Conversations on Health: How We Get There - with Stephani Shelton

I’m calling this an emergency update on autism – as we wait for the new causal studies authorized by Robert F. Kennedy Jr. – the Secretary of Health and Human Services. So far, according to a recent Reuters report, researchers have submitted more than 100 proposals for RFK Jr’s 50 million dollar study of autism’s causes – essentially mining the CDC’s large data base. There’s a separate review in progress on vaccine safety as well as the relationship if any to autism. Secretary Kennedy originally made the unlikely promise to have definitive findings by September – that’s this month - but has now stretched that much further out. Earlier this month Kennedy appeared before the Senate Finance Committee for what evolved into a highly contentious hearing. Mostly on vaccines, changes at the CDC – and autism. There’s an excerpt in the podcast. So I’m bringing back Dr. Amy Wetherby - one of the top US autism experts - for this emergency update. To set you straight on the facts. The science. What we know now about autism’s causes – which is quite a lot. And how early intervention can change an autistic child’s life. Dr. Wetherby was my guest last June on Episode 34. Here’s the link to that much longer and more detailed podcast. https://youtu.be/5EMedABGCrU Amy Wetherby is a Distinguished Research Professor in the Department of Clinical Sciences and Director of the Autism Institute in the College of Medicine at Florida State University. She’s also a Fellow of the American Speech-Language-Hearing Association with over 45 years of clinical experience and the Executive Director of the FSU Center for Autism and Related Disabilities. Amy is also co-developer of the websites Autism Navigator and Baby Navigator - which can provide a huge amount of help to the parents and teachers of autistic children. This update was recorded September 12, 2025. I’ll add to these notes if something coming out of HHS or the CDC substantially changes anything we discussed. YouTube video link: https://youtu.be/0RTTN5Yh4lc Channel link: @conversationsonhealthhowwe4827

The cornerstone of any healthcare system is the general practitioner or GP. In the US we’ve renamed the GP to the rather cold sounding “primary care doctor”. Perhaps because so few of us still have that old multi-year connection with our doctor or perhaps because of the way our huge health insurance companies function. In the last podcast – Episode 35 - we talked about the UK’s still ailing health system – the NHS – a year after the Labor Government took over. Not much change yet but a recently released 10 year plan envisions most standard health care centralized in neighborhoods at the GP level. Including the mushrooming varieties of medical imaging. This doesn’t sound particularly revolutionary – especially if you live in the Czech Republic. Health care there still revolves around the general practitioner. So we’re going to meet a long time GP in this episode – who also teaches and is involved in many international health care projects. In addition to his MD, Dr. Bohumil Seifert also holds a PhD and is an Associate Professor at the Institute of General Practice, First Faculty of Medicine at Charles University. He headed that department for 14 years - until 2023. Dr. Seifert now spends half his time practicing in central Prague – the Czech Republic’s capital. The rest of his time is spent in international activities and research, much of it for the World Health Organization and WONCA - the World Organization of Family Doctors. We used first names in this interview – as is my custom on this podcast. YouTube Episode Link: Dr. David Marx Episode #1 https://youtu.be/io3rVfvYgj4

The United Kingdom’s National Health Service was founded in 1948 and is considered the mother of all government run health care systems - with Sweden’s slightly later plan for universal coverage just behind. We’ve profiled both systems on this podcast series. But we’re going back to take another look at the NHS --almost exactly one year after labor won a huge parliamentary victory. And the new Prime Minister Sir Keir Starmer and his new Secretary for Health and Social Care Wes Streeting declared the NHS was “broken” and promised to fix it. All health systems are having trouble adjusting to rising costs and demographic changes but perhaps the faltering NHS has gotten the most notoriety. Health care waiting lists as long as 2 years, doctor shortages and strikes, no hospital beds available for emergency patients – it’s a very long list. Under the government’s recent “Spending Review” – somewhat like the annual US budget outline – the NHS got the lion’s share of the available money – along with the military. And a 10 year plan emphasizes moving to neighborhood health centers for most healthcare instead of it being hospital-based. But what about immediate help for people? Are there any improvements in this first year? For the answers – I went back to the UK’s David Hunter - who explained how the UK system works in Episode11. He’s Emeritus Professor of Health Policy and Management at the Population Health Sciences Institute, Newcastle University and also Emeritus Professor at Durham University. His long list of endeavors also includes the recent addition of board member at “Ways to Wellness”. Which tries to reduce health inequalities. As you watch or listen - you’ll notice a lot of similarities to the US right now. Think Elon Musk’s DOGE and its abrupt firing of so many health policy related government workers. And of course our unending debate about taxation. This episode was shot, recorded and edited in Prague, Czech Republic before Labor released its 10 year plan to “fundamentally rewire” the NHS. https://www.bbc.co.uk/programmes/l00578wn https://www.waystowellness.org.uk/ Episode 11: David Hunter on the NHS: https://youtu.be/jqrNfpxSayA Episode 18 – Catharina Barkman – Sweden #1: https://youtu.be/Y4pTu_XcSqA Episode 19 – Catharina Barkman – Sweden #2: https://youtu.be/2vdA41ckoVA

What do we actually know about autism? Not enough according to Robert F. Kennedy Jr. – the Health and Human Services Secretary. He’s promised an initial 50 million dollars for his plan to find out what exactly causes autism. With an unusually short turnaround for research proposals . Remember Kennedy first promised he’d have all the answers by September but then extended that to March and now it appears by the funding guidelines it will be a year or more. Still much faster than research norms. Many health experts fear HHS will just cherry pick the answers RFK Jr. has pushed for years - including the long-debunked idea vaccines cause autism. The reality is there is already a solid base of data about autism’s cause. And some very successful methods to greatly improve a child’s ability to overcome it. When I decided to do this episode on autism – i didn’t have to look far to find one of the top experts in the country – Amy Wetherby, PhD. She just happens to be my cousin. Amy is a Distinguished Research Professor in the Department of Clinical Sciences and Director of the Autism Institute in the College of Medicine at Florida State University. She’s also a Fellow of the American Speech-Language-Hearing Association with over 45 years of clinical experience and the Executive Director of the FSU Center for Autism and Related Disabilities. Amy has served on the National Academy of Sciences Committee for Educational Interventions for Children with Autism and her list of credits and activities goes on and on. She is also co-developer of the websites Autism Navigator and Baby Navigator for parents and teachers which we discuss extensively on the podcast. This interview was recorded in early June of 2025; if there are major updates from RFK Jr. – I’ll add them to the show notes also. I learned so much from my conversation with Amy Wetherby – I hope you will also. The podcast is also available on YouTube: https://youtu.be/5EMedABGCrU

It’s no secret our population is aging fast. According to the US Census Bureau, 10,000 Baby Boomers hit that 65 landmark year each day. In fact 2025 is predicted to be “peak 65” demographically – with more than 11,000 Boomers crossing the daily line. Unfortunately as we age – more of us develop dementia and Alzheimer’s – with most of the associated costs paid by Medicare. It’s estimated that for Alzheimer’s care alone – costs are as much as 2.8 times higher than for other seniors. So Medicare has begun an experimental program called Guide. Partnering with some private, digitally oriented companies to create better dementia outcomes - both personally for older people and their caretakers and financially for Medicare. One of those companies is Tembo Health – founded and run by Dr. Anurag Gupta. He’s a practicing emergency physician with both an MBA and an additional degree and board certification in Clinical Infomatics. And lots and lots of real world experience at top rated hospitals. The concept of public-private partnering in healthcare isn’t new; but it’s certainly not every venture capitalist- financed start-up which hopes to make its mark with dementia care. So here’s my really useful conversation with Dr. Anurag Gupta: https://www.tembo.health/ https://www.cms.gov/priorities/innovation/innovation-models/guide YouTube Episode link: https://youtu.be/3Dw1rnp8Rc0

Most of you know something about the opioid crisis. It’s considered one of the most devastating public health catastrophes of our time. Just to summarize briefly – the first wave of deaths began in the mid 1990s when Purdue Pharma’s newly approved pain drug OxyContin was pushed to doctors. Purdue had lied to the FDA, saying OxyContin was less addictive than other opioids. It was, actually, even more addictive. Then came the wave of deaths from many of those addicts switching to “street” heroin. And then, as we all know, came the synthetic opioid fentanyl. 2024 figures aren’t yet finalized but even though there has been a decline in deaths - the US continues to have the highest rate in the world. With that as the background – I just had a very illuminating discussion with Dr. Arun Gupta. He started as an internist. But ultimately, he got so upset about the plight of his addicted patients in his mostly rural Michigan practice that he became a specialized addiction doctor. Then he wrote a book laying out the history of opioids and what needs to be done to help patients recover. This is a conversation I don’t think you want to miss. Note: all episodes are also available in video form on YouTube https://thepreventableepidemicbook.com/ (website is being updated) https://www.samhsa.gov/substance-use/treatment/overdose-prevention/opioid-overdose-reversal (NARCAN etc.)

Have you ever been hit by a huge medical bill when you thought your health insurance would be covering most of it? Do you know that unpaid medical bills are one of the top reasons Americans declare personal bankruptcy? Well, meet Frank Lobb. He’s a retired navy pilot whose later managerial background in law and compliance had nothing to do with health care. But some years ago Lobb had a very frustrating and ultimately tragic fight with his wife’s insurance company. And he began researching health insurers, personal medical bills and your rights under the law. He’s now written four books on what he’s learned – the latest - just recently published – is called “The Big Lie in My Healthcare Bill”. Here’s our conversation -- and I think you’ll learn a lot from Frank Lobb about how you can protect yourself and your family. I certainly did! Note: all episodes are also available in video form on YouTube

Perhaps the hottest, most divisive topic in health care is obesity. Which in the US appears to have stabilized in 2024 at about 40% of adults. Is obesity a disease or a lifestyle result? How does it affect overall health and what diseases can it cause? Who should take the expensive new GLP-1 weight loss drugs like Wegovy? And perhaps the most divisive issue - who should pay for those drugs – and how. Get ready for a great conversation with tons of useful information from my guest Dr. Naser Gharaibeh, MD, CPE, DABOM, NCMP – who heads the Valley Health System Center for Weight and Wellness in New Jersey. Dr. Gharaibeh is board certified in obesity medicine as well as endocrinology, diabetes, metabolism and internal medicine. Note: all episodes are also available in video form on YouTube

Is women’s health moving backward? The Supreme Court’s Dobbs Decision in 2022 overturned what most women believed was settled law – the landmark 1973 Roe v. Wade decision - establishing a constitutional right to abortion. Since Dobbs, many states - especially in the South and Midwest - have banned abortions for any reason or tightly restricted them. Leaving many women in medically dangerous conditions. Even before Dobbs – the United States had a maternal death rate more than double and sometimes triple most other high income countries. More women are obese than men. Causing multiple health issues. These all suggest that after major gains – women’s health in general may be moving backwards. So i asked Dr. Michelle P. Warren to come on the podcast. She’s a distinguished New York City physician who specializes in both endocrinology and gynecology and has spent her lifetime focused on women’s health issues. In 1997, Dr. Warren founded and remains the Medical Director of the Center for Menopause, Hormonal Disorders and Women’s Health at Columbia University Medical Center. Where she is the Wyeth Professor Emeritus of Obstetrics, Gynecology and Medicine. Full disclosure - I have been her patient for many years. Note: all episodes are also available in video form on youtube http://www.center-for-menopause.com/ https://menopause.org/

Lots of us became well-acquainted with telemedicine during the pandemic. And while many of us have gone back to office appointments with our doctors – telemedicine remains useful. Especially for mental health issues. How useful? Well – recently I logged onto a fascinating Health Affairs Journal webinar on telemedicine. And with winter upon us – I thought it would make a timely episode. Joining me is one of the presenters – Ateev Mehrotra, MD, MPH. He’s a practicing physician as well as the Walter H. Annenberg Distinguished Professor and Chair of the Department of Health Services, Policy, and Practice at the Brown University School of Public Health. His research focuses on delivery innovations and their impact on access, quality, and spending. These include innovations such as telemedicine, remote patient monitoring, retail clinics and e-visits. Our interview was recorded earlier this month – before the Trump Administration takes office. Note: all episodes are also available in video form on YouTube The Impact of Telemedicine on Medicare Utilization, Spending and Quality 2019-2022. Ateev Mehrotra MD, MPH and colleagues; published 4/27/2024 in Health Affairs Journal

Open enrollment for Medicare supplement plans, which continues until December 7, runs somewhat concurrently with the annual sign up period for the Affordable Care Act plans - commonly called Obamacare. The plans became available on state marketplaces on November 1 and the window closes on December 15 for coverage beginning January 1. We explained the major Medicare changes for 2025 in Episode 26 - check it out if you or someone in your family still needs the podcast’s actionable information. But right now let’s talk about the other actionable information – the 2025 Obamacare plans and who’s eligible for them. Back again is Dr. Steven D. Culler - our expert from Episode 26 and last year’s more extensive Episodes 14 and 15. He’s an Associate Professor at the Rollins School of Public Health, and Affiliated Associate Professor at the Goizueta Business School at Emory University in Atlanta. Note: all episodes are also available in video form on YouTube

Once again it’s open enrollment time for Medicare plans - which runs for just 6 weeks each year - from October 15 until December 7th. Millions more Americans who don’t get health insurance through their jobs or Medicaid can find or change so-called Obamacare insurance plans from November 1st through January 15th of next year. In this episode we’re concentrating on the biggest changes to Medicare for 2025, including qualifications for weight loss drug Wegovy coverage and the Medicare Advantage plans used by about 50 percent of Medicare recipients. Episode 27 – dropping on November 19th – will catch you up on the Affordable Care Act changes and their relationship to the state-run Medicaid coverage. This is hard information you can – and should use right now. We’re also taking a look at the effect of the top Medicare changes on private, work–related insurance plans, which are likely to make adjustments for 2025. If you need a primer on how these programs actually function – check out Episodes 14 and 15. Dr. Steven D. Culler - our expert from those earlier episodes – was kind enough to come back again for this update. He’s an Associate Professor at the Rollins School of Public Health, and affiliated Associate Professor at the Goizueta Business School – at Emory University in Atlanta. Note: all episodes are also available in video form on YouTube https://www.kiplinger.com/retirement/medicare/three-medicare-changes-on-the-horizon-for-2025 https://www.kff.org/medicare/issue-brief/what-to-know-about-medicare-part-d-premiums/ https://www.cms.gov/

Health experts in many countries – including the United States – are looking beyond standard health care and medical treatments to some kind of community-based care. Both as a way to improve people’s general health - and as a way to cut the spiraling costs of medical procedures and new drugs. The Netherlands appears to be well ahead of most countries with its varied efforts to re-invent what is generally called “social care” - starting right at the neighborhood level. With the huge Boomer population aging quickly - the Netherlands also has a particular focus on integrated care for people with multiple health issues. Which includes giving them access to adequate health care before those issues become serious. My guest is one of the Netherlands’ top experts in these areas - Professor Dr. Mirella M. N. Minkman of Tilburg University, Tias Business School and CEO of Vilans, National Center of Expertise for Care and Support. We cover a lot of territory – including what is a growing problem virtually everywhere – more and more young people with mental health needs. You’ll be surprised to find out how varied – and sometimes how simple social care can be. Note: all episodes are also available in video form on YouTube

Do you know someone – perhaps in your own family – who has spent time in a rehabilitation facility? Maybe after an illness or operation? Lots of people – and particularly older people who live alone – find themselves in rehab or long term care facilities. These are somewhat different from the assisted living or independent care communities we talked about in Episode 10 - when we explored one family’s exhaustive effort to find a place for their Mom in North Carolina. Rehab facilities are often affiliated with hospital groups and deal with everything from recovering from knee replacements to stroke and even dementia care. The residents may be there for just a few weeks – or much longer. My husband and I discovered that two good friends each have someone they care about in residential care at the same, independently owned, northern New Jersey facility. One day they started talking about the issues they’re encountering – like staffing, adequate physical therapy, mental stimulation and the overall differences between this independently owned facility and the more common and usually larger, company-owned facilities. My husband – the video editor and producer for this podcast series said – “you know -– this would make an interesting episode”. And I thought it may also be very helpful. We decided not to use the actual name of the place – or the names of our friends. So – cozy up with a cup of tea or coffee – and join “Maggie”, “Suzanne” and me for the conversation. Note: all episodes are also available in video form on YouTube

We’re spending some time this summer revisiting the UK’s National Health Service. It’s celebrating its 76th birthday this month – although I doubt anyone would use that exact word. Actually, right after the Labor Party swept the UK parliamentary elections on July 4th – both the new Prime Minister Sir Keir Starmer and his new Health and Social Care Secretary Wes Streeting said flat out that the NHS is broken. Both promised to save it. And - both stressed it couldn‘t be done overnight. Small comfort to the nearly 10 million people the BBC says may be on NHS waiting lists for doctor visits, operations or tests. That’s somewhat more than the official NHS count of 7 million. But the lists do seem to depend on who’s counting. There’s a crisis in available hospital beds. In doctors to care for patients in those beds. And - at the point of first patient contact – a shortage of GPs or general practitioners. People in some parts of the UK can wait weeks or months to see their doctor, as overworked GPs retire without being replaced. So - as the new UK government settles in – how do GPs feel about their own future? Do they think the Labor government – the first in 14 years – can make meaningful changes in the NHS? And make them quickly enough to save it - as the party has promised? My guest on this episode is Dr. Jihad Malasi. He’s been a practicing physician in the UK for over 20 years and is trained in family medicine and psychiatry. His practice is in Kent and the borough of Medway - an area south of London. Dr. Malasi is a member of the Royal College of General Practitioners and a Senior Fellow of the Faculty of Medical Leadership and Management. His interests are in primary care, health economics and policy. He holds a Master of Science degree in Health Economics from the London School of Economics & Political Science (LSE) and works for the National Institute for Clinical Excellence (NICE) and Kent & Medway Integrated Care Board as Mental Health clinical lead. Full profile on LinkedIn. The interview was recorded AFTER the July 4th UK Parliamentary elections. Note: all episodes are also available in video form on YouTube

As the US Surgeon General calls for a social media warning label similar to the one on cigarettes and alcohol, we focus on child and teenage mental health in this somewhat longer than usual episode. And about halfway through – we get into a really good discussion on that really big issue: the role of social media in the growing problems of Gen Z and the youngest children – Gen Alpha. We’re talking about all this with a child psychiatrist from the United Kingdom’s storied but now struggling National Health System. And she has some ideas you probably haven’t heard before. This is one of several episodes revisiting the NHS and it’s ongoing shortages and waiting lists from the standpoint of the doctors who keep it functioning. Often with great difficulty. If you haven’t heard or watched Episode 11 – perhaps you might want to for the overall story of the NHS and its current woes. A quick refresher: the NHS began in 1948 – more than 75 years ago – and along with the slightly younger Swedish system – is the basic model for taxpayer financed, government controlled, universal health care. Free at the point of use for all. Many of the NHS doctors that patients see are also its caretakers. Helping their local systems function while they also work in their specialties. Like my guest in this episode - who lives and works in Wales, one of the UK’s four devolved nations. Dr. Amani Hassan is an experienced practicing child and adolescent psychiatrist – a consultant, as many doctors are called in the NHS. She also chairs the Faculty of Child and Adolescent Psychiatry at the Royal College of Psychiatrists in Wales and works as well in learning disability psychiatry. Additionally, Dr. Hassan researches neuro-developmental disorders. She was the Training Program Director (2015 to 2018) of Child and Adolescent Psychiatry at Wales Deanery. There is some discussion about mentally disturbed young people. So I’ve included information below on how to get help if you or someone you know needs it – in both the UK and the US. Note: all episodes are also available in video form on YouTube IN THE UK: NHS National Suicide Prevention Line 0800 689 5652. 6pm to midnight. Backup: 0800 689 0880 999 for life threatening emergencies. Or go to nearest A and E. https://www.spuk.org.uk/national-suicide-prevention-helpline-uk/ IN THE US: 988 Suicide and Crisis Lifeline 24/7 Reaches local crisis centers similar to the way 911 functions for all other emergencies. https://988lifeline.org/

How many times have we all asked – when will they find a cure for cancer? Of course there is no one cure any more than there is just one type of cancer. Each one requires its own research pathway. But there have been great strides in recent years. Some cancers which used to be a death sentence can now be basically cured or turned into treatable, chronic illnesses. My guest for this episode is Theodore Lawrence, MD, PhD. He’s a Professor of Radiation Oncology at the University of Michigan and has an active oncology medical practice. He’s also researching better treatment outcomes for gastrointestinal and central nervous system cancer. His research continues to be supported by the National Cancer Institute. I’ve known Ted for many years – since he was still a medical student, recently married to my second cousin. He’s always been really excited about his work. And he has that rare ability to explain really complicated concepts in a way we can all clearly understand. Note: all episodes are also available in video form on YouTube

This may surprise you with all the medical advances we’ve made in the last decade --but heart disease remains the leading cause of death in the US. As it has been since 1921. A recent poll conducted for the American Heart Association found 51 percent of respondents had no idea! According to the Centers for Disease Control and Prevention – one person dies every 33 seconds in the US from cardiovascular disease. And this may also surprise you. The CDC says in 2019 - the last year it lists - heart disease cost the US about 2 hundred and 40 billion dollars. Think about the inflation you’ve experienced in the last few years and you can imagine how big that number will be for all of 2024. One reason for the growing cost of heart disease is that much of what causes it is treatable now. And as the huge boomer cohort moves into the senior class – older people with heart disease are living longer. So I thought it would be interesting to talk to a heart specialist I know - who would likely have been doing something else just 30 or 40 years ago. Dr. Mohammadali Habibi is an electrophysiologist with the highly rated Valley Health System and Valley Hospital in New Jersey. Valley’s state of the art, new hospital just opened. Valley is also partnered with the country’s top ranked heart hospital – The Cleveland Clinic. Note: all episodes are also available in video form on YouTube

Part 2: I think we all learned a lot in Episode 18 about Sweden's pioneering universal health care system. Most countries except for the U-S have some version of this – health care that’s paid for by taxes, controlled by the government and essentially free at the point of use. But health care costs are skyrocketing everywhere. So now we're going to talk about how AI and other data-driven innovations may help Sweden - and health care systems in general - cope with the demographic changes and expensive medical breakthroughs already straining budgets. This is the second half of my discussion with Catharina Barkman of Sweden’s Forum for Health Policy It's a non-profit, independent think tank aiming to boost innovation and development in the health care system. Catharina has also held several top positions within the system itself in the region of Stockholm – Sweden’s capital. Note: all episodes are also available in video form on YouTube

Part 1: Most of us are familiar with the idea of universal health care. Ideally – tax-paid, “free” health care for all. We know that in the US we don’t have it – while almost all other countries do – in some form. One of the first countries to adopt universal health care was Sweden – in the early 1950s. But how - exactly - does such a system work? And can it keep afloat as health costs keep rising? I ask Catharina Barkman who heads Sweden's Forum for Health Policy - a non-profit, independent think tank aiming to boost innovation and development in the health care system. Catharina has also held several top positions within the system itself in the region of Stockholm – Sweden’s capital. I think you’ll learn a lot about how universal health care works from our conversation – not only in Sweden but also in other countries. And you may be surprised – as I was – to see that even here in the US – we have some aspects of health care for all. Note: all episodes are also available in video form on YouTube.