Transcript
Dr. Vin Gupta: [00:00:00] Knock, knock,
Will: hi! Knock, knock, hi!
Hello, welcome to Knock, Knock, Hi! with the Glockenfleckens. I am sitting here with Lady
Kristin: Glockenflecken, also known as Kristen Flannery. And I
Will: am Dr. Glockenflecken, also known as Will Flannery. We’re so happy to have you. It’s a great day. We’re talking about lots of things as we usually do, but in particular we’re talking about pharmacies.
Yes. Yep, today. And we’re talking about
Kristin: Amazon.
Will: Amazon. And the two of them together. Amazon pharmacies. That’s right. Dr. Vin Gupta. Now, uh, we’ll, we’ll get to our guest here in a second, but first we have a new recording space. Yes. If you’re
Kristin: watching, this is the elephant in the
Will: room. If you’re watching, which we could probably fit an elephant in here.
We might be able to, it’s a bigger room. It’s a bigger room. We finally did it. It’s the same house. Like we’re in the same [00:01:00] place. We just have, we repurposed our, our kids old playroom. Oh, it’s a
Kristin: whole thing. We had to like rearrange half the rooms in our house. Because we have a daughter who’s now in middle school, which for her and many children means she would like her own room.
So we had to do a lot of switching around of
Will: things. If you are watching on YouTube and you notice that the books in the back are color coded, uh, you can thank me for that. You know, typical
Kristin: white man trying to take credit for the work of the woman.
Will: No, Kristen did an unbelievable job with our decorations back there.
So it’s
Kristin: still a work in progress. So you may notice some, some things changing over the next
Will: few weeks. You know, people notice the color coding. Do they? The, like, the, having all the red books and all the black books and all the white books, like, people notice that. It’s very soothing, I think, to people.
Kristin: For some people it’s polarizing because you either love it or you’re like, that is the stupidest way to arrange a book.
Usually those are your bibliophiles, you know, that’s like how you have to separate a series if [00:02:00] each book in the series is a different color and how do you, you know. So I get both sides because I am also a bibliophile but I am also a, what’s a design ophile? I don’t know. I have a, A color obsession. Is there a word for that?
I don’t know. Probably. I don’t know. Somebody could tell us in the comments. But
Will: I got to, I, one more thing I want to talk about. What? I’m a very proud dad right now. Oh, why’s that? Very proud dad, because last night. Oh, yes.
Dr. Vin Gupta: I know what you’re gonna say. Our eight
Will: year old delivered an invitation to me. Yes.
I’m gonna read the invitation. Well, not to you, to everyone in our family. To everyone in the family, yes. We all got one. We all got an invitation. It says, to Daddy. Comedy Joke Club. Come join the comedy joke club, which he abbreviated CJC. Learn how to make funny riddles and jokes. 6 p. m. On Sunday, Tuesdays, and Thursdays.
It’s ambitious. Three night per week comedy joke club. Where, you ask, is this going to be happening? The living [00:03:00] room on the couch. Yep. All right. I am so happy. A joke club!
Kristin: A comedy joke club, not
Will: any kind of joke club. I’ve already got plans. Oh, yeah, we’re gonna, we’re gonna find a topic. Mm hmm. I’m gonna have the kids choose a topic and we’re gonna create jokes around that topic.
What kinds of
Kristin: jokes? I don’t know. You’ll have to put in some restrictions so that it’s, uh. No, no, no. There’s
Will: no restrictions on comedy.
Kristin: Restrictions enhance
Will: creativity. I will, I will see what they come up with, and I will help them formulate a punchline, set up, all the things. No, I think it’d be good,
Kristin: I mean, we’ll see how long this lasts.
Kids attention span is like four
Will: seconds, but. Hey, five minute, three times a week. I mean, we could do like five minute increments.
Kristin: That’s fine. That’s true. That is true. But I do think in all seriousness, I do think it is a fun idea to think of you teaching comedy to our children, right? Like not just, I’m sure they’re like picking things up by osmosis, you know, but, uh, but to have you like sit down and explain to them the mechanics of a joke or [00:04:00] what makes something funny.
Like, I think that’s, that’s pretty
Will: fun. I can’t wait. I’m excited. All right. So let’s talk about our guests. Uh, Dr. Vin Gupta is a practicing pulmonologist who serves as chief medical officer of Amazon Pharmacy. Many people are probably like, I had no idea Amazon had a pharmacy. Well, you’re going to hear all about it today.
He is also affiliate faculty at the University of Washington’s Institute for Health Metrics and Evaluation, uh, and Evans School and a major in the U. S. Air Force Medical Reserve Corps. Very accomplished individual. What doesn’t he do? He also serves as a medical analyst for NBC News. So he’s, he’s, he’s done a lot of things, a lot of fascinating things.
He draws on his expertise and, and, uh, and, and now as his role of, uh, uh, chief medical officer of Amazon pharmacy. So fascinating discussion. Should we get into it? What do you think? Let’s go. You ready? Ready. All right. Here’s Dr. Vin Gupta.
Today’s episode is brought to you by the Nuance Dragon Ambient Experience or [00:05:00] DAX for short. To learn more about how DAX copilot can help reduce burnout and restore the joy of practicing medicine. Stick around after the episode or visit nuance. com slash discover DAX. That’s N U A N C E. com slash discover D A X.
All right. We are
Dr. Vin Gupta: here with Dr. Vin
Will: Gupta. Thank you so much for joining us. It’s a pleasure to have you on.
Dr. Vin Gupta: Um, it’s a huge honor to be here with you guys. Thank you. Happy New Year. So,
Will: so I’ve just, I’ve been looking through kind of what you’ve done in your career so far and like critical care, air transport physician, U.
S. Air Force Reserve, critical care pulmonologist, chief medical officer, Amazon pharmacy. Like if I saw this stuff, I 60 years old. But now that I see you, you’re clearly only like, maybe like, you’re like our age. You’re like our age. Yeah. And it’s like, what am I doing with my life? My good. I just congratulations on, on everything.
It’s, it’s really [00:06:00] impressive. What’s, what’s what you’ve, uh, where you’re at in life right now, .
Dr. Vin Gupta: Well, that, I mean, coming from the two of you, that means a lot, but, uh, I, you know, just like the two of you, uh, honestly, I, I feel like there’s. There’s different ways to have impact and yeah, and I think that’s just what’s
Will: driven me Well, well, I want to start well, first of all before we started recording I you have this very interesting thing in your background of you know behind you And you were telling us it’s a Hindu deity Uh, it’s got a nice frame around it, and it was about to lead to a story of how you met your wife, and we wanted to do it on air, so, because I’d love to hear
Dr. Vin Gupta: it.
Yeah, sure, sure, uh, so we, uh, long story short was, I used to ride the school bus with my wife back in a small town in Sylvania, Ohio, not far from the border with Michigan, and so we, uh, you know, many years, five minutes apart in the same neighborhood. Uh, and she, she used to go to Catholic school. I remember this, [00:07:00] this really pretty girl coming on, you know, back when I was wearing these massive glasses, she wanted nothing to do with me.
And I, there was just, you know, I could never get sort of the time of day. I remember we would always, we’re both Hindu and, uh, I would go to our local temple and we’d have these massive events for Diwali. And I’d walk in and I’d see her with her friends sort of point and stare and, you know, I, I was. That was, I was the guy on the school bus and, and that was 25 years of that and we never actually communicated.
But then towards the end of medical school, I, I was in, I was in China and lived there for a few years and was just on this research fellowship. And she was coming out for a traditional, uh, Chinese medicine sort of two month rotation towards the end of fourth year. And we had a mutual friend who knew me way back in the school bus days, and who is now her, uh, classmate at Ohio State, uh, medical school.
They’re like, you know, you should reconnect with Vin and, um, just, just look him [00:08:00] up while you’re there. And so, uh, but I came back right before and I had convinced her that, hey, let’s go on a few dates here back in Ohio. And if you don’t totally hate me, why don’t you travel with me in Chinese New Year? To Indonesia and to Thailand.
So we actually started getting, uh, We dated in the best possible place to give me the best possible leg up, which is Southeast Asia. And so this is from that trip, that trip, um, in Bali. Oh,
Kristin: that’s great. Kind of like The Bachelor, right? Like you’re gonna, you’re trying to convince these people to fall in love and so you go to these Romantic places and do incredible things.
But
Will: you guys didn’t go to, you didn’t go to med school together? No,
Dr. Vin Gupta: so I was, I was at Columbia and, uh, she was, she was at Ohio State. And so we, we had a mutual friend that made that
Will: connection. And then you ended up, uh, in critical care and, and I understand you do still practice medicine, I think nights, right?
Is that what you, primarily whenever you do have shifts?
Dr. Vin Gupta: Yeah, so, you know, about 30 percent of my time, I’m [00:09:00] a civilian pulmonologist in hospitals here in Seattle, and then, um, really important to me to be at the bedside, and then, uh, still have that reservist component where I still practice whenever we’re deployed.
Will: Night night time in the ICU, that that sounds like easily the top five scariest places in the hospital. I don’t Oh,
Dr. Vin Gupta: man. Oh my god. I, you know, it’s just whether it’s, uh, unexpected code or I get to work with residents who are experiencing it for the first time, or some bloody dialysis line that you have to do at 3am, I mean it is, I will say in this world where there’s different ways to, we were talking about this earlier, have impact, to still be at the bedside and to still have to.
You know, practice the same medicine I practiced 15 years ago when I was first, my first time in the ICU. It’s, it’s humbling and it’s, it’s, I think it’s really important.
Will: And now you said you still, so you’re in civilian medicine, but you also still have this military reserve career. So how does, what’s the balance?
[00:10:00] Tell me about that a little bit. Well, you
Dr. Vin Gupta: know, I, I, I, I’m gonna say since you obviously have such reach and we all, uh, love the two of you in, in, in medicine, I will, I will plug that I got my start in military medicine. Uh, way back in medical school. The re the recruiters, uh, when I was out in New York know where to position themselves at 2:00 AM in the morning on a Friday night.
And so there are like military medical recruiters.
Will: I remember those recruiters. I remember those. Yeah. They took one
Kristin: look at you and were like, no.
Will: No, I remember they, they would come and, you know, when you first, during orientation at least, that’s when I remember them, you know, they’d set up their booth and, you know, very nice, you know, military officers with full, you know, uniforms and everything.
Exactly.
Dr. Vin Gupta: And so, uh, you know, I, they wrote me in and, but it, it ended up being a pretty, I mean, I, I’ve done this for about a decade and coming up towards end my payback, and it is been an incredible experience and, and I think there’s a huge gap between how, how a lot of us conceive of it, how recruiters talk about it and [00:11:00] what the experience is actually like.
So I do in the military exactly what I do in a civilian hospital. I’m, I’m an ICU doc and that’s rare, rare, often, you know, an ophthalmologist on the outside. But on the inside, you’re, uh, you know, you’re doing just flight physicals or you’re checking blood pressure and checking labs. And so rarely is there that sort of matching of skill set, civilian to military.
But I happen, I, lucky sort of specialty where they need ICU docs. And so I practice 30, 000 feet ICU medicine. Um, I’ve deployed a few times for short term stints. And really it’s just providing ICU level care at 30, 000 feet, moving a soldier or a contractor from say the Middle East back to Walter Reed, but those that have critical care needs.
So it’s, it’s actually a fascinating example of our reach in, uh, in the U. S. military. And I think a capability to see more and more as we have less operating bases overseas, like a big base in Afghanistan, more sort of mobility, uh, focus. [00:12:00]
Will: Critical care medicine is like hard enough and then you’re like, Hey, I’m going to go do that thing 30, 000 feet in the air.
Most
Kristin: airplanes don’t even have EpiPens on them. So what does your airplane look like?
Will: Well, I mean, I guess, I mean, it makes sense that you’d need to do that, but I mean, this must, what, what size plane are we talking about? Like how, like what, what’s your setup there?
Dr. Vin Gupta: It’s a C 17, uh, and it’s, there’s no seats.
And so there’s, I mean, it’s, it’s literally for aeromedical evacuation. So that will be. Uh, non critical patients that will be towards the front of the plane, and then imagine just an open bay. We have what are called stanchions that you can put, uh, litters on. And those litters, on top of the litter, there’s the patient.
On top of the patient, there’s something called, it’s called a SMEED, but it’s basically this little platform that you can attach a mobile vent to, suction. Uh, a monitor. You literally have a mobile ICU on this platform positioned right on top of the patient, um, on these, [00:13:00] on this sort of frame that attaches right to the floor of the plane.
And it’s a mobile ICU. It’s pretty incredible. You know, we have epinephrine, uh, drips, um, uh, so we’ve advanced well, well past pens. And it’s pretty incredible. It’s pretty incredible.
Will: Wow, so how much of your time are you still doing that?
Dr. Vin Gupta: Yeah, and you know, this is the thing about, and I’m one of the biggest, I’ll answer your question, uh, like in a circle
Will: here, but Take your time.
Take your
Dr. Vin Gupta: time. One of the, you know, like I keep getting reminded because I’m on a 10 years, I’m about to step out at least for a little bit. It’s hard to square, but it’s a week and a month, two weeks a year. On top of that, if you get deployed for four to six weeks, what have you. So it can add up to. Uh, 50 days a year on top of everything else and you know, you’re doing this on what would otherwise be free time.
So in, I guess it just depends on what the rest of your makeup of your life looks like. But if, if you have a busy professional life [00:14:00] on top of it, it’s hard to square. Um, what’s, what’s interesting though, is that the military medical corps across the Marines Air Force. Uh, uh, Navy has about 60 percent of the docks that they need coming in the pipeline to replace those leaving because nobody wants to do it.
And it’s just, it’s, it’s, it’s, it’s an interesting, I think, less talked about national security risk that we just don’t have enough. Medical capability to care for those that are going to need to, you know, go out to the West Pacific maybe or what, just given the world that we live in. So it’s, it doesn’t get talked enough about in my opinion.
So thank you for highlighting
Will: it. Well, let’s, let’s talk some more about, cause I’m interested in this and what, what are the barriers? What is it that those med students who come in who may be like, I had no idea anything about military medicine. And what, what is it that’s keeping people away from that?
Uh, what are the fears that. Maybe you’re unfounded or that are maybe, uh, you know, to, um, [00:15:00] you know, the things that rumors that go around about military medicine that maybe are not so true. And, and so just help us understand what’s keeping. Does
Kristin: military medicine have a PR
Will: problem? Yeah. What is, what is it exactly?
Dr. Vin Gupta: I think it’s a huge PR problem. Uh, and there’s a lot of misunderstanding because the recruiter and I’m not trying to throw recruiters on the bus, but the recruit recruiters for docs, let’s just take that. are often coming from a totally different part of the military. And they can’t, they can no longer do that job.
Like there are many reformer mechanics that can’t do the job of being a mechanic anymore. So then they slot into being a recruiter and randomly become a health professions recruiter and don’t have any content expertise. And so we’re telling these people to do a job and answer questions. To folks like us that are, you know, pretty high maintenance, if you think about it, you know, we have a lot of needs.
We have a lot of questions. We have a lot of questions. A lot of type A personalities. A lot of type A personalities. And they want details and they, they need to know [00:16:00] everything and, and how it’s going to work out. And, and often they get told a story that’s not accurate and not because anybody’s mouth has bad intentions, but because there’s just, they aren’t the right recruiters for the job.
And so often what gets said is well, you know, you’re gonna get X amount of money over X amount of time and that’s wrong And so there’s over promising of financial support, which is bad because you know many people I did this for frankly for financial support during training a lot of people do that and if you if the if the money doesn’t square the support doesn’t square Well your expectations and you feel like why am I doing this?
Um, often there’s this fear. The second fear is, am I going to get sent to war and die? And the reality is as a doc, you know, and most, I’m usually at the, I’m on the runway in Bagram Air Force Base picking up a patient, but rarely is there an exposure to battlefield medicine. So you are a little removed from direct threat, even though you’re still in the theater [00:17:00] or Um, so there is, I think, a misperception of threat.
There’s some threat, but, and there’s some risk, but it’s, it’s pretty managed and mitigated because they, they need you. I think the third is, and this is, this is what I’ve seen evolve over the 15 years, there felt like there was patriotism and, and a call to duty that existed in the mid 2000s that I can’t tell you how many people now, you know, whisper, like, why am I doing this?
I don’t understand. I don’t believe what we’re fighting for. I don’t believe in this potential war with China and the Western Pacific. I want to get out as soon as possible because there’s that lack of clarity as to, uh, the purpose of the U. S. military in this world, frankly, and what we’re fighting for.
And so I think that third piece actually might be the number one driver of low recruitment. People just don’t feel that, that sense of connection and that, that, that sense of wanting to serve in the first place because of everything that we see go around in our politics and what have you. So that’s what I, and that’s what worries me.
And
Will: that third thing seems like [00:18:00] the most difficult one to. To change the perception on, right? I mean, it’s, um, cause that we’re talking about kind of population, um, as a whole and how, uh, people are feeling and, and the impact also that social media has on, on all this stuff as well. So it’s, man, that’s, it’s interesting.
I certainly would have been, I would say I thought about it. I mean, I definitely, it was like, I was like, Oh man, not having to pay back any student loans. Like that was, it’s, that’s a huge. I mean, think about the cost of medical education now, and like, you know, we’re still paying back our student loans.
Yeah. The only
Kristin: thing I remember you thinking about was being an astronaut doctor, so I don’t know
Will: about this. Well, that’s, a lot of them, that’s military, you know? Now, I guess, yeah. So my, my dad worked in aerospace, and, uh, he’s retired now, but he, you know, he’s working with NASA and all these people, and, and so like, you know.
She would never have let me be an astronaut . [00:19:00] I
Dr. Vin Gupta: don’t know. And
Will: look, I was right. That I think that’s a path you can go down. Uh mm-Hmm. from the military side of things, right? Yeah. Yeah. Did you ever think of being an astronaut?
Dr. Vin Gupta: Yeah. Gosh. Yeah. Uh, not, not on my cup of tea, but that’s, it’s, I I do know a fu docs who’ve gone, uh, Marine to the astronaut, um, oh yeah.
Yeah. Hat. So, yeah, a hundred percent. That’s Wow. So astronaut. Um, yeah, you know, I just,
Kristin: that was an immediate veto. I’m not going to be married to someone who’s not on this planet. That’s just not in my card. But
Will: it is surprising to me, actually, to hear you say that, that what you. What you want to do, say, in like civilian medicine that you’re practicing as a pulmonologist, is not necessarily what you’re going to end up doing in the military.
Like that, that, that is surprising to me. It’s a big
Dr. Vin Gupta: problem. Yeah, I mean, I can’t, I mean, that’s the other piece. There’s a lot of surgeons I know. I know a few neurosurgeons who are Just checking [00:20:00] boxes as primary care docs and there’s nothing against primary
care
Will: docs Well, it’s not what they want to do with their career, right?
So
Dr. Vin Gupta: exactly. It’s you know, like how Tell me there’s not a better way to it leverage the skills of a neurosurgeon And try to have them pass to the top their training. But so there’s a lot of Inefficiency, misuse, miscommunication. Unfortunately, it impacts recruitment in a really
Will: significant way. Well, you, you made a big, uh, it seems to me a large change in your career.
Um, going from all of this critical care medicine. And then, and then I see that you’re the chief medical officer of Amazon pharmacy. So help us connect the dots here because that’s a, that’s a big change.
Dr. Vin Gupta: Yeah, you know, I was full time, uh, back in, well, five years ago, sort of full time physician scientist, just coming out of fellowship, really liked it.
And at the time, had this opportunity when I was finishing up at the Brigham, and my mentor at the time was, was leading, uh, part of the Apple Watches, [00:21:00] uh, study on the sensitivity of its various health features to say, detect a fib, in this case, it was the oxygen functionality. So I got connected to the Apple team, um, as a fellow and was, they were working on, well, can we use this for patients with COPD or emphysema or what have you?
And meanwhile, I’m in, uh, you know, my fellow primary care docs and pulmonologists will, will know this well, or, you know, you’re in this 15 minute visit with somebody with COPD and you’re trying to look at their mead notebook and see how, what are they sat, uh, like 10 days ago and how their oxygen saturation curve is changing over time.
What about their five minute walk and Here is there’s new innovation that people want on their wrist on their wrist whether it’s this or you know Fitbit and it’s automating that whole process And we can just get a dashboard view on it. And so I got, I got connected to digital health while I was full time clinical and um, and just ran with it.
So I was with Apple for a year and then just being [00:22:00] in that ecosystem, Amazon was hiring at the time in 2020, I was back in Seattle and it was, it just felt like this brave new world of, of streamlining evidence based high quality medicine with the best of tech, especially consumer tech companies that knew how to really unlock a great experience.
So I took this opportunity, Amazon said, hey, we can, we’ll still let you be clinical, um, for time. Uh, we’ll still let you do all the things you want to do on the outside, but come join us and help us build a better way to provide care for patients. This is right before the pandemic. This is January 2020 that I joined, uh, pandemic hit, you know, things changed for me, um, uh, in my external roles, obviously clinically, uh, but then it, it sort of put on, on an accelerated path, what Amazon was doing in at home healthcare, uh, experienced the company over the last.
three years, got to know different parts of it. My core was what I experienced and what I learned at Apple, um, in consumer wearables and ultimately landed on, uh, the Amazon Pharmacy team in [00:23:00] early 2023. Building what I just think, I mean, I’ll say the two of you, um, and not to put words in your mouth, but. I was really motivated to join the team because as a clinician, I absolutely hate the retail pharmacy experience as it is today for my patients.
It is a frustrating experience, I can’t tell you how many times it has led to non adherence on inhalers or what have you. And here is a company that I think knows how to unlock great experiences. And I thought that, to me, it felt like an interesting opportunity to learn from incredible talent. So that’s why I’m
Will: here.
Yeah. And I want to, I want to really dive into this idea of Amazon Pharmacy. Let’s take a quick break and then we’ll come right back.
Hey Kristen, doesn’t it seem like AI can do anything? It
Kristin: seems that way.
Will: It’s everywhere. It is, but have you heard of Precision? No, tell me. This is the first ever electronic health record integrated infectious disease AI platform. That sounds fancy, but what does it mean? Yeah, it’s really exciting. So for any [00:24:00] specific patient, It takes all the patient’s clinical data and automatically highlights better antibiotic coverage in real time.
Oh, nice! Yeah, it empowers clinicians to save more lives while also working more efficiently and quickly. To see a demo, go to precision. com slash KKH. That’s precision spelled with an X instead of an E. So, P R X C I S I O N dot com
Dr. Vin Gupta: slash KKH.
Will: All right, we are back with Dr. Vin Gupta. So, so Vin, uh, I know from my personal experience, like going through medical education, medical training, get very limited information, knowledge about how pharmacies work, about the pharmaceutical industry, regulations around pharmacies. So what kind of, I imagine you’ve faced a pretty large learning curve and trying to just understand the landscape of.
the world of pharmacy whenever you were kind [00:25:00] of thrown into this CMO role. Oh
Dr. Vin Gupta: my gosh, uh, yeah, I wouldn’t even say that’s an understatement. I mean, there’s so much, this is such a complicated, highly regulated space, as you just said, uh, and so I’m constantly learning. One of the reasons I took the role is just to learn.
Uh, it’s amazing too because I, one thing I’ve noticed when I’m an inpatient ICU doc, I have an inpatient pharmacist right at my side correcting orders, no Vin, don’t do that, no Vin, do this. On the outpatient side,
Will: we don’t have don’t kill a patient with that drug interaction, yeah, exactly. I remember those days for sure.
Dr. Vin Gupta: And it’s, you love it. I mean, you come to rely on it and, um, in a really serious way and you don’t have that. To state the obvious out outpatient providers don’t have that at their fingertips. Right. And, and, and really truly, uh, I, I oversee a team of, of clinical pharmacists that are, that are in part trying to build that experience for outpatient providers, one medical to begin with.
[00:26:00] Um, and then maybe, you know, as we’re growing more and more providers, but really to say, Hey, let’s give a a, a provider who’s caring for a patient with multiple chronic diseases in and out of the hospital. Let’s let them call a consult and, and, uh, let’s review medication lists together, figure out what we can do to maybe deprecate medications, optimize therapy, and, and in this world where retail pharmacy windows are closing and narrowing their hours, to me, that’s where there feels like there’s, uh, one value add to Amazon Pharmacy among many, but that’s, that’s definitely one.
But yeah, to your point, I, it is an incredibly complicated space, but as we are de complexifying it. We’re realizing that there’s a lot of inefficiencies. You mentioned PBMs and how we procure drugs and, and, you know, price increases that are baked in at every journey of, of, uh, at the journey of the medication being procured from the manufacturer ultimately to the patient, there’s price hikes at every step of that journey.
And as we’re talking about
Kristin: Just for, for people who don’t know, aren’t familiar [00:27:00] with that, um With pharmacy benefit managers. Yeah. Can, can you guys speak, cause I’m not in medicine. So I learned a lot of this just through him and his Silly videos,
Will: but yeah, because as you know, like I’ve, I’ve been very critical of pharmacy benefit managers like Optum and, uh, and, uh, CVS, Caremark, and you know, all these, these basically these are, they, they’ve started out as like the insurance.
I mean, there’s still insurance companies, but they have the separate arm that they, that are what are called pharmacy benefit managers that. Initially, when they started, they were designed to try to quote unquote rein in the pharmaceutical companies and keep medications affordable for patients as kind of a go between from the between the pharmacists and the, the, um, the, uh, the pharmaceutical companies.
But I mean, PBM, they’re going to say they do that. But I think the [00:28:00] reality is that they, there’s, it just adds this kind of middleman type of scenario where you have these, this PBM arm of these companies that are kind of extracting wealth from the healthcare system and generating a lot of money for themselves with questionable impact
Kristin: on the consumer side.
How do they do that? Where does that wealth come from? How does what? How do they extract the wealth? Where does
Will: that come from? Well, Ben, do you want to talk about this a little bit? Yeah.
Dr. Vin Gupta: So, you know, really what, I mean, exactly what ends up happening and as was just mentioned is that drugs are procured through these entities, these pharmaceutical benefit managers in many cases, uh, directly from, you know, an Eli Lilly or any pharmaceutical company at a certain price.
And then they’re sold to distributors, pharmacies, at a different price, and, and usually that there’s a markup there. And so that, that markup of what they acquire the drugs at versus what they sell, sell the drugs at to pharmacies across the [00:29:00] country, there will be a margin there that is introduced because they’re sort of the, that interlocutor
Kristin: between.
Versus just the pharmacy buying directly from the manufacturer.
Will: Exactly. So the idea is that the, the, that those savings. You know, they should be passed down to patients, right, on the consumer end, but is that happening? And so that’s where a lot of the controversy comes into play. Is there
Kristin: regulation around that to make that happen or
Will: no?
That’s a good
Dr. Vin Gupta: question. You know, this, I think this is Am I stepping in something? I mean, yeah, it’s a huge And a good thing. No, I mean, this is, this is changing literally in real time. We’re seeing this with the, with the weight loss drugs and what Lilly announced last week, which was this direct effort that they’re setting up.
Lilly Direct. Uh, at trying to meet this moment of incredible demand for these GLP medications, these weight loss medications. Like Ozempic, right? Yeah, exactly. But now they’re saying, hey, we will help facilitate and directly distribute through third party telehealth [00:30:00] providers and distributors. We, we will start to be more directly involved in distribution and, and as a result, you’re actually seeing the price of the medication because they’re more directly being involved in patient, direct patient care.
Again, through partners, the price of the medication is, is, is, is lower and what’s being built to insurance, what the ultimate copay will be. Cost plus drugs are, you know, as a stakeholder in the space, doing something in generic and in some cases, brand of medications, direct wholesaling or wholesale procurement of medications for manufacturers.
There’s a reason their prices are very low. We’re working with them, um, in some interesting pilots in California in particular, because we think that we can, um, you know, add incremental value, but this is changing in real time. So everything that you’ve been talking about is having impact because This is such, in the complexity of the space, I think this is, this reality has been allowed to go on for decades and now finally people are pushing us to like, why is this actually happening?
They’re de [00:31:00] complexifying it. I
Will: think you’re going to have a lot of people who are skeptical about this behemoth of Amazon and um, you know, the, at times, you know, less than favorable PR that comes from, you know, Amazon and now they’re, you know, treat their workers and the, all these things. And, and so you’re going to have a lot of people are thinking, Oh, Amazon’s going to, going to be in charge of my medications.
And, and so, and people have problems. I think people are going to compare this to the current, uh, um, uh, mail order pharmacy delivery systems out there, which is primarily right. Run by UnitedHealthcare, like OptumRx. Uh, and, um, and Express Scripts, uh, to name a couple of them. And so what would you say to those people who are maybe skeptical that this is going to be a better service for, for them than what’s already out there?
You
Dr. Vin Gupta: know, I’m glad you’re asking that [00:32:00] because we are constantly learning. I’m, I, I, one of the, one of the reasons I stay very close to the bedside is because I don’t want to lose sight of the problems that exist today. And, and so having a foot in both worlds to me helps at least keep me honest as in serving this role for Amazon Pharmacy.
I would say that at a high level, there is so much opportunity for improvement and, and, and the existing incumbents, like you’ve said, ESI. Mail order delivery more broadly, that still only represents 10 percent of all prescription, uh, fulfillment across the country. 90 percent is still, let’s pick it up at that retail counter.
We know what that experience has, is now continuing to become. It’s just not meeting patient needs. I, I, what worries me is that, you know, things that are not sexy problems to talk about because the solutions are really complicated. It’s often we don’t know the solutions. Medication non adherence, 500 billion problem, just in terms of dollars, but we know what that means for re admission.
You know, 30 percent of people don’t [00:33:00] pick up the refills, just because it’s too difficult. A stat that astonished me, and I, I pulmonologist, 85 percent of the time there’s a coupon for branded medication, like an inhaler, to lower the price to the patient. 85 percent of the time it goes unapplied, because people just don’t know it exists.
It is, it’s just Yeah, I’ve never heard
Kristin: of a coupon for my prescription. I mean, I don’t have an inhaler, so maybe it just doesn’t apply to my prescriptions, but. Well, no, I didn’t know that was even a thing.
Dr. Vin Gupta: Exactly. Well, exactly. You know, more drug classes than just inhalers. So even the GLP, the weight loss drugs, have coupons in some cases, other medications, EpiPens.
Most people don’t know these coupons exist if they’re prescribed or involved with medication because the pharmacists, they’re reliant on that retail pharmacist who’s overworked to educate them or their provider to say, Hey, go to this website, download this set of forms, submit it. That’s how you get the discount.
It’s just, it’s a ludicrous process. It’s ludicrous. And yet that’s the process that exists today. And [00:34:00] so Amazon is automating that process for a group of brand new medications. So if a coupon exists, it’s going to be automated. And it’s a true e commerce experience. You don’t have to think about it. And that’s solving an obvious problem.
You know, direct to your doorstep delivery. I think that helps with that refill problem that we talked about. But then even price transparency, it’s, it’s, it’s amazing to me that there was a study done by actually a bunch of, a group of pharmacists that was published in the Annals of Internal Medicine about four weeks ago.
And it looked at the 20 most commonly prescribed generic medications across the country, lots of them cardiovascular. And it asked the question, does GoodRx or does, does our prime prescription savings program, does GoodRx versus Copay. Are any of those providing additional cost savings? So would it be better to not use your co pay and use a discount program through GoodRx or through us?
And I found that if people used us or GoodRx, they would save upwards of 970 million in aggregate on the 20 most commonly prescribed [00:35:00] generic medications across the country, meaning insurance isn’t often your best choice, uh, to purchase at least generic medications. I just think there’s so much. lack of information and awareness on how to build a better pharmacy, how to get a lower cost medication, that to your point, if there is a trust gap, once you start to deliver on things like lower price, direct to doorstep delivery, people see it.
Yeah.
Will: People see it. Yeah. It
Kristin: certainly sounds more convenient. I mean, I think no one can argue that about Amazon. And, you know, cost savings and all of that sounds really good. But just as a consumer, you know, when I think about Amazon delivering my medications, one of the. Things I worry about would be in, I don’t know, maybe I’m, I am a little paranoid.
I’m almost, you know, I’m like a, like a very mild doomsday prepper kind of a person, you know? I am too, I am too, yeah. Good, okay, so, I think about, well, you know, Amazon already knows all of my purchasing history. Do I really want them knowing [00:36:00] my medical history as well with all of this, you know? Do I want them knowing what things I’m getting prescriptions for and what they are and how that’s going?
And are there, you know, there’s like a big data problem with this too, I think, for consumers.
Dr. Vin Gupta: Well, I’m glad you brought that up because I think I’m sure that’s not on the minds of many people that use Amazon for their retail purchases. I can share what I’ve seen directly get built, which is that your health data is your health data and it’s completely compartmentalized and completely blocked off and health sacred.
In any, in a very similar way to what we do with patient, uh, data in the four walls of a health system, brick and mortar health system. So there’s no crosstalk between health data. and retail data because everything that Amazon Health does is completely guided by HIPAA. And, and so that data is very much compartmentalized.
I agree with you that this is convincing people that we’re, that that data is, is held sacred, that it’s not going to be used in any way [00:37:00] to
Kristin: Right, because there’s not, you mentioned trust. There’s not a lot of public trust in how companies use data right now either after Cambridge Analytica and, you know, the aftermath of all that.
Sure.
Dr. Vin Gupta: Well, and we’ve seen other digital health providers. I should say, I should note that Amazon Clinic and a few of our other entities were recently scrutinized with a bunch of other telehealth companies and with regards to how we handle health data. And we were the only one, I think this is published in the Washington Post, that were found to actually adhere to the tenets of HIPAA and to treat health data the way it should be, which is not to cross talk with.
any other sort of consumer like behaviors. So I do believe as a clinician that the company completely is standing by its commitment, but because there’s some high profile examples Where other tech companies are not, have, have failed or have misstepped in that space. I’m not surprised and I think the onus is on us to make sure that we continue to say that your data is private, it’s sacred, it is going to be held and treated in the same way that it is within the four walls of a hospital [00:38:00] system.
That burden of proof is still going to be on all of the new entrants in healthcare, including us, to, to actually Uh, you know, uh, to show that we’re, we mean what we say, because I think there have been missteps elsewhere.
Kristin: Right. Yeah. Cause you know, you could envision a world where, I don’t know, if you have an anxiety medication through Amazon, then you start seeing ads for, you know, weighted blankets or other things that might help you with your anxiety, right?
Like that’d be a little bit.
Dr. Vin Gupta: Oh, it would be inappropriate. Yeah. No. And yeah. So we don’t do that to be clear. Um, and. Yeah. For the reasons that, that would, that would infringe on patient protected health data and the ways in which it could be shared. But How does that get
Kristin: enforced? I mean, it’s HIPAA protected.
Dr. Vin Gupta: Is that, uh, so we, we, we just have, uh, so we constantly, we have a, a secu, uh, a security system and a patient, uh, data team that just complete that ensures that, uh, one person say we have a series of systems in place that by which I’m, [00:39:00] uh, you know. Very non expert and from, uh, yeah, I’m
Kristin: probably asking questions, but like the weeds,
Dr. Vin Gupta: it is to say that we have a patient and we have security experts and data experts that make sure that siloed data, especially health data, doesn’t cross talk, that there’s constant monitoring for say, you know, any type of cyber invasion or intrusion or attack that would weaken our infrastructure.
Uh, but the relevant experts there are constantly mining that to make sure that that remains siloed and protected.
Will: It doesn’t crossfire. So when you’re, when you’re building out our doomsday shelter, like, you know, don’t worry, like there’s, we’ll, we’ll, you know, it’ll be
Kristin: private. We’ll subscribe and save, be available for my prescriptions.
Dr. Vin Gupta: Exactly. Exactly. Well, I, I will say that, I mean, truly. If, I mean, I cannot tell you how many patients come to me and say, you know, that met, I went, I drove in, took me two hours to get my ad there, and it was way too [00:40:00] expensive. Prescribe me something else. There’s, there’s so many unforced errors in the pharmacy space.
And you know, there’s, there’s lots of opportunity to improve. I think Amazon Pharmacy will be part of the solution. Not one, one entity can’t solve it all, but I do believe that if there’s one thing that Amazon is going to do Extremely well, and I’m very bullish on our ability to be at the doorstep, provide price transparency, provide virtual access to pharmacists, and that to me is, is a helpful set of solves for what’s ailing the pharmacy ecosystem.
Will: How long has, how long has Amazon Pharmacy been up and running? Like how long has this been? So
Dr. Vin Gupta: since 2020, and so our origin was in PillPack, um, and the acquisition of PillPack, um, and then we built Amazon Pharmacy, which is a 50 state virtual pharmacy, uh, direct to door step delivery, uh, mail order of all your medications.
Uh, we have seven brick and mortar fulfillment centers across the country, um, and are trying to get faster so that if you, [00:41:00] say, had an acute antibiotic in Manhattan, we can deliver that to you same
Will: day. And then a whole fleet of drones,
Dr. Vin Gupta: right? Uh, well, like, specifically for College Station You got the drones going?
We got some drones going in College Station, Texas as, uh, at least a proof of concept that,
Will: uh Why College Station? Yeah, of all places. I know, well, I, we say that as, uh, we, we both went to Texas Tech. We went to Texas Tech. So we’re Red Raiders and, and, bitter rivals of, of everybody else in Texas and particularly the
Dr. Vin Gupta: Aggies.
I think we actually, we actually, uh, searched to see where you guys went to school and then we decided to Yeah, that’s the warrior album.
Kristin: That was
Dr. Vin Gupta: the deciding factor. Yep. But I, um, I was going to say that, so that’s where Prime Air actually launched this initial set of services. And so we built on top of that.
Oh, gotcha.
Will: Okay. Who knew? There you go. Yeah. You can get your, uh, your insulin delivered by, via drone.
Kristin: Yeah. Too windy in Lubbock. So we could have done it. That’s
Will: the thing. Yeah. That’s probably, that must be why. They tried. I’m sure they tried to do it, instead of College Station, tried to do it in [00:42:00] Lubbock, Texas.
Yeah. But it’s like, oh no, it’s, it’s way too windy. Now let’s, let’s, let’s, you know, we’ll save it for maybe our more powerful drones.
Kristin: There’s like four people listening who understand this joke.
Will: Lubbock, um, is not exactly a destination for people, but I think two of those people are your parents. Yes, exactly.
Is that the future though? Is that, is that, I mean, is it, uh, how serious are you guys about this whole, the drone delivery thing?
Dr. Vin Gupta: I think the future is certainly, uh, serious to learn. And, uh, one, one of the, uh, when Prime Air asked their customers in conversation, what they were most excited about as an additional feature set, one of those common replies was prescription medication delivery, which is why we decided to roll it out in partnership with them.
I think the question, what we’ve noticed, and what I think is absolutely the future is hyper fast delivery. And people come to expect that of Amazon, but you know, it’s not just an expectation of [00:43:00] Amazon. It’s a, it’s a broader expectation in this world of test to treat and the pandemic that, and the two of you know this as well as I, that we’re, and this is just not something health systems writ large are fantastic at, but if you can diagnose somebody earlier in the course of their illness, chronic or acute.
In almost every single case, getting them something started as quickly as possible, a treatment, antibiotic or a chronic med, it’s probably going to be helpful, especially the acute antibiotic or antiviral. And we just saw three years of that experience, that holistic journey, be incredibly difficult to unlock for patients across the board, you know, delays in testing, many days of delay in treatment.
And I do think, when we think about clinical impact and value at a low cost, Amazon is doing hyperfast delivery and narrowing the gap between testing, triage, and treatment. That’s what I’m excited about because we don’t have enough providers to care for patients by the end of the decade. We’re going to have to [00:44:00] protect hospitals for the next, and, and ERs.
So how do you actually do that? We talk so much about it, but how do you actually do it? And I think it’s early intervention, early diagnosis, paired with early treatment. And that’s again, where I think we can be part of the solution where we can deliver hyperfast, keep people away from urgent care and the ER.
The more we build awareness, the more we can do that.
Kristin: So am I hearing you say that Amazon, or maybe they already have, are moving into the telemedicine space?
Dr. Vin Gupta: Uh, so very much, um, uh, I, I would say since, gosh, uh, you know, certainly the beginning of this decade, 2020, I joined AmazonCare, which is now, um, we got a lot of great learnings from AmazonCare, but it’s our telehealth platform.
Uh, with some in person component that has now, um, given way to a few different opportunities that, uh, that we’re really excited about. One is Amazon Clinic, which is a marketplace for external telehealth providers to provide their services, and at a low cost, costs a [00:45:00] range of different, uh, conditions or needs.
And so I think almost 40 different conditions are met, uh, through Amazon Clinic. You can go to virtualcare. amazon. com, um, if anybody that’s listening is interested in learning more. Uh, and we just recently acquired, uh, And this closed about a year ago, One Medical, the acquisition of One Medical, which is in person and virtual care, uh, in about 30 markets across the country, there’s an in person component coupled with 50 state access to virtual care.
And I, you know, obviously I’m biased, uh, cause I see what gets made and I see the quality behind it. And of course I’m affiliated with these efforts, but I’ve transitioned my entire primary care to One Medical. It is, it solves the issue of access and timely access. You don’t have to call anybody. Sub same day, you can get an appointment.
Amazon clinic, uh, the payment is often less than your copay for immediate access to triage services. And so you can really go from test to treat if you wake [00:46:00] up feeling unwell using our services and get what you need within a half day at a very low cost. I think in a world where the Commonwealth Fund says one in two people don’t have access to same day or next day care if they’re acutely ill, this is right before the pandemic they published that finding, that’s where I do think what we’re building, what some of our peers are building, it’s going to help be part of a broader solve.
Will: Is this a pretty competitive space or do you, because I hear a lot of kind of collaborative efforts being, being done, talking about cost plus drugs, um, what’s the landscape right now of, of this space? And are there a lot of people doing this? Is there a lot of competition
Dr. Vin Gupta: here? I would say very collaborative on the pharmacy side, in the sense that COSPLUS and us just worked on, uh, just announced with Blue Shield of California an effort to source drugs differently.
So COSPLUS is going to source medications directly from manufacturers across a range of different therapeutic categories. for um, [00:47:00] enrollees within the Blue Shield program in California.
Will: I would kind of assume that you’d be at odds with, with the big insurers.
Dr. Vin Gupta: Well, you know, there’s, there, uh, credit to Blue Shield.
They’re, they’re looking for value. And I think so many people, yeah, how many times did we talk about value based care? It’s, I mean, it’s just become, it’s almost become meaningless to some degree because we talk about value based care, it’s still in a paradigm, at least in hospitals, that’s very much fee for service and quantity versus quality.
So I tip my hat to Blue Shield, it’s a cost plus for being willing to partner with us. I would say very collaborative in the sense that, uh, you know, let’s take everything that we see every day. There’s a new headline, amazing therapeutic that does this for weight loss or heart disease. Uh, there’s a new COVID flu over the counter test from Pfizer, and most people don’t know about it because it’s 40 bucks a pop.
And the prob I always get, during the October, sort of [00:48:00] November season, I got a lot of people asking me about the RSV vaccine. And at the time, insurance wasn’t covering it. And now they’ve changed. But to me, if we’re talking about value based care and keeping people out of the hospital at the lowest cost possible, keeping them healthy.
If insurers are going to have to figure out a way to wrap their head around all this innovation that’s happening, because right now, many insurers say we’re not going to cover the weight loss drugs, even for those that need them. And that doesn’t make sense.
Will: I, I love the idea that it’s, it’s kind of forcing them to change and kind of get with the times and Yeah, but the
Kristin: cynic in me is like, oh, so they’re going to take the thing that’s trying to make things better and they’re just going to buy it up or, you know, they’re gonna, I don’t know.
I’m very cynical about insurance
Will: companies. Good luck buying up Amazon.
Kristin: I don’t know. Yeah, that’s true. Well, like if you can’t beat them, join them, you know, like, I just, I don’t know. I
Will: Yeah, you’re right. I think you’re right to Most insurance companies. To be skeptical of of how much the insurance companies can evolve to continue to go into like a cost saving for the patient.
Right. [00:49:00] Side
Dr. Vin Gupta: of things. Yeah. Well, you know, I hope, I mean, my belief is that they truly invest and this pilot with Cost Plus will show us. It’s a proof of concept that if we can show that we’re saving patients money and we’re keeping them out of the hospital, I start to think then that catches fire as a model for other, uh, for others to mimic and to emulate hopefully, but it’s, it’s very much to be determined.
You’re
Will: right. Well, if you can, if you can crack, uh, tele ophthalmology, uh, for, it’s kind of the average, like, I’d just, I’d be interested. Ooh, what
Kristin: about like, you know,
Will: the glasses? Yeah. Let’s see. Right? You got the, what, you talk about the Ray Bans? Well, nothing
Kristin: that exists, but there’s all sorts of, like, smart glasses, right?
Yeah, yeah. Maybe someday there’s tele ophthalmology glasses that, like, can
Will: take the picture. Well, there’s some tele ophthalmology that’s done, like, worldwide, but there’s limits to it. And I got a
Kristin: I remember during the pandemic, it’s like people just trying to, you know, like, Put their eyeball by the webcam, you know,
Dr. Vin Gupta: it just wasn’t very effective.
It was rough.
Will: It [00:50:00] was rough. I’m trying to do, on the fly, figuring out tele ophthalmology, uh, in a world, in the U. S. at least, where it’s just not done at all. Eye care, just not done. And it was, it
Dr. Vin Gupta: was tough. I, you know, I mean, since you mentioned it, I, none of them have seemed to really risen to the, uh, sort of FDA approval, but I feel like I’ve used to, I remember getting approached with different apps that promised an eye scan that, that can tell you whether or not you were COVID positive.
And I’m wondering, do you feel like the eye is underutilized as a, as a way to diagnose systemic disease?
Will: Excellent question. Well, I will tell you there’s been work done for quite a while about, uh, using things like AI, uh, for mainly on the diabetes side. So diabetic retinopathy and, and using that data to figure out kind of how well controlled someone’s diabetes is.
So diabetic retinopathy is a thing that’s been in the AI space for a while because you can [00:51:00] It’s one of the great things about, about having, being in ophthalmology is you can take pictures of people’s retina. Right. And there’s, there’s really interesting things going on with like Alzheimer’s and, and certain other diseases.
Again, it’s not like there yet to really make a big impact, but the work’s being done. So yeah, I’m, I’m really hopeful. That, uh, you know, selfishly, I just, I would love every hospital, every emergency department to have a fundus camera to be able to take a picture of the retina and to send to people. And I would love that.
So I don’t know. Wow. Let’s keep, keep working smart people who do
Dr. Vin Gupta: computers. Exactly.
Will: Like you, go tell Amazon, get it, get it going, get your Amazon op, Amazon eye, I don’t know what I should call it, I don’t know, whatever, but, um, I do have, before we finish, uh, uh, I’ve got just a couple of quick questions for you.
When was the last time you saw an ophthalmologist in the ICU? Oh, [00:52:00]
Dr. Vin Gupta: oh
Kristin: my gosh. Do you ever need an ophthalmologist in the ICU? Is that even a thing?
Dr. Vin Gupta: I’m trying to think if like an orbital eye or some sort of. Uh, I, I can’t, I, I don’t remember. Such a tough question. Right. I don’t think I’ve ever
Kristin: seen it. Some med student will be listening and think of the one very obscure
Will: time.
At the peak of the pandemic, did you ever get any redeployed ophthalmologists? No. Do you
Dr. Vin Gupta: remember that? No. I don’t. No. Was that your experience though? I’m curious. No,
Will: no. Fortunately, I thought it might happen, but it never did for me. Um, but my other question for you is, uh, last question is, do you check all the patients in the ICU for contact lenses?
Dr. Vin Gupta: No, I don’t. Should I be?
Will: Especially, especially the young people. You got a young person comes in, got to check and make sure, see if they wear contacts, like ask, you know, their family. And I always, I always tell like residents and, you know, trainees that because, uh, too many times, mostly during, I don’t, I don’t head to the ICU very much these [00:53:00] days in private practice, but when in training, it’s like every week you’d go up there and you, you know, someone’s admitted.
It’s a young person was admitted for several days and, and I take a look at their eyes and sure enough, they got contact lenses in there. It’s not something you want to leave in there.
Kristin: So he talked about that so much that then he was a patient in the ICU and I, and was not able to speak for himself. And so I knew I was like, Oh man, I’m going to have to ask this intensivist.
If, if they’ve checked to see, you know, if his eyes are like lubricated, what are they doing with his eyeballs? Like he doesn’t wear contacts, I didn’t have to worry about that, but I had to, I had to make sure they were
Dr. Vin Gupta: taking good care. You asked about artificial tears. Yeah. For me. You know, that’s such a, oh my gosh, that’s such a, it’s one, it’s a great prompt and for doing that.
But two, it’s, you know, what’s interesting too is we focus so much on delirium. I can’t, I mean, the morning rounds is, how do we do a spontaneous awakening trial, spontaneous breathing [00:54:00] trial? Yeah. Think about delirium, get them off the vent, and talk about their mental status all the time. But gosh, if you can’t see properly, because maybe you don’t have context in, but you should have context in.
Right. Right. I never, 15 years thought about And let’s prompted by the family. Is this, can this person see 2020? Um, or can they see clearly at all because of a contact lens issue and how that might impact their delirium? So this is, that’s, I mean, that is a, that’s huge. That’s huge. There’s an
Kristin: application for ophthalmology in the ICU.
Awesome. We had to, it’s a really roundabout way to get there. We got there
Will: the whole time. This, this whole, this was just a ruse to end up talking about, you know, ophthalmology in the eyes. In the ICU, there you go. You could do that and
Kristin: you could talk about ophthalmology on a plane, right? With, with
Will: Ben here.
That, that, exactly. Actually, you know, there is, there’s Orbis. Orbis is like, it’s called the Flying Eye Hospital. I don’t know if you’ve ever heard of this thing. No. It’s a non profit [00:55:00] organization. They have an OR. Where they can do cataract surgery and other surgeries like flying through the air. And
Kristin: why would you need to do that?
You know. Cause it’s cool?
Will: Well, I mean, they don’t, they also will like just park the plane and bring patients in and do. Again, why? Because it’s a humanitarian effort and it’s super cool. I see. Got you. It’s awesome as well. Alright, well, we won’t keep you any longer. We really got off track there at the end. So, anything you want to plug, tell us about, uh, that you haven’t talked about already, that we haven’t discussed?
Dr. Vin Gupta: No, you know, I mean, I guess the last thing I would say, and just a kudos to the two of you is, uh, I, I spent a lot of my time outside of clinical and, and, and health and health technology, just on, on effective health communication. Almost like, uh, I mean, it became overwhelming, but do it for mainstream media.
And I, I’ve come to really rely on the two of you, one, both to [00:56:00] inject great information out there at scale because you have a large platform. Um, also keep it, uh, light, uh, uh, when it’s appropriate and, uh, just to be a source of, uh, just, you know, inspiration and, uh, and levity when we needed it the most. But just on the, on the public facing communication piece and being somebody that we could look to for best practices, uh, but also just to get the right information out there just given that I spend a lot of my time on that as well.
Um, I just wanted to say that, uh, you know, I don’t know if I’ll, I haven’t had the chance to say that to the two of you yet, and so I didn’t want this time to go by without just one saying thank you, uh, the fellowship there, but then I think it’s, I think it might be the most important thing any of us do beyond the pet side, which is, you know, how do we reach people with better information.
Will: Well, thank you. And the, the feeling is mutual for sure. And I know you’re, uh, you, you do spend some time still doing the NBC, MSNBC analyst role.
Dr. Vin Gupta: Yeah. You know, I, I, you don’t move to Seattle, Washington to thinking that that’s going to be in [00:57:00] your parts. Um, I think you stay in the Northeast, but I, so I, I’ve always done it for organic reasons.
Um, it happened organically. I feel like there’s impact just like, I think you two have such impact. And so if people trust what you say and you can reach people with good information, it’s, um, it’s invaluable. And so now I, I try to do it for the right reasons, but I, I, I,
Kristin: Well if they ever need an internet comedian ophthalmologist to weigh in on some public health issue, you just let us know.
Will: Let NBC know. I will do that. I’ll, I’m there. I will do that. Thanks again, and people can find you on social media, uh, at VinguptaMD, uh, and on NBC from time to time as well. Um, and then what was the, how can people find more information about Amazon, um,
Dr. Vin Gupta: pharmacy? Yeah, um, well, pharmacy. amazon. com, um, or please reach out.
I’m at VinguptaMD, uh, you know, message is open, would love to, frankly, love to just get feedback. Cause I think. Often the [00:58:00] best feedback we get is from providers saying, They love our call in line because it takes a minute to reach a human versus 30 minutes in some cases. So, I, just hearing from providers about what’s working, what’s not working is fantastic.
But, you know, try something new. Pharmacy. amazon. com. I, I, I do think you’re going to be delighted and pleasantly surprised. But what it means for your patients more than anything.
Will: Well, thanks again for joining us.
Dr. Vin Gupta: It’s a pleasure. Thank you.
Will: Hey, Kristen. Yeah. Our anniversary is coming up. Yes, that’s right. You know what I got you? What?
Dr. Vin Gupta: A bouquet!
Kristin: Oh, you shouldn’t
Will: have. They’re Demodex
Dr. Vin Gupta: mites. That’s
Will: why you shouldn’t have. Look how cute those faces are, and the little legs. It’s kind of cute,
Dr. Vin Gupta: know
Will: what these things do? What? They cause you to have like, itchy, red, irritated eyelids.
That’s not cute. Well, it’s a disease. It’s actually a pretty common disease called Demodex Blepharitis. How do you
Kristin: know if you have it? What does it look like? [00:59:00] Well,
Will: you end up with this crusty, flaky buildup. on your eyelashes and it’s pretty easy to see if you just look at them under a microscope. Pretty gross though.
Yeah. Yeah. So, well, you don’t get grossed out. Okay. You gotta get checked out. Okay.
Kristin: That’s a fair point. Yeah. You
Will: gotta go in. And, and, and we’ll look at your eyelids. You just go to eyelidcheck. com to get more information. That’s E Y E L I D CHECK. COM to get more information about demodex blepharitis. These cute little guys.
Yeah. That’s the most
Kristin: romantic anniversary gift you’ve ever given me. You’re
Will: welcome.
Dr. Vin Gupta: Well, that was
Will: fascinating. It really was. Amazon, I, I feel like I have a better understanding of kind of what, Yeah, it didn’t make sense
Kristin: to me when I first heard about it. I was like, what do you mean Amazon
Will: pharmacy? Well, I, you know, I, I am naturally very skeptical of these, of this mail order just because of what like Optum has put people through.
And, but I, I feel like [01:00:00] they’re, they’re coming at it. At least, you know, just from the right perspective, right? And really trying to like save people money and, and it sounds like it’s a great way to try to do that. At least, at least make the, make the health insurance companies a little nervous, you know, like, Oh, we got to change with the times.
People are going to have
Kristin: options.
Will: Yeah. I
Kristin: do like that aspect of it.
Will: Competition in a space like healthcare, where there’s like less and less competition as things get consolidated. I
Kristin: see. Then that’s what I’m worried. Like then if they’re being Collaborative with them, then is it going to be just one consolidated conglomerate of, you know, I, I feel like we need to.
Things
Will: can always go
Kristin: sideways. Right. So I don’t know. I don’t know what the answer to that
Will: is, but. I do also like the cost plus drugs. You mentioned that and it seems like a very similar model. And so, you know, I don’t know. We’ll see. We’ll see how it goes. Um, but it was just, uh, fascinating to talk with, uh, Dr.
Gupta about that.
Kristin: Yeah, he’s had just such an
Will: interesting path. I like his perspective [01:01:00] on things. Yeah. Yeah, for sure. Um, all right, let’s get to our, we have a fan story. All right. Yeah, you want to hear it? Yep. Okay, here we go. This is from Stuart. Stuart says, Hello, Dr. G and Lady G. I’m dying to know, Dr. G, do you have a Jonathan?
If you do, you should consider interviewing them for your Knock Knock High series. If you don’t have one, you could interview one anyway. I’m sure there are, uh, many of your subscribers would love to hear the perspective of a real Jonathan. That’s a, that’s a great idea. Should I get my original Jonathan off me?
Well
Kristin: that’s why I was laughing because I was trying to imagine him coming on a podcast. Do you think, yes, do you think he would, he’s so quiet.
Will: So Luis is, was my, it was, was the, my, the, my first scribe that I worked with when I started my job, um, out of training and. He’s, I kind of built the character around him and the amazing things that he did as a scribe.
Now he works as a technician. Yeah. Uh, which is great because he has more experience in [01:02:00] doing different jobs in the eye clinic. So I’m going to ask him. I’m gonna see what we can do. See what we can do about that. Um, uh, and then Stuart also said, until very recently, I thought Jonathans were a fictional invention by you, but I posted a question on one of your videos and another subscriber told me that they were actually real.
Yes. Medical scribes are real people and they do real amazing work. I love them. Uh, so thank you, Stuart, for that. And thank you all for listening. Thank you for your stories. You can send us your stories. Knock, knock high at human content. com. Let us know what you thought of the episode. What do you think about Amazon pharmacy?
What do you think about Amazon? Kind of, you know, sending you medications via drone.
Sounds cool to me. I don’t know. They drop it, uh, uh, we didn’t ask like what, what happens if you’re not home and they like,
Kristin: well, you have that
Will: issue now, I guess that’s, that’s never going to go away, but unless [01:03:00] you’re always home, but, um, all right. And let us know if you have any other suggestions for guests.
We’d love to hear your thoughts. Lots of ways to hit us up. Email us at knocknockhigh at human content. com. Visit us on all the social media platforms, you can hang out with us and the Human Content Podcast family on Instagram and TikTok, at Human Content Pods. We just got through the holidays not too long ago.
We spent some time with our
Kristin: family. We did. Yes. We got together for the holidays.
Will: Our real family and our Human Content family. Shout out to all the wonderful listeners leaving feedback. We love you guys. We love the feedback, just the ones that are giving us good feedback. No, we love the ones that are giving us like not so good feedback either.
Uh, we love all of you. I haven’t seen any lately, which is, which is great, but you know, we welcome all feedback. But if you leave a great review, if you subscribe and comment on your favorite podcasting app and on YouTube, we can give you a shout out. Like Jenny Grace on Apple said, best doctor. I love this podcast.
Wow. [01:04:00] On making eyeballs interesting. Thanks for starting this and hope you never run out of topics. She’s referring to the knock knock. Eye episodes that I do once a week, um, where I just, I nerd out on eyeballs with you guys. I think
Kristin: she is as surprised as I am that you have made eyeballs
Will: interesting.
Guess what? I have people say that they love listening to that on their commute to work. Just getting ready for work by listening to an ophthalmologist talk about ophthalmology things. Got a
Kristin: lot of eyeball questions, I guess.
Will: Full video episodes are up every week on my YouTube channel at DGlockenflecken.
Also have a Patreon, lots of cool perks, bonus episodes, where we react to medical shows and movies. Hang out with other members of this wonderful, brilliant, hard working community. Um, uh, we’re active in it, we’re doing all the things. Our early ad free episode access, livestream events, and much more.
Patreon. com slash Glockenflecken, or go to Glockenflecken. com. Speaking of Patreon community perks, new member [01:05:00] shoutouts! We got Jocelyn, Michelle H, and Roy R. Thank you all for being patrons. Uh, and also shout out as always to the Jonathans. A virtual head nod to you all. Patrick, Lucia C, Sharon S, Omar, Edward K, Stephen G, Jonathan F, Marion W, Mr.
Grandaddy, Kaitlyn C, Brianna L, Leah D, K L, Rachel L, Keechie, JJ H, Derek N, Mary H, Susannah F, Mohamed K, Aviga, Parker, Ryan, Medical Mag. Bubbly Salt, and Pink Macho. Thank you all.
Kristin: There’s too many for you to do it all in one breath now. I know. It’s
Will: amazing. Uh, and uh, uh, Patreon Roulette. Random shout out to someone on the emergency medicine tier.
Shout out to Justin for being a patron. Thank you, Justin. Thank you all for listening. We are your hosts, Will and Kristen Flannery, also known as the Glockenfleckens. Special thanks to our guests, Dr. Vin Gupta. Our executive producers are Dr. Will Flannery, Kristen Flannery, Aron Korney, Rob Goldman, and Shahnti Brooke.
Editor and engineer is [01:06:00] Jason Portizzo, our music is by Omer Ben Zvi. To learn about our Knock Knock Highs program, disclaimer, and ethics, policy, submission, verification, and licensing terms, and hyper release terms, go to Glockoflaca. com or reach out to us at knockknockhigh at human content. com with any questions, concerns, or Porn medical puns!
Yeah, those too! If you want, Knock Knock High is a human content production. Goodbye!
Hey, Kristen. Yeah? You know, sometimes I come home from work and I just, like, feel really run
Kristin: down. Yeah, because, you know, despite popular opinion, you actually do see a fair number of patients every
Will: day. I do. My clinics are pretty busy, but I’m not the only physician that feels that way. So many people feel overwhelmed and burdened, so much that work life balance feels
Kristin: impossible.
Yeah, nobody gets into this job for the paperwork.
Will: Most people. Definitely not me. And, uh, but let me tell you about the Nuance [01:07:00] Dragon Ambient Experience, or DAX for short. Tell me. This is AI powered ambient technology. It sits down in the room with you. It’s transforming healthcare with clinical documentation that writes itself.
Ooh, that sounds
Kristin: nice. It’s like having a Jonathan there. Yeah, perfect. And I got some stats
Will: for you. Ooh, I love stats. You’re going to love this. Seven minutes is saved per encounter by reducing clinical documentation time by 50%.
Kristin: Seven minutes. That’s an entire surgery for
Will: you. Yeah, that’s what DAX can do for you.
And, uh, across all specialties, 70 percent of physicians report a reduction in feelings of burnout and fatigue. That’s pretty incredible. It really is cool technology. Uh, to learn more about the Nuance Dragon Ambient Experience or DAX, visit Nuance. com slash discover DAX. That’s N U A N C E dot com slash discover D A X.[01:08:00]
