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Episode 109
Duration 36:23

Tina Loarte-Rodríguez: Understanding Inequities in Healthcare


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’re excited to welcome Tina Loarte-Rodríguez today. But first we like to check in on current or hot topics in health and healthcare. And Harlan, you and I always prep a little bit for this to figure out what we’re talking about. And there was a lot that we could have talked about, but I’m going to turn it over to you to decide what we are going to talk about now.

Harlan Krumholz: Well, I thought it was worthwhile for us to dig in still further to this issue about these new CRISPR meds for sickle cell. And again, CRISPR, for those listening, this is the technology that allows editing of the genome. So we’re born with a certain blueprint of our lives that we inherit, and up until now, there’s nothing you could do about it. I mean, there are changes that occur based on our lives and our exposures, and those are called epigenetic influences. We’ve talked about that before on this program where there are modifications that occur. But for us to go in and design a change in the genome, to fix some intrinsic problem like sickle cell disease, is just still mind-blowing to me. But I thought—

Howard Forman: Mind-blowing, but also so simple, right? Because we’re taught in medical school that it’s one little error. It’s one tiny error. It would seem so simple to imagine, pull out a stem cell, change that one error, put it back in, done. Right? Is that how simple it is, Harlan?

Harlan Krumholz: Well, I think it’s important for people listening, we start talking about this amazing breakthrough. And again, the FDA approved two treatments for sickle cell using these Nobel Prize–winning techniques. By the way, the Nobel Prize for this just won in 2020, and this is still all relatively new. But for the hundred thousand Americans who have sickle cell disease, most of them Black Americans, the approval comes with a hope. Like you said, Howie, “Wow, this is going to be a great thing. Just go in there, snip it out, fix it, and do it.” But if you really dig into this, it’s a lot more complicated. And this goes beyond the fact that the price of these meds are ... one of them is $2.2 million, one of them is $3.1 million, so the price is out of this world. I’m going to be interested in what you have to say about that.

But this isn’t easy to receive. It’s not like someone comes in, they just get a shot like a vaccine, and they’re all fixed. People have to spend weeks, even months, in the hospital before and after the therapy is administered. And these steps that they have to take in advance can cause serious side effects because you’re really essentially taking out what are called stem cells, these cells that, progenitor cells. They’re cells that can help populate the body with a new script, this new genome, but then you have to wipe out all the old cells. And that can lead to severe infections, painful mouth sores and fertility ... and the thing is, not only is it complicated for the patients, I mean, listen to what I’m saying, months and months of very difficult treatments in order to successfully execute on this new therapy. But in addition, it takes a lot of resources at each center.

Well, the other thing I learned, Howie, was that there are only a few centers in the whole United States that currently are prepared to do this. They’re going to do more. But even the most advanced centers with the most experience are saying, “We think we can only do 10 or 20 a year.” So I’m curious what you think about this. I mean, it’s extraordinary that we can do this, but there’s a hundred thousand people in the country potentially could benefit. Price is high. The barrier for individual patients is a lot. And who’s going to get in? I mean, it’s only a few people are going to be able to get in just because of capacity. So this is complicated really.

Howard Forman: Yeah. So I have a lot of thoughts on this, and I think you and I agree that in the outro, we’ll talk more about the business side of it. But on the side that you’re talking about now, the technical side, I was fascinated by the fact that, for instance, we have one of largest tertiary care medical centers that you and I are physically in right now, Yale, New Haven Hospital. We have a very large sickle cell program. This will not be available in Connecticut at all. Boston, New York, yes. Nowhere else in New England basically, from what I could tell from the map. That’s how it’s going to start at least. And that’s both treatments.

And as you point out, it’s expensive. But it turns out that the institute, I think it’s called the Institute for Cost Effectiveness Research, maybe it’s Clinical Effectiveness Research, ICER, they came out and they said $2.1 million is actually cost-effective. So they don’t even think this is ridiculously high because theoretically at least, we don’t know this for sure, but theoretically, it’s one and done. You treat, it’s over. It’s not like some of the other drugs we’ve talked about where you actually have to treat someone for two hundred—

Harlan Krumholz: And people have looked at this. Over a lifetime, people incur almost $2 million in cost—

Howard Forman: Exactly, yeah.

Harlan Krumholz: …for the treatment. Because these people end up in the emergency room a lot, they have painful crises. They’re expensive because of the disease itself. And so—

Howard Forman: Exactly. And I see them. And put aside the expense, imagine when you’re the person who has to go to the hospital three or four days a month. Imagine when you’re being admitted to the hospital two or three times a year for these crises for your entire life. That impacts your productivity; it impacts your ability to be a parent, to be a worker. So many other things besides the healthcare costs themselves. So look, I’m extremely enthusiastic about this because I think this is one step that is going to just explode in the next 10 or 15 years. We’ll have a lot more to show for it. And unlike some of the other innovations we’ve talked about on the program, like for Alzheimer’s disease, this is clearly an improvement. There’s no question this is impactful. But we’re going to have to wait and see. We’ll have to wait and see how many people are willing to go through what you’ve described, correctly, as a very serious treatment, practically a surgery, an immunosuppression period, a period of recovery. This is no small thing for people.

Harlan Krumholz: I was interested that basically, even for the data that was generated for this was a relatively small number of people, but because it was such a dramatic impact, they didn’t have to study large numbers. And one of the first people that was studied, I saw reported in the Times I think, that he’s continued to be pain free. And this thing ... but we have to follow it and see how long it lasts. My biggest concern is we have this medical miracle, this life science advance, and in the end of the day, 15 years from now, only a handful of people have benefited from it. So we’ll have to keep a close eye on the implementation side of this and see—

Howard Forman: I agree.

Harlan Krumholz: If we make a national commitment to, say, people who do. For the moment, it’s going to be the most severely affected individuals. And again, can I just say one other facet about this I find so interesting? I’ll just say in the discovery life sciences of this, so one of the treatments actually goes in and fix the defect in hemoglobin, the oxygen-carrying molecule that’s within red blood cells that really is able to pick up oxygen, deliver it, and take out the carbon dioxide. But the other one, there was an observation that people with sickle cell that the kids, the infants, were—

Howard Forman: Were fine.

Harlan Krumholz: …not affected. I mean, that was just an observation someone made in the 1940s to say like, “That’s curious. Why is that?” And it turns out that we have a different kind of hemoglobin that’s active when we’re in utero and in very early stage, called fetal hemoglobin, that when the usual hemoglobin is affected in sickles and causes clots and problems, that one isn’t affected. There’s no mutation there. And while that’s turned on, it actually carries oxygen and people ... the kids, the very little kids, were doing fine. The idea was the second one actually turns on the fetal hemoglobin.

Howard Forman: That’s right.

Harlan Krumholz: And so that kind of—

Howard Forman: That’s the mechanism. Right, the mechanism isn’t to fix the sickle. The mechanism is to turn on fetal hemoglobin.

Harlan Krumholz: Anyway, there’s just so much cool stuff in there. But at the end of the day, like I always say, I’m an outcomes guy. I want to see that actually people’s lives are better.

Howard Forman: And in the outro, we’re going to talk a little more on this because I’m fascinated by yet one more aspect of it.

Harlan Krumholz: Great. I can’t wait.

Howard Forman: So I also want to point out, Harlan, you, in the last week, a big announcement came out. You’re taking on an enormous new responsibility for the Journal of the American College of Cardiology, and not just a journal, but basically some level of oversight for 10 journals. This is no small task, and you are already a very busy man. I’m excited for you. But I want to hear if you have a couple of words to say about why you’re doing it and what you’re thinking.

Harlan Krumholz: Well, thanks, Howie. And for me, at this stage, the question is where can I make the best contribution. And the idea of being able to work in publishing, not just to publish the very best science but to use it as a platform, as a force of good. How do you use the deep anchor in science and try to create social progress? How do you create the means by which we can address a lot of things we talk about on this program and be a place where you can convene people, you can try to create solutions? But again, anchored in the very best science, put out and attract and synthesize and educate around the very best science. So for me, it was an opportunity to build community too, that it’s global in its scope. And anyway, it’s a deep responsibility, and I’m going to work hard to be worthy of it, but I’m really excited about it.

Howard Forman: And just to point out for our listeners, this is a very high-impact-factor journal. I think it has an impact factor of 24. It has enormous readership. We talk about—

Harlan Krumholz: We’re just getting started.

Howard Forman: I know, I know. But we talk about JAMA and New England Journal of Medicine a lot, but this is right up there with those.

Harlan Krumholz: No, I think it’s arguably—and it’s certainly one of the leading cardiovascular journals. And it builds on a remarkable tradition. Lots of great prior editors and lots of great work, and we’re going to just try to build on that. But thanks, Howie.

Howard Forman: I’m excited for you. I really am.

Harlan Krumholz: Thank you.

Howard Forman: Okay, let’s get to our guest. Tina Loarte-Rodríguez is the associate director of Health Equity Measures at the Center for Outcomes Research and Evaluation, or CORE, at Yale. She previously served as the vice president of nursing at Wheeler Health, a community health center in Connecticut, and has experience in risk management, quality and safety measures, infection control, and nursing. Dr. Loarte-Rodríguez’s work revolves around advocacy, healthcare equity, and patient-centered care. She has won several awards for incredible work, including the Hartford Business Journal Hero Health Award and the Connecticut Nursing Association Excellence Team Award. She recently authored a book titled Latinas in Nursing, which features narratives from Latina nurses around the U.S. The book evaluates the state of nursing in America and gives insight on how to better support and foster support for Latinas in the healthcare profession. Dr. Loarte-Rodríguez received undergraduate degrees from both Cornell University and the University of Connecticut, and she completed her doctorate of nursing practice at Quinnipiac University.

So first, I just want to welcome you to the podcast. I also appreciate that you wrote this book. I mean, most people aren’t going to see any video from this, but I am holding up the book that you wrote, and more importantly than just writing it, is you really edited a collection of essays from a group of amazing women who are all nurses and all Latinas. And I want to start off by asking for people who may listen to our podcast and may want to get this book and read it, these are really inspiring stories. Whether you’re interested in healthcare, whether you’re interested in education, whether you’re interested in almost any topic, this is an uplifting book. I’ve read it over the last few evenings before I went to sleep. It was very calming to me. It gave me happy thoughts before I went to bed. Can you tell me what inspired you to write that book and what you drew from it, maybe surprisingly?

Tina Loarte-Rodríguez: Well, thank you so much, Howie, for that beautiful introduction. And Harlan, thank you again for having me on the podcast. 2020 was a monumental year for the world. COVID, as well as the ongoing racial injustices and murders of people who look like me and those that I loved really took its toll on me. So by the end of 2020, I was really morally injured. I was exhausted, and I was searching one night late in my office for a source of inspiration to comfort me and to uplift me, just as you have found recently as you’ve been reading it. And unfortunately when I was looking for that, I didn’t find one. I did find a handful of books written about African-American and Black nurses, but still not enough as well to appropriately mirror their contributions to healthcare and nursing. And so that was really the inspiration. I knew I had to write this book to tell these stories.

Howard Forman: And just quickly, was there anything that surprised you when you finally put it together and collected these essays? Was there anything surprising from it?

Tina Loarte-Rodríguez: The biggest surprise of it is how it really transcends into all different specialties, applications. It’s not just for nurses or Latinas or people in healthcare. As you said, it’s really stories of inspiration and triumph, resiliency, and the belief of community that can really assist anyone achieve their dream. So that for me has been an essential theme for the community that I have now embraced because of the book.

Harlan Krumholz: It’s a gift that you put this together, and maybe sometimes good things still come out of the pandemic, even as it wreaked such havoc and took so many lives. But there are some things, some people, who took that challenge and actually helped to make things better in a way for the future, and you’re one, through what you did on this book. But I think people as they’re hearing about this might wonder a little bit about your background. Can you tell a little bit about your journey? I mean, where are you from, what got you interested in healthcare, and what turns you towards nursing in the first place?

Tina Loarte-Rodríguez: Absolutely. So I am a proud Afro-Latina from the Boogie Down Bronx, born and raised. I am the first in my family to graduate from college and then to go on to complete master’s and now a doctoral degree. Thankfully, I’m now not the only that has undergraduate degrees, and actually my goddaughter is also aspiring to get her Ph.D. So it’s really been exciting to see how we’ve been able to break the cycle of lack of education within the family. So again, I’m an eternal learner. I love learning and have really transitioned from actually being an educator at first, which is how I really felt I learned better, and went on to teach middle school math in Jersey City for four years. And it was just beautiful to be within a community that looked like mine and to really represent the students and families that I was teaching.

Oftentimes throughout my educational journey and my professional journey, I am often the one and only person of color or woman of color. And so even as a teacher, a young teacher, that was true in that setting. So being able to be that role model for my students and the rest of the school was really important to me. One summer during my teaching tenureship, my mother-in-law became ill, and she was hospitalized with viral encephalitis and then had to go on to rehabilitation as well. Because it was the summer and I was a teacher, I was off from work, so I was able to be with her throughout that process. And being with her in the ICU and then the step-down and then the rehab, I was really comfortable in those settings.

When the attendings and the residents came in to give updates, I followed along and I had follow-up questions and was able to really be that conduit, that communicator, that liaison between my husband and his family as well as the healthcare team. And it was during one of those times that one of the attendings asked me if I was a med student. “No, I’m an educator, I’m a teacher.” And he continued to say, “Well, you have a gift for this, so you should consider something in healthcare.” And so I sat with that for a little bit and realized that I did have an interest in it and realized nursing was where I wanted to land because of the ability to have more of the patient interaction and be more of an advocate, but then also having a shorter educational track, was really how then I became a nurse.

Howard Forman: I want to pivot to really Harlan’s area. So you’ve now been working at CORE on health equity measures. We’ve talked about health equity measures more generally and certainly about health equity on the podcast, but there’s very, very specific data that could be collected and is collected about patients in our various types of databases. What is your role at CORE, and what could we be doing better to advance health equity for various minority groups, ethnic groups, and so on?

Tina Loarte-Rodríguez: Well, I have the privilege and honor of really working with the health equity teams here at CORE on a number of measures in various stages from development to implementation. And so I have oversight over a couple of specific measures. The assessing for social need measure, which is under development, as well as the current hospital and/or facility commitment to health equity measures.

Howard Forman: When Harlan and I were in medical school and really beyond for the beginnings of our careers, we very often would include in our history our own identification of a patient’s race, ethnicity, and so on. And over time, and we’ve talked about this on the podcast as well, we’ve encouraged people not to do that. Unless it’s specifically relevant, we don’t do that. And yet we are trying to collect all this information, and we also recognize that a lot of this information is a social construct and certainly not a biological construct. Are there best practices for us to be collecting this information in a way that is not intrusive but does inform our research and does inform better population health in the future?

Tina Loarte-Rodríguez: Absolutely. I think it’s really regarding the intent and the degree of trust between the patient and the provider. And there are instances where it is impactful and relevant to the diagnosis or the treatment plan where you do need to understand a multitude of the other factors and intersectionalities of a patient. A patient isn’t just one thing, they’re a multitude of different identities and how those intersect and interact with the healthcare system, the provider but then also their bigger life. So it is definitely a benefit, as the research is showing, to have a better understanding of the patient’s identities.

Patient self-reporting is the best method. Really ensuring patients have an understanding and a trust that the information being asked is for their benefit, and that will be meaningful to the provider and have a direct positive impact to their treatment and their outcomes, is definitely how we should be practicing. I think it’s also really important to educate the educational institution, the frontline staff, particularly registration staff and some of those assisting staff or supporting staff, the medical assistants, who might not understand the impact that these questions can have on the care and really embrace the value of it versus as, “Oh, it’s another checkbox I have to fill out.” Because when it just stays as a checkbox that has to be completed, it won’t have its impact. It can’t reach its fullest potential.

Harlan Krumholz: And I just want to be clear again for people listening about what the strategy here is at CORE. The idea is that as long as things are invisible or that there’s not explicit commitments made, that it’s easy to maintain a status quo that is not adequately serving the needs of society and particularly maybe those who are most vulnerable. And in the health equity initiative within CORE is an idea that we can work with the government to help develop measures and the strategies that can help surface our levels of performance within healthcare at large that show us where the areas of improvement are greatly needed. And then when people are trying to make progress, whether or not we’re making any progress towards goal, and the one thing about the hospital, I just want to fill this in because I thought you described it really well, Tina, but I want to make sure ... I want to double down on this, that the CORE team, and Tina is of course an intrinsic leader of this team, Karen Dorsey, others, a large group of people within CORE have worked with the government to ensure that the hospitals have to make an explicit commitment in five areas about what are they doing to ensure that the people in their areas are getting a fair shake, that make sure that everybody gets a chance to live a long and healthy life, and they as a healthcare provider are participating importantly in that. So I just wanted to double down on that.

And then I have a question for you because in the course of doing these measures, and there’s lots of processes that are complicated in order to navigate the federal bureaucracy and so forth, but one really cool key thing is you guys convene a whole bunch of essentially what are focus groups, where you’re listening to people out in the field. You’re not just sitting in an ivory tower developing something, but you’re getting out into the world and bouncing these off other people. Can you just ... what has it meant for you to be listening to people? What are the kinds of things you hear when you tell people that we’re trying to do this and build these measures? Do people say, on one hand, that “nothing’s going to happen,” “I don’t care,” or do they engage? What’s your experience hearing from folks as you start trying to vet these things and make them better?

Tina Loarte-Rodríguez: I think, for me, the most meaningful part of my experience so far with CORE has been really getting to hear from the patients and families. So this is both professional alignment but also personal because I still have many members of my family who live in areas where they don’t receive high-quality healthcare and don’t have the tools and access and resources that I and so many others have. And so really having that voice, those experiences, come into our measure exploration, our measure development, is fundamental. Because at the end of the day, it has to benefit the majority of those which these services are provided for. And if we’re not listening to them, if we’re not giving them the opportunity to share their experiences and tell us what works but also what’s not working and also what they want to see better, then we’re missing our purpose.

Harlan Krumholz: And do you have an example, a story that you heard from someone, that particularly moved you?

Tina Loarte-Rodríguez: Absolutely. So it was during a recent patient and family engagement group where they shared how they were actually sitting in ... actually, not even sitting. They were in an overcrowded emergency room for over 12 hours, and for most of that time, they weren’t even able to sit down. And that was just prior to waiting to go in to being seen by the clinical team. So for over 12 hours, they were waiting in a crowded emergency room without even having a seat, not being able to get updates, not being able to understand why their wait was extended for so long. And then that was just the iceberg tip of it because then once they get pulled back, there’s other delays in them being able to be assessed, to be tested, to have a diagnosis, and then to have a treatment plan that they’re able to adhere to.

Harlan Krumholz: And that can be a spark for a measure that says we need to be accountable for how long people are waiting. We need to be able to surface that and also look by different groups to see whether or not people of color, for example, are waiting longer. That’s how you would take that information.

Howard Forman: Yeah. I wanted to follow on that because this summer our colleagues published a paper about queue-jumping in the emergency room. And one of the findings in that was that people who are basically, I may get this slightly wrong, but richer, whiter, and primarily English-speaking, we’re more likely to queue-jump. And queue-jumping for our listeners is that when you’re in the emergency room, there may be 30 people ahead of you, and I can only speculate, but I imagine that if you’re with a family member who keeps going up to the desk and saying that, “My brother, father, son is in agony right now, what can we do?” that you’re more likely to move up to getting a bed or being seen than you are if you’re sitting alone and maybe feel that language is an absolute barrier. And language is just one possibility there.

I mean, just income, wealth, and that can actually put you in a subservient role. I’m wondering if we are able to think about, even now, whether creating navigators for people, as we’ve done in cancer centers, but whether we can do that to help people at the entryway to the system so that they don’t wait, that they aren’t stuck for 12 hours. Because the story you told is all too common. It’s not just for marginalized groups. That can happen to anybody, but it seems like we could do better there. Are there ways that we could be, as Harlan said, measuring this but also thinking about what the solutions are upfront?

Tina Loarte-Rodríguez: Absolutely. There’s a multitude of opportunities to examine, even just from the number of clicks that providers are taking on the patient’s chart for the history, social and medical. And are they really doing a detailed chart review before they’re going to a diagnosis and getting that full picture of the patient? As well as having more access for patients to self-report a lot of this information in an easy and trustworthy fashion. But my previous life in the FQHC space, the federally qualified health centers, one of the best practices was community health workers that were really the people from the community that were in the waiting rooms and in the communities really being those liaisons and those voices to educate and to empower the patient to understand better what the process would be and then how to also prepare them for when they were finally in front of the provider, that they had the tools they needed to correctly identify their needs and their questions and their next steps.

Harlan Krumholz: Tina, I just want to thank you so much for joining us today. Let me just go back to recommending that people take a look at your book. It’s really, like Howie said, it’s an inspiring piece, and I’m so glad that you took the time to put that together, and I hope that we’ll generate some sales based on your appearance here. And thanks so much for talking a lot about this issue, about how do we really move towards a better, fairer healthcare system, one that gives everyone a chance to get the very best care and to get the very best outcomes. And I want to just commend you for the work you’re doing. We’re so lucky that you came to CORE. We’re so lucky you’re on this team. And I think the nation’s lucky that you’re in this position to try to push these issues forward. So thanks so much.

Tina Loarte-Rodríguez: Thank you.

Harlan Krumholz: Well, Howie, that was a terrific interview. I’m so glad that we had her on. But I’ve been waiting to hear those additional insights that you have about these sickle cell therapies, and I was held in suspense, so why don’t you—

Howard Forman: Yeah, no. So you and I will talk about this because I’m going to keep this really short, but this just always fascinates me. I talk about it in class, but this is just a crystal-clear example of it. I think the public grossly overstates the profitability of the pharmaceutical sector. Not that they’re not profitable in aggregate, but everybody always thinks all you have to do is invest money in drug development and you’re going to become enormously wealthy. But the problem is they only see the winners. And so here we come right now with two separate companies getting approval on the same day last week for the sickle cell therapy that we talked about in the intro. One of the companies is Bluebird Bio. That’s the one that actually is helping to recreate hemoglobin A, the normal hemoglobin, not hemoglobin sickle. So that’s that company. You talked about the other company with the fetal hemoglobin. So Bluebird Bio. Let’s talk about Bluebird Bio really briefly.

Bluebird Bio is a company that, with this drug now approved, expects to get about $3 million per treatment for this drug. This is a successful drug, it’s approved by the FDA; it works. There’s some risks associated with it, but $3 million is a lot of money. You would think that they would be an absolute winner as a stock, but you would be wrong. This company has traded over the last 10 and a half years, and I don’t think there is a single investor in this company who has made money if they’ve held onto the stock over time. The stock currently trades 98% below its all-time high of March 2018. It is down 80% from its initial public offering of over 10 years ago. And it is basically a penny stock that is potentially going to go bankrupt, even as it has a successful new drug for this important disease. We can go over all the reasons why this is the case, but I just want our listeners to understand that investments in life sciences are very high-risk propositions, even when the ideas, products, and markets are strong.

Harlan Krumholz: Let me just get this straight. They did everything right.

Howard Forman: Well, not everything.

Harlan Krumholz: Well, they did some things right. They were part of an effort ... by the way, these are all multiple groups working together, but this is part of an effort to create life-changing therapy. FDA has approved it and they’re in trouble. Is that right?

Howard Forman: Exactly. So let me just—

Harlan Krumholz: No. Go ahead.

Howard Forman: No, I was going to say, by the way, I would never have heard about this company except that a few years ago, my students presented it in class. We present companies at the end of my graduate class, and I occasionally learn about companies I never knew about, and I learned a lot about this company probably two, three, or four years ago. And so I have followed it a little bit, and it’s amazing how much they have struggled all along to get to this point.

Harlan Krumholz: And this is the issue that people talk about innovation. On the one hand, there’s all this stuff about, we’ve talked about the Inflation Reduction Act. I mean, is this going to stymie innovation and returns? And then there’s all this other stuff that can make investors skittish about investing these kinds of things. And then I just wonder, at some point, should the government be the one who’s investing in these things? A lot of people will ... their hair will go on edge when I say that. But some of these things are like should the gov—Medicaid is going to pay for a lot of these treatments. What role should the government be paying in both investing and in making sure that Americans get access to truly life-changing therapeutics? Anyway, it’s just something to continue to think about.

Howard Forman: It fascinates me, and by the way, you could buy this entire company right now for I think $300 million, so they’re charging 3 million—

Harlan Krumholz: Well, Howie, let’s get the money together—

Howard Forman: I know, you and I, we’ll just pool all our excess cash.

Harlan Krumholz: …and then we’ll make sure everyone has access. That’d be great.

Howard Forman: Yeah, exactly. It is fascinating. And I learned a lot just about reading about this over the last few days, and I’m looking forward to learning more.

Harlan Krumholz: That’s great. 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 us on Twitter, X, LinkedIn, Instagram. Wherever you want to look, we’ll probably be there. But for the moment, Twitter is where we’re anchored.

Harlan Krumholz: Well, and you’ve turned me on to LinkedIn and I want to expand out farther. I just haven’t had a chance yet. But on Twitter, X, I’m @HMKYale, that’s HMK Yale.

Howard Forman: And I’m @thehowie. That’s at T-H-E-H-O-W-I-E. You can also email us at Aside from Twitter and our podcast, I’m fortunate to be the faculty director of the healthcare track and founder of the MBA for Executives program at Yale. And the co-founder of the Pozen-Commonwealth Fund Fellowship in Health Equity, which is a fully funded EMBA fellowship for providers with a focus on closing disparities in health. And it is accepting applications right now to start in the summer of 2024. You can learn more by going to Feel free to reach out via email for more information on those and additional programs at our website at

Harlan Krumholz: Yeah, and you do that with Marcella, right? Marcella Nunez-Smith.

Howard Forman: That’s right.

Harlan Krumholz: Yeah. So I’m going to say the next thing that I always say, but I did hear from a listener that said, “Why do you say the names of your students with such gusto?” I just want to say that I was, first of all, I’m committed to saying names the way people want me to say those names. And Ines Gilles and Sophia Stumpf taught me how to say their names. But I must admit every time I kind of gather myself up when I say their names, because I’m trying to perform so well that I probably do sound like I’m emphasizing it.

Howard Forman: No, you sound great. I think you’re doing it great.

Harlan Krumholz: All right, ready? Here it comes. Health & Veritas is produced with the Yale School of Management and Yale School of Public Health. Thanks to our researchers, Ines Gilles and Sophia Stumpf. Into our producer, Miranda Shafer. Extraordinary people that we have the good fortune to work with every week.

Howard Forman: I couldn’t agree more. Thank you very much to them and to you, Harlan.

Harlan Krumholz: Oh my God, I forgot to say. Talk to you soon, Howie.

Howard Forman: Talk to you soon, Harlan.

Harlan Krumholz: All right, bye.