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Pulse: Monitoring Change in Health Care with Dean/CEO Paul B. Rothman, M.D.

Pulse is the name of Dr. Rothman's podcast.

We are in the midst of a transformation in the way health care is delivered and paid for in this country.

Through this monthly podcast, I hope to share with our listeners informed commentary on research directions, policy questions, the economics of health care and other complex issues. 

On alternate months, other senior JHM leaders will  offer their expert opinions on specific new developments in medicine nationally and internationally.

Please tune in and reach out to us with suggestions on issues you would like us to address in future segments.

- Dr. Paul B. Rothman

 

The Impact of Civility on Healthcare Workplaces: July 2019

Kevin Sowers

Hosts: Elizabeth Tracey and Kevin Sowers

This month’s Pulse with Kevin Sowers focuses on the Johns Hopkins civility initiative. Civility has an impact on healthcare quality, safety and overall outcomes, and a team has been assembled to identify expected behaviors in the workplace to which all will be held accountable. The initiative also will develop interventions that are appropriate, with the aim of creating a culture where all at Johns Hopkins can thrive.

Program notes:

0:20 Civility in the workplace
1:20 Peer-to-peer conflict at times
2:20 What are the expected behaviors?
3:20 More embedded in who they are
4:24 Documented wwll in the healthcare workplace
5:24 Patient interactions
6:30 Manage our emotions to have a fact-based conversation
7:53 End

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Full Transcript

00:00 Elizabeth Tracey: Welcome to this month's Pulse, I'm Elizabeth Tracey..

00:02 Kevin Sowers: Thank you. I'm Kevin Sowers, it's a pleasure to be with you today.

00:06 ET: It's wonderful to be with you. Talk to me about civility. We have a new institutional initiative going forward that is really emphasizing that in the workplace.

00:16 KS: You know, when you think about civility in the workplace, it really is an opportunity for us to step back and understand how, not just the outcomes that we achieve every day make this organization successful, but how we treat each other in getting there and civility has been shown multiple times to have an impact in the workplace on quality and safety and just overall outcomes. And so creating an environment where we feel supported for who we are and what we bring to the table and respected is incredibly important.

00:49 ET: In fact, I just saw a study, it was looking at surgeon behavior and the OR and it showed that when a surgeon acted out during a procedure, it had a deleterious effect, not just on the staff, but also on a patient.

01:02 KS: That's correct. And it's not just in the OR. It's in the ICUs, it's in any type of unit where there may be work culture issues and behavior issues between individuals and it's not always just physician related. In nursing, there is peer to peer conflict at times and so we need to think about how we treat each other when we come to work each day.

01:23 ET: It seems like common sense, doesn't it?

01:26 KS: It does, but for some managing your emotions in the midst of a chaotic or a stressful day can sometimes be difficult and so understanding when it's important to step back to, to take a couple of deep breaths and really think through what you're going to do next instead of reacting. Be more proactive in learning how to manage yourself.

01:48 ET: Well. That sounds like a short prescription then for how to do this. Do we have a plan in place institutionally to make this happen?

01:55 KS: Actually, there's a group that we've accounted that's being led by Inez Stewart, who is our chief human resource officer of Johns Hopkins Medicine, and also Jennifer Nichols, who is our chief of staff. Jen and Inez are working on a group and the first step, if you've looked at how most organizations have dealt with this, is really sit back and really think through what are the expected behaviors that we expect from everybody when they come to work and then how do we hold people and evaluate people to those behaviors on an ongoing basis?

02:27 ET: Are there specific tools that right now you would say to folks, "Hey, here's what I think I need you to do if you're feeling like there's a situation developing that might result in this incivility."

02:39 KS: The sensibility thing is a little bit more complex than just a tool. I'll share with you in my experience. 

Sometimes people have these moments in the workplace where they're stressed on that particular day and they just can't hold it together. On that situation, you sit down with the person and say, "Here's what I saw you do. Here's what I heard you say. I need you to know that that wasn't appropriate and here's how I'd like to see you to manage it the next time." 

At times that's the only intervention you need to do and that person will change their behavior. In others situations, people have had things that have happened in their personal lives that have led to the behavior that you might see in the workplace. That's a lot more embedded in who they are. That sometimes takes a different level of intervention. Sometimes it's a coach, an ongoing coach, to look at what are the things that trigger the behavior in the workplace. Sometimes it's someone sitting down with the counselor because there's a lot of either grief or anger that's built in from life experiences that they have to work through to deal with that. 

And then the last piece is really in some instances there are situations where people have substance abuse issues, have had difficult marital situations, a lot more complex social type experiences that require a different level of intervention. 

So for me, as I've gone through this in my career, it's not one tool that will help everyone. You have to sit and understand to make sure you understand the complexities of what's driving the behavior in the workplace.

04:15 ET: Would you say see that the healthcare environment is peculiarly prone to this?

04:20 KS: I would say that it's documented well in the healthcare workplace. Do I think that it's only healthcare? Absolutely not. It's human behavior. So I think this exists in other disciplines and other types of organizations, but I would say the thing that's unique about healthcare is it's still based upon human interactions. Both from a patient perspective but from care coordination perspective of a plan of care. 

And it's in those delicate interactions of where we can't lose sight of what those interactions mean in the lives of the people we're serving. And so that's why civility becomes really important because if I'm a provider and I just had a bad interaction with somebody, there's now research to show that that impacts the rest of my day and how I feel about myself and how I question myself for the rest of the day. So it does have an impact.

05:16 ET: Some of the examples that you cited, having borne witness, and I know you have abundant experience with this also, interactions with patients and caring for patients can be incredibly emotionally charged. How can we deal with that aspect of the healthcare environment so that it doesn't bleed then into our interactions with our colleagues?

05:35 KS: So, I think having the ability to have peer conversations are critically important. 

As a nurse, I've been in situations before where I as a nurse may differ in my view of what should happen to a patient than a provider may feel. But in those situations, I've also found that I may not understand completely everything that providers thinking. What they're seeing, I might not be seeing. But the ability to not become immediately emotional, but to be able to have a fact based conversation with the provider to say, "Here's what I see. Here's what I understand. Obviously you're thinking something different. Can you help me understand?"

That's not always where we start. We start with the emotion of can you believe this? Look what they're doing. And so how do we make sure that we are able to manage our emotions in a way that allow us to have a fact-based conversation to learn someone else's perspective? That becomes incredibly important as we learn to partner together around civility.

And so we need to make sure that we have all the vehicles in place in our institution to support people through what's going on with them personally, what's going on with them in their work environment, and then also having programs that if they do have problems, that they need psychological support for a variety of different reasons that we have those programs in place to support them.

07:04 ET: It sounds like the common denominator in all of this is something that you identified about really listening and then compassionately saying, "How can I help?"

07:15 KS: That's correct. I think I would say to anyone working in an organization, if you see a colleague that you think is acting differently than they have been before, you should sit down with them to make sure that they're okay. We owe that to each other because it's not just about caring for our patients or loved ones, but it really is about us caring for each other too. That will make us a better organization.

07:41 ET: Thank you so very much.

07:41 KS: Thank you for having me today.

 


Federal Regulations on Hospital Costs: May 2019

Redonda Miller

Hosts: Elizabeth Tracey and Dr. Redonda Miller

On this month’s Pulse, Redonda Miller, president of the Johns Hopkins Hospital, talks about federal regulations requiring hospitals to publish online ‘chargemasters,’ a complete listing of all the things a person might be charged for while hospitalized. She applauds the move as potentially increasing transparency for patients but notes that improvements, especially with regard to negotiated pricing, need to be made.

Program notes:

0:10 Federal regulations regarding hospital costs
1:12 CMS mandated charge masters on websites
2:10 May not reflect a negotiation
3:06 Other things involved with care not reflected online
4:10 More complexity
5:06 Advice to patients
6:35 End

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Full Transcript

00:00 Elizabeth Tracey: Welcome to this month's Pulse, I'm Elizabeth Tracey..

00:03 Redonda Miller: Hi I'm Redonda Miller, the president of the Johns Hopkins Hospital.

00:06 ET: Redonda, this month we're talking about something, that I at least think is rather interesting. The federal regulation that hospitals need to provide price lists so that people can scan those and say hey I can understand what this bill is about. What are your thoughts about that?

00:22 RM: I can certainly understand the intention of the federal government and CMS. Price transparency is pretty key nowadays. Think about the average American and how much each of us are spending on healthcare. Over the last five years we have seen a huge rise in high deductible plans. Almost half of adults in the U.S. now have a high deductible insurance plan where they are paying fifteen hundred dollars or more out of pocket before their insurance even kicks in. For some families it's five thousand. So as a patient who one could argue is purchasing and consuming healthcare, it is really important that you understand what you're paying for and how much.

01:07 ET: Do these price lists that hospitals are obligated to provide health to answer that?

01:12 RM: That is the question. As of now, CMS has mandated that hospitals put their charge master on websites and update it at least once a year. If you've ever seen a charge master, it is sometimes fifty thousand lines of things you might consume in a hospital during your stay with the price besides each one of them. They could be incredibly tedious to go through from a patient, but I think there more issues with them if you don't mind if I elaborate?

01:43 ET: Not at all, please do.

01:45 RM: I think one of the big issues is buying healthcare is not necessarily like buying a car. The price when you walk into car dealer, you see a sticker price on a car, it's not necessarily the price you pay. There's a negotiation between you and the car dealer. In healthcare, it's similar to some degree in the sense that the price you see on that charge master may not reflect a negotiation that occurred between an insurance company and the hospital. A hospital may charge a hundred dollars for this a contract between that hospital and an insurer - says the insurer only agrees to pay fifty dollars and that's what the patient would see. The bottom line is what you see on the price master may not be what you're actually charged via an insurance contract.

02:35 RM: Along the same lines, if we go with car analogy, so to speak. The sticker price when you walk into the car dealer is not always all inclusive. You remember you go back and you want to buy the car, by the way you need to purchase tags, a certificate or maybe there's a warranty you need. The same thing, the charge master for a procedure in a hospital is the hospital charge. But as a patient there may be a physician charge. You need to remember that are other things involved with that care or maybe you leave the hospital and have to go to a rehabilitation stay. There are other aspects of care not reflected online.

03:14 ET: How are we going to answer this? These are certainly questions I think that as a consumer, I would want to discern what I'm really being charged.

03:24 RM: I know it's a difficult question. As a hospital president but also as a physician myself, I would say cost isn't the entire picture because there are more to delivering care. For instance, the numbers on a charge master may not reflect the quality. Is this the surgeon who has done a thousand of these procedures and has excellent outcomes versus someone who has done one or two and the outcomes may be poor. How do you put a price on that? Or the complexity - here I'm coming from a perspective of Johns Hopkins, where we see cases who are often the second or third time the case is being done. For instance, a simple spine surgery somewhere else may have a complication, and they come to the Hopkins Hospital as redo operation, which is much more complex. Finally, there's this trust factor. A patient knowing his or her physician and that trust. So these are all added dimensions of healthcare that are hard to capture in a charge master.

04:25 ET: What is your sense right now of the utility of these things? You may know that federal government recently invited consumers to come on to a website created solely for this purpose and comment one what they experienced with them has been.

04:42 RM: I think that's where we are now. I'm so glad that the government has asked the patient - the consumer what he or she thinks because most will tell you right now that they are not terribly useful to them. How can we improve it? How can we reflect all the different elements that go into pricing healthcare? I do think we owe that to our patients. I really do. So we'll have to work on it.

05:04 RM: In the meantime, if you're a patient I do have some advice that I could offer. That would be to ask questions. If you see a charge on a website that you don't understand, call your insurance company. Go through the details of the procedure with your insurance company, so you have a true sense of what your plan covers and doesn't. That would be a more realistic picture.

05:29 RM: My second piece of advice is if you see a charge or you're worried about needing a procedure and can't pay it, please call the hospital. Our finance department offers all kinds of plans and financial assistance that we can help you work through it so you can afford the care you need. We are prepared to help.

05:48 RM: So those would be two pieces of advice I would offer.

05:50 ET: Those are excellent. What would you say in your estimation as the timeline when all of this might actually get a little more practical?

05:57 RM: I think the public will demand it. I don't see in the near term that out-of-pocket costs for our patients are going down by any dramatic amount. I think our patients will demand it and as I mentioned they deserve it. I'm hopeful the timeline will be measured over the next year too and not more than that.

06:15 ET: Excellent. Thank you so very much. That's this month's Pulse.

06:18 RM: Thank you.

 

Industry Involvement in Clinical Research: February 2019

Paul Rothman

Hosts: Elizabeth Tracey and Dr. Paul B. Rothman

“The complexity of taking science and translating it into cures, therapeutics or diagnostics, requires interaction with industries because of their interactions and expertise,” says Paul B. Rothman, dean of the medical faculty and CEO of Johns Hopkins Medicine. This month, Dr. Rothman shares his thoughts about the presence of industry into the research, why Johns Hopkins is trying to build our interactions with industry, and how to avoid bias when industry is sponsoring clinical trials.

Program notes:

0:13 Industry involvement in clinical research
1:13 One of the reasons we’re investing in tech transfer
2:10 Has to be devoid of conflict
3:13 Parachute study
4:13 Real skill to design trials correctly
5:14 Academia brings a lack of bias
6:14 Trials will have certain endpoints
7:15 That’s the scientific method
8:20 End

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Leadership Skills: October 2018

Kevin Sowers

Hosts: Elizabeth Tracey and Kevin Sowers

“[One part of leadership is] being grounded in who you are and understanding the skills required to lead people forward,” says Kevin Sowers, president of the Johns Hopkins Health System and EVP of Johns Hopkins Medicine. In this month’s Pulse podcast, Sowers reveals the five leadership skills he thinks shapes a good leader. Take just a few minutes and listen to the latest podcast.

Program notes:

0:12 Leadership skills
1:12 Emotions and feelings don’t get in the way
2:12 Rise above the chaos
3:00 Can’t lead if you are insecure in your ability to lead
4:00 Collaborative creativity
5:00 Prove that they can do it
6:01 Softer skills after hard skills
6:58 Leadership is all about self-awareness
8:15 No organization is about one person
9:14 The need to know and recognize your ability to collaborate
10:01 Not losing sight of your purpose
11:03 Kept thinking how to develop trust
12:04 Learned a lot from a 7 year old
13:01 Life is figuring it out
13:44 Understanding your values
14:01 White coat?
14:50 What are the differences?
16:31 End

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The State of Telemedicine: August 2018

Redonda Miller

Hosts: Elizabeth Tracey and Dr. Redonda Miller

This month, Dr. Redonda Miller, president of The Johns Hopkins Hospital, discusses how telemedicine makes access to high-quality care more convenient, as well as the barriers to implementing telemedicine and what Maryland is doing to make it easier for clinicians to practice telemedicine nationally.  

Program notes:

0:30 State of telemedicine at Johns Hopkins
1:30 Lost mobility and can't come to clinic
2:30 Highly technical treatment for stroke
3:30 Johns Hopkins Community Physicians using
4:26 Serve patients in rural areas
5:30 23 States recognize licensure
6:32 Economy no longer bound by state lines

7:15 Does offer more convenience
8:04 End

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The Joy in Medicine: April 2018

Paul B. Rothman

Hosts: Elizabeth Tracey and Dr. Paul B. Rothman

This month, Dr. Rothman shares his thoughts about why clinicians experience burnout and the steps Johns Hopkins is taking institutionally to bring back clinicians’ joy by improving work/life balance and creating a more supportive work environment. Take just a few minutes and listen to the latest podcast.

Program notes:

0:08 Joy in Medicine
1:02 How do you help people rediscover the joy?
2:03 Help with clinical workflows
3:03 Everyone blames the electronic record
4:03 How to reduce the administrative burden
5:05 A lot of that is technology
6:05 Work life balance in general
7:13 End

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Involvement in the Local Community: January 2018

Redonda Miller

Hosts: Elizabeth Tracey and Dr. Redonda Miller

This month, Dr. Redonda Miller, president of The Johns Hopkins Hospital, discusses the link between impoverished areas and the health of a community and shares what Johns Hopkins is doing locally to help address the problem.  

Program notes:

0:17 Jobs problems and health
1:17 Living in an impoverished area
2:11 Community health needs assessment
3:11 Hire locally
4:16 Over 400 interns from the city
5:11 Returning citizens program
6:50 End

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High Value Care and Precision Medicine: November 2017

Paul B. Rothman

Hosts: Elizabeth Tracey and Dr. Paul B. Rothman

This month, Dr. Paul Rothman discusses value-based health care, the Johns Hopkins inHealth initiative, the importance of big data in the future of medicine, and more.

Program notes:

0:16 High value care and inHealth
1:20 Increasing value of care delivered
2:19 More precisely define subsets of disease
3:17 Precision medicine center of excellence
4:18 Genetics is a test but not the only test
5:20 Forum in the Senate building
6:14 Quality and cost
7:16 We’re looking to bring in an array of disciplines
8:08 End

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Health Care Ranking Systems: September 2017

Redonda Miller

Hosts: Elizabeth Tracey and Dr. Redonda Miller

 With the number of physician and hospital rating sites growing at a rapid rate, Redonda Miller, president of The Johns Hopkins Hospital, discusses why there’s merit to these ranking systems and the issues that need to be addressed to continually improve them. 

Program notes:

0:12 Rankings of all types relative to healthcare
1:12 Only a very few ratings per physician
2:09 To help patients make informed decisions
3:10 Administrative or billing data
4:10 Physicians managing own reputation
5:12 Being proactive as a provider
6:12 Care that ratings can't capture
7:10 Recent oncology patient
8:04 End

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The Joy of Medicine: June 2017

Paul B. Rothman

Hosts: Elizabeth Tracey and Dr. Paul B. Rothman

This month, Dr. Paul Rothman discusses physician burnout, the demands of working in medicine and at an academic medical center, the importance of making clinical workflow more efficient, and more.

Program notes:

0:17 I have noticed that people are overwhelmed
1:12 54% of physicians feel a sign of burnout
2:12 They feel isolated from colleagues
3:10 Technology will help solve some but not all
4:04 All task forces have members from all hospitals
5:01 Give them support and tools
5:36 End

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Skyrocketing Drug Prices: May 2017

Redonda Miller

Hosts: Elizabeth Tracey and Dr. Redonda Miller

 This month, Dr. Miller discusses why the price of prescription drugs are continuing to rise in our country. She shares what Johns Hopkins is doing to address the problem locally and gives her perspective on what the country could to regulate fair pricing. 

Program notes:

0:30 Drug price increase
1:26 Prices increased 18%
2:27 Treats spinal muscular atrophy
3:28 Treatment for very high blood pressure
4:31 Do think there are bad actors in pharma
5:30 Raising awareness among clinicians
6:31 Making sure every drug has merit
7:32 FDA has no oversight
8:32 Public dollars for research and development
9:42 End

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The Popularity of Medical Apps: March 2017

Paul B. Rothman

Hosts: Elizabeth Tracey and Dr. Paul B. Rothman

This month, Dr. Paul Rothman discusses how health care apps are empowering patients to become more involved in their care. He also shares his perspective on the future of how real-time patient information may help populate the electronic medical record and how Johns Hopkins is getting involved in the medical app revolution. 

Program notes:

0:20 If not the most popular app certainly close
1:20 Help allow patients to become empowered
2:20 Just working with an EKG app
3:20 They’ll be a range of them at different price points
4:20 All important information for the health record
5:52 End

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The ABCs of Cardiovascular Disease Risk Management: December 2016

Redonda Miller

Hosts: Elizabeth Tracey and Dr. Redonda Miller

This month, Dr. Redonda Miller discusses new statin guidelines from the U.S. Preventive Service Task Force and a new cardiovascular disease risk assessment tool released by the American Heart Association and the American College of Cardiology. 

Program notes:

0:30 Updated statin guidelines
1:30 Risk for an event with too many medicines
2:30 Patients really look to their physician
3:35 Million Hearts Initiative
4:35 Variables that are most important
5:31 Nice to know your changes have an impact
6:50 End

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The Reproducibility of Scientific Results: November 2016

Paul B. Rothman

Hosts: Elizabeth Tracey and Dr. Paul B. Rothman

This month, Dr. Rothman discusses the importance of conducting research that leads to reproducible results.

Program notes:

0:10 Reproducibility of research results
1:11 Outright fraud uncommon
2:12 Each requires a different tack to solve
3:14 Make sure the right number of controls is in place
4:10 Institutional data back for primary data
5:09 Data must be added in proper format
6:15 Negative side effects must be reported
7:25 End

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Humanity in Medicine: August 2016

Paul B. Rothman

Hosts: Elizabeth Tracey and Dr. Paul B. Rothman

This month, Dr. Rothman discusses how Johns Hopkins is embracing technology while working to ensure the human interaction between the doctor/patient relationship remains intact. 

Program notes:

0:22 Humanity in medicine
1:23 We think about how to use technology and keep needed variation
2:25 Strategies to bridge?
3:24 Students with humanistic qualities
4:24 Powerful tools to assist the physical exam
5:25 May do a more accurate job
6:21 Can integrate apps
7:21 EPIC can access anywhere
8:17 End

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Addressing the Prescription Drug Crisis: June 2016

Redonda Miller

Hosts: Elizabeth Tracey and Dr. Redonda Miller

This month, Dr. Rothman’s guest host on Pulse is Dr. Redonda Miller, senior vice president of medical affairs for The Johns Hopkins Hospital and Health System, who discusses the issue of skyrocketing prescription drug prices in the United States. 

Program notes:

0:09 Prescription drug crisis
1:09 Some patients chose to order internationally
2:09 New high tech agents entering the market
3:13 How we approach shortages
4:10 We have been able to preserve quality
5:09 A lot of options for generics
6:05 Don’t want to stifle innovation
7:05 PCORI says no QUALY
8:07 Top tiers most expensive for patients
9:38 End

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Choosing Wisely: April 2016

Paul B. Rothman

Hosts: Elizabeth Tracey and Dr. Paul B. Rothman

This month, Dr. Rothman discusses the Choosing Wisely Initative, which originally began at the American Board of Internal Medicine. Choosing Wisely involves teaching residents and trainees best practices to provide high quality care to patients while reducing costs.  

Program notes:

0:23 Choosing Wisely
1:23 Bring down cost of care while providing good care
2:23 Most of what is being implemented has already been tested
3:23 There is a needed variation in medicine
4:24 Payers need to look closely
5:23 Very well informed patient knows
6:10 End

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Reducing the Cost of Care and Improving Patient Outcomes: March 2016

Landon King

Hosts: Elizabeth Tracey and Dr. Landon King

This month, Dr. Rothman’s guest host on Pulse is Dr. Landon King, executive vice dean of the Johns Hopkins University School of Medicine, who discusses patient safety initiatives and data from the Centers for Medicare and Medicaid Services (CMS), based on findings revealed at a recent CMS conference.

Program notes:

0:21 Huge death reduction and cost savings
1:30 Quality side and metrics

2:31 What are the things that are important outcomes?
3:35 Kind of a dialogue with CMS
4:31 How difficult to advance safety measures?
5:35 Primary is patient care
6:35 We are as active in dialogue as we can be
7:35 Potential alignment of interests
9:13 End

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The Effects of Publishing Negative Research: February 2016

Paul B. Rothman

Hosts: Elizabeth Tracey and Dr. Paul B. Rothman

In the first of a new series of podcasts, Dr. Paul B. Rothman, Dean/CEO of Johns Hopkins Medicine, discusses the National Institutes of Health's mandate to establish a website to publish negative research results.

Dean Rothman is a member of the Merck Board of Directors and receives compensation in the form of income and stock.

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