Michael Sherling: Building a Better Electronic Health Record

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. Michael Sherling, but first, we always like to check in on current hot topics in health and healthcare, and I think you’ve got a quick hit and then a deeper dive on a different topic, Harlan. Tell us what you’ve got.‌

Harlan Krumholz: I’ve got a quick hit and then I’ve got a deeper dive, exactly, Howie. And so, first of all, just because we’re in the season where people are talking about COVID vaccines, I thought we’d go to Akiko Iwasaki, who we’ve had the pleasure of having on the podcast, and who I get the privilege of working with, to ask her what she thought about what’s going on, what about this vaccine, what does she recommend. So here’s what she sent in to us that we could share with our listeners.‌

She says, “The updated 2024–2025 COVID vaccine is based on the KP.2 variant, or the JN.1”—which is Novavax—“which are much better matched for the current circulating variants, which are actually KP.3.” So, the Moderna and Pfizer is based on one type of variant, the Novavax on another, but what she’s saying is, even though they’re slightly off on what’s circulating and what may be circulating in the future, all evidence is they’re a pretty good match. And so “they induce high levels of neutralizing antibodies against these variants and is predicted to provide a significant protection against severe disease even if the vaccine doesn’t prevent the infection itself.”‌

And she talks about this KP.3.1.1 lineage that’s dominating. You should all know we actually are right at this moment through that wave; the wastewater—when people go in and they look at the wastewater and look for a virus as an indicator of what the population is seeing—is more at a nadir now. It’s low compared to what it’s been, but I think everyone expects that we’re going to have further waves throughout the winter. And so she says at the end, she recommends everyone get the updated vaccine, that they not only reduce the risk of severe acute COVID, but she says that they reduce the risk of developing long COVID. There’s some controversy; people may dispute some of these parts about the vaccine and this and that. Look, I think there’s no better expert than Akiko, and I really look to her for guidance. She does note, like you do ,Howie, that the Novavax has been reported to have fewer side effects, but yeah.‌

Howard Forman: Going forward today, going forward today.‌

Harlan Krumholz: I will say I was vaccinated already. I just thought, all things being considered, it was a good idea. As you know, I haven’t had COVID yet, so also—‌

Howard Forman: Yeah, you’re really rare.‌

Harlan Krumholz: ... I’m one of the rare ones. Yeah.‌

Howard Forman: Yes. So what else you got?‌

Harlan Krumholz: Okay. I want to talk just a little bit about this company called CareBridge. Some people may have heard about it. This is an organization that’s combining technology, social services, and financial models to improve care while trying to reduce costs, and particularly focusing on vulnerable populations like Medicaid populations. So there are a couple of things that are interesting here. First of all, it was founded in 2019, only 2019, by Brad Smith and someone you know and I know, former U.S. Senator Bill Frist. And the idea was to address this gap in the healthcare system, the management of home and community-based services for Medicaid patients. So they really focus on this area of Medicaid.‌

You and I have talked about what went on in North Carolina, where they start paying attention to housing and other social needs. Well, here was a company that emerged that said, “We’re going to try to be able to scale this kind of approach.” So looking at individuals, many with chronic, developmental, or complex health needs, and these people typically require significant healthcare resources. And their thesis was, if you really look at them holistically, then you could actually make a difference. And so their special sauce, what they went in to do is, they said, “Well, we could use technology as a background and equip patients and caregivers with tablets to provide 24/7 access to clinical support. Whether it’s around medication issues or behavioral health needs or emergencies, they could connect instantly with clinicians or other healthcare professionals who could help them with their needs.” Again, spreading it out, not just strict traditional medicine but also behavioral health or other things to really think about integrated care. And so these social determinants, such as housing, food security, mobility, they went in for risk sharing, so they had this unusual approach where they said, we’re going to work holistically. And when they built their contracts, they said, “Pay us X amount. If the cost of the people that we’re caring for, that we’re responsible for goes above it, it’s on us. If we go below, then we’ll be able to retain that margin.” But they also had to hit specific quality metrics, that they wouldn’t give short shrift to these patients. And again, because it was Medicaid, there’s of course a lot of scrutiny to make sure that these patients are getting what they are entitled to, what they deserve, what they need. And then they started going state to state. Brad Smith had worked at CMS, had led that innovation group there, and so was very familiar, I think with how you needed to deal with the rules that were state to state. And they also made some strategic acquisitions. So they acquired companies that had existing Medicaid contracts, so that they could go get a head start.‌

I’m bringing them up today because Elevance, which is one of the big insurers, one of the Blue Cross big insurers, became one of their major customers, and now has stepped in, and actually is going to acquire them. And so this represents a very successful validation of this model. The reports are that they were able to drop hospitalizations by maybe 20% and nursing-home stays down by 16%. The fact that Elevance is willing to buy them makes me think these numbers probably are true. I always have some skepticism about that. I mean, I just want to share that, Howie, because it’s a story of a company that was trying to incorporate this different view of how to care for people more holistically, more integrated with technology, but bringing in these social determinants. And now they’ve had what looks like a pretty impressive exit with Elevance.‌

Howard Forman: I’m still a little skeptical, but I’m hopeful, as you are, and optimistic, as you are, that this could represent real innovation in the space. This is part of Elevance and all the major payers’ strategy of basically vertical integration, buying practices, buying innovators in the space for different areas, and we’re going to keep watching and going to keep seeing what they do. This is similar to what Humana has done with CenterWell, consolidation, and UnitedHealth Group with Optum.‌

Harlan Krumholz: Yeah, just because we’ve been talking about this, can you build a company that pays not only attention to traditional risk factors, but looks at housing and food and—‌

Howard Forman: Well, let’s hope.‌

Harlan Krumholz: ... other needs, behaviors, would that be a path towards better health and lower healthcare utilization holy grail? Still, story yet to be told, but this is an interesting path—‌

Howard Forman: I hope so.‌

Harlan Krumholz: ... for this company.‌

Howard Forman: Yeah.‌

Harlan Krumholz: All right, let’s get onto our guest today.‌

Howard Forman: Dr. Michael Sherling is the co-founder and chief medical and strategy officer of Modernizing Medicine, an electronic medical record company that provides software solutions for specialty physicians. Modernizing Medicine currently integrates around 35,000 providers and employs over 4,000 people. For his work on the company, he received the U.S. Chamber of Commerce’s Leadership and Healthcare Award in 2014. Before starting Modernizing Medicine, Dr. Sherling practiced dermatology in Boston and then South Florida, where he still practices part-time. Dr. Sherling completed his undergraduate degree at Brown; he obtained his medical degree and his MBA simultaneously in the first class of MD/MBA students at Yale. He completed his residency at Harvard School of Medicine where he served as chief resident in dermatology before completing a fellowship in laser and cosmetic dermatology at the Massachusetts General Hospital. So first of all, I want to welcome you to the podcast. It is really an honor and a privilege to be able to have you. You are from that first class of MD/MBA students, and I tell your story often. I want to start off though by hearing from you what the journey was like. You graduate Brown; I think you might have even had a gap year in there. How does the journey progress to doing the MBA and eventually starting this company?‌

Michael Sherling: Thanks, Howie. It’s great to be here, really enjoying this, and love to chat with you about my journey. It really started in med school at Yale. And during that first year there was a course called How to Start a High-Tech Company. I’m not even kidding. It was taught by a venture capitalist who had put money into Pyxis. And so he was telling the story about how he invested in this company and took it public. He taught us the basic skills of how to write a business plan, some high level of how to raise money. And believe it or not, as this first-year medical student, I took that with me and I put it in my back pocket. And I wasn’t exactly sure how I was going to use it, but obviously, Howie, came up with the Yale MD/MBA program, it was the first year I had applied, and definitely got my start with combining business and medicine.‌

Howard Forman: So I do want to fast-forward. Then you do this residency, you go into practice first in Boston briefly, and then you move to South Florida, and you’re in private practice, and you’re not starting a startup, you have lots of ideas. Can you briefly take us through those next steps? And then I’ll let Harlan get some words in.‌

Michael Sherling: For sure. I was in private practice for about a year. My practice was in Lake Worth, Florida. And typically I see a lot of retirees, but I happened to catch a patient who was around my age, who was a little tan, and I saw on his intake sheet that he’s a software entrepreneur. I was really interested in that. And I was chatting him up before the exam, and he had founded a company called Blackboard, which is an e-learning company that he took public on the NASDAQ for about $1.6 billion. And here he is in my room, he’s naked, I’m doing a skin check on him. It’s probably not the right time to start a company, but I waited for his clothes to come back on, and I said, “Hey, I’d love to collaborate with you,” which of course he gets all the time. And all of his past co-founders were named Michael, which is a little bit weird, but I took him out to his favorite restaurant. I drew on a napkin this visual interface of what I wanted doctors to have to chart notes. And we started the company a week later, 15 years ago.‌

Harlan Krumholz: So it had to be more complicated than that.‌

Michael Sherling: It was definitely more complicated than that. It was during the subprime mortgage crisis. Here’s Dan, he’s raised hundreds of millions of dollars, and it was really tough to raise money then. And if you’re looking at starting a company with an idea, you have to look at your competition. At the time there was about 900 health IT companies building electronic medical records, building practice management systems, some of which who have been doing it for 40 years. And so you have an idea that investors don’t really understand how it’s different, and the investment environment is very tough, obviously it’s during a recession. And so we tried to raise money, but we were rejected about 40 times doing that. But that didn’t deter us, and as an entrepreneur, one thing you learn pretty quickly is that the word no doesn’t mean anything to you. He’s like, “You just keep going, you’re very resourceful and resilient.”‌

And we started to build the product. So I tried to teach Dan dermatology. Dan was an undergraduate at Cornell, majored in economics, doesn’t know anything about medicine at all. And he said, “You know what, Michael? I’ll teach you how to code.” And so he taught me how to code. I coded the medical knowledge base; he coded the platform. We built the platform together, the two of us, in about six months. And again, we tried to raise money, but we couldn’t. So we demoed the product to physicians, and actually physicians invested in the company, they were the first, about 30 people that believed in us. So that was actually really great. And that got us to the first real product launch, which was in 2010, and got us enough capital where we could implement it for the first 50 practices. And then another thing happened—one of the physicians brought in an investor, Stephen Rubin, he’s an entrepreneur, he owns Pentland, which is a company in Europe that owns Speedo as well as Lacoste and other sporting goods. And he believed in us and gave us our first check. At the time it was $5 million, which still is a lot today, but we were able to really grow the business.‌

Harlan Krumholz: That’s incredible. Also incredible that you had a co-founder who actually was a serial entrepreneur, had successfully exited with an IPO, and you still had trouble raising, and you still persisted. This other person must have had a million other opportunities but stuck with you.‌

Michael Sherling: Yes, it’s common, their business cycles boom and they bust. And when there isn’t a lot of money out there, there just isn’t. And that’s also the best time to innovate, because you don’t have a lot of focus, we’re like, “Okay, I can’t raise money right now, so I’m just going to hunker down and just build the most differentiated product I can build. And then when the money comes, it comes.” And then obviously from an investor perspective, you understand when you’re building something that has recurring revenue, that people want, then that’s an easier profile to invest in.‌

Harlan Krumholz: So just for people listening, what was the pitch in the beginning?‌

Michael Sherling: Well, okay, so I’m just going to take us all back. We’re in a restaurant, I say, “Dan, I want an experience where doctors can chart, where they don’t have to type, just touch on the screen. And I want it to output all of the notes, all of the orders, everything from that one interaction. I want that interaction to be less than a minute.” This was before the iPad was invented. And so we initially designed this experience to be on a laptop that was touch-based, there were some PC tablets that were touch-based, but five months later, the iPad came out, which was really the thing we needed. And then obviously the government had a lot of stimulus money for doctors to get electronic, which also helped. So timing is everything, but it’s not just timing, it’s not giving up, it’s really believing in your idea and working hard to see it through.‌

Howard Forman: Can you tell us a little about, that’s the pitch right at the beginning, but you have gotten a lot of physicians to adopt this in a climate where so many physicians are part of health systems that are purely using Epic or another large electronic medical record company. How do you move into a space that is so dominated by one big company?‌

Michael Sherling: Yeah, so I think you just have to take the long view. And if you look at companies that have been there for 40 years, they evolved too. Maybe they were an LIS system, lab information system, or they were a practice management system that then got an electronic health record, but they’ve had 20, 30, 40 years to evolve. And sometimes that’s a positive, and sometimes that’s a negative, because technology has rapidly improved every year, there’s new things. And so if you have an existing user base that’s used to a certain workflow or a platform that’s been there for 20, 30, 40 years, it’s harder to move that ship, it’s harder to be agile. Whereas when you start a company, you get all the best new technology. I think cloud computing had just come, AWS, Amazon Web Services had just come onboard for healthcare. So a lot of things were in our favor at the time. But in terms of how to get doctors to move, it’s really simple, it’s what is their time worth? The doctor’s most precious asset is their time. They don’t want to be in front of a computer, they want to be in front of a patient. If there’s anything that you can do to make that happen quicker, then you’ve got them. And I think the specialties we went into intentionally were fast-paced, they see 50, 60, 70 patients a day.‌

Howard Forman: And can you tell us how many specialists you have now, how many different specialties you cover?‌

Michael Sherling: Yeah. We’re in 11 specialties. We have about 35,000 providers nationally, but we’re in dermatology, ophthalmology, orthopedics, ENT, plastics, OB/GYN, urology, allergy, gastroenterology, pain—interventional pain. ‌

Howard Forman: That’s great. That’s amazing.‌

Michael Sherling: Yeah.‌

Harlan Krumholz: So as a chief strategy officer, one of the most important things is how you continue to innovate in an atmosphere where things are moving quickly all around you, and particularly with what A.I. presents with generative A.I. and ambient A.I. coming out within the offices, changing the nature of how people are going to be doing notes and so forth. So how do you see the future and what are you doing to continue your edge? I mean, it seems to me like your secret sauce was you know what it’s like to be a doctor, but now you’re at a point where you’ve got people, but the world’s changing rapidly. How are you keeping up, and what do you think about that?‌

Michael Sherling: I think all of us at ModMed are very focused on not losing that technological edge. And you can see in technology companies, new technology happens and you don’t want to be left behind, you don’t want to be creatively destroyed by somebody else. And so I think we’re at that inflection right now, and I think there’s a lot of investment, there’s a lot of hype around artificial intelligence and how we can use it. From a physician standpoint, there’s a lot of low-hanging fruit, around this drudgery of healthcare, around the burden of documentation, using A.I. to just do these mundane tasks over and over and over again. Obviously ambient listening is a hot topic, a lot of doctors are really excited about this as a prospect. Our approach to ambient listening is a little bit different. I think we’re not just interested in capturing that conversation and classifying and summarizing it, because there’s still work that a doctor has to do. They have to take that text, cut and paste it into parts of their notes. They still have to write that prescription, they still have to do that lab order, they still have to write that encounter form. So if you add it up, yes, it saves some time, but it’s not that exciting amount of time where they’re freed up and they can just leave at the end of the day.‌

And for us, it’s much more, because we’re the electronic health record, we’re able to do things, not just predict the summary, this classification, but we want to predict the structured output directly. And I think that’s really what saves doctors time. So this is something that’s currently in development. I’m using it in my clinic right now with the doctors that we have, and it’s a really exciting space. We’re looking to beta to some of our customers in dermatology this fourth quarter of this year and then make it generally available next year. So we’re really, really excited by it.‌

And we’re not just building the medical knowledge base for the EMR, we’re also the ones that are training the A.I. as well. So we’re seeing how the model works, and we’re tweaking it. Physicians, when they talk to their patients, they don’t talk in a clinical way, they don’t just spat out the diagnoses and the interventions, they use shortcuts that patients can understand, and each specialty is different. So the fun that we had was we taught our A.I. what this vernacular was for a patient to understand. So I may say, “Hey, you got a rough spot on your face and we’re going to freeze that,” and the A.I. knows that’s an actinic keratosis, and we’re going to use liquid nitrogen to treat it. And that’s just it, like in orthopedics, they never say, “I’m going to do an interarticular injection of your knee.” They’re like, “I’m going to give you a shot in your knee.” So you don’t want to have to change the way you speak to patients, to have A.I. follow you. And I think that’s really a specialty-specific take that I think we’re doing that’s really unique.‌

Harlan Krumholz: That’s really brilliant.‌

Michael Sherling: Yeah.‌

Howard Forman: I wanted to come back to your clinical practice, because I remember in the early years of starting this company, you would say to me, “I went from five days a week in clinical practice to four, to three as I transitioned into a more full-time role at the company.” The business is a huge business right now, you have two executive roles, your ability to practice is more limited. Can you tell us about why you stay clinically connected at all, and then tell us a little about what that practice is like?‌

Michael Sherling: Yeah, for sure. Thanks, Howie. Being a doctor is my identity, I spent a lot of time training to be a dermatologist. And that is the edge for the company as well, is we have customers inside the company using the products. And so I still practice, one, because I enjoy it and I want to give back. So I practice, I volunteer in an underserved clinic in Delray Beach, and I see patients who don’t have any means to access a dermatologist, and I treat real things, which makes me feel really good. At the same time, it’s a way for me to also test the latest A.I. ambient listening solution. Obviously I consent the patients for this and all that, but it’s still a way for me to feel close to the technology, to make sure that it works. And the users expect that, they want the medical directors of the company not just to provide the direction or the content, but to use it as well, and to make sure that it’s as fast as possible, that it works as well as it can.‌

Howard Forman: Before we get to the end, I just wanted to ask a question about the later fundraising of the company at this stage, because you’re a big company, and it’s not often that companies of your size have decided not to go public or to raise funds in alternate ways. And your last round that I’m aware of was through private equity. You went, I think to Warburg Pincus, you could correct me, and you raised money that way. And I’m just curious to know why does a company move away from venture capital and towards private equity, what’s the advantage to that, what went into your thinking about that?‌

Michael Sherling: Yeah, I think there’s different phases of a company. And I think for us, we initially raised money through angel investors, and then as a company grows and scales, you need to invest a lot in the sales capacity. So I think venture capital is really just ideal there, where the focus of that company is growth. As a company scales, which we did with one product in the dermatology space, we decided, “What’s our next journey?” And one, I think that venture capital, they have a time horizon of five to seven years. And so with that, we brought in private equity to give them their return, their liquidity, and then take it to the next level. So I think a lot of people use private equity, particularly if they’ve had venture funding to get that liquidity for the venture people. But I think why we picked who we did, we’re very growth-focused, and so we liked a partner that believes in our mission, that would align with us in deploying capital to continue to grow into the other specialties, but also other products beyond the electronic medical record, practice management system, patient engagement, and other things. And they’ve been a great partner to us, and they’re still with us.‌

Harlan Krumholz: Howie, we’re getting to the end, I want to just recount some of the lessons I’ve learned from talking to you. First of all, it’s been wonderful to speak with you. First, one path to success is just being really strongly mission-driven from the very outset, starting a business in an area you know, there was no one who knew more than you did about what it was like to solve.... You were solving your own problem with the business you were creating, and the idea of most overnight successes are not truly overnight, but they represent persistence despite challenges, hearing that you had more than 40 rejections. I mean, first of all that you had the gumption to ask him out to dinner and really push your idea, that took a certain amount of grit to do that. And then to have this idea with an established entrepreneur, and to be told all those times no, and yet to keep going. And not only keep going, but say, “Darn it, let’s just build it.” And then being willing to learn new skills along the way, to be able to be part of what you were building, and then continuing with your practice so that you know every day what those pain points are as they evolve, and being able to build your product to manage that.‌

I mean, all these things actually I’m taking away as real good take-homes, for any advice, to anyone who wants to get started, it’s not easy. Start in an area you know, be persistent, roll up your sleeves and actually do the work. And yeah, it does take some serendipity, but you need to be in the position where you’re in the game and you can take advantage of good things that can come by and recognize them. So anyway, I just wanted to thank you so much. I mean, did I cover everything, or is there any other cool lessons that I missed there? Because there was a lot embedded in what you said.‌

Michael Sherling: I think you covered it. It’s definitely a lot of work. It’s a lot harder than being a resident in training, I’ll tell you that. There are a lot of sleepless nights as an intern, but there’s a lot more being an entrepreneur.‌

Harlan Krumholz: Well, and people from afar can look at you and go like, “Wow, look at that—”‌

Howard Forman: “It was easy.”‌

Harlan Krumholz: “... it must have been so easy.”‌

Howard Forman: Yeah.‌

Michael Sherling: It’s not easy, ever, and it’s still hard.‌

Howard Forman: Yeah, well—‌

Harlan Krumholz: Well, congratulations.‌

Howard Forman: ... I get that. Really—‌

Harlan Krumholz: It was a great pleasure.‌

Howard Forman: ... thank you so much for all this. And I’ll point out for our listeners that your wife beat you to the podcast two years earlier, because your wife came out with a book on healthy eating.‌

Harlan Krumholz: And what was Howie like in that first class, Michael? I mean, this is his first class of MBAs when he’s initiating the program. You took a leap of faith to join.‌

Howard Forman: It’s true.‌

Harlan Krumholz: This thing wasn’t a legacy program. It was just the beginning.‌

Michael Sherling: It was great. And Howie’s been such a supportive mentor really, not just during the classes, but really all these years. And it’s great to have him here at Yale, just to show that there’s other paths in medicine. It’s great for Yale to have him, honestly.‌

Howard Forman: Thanks, you guys can keep going on.‌

Harlan Krumholz: Absolutely agree, absolutely agree.‌

Howard Forman: Anyway, look, thank you very much.‌

Harlan Krumholz: Thank you so much.‌

Howard Forman: Have a great rest of the day.‌

Harlan Krumholz: Hey Howie, that was a great interview. Love, love, love seeing your former students, and ones who’ve done so well.‌

Howard Forman: Yeah, it’s fun.‌

Harlan Krumholz: Yeah, you should have a lot of pride in that, but let’s get to my favorite part, the Howie Forman part of the show. What’s on your mind?‌

Howard Forman: Yeah, so for most of the 21st century, there were about 10 to 50,000 pertussis cases in the United States. So pertussis is whooping cough. And its named whooping cough because it has this characteristic hacking cough followed by a whooping sound as they gasp for air. It is another vaccine-preventable illness that causes its most severe effects in infants under one year of age, where it results in hospitalization in about one third of them, and one in 100 to one in 200 will die after infection. So it’s a pretty significant disease of these infants. Starting during the pandemic, pertussis cases failed dramatically to 6,000 in 2020, and then 2021, 3,022, and 5,600 in 2023, still well below the trend we used to have. Some of the drop was probably due to underdiagnosis, but some was likely due to social distancing and other non-pharmacologic measures that we took during the pandemic, because immunity wanes considerably, adults end up being the natural reservoir for the bacterium, and it’s likely that their reduced exposures during the pandemic resulted in less risk to the infants around them. So I just want to make that part clear, it’s not just or even partly due to decreased vaccination of infants, it’s really probably due to reduced exposure from adults.‌

It should not be terribly surprising that there is a big rebound right now, but it is 18,500 cases so far this year, with 11 weeks to go. And if it tracks the way, I suspect will hit about 24,000 to 25,000 cases. And that would be high, but not extremely high, there were six other years in the last two decades that were higher, so nothing crazy. So why do I bring this up? Number one, it’s an extremely preventable illness. Whooping cough is a tough disease on infants and even some young kids, and it’s avoidable if you just get vaccinated. And unlike many of our other vaccines, there is much less of a herd effect, meaning that my vaccination does not necessarily protect you from pertussis. So there’s every good reason for parents to get their own children caught up on their vaccinations. Immunity also wanes, and so we give five shots before the age of six, or by the age of six I should say. And pregnant women also need to be vaccinated, since that’s the only way to protect one of the highest groups, infants below two months of age, before they get their first vaccination. And yet more than 40% of pregnant women do not get vaccinated, according to the most recent study from last month, only 80% of children appear to be up to date on pertussis vaccination, substantially lower than polio or the measles, mumps, and rubella vaccine.‌

So it’s just a reminder to everybody that during this time of the year, vaccination programs are really important, but they only work if people use them. I hope this raises awareness for folks that these are not minor diseases, these may be life or death, and I hope you choose wisely. And I don’t know, I’m always disappointed that any type of preventable death still occurs.‌

Harlan Krumholz: Howie, I’m really glad you brought this up. Traditionally, pertussis is more common in infants than young children, but this year we’re seeing outbreaks in older kids and teens. Do you have any line of sight into what may be contributing to that shift?‌

Howard Forman: So a lot of people think it’s the vaccine issue, that they’re just not getting the full array of vaccines.‌

Harlan Krumholz: The lag, but the vaccine they should have gotten a lot earlier, now it’s manifesting?‌

Howard Forman: So they may not have gotten their vaccine at the age of six or four. And because it wanes, and we recommend it almost every 10 years in younger people, because it wanes, it may be that we’re starting to see these cases. There’s a lot of reasons. It’s also that we’re just seeing a rebound, because there’s lack of immunity, exposures over the last few years. Adults may be having more sort of subclinical exposures that don’t result in diagnosis, but maybe just carrying it. It is basically carried by adults, even though we see the manifestations mostly in young people.‌

Harlan Krumholz: And I think people listening need to know that sometimes this is called the 100-day cough, it can really be disabling and have a really long tail to it. So like you said, it’s so worth seeing if we can prevent this. I do worry that this backlash against public health and against vaccines is going to manifest itself in a lot of different ways. We’ve seen measles, now we’re seeing pertussis, things, like you said, that we can prevent, that we thought we had maybe conquered even, that seem to be coming back. And it does seem like a social phenomenon, right?‌

Howard Forman: Yeah.‌

Harlan Krumholz: It’s a social phenomenon that’s creating this.‌

Howard Forman: And I do think that most of other vaccines have herd effects. So people do get lackadaisical, like, “If there’s not an outbreak, my child’s safe even if they’re not vaccinated.” With pertussis, it’s just not the case.‌

Harlan Krumholz: Yeah, thanks for bringing that up. 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, email us at health.veritas@yale.edu, or follow us on any of social media.‌

Harlan Krumholz: We very much want to hear your feedback, questions, experiences on these topics. Feel free to like us on social media, it helps other people find us. And we always appreciate any personal contact.‌

Howard Forman: We truly do. 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 the website at som.yale.edu/emba.‌

Harlan Krumholz: Health & Veritas is produced through the Yale School of Management, Yale School of Public Health. Thanks to our researchers, Ines Gilles, Tobias Liu, and Sophia Stumpf, and to our producer, Miranda Shafer. They are terrific, they are terrific, and help us do well every week.‌

Howard Forman: Absolutely.‌

Harlan Krumholz: Talk to you soon, Howie.‌

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