MTT #109: Healthcare affordability, GLP-1s and the patient revolt ahead

0:11Dr. Robert Pearl: Hello and welcome to Medicine the Truth, one of the four weekly podcasts in our Fixing Healthcare podcast series. I'm Jeremy Corr, host of the New Books of Medicine podcast and CEO of Executive Podcast Solutions. With me is Dr. Robert Pearl. For 18 years, Robert led the Permanente Group, the nation's largest physician group. He's a healthcare contributor at Forbes, bestselling author, and professor at both the Stanford University School of Medicine and Business. His most recent book, ChatGPTMD, How AI-Empowered Patients and Doctors Can Take Back Control of American Medicine, and the impact generative AI will have in healthcare remains a bestseller.

0:40Dr. Robert Pearl: Information on a broad range of medical topics can be found on his website, robertperlmd.com. Robbie, with the midterm elections happening in a little over three months, what is on the mind of Americans relative to healthcare?

0:51Jeremy Corr: Jeremy, people have growing concerns with medical care, including access and coverage. But the biggest issue on voters' minds, that's affordability. And they're right to have that fear. The most recent data show that medical costs rose to$5.7 trillion last year. And for the third consecutive year, the cost increased by over 7%. The preliminary forecasts for this year are about the same rate of cost inflation will happen again. And that'll be, once again, approximately twice as high as the growth in GDP or wages. Currently, federal actuaries project that by 2034, medical care and services will reach nearly$9 trillion.

1:33Jeremy Corr: That will represent more than 20 % of GDP, which is the total dollar spent on everything Americans buy, including both goods and services, driving health care inflation as a combination of higher demand by patients, and expanded use of GLP-1 medications. Among the medical categories, hospital costs rose the most in total dollars, and it's now$1.8 trillion a year. Inpatient care already accounts for the largest share of our nation's healthcare expenses at over 30 % of the total. However, drug spending increased the fastest. That's up 11%. As to the impact of the election, healthcare affordability is likely to be a major factor.

2:16Jeremy Corr: As an example, a recent Axios-Ipsos poll showed that 45 % of voters would be inclined to cast their ballot for a candidate who pledged to restore the added premium support that listeners may remember expired at the end of last year for individuals on a healthcare exchange, while only 16 % would be less likely. Overall, about half of Americans say that measures aimed at drug and insurance affordability they're likely to influence which candidate they vote for. The group struggling the most with its medical expenses, that group is Paris, between the ages of 30 and 49, the ones with kids under 18.

2:54Jeremy Corr: Health care as an election issue is likely to bring them out to vote. In a similar survey of over 2 ,000 voters with good health care coverage provided through their employer, nearly 53 % had either rationed their own medical care, taken on debt, or switched to worse coverage. And overall, 74 % had experienced major cost increases over the past two years, from rising premiums or higher copayments. In the past, only the poorest Americans had trouble affording medical care. Now, it's just about everyone, including those with private insurance, those on Medicare, and individuals who purchase coverage for themselves and their family through exchange based on the current rate of medical inflation, today's problems are going to get worse in the future.

3:45Dr. Robert Pearl: Robert, those health care inflation numbers are huge. Can you break down the pieces in greater detail for listeners?

3:51Jeremy Corr: Jeremy, as you note, the numbers are massive and increasingly unaffordable for both the government and private insurers. A couple of themes jump out of the data. First, hospital costs, as we just said, are a huge driver of this medical inflation. And if anything, unless changes are made, I think the actual costs for inpatient care, they'll continue to grow rapidly. Nursing unions have a strong grip on hospital administrators. As a result, salaries and benefits are likely to rise even faster with each contract negotiation, particularly as demand rises and the population ages. Already some of the opportunities to increase quality and lower cost, particularly ones through the use of generative AI being blocked and the contracts being signed.

4:39Jeremy Corr: Many opportunities, including the expansion of hospitals at home and chronic disease management through a generative AI application, these are being resisted. Furthermore, the majority of doctors are now hospital employees. employees, and approaches that reduce inpatient senses, they won't be valued by them under their contract terms. The second number that caught my attention was around the cost of drugs, particularly GLP-1 medications. This is a more nuanced area. Based on historical data, we know that it takes between five and 10 years for improvements in lifestyle to pay off in terms of fewer heart attacks, strokes, cancers, and kidney failures.

5:20Jeremy Corr: As such, we would expect short-term costs to rise as usage grows, and embedded in that is the hope that our nation will see costs fall significantly in the future. But the question that isn't answered is the relative cost benefit of improved health against the current prices. In rough numbers, the monthly cost would need to be no more than maybe$200 a month for the savings in improved health to match the dollars spent. And so far, the lowest retail prices for the brand name drugs, they're double that. As such, we can expect the rising number of prescriptions for GLP-1 medications to increase healthcare costs, not lower them in the future.

6:07Jeremy Corr: Satellite to 2027, the government's plan to reduce federal costs seems to be focused mainly on excluding people who are currently enrolled in programs like Medicaid and the exchanges. But rather than lowering total health care expenses, this approach will simply transfer the cost for the federal government to states and local communities.

6:30Dr. Robert Pearl: Earlier this year, we discussed on this podcast the likely changes to the health care exchanges. What's happened?

6:36Jeremy Corr: Unfortunately, Jeremy, we were spot on. And what we predicted has happened. Overall, out of 23 million enrollees, the loss of premium support at the start of this year has resulted in 4 million Americans dropping coverage due to being unable to afford their new, much higher premiums. Most have seen a double-digit price increase since Congress failed to continue the added government subsidies that have been put in place by President Biden during the COVID pandemic. And now that this exodus has started, it's likely to produce a downward spiral as the sickness patients can't afford to drop coverage.

7:16Jeremy Corr: They stay in the program while they're healthy enrollees. They decide to leave, just take their chances. The 4 million figure this year of disenrollment, that contrasts with a mere 400 ,000 people who exited last year, and preliminary data indicates that another double-digit rise in premiums is coming in the year to come. Is there anything positive on the cost side? At least from the perspective of patients, there's a recent positive development. For the first time, Medicare will cover GLP-1 medications for weight loss, and the co-payment of price to enrollees, that will be only$50 a month. That's about 80 % less than the price that individuals who don't use their insurance pay under the recent agreement enacted between the Trump administration and manufacturers.

8:10Jeremy Corr: Although the$50 a month price tag is great, there are limitations to the program. First, it's being rolled out as a pilot program called the Bridge Program, and it isn't guaranteed to last after 18 months. The reason this approach is being employed is that Congress has prohibited medications for weight loss alone to be covered by Medicare. So CMS is making the bridge program a pilot project. That means that it can be put in place outside of the congressional restrictions. However, research has shown that most patients regain the weight they lost if they stop taking the GLP-1 medications. As such, there's no guarantee that there will be a positive impact should the low-price option be eliminated in a year and a half.

8:58Jeremy Corr: Second, coverage isn't automatic. There are multiple administrative steps that CMS requires doctors, pharmacists, and insurance contractors who are overseeing the process to complete. It's estimated by CMS that pre-approval will take 72 hours. However, at least at first, many observers feel these types of approvals will take far longer. As the projected volume of enrollees, that's likely to be extremely high, given the more affordable price. Robbie, who will be eligible under this program? Jeremy, the coverage will only apply to individuals with a body mass index, what's often called the BMI, over 35.

9:40If they're healthy, they'll apply to Medicare

9:45Jeremy Corr: enrollers who have heart failure, extremely elevated, uncontrolled blood pressure, or prediabetes if their BMI is over 30. The final exceptions will be people with severe medical problems, ones with prior heart attacks, strokes, or symptomatic peripheral vascular disease. For them, the eligibility level goes down to a BMI of 27. People with diabetes, cardiovascular disease, and sleep apnea, they can already obtain these medications through their Medicare Part D coverage, although they pay more than they would under the new pilot program. These individuals will be required to continue to use the Part D route, even when this alternative program is put in place.

10:28Jeremy Corr: In addition, a piece of good news for those accepted is that they will have four options relative to the specific medication prescribed. They can choose a once a week injectable. They can choose a daily pill, either from Eli Lilly, we're talking about Zepan for injection, or the pill Fondeo, or choose Novo Nordisk's Wugovi, either in the injectable or pill version. Overall, the two offered injectable medications both result in somewhere between a 15 % and 20 % weight loss on average, while the pills, they help people lose between 10 % and 15%. Finally, if they are now using a GLP-1 medication, but they don't currently qualify based on the BMI requirements, but they did when they started the drug, they will still be eligible for coverage.

11:21Jeremy Corr: The program will be administered by Humana. It will not be part of the Part D of the current Medicare program. And for that reason, the$600 a year of out-of-pocket expenses that people will have to pay won't count toward their annual Part D deductible, nor to the$2 ,100 annual out-of-pocket drug coverage cap. The government will purchase these drugs for around$245 a month, which brings the cost for the federal officials into the$200 range that I mentioned earlier for long-term cost effectiveness. But of course, all these numbers, they're estimates. No one really knows how many individuals will enroll in the program, the total expense of the coverage, or the ultimate dollars that will be saved.

12:07Jeremy Corr: Among our Medicare's 70 million members, estimates are that around 40%, or close to 30 million individuals, appear to meet the coverage criteria and therefore would be eligible under the rules. Although among that number, currently 16 million are already on the drug through their Medicare Part D option based on having diabetes, heart disease, or sleep apnea. And of course, although$50 a month is much less than the$245 that's going to cost the government, the Kaiser Foundation Family Health Research Report indicated that half of the current enrollees live on incomes of$43 ,000 a year, with half of those, or a quarter of the total, having an income below$24 ,600.

13:01Jeremy Corr: And for both groups,$600 a year may prove prohibitive. Putting all the pieces together, this should be a very educational experiment around people's interest in taking a GLP-1 drug, around their ability to afford one, and around how much health improvements actually occur once treatment begins. And of course, the reality is that if the program is successful, but the funding isn't continued after 18 months, enrollers are likely to regain the weight, and the pilot will have been a failure.

13:36Dr. Robert Pearl: Listeners always enjoy when you discuss something out of the ordinary. What do you have for us today? I can think of two very unusual stories.

13:45Jeremy Corr: The first one dates back to my time in high school biology. I remember reading the chapter on the origin of life in ninth grade biology. And despite a clear description of amino acids coming together, form proteins to create the first life form, I could never make sense of how that would happen. The odds seemed impossibly long. Of course, I got the questions right on the test. I just parroted how a variety of chemicals came together to form the first single-cell organism in a causal-like environment billions of years ago. However, recent research explains how it could have been possible. Detroit has solved the mystery of the origin of life.

14:27Jeremy Corr: For decades, scientists have tried to work backwards. They take their current life forms and remove part after part until they got as close as possible back to what could have been the first life form. At a basic level, they would require that what was left would have the ability to feed in order to have energy, to grow in order to be able to divide into two parts without perishing, and to reproduce, be able to accomplish the cell division that would be needed to create the next generation of life. Despite massive efforts for decades to make this happen, scientists have been unable to get even close to that required endpoint.

15:13Jeremy Corr: All right, I got it so far, but what happened next? Jeremy, similar to our recent conversation about the Erdos mathematics solution, finding an answer required a counterintuitive approach. A team from the University of Minnesota took a major step forward, not by subtraction, but by addition. They began with simple amino acids and other basic substances and made a synthetic cell using only inorganic materials. And the cell they created came very close to fulfilling the three criteria that the researchers had previously used to define life. has to eat, grow, and divide. To accomplish it, the size blended dozens of inorganic ingredients into a broth, added some other chemical substances that would cause bubbles to form, and in this way synthesized simple cells.

16:12Jeremy Corr: What was even more remarkable was different cells began to compete for food, with the most successful ones surviving and the others dying away, just as Darwin predicted in The Survival of the Fittest. Although the work didn't quite reach the line between inorganic and life, it was much closer than any of the approaches that the scientists using subtraction were able to achieve. Dr. Kate Ademala, the lead researcher, she called the product a spud cell based on its resemblance to a potato and measure the first one at a 20th of a millimeter, or about a fourth of the size of a fine grain of sand. This ability to create life solely from inorganic materials, it provides huge medical possibilities.

17:03Jeremy Corr: By building who's scratch, scientists can figure out which parts of a gene are essential and what functions the rest of the DNA accomplishes. And these engineered cells could be sources of new medications, as they could be programmed to produce proteins that don't exist in nature. Small molecule drugs, these are the ones that are over the counter, as an example. They can be synthesized in a chemistry lab, but the larger ones, like insulin, require a living organism. When it comes to genetic research, the small number of genes simplifies the work. since the more genes that exist, the harder it is to isolate the impact of any single one.

17:44Jeremy Corr: And unlike the E. coli bacterium, the one that's often used for this type of scientific work, it has 4 ,460 genes, while the spud cell has a mere 36. Of interest, the smallest number of genes that the scientists who approach the problem of subtraction have been able to accomplish while preserving life, that was 525, of which the scientists still don't understand what a third of them do.

18:15Dr. Robert Pearl: Jeremy, the success is amazing. Is it the end of the journey?

18:19Jeremy Corr: Jeremy, unfortunately, no. Although the research got close, they weren't able to figure out what the process needed for the cells to build what's called ribosomes. This is part of a cell that uses the DNA from the nucleus and makes the actual proteins upon which life is dependent. As a result, they had to insert ribosomes from living organisms, not inorganic chemicals. And rather than these ribosomes working forever, they became ineffective and they died out after five to ten generations. Now, some listeners may scoff at the idea that this work is even close to life, given the inability to get it perfect at this time.

19:02Jeremy Corr: But the researchers point to aviation as a comparison. They remind people that the Wright brothers flew for a total of 12 seconds. And now planes go from the United States to destinations halfway around the world. The reality of the future is built on the basic science breakthroughs of today. And this is a powerful example.

19:24Dr. Robert Pearl: Barbie, before we get to your other unexpected story, let's return to something you mentioned before. You told listeners about the potential for up to 30 million Americans over the age of 65 to be on a GLP-1 drug in the future. What's happening more broadly with these?

19:38Jeremy Corr: Given the cost of these medications, Jeremy, I find the statistics staggering. An estimated 15 % of all Americans have already tried a GLP-1, and 11 % report currently using them. That's nearly one in eight individuals. And the rate of uptake, that's rapid. The number today is 3 % more than it was in 2024, and it's likely to continue to rise now that a pill is available, rather than a shot, as the price for these drugs continues to drop. Recent data shows that the obesity rate in the United States, that too is falling. Listeners may remember from an early medicine, the truth, that in 2022, obesity had risen to 40 % of Americans, but now it's dropped down by 3.5 % to around 36.5%.

20:29Jeremy Corr: That's still high, but assuming most of the decline results from the availability of those GLP-1 drugs, then as the medications become less expensive and therefore more ubiquitous, the decline could be double digits or more. And that would have a major salutary impact on people's health, and would be expected to reduce the number of heart attacks, strokes, kidney failures, cancers, and lower limb amputations by as much as 50%. Robbie, okay, let's now have our other unusual story. Jeremy, this one has to do with cannibalism. I assume most listeners think the practice essentially disappeared and did so because of either the ick factor or maybe some kind of ethical realization.

21:21Jeremy Corr: But new research concludes that medical consequences likely had a major influence. Scientists discovered that cannibalism led to harm for the participants by causing life-threatening illnesses in those who consumed other people compared to individuals and tribes that didn't. The researchers applied a mathematical model. They found that from a caloric perspective, humans are similar to other animals. So that wasn't the difference maker. But unlike other sources of food, the bacteria and viruses of the victims, assuming the person that died, let's say from an infection, those bacteria and viruses would be equally lethal for the consumer as they were for the victim.

22:10Jeremy Corr: And that's different than when they eat animals whose bacteria and viruses often don't harm people. And the research shows that the risks rise exponentially when cannibals eat other cannibals. The reason is they're likely to only consume people in their own tribe who have died from natural causes, as we said, often infectious. Or when they ate individuals from other tribes, they would have been healthy people killed in battle. And when tribes that cannibalize become very sick, while those who don't stay healthy, the cannibal tribes become weak and don't survive. Even cooking doesn't eliminate all the risks for the cannibals, particularly from various neurologic diseases that are caused by what is often called prions.

23:02Jeremy Corr: As an example, in Papua New Guinea, one particular tribe would cook and eat their dead relatives, believing that doing so would free the spirit of them to allow a better afterlife. But when the person suffers from these diseases, the individual would often develop a debilitating condition like kuru. This is a prion encephalopathy that results in loss of coordination, tremors, and uncontrollable laughter. The scientists hypothesized that the practice of cannibalism became taboo as other members of the tribe connected the practice with these distressing neurologic outcomes.

23:43Dr. Robert Pearl: Robbie, several listeners said that they were frustrated that their wearable watches and rings generate tons of important data, but they can't figure out how to get the information onto their medical care. What do you suggest?

23:54Jeremy Corr: Our listeners are correct that rarely do physicians have the time to review all this additional information in a typical office visit. Jeremy, doctors don't want reams of data coming to their office for analysis and response. The problem is a combination of regulatory restrictions and unwillingness of insurers to pay for the time it would take. From a regulatory perspective, any tool to analyze this information would be labeled a medical device and under current law would require manufacturers to spend a huge amount of time to complete the very expensive FDA approval process. And for this reason, none of the major brands have done so.

24:34Jeremy Corr: The solution to the loss of data would be a generative AI tool that could collect the data from the watch or from the ring, do a statistical calculation of whether the information was improving or becoming worse, and allow the patient to know how things were going and whether intervention was needed. In that way, rather than waiting months for the next in-office visit, changes in medication could be accomplished quickly and without requiring a huge amount of clinician time. And if all was well, there wouldn't be any need for the doctor to see the patient, unless of course there were new symptoms that needed to be evaluated and treated.

25:12But this

25:13Jeremy Corr: is where the insurance reimbursement issues come into play. If doctors aren't paid to evaluate a patient's problem and make outpatient clinical shifts in care, then they won't do it. So today we're wasting information and opportunity, not because of technology, but human constraints. In the most recent AMA survey of over 2 ,000 doctors, only 6 % had integrated data from patient wearable devices into their electronic medical record and clinical practice. Robbie, what else is new? Jeremy, as listeners know, the parasitic infection, cyclosporiasis, has dominated the media. As of today, we don't have a complete understanding of the source of the outbreak, but FDA officials think that Taylor Farms' lettuce is likely to be the cause.

26:05Jeremy Corr: A week or so ago, the FDA announced a positive test on some of the company's lettuce, but later had to retract the conclusion saying that the test had proved false positive. Already, there's been an estimated 12 ,000 cases, either confirmed or suspected, from 34 states, with Michigan seemingly the epicenter and accounting for around half of the cases so far. Most likely, those official numbers significantly undercount total cases, since not everyone infected becomes very sick or seeks evaluation, testing, and medical treatment.

26:40Dr. Robert Pearl: Let's start at the beginning. What is this infection? Why has it been so hard to find the source? And how can people protect themselves? And what is the treatment?

26:48Jeremy Corr: Jeremy, the disease is a foodborne illness that's caused by a microscopic parasite that's found in feces of infected individuals. It passes either on people's hands or through contaminated water to produce that's being harvested or processed. From there, it goes to the GI tracts of individuals when they eat products like lettuce, raspberries, cilantro, or basil. In this case, many of the patients are assumed to become infected through the lettuce they ate at a Taco Bell restaurant. Taylor Farms is the largest supplier of lettuce in the country, with many fast food and other retail stores selling their produce.

27:26Jeremy Corr: Part of the challenge is that unlike with food poisoning that's caused by a bacterium, cyclosporiasis usually doesn't produce symptoms for one to two weeks. The reason is that the feces initially only contain an early stage of the parasite, and the organism must mature in the GI tract of the patient before it produces symptoms. And when the disease begins, the first stage is similar to many infections. There's flu-like symptoms. We're talking about fatigue and body aches, but then the problem becomes dramatically worse with patients having explosive watery diarrhea, severe stomach aches, and nausea.

28:07Jeremy Corr: This delay makes details of what people ate challenging to figure out. Listeners should consider how accurately they can reconstruct all the food they consumed over the past 14 days and the specific brands. I know I would have trouble doing so. The treatment is an antibiotic, usually Bactrim. If not treated, the infection often persists for weeks. And until the antibiotic works, it's important that individuals stay hydrated by drinking lots of water. Around 10 % of infected people require hospitalization, usually from dehydration. And those at greatest risk are the elderly or frail individuals, young children, or immunocompromised persons.

28:53Jeremy Corr: Of course, there's also a political controversy. It revolves around cutbacks in funding by the Trump administration for the CDC surveillance of infectious diseases. In the past, states had to track and report on cyclospora infections. A year ago, the CDC made that optional as it cut back on its foodborne diseases active surveillance network. Had it been in existence, it's possible this outbreak could have been recognized sooner and the products removed. And if the mode of transmission were person to person, that would have been vital. But in this case, experts aren't sure how much of a difference it would make because of the difficulty in establishing the diagnosis and figuring out the source.

29:40Jeremy Corr: Comparing the problem, the only sure way to kill the parasite is by cooking the produce to temperatures above 158 degrees Fahrenheit. And that's something we don't usually think about doing for lettuce and strawberries. But thoroughly rinsing produce and agitating the surface vigorously, that can help reduce the risks greatly. Experts recommend purchasing whole heads of lettuce and then removing the out of leaves before washing. It's less risky than buying bagged lettuce or salad mixes. And as we are recording this on Friday, July 24, a new outbreak has been reported with at least 74 cases and no identified source yet.

30:22Jeremy Corr: We certainly haven't heard the last of cyclospora. Robbie, what's another health care story? Jeremy, one of the biggest new sources of injury and medical risks, particularly in kids and adolescents, is the e-bike. I don't know what it's like in Iowa, but in California, they're everywhere and often being driven by kids who appear to be in middle school. In fact, 40 % of ER visits for e-bike injuries involve someone ages 10 to 19. Over the past five years, there's been a quadrupling of e-bike sales in the United States. And most worrisome to me as a physician is that almost a third of the injuries are to the head, face, or neck.

31:04These are the types of problems that can lead to brain injury from a skull fracture or paralysis from cervical spine cord damage.

31:12Dr. Robert Pearl: Robbie, since we talked about the new data on the importance of lowering the LDL, the bad cholesterol, to extend lives and prevent heart attacks, listeners have thanked us for the information. They want to know if there's anything new.

31:24Jeremy Corr: The answer is yes. Yes. In fact, Jeremy, the FDA has now approved a new medication in pill form that may be able to lower cholesterol levels to the very low numbers that we discussed on our podcast. But listeners should remember that getting that low, it appears essential mainly in a small select group of patients with high risk factors that greatly increase the probability of a life-threatening cardiovascular event. For most people, people at average risk, a low-priced generic statin is what's recommended rather than this new medication with its retail price projected to be around$4 ,000 a year.

32:03Jeremy Corr: The good news is that the pill works in the same way as the currently available injectable medication that's an equivalent and costs between$6 ,000 and$8 ,000 a year. The current manufacturer of the injectable drug hasn't indicated whether the company will reduce prices, but it's hard to see how they won't. And many patients are likely to want to shift anyway, preferring a pill to a shot. Robbie, I think it's time for a political story. What happened this month? As listeners will remember, Jeremy, we talked about the large number of federal agencies without a permanent director and how the president was likely to nominate Dr.

32:43Jeremy Corr: Erica Schwartz for the CDC post. Her congressional hearing at the Senate Health Committee began this month. She's a highly regarded physician with extensive experience in public policy. For all the right reasons, she's likely to be approved by the Senate. However, her testimony highlighted the concerns that doctors have about the undue influence of politics on science for this bastion of prior scientific independence. In the past, she's been supportive of childhood vaccines, consistent with the recommendations of all the pediatric medical societies. and she's expected to continue to follow the science once confirmed.

33:24Jeremy Corr: But the committee members, particularly the committee chairman, Senator Bill Cassidy, who's a physician and a Republican for Louisiana, pushed her on Health Secretary Robert F. Kennedy Jr.'s attempts to rescind these recommendations that we've discussed on Medicine, the Truth in the past. In the hearing, Senator Cassidy said, quote, quote, we need a CDC director who will actually stand up to crazy, stupid things being said that undermine faith in immunization. And then he added, are you that person? There were many ways for her to say yes, but she chose none of them. Instead, she said that she did not think that Mr.

34:05Jeremy Corr: Kennedy or Mr. Trump would ever ask her to do anything to hurt public health or break the law. Many of the committee members were dissatisfied with their statements. They pointed to multiple examples over the past year of RFK Jr. doing just that. She did affirm the efficacies and safety of all the recommended vaccines, including the mRNA technology underlying the COVID vaccine, which differs from what RFK Jr. has said in the past. And she provided her support of giving vitamin K shots to all newborns. This is another area where social media is eroding trust in an approach that has been shown to prevent internal bleeding and death in nearly all neonates.

34:47Jeremy Corr: Assuming she's confirmed, she'll inherit an agency that has lost a third of its people due to resignations and layoffs. And its record around infectious diseases, including measles and now cyclospora infections, is being criticized. I suspect the challenges are only starting for Dr. Schwartz. And contrary to what she said, she will face pressures to compromise personal beliefs, and difficulties in restoring the reputation of the CDC agency.

35:17Dr. Robert Pearl: Along those lines, what has happened relative to measles since we discussed the growing number of cases earlier this year?

35:22Jeremy Corr: As we predicted at the time, the number of measles cases has continued to rise, and it's already reached 2 ,295. That's more than the U.S. has seen at any time in any year over the past 35 years, according to researchers at Johns Hopkins University. If there are true for huge outbreaks in Texas and in Utah and South Carolina, nearly all these new cases, there are people who are unvaccinated. But in addition, a small percentage occur in individuals whose protection wanes over time. And this possibility has major risks for all Americans. Remember that the measles virus is very contagious, requires a vaccination rate of 95 % to provide what's called herd immunity.

36:09Jeremy Corr: When the vaccination rate drops below that, people become exposed to the virus. And both those who are unvaccinated and individuals whose protection has waned, such as immunocompromised patients on cancer chemotherapy, they are in grave danger.

36:27Dr. Robert Pearl: A listener was curious about the application of generative AI to drug development. What can you Teller.

36:33Jeremy Corr: Jeremy, this is a very interesting area to me. AI has massive potential, but very little to show to date as measured by the development of innovative breakthrough products. A new survey supports that view. Based on data from 80 bio-pharm art leaders, it showed in the early part of the research process. This is when many of the tasks are administrative, and Gen. AI can reduce costs and accelerate the work. It is unexpected, since the technology does the same thing in most industries, including legal, consulting, and accounting firms. It can review the literature, provide articles, write documents, and organize the endeavor.

37:10Jeremy Corr: And once the research itself begins, Gen.AI can serve as a repository of data, find correlations among findings, and assist with statistical analysis. Phrased differently, Gen.AI can learn and accelerate the tasks that humans currently do. But at least so far, it hasn't been able to design new drugs. And as a result, there are no AI-generated medications that have yet obtained FDA approval.

37:38Dr. Robert Pearl: Robbie, any final thoughts?

37:41Jeremy Corr: Jeremy, although we post a podcast every Tuesday night, we rotate four different programs, Fixing Healthcare, Diving Deep, Medicine the Truth, and Unfiltered, one each week. And as listeners know, unlike the other podcasts, on our Fixing Healthcare show, we always have a guest with a lot of varying by the theme. The current season 11 is focused on learning what the average American is saying about medicine. To do that, rather than having academics and healthcare policy experts, we've invited a range of individuals with large social media followings. They've included several hundred thousand to over a million followers.

38:25Jeremy Corr: The first question I ask are what are three things that the guest is hearing from people most commonly? I never know what the guest is going to say. And the rest of the program isn't preplanned, but instead dives deep into the three topics that the guest has introduced. As the season progresses, I'm amazed at how different the concerns the average American are for what clinicians and national medical societies are most worried about. What most people are wanting isn't unreasonable or overly demanding. They desire the ability to easily access medical care when they need it. They want it to be affordable for them and their families.

39:13Jeremy Corr: They'd like the recommendations to be personalized. In contrast, I really hear healthcare professionals asking themselves, how can we make care more convenient for patients? How can we make it cost less? And how can it be personalized so that it reflects the individual's specific life circumstances and personal preferences? And that realization leads me to consider large language models like ChatGPT, Claude and Gemini, and to think about them differently. Patients can access them 24 by 7. They already use an LLM, and they can request as much clinical expertise as they want, at no additional cost.

39:55Jeremy Corr: And the more information they provide the genitive AI application, the better and more personalized the answers will be, the patient is empowered and in control. Currently, a growing number of doctors are worried that an insurance CEO or hospital administrator will decide to replace them with a genitive AI tool. What I now can see is that the biggest threat won't be from inside the current medical system, but instead it will come from patients in their home who are frustrated, worry, and feel unheard.

40:32Dr. Robert Pearl: As a reminder to listeners, this episode is available on our website, FixingHealthcarePodcast.com, and on all podcast apps, including Apple Podcasts and Spotify. If you like the show, please rate it five stars and leave a review. Share it with your friends and family. and to submit a question or comment to the host, please visit the contact page on our website or send us a message on LinkedIn, Twitter, or Facebook. Thank you for listening and have a great day.