Vin Gupta: Impact at Scale

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. Vin Gupta. But first, we always like to check in on current hot topics in health and healthcare. What’s on the agenda today, Harlan?‌

Harlan Krumholz: Well, one of the hot topics is what the Biden administration’s doing. So, let’s start with this. As you know, we’ve talked about, obesity is not just about willpower or appearance. It’s a chronic disease. It contributes to diabetes, heart disease, cancer, lots of other health conditions. But yet for decades, the tools to fight it effectively have been out of reach for millions of Americans, largely because we just haven’t had things that have worked. But now, we have things that work. Not only do they work for fighting obesity, but they clearly are reducing risk. And so, not only now do we have them, but the issue about access may change for Medicare beneficiaries.‌

The Biden administration proposed a landmark policy, Medicare and Medicaid coverage for anti-obesity drugs like Wegovy and Ozempic, starting in 2026. This could make a transformative difference for millions. But it’s not without controversy, so let’s dive into this a little bit. The core of the proposal, the Centers for Medicare and Medicaid Services, or CMS, the group that oversees Medicare and Medicaid, would reinterpret existing rules to classify obesity as a chronic disease. This isn’t about a cosmetic disease, which is where it was before and they said, “We’re not going to cover it.” But they’re going to classify it as a chronic disease. So, that means anti-obesity medications would be covered under Medicare Part D and Medicaid, and this coverage wouldn’t extend to people who are overweight without other medical issues, just those classified with obesity.‌

So, who stands to benefit? About 3.4 million people on Medicare, 4 million Medicaid recipients, all these people now could have access with support from the federal government. Right now, they’re largely unavailable unless prescribed for related conditions. So, if they get these medications for diabetes or heart disease, sure, they’ll be covered. But for people with obesity who could benefit from these medications, there are many of them who previously would have had to just pay out of pocket totally for this. And you know there’s a bit of a sticker shock here, because the drugs can cost upwards of $1,000 per month without insurance.‌

So, for many people, this proposal can be life-changing. Remember, half of Americans don’t have even $500 put away for emergencies. So, when you’ve got a drug upwards of $1,000 per month without insurance, it’s a deal-breaker for them. So that’s what makes this such a big deal. And these drugs like Wegovy and Ozempic have shown remarkable benefits. There’s just, we talked about it just last week about the AHA, there continues to be a win streak on the studies. They help with significant weight loss, but that’s just the beginning. There’s reductions in heart attacks, blood pressure. They’re treating heart failure. There’s a whole range of areas and areas that are being explored in addition.‌

Howard Forman: Medicare was covering bariatric surgery, right, Harlan?‌

Harlan Krumholz: So, this is the thing, Howie. Yeah, exactly. So, this procedure, which is a big deal and fairly expensive, although it’s a one-time cost because it is a one-time surgery, they would cover that. Indeed. But for the medications for obesity, were sort of not there. And I think, on the equity front, this proposal holds a lot of promise. Obesity disproportionately affects Black and Brown Americans, and for the vast majority of, we’ve written about this, that among the vast majority who would need to be covered, they don’t have the discretionary money to be able to pay for it. This could change that, at least for those in Medicare and Medicaid. The key issue here—Howie, this is right down your alley—the coverage alone is projected to add $25 billion over 10 years for Medicare, for Medicaid $11 billion, and these are just estimates. People have raised concerns about whether we should be negotiating drug prices. That’s all in play.‌

There’s also questions about whether if you treat obesity, whether or not actually it will lower hospitalizations and may offset some of these costs. And then, there’s issues, people are talking about long-term safety and effectiveness. This has always come up, and we still need to continue to collect data, figure out what’s going on. The New York Times wrote an article about this, and some people on that feed were saying, the commenters, “Well, maybe we should just focus on our food systems.” By the way—that’s what RFK Jr. is saying. I think that there’s others, and I’m one of them who says that absolutely we should be focusing on lifestyle, improving the food system, and exercise.‌

But for many people, they’ve tried everything, and they cannot address their obesity. These drugs become a game changer. And by the way, Dr. Oz, Mehmet Oz, who’s been tapped to lead CMS—he supports them. Of course, he’s a friend of Oprah who’s a big fan. So, in any case, this is a big deal, Howie.‌

Howard Forman: I agree.‌

Harlan Krumholz: And the proposal reflects a shift in how we think about obesity. More than just paying, labeling obesity as a chronic condition is going to change people’s frame of reference. This shame and blame on people saying they lack willpower, now we’re going to start to really recognize the truth, that these people are suffering from a chronic condition.‌

Howard Forman: Yeah.‌

Harlan Krumholz: They shouldn’t be blamed, and we should really be figuring out how we can help them, as it is a treatable medical condition, though.‌

Howard Forman: Yeah. I think the decision is a no-brainer, and I think we have to deal with the cost consequences and how to manage that over the next decade. I have no doubt that we’re going to see more competition in this space, and that hopefully we’ve seen the high-water mark on pricing, and that competition will drive prices down over time.‌

Harlan Krumholz: Yeah, I’ll just say, there are more than 50 drugs in the pipeline. There’s lots of activity in the life sciences area. As more options come into market, pills once a month, once-every-six-month injections, I think that competition’s going to drive down these prices.‌

Howard Forman: I agree.‌

Harlan Krumholz: Great. Hey, let’s get to our interview with Vin Gupta. He’s amazing. I’m so glad he’s on the program today, and let me hand it over to you.‌

Howard Forman: Dr. Vin Gupta is the Chief Medical Officer for Amazon Pharmacy, but he has served in many leadership roles in Amazon, and we may go into that, but there’s a lot that he’s done for that company. And his early career commitments, though, included many different positions, many with a global health impact, including working for Centers for Disease Control and Prevention, but in Bangkok, work in Shanghai as part of the Fogarty Fulbright Fellowship, through the World Health Organization, the Department of State, and the Pentagon Center for Global Health Engagement.‌

He is well known right now as a regular featured medical analyst on NBC News, and is also a contributor to several other media outlets. He was frequently on the news during the COVID pandemic representing the medical community, but more importantly, working clinically as a critical care pulmonologist at Virginia Mason Medical Center, continuing to practice medicine, as well as an air transport physician as part of the Air Force Reserve, serving at the rank of major. Dr. Gupta earned his bachelor’s degree from Princeton, his MD from Columbia, before completing his residency at the University of Washington and Seattle, and then a fellowship in pulmonary and critical care back on the East Coast at the Brigham and Women’s Hospital. He also holds a master’s degree in international relations from the University of Cambridge, and a master’s in public administration from Harvard. He has also completed reserve commissioned officer trainings here.‌

Harlan Krumholz: Howie, who is this guy? I mean, my goodness.‌

Howard Forman: I mean, I was thinking, as I was editing this down, Ines helps us get the bio together, and I was thinking like, how can I trim this down? And I did trim it down.‌

Harlan Krumholz: How does one guy do all this stuff?‌

Howard Forman: I know, that’s the first question we should ask. But I do, I want to just start off, though. You really have been an incredible voice of reason throughout the COVID pandemic and beyond. You’re just a thoughtful, calm voice. And I wonder, and this is I think a surprise, this is not something Ines captured in the bio, but you are yet another amazing Ohioan. And so, I just want to know, what is in the water?‌

Harlan Krumholz: He says that because I’m from Dayton, Ohio.‌

Howard Forman: And he’s from Toledo.‌

Harlan Krumholz: Yeah.‌

Vin Gupta: Yeah.‌

Howard Forman: When did you first get to passion for wanting to do this type of work?‌

Vin Gupta: Yeah. Well, I mean, first of all, Howie and Harlan, I think those of us trying to have impact look to physicians like yourselves as examples that, what we aspire to, especially because I didn’t have mentors that were able to have the level of impact that the two of you have had, collectively. And so it’s really just an honor to be here. On communication, I think the best part, at least what feels like the best part of and most satisfying part of my journey is that all of it came unexpected.‌

And I often tell medical students or those looking for advice, either because they want a career in health technology and balancing that with clinical or communications, whatever it may be, but just a nontraditional path that—what I realized going through the ranks, whether it was academics, the military, and experiences in between, was it felt like outside of the four walls of, say, the Brigham when I was in fellowship, the way we communicate, the two of you know this because you do this all the time in your respective spheres of influence, it’s just a different way to communicate, to be able to persuade and have impact at scale.‌

And I don’t know that we get that training during a traditional pre-medical career. Certainly, I didn’t feel like I got that in medical school, and I was exposed to a different way to communicate and persuade, negotiate. Through the reserves, I deployed three times through some of these degree programs that were not at all related to med school, and I got really interested in diplomacy, negotiation, some of those concepts, studied some of those concepts at the Kennedy School, and really, sort of a few years before the pandemic, it all came together where I would start to get opportunities to communicate on vaping or climate and health, gun violence, and just found my voice. And it’s been extremely satisfying.‌

Today, we just did a segment at 4:30 a.m. West Coast time on Wegovy and its potential impacts on alcohol addiction. And so, it’s just, I think there’s so many different ways to have impact that scale. You two are examples of that, but I think effective communication is just something that clearly can have impact, and I’ve been delighted just to be a part of that world.‌

Harlan Krumholz: Yeah, no, it’s been great to watch you. I see some people who are doing what you’re doing who are willing to compromise how well anchored they are to evidence, for popularity. And actually, you’ve never done that. As I see you explain things, you’re always strongly anchored, and okay, what does the evidence say? What’s the science say? How can I communicate that best where there are areas of uncertainty, willing to admit it. But that’s just so important in this world that we’re still sticking to, what do we know and why? Where are those areas of uncertainty? How do we come together?‌

Vin Gupta: I would think, if I were to do anything differently, I would worry about, “What would Howie and Harlan think?” Anything that I put out there will be with different intentions. And I’ll also just say, just to vent on this, it feels like some people, to your point, Harlan, recognize that there’s an easier path if they’re doing it for the wrong reasons to fame or glory. If they do clickbait versus if you do things through evidence, maybe the road’s winding, but it’s the right thing to do. It’s just, I’ve noticed that there’s sort of a fork in the road, and some people choose one side, to your point, some people choose others. But I’m glad that we’re all on what I think is the right path.‌

Howard Forman: Can I follow up, though? You’re not only doing this type of service to the public in communications, but you’ve consistently done government or government-adjacent work. I mean, you serve in the military. I mean, you’re still in the reserve, I believe. I just find that to be so admirable. I know a lot of people say “Thank you for your service,” and I’m sure most of them mean it, but as somebody who, early in his career contemplated and realized that, number one I couldn’t, but number two, I would be afraid of it, it’s, I mean, it’s really an incredible contribution that you do that, that you learn from that. Where did this service orientation come from? Because you started doing it as an undergraduate.‌

Vin Gupta: My first day in college at Princeton was September the 11th, 2001.‌

Howard Forman: Oh, wow.‌

Vin Gupta: And I remember my parents dropped me off that morning. We had breakfast, we had seen the first plane fly in, confused, scared, but didn’t really know what was going on. They then drop me to my dorm, and walked in, people were crying. I later found out several of my hallmates had parents that had perished. And that was, I mean, quite literally my first day in college, and I remember my parents drove back, so the drive back on 90, and tell me now to this day, they were shocked that they left me there. But for somebody that had never really been away, it was—we had to grow up really quickly. And I remember at that time the level of patriotism, and gosh, that this is an outrage, and being surrounded by people that were actually, I served in a doctorate capacity, so removed from the front lines. But seeing the example of others that were graduating, that were changing their life course to enlist was really motivating.‌

And so, that next year, I had signed up for the what ultimately was the reserves, and then a pathway into the healthcare reserves, which provided stipend support, tuition support. And it was built out of, that was the antecedent of it, which was seeing examples of real, I mean, just incredible service around me at a moment in which I think we’ve, at least in my lifetime, I’ve never experienced that level of sort of public patriotism.‌

Our public discourse doesn’t allow us to talk about this, Harlan and Howie, but I’ve seen it now for 10 years in the reserves. I’ve done three deployments, 90 days. Again, just to emphasize, I’m the one that’s helping safely transport people that are injured or sick or anything in between. I’m not experiencing anything in the way of direct bullets or direct harm. But what I’ve seen has been incredibly humbling. I also think it teaches you how to operate within a chain of command, which is not something that I think is commonplace. But it’s also shown me how, I worry about our military medical force. It was deployed all the time during COVID. It has a 40% gap in terms of the need. There’s not enough people going in. And we don’t really talk about that in our public discourse, how few people are actually volunteering anymore because the sense of patriotism and wanting to do it has been, I think, impacted by the polarization that we see across society.‌

And so, I know, sort of a tangent, but just something that came up.‌

Harlan Krumholz: No, that’s incredible. I want to pivot a minute though to talk about some of what you’re doing now, because I think it actually has profound implications for U.S. health care and what we can do for reaching people. So, you’re the Chief Medical Officer of Amazon Pharmacy, and I think to me, a lot of what’s happening here is really at the cutting edge. I mean, take RxPass, for example. This subscription service that’s offering access to a selection of generic medications for a flat fee of $5 per month for Prime members. I mean, as you think about the potential for this, you can reach people all around the country. I mean, is this a way to increase accessibility, address disparities, to kind of make medicine more affordable, kind of disrupt a bit what’s going on across the nation with regard to financial toxicity of healthcare and how people are being left out?‌

Vin Gupta: Yeah, absolutely. It’s why I love what I do and have a foot in health tech and a foot at the bedside because this is a space that has seen meaningful disruption at scale across the country, in my lifetime, I would argue even in the last half century, in part because to do so, you need scale, and pharmacy can and is a logistics business to some degree. And it’s an interesting convergence of factors. But patient behavior has changed as, I don’t have to tell either of you this, that things have changed. People want to consume healthcare at home, especially potentially for urgent needs where we can compare telehealth with a next-generation home delivery experience. But there’s something about Amazon Pharmacy that I truly believe in. I know I’m biased, I’m affiliated with the organization, but J.D. Power & Associates just ranked us as the best home delivery experience in the country.‌

And there is something resonating amongst patients about wanting to receive their medications in a blister pack if they have multiple chronic meds, or Howie has mentioned this earlier, 30- versus 90-day. Thirty percent of people don’t even pick up their refills. Fifty percent of people are not adherent to their medications, and again, it’s not a sexy topic to talk about. But it takes a company, I think, like Amazon that knows what the customer experience should be like, and it has scale and can couple that with clinical expertise. We have a team of clinical pharmacists available around the clock.‌

To me, there’s a magic there that I think that we’re beginning to finally have traction. And people are saying, “Okay, I’m willing to maybe receive my meds via home delivery, and that makes sense.” Versus, we did a survey, on average, 13 hours every single year, that’s how long people on average wait in the retail pharmacy line for their medication needs. And 90% of meds are still picked up in the retail environment, and we wonder why 50% of people are non-adherent to their medications.‌

Harlan Krumholz: There are pharmacy deserts out there, right? I mean, people who are living a long way from pharmacies or it’s inconvenient, or they need to take public transportation to get there.‌

Vin Gupta: Absolutely.‌

Harlan Krumholz: Which takes time away from their job, it costs them some money, right?‌

Howard Forman: Or they’re about to be 92 years old, as my father is, and he still wants to go to the pharmacy every time. And so, I’m going to transition. And my experience with Amazon, which I only started a month ago, because as Harlan knows, I became fed up with CVS Caremark. I became completely fed up with them, and I figured, let me just look at Amazon. And not only were the prices cheaper and more convenient, but it blew my mind that the prescriptions were arriving in 18 hours. I don’t even know where they come from, but they’re showing up within 18 hours.‌

Vin Gupta: Well, it’s interesting, Howie, our operations team is moving towards, half the United States by the end of ’25 will have some same-day deliveries. So, well, all across Manhattan, Staten Island and parts of Brooklyn, if let’s say you had your order in by 9:00 a.m., prescription was sent to us, you did your virtual check-out, you could have your azithromycin if you have atypical pneumonia, at your doorstep by 1:00 p.m. And so, the stuff that we talked about, peak pandemic, test to treat, get triaged through your—‌

Harlan Krumholz: So, one thing I was curious about, and maybe Howie can respond to this. So, how difficult was it to get your insurance to transfer over to Amazon? Was there any issue there?‌

Howard Forman: It was so simple, Harlan. That was the biggest—‌

Harlan Krumholz: And by the way, we’re not being sponsored by Amazon. This is just Howie’s testimony.‌

Howard Forman: No. I know. I’m embarrassed.‌

Harlan Krumholz: This is his testimonial.‌

Howard Forman: Yeah, I’m embarrassed to be fawning so much, but I really am. And it wasn’t about the timing of having—‌

Harlan Krumholz: But you didn’t have trouble transferring the payment or anything like that?‌

Howard Forman: It was so easy, Harlan. I went online, they asked me a series of questions. They asked for my insurance card, they asked which prescriptions they wanted transferred, and next thing you know, they were there. And then, it was just a matter of whether I was ready for them or not.‌

Harlan Krumholz: Interesting. Wow, that’s amazing.‌

Vin Gupta: And I say this because I think a lot of, in a few weeks, actually in January, we’ll be able to share this publicly, but there’s a peer-reviewed publication coming out on RxPass. It’s in a very notable journal that you’re very familiar with, that something that is consumer-focused, Harlan, to your example on RxPass, that’s easy to navigate, that, I think the messaging around it to the patient is very easy to understand, can drive adherence. In a world where I think, what are the solutions for non-adherence? They’re not sexy, we don’t talk about it a lot. Maybe it is about patient engagement. And so, I can’t wait to share the publication with you.‌

Harlan Krumholz: Is it though, because you need a Prime membership, is that somehow precluding certain vulnerable populations who just don’t even have that amount of discretionary income from participating?‌

Vin Gupta: For those that don’t have access, or for which, say the annual fee when it’s sort of amortized over the course of the year—‌

Harlan Krumholz: And it’s not so bad, what is Prime? It’s 100 bucks or something?‌

Vin Gupta: ... It’s $100. And so, there’s Prime access, which cuts that to about half. There’s other sort of discounts, my understanding for students and others that can’t afford that. What we’ve seen with RxPass is that the program pays for itself. It actually pays for the cost of a Prime membership. It’s $5 a month add-on, but it actually saves about $90 for somebody who might have a med-basket of two to three meds, and actually saves that person about $5, or about $90 over the course of a year on a typical med-basket of two to three chronic medications, versus if you use sort of traditional out-of-pocket cash pay, or out-of-pocket from whatever your copay is as a result of applying commercial insurance. Relative to that, the $5 through RxPass can actually net in cost savings of about $90 over the course of a year.‌

Harlan Krumholz: One thing I thought about with the platform is, there really is a lot of potential for disease management. I mean, if you’ve developed this relationship, you can help people navigate. I mean, also, are there meds in conflict? Are there duplicate meds? Are you thinking about those things too? Because especially with the AI too, not just rule-based, but being able to optimize for individuals?‌

Vin Gupta: Absolutely. And so, we have, part of One Medical, which is now part of Amazon Health, they have, formerly Iora Health, now One Medical Seniors, we’ve started a program where, I work with a team of clinical pharmacists that are focused on health outcomes, medication, therapeutic management, and the like. And what we’ve started to do is, for anybody that’s within the One Medical Seniors catchment, if they’re 65 years of age and older and they meet certain criteria, they’re in that catchment. If they happen to be on 10 or more medications, which I think 25% of the seniors’ population, well, nationwide, is on at least 10 or more, we now do proactive medication reconciliations with a focus on deep prescribing.‌

Harlan Krumholz: That is amazing. That’s amazing.‌

Vin Gupta: Yeah. And I will say the providers love it. And it reminds me of the inpatient worlds where the clinical ICU pharmacist, in my case, is constantly improving care. They’re constantly improving my vancomycin dosing, but I don’t feel like we have that paradigm in the outpatient world. And so, I do think Amazon has the ability to really mirror it.‌

Harlan Krumholz: We did a study once where we’re looking at patients with heart failure, and we said, “You know what, what we’re telling them when they leave the hospital, we’re basically giving them a portfolio of medications that require them to swallow 30 or more pills a day.” And I would go to the teams and I would say, “This is a full-time job.” I mean, really, have you thought about what it takes to actually be swallowing 30 pills a day? And this de-escalation of the polypharmacy, the attacking of this to say, what are the essential meds, what are legacy meds that may no longer be doing anything for someone, is such an important problem to address.‌

Vin Gupta: And I would say is, I mean, it falls under that sort of rubric of pharmacist scope of practice, which I would say our pharmacists, they were trying to use generative AI to minimize paperwork and streamline prescription ingestion, to minimize errors. So they have more time to do first fill counseling, they have more time to help with goal-directed therapy, do collaborative practice agreements. I mean, it stuns me that we have a 50-state approach to what pharmacists can and cannot do from a scope-of-practice standpoint when they are so skilled and they’re so educated. And so, we’re trying to, I do think that’s an area where I’m hopeful Amazon Pharmacy can continue to lead, but de-escalation’s basically—‌

Harlan Krumholz: Okay, let me jump in with one more thing, Howie, then I’m going to let you go, but I can’t resist. So, Amazon has made such a big investment now in Anthropic, and so people may know that Claude’s the basic foundational interface for Anthropic. I’m excited. I can’t wait to see what Amazon is going to do with this from anything from Alexa. But in healthcare, I can just only imagine the kind of things. I mean, what are you thinking about with regard to this, because this is a major direction for Amazon, right?‌

Vin Gupta: Yeah. I mean, I guess what I can share publicly is that there is an effort to make sure that people at the point of need have better information. And so, is there a way that if somebody’s searching on .com or if they have a question, can we leverage a large language model to be able to give them better information at the point of need, to avoid potentially needing to speak to a human, or to be able to triage somebody who absolutely needs to speak to a human more effectively?‌

And so, I think part of, that’s driving some thinking. It wouldn’t surprise you, and I don’t think this is any different from the health system down the street from me or at Yale, where I’m very bullish on large language models helping to improve clinical decision-making. And you probably saw the study that was, I think the Times reported on yet another study showing that assembling a differential diagnosis, leveraging a generative AI tool in the EMR just leads to better patient care.‌

Harlan Krumholz: Yeah.‌

Vin Gupta: And in some cases, maybe independently of any human thinking. But, so I think better helping streamline diagnosis, mitigate the misdiagnosis, and better information on the point of need.‌

Howard Forman: I want to just give you an opportunity to give us some sound bites about pharmacy services because, sure, probably led with that. I have no sense of the scale of the business right now. Where does it stand right now and how fast is it growing?‌

Vin Gupta: Sure, absolutely. Thank you. So, we have seen triple-digit growth, percentage-wise, in terms of just new patients within our catchment, filling scripts on Amazon Pharmacy over the last 12 months. We’re a 50-state, fully virtual pharmacy with a team of clinical pharmacists that are available, with rapid service line accessibility. So, within a few minutes, you can speak to somebody if you’re a provider. Call in a script, make a change, which, sometimes, honestly, Howie and Harlan, when I hear from my fellow providers why they like Amazon Pharmacy, and I’ve heard it from many, they like the call-in experience because they don’t have to wait in line 30 minutes and hope to speak to somebody, which I think we’ve all seen at some point or experienced.‌

We’re non-specialty, largely. It’s specialty-light when it comes to, say, GLPs and migraine medications. We don’t do specialty though today. And whether it’s sort of through, as the exclusive mail-order partner to a Medicare plan, a state-based Medicare plan or Blue Shield of California where in 2025, we’re actually working with Blue Shield of California, Cost Plus, and us on a very different model to source medications through Cost Plus direct from manufacturer, we’d be the distributor on the back end. Blue Shield of course is sort of the overarching payer.‌

The idea there is, we want to partner with progressive-minded stakeholders that have a stake in the journey of a prescription, but in some ways, can we navigate around traditional models that are dependent on a PBM [pharmacy benefit managers], and that ultimately results in markups at every step of the way, meaning higher costs for the patient. We are looking at those types of models here, and so we’re really excited about things like what we’re announcing, or what we’re going to go live with in ’25 with Blue Shield of California and Cost Plus, and I think that could be a model for the country.‌

Howard Forman: Well, it’s been awesome having you. I mean, we’ve been looking forward to this for a while, and I learned a lot, and I hope we’ll be able to have you back. But I just want to emphasize to our listeners just how many other things we could have talked about, and we appreciate all of your service.‌

Harlan Krumholz: Yeah. Vin, you’re the real deal, and it’s great having you on.‌

Vin Gupta: Thank you so much for both of your examples and for having me. Truly.‌

Harlan Krumholz: Thanks. Hey, that was a great interview. Really, really enjoyed him.‌

Howard Forman: He’s fun.‌

Harlan Krumholz: Yeah, he’s terrific.‌

Howard Forman: He’s very smart.‌

Harlan Krumholz: You can see why he’s doing so well. Yeah. So, let’s get to your segment, Howie. I think we’re on the cusp of Thanksgiving. People will get this on Thanksgiving. I don’t know. I’m wondering if you’re going to talk about something like that.‌

Howard Forman: That’s exactly right. So, I just want to emphasize that we all have much to be thankful for. And at a time when there are endless crises in the news, concerns that we’re drifting backwards, the reality is that we’ve accomplished a lot both domestically and globally this year. So, I just thought, give you a few ideas of brief news. These are not meant to be consummate at all. Just some ideas I came up with. One is, for the last two years, we’ve been concerned about Medicaid disenrollment as the pandemic emergency ended. But as of right now, after about 18 or 19 months since the pandemic emergency ended, we are tracking at about 80 million Medicaid enrollees, which is up more than 10% from pre-pandemic levels. And enrollment on the ACA exchanges is also up to record levels, nearly double the pre-pandemic level. So, there has been Medicaid disenrollment, but it has not been nearly as aggressive as we worried about, and we seem to be doing well with overall enrollment at this time. So, that’s number one.‌

Number two, global infectious diseases. If you remember earlier in the year, we talked about Cabo Verde eradicating malaria, but just last month—and I missed this—the World Health Organization announced it. Now, Egypt is also malaria-free. And recall that we talked about much progress about the Guinea worm earlier this year. So, global infectious disease is a lot to tackle, but we are making progress in many areas and for many diseases. ‌

And then, in keeping with our theme of our talk with Vin Gupta, pharmaceutical innovation. You and I have continued to have these conversations just in the intro. We talked about GLP-1 drugs and the truly miraculous outcomes that keep flowing. That’s an innovation that continues to build on itself. And while the news on sickle cell might seem a little bit more mixed, the fact that there are now patients being cured, truly cured of sickle cell disease, is yet another biomedical science success story. and there’s many others there as well.‌

And I’ll just make this even more personal for me. One month ago, I was finally treated via non-surgical but procedural intervention from my 34-year history of atrial fibrillation. And I want to talk more about it in a future episode, but one of the pivotal innovations that made this possible was only approved at the beginning of the year by the FDA, and that’s pulse field ablation. And while my personal outcome is still awaiting a sufficient interval to judge, the data on this new technology is very strong, reduces side effect, and it reminds us that we, the United States, remain a leader in medical device innovation, curing diseases that have very high morbidity.‌

And lastly, and this we talked about also with Vin Gupta, AI in medicine. I can’t talk about anything that we can be thankful for without talking about AI. And in my own radiology practice, this just last evening, I felt this. I don’t so much rely on AI as constantly benefit from it, and patients even more so. We’re able to detect consequential disease at greater rates with fewer false negative exams, and I personally have come to use medical large language models to help round out differential diagnoses, much as Vin Gupta mentioned, on complicated cases.‌

There is much to bemoan and be concerned about in medicine, health, public health, and healthcare. But there is so much more to be excited about and, yes, thankful for. And I just could not end without saying my sincere thanks to our listeners; to you, Harlan, who has been a great partner in this enterprise; to Miranda, our producer; to Sophia, Ines, and Tobias, our research assistants; to our amazing guests, including Vin Gupta today; and to the teams at the School of Public Health and the School of Management who allow us to do this week after week.‌

Harlan Krumholz: Well, thank you, Howie. Gratitude’s always a good thing. This is a good time of year to reflect. You’ve preempted all of my thanks to our extraordinary team. I want to just also express thanks to friends who sustain us, and you in particular, for me, has been such a great friend and colleague and partner on this podcast. And to my family, to my wife, Leslie, who’s just extraordinary and keeps me going, and to colleagues and those around us who have worked for good, trying to make a difference in the world. And, yeah, we should be grateful that we have something meaningful to do and that we’re working with such amazing people around us. And, yeah, it’s a good time of year too, despite all the things happening, to reflect that, there always are good things to reflect on, have gratitude.‌

Howard Forman: Absolutely. And I should shout out to my parents and my daughters and every friend and family around me who’s allowed me to get through my recent illness or my recovery and everything else. A lot to be thankful for, personally.‌

Harlan Krumholz: Lots to be thankful for. ‌

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

Howard Forman: How did we do? To give us your feedback or to keep the conversation going, email us at health.veritas@yale.edu or follow us on any social media, and Harlan has promised me he’s going to make a migration over to Bluesky.‌

Harlan Krumholz: I’m definitely going to add that to my portfolio. I’m going to start putting out posts, and we very much want to hear your feedback, questions, your experience with these topics. Anything you want to tell us, rate us, review us, it’s always great to hear from you, and it helps people find us.‌

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

Harlan Krumholz: Health & Veritas is produced with Yale School of Management and Yale School of Public Health. As Howie said, we are so grateful to Ines Gilles, Sophia Stumpf, Tobias Liu, and especially to our producer, the amazing Miranda Shafer. Talk to you soon, Howie.‌

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