TALKING ABOUT WHICH ALSO

1482
00:56:56,028 --> 00:56:57,463
HAS IMPLICATIONS FOR DELIVERY OF

1483
00:56:57,463 --> 00:57:02,168
HEALTH CARE AS WELL AS THESE 

1484
00:57:02,168 --> 00:57:04,370
OTHER KINDS OF THINGS THAT ARE

1485
00:57:04,370 --> 00:57:08,074
NOT GETTING NEARLY ENOUGH

1486
00:57:08,074 --> 00:57:08,341
ATTENTION.

1487
00:57:08,341 --> 00:57:11,777
AND HOW DO WE DO THIS?

1488
00:57:11,777 --> 00:57:13,779
WELL, I THINK LARGE SWATHS OF

1489
00:57:13,779 --> 00:57:16,282
THE BUDGET COULD BE MOVED INTO

1490
00:57:16,282 --> 00:57:18,017
STUDYING DELIVERY AND STUDYING

1491
00:57:18,017 --> 00:57:20,553
NEED AND STUDYING STRATEGIES FOR

1492
00:57:20,553 --> 00:57:23,256
IMPROVING UPTAKE OF TREATMENTS.

1493
00:57:23,256 --> 00:57:25,892
WHEN I DID THE WORK ON HIV WE

1494
00:57:25,892 --> 00:57:29,195
HAPPENED TO GO INTO THE FIELD

1495
00:57:29,195 --> 00:57:32,632
JUST AS HIGHLY ACTIVE AND

1496
00:57:32,632 --> 00:57:33,799
ANTIRETROVIRAL THERAPY BECAME

1497
00:57:33,799 --> 00:57:34,233
AVAILABLE.

1498
00:57:34,233 --> 00:57:35,234
WE TRACKED DIFFUSION OF

1499
00:57:35,234 --> 00:57:36,536
TREATMENT IN THE POPULATION IN

1500
00:57:36,536 --> 00:57:37,737
THE UNITED STATES.

1501
00:57:37,737 --> 00:57:40,273
PEOPLE WHO WERE IN CARE.

1502
00:57:40,273 --> 00:57:41,741
AND AMONG PEOPLE WITH ADVANCED

1503
00:57:41,741 --> 00:57:44,644
DISEASE IT SHOULD COME AS NO

1504
00:57:44,644 --> 00:57:48,147
SURPRISE THAT WHITES GOT TREATED

1505
00:57:48,147 --> 00:57:50,683
MORE RAPIDLY THAN BLACKS, THAT

1506
00:57:50,683 --> 00:57:52,852
MEN SOONER THAN WOMEN, THOSE

1507
00:57:52,852 --> 00:57:55,054
WITH PRIVATE INSURANCE SOONER

1508
00:57:55,054 --> 00:57:57,023
THAN PEOPLE WITH MEDICAID MORE

1509
00:57:57,023 --> 00:58:01,093
LIKELY UNINSURED, AND SO ON.

1510
00:58:01,093 --> 00:58:01,861
AND THOSE ARE UNACCEPTABLE

1511
00:58:01,861 --> 00:58:02,261
PATTERNS.

1512
00:58:02,261 --> 00:58:07,200
AND ALL OF THAT NEEDS TO BE

1513
00:58:07,200 --> 00:58:07,633
ADDRESSED.

1514
00:58:07,633 --> 00:58:10,603
YOU KNOW, YES, TREATMENTS ARE

1515
00:58:10,603 --> 00:58:12,104
IMPROVING FOR VARIOUS

1516
00:58:12,104 --> 00:58:12,638
CONDITIONS.

1517
00:58:12,638 --> 00:58:15,741
LET'S MAKE SURE THAT TREATMENTS

1518
00:58:15,741 --> 00:58:17,276
THAT ARE GIVEN PRIORITY IN THE

1519
00:58:17,276 --> 00:58:19,178
SYSTEM ARE AVAILABLE TO

1520
00:58:19,178 --> 00:58:19,445
EVERYONE.

1521
00:58:19,445 --> 00:58:21,981
LET'S MAKE SURE THAT IF THE

1522
00:58:21,981 --> 00:58:23,883
UPTAKE ISN'T EQUITABLE WE FIGURE

1523
00:58:23,883 --> 00:58:29,989
OUT WHY IT ISN'T EQUITABLE.

1524
00:58:29,989 --> 00:58:31,424
SO ARE THERE SMART PEOPLE AROUND

1525
00:58:31,424 --> 00:58:32,825
WHO CAN FIGURE THIS OUT?

1526
00:58:32,825 --> 00:58:36,662
THE ONE THING I DROPPED IN, I

1527
00:58:36,662 --> 00:58:44,737
REALIZE NIH CAN'T JUST DO THIS, 

1528
00:58:44,737 --> 00:58:46,606
BUT, YOU KNOW, A FRIEND OF MINE

1529
00:58:46,606 --> 00:58:48,140
WHO IS A REPUBLICAN COMMENTED

1530
00:58:48,140 --> 00:58:50,910
THAT FOR THE NIH TO FUND A

1531
00:58:50,910 --> 00:58:52,511
STUDY, THAT LEADS TO THE

1532
00:58:52,511 --> 00:58:53,813
DEVELOPMENT OF A DRUG AND GET

1533
00:58:53,813 --> 00:58:58,117
NONE OF THE REVENUE IS

1534
00:58:58,117 --> 00:58:58,618
SCIENTIFIC MALPRACTICE.

1535
00:58:58,618 --> 00:59:01,988
AND THIS WAS SOMEONE WHO WORKED

1536
00:59:01,988 --> 00:59:04,657
IN THE TRUMP ADMINISTRATION.

1537
00:59:04,657 --> 00:59:06,225
AND I THINK THAT'S TRUE.

1538
00:59:06,225 --> 00:59:08,661
WHY NOT BRING A LOT OF THAT

1539
00:59:08,661 --> 00:59:16,335
REVENUE BACK INTO THE NIH AND 

1540
00:59:16,335 --> 00:59:19,372
USE THAT FOR STUDYING

1541
00:59:19,372 --> 00:59:20,072
DISSEMINATION, STUDYING

1542
00:59:20,072 --> 00:59:20,439
IMPLEMENTATION?

1543
00:59:20,439 --> 00:59:24,210
IN A FAR MORE SERIOUS WAY.

1544
00:59:24,210 --> 00:59:26,312
>> FIND A WAY TO REDUCE
OUR BASE

1545
00:59:26,312 --> 00:59:30,449
BUDGET IF WE DID THAT, JUST LIKE

1546
00:59:30,449 --> 00:59:30,716
WITH FDA.

1547
00:59:30,716 --> 00:59:35,921
I THINK IT IS A TOPIC OF

1548
00:59:35,921 --> 00:59:37,123
DISCUSSION, PARTICULARLY AROUND

1549
00:59:37,123 --> 00:59:39,091
THE RIDICULOUS HIGH COST OF

1550
00:59:39,091 --> 00:59:41,394
DRUGS FOR PEOPLE PAYING BOTH OUT

1551
00:59:41,394 --> 00:59:44,463
OF POCKET, NOT JUST FOR RARE

1552
00:59:44,463 --> 00:59:45,965
DISEASES OR UNCOMMON BUT ALSO

1553
00:59:45,965 --> 00:59:48,301
FOR COMMON DISEASES LIKE HEART

1554
00:59:48,301 --> 00:59:49,402
FAILURE, DIABETES, ET CETERA.

1555
00:59:49,402 --> 00:59:53,773
SO LET ME GO TO AN AUDIENCE

1556
00:59:53,773 --> 00:59:54,140
QUESTION.

1557
00:59:54,140 --> 01:00:04,684
CAN DR.  SHAPIRO CLARIFY WHAT HE

1558
01:00:08,921 --> 01:00:09,455
MEANS BY "GOVERNMENT."

1559
01:00:09,455 --> 01:00:15,661
>> I THINK THAT'S A FAIR

1560
01:00:15,661 --> 01:00:16,862
CHARACTERIZATION, YES, WE'RE

1561
01:00:16,862 --> 01:00:19,165
PROBABLY NOT GOING TO GET A

1562
01:00:19,165 --> 01:00:21,901
SINGLE PAYER SYSTEM WITHOUT

1563
01:00:21,901 --> 01:00:22,568
ELECTED OFFICIALS PARTICIPATING.

1564
01:00:22,568 --> 01:00:24,437
IN TERMS OF THE AGENCIES, LOOK,

1565
01:00:24,437 --> 01:00:25,838
I MENTIONED HOW WE SHOULD MAKE

1566
01:00:25,838 --> 01:00:27,039
SURE EVERYTHING IS COST

1567
01:00:27,039 --> 01:00:27,606
EFFECTIVE.

1568
01:00:27,606 --> 01:00:31,010
THEN YOU HAVE PEOPLE IN CONGRESS

1569
01:00:31,010 --> 01:00:32,445
WHO WILL NOT ALLOW PCORI, FOR

1570
01:00:32,445 --> 01:00:35,047
EXAMPLE, TO DO COST

1571
01:00:35,047 --> 01:00:35,881
EFFECTIVENESS ANALYSIS.

1572
01:00:35,881 --> 01:00:38,884
WHICH IN THE U.S., NOT TO DO

1573
01:00:38,884 --> 01:00:39,752
COST EFFECTIVENESS ANALYSIS IS

1574
01:00:39,752 --> 01:00:42,822
LIKE WHAT ARE THEY THINKING?

1575
01:00:42,822 --> 01:00:46,792
OR AS YOU PROBABLY -- MANY OF

1576
01:00:46,792 --> 01:00:50,229
YOU WILL KNOW, WHEN OF THE

1577
01:00:50,229 --> 01:00:51,664
PRECURSOR OF AHRQ I DON'T KNOW

1578
01:00:51,664 --> 01:00:53,265
FUNDED AND SUPPORTED A STUDY

1579
01:00:53,265 --> 01:00:54,800
THAT SUGGESTED CERTAIN BACK

1580
01:00:54,800 --> 01:00:59,705
SURGERIES WERE NOT BETTER THAN

1581
01:00:59,705 --> 01:01:00,272
MEDICAL TREATMENT, THE

1582
01:01:00,272 --> 01:01:03,976
ORTHOPEDIC LOB  LOBBY GOT THE

1583
01:01:03,976 --> 01:01:06,078
HOUSE TO ZERO OUT THE BUDGET.

1584
01:01:06,078 --> 01:01:11,550
OTHERS  TOOK AWAY THE GUIDELINES

1585
01:01:11,550 --> 01:01:11,951
PORTFOLIO AS WELL.

1586
01:01:11,951 --> 01:01:13,753
THERE ARE REALLY PROBLEMS IN THE

1587
01:01:13,753 --> 01:01:16,021
POLITICAL PROCESS BUT WITHIN

1588
01:01:16,021 --> 01:01:16,989
AGENCIES THERE ARE PRESUMABLY

1589
01:01:16,989 --> 01:01:19,091
THINGS THAT COULD BE DONE.

1590
01:01:19,091 --> 01:01:21,527
THE APPROPRIATION WITHIN THE NIH

1591
01:01:21,527 --> 01:01:23,295
BUDGET OBVIOUSLY THERE IS SOME

1592
01:01:23,295 --> 01:01:25,464
MANDATE WITHIN THAT BUDGET.

1593
01:01:25,464 --> 01:01:27,299
BUT THERE IS MORE DISCRETION.

1594
01:01:27,299 --> 01:01:27,733
AND --

1595
01:01:27,733 --> 01:01:30,936
>> THERE IS BUT JUST TO
MAKE

1596
01:01:30,936 --> 01:01:37,076
SURE WE ALL UNDERSTAND, NIH IS A

1597
01:01:37,076 --> 01:01:40,346
FEDERATION OF 24 GRANT-GIVING

1598
01:01:40,346 --> 01:01:42,448
INSTITUTES AND CENTERS, AND SO

1599
01:01:42,448 --> 01:01:44,250
IT'S REALLY THE PRIORITIES ARE

1600
01:01:44,250 --> 01:01:46,719
SET BY EACH OF THE INSTITUTES.

1601
01:01:46,719 --> 01:01:50,756
IT'S NOT LIKE WE IS MOVE LIKE

1602
01:01:50,756 --> 01:01:54,827
MONICA BERTAGNOLLI CAN SAY $10

1603
01:01:54,827 --> 01:01:56,462
BILLION INTO THIS OR $8 BILLION

1604
01:01:56,462 --> 01:01:57,563
INTO THAT, IT DOESN'T WORK THAT

1605
01:01:57,563 --> 01:01:58,964
WAY AT NIH.

1606
01:01:58,964 --> 01:02:00,266
IT'S ONE OF THE UNIQUE

1607
01:02:00,266 --> 01:02:00,533
STRENGTHS.

1608
01:02:00,533 --> 01:02:04,236
LET ME GO BACK TO HEALTH SYSTEM

1609
01:02:04,236 --> 01:02:06,105
SOLUTIONS PERHAPS.

1610
01:02:06,105 --> 01:02:08,507
I THOUGHT THAT DOING THE

1611
01:02:08,507 --> 01:02:08,974
AFFORDABLE CARE ACT

1612
01:02:08,974 --> 01:02:10,810
IMPLEMENTATION ONE OF THE

1613
01:02:10,810 --> 01:02:12,111
DRIVERS, AS YOU PROBABLY KNOW

1614
01:02:12,111 --> 01:02:13,946
NOW THAT YOU'VE BEEN AN EAST

1615
01:02:13,946 --> 01:02:16,382
COASTER FOR A FEW YEARS, THERE'S

1616
01:02:16,382 --> 01:02:18,017
A DRAMATIC DIFFERENCE IN HEALTH

1617
01:02:18,017 --> 01:02:19,652
CARE ORGANIZATION IN SOME WAYS,

1618
01:02:19,652 --> 01:02:24,123
NOT ALL, NOT IN MANY  BUT SOME

1619
01:02:24,123 --> 01:02:25,458
BETWEEN EAST AND WEST,

1620
01:02:25,458 --> 01:02:27,626
PARTICULARLY AROUND THE VALUE OF

1621
01:02:27,626 --> 01:02:28,961
PRIMARY CARE AND PARTICULARLY

1622
01:02:28,961 --> 01:02:31,997
AROUND THE ISSUE OF HOW PEOPLE

1623
01:02:31,997 --> 01:02:35,167
LOOK AT POPULATION HEALTH.

1624
01:02:35,167 --> 01:02:36,702
THAT ASIDE, THERE WAS A MOVE, A

1625
01:02:36,702 --> 01:02:38,237
DIRECTION TOWARD ACCOUNTABLE

1626
01:02:38,237 --> 01:02:39,905
CARE ORGANIZATIONS WHERE THE

1627
01:02:39,905 --> 01:02:41,540
IDEA WOULD BE THAT HEALTH CARE

1628
01:02:41,540 --> 01:02:44,710
SYSTEM WOULD SAY I'M RESPONSIBLE

1629
01:02:44,710 --> 01:02:47,346
FOR THESE PEOPLE WHO ARE UNDER

1630
01:02:47,346 --> 01:02:49,648
THE SYSTEM AND THEN WE WILL

1631
01:02:49,648 --> 01:02:51,283
COVER EVERYBODY AND DO WHAT WE

1632
01:02:51,283 --> 01:02:53,486
CAN WITH ALL THE SERVICES AND

1633
01:02:53,486 --> 01:02:57,623
RESOURCES THAT WE HAVE, AND WE

1634
01:02:57,623 --> 01:02:59,225
HAVEN'T FIGURED OUT BUDGETS,

1635
01:02:59,225 --> 01:03:03,562
STILL DRIVEN BY FEE FOR  FEE FOR

1636
01:03:03,562 --> 01:03:06,966
SERVICE OR A LOT THROUGH STAFF

1637
01:03:06,966 --> 01:03:10,369
MODEL HMO OR HMO-TYPE SYSTEMS

1638
01:03:10,369 --> 01:03:11,670
PAYMENT PER MEMBER PER MONTH.

1639
01:03:11,670 --> 01:03:13,739
THAT SEEMED TO END OR AT LEAST

1640
01:03:13,739 --> 01:03:18,444
WAS I WOULDN'T SAY END BUT WAS

1641
01:03:18,444 --> 01:03:20,613
PAUSED COMPLETELY IN 2017, AND

1642
01:03:20,613 --> 01:03:21,847
HASN'T REALLY BEEN REIGNITED, I

1643
01:03:21,847 --> 01:03:24,450
HAVEN'T SEEN IT AT LEAST, ANY

1644
01:03:24,450 --> 01:03:30,155
THOUGHTS ON THAT AS A POTENTIAL 

1645
01:03:30,155 --> 01:03:30,689
INCREMENTAL STEP?

1646
01:03:30,689 --> 01:03:32,157
>> WELL, YOU KNOW, MY

1647
01:03:32,157 --> 01:03:34,126
UNDERSTANDING, AGAIN I'M NOT AN

1648
01:03:34,126 --> 01:03:36,962
EXPERT IN THAT, IS THAT IT

1649
01:03:36,962 --> 01:03:39,932
LOOKED LIKE IT HAD TINY EFFECTS,

1650
01:03:39,932 --> 01:03:41,901
WASN'T HAVING MAJOR EFFECTS.

1651
01:03:41,901 --> 01:03:46,305
AND MY SENSE IS THAT THE --

1652
01:03:46,305 --> 01:03:48,807
THERE WAS ALSO AN EFFORT TO GET

1653
01:03:48,807 --> 01:03:50,175
MORE DOCS TO TAKE MEDICAID

1654
01:03:50,175 --> 01:03:52,444
PATIENTS AND I THINK LIKE A 2%

1655
01:03:52,444 --> 01:03:53,846
JUMP FOR A WHILE.

1656
01:03:53,846 --> 01:03:57,583
WHILE INCENTIVE WAS THERE BUT IT

1657
01:03:57,583 --> 01:03:59,318
WENT AWAY.

1658
01:03:59,318 --> 01:04:03,489
THAT IT REQUIRES BIGGER KINDS OF

1659
01:04:03,489 --> 01:04:04,690
INTERVENTIONS THAN LITTLE

1660
01:04:04,690 --> 01:04:07,693
ECONOMIC MANIPULATIONS, NOT WITH

1661
01:04:07,693 --> 01:04:09,295
STANDING PERSPECTIVE OF

1662
01:04:09,295 --> 01:04:09,762
ECONOMISTS, BEHAVIORAL

1663
01:04:09,762 --> 01:04:12,698
ECONOMISTS ON ALL OF THIS.

1664
01:04:12,698 --> 01:04:14,433
THE MOVIE JURASSIC PARK, YOU MAY

1665
01:04:14,433 --> 01:04:15,768
REMEMBER THE EXPRESSION, NATURE

1666
01:04:15,768 --> 01:04:17,403
FINDS A WAY.

1667
01:04:17,403 --> 01:04:18,070
RIGHT?

1668
01:04:18,070 --> 01:04:20,906
WELL, I THINK THAT'S LIKE THE

1669
01:04:20,906 --> 01:04:22,908
RESPONSE OF THE PROCEDURALLISTS

1670
01:04:22,908 --> 01:04:24,276
TO THE RELATIVE VALUE SCALE, OH

1671
01:04:24,276 --> 01:04:26,579
MY GOD, THIS IS A CATASTROPHE.

1672
01:04:26,579 --> 01:04:28,213
BUT TURNS OUT THEY ARE DOING

1673
01:04:28,213 --> 01:04:29,648
EVEN BETTER THAN THEN BECAUSE

1674
01:04:29,648 --> 01:04:32,251
THEY FOUND A WAY TO WORK AROUND

1675
01:04:32,251 --> 01:04:32,918
THE SYSTEM.

1676
01:04:32,918 --> 01:04:34,787
WE NEED A SYSTEM THEY CAN'T WORK

1677
01:04:34,787 --> 01:04:35,020
AROUND.

1678
01:04:35,020 --> 01:04:37,856
WE NEED A SYSTEM THAT DOES NOT

1679
01:04:37,856 --> 01:04:41,360
OFFER THE POSSIBILITY OF 

1680
01:04:41,360 --> 01:04:42,761
BUSINESS AS USUAL.

1681
01:04:42,761 --> 01:04:46,498
AND AGAIN I DON'T PRETEND TO

1682
01:04:46,498 --> 01:04:48,033
HAVE THE SOLUTION.

1683
01:04:48,033 --> 01:04:51,003
BUT LOTS OF RESOURCES NEED TO --

1684
01:04:51,003 --> 01:04:54,807
YOU GUYS DO IMPORTANT WORK.

1685
01:04:54,807 --> 01:04:56,909
I REALLY BELIEVE IN WHAT NIMHD

1686
01:04:56,909 --> 01:04:57,343
IS DOING.

1687
01:04:57,343 --> 01:04:59,745
AND THERE'S A LITTLE BIT OF WORK

1688
01:04:59,745 --> 01:05:01,380
SUPPORTED BY OTHER INSTITUTES

1689
01:05:01,380 --> 01:05:04,216
BUT IT'S NOT NEARLY ENOUGH.

1690
01:05:04,216 --> 01:05:05,951
WHY CAN'T YOUR INSTITUTE HAVE $2

1691
01:05:05,951 --> 01:05:06,552
BILLION A YEAR?

1692
01:05:06,552 --> 01:05:08,187
YOU COULD DO MORE WITH $2

1693
01:05:08,187 --> 01:05:11,624
BILLION A YEAR THAN YOU DO WITH

1694
01:05:11,624 --> 01:05:13,926
FOUR OR FIVE HUNDRED MILLION.

1695
01:05:13,926 --> 01:05:15,427
>> I'LL PRETEND I DIDN'T
HEAR

1696
01:05:15,427 --> 01:05:15,861
THAT.

1697
01:05:15,861 --> 01:05:17,730
LET ME TURN TO MONICA TO SEE IF

1698
01:05:17,730 --> 01:05:25,838
SHE HAS A QUESTION OR COMMENT. 

1699
01:05:25,838 --> 01:05:28,907
>> YOU KNOW, ONE OF THE
THINGS

1700
01:05:28,907 --> 01:05:31,543
THAT YOU MENTIONED WAS ABOUT THE

1701
01:05:31,543 --> 01:05:33,078
MEDICAL SCHOOL ASPECT OF THIS,

1702
01:05:33,078 --> 01:05:34,647
AND THAT'S SOMETHING THAT REAL

1703
01:05:34,647 --> 01:05:36,582
NEEDS TO BE ADDRESSED.

1704
01:05:36,582 --> 01:05:39,351
AND I WANTED YOU TO SAY MORE

1705
01:05:39,351 --> 01:05:40,653
ABOUT THE CURRICULUM CHALLENGES.

1706
01:05:40,653 --> 01:05:41,954
I CAN REMEMBER BEING FACULTY

1707
01:05:41,954 --> 01:05:46,859
MEMBER AT A MEDICAL SCHOOL, AND 

1708
01:05:46,859 --> 01:05:48,761
I RAISED A FEW ISSUES IN TERMS

1709
01:05:48,761 --> 01:05:50,729
OF RACISM IN THE MEDICAL SCHOOL

1710
01:05:50,729 --> 01:05:51,997
CURRICULUM WHICH WAS IMPLICIT

1711
01:05:51,997 --> 01:05:55,434
BUT FOR ME IT WAS JUMPING OUT AT

1712
01:05:55,434 --> 01:05:55,668
ME.

1713
01:05:55,668 --> 01:05:57,436
I REMEMBER GETTING PRETTY

1714
01:05:57,436 --> 01:05:58,837
SIGNIFICANT PUSHBACK FROM SOME

1715
01:05:58,837 --> 01:06:01,040
OF THOSE ON THE CORE CURRICULUM

1716
01:06:01,040 --> 01:06:03,008
TEAMS ABOUT MAKING THOSE

1717
01:06:03,008 --> 01:06:03,442
CHANGES.

1718
01:06:03,442 --> 01:06:04,309
INTERESTINGLY ENOUGH FAST

1719
01:06:04,309 --> 01:06:07,079
FORWARD TO 2020, I WAS GETTING

1720
01:06:07,079 --> 01:06:08,480
E-MAILS, APOLOGIZING SAYING

1721
01:06:08,480 --> 01:06:09,848
YOU'RE RIGHT, WE SHOULD CHANGE

1722
01:06:09,848 --> 01:06:11,150
AND WE WILL.

1723
01:06:11,150 --> 01:06:12,918
EVEN IN THE WAY PEOPLE ARE

1724
01:06:12,918 --> 01:06:14,486
TRAINED IN TERMS OF DISPARITY

1725
01:06:14,486 --> 01:06:16,388
REDUCTION, AN IMPORTANT PART OF

1726
01:06:16,388 --> 01:06:17,089
THIS BROKEN SYSTEM, IT'S

1727
01:06:17,089 --> 01:06:19,024
INTERESTING IF YOU COULD COMMENT

1728
01:06:19,024 --> 01:06:23,295
ON THE CURRICULUM CHANGES

1729
01:06:23,295 --> 01:06:24,363
SPECIFICALLY AROUND ADDRESSING

1730
01:06:24,363 --> 01:06:30,069
UNDERSERVED POPULATIONS. 

1731
01:06:30,069 --> 01:06:35,307
>> YOU KNOW, IT'S HARD TO
KNOW

1732
01:06:35,307 --> 01:06:36,975
BECAUSE MEDICAL STUDENTS WHO I

1733
01:06:36,975 --> 01:06:38,410
ENCOUNTER NOW AT CORNELL, YOU

1734
01:06:38,410 --> 01:06:41,146
KNOW, WILL OFTEN EXPRESS

1735
01:06:41,146 --> 01:06:43,682
POSITIVE SOCIAL VALUES ABOUT,

1736
01:06:43,682 --> 01:06:45,117
OH, WE'RE AGAINST RACISM, WE'RE

1737
01:06:45,117 --> 01:06:46,985
FOR JUSTICE AND ALL THIS.

1738
01:06:46,985 --> 01:06:48,620
BUT WHEN IT COMES TO CHOOSING

1739
01:06:48,620 --> 01:06:51,790
THEIR SPECIALTIES A LOT ARE

1740
01:06:51,790 --> 01:06:53,192
STILL CHOOSING HIGH-PAID FIELDS,

1741
01:06:53,192 --> 01:06:59,231
A LOT ARE STILL GOING INTO

1742
01:06:59,231 --> 01:07:00,532
PRACTICES WHERE INSURANCE

1743
01:07:00,532 --> 01:07:04,136
CHOICES ARE QUITE LIMITED.

1744
01:07:04,136 --> 01:07:06,338
AND I THINK THAT -- I SUGGESTED

1745
01:07:06,338 --> 01:07:08,507
HALF OF THE FIRST TWO YEARS,

1746
01:07:08,507 --> 01:07:10,476
PEOPLE EVEN TALKED ABOUT

1747
01:07:10,476 --> 01:07:11,710
DECREASING MEDICAL SCHOOL BY A

1748
01:07:11,710 --> 01:07:14,680
YEAR, BUT WHY NOT GIVE THEM A

1749
01:07:14,680 --> 01:07:17,950
YEAR OF -- OR YEAR AND A HALF IN

1750
01:07:17,950 --> 01:07:22,988
WHICH HALF OF WHAT THEY ARE 

1751
01:07:22,988 --> 01:07:24,957
DOING IS HAVING POSITIVE VALUE

1752
01:07:24,957 --> 01:07:25,724
REINFORCED, ALL KINDS OF

1753
01:07:25,724 --> 01:07:27,126
EXPERIENCES THAT MIGHT HAVE A

1754
01:07:27,126 --> 01:07:27,993
POSITIVE EFFECT ON PEOPLE.

1755
01:07:27,993 --> 01:07:30,429
ALL OF THAT NEEDS TO BE STUDIED.

1756
01:07:30,429 --> 01:07:33,265
WHAT IS IT THAT'S GOING TO TAKE

1757
01:07:33,265 --> 01:07:34,666
PEOPLE, GET PEOPLE TO WANT TO

1758
01:07:34,666 --> 01:07:37,402
TAKE CARE OF POOR PEOPLE, TO

1759
01:07:37,402 --> 01:07:38,403
SACRIFICE SOME INCOME IF

1760
01:07:38,403 --> 01:07:41,573
NECESSARY TO TAKE CARE OF POOR

1761
01:07:41,573 --> 01:07:41,840
PEOPLE?

1762
01:07:41,840 --> 01:07:44,243
WHAT WILL LEAD PEOPLE IN THAT

1763
01:07:44,243 --> 01:07:45,077
DIRECTION?

1764
01:07:45,077 --> 01:07:46,812
WHAT WILL MOTIVATE THEM TO SPEND

1765
01:07:46,812 --> 01:07:49,314
MORE TIME WITH A PATIENT WHO

1766
01:07:49,314 --> 01:07:51,750
NEEDS THEIR ATTENTION AND WHO

1767
01:07:51,750 --> 01:07:52,718
NEEDS THEIR COMPASSION?

1768
01:07:52,718 --> 01:07:56,121
HOW DO WE GET TO THAT?

1769
01:07:56,121 --> 01:08:02,928
THIS IS ALL THE KIND OF THING

1770
01:08:02,928 --> 01:08:04,897
FOR WHICH 100,000 STUDIES SHOULD

1771
01:08:04,897 --> 01:08:06,331
BE DONE UNTIL WE FIND THE THINGS

1772
01:08:06,331 --> 01:08:11,436
THAT REALLY MAKE THE BIGGEST

1773
01:08:11,436 --> 01:08:12,738
DIFFERENCE.

1774
01:08:12,738 --> 01:08:14,773
IT MIGHT BE CLINICAL

1775
01:08:14,773 --> 01:08:17,976
EXPERIENTIAL THING, I'M NOT

1776
01:08:17,976 --> 01:08:18,443
SURE.

1777
01:08:18,443 --> 01:08:20,612
AGAIN, IT ALL REQUIRES

1778
01:08:20,612 --> 01:08:22,047
VALIDATION AND VERIFICATION.

1779
01:08:22,047 --> 01:08:24,449
I THINK SINCE THE CURRENT

1780
01:08:24,449 --> 01:08:25,250
ARRANGEMENTS CONTRIBUTE TO THE

1781
01:08:25,250 --> 01:08:27,319
PROBLEMS, CONTRIBUTE TO THE

1782
01:08:27,319 --> 01:08:29,421
DISPARITIES IN LIFE EXPECTANCY,

1783
01:08:29,421 --> 01:08:30,823
YES, OF COURSE THERE'S OTHER

1784
01:08:30,823 --> 01:08:31,924
THINGS BESIDES MEDICAL CARE.

1785
01:08:31,924 --> 01:08:35,961
BUT IN THE FACE OF ALL THAT, I'M

1786
01:08:35,961 --> 01:08:37,396
SITTING AT 91st STREET IN

1787
01:08:37,396 --> 01:08:37,729
MANHATTAN.

1788
01:08:37,729 --> 01:08:41,567
GO 30 BLOCKS NORTH AND PEOPLE

1789
01:08:41,567 --> 01:08:43,535
ARE LIVING 15 YEARS LESS.

1790
01:08:43,535 --> 01:08:44,403
THAT'S NOT OKAY.

1791
01:08:44,403 --> 01:08:47,472
THERE SHOULD BE FAR MORE

1792
01:08:47,472 --> 01:08:48,774
RESOURCES THAN THERE ARE TO

1793
01:08:48,774 --> 01:08:53,812
PEOPLE IN MY BUILDING AND MY

1794
01:08:53,812 --> 01:08:54,146
NEIGHBORHOOD.

1795
01:08:54,146 --> 01:08:58,083
AND IT WILL REQUIRE A VERY 

1796
01:08:58,083 --> 01:09:00,052
DIFFERENT MINDSET FOR THE

1797
01:09:00,052 --> 01:09:01,920
PRACTITIONERS, AND ULTIMATELY

1798
01:09:01,920 --> 01:09:02,988
FOR THE HEALTH SYSTEMS TO TREAT

1799
01:09:02,988 --> 01:09:06,291
IT IN A DIFFERENT KIND OF WAY

1800
01:09:06,291 --> 01:09:06,792
TOO.

1801
01:09:06,792 --> 01:09:09,695
SO THE CURRICULUM, YES, THE

1802
01:09:09,695 --> 01:09:10,662
CURRICULUM NEEDS TO CHANGE.

1803
01:09:10,662 --> 01:09:13,498
THE CONTENT OF THE CURRICULUM.

1804
01:09:13,498 --> 01:09:16,235
I THINK THE SCIENCE BASIS, THE

1805
01:09:16,235 --> 01:09:19,104
FACT THAT STUDENTS TEND TO GET A

1806
01:09:19,104 --> 01:09:23,141
TASK EVERY TWO WEEKS OR SO -- A

1807
01:09:23,141 --> 01:09:28,547
TEST EVERY TWO WEEKS OR SO,

1808
01:09:28,547 --> 01:09:30,782
RAT-TAT-TAT THE WHOLE TIME.

1809
01:09:30,782 --> 01:09:35,954
THEY WILL HAVE THEIR DOCTORING

1810
01:09:35,954 --> 01:09:37,589
CURRICULUM OR THEIR SOCIAL

1811
01:09:37,589 --> 01:09:39,892
MEDICINE COURSE WHICH IS NOT

1812
01:09:39,892 --> 01:09:42,294
GREAT GRADED THE SAME WAY WHICH

1813
01:09:42,294 --> 01:09:43,061
DOESN'T AFFECT INTERNSHIP

1814
01:09:43,061 --> 01:09:44,596
APPLICATIONS THAT HAS VERY

1815
01:09:44,596 --> 01:09:45,464
LITTLE IMPACT.

1816
01:09:45,464 --> 01:09:48,433
ALL OF THAT NEEDS TO CHANGE.

1817
01:09:48,433 --> 01:09:50,235
IT'S A DIFFERENT THING THAT

1818
01:09:50,235 --> 01:09:51,970
NEEDS TO HAPPEN, I THINK.

1819
01:09:51,970 --> 01:09:53,472
YES, IT'S NOT GOING TO BE EASY

1820
01:09:53,472 --> 01:09:55,674
TO GET THERE.

1821
01:09:55,674 --> 01:09:58,844
BUT I THINK THE NIH COULD HELP

1822
01:09:58,844 --> 01:10:00,812
IF THEY REALLY DECIDED TO PUT

1823
01:10:00,812 --> 01:10:04,316
MONEY INTO TRYING TO IMPROVE

1824
01:10:04,316 --> 01:10:04,516
THESE.

1825
01:10:04,516 --> 01:10:04,983
>> ALL RIGHT.

1826
01:10:04,983 --> 01:10:09,121
LET ME TURN TO ANOTHER AUDIENCE

1827
01:10:09,121 --> 01:10:09,554
QUESTION.

1828
01:10:09,554 --> 01:10:11,857
DR. SHAPIRO, THANKING YOU FOR AN

1829
01:10:11,857 --> 01:10:12,958
ENLIGHTENING PRESENTATION.

1830
01:10:12,958 --> 01:10:15,360
WHAT KEY HURDLING BEYOND

1831
01:10:15,360 --> 01:10:18,530
POLITICS AND SUPERFICIAL 

1832
01:10:18,530 --> 01:10:19,164
SOLUTIONS HAVE HINDERED

1833
01:10:19,164 --> 01:10:20,832
SUBSTANTIAL REFORM IN THE

1834
01:10:20,832 --> 01:10:21,934
AMERICAN HEALTH CARE SYSTEM, CAN

1835
01:10:21,934 --> 01:10:23,902
WE LOOK TO SUCCESSFUL MODELS IN

1836
01:10:23,902 --> 01:10:31,109
OTHER COUNTRIES FOR 

1837
01:10:31,109 --> 01:10:32,110
INSPIRATION?

1838
01:10:32,110 --> 01:10:34,046
IF SO WHICH COUNTRY IS A

1839
01:10:34,046 --> 01:10:38,684
PROMISING MODEL FOR REFORMING

1840
01:10:38,684 --> 01:10:39,284
AMERICA'S HEALTH CARE SYSTEM?

1841
01:10:39,284 --> 01:10:42,287
>> I DON'T KNOW THE MODEL

1842
01:10:42,287 --> 01:10:47,225
THATTEDS SHOULD BE A-- MODEL

1843
01:10:47,225 --> 01:10:51,630
THAT SHOULD BE ADOPTED. 

1844
01:10:51,630 --> 01:11:02,174
ALMOST ALL  WESTERNIZED SYSTEMS.

1845
01:11:04,509 --> 01:11:06,378
THERE ARE PROBLEMS IN CANADA,

1846
01:11:06,378 --> 01:11:07,913
THEY COULD EXPAND TO A LEVEL

1847
01:11:07,913 --> 01:11:11,783
THAT WOULD SOLVE PROBLEMS

1848
01:11:11,783 --> 01:11:13,685
WITHOUT COMING NEAR WHAT THE

1849
01:11:13,685 --> 01:11:16,321
U.S. IS WASTING ON U.S. HEALTH

1850
01:11:16,321 --> 01:11:16,555
CARE.

1851
01:11:16,555 --> 01:11:19,725
I WOULD POINT TO THAT.

1852
01:11:19,725 --> 01:11:22,260
THERE ARE ISSUES BEYOND THE

1853
01:11:22,260 --> 01:11:24,196
ECONOMIC AND POLITICAL, AND SOME

1854
01:11:24,196 --> 01:11:25,764
IS REFLECTED IN PEOPLE'S VALUES

1855
01:11:25,764 --> 01:11:27,099
AND NEEDS AND EXPECTATIONS.

1856
01:11:27,099 --> 01:11:30,602
YOU ARE KNOW, THE PATIENTS WHO

1857
01:11:30,602 --> 01:11:34,072
CONTINUALLY DEMAND CARE AND

1858
01:11:34,072 --> 01:11:35,273
SERVICE AND TESTS, BECAUSE THEY

1859
01:11:35,273 --> 01:11:38,010
CAN'T DEAL WITH THE FACT THAT

1860
01:11:38,010 --> 01:11:39,544
GRANDMA IS DYING OR THEY ARE

1861
01:11:39,544 --> 01:11:42,414
ANXIOUS OR THEY ARE DEPRESSED

1862
01:11:42,414 --> 01:11:43,715
AND THEY WON'T -- AREN'T ABLE TO

1863
01:11:43,715 --> 01:11:45,617
GET THE CARE THEY NEED FOR THAT,

1864
01:11:45,617 --> 01:11:48,186
OR THEY ARE NOT PREPARED TO

1865
01:11:48,186 --> 01:11:48,954
CONFRONT THAT.

1866
01:11:48,954 --> 01:11:53,025
THE PEOPLE WHO GO INTO MEDICINE

1867
01:11:53,025 --> 01:11:55,560
AND HAVE PERSONAL PROBLEMS, YOU

1868
01:11:55,560 --> 01:11:59,798
KNOW, THAT MAKE THEM

1869
01:11:59,798 --> 01:12:01,366
UNCOMFORTABLE DEALING WITH

1870
01:12:01,366 --> 01:12:04,936
PATIENTS WHO HAVE INTENSE

1871
01:12:04,936 --> 01:12:06,505
PSYCHOLOGICAL NEEDS, I HAD AN

1872
01:12:06,505 --> 01:12:09,441
EXPERIENCE, A RATHER INTERESTING

1873
01:12:09,441 --> 01:12:10,976
ONE.

1874
01:12:10,976 --> 01:12:15,347
WE HAD A HOLOCAUST SURVIVOR ON

1875
01:12:15,347 --> 01:12:16,648
SERVICE WHO DIED, AND I CAME

1876
01:12:16,648 --> 01:12:18,283
INTO ROUNDS THE NEXT DAY, HEARD

1877
01:12:18,283 --> 01:12:19,284
ABOUT IT.

1878
01:12:19,284 --> 01:12:20,719
NO ONE WAS TALKING ABOUT HER.

1879
01:12:20,719 --> 01:12:23,021
I NOTICE SHE'S NOT ON THE LIST.

1880
01:12:23,021 --> 01:12:24,523
SOMEONE SAID, SHE CODED.

1881
01:12:24,523 --> 01:12:26,291
WELL, SHE WAS NOT CODED.

1882
01:12:26,291 --> 01:12:27,159
SHE DIED.

1883
01:12:27,159 --> 01:12:29,361
IT WASN'T TO BE RESUSCITATED.

1884
01:12:29,361 --> 01:12:30,996
I SAID LET'S TALK ABOUT HER AND

1885
01:12:30,996 --> 01:12:33,098
HER EXPERIENCE A LITTLE BIT AND

1886
01:12:33,098 --> 01:12:34,833
TALK ABOUT DEATH AND DYING.

1887
01:12:34,833 --> 01:12:36,268
SO WE DID THAT.

1888
01:12:36,268 --> 01:12:37,669
PEOPLE TALKED ABOUT THEIR

1889
01:12:37,669 --> 01:12:38,036
EXPERIENCES.

1890
01:12:38,036 --> 01:12:39,104
WE TALKED ABOUT HER.

1891
01:12:39,104 --> 01:12:41,940
AND THEN I PULLED OUT SOME POEMS

1892
01:12:41,940 --> 01:12:43,708
FOR PEOPLE TO READ ABOUT DEATH

1893
01:12:43,708 --> 01:12:46,445
AND DYING.

1894
01:12:46,445 --> 01:12:47,412
SOME FAMOUS STUFF.

1895
01:12:47,412 --> 01:12:49,481
AND ASKED EACH TO READ A POEM, I

1896
01:12:49,481 --> 01:12:50,682
READ A POEM.

1897
01:12:50,682 --> 01:12:52,350
WHEN READING MINE TEARS WERE

1898
01:12:52,350 --> 01:12:56,088
STREAMING DOWN MY CHEEK.

1899
01:12:56,088 --> 01:12:57,722
I WAS CRYING.

1900
01:12:57,722 --> 01:12:59,191
AND AFTERWARDS THE RESIDENT TOLD

1901
01:12:59,191 --> 01:13:01,793
ME THE STUDENTS HAD COME OVER

1902
01:13:01,793 --> 01:13:05,063
AND ASKED IF I HAD A COLD.

1903
01:13:05,063 --> 01:13:08,366
THAT IT WASN'T SEEN AS BEING

1904
01:13:08,366 --> 01:13:10,969
OKAY TO EMBRACE THE EMOTIONALITY

1905
01:13:10,969 --> 01:13:13,405
OF DEATH, OF DYING, OF HUMAN

1906
01:13:13,405 --> 01:13:13,705
EXPERIENCE.

1907
01:13:13,705 --> 01:13:16,041
AND I THINK ALL OF THIS NEEDS TO

1908
01:13:16,041 --> 01:13:17,109
BE ADDRESSED TOO IF PEOPLE ARE

1909
01:13:17,109 --> 01:13:20,745
GOING TO GET THE CARE THEY NEED

1910
01:13:20,745 --> 01:13:21,947
AND TRUST DOCTORS AND THE

1911
01:13:21,947 --> 01:13:24,349
SYSTEM.

1912
01:13:24,349 --> 01:13:25,217
 

1913
01:13:25,217 --> 01:13:27,686
>> LET ME TURN TO KATRINA.

1914
01:13:27,686 --> 01:13:33,391
>> YEAH, I WANT TO ALSO
GIVE AN

1915
01:13:33,391 --> 01:13:36,361
AUDIENCE QUESTION. 

1916
01:13:36,361 --> 01:13:38,663
SO, HE UNCOURAGED NIH TO FUND

1917
01:13:38,663 --> 01:13:39,598
MORE POPULATION STUDIES.

1918
01:13:39,598 --> 01:13:41,066
WHO IN AN INSTITUTE MAKES THAT

1919
01:13:41,066 --> 01:13:43,502
DECISION AND HOW CAN WE

1920
01:13:43,502 --> 01:13:45,337
INFLUENCE THAT PERSON OR GROUP

1921
01:13:45,337 --> 01:13:46,872
TO FUND IN THAT DIRECTION?

1922
01:13:46,872 --> 01:13:52,677
I WANT TO ADD MY OWN QUESTION,

1923
01:13:52,677 --> 01:13:57,182
WHICH IS, PART OF WHAT YOU WERE

1924
01:13:57,182 --> 01:13:59,251
CONCERNED ABOUT WITH SCIENTISTS

1925
01:13:59,251 --> 01:14:01,219
IS THAT WE LOBBY AND ADVOCATE

1926
01:14:01,219 --> 01:14:03,955
FOR OUR AREAS OF SCIENCE, SO IF

1927
01:14:03,955 --> 01:14:05,924
WE ARE HEALTH SERVICES

1928
01:14:05,924 --> 01:14:08,226
RESEARCHERS, ARE WE NOT GUILTY

1929
01:14:08,226 --> 01:14:11,296
OF THE SAME THING THAT OTHER

1930
01:14:11,296 --> 01:14:14,132
SCIENTISTS ARE DOING IF WE'RE

1931
01:14:14,132 --> 01:14:15,901
ADVOCATING FOR MORE OF THE KINDS

1932
01:14:15,901 --> 01:14:18,136
OF WORK THAT WE DO?

1933
01:14:18,136 --> 01:14:25,210
>> THEY ARE BETTER AT IT
THAN 

1934
01:14:25,210 --> 01:14:26,444
YOU ARE, CLEARLY.

1935
01:14:26,444 --> 01:14:27,946
WHO WITHIN AN INSTITUTE?

1936
01:14:27,946 --> 01:14:29,915
WELL, I TOLD YOU ABOUT HE WHO

1937
01:14:29,915 --> 01:14:32,984
MUST NOT BE NAMED WHO DIDN'T

1938
01:14:32,984 --> 01:14:34,419
THINK THAT OUTCOMES RESEARCH IN

1939
01:14:34,419 --> 01:14:39,991
HIV WAS IN THE MANDATE OF THE

1940
01:14:39,991 --> 01:14:40,825
NIAID.

1941
01:14:40,825 --> 01:14:42,727
PRESUMABLY, AT THAT LEVEL, THERE

1942
01:14:42,727 --> 01:14:44,696
IS SOME PRIORITIZATION THAT CAN

1943
01:14:44,696 --> 01:14:45,130
BE SHAPED.

1944
01:14:45,130 --> 01:14:46,798
BUT I THINK THERE'S ALSO THE

1945
01:14:46,798 --> 01:14:50,735
ISSUE ABOUT THE RELATIVE BUDGETS

1946
01:14:50,735 --> 01:14:51,436
OF INSTITUTES.

1947
01:14:51,436 --> 01:14:53,672
AND THERE ARE A NUMBER OF

1948
01:14:53,672 --> 01:14:55,340
INSTITUTES THAT SHOW INTEREST IN

1949
01:14:55,340 --> 01:14:56,741
THIS KIND OF WORK.

1950
01:14:56,741 --> 01:14:59,511
THE OPPOSITE THING, BY THE WAY,

1951
01:14:59,511 --> 01:15:00,912
WAS DIRECTOR OF NIMH DECIDING

1952
01:15:00,912 --> 01:15:03,148
ALL HE WANTED TO SUPPORT WAS

1953
01:15:03,148 --> 01:15:04,749
BASIC SCIENCE AND CLINICAL

1954
01:15:04,749 --> 01:15:04,983
TRIALS.

1955
01:15:04,983 --> 01:15:06,718
SO CLEARLY SOME OF THAT OCCURS

1956
01:15:06,718 --> 01:15:09,454
THERE BUT IT'S THE ABSOLUTE

1957
01:15:09,454 --> 01:15:10,655
LEVEL OF SUPPORT FOR DIFFERENT

1958
01:15:10,655 --> 01:15:16,027
KINDS OF WORK FOR DIFFERENT

1959
01:15:16,027 --> 01:15:21,066
KINDS OF -- WITHIN THE

1960
01:15:21,066 --> 01:15:22,934
INSTITUTES, AND I THINK IT

1961
01:15:22,934 --> 01:15:24,002
OPPORTUNITIES WITH SMALL

1962
01:15:24,002 --> 01:15:24,569
BUDGETS, THREE, FOUR, FIVE

1963
01:15:24,569 --> 01:15:28,473
HUNDRED MILLION A YEAR

1964
01:15:28,473 --> 01:15:30,141
INSTITUTES, THEY ARE HONORABLE

1965
01:15:30,141 --> 01:15:30,442
AND WORTHY.

1966
01:15:30,442 --> 01:15:33,745
THEY OUGHT TO BE ON THE SAME

1967
01:15:33,745 --> 01:15:35,680
FOOTING AS THE -- YOU KNOW,

1968
01:15:35,680 --> 01:15:36,815
NINDS WITH ITS $2 BILLION THAT

1969
01:15:36,815 --> 01:15:39,684
DOESN'T DO ANY OF THIS RESEARCH

1970
01:15:39,684 --> 01:15:41,519
AND SO ON.

1971
01:15:41,519 --> 01:15:44,155
SO, YES, LEADERSHIP WITHIN

1972
01:15:44,155 --> 01:15:44,456
INSTITUTES.

1973
01:15:44,456 --> 01:15:46,224
PART OF IT OF COURSE DEPENDS WHO

1974
01:15:46,224 --> 01:15:50,829
YOU APPOINT AS DIRECTOR OF BE A 

1975
01:15:50,829 --> 01:15:51,363
INSTITUTE.

1976
01:15:51,363 --> 01:15:52,931
I SUSPECT THERE ARE OTHER PEOPLE

1977
01:15:52,931 --> 01:15:54,766
ON THIS CALL WHO KNOW A LOT MORE

1978
01:15:54,766 --> 01:15:57,402
ABOUT WHAT IT WOULD TAKE TO MOVE

1979
01:15:57,402 --> 01:15:59,271
MONEY AROUND WITHIN THE NIH

1980
01:15:59,271 --> 01:16:01,473
BUDGET.

1981
01:16:01,473 --> 01:16:02,774
 

1982
01:16:02,774 --> 01:16:04,743
>> THANK YOU, MARTIN.

1983
01:16:04,743 --> 01:16:08,913
THERE HAS BEEN I WOULD ALMOST

1984
01:16:08,913 --> 01:16:12,717
SAY A GENERATIONAL TRANSITION OF

1985
01:16:12,717 --> 01:16:13,585
INSTITUTE DIRECTORS WHERE YOU DO

1986
01:16:13,585 --> 01:16:16,121
HAVE A GROUP NOW THAT IS

1987
01:16:16,121 --> 01:16:17,522
PRIMARILY COMING FROM A

1988
01:16:17,522 --> 01:16:21,926
DIFFERENT SET OF DISCIPLINES AND

1989
01:16:21,926 --> 01:16:26,064
BACKGROUNDS ACROSS THE NIH. 

1990
01:16:26,064 --> 01:16:28,333
SO, I'M SITTING HERE, EIGHT-PLUS

1991
01:16:28,333 --> 01:16:30,001
YEARS SINCE ARRIVING, I'M THE

1992
01:16:30,001 --> 01:16:30,769
MIDDLE OF EXPERIENCES.

1993
01:16:30,769 --> 01:16:33,071
YOU CAN GET A FLAVOR THAT PEOPLE

1994
01:16:33,071 --> 01:16:38,543
DO TURN OVER AND THERE HAVE BEEN

1995
01:16:38,543 --> 01:16:39,444
TRANSITIONS.

1996
01:16:39,444 --> 01:16:41,479
SO I REMAIN ETERNALLY OPTIMISTIC

1997
01:16:41,479 --> 01:16:43,715
THESE THINGS WILL GRADUALLY

1998
01:16:43,715 --> 01:16:44,649
CONTINUE TO CHANGE.

1999
01:16:44,649 --> 01:16:47,686
LET ME ADD ANOTHER QUESTION FROM

2000
01:16:47,686 --> 01:16:47,952
AUDIENCE.

2001
01:16:47,952 --> 01:16:51,323
IN WHAT WAYS CAN WE FOCUS ON

2002
01:16:51,323 --> 01:16:53,091
PRODUCING EVIDENCE NEEDED TO

2003
01:16:53,091 --> 01:16:56,061
OPTIMIZE POPULATION HEALTH AND

2004
01:16:56,061 --> 01:16:57,696
NOT JUST INDIVIDUAL

2005
01:16:57,696 --> 01:17:02,734
PATIENT-LEVEL HEALTH?

2006
01:17:02,734 --> 01:17:10,041
>> WELL, I THINK STUDIES
IN A

2007
01:17:10,041 --> 01:17:12,477
LOOK AT POPULATIONS, YOU KNOW,

2008
01:17:12,477 --> 01:17:15,180
COULD BE REALLY HELPFUL.

2009
01:17:15,180 --> 01:17:17,315
YOU KNOW, YOU CAN'T ALWAYS DO A

2010
01:17:17,315 --> 01:17:18,516
PROJECT LIKE THE HIV STUDY THAT

2011
01:17:18,516 --> 01:17:26,825
I GOT TO DO, $25 MILLION OR SO.

2012
01:17:26,825 --> 01:17:30,028
BUT BY STUDYING A REPRESENTATIVE

2013
01:17:30,028 --> 01:17:31,529
POPULATION WITH AN IMPORTANT

2014
01:17:31,529 --> 01:17:33,064
DISEASE, NOT JUST LOOKING AT

2015
01:17:33,064 --> 01:17:35,033
MEDICAL RECORDS BUT ACTUALLY

2016
01:17:35,033 --> 01:17:38,336
TALKING TO PEOPLE AND SO ON,

2017
01:17:38,336 --> 01:17:39,971
PRODUCED EVIDENCE OF WHERE SOME

2018
01:17:39,971 --> 01:17:43,775
OF THE PROBLEMS WERE.

2019
01:17:43,775 --> 01:17:46,644
AND I THINK LOTS OF STUDIES LIKE

2020
01:17:46,644 --> 01:17:53,618
THAT COULD BE DONE OF LOTS OF

2021
01:17:53,618 --> 01:17:54,419
THINGS.

2022
01:17:54,419 --> 01:17:56,254
WHY AREN'T PEOPLE GETTING

2023
01:17:56,254 --> 01:17:57,122
BETTER -- GETTING DIABETES

2024
01:17:57,122 --> 01:18:00,625
BETTER CONTROLLED ON A

2025
01:18:00,625 --> 01:18:02,026
POPULATION LEVEL?

2026
01:18:02,026 --> 01:18:06,231
WHY ARE 16,000 PEOPLE STILL

2027
01:18:06,231 --> 01:18:09,300
DYING EVERY YEAR OR 14,000 OF

2028
01:18:09,300 --> 01:18:11,503
HEPATITIS C?

2029
01:18:11,503 --> 01:18:15,974
WHY ARE SO MANY KIDS IN POOR

2030
01:18:15,974 --> 01:18:19,477
COMMUNITIES WITH ASTHMA ENDING

2031
01:18:19,477 --> 01:18:20,678
UP HOSPITALIZED?

2032
01:18:20,678 --> 01:18:22,080
AND SO ON.

2033
01:18:22,080 --> 01:18:24,282
THAT COLLECTING DATA AT A

2034
01:18:24,282 --> 01:18:26,284
POPULATION LEVEL CAN BE

2035
01:18:26,284 --> 01:18:28,353
COMPELLING, YOU KNOW?

2036
01:18:28,353 --> 01:18:30,321
THE USUAL NIH GRANT WHERE YOU

2037
01:18:30,321 --> 01:18:34,626
CAN HAVE UP TO, YOU KNOW,

2038
01:18:34,626 --> 01:18:36,995
$500,000 A YEAR TOTAL, WELL,

2039
01:18:36,995 --> 01:18:39,297
DIRECT COSTS, TO DO A STUDY, YOU

2040
01:18:39,297 --> 01:18:40,698
CAN DO DECENT STUDIES BUT THEY

2041
01:18:40,698 --> 01:18:45,003
ARE NOT GOING TO PRODUCE

2042
01:18:45,003 --> 01:18:45,637
REPRESENTATIVE POPULATION-BASED

2043
01:18:45,637 --> 01:18:46,037
DATA.

2044
01:18:46,037 --> 01:18:51,976
SO I WOULD THINK TAKING ON BIG

2045
01:18:51,976 --> 01:18:53,411
PROBLEMS IN THAT KIND OF A WAY

2046
01:18:53,411 --> 01:18:57,682
WOULD BE A GOOD THING. 

2047
01:18:57,682 --> 01:18:58,450
>> OKAY.

2048
01:18:58,450 --> 01:19:00,084
LET ME TURN TO MONICA.

2049
01:19:00,084 --> 01:19:02,086
WE'RE DOWN TO THE LAST TEN

2050
01:19:02,086 --> 01:19:04,689
MINUTES OR SO.

2051
01:19:04,689 --> 01:19:07,625
 

2052
01:19:07,625 --> 01:19:09,394
>> I MEAN, I THINK AS I'M
TRYING

2053
01:19:09,394 --> 01:19:11,529
TO THINK ABOUT ALL THIS, IT IS

2054
01:19:11,529 --> 01:19:14,199
AS ELISEO SAID IN THE BEGINNING

2055
01:19:14,199 --> 01:19:15,733
JUST PRETTY DAUNTING.

2056
01:19:15,733 --> 01:19:17,602
ONE OF THE THINGS THAT I WANT TO

2057
01:19:17,602 --> 01:19:20,972
ASK I GUESS ABOUT LASTLY IS

2058
01:19:20,972 --> 01:19:22,841
DURING THE PANDEMIC EXPERIENCE,

2059
01:19:22,841 --> 01:19:24,042
THERE WAS A NEED, IT WAS CLEAR

2060
01:19:24,042 --> 01:19:26,778
THERE WAS A NEED FOR HEALTH

2061
01:19:26,778 --> 01:19:29,414
SYSTEMS AND PEOPLE WHO WORK IN

2062
01:19:29,414 --> 01:19:31,349
HEALTH CARE, AND THE PUBLIC

2063
01:19:31,349 --> 01:19:35,320
HEALTH SECTOR TO BE WORKING

2064
01:19:35,320 --> 01:19:36,721
TOGETHER IN THIS COUNTRY AND

2065
01:19:36,721 --> 01:19:37,922
PROBABLY IN OTHERS.

2066
01:19:37,922 --> 01:19:39,791
BUT I GUESS THINKING ABOUT THIS

2067
01:19:39,791 --> 01:19:41,793
COUNTRY SPECIFICALLY.

2068
01:19:41,793 --> 01:19:42,961
AND EVEN SOME DISCUSSION, YOU

2069
01:19:42,961 --> 01:19:46,464
KNOW, ABOUT THE THINGS THAT NIH

2070
01:19:46,464 --> 01:19:48,199
SHOULD BE FOCUSED ON, MORE IN A

2071
01:19:48,199 --> 01:19:48,967
PUBLIC HEALTH DOMAIN.

2072
01:19:48,967 --> 01:19:51,603
WHAT ARE YOUR THOUGHTS ABOUT HOW

2073
01:19:51,603 --> 01:19:52,570
PUBLIC HEALTH AND HEALTH CARE

2074
01:19:52,570 --> 01:19:54,672
SYSTEMS AND HEALTH CARE

2075
01:19:54,672 --> 01:19:55,874
CLINICIANS CAN BE MORE

2076
01:19:55,874 --> 01:19:57,408
INTEGRATED GOING FORWARD USING

2077
01:19:57,408 --> 01:20:02,847
LESSONS LEARNED IN THAT

2078
01:20:02,847 --> 01:20:03,848
EXPERIENCE TO IMPROVE HEALTH

2079
01:20:03,848 --> 01:20:06,584
CARE TO POPULATIONS AS WELL AS

2080
01:20:06,584 --> 01:20:11,422
OUTCOMES AND FOR ADDRESSING 

2081
01:20:11,422 --> 01:20:11,623
GAPS?

2082
01:20:11,623 --> 01:20:13,157
>> WELL, HEALTH SYSTEMS
FEEL

2083
01:20:13,157 --> 01:20:15,026
LIKE THEY NEED TO RESPOND TO THE

2084
01:20:15,026 --> 01:20:17,962
FRESHES ON THEM.

2085
01:20:17,962 --> 01:20:18,630
 PRESSURES ON THEM.

2086
01:20:18,630 --> 01:20:21,332
LOOK AT NEW YORK OR L.A.

2087
01:20:21,332 --> 01:20:25,169
I REMEMBER IN L.A., UCLA AND

2088
01:20:25,169 --> 01:20:28,039
CEDARS-SINAI, AND A COUPLE OTHER

2089
01:20:28,039 --> 01:20:29,140
BIG SYSTEMS WERE SCRAMBLING FOR

2090
01:20:29,140 --> 01:20:30,875
MARKET SHARE.

2091
01:20:30,875 --> 01:20:33,077
I REMEMBER THINKING THAT THEIR

2092
01:20:33,077 --> 01:20:35,280
ATTITUDE TOWARDS ONE ANOTHER WAS

2093
01:20:35,280 --> 01:20:37,348
SOMETHING LIKE THE EXPERIENCE OF

2094
01:20:37,348 --> 01:20:43,688
THE PRESIDENT IN THE MOVIE

2095
01:20:43,688 --> 01:20:44,822
"INDEPENDENCE DAY IMTS" TALKING

2096
01:20:44,822 --> 01:20:49,961
TO THE  ALIEN, WHAT DO YOU WANT

2097
01:20:49,961 --> 01:20:51,496
US TO DO?

2098
01:20:51,496 --> 01:20:53,131
DIE.

2099
01:20:53,131 --> 01:20:55,433
SYSTEMS WANT TO INCREASE MARKET

2100
01:20:55,433 --> 01:20:57,168
SHARE AND REVENUE, AND SO IT

2101
01:20:57,168 --> 01:20:57,502
GOES.

2102
01:20:57,502 --> 01:21:03,308
AND THEY ACT IN WAYS THAT ARE

2103
01:21:03,308 --> 01:21:08,413
CONSISTENT WITH THIS APPARENT

2104
01:21:08,413 --> 01:21:09,948
REQUISITE, AND ROSEMARY STEVENS

2105
01:21:09,948 --> 01:21:14,552
WROTE A GOOD BOOK ABOUT 

2106
01:21:14,552 --> 01:21:16,087
HOSPITALS, DEVELOPMENT OF

2107
01:21:16,087 --> 01:21:17,188
HOSPITALS TOWARDS WANTING TO

2108
01:21:17,188 --> 01:21:19,057
EXPAND, EXPAND AND GROW AND

2109
01:21:19,057 --> 01:21:24,195
GROW, OF COURSE BEING ABLE TO

2110
01:21:24,195 --> 01:21:26,064
BUILD THEIR MORTGAGE COST,

2111
01:21:26,064 --> 01:21:28,299
ESSENTIALLY, INTO THEIR MEDICARE

2112
01:21:28,299 --> 01:21:28,499
RATES.

2113
01:21:28,499 --> 01:21:29,567
WHAT HAVE YOU.

2114
01:21:29,567 --> 01:21:31,436
THAT I THINK THERE ARE

2115
01:21:31,436 --> 01:21:32,303
STRUCTURAL THINGS THAT

2116
01:21:32,303 --> 01:21:36,140
CONTRIBUTE TO THIS KIND OF

2117
01:21:36,140 --> 01:21:36,574
BEHAVIOR.

2118
01:21:36,574 --> 01:21:39,877
BUT, YOU KNOW, I WOULD LIKE TO

2119
01:21:39,877 --> 01:21:41,946
SEE THESE CEOS OF HOSPITAL WHO

2120
01:21:41,946 --> 01:21:44,682
PRESENT PROBLEMS, DEANS OF

2121
01:21:44,682 --> 01:21:46,017
MEDICAL SCHOOLS, EVEN THOUGH

2122
01:21:46,017 --> 01:21:47,719
THEY ARE MISGUIDED A LOT OF

2123
01:21:47,719 --> 01:21:49,520
TIME, THEY ARE NOT AS MUCH OF

2124
01:21:49,520 --> 01:21:51,689
THAT PART OF THE PROBLEM AS THE

2125
01:21:51,689 --> 01:21:54,225
CEOS ARE BUT THE CEOS HAVE A LOT

2126
01:21:54,225 --> 01:21:56,260
OF SAY OVER WHAT GETS DONE AND

2127
01:21:56,260 --> 01:22:00,565
WHAT GETS PRIORITIZED IN TERMS

2128
01:22:00,565 --> 01:22:02,100
OF CLINICAL PRACTICE.

2129
01:22:02,100 --> 01:22:04,202
AND CAN YOU REEDUCATE THEM?

2130
01:22:04,202 --> 01:22:06,170
NOW, BELLA'S BOOK I THOUGHT

2131
01:22:06,170 --> 01:22:06,938
WHICH WAS OTHERWISE BRILLIANT

2132
01:22:06,938 --> 01:22:10,008
BUT A LITTLE NAIVE IN THINKING

2133
01:22:10,008 --> 01:22:12,744
THEY COULD ACTUALLY CHANGE

2134
01:22:12,744 --> 01:22:14,479
CORPORATE BEHAVIOR BY, YOU KNOW,

2135
01:22:14,479 --> 01:22:16,881
THROUGH EDUCATION, I THINK

2136
01:22:16,881 --> 01:22:19,851
YOU'VE GOT TO CHANGE THE

2137
01:22:19,851 --> 01:22:20,318
INCENTIVES.

2138
01:22:20,318 --> 01:22:23,621
WHY SHOULD THE -- I MEAN TWO

2139
01:22:23,621 --> 01:22:26,190
CEOS IN NEW YORK CITY WHO IN THE

2140
01:22:26,190 --> 01:22:29,794
LAST YEAR FOR WHICH DATA WERE

2141
01:22:29,794 --> 01:22:33,564
AVAILABLE, THAT HAD TOTAL

2142
01:22:33,564 --> 01:22:37,235
COMPENSATION AROUND $12 MILLION.

2143
01:22:37,235 --> 01:22:39,170
AND MANY LEVELS OF EXECUTIVES

2144
01:22:39,170 --> 01:22:40,071
BELOW THAT EARNING A LOT OF

2145
01:22:40,071 --> 01:22:40,438
MONEY.

2146
01:22:40,438 --> 01:22:41,406
THEY WOULDN'T BE EARNING THAT

2147
01:22:41,406 --> 01:22:43,808
KIND OF MONEY IF THEY WEREN'T

2148
01:22:43,808 --> 01:22:44,909
GENERATING LARGE SURPLUSES.

2149
01:22:44,909 --> 01:22:49,514
SO GETTING THEM TO CHANGE THEIR

2150
01:22:49,514 --> 01:22:52,016
PRIORITIES TO REALLY FOCUS UPON

2151
01:22:52,016 --> 01:22:54,118
OPENING THEIR DOORS TO A BROAD

2152
01:22:54,118 --> 01:22:55,319
POPULATION, MANY OF WHOM ARE NOT

2153
01:22:55,319 --> 01:22:58,523
GOING TO PROVIDE THAT LEVEL OF

2154
01:22:58,523 --> 01:22:59,190
REIMBURSEMENT, TO PUTTING

2155
01:22:59,190 --> 01:23:00,658
CLINICS IN ALL PARTS OF THE

2156
01:23:00,658 --> 01:23:01,959
COMMUNITY, INCLUDING PARTS OF

2157
01:23:01,959 --> 01:23:03,261
THE COMMUNITY WHERE A LOT OF

2158
01:23:03,261 --> 01:23:07,832
PEOPLE DON'T HAVE GOOD

2159
01:23:07,832 --> 01:23:08,099
INSURANCE.

2160
01:23:08,099 --> 01:23:10,568
IT WOULD TAKE A SEA CHANGE, BUT

2161
01:23:10,568 --> 01:23:15,707
IT'S NOT TO SAY IT'S IMPOSSIBLE.

2162
01:23:15,707 --> 01:23:17,575
THERE WOULD HAVE TO BE POLICIES

2163
01:23:17,575 --> 01:23:18,776
AND DIFFERENT PEOPLE IN

2164
01:23:18,776 --> 01:23:22,146
LEADERSHIP THAT WOULD MAKE THAT 

2165
01:23:22,146 --> 01:23:24,148
HAPPEN, I THINK. 

2166
01:23:24,148 --> 01:23:26,651
>> LET ME TURN TO ANOTHER

2167
01:23:26,651 --> 01:23:28,519
QUESTION IN THE CHAT.

2168
01:23:28,519 --> 01:23:31,589
I'M CURIOUS TO HEAR MORE

2169
01:23:31,589 --> 01:23:34,659
THOUGHTS ABOUT INTEGRATIVE AND

2170
01:23:34,659 --> 01:23:35,693
COMPLEMENTARY INTEGRATIONS LIKE

2171
01:23:35,693 --> 01:23:38,596
YOGA TO SUPPORT MENTAL HEALTH,

2172
01:23:38,596 --> 01:23:40,131
WELL-BEING, LIFESTYLE CHOICES

2173
01:23:40,131 --> 01:23:42,200
AND OR SOCIAL HEALTH CHALLENGES

2174
01:23:42,200 --> 01:23:43,301
WHICH BURDEN THE MEDICAL SYSTEM

2175
01:23:43,301 --> 01:23:45,803
AND OFTEN HAVE POOR OUTCOME WHEN

2176
01:23:45,803 --> 01:23:48,773
TREATED BY PRIMARY CARE

2177
01:23:48,773 --> 01:23:49,874
PHYSICIANS.

2178
01:23:49,874 --> 01:23:50,241
AND MEDICATIONS.

2179
01:23:50,241 --> 01:23:51,743
AS A YOGA PROFESSION THERE ARE

2180
01:23:51,743 --> 01:23:53,144
MANY CONVERSATIONS ABOUT

2181
01:23:53,144 --> 01:23:55,246
INTEGRATING YOGA INTO HEALTH

2182
01:23:55,246 --> 01:23:55,546
CARE.

2183
01:23:55,546 --> 01:23:57,849
WHAT ARE YOUR WARNINGS OR

2184
01:23:57,849 --> 01:23:59,517
ENCOURAGEMENT FOR THIS WHEN

2185
01:23:59,517 --> 01:24:00,251
CONSIDERING ACCESS AND

2186
01:24:00,251 --> 01:24:02,453
POPULATION HEALTH OR WORKING TO

2187
01:24:02,453 --> 01:24:05,089
REDUCE NEGATIVE SOCIAL

2188
01:24:05,089 --> 01:24:07,391
DETERMINANTS OF HEALTH?

2189
01:24:07,391 --> 01:24:08,092
>> IT'S INTERESTING.

2190
01:24:08,092 --> 01:24:13,731
I THINK THESE SORTS OF

2191
01:24:13,731 --> 01:24:17,935
ALTERNATIVE THINGS, YOGA, TAI

2192
01:24:17,935 --> 01:24:20,738
CHI, SOME IN V.A. PROVIDE THESE

2193
01:24:20,738 --> 01:24:22,406
TO VETERANS WITH PTSD BECAUSE

2194
01:24:22,406 --> 01:24:24,876
IT'S AN INTEGRATED SYSTEM.

2195
01:24:24,876 --> 01:24:29,480
THE PROBLEM WITH ALMOST ALL OF

2196
01:24:29,480 --> 01:24:30,915
THE SYSTEMS THAT PEOPLE, WHERE

2197
01:24:30,915 --> 01:24:36,587
PEOPLE GET MEDICAL CARE THEY ARE

2198
01:24:36,587 --> 01:24:38,990
NOT INTEGRATED, AND IS THE

2199
01:24:38,990 --> 01:24:43,027
GENERAL MEDICINE CLINIC AT UCLA

2200
01:24:43,027 --> 01:24:49,167
OR UCSF OR CORNELL OR COLUMBIA

2201
01:24:49,167 --> 01:24:51,102
GOING TO HIRE A YOGA INSTRUCTOR

2202
01:24:51,102 --> 01:24:52,703
TO WORK WITH THEIR PATIENTS?

2203
01:24:52,703 --> 01:24:54,639
THEY MIGHT, BUT MAYBE THEY THINK

2204
01:24:54,639 --> 01:24:56,073
WELL, WHY DON'T WE INVEST THAT

2205
01:24:56,073 --> 01:24:57,475
IN A NURSE, RIGHT?

2206
01:24:57,475 --> 01:25:00,211
AND THE POINT IS THAT YOU CAN DO

2207
01:25:00,211 --> 01:25:02,113
ALL OF THESE THINGS IF YOU THINK

2208
01:25:02,113 --> 01:25:03,614
THAT THIS IS -- IF YOUR MISSION

2209
01:25:03,614 --> 01:25:06,450
IS TO HELP ALL OF THESE PEOPLE.

2210
01:25:06,450 --> 01:25:07,985
AND THE REALITY IS OF COURSE

2211
01:25:07,985 --> 01:25:09,854
THAT MANY OF THE AFFLUENT PEOPLE

2212
01:25:09,854 --> 01:25:17,328
THAT GET CARE IN THESE SYSTEMS

2213
01:25:17,328 --> 01:25:19,831
CAN GET YOGA OUTSIDE THE HEALTH

2214
01:25:19,831 --> 01:25:21,666
CARE SYSTEM AND OFTEN DO.

2215
01:25:21,666 --> 01:25:23,901
SOME IS AN ORGANIZATIONAL

2216
01:25:23,901 --> 01:25:27,271
QUESTION, HAVING AN ORGANIZATION

2217
01:25:27,271 --> 01:25:28,172
COMMITTED TO COMPREHENSIVELY

2218
01:25:28,172 --> 01:25:30,174
ADDRESSING THE WELL-BEING OF AN

2219
01:25:30,174 --> 01:25:31,242
ENTIRE POPULATION, AS I SAID,

2220
01:25:31,242 --> 01:25:32,543
THERE ARE A LOT OF PEOPLE WHO

2221
01:25:32,543 --> 01:25:36,247
COME TO MEDICAL CARE AND DEMAND

2222
01:25:36,247 --> 01:25:37,381
SERVICES, THEY DON'T REALLY

2223
01:25:37,381 --> 01:25:38,449
UNDERSTAND WHAT'S WRONG BUT

2224
01:25:38,449 --> 01:25:39,884
OFTEN THEY ARE DEPRESSED OR

2225
01:25:39,884 --> 01:25:41,285
ANXIOUS OR THEIR LIFE IS JUST

2226
01:25:41,285 --> 01:25:45,323
NOT GOING THE WAY IT SHOULD.

2227
01:25:45,323 --> 01:25:48,192
AND THOSE ARE PEOPLE WHO WOULD

2228
01:25:48,192 --> 01:25:49,961
BENEFIT FROM HAVING ACCESS TO

2229
01:25:49,961 --> 01:25:52,763
ADDITIONAL RESOURCES.

2230
01:25:52,763 --> 01:25:55,399
 

2231
01:25:55,399 --> 01:25:56,334
>> KATRINA?

2232
01:25:56,334 --> 01:25:59,570
>> YEAH, I WANTED TO ASK
ANOTHER

2233
01:25:59,570 --> 01:26:07,111
AUDIENCE QUESTION OF HOW CAN 

2234
01:26:07,111 --> 01:26:07,712
COMMUNITY-BASED ORGANIZATIONS

2235
01:26:07,712 --> 01:26:08,779
PLAY PIVOTAL ROLE TO PROLONG

2236
01:26:08,779 --> 01:26:10,948
QUALITY OF LIFE SO THINKING

2237
01:26:10,948 --> 01:26:13,050
ABOUT OUR HEALTH CARE SYSTEM,

2238
01:26:13,050 --> 01:26:15,453
HEALTH SYSTEM AS A WHOLE, THAT

2239
01:26:15,453 --> 01:26:19,390
GOES BEYOND HEALTH CARE DELIVERY

2240
01:26:19,390 --> 01:26:24,762
SYSTEMS, AND REALLY BECOMES PART

2241
01:26:24,762 --> 01:26:25,329
OF POUR COMMUNITY.

2242
01:26:25,329 --> 01:26:29,233
>> OVER THREE TRILLION A
YEAR,

2243
01:26:29,233 --> 01:26:30,902
MAYBE FOUR, THAT GOES INTO

2244
01:26:30,902 --> 01:26:32,970
HEALTH CARE, ALMOST NONE TO

2245
01:26:32,970 --> 01:26:34,138
COMMUNITY ORGANIZATIONS.

2246
01:26:34,138 --> 01:26:37,575
AND I REMEMBER ONE POINT WHERE

2247
01:26:37,575 --> 01:26:40,845
THEY WERE DISCUSSING AT UCLA

2248
01:26:40,845 --> 01:26:42,813
PUTTING CLINICS AROUND THE

2249
01:26:42,813 --> 01:26:44,916
VARIOUS PARTS OF THE LOS ANGELES

2250
01:26:44,916 --> 01:26:45,116
BASIN.

2251
01:26:45,116 --> 01:26:46,617
IT REALLY LOOKED LIKE THEY WERE

2252
01:26:46,617 --> 01:26:47,818
ONLY CERTAIN PARTS OF THE LOS

2253
01:26:47,818 --> 01:26:49,287
ANGELES BASIN WHERE THEY WERE

2254
01:26:49,287 --> 01:26:50,922
PUTTING THE CLINICS.

2255
01:26:50,922 --> 01:26:52,556
THEY WEREN'T PUTTING THEM IN

2256
01:26:52,556 --> 01:26:53,457
SOUTH CENTRAL OR EAST LOS

2257
01:26:53,457 --> 01:26:53,791
ANGELES.

2258
01:26:53,791 --> 01:26:55,526
I SAID WHAT ABOUT THE HISPANIC

2259
01:26:55,526 --> 01:26:56,327
AND BLACK PEOPLE?

2260
01:26:56,327 --> 01:26:58,262
WHO IS GOING TO TAKE CARE OF

2261
01:26:58,262 --> 01:26:58,496
THEM?

2262
01:26:58,496 --> 01:27:02,266
THE ANSWER I GOT WAS, OUR

2263
01:27:02,266 --> 01:27:03,401
AFFILIATES, MEANING THE PUBLIC

2264
01:27:03,401 --> 01:27:03,734
HOSPITALS.

2265
01:27:03,734 --> 01:27:05,603
THAT'S NOT AN OKAY ANSWER.

2266
01:27:05,603 --> 01:27:08,539
IT'S ALSO NOT OKAY TO SAY, WELL,

2267
01:27:08,539 --> 01:27:09,307
YOU COMMUNITY ORGANIZATIONS

2268
01:27:09,307 --> 01:27:10,741
SHOULD GO AND DO STUFF.

2269
01:27:10,741 --> 01:27:15,313
I THINK IF COMMUNITY

2270
01:27:15,313 --> 01:27:16,180
ORGANIZATIONS WERE FUNDED,

2271
01:27:16,180 --> 01:27:21,786
SOMETHING THAT EASILY COULD BE

2272
01:27:21,786 --> 01:27:24,288
STUDIED, ADEQUATELY, YOU KNOW,

2273
01:27:24,288 --> 01:27:27,658
TO HAVE PAID STAFF SUPPORTED BY

2274
01:27:27,658 --> 01:27:29,694
THE HEALTH BUDGET, THAT MIGHT

2275
01:27:29,694 --> 01:27:30,861
DECREASE OTHER MEDICAL COSTS.

2276
01:27:30,861 --> 01:27:33,397
OR EVEN IF IT DIDN'T DECREASE

2277
01:27:33,397 --> 01:27:35,399
COSTS IT MIGHT IMPROVE THE

2278
01:27:35,399 --> 01:27:36,567
HEALTH OF MANY PEOPLE.

2279
01:27:36,567 --> 01:27:40,304
SO I THINK IT'S A GREAT IDEA TO

2280
01:27:40,304 --> 01:27:41,372
HAVE COMMUNITY ORGANIZATIONS

2281
01:27:41,372 --> 01:27:41,639
INVOLVED.

2282
01:27:41,639 --> 01:27:48,012
ONE CAVEAT I WOULD OFFER IS YOU

2283
01:27:48,012 --> 01:27:49,714
SHOULDN'T HAVE PEOPLE IN THE

2284
01:27:49,714 --> 01:27:52,016
COMMUNITY BEING THE ONLY PEOPLE

2285
01:27:52,016 --> 01:27:55,186
IN THE SYSTEM, AROUND THE

2286
01:27:55,186 --> 01:27:56,721
SYSTEM, WHO ARE CULTURALLY CLOSE

2287
01:27:56,721 --> 01:27:59,657
TO THE PATIENTS.

2288
01:27:59,657 --> 01:28:02,827
YOU DON'T WANT YOUR DOMINICANS

2289
01:28:02,827 --> 01:28:08,966
AND YOUR AFRICAN AMERICANS AND 

2290
01:28:08,966 --> 01:28:10,634
OTHERS TO HAVE A COMMUNITY

2291
01:28:10,634 --> 01:28:13,771
WORKER OR PERSON WHO COMES TO

2292
01:28:13,771 --> 01:28:16,540
HELP THEM OUT, AND WHO HAS A

2293
01:28:16,540 --> 01:28:17,508
DOCTOR THEY CAN'T POSSIBLY

2294
01:28:17,508 --> 01:28:18,009
COMMUNICATE WITH.

2295
01:28:18,009 --> 01:28:19,710
THOSE ARE PROBLEMS THAT NEED TO

2296
01:28:19,710 --> 01:28:27,151
BE ADDRESSED IN PARALLEL. 

2297
01:28:27,151 --> 01:28:28,152
>> OKAY.

2298
01:28:28,152 --> 01:28:29,887
WELL, I THINK WE'RE ABOUT TO RUN

2299
01:28:29,887 --> 01:28:31,322
OUT OF TIME.

2300
01:28:31,322 --> 01:28:35,659
SO I'M GOING TO BRING THIS TO A

2301
01:28:35,659 --> 01:28:36,460
CLOSE.

2302
01:28:36,460 --> 01:28:40,965
I THINK THIS HAS BEEN VERY

2303
01:28:40,965 --> 01:28:42,299
THOUGHT PROVOKING, MARTIN.

2304
01:28:42,299 --> 01:28:45,336
I REALLY APPRECIATE YOU TAKING

2305
01:28:45,336 --> 01:28:48,072
THE TIME TO PRESENT HERE AT NIH.

2306
01:28:48,072 --> 01:28:49,173
WE'LL FIND OUT ULTIMATELY HOW

2307
01:28:49,173 --> 01:28:50,941
MANY PEOPLE ACTUALLY TUNED IN,

2308
01:28:50,941 --> 01:28:53,110
I'M SURE WE HAD MANY MORE

2309
01:28:53,110 --> 01:28:56,847
QUESTIONS LINED UP THAT WE COULD

2310
01:28:56,847 --> 01:28:59,617
ASK BUT I ENJOYED THE

2311
01:28:59,617 --> 01:29:01,018
PERSPECTIVES THAT KATRINA AND

2312
01:29:01,018 --> 01:29:02,987
MONICA BROUGHT TO THE QUESTIONS,

2313
01:29:02,987 --> 01:29:05,423
TO THE CONVERSATION WITH YOU.

2314
01:29:05,423 --> 01:29:08,025
AND SO AGAIN I WANT TO EXPRESS

2315
01:29:08,025 --> 01:29:11,395
MY APPRECIATION FOR YOUR

2316
01:29:11,395 --> 01:29:14,165
PRESENTATION, TO OUR COMMUNITY,

2317
01:29:14,165 --> 01:29:17,435
AT NIMHD, AND NCI, AND THE

2318
01:29:17,435 --> 01:29:18,869
OUTCOMES AFFECTING RESEARCH

2319
01:29:18,869 --> 01:29:20,371
INTEREST GROUPS.

2320
01:29:20,371 --> 01:29:21,505
SO THANKS AGAIN, MARTIN.

2321
01:29:21,505 --> 01:29:22,807
>> WELL, THANK YOU VERY
MUCH.

2322
01:29:22,807 --> 01:29:25,009
IT'S REALLY BEEN A PLEASURE AND

2323
01:29:25,009 --> 01:29:25,976
IT'S BEEN VERY STIMULATING

2324
01:29:25,976 --> 01:29:26,844
DISCUSSION FOR ME.

2325
01:29:26,844 --> 01:29:29,246
IF ANY OF YOU DO GET THE CHANCE

2326
01:29:29,246 --> 01:29:31,482
TO READ MY BOOK, THE PRESENT

2327
01:29:31,482 --> 01:29:38,656
ILLNESS, PUBLISHED BY JOHNS 

2328
01:29:38,656 --> 01:29:41,192
HOPKINS, YOU CAN DISSECT MY

2329
01:29:41,192 --> 01:29:42,159
ANALYSIS AND PROPOSALS LINE BY

2330
01:29:42,159 --> 01:29:44,128
LINE AND COME UP WITH BETTER

2331
01:29:44,128 --> 01:29:44,562
IDEAS.

2332
01:29:44,562 --> 01:29:48,532
OR MAYBE AGREE WITH A FEW. 

2333
01:29:48,532 --> 01:29:49,700
BUT IT'S BEEN WONDERFUL.

2334
01:29:49,700 --> 01:29:50,367
>> THANK YOU, MARTIN.

2335
01:29:50,367 --> 01:29:51,368
>> IT'S BEEN WONDERFUL TO
TALK

2336
01:29:51,368 --> 01:29:52,603
TO YOU.

2337
01:29:52,603 --> 01:29:52,970
THANK YOU.

2338
01:29:52,970 --> 01:29:55,306
>> THANK YOU.

2339
01:29:55,306 --> 01:29:55,739
BYE-BYE.

2340
01:29:55,739 --> 01:29:56,006
TAKE CARE.

2341
01:29:56,006 --> 01:29:57,641
>> THANKS, EVERYONE.

2342
01:29:57,641 --> 01:30:07,641
BYE.