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Episode 72
Duration 32:43

Harlan Krumholz, This Is Your Life


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, and we’re trying to get closer to the truth about health and healthcare. We were going to interview the chairman of the Federal Reserve today, but he got pulled away to look at banking matters or something like that.

Harlan Krumholz: Oh, come on, Howie.

Howard Forman: But we do have a real surprise for our listeners. Harlan Krumholz, this is your life!

Harlan Krumholz: Oh, you know how reluctant I am to do this focusing on me.

Howard Forman: I do. I do. And I think it’s hard to do, but let, let’s do this and see.

Harlan Krumholz: Oh, my gosh.

Howard Forman: Let our listeners judge.

Harlan Krumholz: Anyone listening to them, I’m reluctantly being pulled into this. We have these periodic sessions where we don’t have a guest scheduled, and Howie and I usually just schmooze, discuss articles, talk about things.

Howard Forman: We decided that mutually that this would be good for our listeners to know a little more about you.

Harlan Krumholz: I think he decided—Howie decided individually—and I’ve been dragged along into this, so I just wanted to say, I want to make sure that’s clear for the outset, but I did interview you. We did have a great interview with you, so I thought—

Howard Forman: That’s true. That’s right. And that was a while ago. So here we got to get you.

Harlan Krumholz: It only seems fair.

Howard Forman: Harlan Krumholz is a cardiologist and a Harold Hines Jr. Professor of Medicine and the founder and director of the Yale Center for Outcomes Research and Evaluation, or CORE. And I want to just stop there because he’s so much more than his titles of which there are many, many, many. But there are a few objective measures that I think our listeners should contemplate here. He has over 1,400 scientific publications, and by some measures, over 2,000; he has been cited by scholars a whopping 300,000 times, 300,000 times scholars have referenced his paper and without—

Harlan Krumholz: I think that’s my mother. She just keeps doing it over and over and over.

Howard Forman: …without spending too much time explaining this. His H index, which is a measure of not just how productive someone is but how much attention they draw to their research, is approaching 230, which is exceeded by just a few clinician scientists in the world and is tops at Yale. Making this all the more extraordinary is that he remains a practicing physician. One of the most sought-after mentors for undergraduates, graduate students, and faculty, and being sought after is one thing, he actually delivers in all categories with a long list of accomplished scholars to his mentoring credit. He’s one of the most forceful advocates for open science and for patient empowerment and one of the earliest clinicians and scholars to see and apply big data and advanced analytics to answering some of the most challenging questions in healthcare. I could not begin to list the number of awards and honors that he has achieved, but suffice it to say that he is widely recognized as one of the leaders in medicine, health policy, and health services research.

He’s also an entrepreneur and an intrapreneur and wildly recognized as a compassionate caregiver and one who has and continues to be deeply committed to improving the lives of all people regardless of their position in life. I first want to thank you for all that you do and for agreeing to do this, as you are on the cusp of a very big birthday next week. So in advance from me and our listeners, I want to wish you a happy 25th birthday. You grew up in Dayton, Ohio, the son of a practicing physician. When was the first time that you knew that you wanted to be a physician yourself?

Harlan Krumholz: I had a privileged position to be able to have a father who was a very caring and devoted physician and who from a very early age would take me along to the hospital. I mean, it’s sort of unthinkable these days that somebody could bring a young kid into a hospital, but even from the time I was as small, as I can remember, he would take me on rounds with him on the weekend and I would just follow him around and watch and learn. And even at that time, I was too young to think about what I was going to do with my life, but I was fascinated by the interactions between a doctor and a patient and the means by which he was able to turn what could be a challenging and stressful interaction into one in which he really could bring out a smile in a patient. He really knew who those people were, could demonstrate his empathy and caring for them and use his brains to try to figure out how to help them. And so I never wanted to be anything else.

I wonder about people who have to go through life trying to figure out what fits him, because for me, it was just always that, and even to today, it’s all I want to be is a really good doctor. I want to help people. And that was where it started was when I followed him on rounds.

Howard Forman: And what got you to want to go to Yale as an undergrad? You majored in biology here. Tell me about the decision and then what happened at Yale that might have impressed upon you what you could do with your life.

Harlan Krumholz: Yeah, that was a really important juncture for me. As you said, I grew up in Dayton, Ohio. It was a great place. I went to public high school. I learned a lot of things in that. The high school was very mixed. We were in the midst of integration. It was a highly controversial time in Dayton. I was beginning to get my sense of the importance of social justice and being able to push lots of different issues that were being resisted in some ways in the community. The high school, about a third of people went to college and we didn’t even have, that I remember, advanced placement courses and so forth. But it was a really good education and lots of good friends, and it was a good environment to grow up. As I look to go to college, I don’t know, I guess I wanted to try something different.

And I go back, I tell people that when I was growing up, we had these World Book Encyclopedias, and kids aren’t going to know what those are these days.

Howard Forman: Me too.

Harlan Krumholz: You did? So we used to flip through the encyclopedia and there was this entry for Yale that had the Beinecke Rare Book Library, and it had just this picture of the rare book library. And I don’t know when I saw that, just flipping through that I thought that would be a great place to go. I mean, I applied broadly, but I felt so lucky that I’d gotten into Yale. I’d spent a summer doing a high school summer science institute that the National Science Foundation had sponsored. And I think that might’ve given me an edge, but I just was really fortunate to get in. And then I was surrounded by the most amazing classmates you could ever imagine who opened worlds to me that I hadn’t been exposed to before. But boy, I had to work really hard, keep up. It changed me in very fundamental ways in terms of what I thought I could do and what the world was like.

Howard Forman: And so after that, you went off to Harvard Medical School, and tell me what it was like to go from, I think of as a less competitive environment at Yale, to what has always seemed to be a much more competitive environment at Harvard Medical School, but that may be just my interpretation. Did anything change for you at Harvard? I know that Lee Goldman was an influential physician and mentor there. How did that seem to you? What changed for you there?

Harlan Krumholz: Yeah, let me just reflect one more thing about Yale, and then I’ll tell you what the transition was like. When I see, I think one of the more important things I did was they had an internship program where you could apply and go in the summer session and then take a semester doing some activity. They also had this opportunity to go to North Carolina and work in with the Office of Rural Health Services and be posted out in rural North Carolina. And that really sort of opened my eyes to the vast variation in the way in which healthcare was delivered, the kind of health of people. I spent a lot of time in that semester going around just meeting with people, going to their homes. I was invited in and was able to hear what their concerns were about their healthcare. And that got me really interested in the sociology of healthcare, the way in which it’s delivered, not just the basic science side, but the social science side and how it came together.

And then there was just before I was fortunate enough to get into Harvard Medical School, which is just an amazing place. They also had these traveling fellowships at Yale, which I applied for at the end of my senior year to be able to look more deeply at rural healthcare around the world. By the way, I didn’t get any of those, but there was a instructor, Ted Marmor, who was in the college and had gotten to know me, and he said to me, “I really like your proposal. What if I support it at Institute for Health and Policy Studies, IHPS?” And he sort of sponsored me with a very modest amount of money, but with the moniker of a Yale traveling fellowship to look at rural healthcare at that time. 1980, 1981, I was able to go to England, Sweden, India, and China, China in 1981, to look at the way in which rural healthcare was being delivered.

That also had this sort of profound influence on me because I began to realize that there were social factors that were influencing the organization, the healthcare delivery systems, which were very important influences in the way in which people were able to achieve their health. That was independent of their own behaviors and the underlying science that we knew in medicine.

By the way, there’s this thing where I got into Harvard Medical School and I told my mother I was going on this traveling fellowship and I’d have to reapply to medical school because Harvard wouldn’t give you a deferral. They made you reapply. And my almost my mother, almost plotzed when I told her that.

Howard Forman: That has changed. Yeah.

Harlan Krumholz: But anyway, but when I came back, I was able to go and I think I was again, kind of had been changed and found I was much more grounded. I’d seen much more of the world. I mean, I had a pretty parochial upbringing in Dayton. I hadn’t seen very much of the world, and this year had given me a lot of different experiences and I didn’t find Harvard Medical School competitive at all, actually.

I found it very collaborative and for me, I was searching for where I could end up in medicine, still thinking I was primarily going to practice, but thinking where would I end up? And I found I worked with people at the School of Public Health in Roxbury. I brought some of the things I’d learned abroad to try to build communities, healthcare communities, learning communities within Roxbury housing projects, and began to think that these things might interest me.

One of the classes in medical school, my third year was taught by Barbara McNeil and Lee Goldman, two giants in the field of what really is sort of outcomes research or clinical decision-making research. And I sat in that class and I was just thought, this is what I really want to do. These people are developing knowledge that can be directly applied in practice and policy in ways that can improve people’s outcomes. I wasn’t even talking about it as outcomes research then, but seeing this is very pragmatic applied work that’s very, sometimes, often very clever and taking a different frame on questions. And if we could channel our ability to generate that kind of knowledge, then we could fundamentally elevate our ability to help deliver the services, help inform the choices people make, and help shape the policies that would put us in a much stronger position than we were otherwise.

And the one thing about this just to quickly say, is that because that was in a singular class, I always have deep respect for the ability of a teacher like you to be able to have a profound influence on a student, even in a one-time interaction. Because really Lee came into that class, Lee subsequently became dean of Columbia and worked in different places, but Lee came in with a single lecture and I thought, I want to learn from him. And anyways, can be a very powerful thing, even a very short-term interaction.

Howard Forman: So you and I have never talked about this before. It really was in preparing for this that I sort of honed in on some of these things, but you were at UCSF at the height of the AIDS crisis. You were practicing medicine when for most people that looked at this population, all hope was lost. And you wrote what seems to be your first widely cited paper. You talked about community acquired pneumonia in AIDS patients, and this was during residency. Very few residents really write a meaningful first authored paper, but you did. Can you tell me about how that influenced your trajectory?

Harlan Krumholz: Yeah, I mean, again, another profound experience. I was engaged to the most amazing person I’ve ever met. Leslie, my wife, who I’m still married to, she’s amazing. And we were sort of trying to figure out where we wanted to do residency. A lot of my classmates, most of my classmates stay in Boston and we thought—Lee Goldman, again, my mentor in medical school, had spent time at UCSF in residency and suggested I go out and take a look. I think he thought probably I wouldn’t go, but I should just take a look. Leslie and I went out. It was a beautiful weekend in San Francisco. We were just enamored by the environment and also the fact that that residency attracted people from all over the country. It was a really a big mix of individuals and at that time, calling it AIDS, that epidemic, HIV/AIDS epidemic, we didn’t even know it was HIV at the time.

That was a place where that was happening, and it seemed like it would be an important opportunity to learn and to help. It was heartbreaking. There were so many people who were dying of lack of being able to breathe or having horrific other symptoms like diarrhea, skin lesions, I mean the whole range of things. And you really got to know these people. I mean, the best you could do was sit at the bedside and just comfort and learn from them. It was amazing that that paper was just a matter of seeing a lot of those patients and thinking like, “God, so we’ve got to start describing this.” And I went to the medical records room and just was able to get permission to look at consecutive charts of people who had suffered this and tried to summarize it. And I think it was a time when I started feeling inspired by the ability to generate knowledge that other people could leverage.

Howard Forman: So 1992, you’re doing a fellowship in cardiology at Harvard, the Beth Israel Hospital, and you’re also doing a master’s degree at the Harvard School of Public Health and Health Policy and Management, and you led a paper in The New England Journal of Medicine, the cost-effectiveness of streptokinase. This was a very important paper in arguably the most important journal in American medicine. And you, a fellow, not a faculty member, were first author. What was that experience like?

Harlan Krumholz: Well, that was bracing. I’d gone to, actually came back to Boston because Lee had recruited me back. Again, the importance of mentors. He had been a very important mentor, and actually for a moment it looked like he was going to be chair of medicine at Beth Israel, so it looked like it would be a place to be where he would help support me by helping to allow me to go get a degree while I was doing my fellowship and help me collaborate with him. I mean, teach me about research. He ended up not getting that position at that time. Of course, he goes on to be chair of medicine at UCSF and dean of Columbia. I mean, he’s got an illustrious career, but he didn’t retreat from that support of me. He was still at the Brigham. I was at the BI, but he was 100% supportive and they had at that time, a clinical effectiveness course.

You may know about this. There’s a summer course at Harvard for people who are doing fellowships, where it’s a very intensive stats, epi, health policy, sort of like when we have the RWJ Clinical Scholars program, we tried to put together. It’s similar, Lee was at Yale, as you know, Yale medical student and a loyal alumnus of Yale, and I think maybe he saw some of that through what Alvan Feinstein had put together and Ralph Horowitz and I think brought it to Harvard and was able to build this course that was amazing.

In the course of it, we were starting to learn to ask questions. There was this question about whether we should be using these clot-busting drugs for older people with heart attacks. A lot of people said that the relative benefit was smaller and the risks were higher in older people, they would be more likely to bleed and their benefit would be less, the relative reduction that they would achieve.

And I started thinking, “Yeah, but their risks are so high from the heart attack. Even a smaller relative reduction in risk could translate into a very large absolute benefit.” That is 10% of a larger number, their larger risk of dying, could translate into a bigger benefit and outweigh that risk by a long shot.

One of the courses I was taking was one where we were doing modeling, and so we started doing simulations of this with different assumptions and was able to show that this was a dominant benefit to older people and they shouldn’t be excluded from the use of the drug. Obviously, they should be informed to the risk, but if they want to, that this will, this is actually a great deal for them. I mean, it’s a good treatment.

When I first went to Lee, by the way, he taught me something. When I first went to Lee, he wasn’t really very excited about the idea and was actually discouraged me from following it. Being how I am, I sort of persistently pursued it anyway, and eventually I got it back to him. Probably he wasn’t wrong. I mean, my early ideas were a little crude, but by the time I improved it, he got very enthusiastic about it. He helped to add a cost-effectiveness side to it. Literally wouldn’t have been published without his help. He made all the difference, but it was really a nice, I always tell this to my students, if I’m not in favor of something you’re for, don’t take me as the gold standard. Keep working at if you want, keep trying another shot. Maybe I am not seeing something. But anyway, that was a really important paper. It came out just as I was starting faculty at Yale in July of ’92, and it was a great way to start out on a faculty.

Howard Forman: And worth pointing out that your productivity during this time early at Yale and so on, you are incredibly productive. And really, John Eisenberg, my mentor, my hero, a man who died way too young about 21 years ago now, he was publishing at the same pace as you, but he was a full professor. He was, I think, section chief of General Internal Medicine. You were operating at that level at that time.

In 2004, you collaborated with our upcoming guest, Carrie Gross, on a paper that was first authored by our nation’s current surgeon general. It is one of your most widely cited papers, current time there’s about 2000 people that have cited that one paper. Tell us what you found there.

Harlan Krumholz: Well, thanks to Vivek [Murthy] and Carrie, that’s a terrific paper. It was part of a theme of papers that was sort of looking at representation within some of the clinical research that we were doing. And there’s that paper, but there’s actually a body of work. I mean, there are a couple things. One is, I mean, if I have a superpower, I think it’s like I have lots of ideas. If I have another superpower, it’s really, I mean, I’m lucky to be working with really great people, and that’s not superpower as much as it is just good fortune. But that really talented, amazing people around me, in this case, these guys really powered this paper, but it was part of a, maybe, I don’t know, 10 or 20 papers we’d written, which really characterized this sort of inherent bias in our system to exclude women or minoritized populations. I mean that too often our research had been focused on white males and that we really needed to be attentive to the strategies that we were using that were recruiting people into these studies. And yeah, that’s highly cited, but like I said, there’s also a big body of work that I’m really proud of that I think began the conversation nationally with others, about how now we’re still not there, by the way. We’re not done with this. But it’s still like a pathway.

Howard Forman: No. But you were early on. I will say, when I go back and look in preparing for this, I went back and looked at a lot of what you did. You are years ahead of most other people in hitting what I consider to be the most important topics. You were writing about health equity way more than 10 years before it became a topic that mainstream media was covering in a big way. And I think papers like that had a huge impact, and they are rightly highly cited. So I want to keep going through. I know we’re—

Harlan Krumholz: Yeah, thanks Howie. I think we try to catalyze this stuff, you know?

Howard Forman: Yeah. No, no, no. I’m not saying you were the first. You were definitely on the leading edge of this. I want to, we have a few more things I want to touch on and we have limited time.

In 2006, you were working with the current Vassar president, Betsy Bradley. She was a relatively junior faculty member, mid-level faculty member here in the School of Public Health, a very close friend to me and you. But you wrote an incredibly impactful paper on how to deliver better care to acute heart attack patients, to use sort of colloquial language. A lot of research does not change practice, but this certainly seemed to, and it has over a thousand citations, a highly cited paper. When you look out there on the landscape now and see documented reduced mortality and better consistency in practice around cardiovascular care, are you able to sit back and reflect on what your role through this paper and so many others has been? Because I think it’s incredible.

Harlan Krumholz: Yeah, that’s one of the things I’m most proud of. I mean, we got an NIH grant to look at this issue of delays in treatment for patients with heart attacks. And we knew that it was a very difficult problem to solve nationally. There just were hours that would pass while people would sit in the emergency room before they would get definitive care for a blockage that was causing a heart attack that needed to be relieved.

And we just started systematically learning what represented best practice. We started building out this idea of positive deviators. Who was actually excelling? What could we learn from them and how could we generalize it and scale it across the country? And this started from a very set number of studies to try to distill insights about top performers to ultimately a national effort that included over 2,000 hospitals around the country and got to the point where you can go anywhere with a heart attack and you’re almost guaranteed to be treated within a half hour.

Prior to that, it was 90 minutes to two hours that in general it was taking, and some people even longer. And this was a tribute, by the way, not just to the research but to the way in which the clinical community engaged at every level, from people who are giving electrocardiograms, nurses, transport cardiologists and interventional cardiologists, emergency medicine docs, and more.

And we did a whole bunch of cool things, Howie. We brought in NASCAR pit crews who would teach clinicians. No matter how good a driver you are, unless your pit crew is good, you’re not going to win the race. So you can’t be like a star interventional cardiologist without paying attention to your team, getting people all working together. I’ll say one other thing about this with Betsy. She is amazing that this was about also getting into mixed methods, quantitative research, and also hearing stories. Betsy is a specialist in qualitative research, and we sort of brought that into what’s called mixed methods. And anyway, it was a terrific run and made a huge difference.

Howard Forman: I want our listeners to understand though, that it’s not just about saving lives because you have saved a lot of lives with this. It’s also even the lives that wouldn’t have died, they would’ve lived with less heart muscle alive. They would’ve lived in less good condition. And because of the changes that have been implemented from that, we’ve really seen a dramatic improvement in cardiovascular outcomes, not just a reduction in deaths.

Harlan Krumholz: And this was also, by the way, the American Heart Association. American College Cardiology in particular was a strong partner, but American Heart Association also contributed in Portland. I mean, this was a broad base of credit, ought to go out here, but really proud of the work that we did to develop the science.

Howard Forman: So your work on avoidable readmissions, which maybe I’ll let you explain to the audience, is incredible because again, I found over a hundred instances of papers that include you as an author, on this topic alone. Why has this been such an important topic for you and what have we learned about this?

Harlan Krumholz: Yeah, well, there’s this persistent issue of people who are hospitalized ending up back in the hospital within 30 days way too commonly. And it’s sort of mind-blowing. I mean, within 30 days, maybe one in four people end up back in the hospital, among Medicare beneficiaries. And even if you include it more broadly, it’s still a high number. And the story, we were working with the federal government around trying to develop measures that we would publicly report that would start to draw light to the quality of care within the healthcare system. We had just worked on a measure on mortality, and it was being publicly reported, drawing attention to the variation within the country and the ways in which we could improve. And they said, we want you to maybe, how about what if we start looking at cost? And we said, well, cost is a hard one because how do you know what the right number is?

Some people are spending more money, maybe they’re getting better outcomes. It’s worth it. And we had been doing work since the nineties on this idea of really trying to draw attention to this readmission issue, which is largely ignored. By the way, when I’m a resident, people are just talking about freq—I hate to say this, but this is the kind of disrespectful language we would use, frequent flyers. Oh, somebody’s back again.

Howard Forman: That’s right. Absolutely true.

Harlan Krumholz: You wouldn’t sit there and say, this is in many cases a failure of the system. How did we help with the transition? What did we do to reduce the risk? We just were like, “Hey, so-and-so’s back.” It’s horrible. So we were able to sell the idea to Centers for Medicare and Medicaid Services, the Medicare Group, to be able to look towards readmission. And we also recognize that there was variation in readmission.

And in one of the studies I’m most proud of, I’ll just tell you this quickly, was we did a study of the same person going to a high-performing readmission hospital, meaning low readmission rates and a low performing readmission rate. So somebody admitted to two different hospitals within a very short period of time, what was the readmission rate at those two hospitals? And it turned out that same patient, you go to the worse-performing hospital, you had a higher likelihood of being readmitted. And so we’re kind of isolating this as actually a quality measure. And so a lot of this work has been both trying to understand what you can do to improve it, illuminating the variation and key factors associated with it and trying to help us as a healthcare system make sure that people have better recoveries after they’ve been hospitalized.

Howard Forman: Can you quickly tell us, I know this has been controversial for some, and I know that even your opinion about how do we judge this has evolved. Can you give our audience just a little bit of the nuance about why this isn’t like a no-brainer, to use the term, why it’s not easy to judge a hospital based just on their readmission rate?

Harlan Krumholz: Well, I mean, all the hospitals, the hospitals get different sorts of patients. And so that has to do with their thresholds for who they’re admitting, where they’re located, what kind of patient groups that they’re caring for. And so you want to be fair to them. And so you want to be able to take into account the differences in the type of patients that come in. And this turns out to be challenging, and it’s hard to know whether you’ve actually done it well enough. And so we’ve worked really hard to try to level the playing field and make these kind of fair comparisons.

Now, some of the hospitals, and in particular safety-net hospitals in this country, say, well, people who are poor or minoritized populations have higher risks of readmission. We think that that’s not our fault. That has to do with the context of life, social determinants. And what I say is that, but we don’t want to hide it by adjusting for those factors. We don’t want to obscure it. Now, we may want to figure out what our response ought to be as a society, but it’s important for us to know whether or not there’s certain groups that are subject to worse outcomes, and then we ought to be all holding hands and figuring out what to do about it.

But yeah, this turns out to be controversial because hospitals don’t want to be judged on the readmission rates, and they want to say that it’s not their responsibility. But I’ll tell you one thing, during the pandemic, readmission rates went down, and so—without evidence of any mortality rise among those people who had a lower readmission risk. So it is modifiable, but it has to do with patient behaviors and also hospital strategies.

Howard Forman: I don’t want to let the time run out without reflecting of the fact that, as you mentioned, you are a father, a husband, a grandfather, a son, and truly a great friend to me and many other people, you also work insanely hard. How do you find that balance?

Harlan Krumholz: Yeah, that’s really a constant point of reflection. I really enjoy what I do. I don’t even call it my work. I really enjoy what I do, and at the same time, what’s enriching in life are relationships and you know, want to be sure you’re attentive.

When the kids were growing up, I mean, I wouldn’t start working till they went to sleep. I mean, that might’ve been 10 or 10:30. So a lot of times I was up till 2:00. I was tired, but I knew that time of life would be short.

And similarly with friends and in investment in others, I mean, can always do better. But I always try to believe that that’s where the priority should be. With regard to the work itself, yes, I mean, same on you. You know, for a lot of us, there’s a toll. There’s sometimes a toll that you get tired sometimes because of it, but you’re also energized and enthused, and we get to work with students and it’s the best job in the world. And so I think the most important thing is to make sure that you’re attentive enough to important relationships in your life, and then otherwise, do the stuff that really jazzes you and gets you going.

Howard Forman: We’ve barely scratched the surface of your career, but hopefully this gives our listeners a little bit of insight into Harlan Krumholz on the cusp of his 25th birthday.

Harlan Krumholz: That’s so nice. Yeah. I do want to say one thing though, that in this era of my career, I’m really focusing a lot on data science, digital transformation, how to turn medicine in the next era in a way that’s more effective, efficient, equitable, patient-centered, and that we really produce better results for our patients. So sometime we’ll talk about that, but that’s where the next horizon is, I think.

Howard Forman: I agree with you, and you really walk the talk, as they say. You’re really working on this on many different fronts, and I appreciate you personally a lot.

Harlan Krumholz: Thanks so much, Howie. I hope at least one person found this interesting. Maybe my mother will, if she listened. But thank you for doing it. You’ve been way too kind. But I do appreciate the opportunity to reflect a little bit on my career. Thank you so much.

You’ve been listening to Health & Veritas with Harlan Krumholz and Howie Forman.

Howard Forman: So how did we do? To give us your feedback or to keep the conversation going, you can find this on Twitter.

Harlan Krumholz: I’m @HMKYale, that’s HMKYale.

Howard Forman: And I’m @TheHowie. That’s at T-H-E-H-O-W-I-E. You can also email us Aside from Twitter and our podcast, I am fortunate to be the faculty director of the healthcare track and founder of the MBA for Executives program at the Yale School of Management.

Feel free to reach out via email for more information on our innovative programs or you can check out our website at

Harlan Krumholz: Health & Veritas is produced with the Yale School of Management. Thanks to our researcher Jenny Tan, and to our producer, Miranda Shafer. They are absolutely amazing, and they make this program great. Talk to you soon, Howie.

Howard Forman: Thanks again for doing this, Harlan. Talk to you soon.

Harlan Krumholz: Thanks, Howie. Really appreciate it.