Medical Societies Start Pushing Back on RFK Jr.

— MedPage Today reporters offer further insights into recently covered topics

The following is a transcript of the podcast episode:

Rachael Robertson: Hey everybody! Welcome to MedPod Today, the podcast series where MedPage Today reporters share deeper insight into the week's biggest healthcare stories. I'm your host, Rachael Robertson.

Today we are talking with MedPage Today's editor-in-chief Jeremy Faust, MD, about his interview with Jeanne Marrazzo, MD, MPHopens in a new tab or window. Joyce Frieden will then share how doctors responded to HHS Secretary Robert F. Kennedy Jr.'s recent comments about artificial intelligence (AI) providing better careopens in a new tab or window than some doctors. I'll close out the episode with how – and why – some patients email the C-suite over denied insurance claimsopens in a new tab or window.

But first, a word from our sponsoropens in a new tab or window. For information about treatment strategies for psoriasis, take a look at an Ad Insights article from Takeda.

Robertson: MedPage Today has an ongoing series interviewing influential physician leaders. Our editor-in-chief, Jeremy Faust, MD, recently spoke with Jeanne Marrazzo, MD, MPH, who is currently the CEO of the Infectious Diseases Society of America (IDSA), and she was formerly director of the National Institute of Allergy and Infectious Diseases (NIAID). Jeremy's here in the studio for an interview debrief.

So, Jeremy, let's start. Tell us how this conversation came about in the first place.

Jeremy Faust: I first met Dr. Marrazzo when she succeeded Dr. Fauci at NIAID, and then was promptly firedopens in a new tab or window. And so then she has become someone who filed a whistleblower complaint, and we've been in touch. It's funny, I'm so guilty, I texted her so many times saying, "When can we talk? When can we talk?" And she finally said, "Why don't you email me, and we'll set this up."

And in the meantime, she's become the CEO of the Infectious Diseases Society of America, and I think in that role has helped that organization kind of meet the moment of what's going on.

Robertson: So, in your conversation with her what were some key takeaways?

Faust: I think that she articulated what I have sensed happening, which is that a lot of these medical societies, be it the American Medical Association, or hers, the IDSA, are becoming less shy about speaking out against the nonsense and garbage coming out of the federal government.

I think there was a time when people wanted to be a little guarded and careful with their messaging because, at the end of the day, there still needs to be a partnership. And what I find interesting is that we've moved towards a place where organizations like hers, and again others, are willing to say not just, "Hey we think that vaccines are great," but they're willing to say, "We think the federal government is messing it up, is screwing it up, that RFK Jr. is actually not helping people, and that there's an anti-vaccine agenda." They're really becoming more emboldened to say these things.

At the same time, what I found fascinating in this conversation was that there is a need to thread this needle, where she can say, "Look, Secretary Kennedy and HHS has had a shameful response" -- that's the word she uses, shameful -- "to measles in Pennsylvania," and yet 5 minutes later she can say, "Well, yeah, but we're still willing to take HHS money -- and we need to."

So it's really interesting to see that develop because I think the fear had been if these organizations spoke out against misinformation and nonsense coming from the feds, they would be lighting their contracts and collaborations on fire with said groups. I think to some extent it's case-by-case.

Robertson: After your conversation with her, has there been anything that you've been thinking about in the days since you spoke?

Faust: The thing that I'm thinking about is how organizations like IDSA can best serve the public.

And it's really hard because in our conversation, we did talk about this perceived conflict of interest where Pfizer or Sanofi or Moderna gives money to the American Academy of Pediatrics (AAP) to support their programs, and then the American Academy of Pediatrics also has to do a vaccine recommendation for the year because the CDC's advisory committee is currently shuttered, right? So how do we explain to people who are a little bit suspicious of that kind of influence that both things can be true?

Like yes, the AAP or the IDSA do take grant money from all kinds of people. They take from the federal government. They take money, grants, from industry. Does that mean that they can't be trusted? I would say it doesn't mean that. It just means that you have to look everything case-by-case and say, look, what are they saying? Have they shown their work?

So to me, the takeaway is what it's always been: show your work, and then we can decide on a case-by-case basis whether what's coming at us is to be trusted.

Robertson: Well, thank you for popping in today, Jeremy. Listeners, if you want to watch the whole interviewopens in a new tab or window between Jeremy and Dr. Marrazzo, we have it linked right here on our site MedPage Today. Thanks, Jeremy.

Faust: Good to see you.

Robertson: While speaking at a Make America Healthy Again summit meeting, Kennedy said that artificial intelligence could provide healthcare that was better than that provided by many physicians – and you'll be absolutely shocked to hear that a lot of physician groups pushed back against his comments. Washington editor Joyce Frieden is here to discuss the pushback.

So, Joyce, what exactly did Kennedy say?

Joyce Frieden: Well, Rachael, this was part of a fireside chat that Kennedy was doing with Vice President JD Vance. Kennedy said that Sam Altman, founder of AI company OpenAI, had come to visit HHS, and "He said that 2 years ago, 'I wouldn't have advised anybody to take medical advice alone from AI. But today it would be malpractice for a doctor to make a diagnosis or to make a prescription without at least checking AI.'"

He went on to say, if a patient has a 1,000-page medical record, "you have 6 minutes with a doctor today. He's not going to be able to review it, but the AI can ... It can give you a second opinion that is much better informed than any doctor in the country."

Robertson: Wow, what did the doctors' groups have to say about that?

Frieden: Well, the American Medical Association, along with five other groups, issued a joint statement saying that Kennedy's suggestion that AI is better informed than doctors "diminishes physician expertise and risks undermining patients' trust."

The groups pointed out that doctors draw on their years of experience and understand each patient's unique needs and circumstances, and that unlike AI, they take responsibility for care they provide.

Robertson: Did Kennedy say anything else that was controversial?

Frieden: Yes, he also said that his agency was making it easier for every American to use AI, and that this means they can check the advice of public officials. For example, he said, "If somebody tells you masks work, trust the experts. AI may tell you otherwise." That ability to check things will "free us from medical tyranny," he said.

In response to Kennedy's comments on that, Jason Goldman, MD, immediate past president of the American College of Physicians, said in a video posted on Instagram that Kennedy's remarks "show his ignorance of and contempt for the medical profession." Goldman said there's no such thing as medical tyranny, and that no one is forcing patients to see physicians or to follow their recommendations. "There is nothing tyrannical about it," he said.

Robertson: Well, thank you so much, Joyce.

Frieden: Thanks, Rachael. And now it's my turn to interview you.

Navigating insurance denials is a maze many patients opt not to wander into. Traditional pathways are labor-intensive and often don't work, so some patients have tried other strategies, like going straight to the top and emailing the insurance CEO directly about their denied claims. Reporter Rachael Robertson will tell us more about some patients who did this.

So, Rachael, tell us about the patients who reached out to the CEO. Why did they do that instead of going through traditional channels?

Robertson: So one patient, Elizabeth Nichols, was diagnosed with breast cancer at age 36. After months of treatments, her insurance company refused to cover the type of chemotherapy her oncologist recommended. She was understandably fed up, and so she emailed her insurance company CEO. She soon received a message from the company's chief scientific officer saying that the treatment was now approved.

Another patient is Donald Grant Jr. who is a 49-year-old with severe congenital cervical stenosis. He had an initial surgery which failed to adequately decompress his spinal cord, leading to later complications. So he scheduled a surgery with Hyun Bae, MD, who is a spine surgeon at Cedars Sinai in California, and he's the leading expert on Grant's condition.

But there's a catch: Bae isn't in network with Grant's insurance, even though everything else in the operation is.

Grant used the artificial intelligence tool Claimable to help him put together an 11-page legal and medical appeal, explaining that his insurance doesn't have any in-network surgeons with comparable qualifications. It also cited relevant regulations and asked that the insurer not use any algorithms to determine the outcome of his case. He sent it to the insurance company's leaders, and sure enough, the surgery was approved at the in-network rate.

These stories that I wrote about definitely struck a chord with our readers. I had a few reach out to me afterwards and share their own similar stories and similar successes. Our story was actually inspired by Wendell Potter's Substack newsletteropens in a new tab or window on this topic, and I spoke with him about it for the story.

Frieden: What did Potter say?

Robertson: Well, as you know, Joyce, Potter is a former insurance executive turned whistleblower. He told me that first and foremost, doctors and patients should never take "no" as a final answer from their insurance companies.

He also said that more patients should take their concerns straight to the top. Back when he worked at Cigna, he said cases that were being looked into by a reporter were elevated. He said big insurance companies have a group of people dedicated to high-profile cases, like those that are raised to the CEO or public relations, and those cases do get special attention.

Frieden: Should doctors escalate patient denials in a similar manner?

Robertson: I asked the experts that, and Potter said yes, though he acknowledged this can carry some risk. He said, "If a doctor becomes a frequent squeaky wheel, that could annoy the insurance company ... [and] you could be kicked out of network. Insurance companies do that all the time."

I also spoke with Stephen Parente, PhD, MPH, who is the chair of health finance at the University of Minnesota, and he had a bit of a different view. He said that there's other non-traditional ways to help, like reaching out to an insurance company's medical director.

He said: "If you talk to the medical director, it might go to the C-suite pretty quickly ... [depending] on how compelling the case is."

Regardless, it's tragic that this kind of thing is necessary, but it seems to be one way to help patients get the care they need.

Frieden: Thanks, Rachael.

Robertson: Thanks, Joyce. I'll take it from here.

Forgive me for repeating myself, but measles is still quite bad.

There were 235 cases last week and 223 the week prior. Pennsylvania is still where the bulk of cases have been. The state crossed the 1,000-case threshold with 159 new cases last week, becoming the state with the most cumulative measles cases at 1,152 overall.

For a detailed breakdown, check out our interactive measles mapopens in a new tab or window, which is updated at the top of each week.

And that is it for today. If you like what you heard, leave us a review wherever you listen to podcasts, and hit subscribe if you haven't already. We'll see you again soon.

This episode was hosted and produced by me, Rachael Robertsonopens in a new tab or window. Sound engineering by Greg Laubopens in a new tab or window. Theme music by Palomar. Our guests were MedPage Today reporters Jeremy Faustopens in a new tab or window, Joyce Friedenopens in a new tab or window, and Rachael Robertson. Links to their stories are in the show notes.

MedPod Today is a production of MedPage Today. For more information about the show, check out medpagetoday.com/podcastsopens in a new tab or window.