Alexi Nazem: Building Healthcare Solutions

Harlan Krumholz: Welcome to Health & Veritas. I’m Harlan Krumholz.‌

Howard Forman: And I’m Howie Forman. We’re physicians and professors at Yale University. We’re trying to get closer to the truth about health and healthcare. Our guest today is Dr. Alexi Nazem. But first we like to check in current hot topics in health and healthcare, and you’re just back from a major meeting, I hope you’re going to tell us something from that.‌

Harlan Krumholz: I know you’re asking me to talk to you about this meeting so I’m glad to do it. I was at the American College of Cardiology meeting in Chicago, it’s one of the two major U.S. cardiology meetings that occurs every year. There’s a third major meeting that occurs in Europe and, of course, a lot of other meetings all over the year, but these are the meetings that you tend to get the major presentations. It was a good meeting, maybe around ten or fifteen thousand people, I know that’s not as many as you get to the radiology meetings, but—‌

Howard Forman: It’s still big.‌

Harlan Krumholz: ... it was a crowd, it’s in McCormick—‌

Howard Forman: Same place.‌

Harlan Krumholz: ... in Chicago, main convention hall, a lot of great energy. I think it feels fully back from the pandemic, we talked about that even last year, and there weren’t any truly ground-breaking studies that were presented, but a lot of interesting things. I’ll tell you the one that caught my eye that I thought was very interesting was a study of people with diabetes and testing our old friend here, semaglutide, Ozempic, but not in people who had obesity but in people with type 2 diabetes. As you know, this drug has been used in people with diabetes for a long time, but here was a situation where people had peripheral arterial disease. So, they had problems—‌

Howard Forman: Complications, yeah.‌

Harlan Krumholz: Problems getting blood to their limbs and so, when they walk, they start getting something called claudication, they get pain in their legs, which it turns out to be quite limiting. They can’t walk very far without getting pain; their lives become very constrained. And we’ve had very few medicines, in fact, there are no really, really effective medicines for them, and so they’re left with, if they’ve got anatomy that’s amenable to procedures, people can do procedures. We have a team here led by Carlos Mena that’s remarkable, they do a lot of procedures but a lot of people don’t have that kind of anatomy or don’t get those kind of results, medicines have been short. So, what they asked the question is, what if we gave people semaglutide, this injection, once a week? What would it do for their peripheral artery disease?‌

And Howie, it was published in The Lancet. It was a remarkable result. These people walked longer, their perfusion improved, and it worked for people whether or not they were living with obesity, people who did not have obesity had same kind of benefits. It’s beginning to turn the tide toward thinking about these drugs as vascular drugs. I’ve talked about them as cardiometabolic drugs because they have favorable effects on inflammation and on lipids and on hypertension, but this was interesting because it was really a measurable benefit on how far they could walk, how well they were perfusing their limbs, and it was the main presentation at the main session and it was really well received.‌

A couple of other things of interest, there were a couple of studies that were about testing things that we tended to do and thought that it was the right thing to do and showing that they weren’t. I’ll give you two quick examples. One is when people come in with cardiogenic shock, there is a device we can put into their aorta which blows up a balloon when their heart’s relaxing, improving the perfusion to the heart, and it rapidly deflates when the heart squeezes, almost sucking blood out of the heart. It’s called an intra-aortic balloon pump, used quite commonly for patients who are failing, for failing—‌

Howard Forman: For decades now, 40 years, yeah.‌

Harlan Krumholz: They did a randomized trial in Italy, a relatively modest trial, but it was the first time this had been studied in this way and found no benefit for this device which can cause complications.‌

Howard Forman: Crazy.‌

Harlan Krumholz: So, it’s causing people to rethink it. A lot of people are calling for more studies but it’s interesting to show that. Just quickly, another one was patients with cancer who had blood clots, “venous thrombotic disease,” as we say, are put on anticoagulants. Usually they’re put on full-dose anticoagulants for a long time but many of these people suffer complications from these anticoagulants, they get bleeding, for example. And they tested a reduced-dose regimen and found that it was just as beneficial in preventing the—‌

Howard Forman: They had complications.‌

Harlan Krumholz: These complications, these blood clots, and of course had a lower, not of course, it showed it was safer, fewer bleeds as a result and now it’s going to lead people to probably deescalate. This article appeared in The New England Journal of Medicine, also was at that main session, it was a terrific... There were many others, but—‌

Howard Forman: That’s great.‌

Harlan Krumholz: ... that’s just a smattering of stuff that people can.‌

Howard Forman: Yeah, I tell you, I only follow this because I’ve known you and so I look and see what’s going on but I’m looking forward. You and I have to talk about atrial fibrillation and the technological advancements there because I did see there was one major paper on that that relates to the procedure I had just five months ago. So, in a future episode, we could—‌

Harlan Krumholz: A lot of advancements around that. By the way, our journal, JACC, published an article looking at long-term outcomes, but—‌

Howard Forman: I’d love to talk more about it, it’s just, it is great to see how much advancement there is in a year.‌

Harlan Krumholz: So, cardiology is still going great, a lot of vibrancy but, like I said, at this meeting, there wasn’t one study that was going to shock the world but it was, for us in the field, lots of good evidence being generated.‌

Howard Forman: That’s good, to have good news.‌

Harlan Krumholz: Let’s get your guest. Another student of yours, someone I also know from this time at Yale and—very well.‌

Howard Forman: Yeah.‌

Harlan Krumholz: All right, great. Let’s go.‌

Howard Forman: Dr. Alexi Nazem is a physician-entrepreneur and general partner at AlleyCorp, an early-stage venture fund where he leads the healthcare team and oversees investments and incubations across digital health with a focus on value-based care and physician entrepreneurship. Previously, Dr. Nazem co-founded and served as the CEO of Nomad Health, a digital marketplace for freelance clinical work where he continues to serve as a board member. Under his leadership, Nomad connected over 400,000 clinicians to jobs and was ranked as the fastest-growing staffing firm in the U.S. in 2023. He serves as an assistant professor of medicine at Weill Cornell Medicine and previously practiced as a hospitalist at New York Presbyterian Hospital. He received his bachelor’s degree and MD degree from Yale and an MBA from Harvard Business School before completing an internal medicine residency at Brigham and Women’s Hospital.‌

So, first, I want to welcome you to the podcast. I’ve known you for a long time, quite honestly, I think my first introduction to you came via Brian Osias, who’s a Yale College graduate as well, who’s not really in healthcare, and I remember Brian telling me about you at that time. But then the other connection was that, I believe, you succeeded Erika Pabo at IHI around the same time—at the Institute for Healthcare Improvement working under Don Berwick—and that, to me, was your first big healthcare credential. I’d love to hear the path from Yale College to Yale Medical School, stopping off at IHI and how that informed your career right now.‌

Alexi Nazem: Sure, thank you. First of all, it’s just such a privilege to be on this podcast. I’m a long-time listener so I’m thrilled to actually be able to be a guest and, most importantly, because both, Harlan and Howie, you’ve been impactful to me and my career. So, this has been a—‌

Harlan Krumholz: Sorry. I love when they start that way, Howie, long-time listener, first time guest.‌

Alexi Nazem: Yeah.‌

Howard Forman: I know. And we want them to be a second-time guest eventually, yup, yup.‌

Alexi Nazem: Yeah. What’s the door prize? No, this is a real highlight for me. If you had told me 20-some-odd years ago, when I first met you, Howie, that we’d be doing a podcast talking about how I actually achieved what I had hoped to do by getting advice from you, I wouldn’t have believed it. But yeah, so in the early 2000s, I was an undergrad at Yale, and it was a very interesting time. When I arrived, it was at the peak of the dotcom boom, it was before the bust and there was just a great fervor around being an entrepreneur and creating new things and the role that technology could play in our lives, the internet was just really taking off. And so, there was this just interesting milieu that I walked into.‌

And at the same time, there was a lot of exciting stuff happening in the world of science during my ... I think it was my freshman year, the Human Genome Project was completed, and there was just this tremendous well of excitement around the idea that, well, a rational future around life sciences was upon us, this intersection of huge computing technology and new frontiers in life sciences would cross over and create a whole new era of health and healthcare. And so, in that mix, I started to get very, very excited about, well, what could my career be and could I play at that intersection and that’s how I found my way first to you, Howie. Brian did indeed introduce us. I think I still have the email from way back when.‌

I was just looking for what, at the time, was a very unusual career path, I think. At the time, I think there was only six programs in the country that allowed for a joint MD-MBA, Yale being one of them, and I didn’t know anything about it. I didn’t even know that I wanted to be a doctor, much less combine it with business, and so I was just seeking out people who could be examples and models and Brian connected me to you. And some of those conversations were very influential as demonstrating, “Hey, there is a real pathway here,” not only a pathway but also a pathway to an opportunity. There were some interesting things that one could do as a professional by being a native speaker of both the languages of medicine and business. And so, I didn’t know precisely what I wanted to do, as I said, I was thinking in the life sciences and the role that business could play in the life sciences. I was an undergraduate molecular biophysics and biochemistry major, I thought maybe I would live at the bench, hopefully, bring something that I discovered into the commercial realm.‌

But as I kept meeting people, and that was one of the great things about being an undergrad at Yale, was just you were one or two hops away from some really phenomenal people and everyone was kind, people like you would always make a forward introduction and say, “You know, based on what you said, you should probably go talk to this person.” One thing led to another, I ended up meeting ... I think it was Gayle Capozzalo who introduced me, at the time, I believe, was on the board of IHI, and she said, “You know, this could be an interesting area for you to go talk to some people over there,” not even the thing about it as a job, just... and so, I hopped on the Amtrak one day that I had a free afternoon or something, and I met with some of the staff at IHI and found it very interesting and then one thing led to another—literally, as I was there, and they said, “You know, would you maybe be interested in a job here when you graduate next year?” ‌

And then, at the time, I didn’t realize what a big deal it was, but they brought Don Berwick into the room, and then Don and I just talked for an hour and a half and then he ended up offering me a job to be his special assistant, which, in retrospect, even 20-some-odd years later, is probably the single most important job I ever got to have because, obviously, Don is a legend in the systems improvement, quality improvement, patient safety world but just generally in healthcare policy, healthcare scholarship. And as a result of just riding sidecar on everything that he got to do, meeting all the people that would come through his office every day and helping him do research and write speeches and things like that, I got a very rapid education in this world, the care delivery world, and actually ended up getting drawn much more in that direction rather than the direction of life sciences and biotechnology despite my specific training—‌

Harlan Krumholz: So, you had this close proximity to him. What were some of the most important things you learned?‌

Alexi Nazem: The list is so long, I don’t think we have a long enough time to talk about it. I think probably the single biggest lesson, though, that I drew from it was—I started first working as a special assistant, as I said, and that was a jack-of-all-trades kind of job. But during my tenure there, the IHI launched this thing called the 100,000 Lives Campaign, and this was this concept of there’s all this great evidence-based practice but it isn’t widely adopted, it’s not the standard of practice. And so, Don had this idea of we should make a specific goal, because people respond to goals. They set a specific goal, let’s prevent 100,000 deaths in hospitals in the United States by a specific date, June 14, 2006, which was 18 months forward from the time that he announced it at one of the annual conferences. And I ended up transitioning to the campaign team, and I built out the field operations, coordinating all of the hospitals and state medical boards and American Hospital Association, all of them working together.‌

And we were a small team—we were eight people, I believe, on the campaign team—and ultimately had a big impact on over 3,000 hospitals. And depending on what you believe about the statistical research, we actually reached our goal, exceeded our goal of 100,000 deaths prevented. And bringing it back to the lesson from Don, it is amazing what a small group of motivated people with a very clear goal can do to change healthcare or to indeed change anything in the world but, in our case, healthcare. And the IHI itself was a very small organization at the time, I think it was maybe a hundred people, and it was a real leader in terms of thought leadership, in terms of scholarship. And so, this idea that smart, clear thinking and passionate communication and hard work could really drive change is something that has actually undergirded, I think, my entire professional career since, and that’s a big lesson that I took from him.‌

Harlan Krumholz: The one thing I do know, that he was able to generate almost religious revivals around improving quality and that emotional sense of people engaged in their jobs, excited about trying to make things better, is something I’ve almost never seen before when he would give a speech or those kinds of things. The thing that’s interesting about the measurement, I just want to say one more thing about it: we have still this problem today. And so, as all these changes are going on in the federal government, which is a little bit of a different kind of change than what you guys were trying to do, we’re going to want to look very closely and actually capture what happens, what’s going on, is there harm accruing as you drop 20,000 people from HHS, as you get rid of the patient safety net, as you drop people from a wide range of areas.‌

It just strikes me that it still is this one area that we’ve got to fix because we need early warning systems. Both early warning systems when there’s just abrupt change and we want to know “are people harmed?” and also, when you’re trying to make things better, we need early detection systems as to whether the investment is actually turning around.‌

Alexi Nazem: Yeah, I think measurement has been one of the hardest challenges in care delivery. At first, we don’t necessarily have yet great measurements about what is quality. I know you might dispute that, Harlan, I know this is your area of expertise so I can—‌

Harlan Krumholz: No, I still think we’re at early phases, even now after all this time.‌

Alexi Nazem: And even if we had perfect measures of quality, these are such complex real-world experiments where you can’t have a true control group or anything like that and so everything’s so.... There’s so much crossover that it becomes really difficult to understand at scale what this all means, and we want to move so fast. It’s only been 15 years since the ACA was passed, that’s probably still not enough time to see the impact of all these CMMI programs, and yet we’re adding and dropping programs all the time, and there’s so much different plan design, and it’s just really hard to know, are we making the progress that we seek to make? But I guess you just got to keep pushing forward, and that’s why you end up relying a little bit on gestalt and on anecdote, unfortunately. It’s antithetical to the scientific enterprise, but it defies a little bit of the standard approach to measurement.‌

Howard Forman: I want to jump ahead by a decade and get to you co-founding Nomad Health at a time when physicians and eventually nurses and other providers are seeking short-term engagements and institutions are seeking short-term coverage from those groups. What inspired you to pursue that track, and can you tell us about how the original vision changes over time and how you roll with it as a founder and CEO?‌

Alexi Nazem: Sure, a lot there to unpack. I think, just first and foremost, what caused me to step out of day-to-day practice and go found a company and, really, it’s when you’re on the frontline, you see all the problems but you don’t really have the agency and certainly not the time to go fix those problems. And I would always walk around with a little notebook in my white coat and note down all the problems. Eventually I just said, “I got to go fix one of these things.” I was just getting a little bit of an itch. This one in particular was interesting in that my co-founders are some other Yalies, in fact, one of your previous guests, Max Laurans, was a co-founder. And so, he and another neurosurgeon had the original kernel of the idea of a marketplace for short-term staffing for doctors, and I was separately on one of the most annoying problems in healthcare, which is credentialing, and we ended up getting all reintroduced to each other and ended up building this company.‌

And what we ended up building became a little bit different than what we each came into the business with. Ultimately, our biggest growth area was in short-term staffing for nurses instead of doctors, but you respond to what’s working, where there is fit between the product and the market. And so, that’s actually one of the hardest things to do because you invest so much of your personal energy, emotional energy into something, and you think it’s right, and you have to believe it against all odds and when everyone else is telling you it’s not working but, eventually, you kind of have to realize it isn’t working so you got to move on to the next thing. And so, having multiple irons in the fire and being able to compare them against each other is another useful way. We started with a doctors’ marketplace about a year later, launched a nurses’ marketplace, ran them both for a while and then, ultimately, the nurses became a little bit more of an interesting and valuable business to our customers, and so we doubled and tripled down there.‌

Howard Forman: And just to follow up on that, COVID comes along and surprises the hell out of all of us. COVID changes everything in every way. What is the biggest surprise for you about how COVID impacted your business model?‌

Alexi Nazem: That’s a great question. I go back and forth between was COVID the best thing or the worst thing that ever happened?‌

Howard Forman: That’s what I’m getting at. That’s exactly what I’m getting at, yeah.‌

Alexi Nazem: Yeah. So, on the one hand, it ... We were, for years beforehand, four years before the pandemic, five years before the pandemic hit, building this thing so in a small corner of the world that nobody really thought about. And then, all of a sudden, COVID comes along, and what we’re doing becomes the most important thing in healthcare, getting staff where they’re needed. And so, over the course of the pandemic, our business grew by about 60 times, which is an insane amount of growth for anything to handle, and lots of stuff broke. And so, it was positive in the sense that it allowed us to demonstrate how scalable our business was. It was the fastest-growing staffing because—not just healthcare, of any kind in the United States for five years—because of what we did over the pandemic. And it’s just because we built a technology, and this is what showed that we were differentiated and better than the traditional recruiters, is that technology can handle that massive scale, can go overnight 10x larger, and so that was a great demonstration.‌

The reason it was a bad thing for the business ultimately is that it was a bad thing for the industry. It created this real antagonism between the providers of these services and the buyers of the services, mostly health systems. And so, while short-term staffing is a necessary part of any health system—100% of healthcare systems use short-term staff—this became a four-letter word. So, you had this very complicated relationship with your customers post-pandemic and not through malice on either side but that was a very hard dynamic to work through over the last couple of years, and we’re finally getting through it but, gosh, it was ... that’s why I think maybe COVID was both the best and the worst thing that happened to us.‌

Howard Forman: I wanted to just, first of all, appreciate you coming on, a lot of insights, we could spend a lot more time but we’ll have to have you back on. I wanted to just maybe ask you one thing here at the end. You had written about this entrepreneur’s box that you, as you went through, started collecting ideas and putting them in a dropbox that you were collecting. How did you get yourself in the mindset of being solution-oriented where you were like, “What needs to be fixed and then how do I record that and then how do I come back to them?” Give us a sense of what was in your list of things that needed to be fixed in healthcare.‌

Alexi Nazem: Yeah. So, it’s a long list, I think what I started with was just noting problems, things that caused either friction or, even worse, bad outcomes. What was preventing something good from happening? And it could have been small stuff like there are not enough elevators to move patients from the ED to the floors and the flow through the hospital was slowed down and, as a result, discharges were—that’s a small problem. And then big problems around medication administration and errors introduced therein, the complexities of having the multiple steps between order to retrieval to delivery to actual taking of the medication. And so, I just looked at problems. I just said, “What are the problems?” Then I started, to your question about, “Well, how do you be solution-oriented?,” I’ve just always been a tinkerer since I was a little kid. I like taking things apart, putting them back together, I like building, and so, for me, whenever there was a problem, it was always fun to try to build a solution.‌

The thing that was the most challenging step, though, was figuring out, is it worth it to build those solutions? Is this problem big enough to solve? Can you build that solution in a way that is sustainable, durable, and then, of course, viable from an economic standpoint? And that’s where when I started getting conviction around the economic viability and the value of solving a problem, that’s when it goes from the notebook in the pocket to maybe this could be a business to start. And I’ve got a whole bunch more on my list and so, hopefully, I’ll get to building them or at least funding the people who are going to go build them.‌

Howard Forman: And speaking of that, as one last quick question, you’re at AlleyCorp now, you’re doing a lot of early-stage investments and following and incubating those, what percent of the things that you’re funding or, if you want to choose, that you’re looking at are centered on AI in one way or another right now? Because it seems to me like that’s the only thing people get excited about at the moment.‌

Alexi Nazem: Yeah, the tide has really turned, it’s almost like criminal as a founder to show up without AI in your pitch at this point. But from an investment perspective, we haven’t made a significant number of AI investments. We’ve made some, and I think that speaks to a little bit of the conservatism in healthcare and really understanding where will these things be adopted. If I fast-forward five years from now, I would be very surprised if it was in a much, much larger percentage of our portfolio, not because that’s the in-vogue thing but because I actually believe there’s real value-creation ability here. It provides some capabilities that were truly unbelievable, in the literal sense of the word, unbelievable even a couple of years ago. From my lens of having built Nomad, which is a workforce company, thinking about the potential to massively expand the capacity of clinical talent in the world is a very, very appealing thing to think about. There are many regulatory, ethical, philosophical, and financial things to think about between here and there, but the fact that it’s even a possibility makes you want to go find those businesses, invest in them because it will actually change healthcare and outcomes for the better.‌

So, that’s the reason to invest in it. You don’t want to invest in it just because it’s AI, it’s a small percent now, I think it’s going to be a much larger percentage as people start figuring out what’s the right way to use these things in healthcare. And right now, it’s mostly administrative stuff, which is interesting but not game-changing. I think when we start talking about clinical use cases of AI, it’ll start to get very, very meaningful and, from my perspective, investable.‌

Howard Forman: We hopefully will have you back sooner than that to give us an update on that, so we really appreciate you joining us and for all that you’ve done.‌

Harlan Krumholz: So great to see you.‌

Alexi Nazem: Thank you, guys, this is a lot of fun.‌

Harlan Krumholz: That was a terrific interview, always fun to have people back. I love having a long-time listener as one of our guests, that’s always a thrill.‌

Howard Forman: It was good.‌

Harlan Krumholz: But Howie, what’s on your mind this week? So much going on.‌

Howard Forman: Yeah. Well, you gave us good news; I’ll just go over some bad news. We’ve touched on some of the early policy and personnel changes of the new administration but, now that we’re well into things, it’s a good time to briefly explain what we know and what it means for health and healthcare. And this is neither meant to be exhaustive nor finished, I think much more will happen, we’re going to periodically report and discuss this, but there’s enough now that we can talk. So, there’s been an enormous shift in personnel in essentially all of the health agencies. Some of this has occurred due to voluntary early retirement, some because of firing of folks from their probationary periods, some of it through wholesale reductions in force including closing of massive programs in some cases, and some of it has been partially or fully voluntary when senior officers just no longer want to be there anymore and they leave. And the net effect of this is that large programs have been closed, leadership in key regulatory roles has been lost, and the bench is either thin or nonexistent and the remaining staff are left trying to figure out who they even report to and how they do the work.‌

There have been broad cuts in the National Center for Chronic Disease and Health Promotion within the CDC, and that came alongside cuts to programs to prevent HIV, injury prevention, and reproductive health. At the FDA, leaders of major divisions, including our former faculty member Peter Marks, who led the biologic center, were forced to resign, entire groups and centers shut down or plan to shut down. And it’s really important for people to understand: we’re not talking about the political appointees who routinely turn over when a new administration arrives, these folks are part of the permanent workforce and have worked for Bush, Obama, Trump, and Biden in the recent past—now, no more. We now have a clearer picture of how funding research is changing and, in many cases, high-priority areas are losing their funding or being dramatically deprioritized. So, while we’ve talked about health disparities and the need to prevent and treat HIV, these are no longer priorities for this administration.‌

In some instances, for seemingly calibrated political purposes, institutions such as Columbia, Princeton, and Penn are having grants canceled and, at the same time, researchers there and elsewhere are having to either change their focus or fight for internal funding for ongoing important work including diabetes, COVID, rare diseases, all at risk and this will separately impact the educational mission of these schools. Eleven billion dollars of appropriated funding to the states for public health preparedness and epidemic management have been withdrawn, this at a time when we’re having the worst measles outbreak in over 30 years. Twenty-three attorneys general of these states are fighting this, but the intent of the current administration is clear, and legal maneuverings have mixed records of success. Beyond specific programs, institutions near and far are curtailing or shutting many graduate programs that were previously fully or partly funded by the federal government, and state governments are facing uncertainty of their own in terms of budget decision-making. This is all to say that first-, second-, and third-order effects are still to be determined in full.‌

And lastly, I’ll just say the impact on global health, both from the effective shutdown of USAID and the delayed or cancelled funding of PEPFAR, will lead to countless deaths globally and a huge loss of standing of the U.S. in the world. Our medical diplomacy days are over, apparently—at least for now. So, I could go on and on, unfortunately, the more I looked into it, the more I could see specific programs, AHRQ, ASPE, lots of things that were considered embedded in government and very important are just disappearing right in front of our eyes. It’s a challenging time.‌

Harlan Krumholz: Thanks, Howie. Your words are going to resonate across, I think, our listeners. The key to me is there are two kinds of things going on here. One is the assault on the universities and the impact on existing grants that have gone through peer review, been approved, have been through a process and now are being either withheld for other reasons or because the government is no longer feeling that they’re aligned with what those prior decisions were. I’ll come out clearly that, if people got a grant based on merit and it’s in progress, it’s wasteful to stop the grant—‌

Howard Forman: A hundred percent.‌

Harlan Krumholz: ...it’s wasteful to stop the grant.‌

Howard Forman: Terrible.‌

Harlan Krumholz: Now, are there things we can do to improve accountability for the investments made by the federal government? Of course. Are there ways for us to innovate on the way in which grants are given and the cycle times that are required? Of course. But people are halfway through grants, they’re midway, they’ve made investments, they’ve made commitments, and these have been awarded based on merit. They should be allowed to proceed. They shouldn’t be tied up also in politics at the higher university level, they shouldn’t become pawns in this—‌

Howard Forman: Right, the political game.‌

Harlan Krumholz: These political issues. Now, it’s perfectly legit for the federal government to talk to universities if they think that they’ve violated federal standards but, again, if the casualty is research that’s been meritoriously provided and that’s going to harm people with the conditions, it’s going to harm people who are in the study, it’s going to harm the investigators, I’m not for it. On the side of all of these cuts, I don’t think we fully have a feel about what’s going on with all these cuts yet. We are going to need monitoring systems to understand what the impact is and, if it’s a negative impact, I can only hope that the government has the agility to react and address. The problem is that many of these, if they’re causing harm, are going to be very hard to undo, especially in the short run. But we’re going to need to watch this very carefully and it’s going to be important to understand what the impact is as we try to do this.‌

I know Rob Califf has come out, I think, and clearly said that history’s not going to look well on this. There are many reasons to be concerned about it, I believe, but we are going to need the facts. We’re going to need data, and we’re going to need to be able to show what’s happened as a result of this in order to make wise choices going forward.‌

Howard Forman: And to the point you made about Robert Califf, former FDA commissioner, this has an impact on industry. Investments in biomedical innovation will be slowed if the FDA is not able to carry out its processes for approving or not approving drugs.‌

Harlan Krumholz: Yeah, and the market’s reacting now, there’s a lot of ... Yeah, there’s a lot of concern and anxiety in the marketplace right now that’s also being reflected back, so let’s just watch this carefully. Look, the issue is that, of course, I’d like to see innovation, I’d like to see change, I’d like us to think about how we can optimize our processes. This rapid change that seems to be less precise and more broad-based and focused on areas where people were at odds with the current administration, it seems more like revenge than it does about wise choices. It’s a concern. Okay, well, you’re listening to Health & Veritas. Next week we’ll try to bring you better news.‌

Howard Forman: You brought good news today. I’m the one who brought the bad news.‌

Harlan Krumholz: I’m Harlan Krumholz and I’m here with Howie Forman.‌

Howard Forman: How did we do? To give us your feedback or to keep the conversation going, email us at health.veritas@yale.edu or follow us on any of social media, including LinkedIn and Bluesky.‌

Harlan Krumholz: And we love your feedback, please give it to us. We’re trying to just fairly call it as we see it but we always appreciate everyone’s feedback. We read it, and it’s important to us.‌

Howard Forman: If you have questions about the MBA for Executives program at the Yale School of Management, reach out via email for more information or check out our website at som.yale.edu/emba.‌

Harlan Krumholz: We are sponsored by the Yale School of Management and the Yale School of Public Health. We are blessed to have the most amazing dream team working with us, that includes Inès Gilles, Sophia Stumpf, Tobias Liu, our superstar students, and by our amazing and remarkable producer, Miranda Shafer.‌

Howard Forman: And we’re going to have an opportunity in the next couple of weeks to have a send-off for Inès and Sophia, who are both graduating this year.‌

Harlan Krumholz: Yeah, we’re going to bring them on the program and they can actually.... You guys can hear them and we’ll get a chance to say a few words to them, so, anyway, that should be terrific. Anyway, great to talk to you today, Howie. Talk to you soon.‌

Howard Forman: Thanks, Harlan. Talk to you soon.‌