c-span's washington journal live every day with news and policy issues that impact you. coming up sunday morning, the christian science monitor representative discusses the mueller report. also a discussion about criminal justice reform and reentry programs for convicted. join the discussion. >> new york university hosted this discussion on health care. this is 90 minutes. >> welcome to our second conversation. journalismessor of

here at nyu. you are here at the journalism institute at nyu. we are pleased that c-span is here with us as well as our usual live streaming and we would encourage those of you watching the livestream to tweet questions. it is a real pleasure to have our guests here. they have found ways to do great journalism, great reporting while also accruing very large audiences. we have a number of people in

the room who would love to do exactly that. as well as people who are joining us online. our host is a distinguished writer and resident here at the carter institute. he will moderate the discussion and also do the introductions. take it away. >> thank you. welcome. intourpose here is to dig how we report the story of science and medicine. to do that, we bring together the best in science journalism, the best in science medications, to explore how new research reaches the public. what can journalists learn about reporting from scientists? what can scientists learn from those who cover them closely? what do there differing perspectives tell us about how

the news of science is changing? how it reaches the popular culture and how journalists and scientists and doctors might the you the whole thing better than we do now. conversationsse .re sponsored this is the second in our spring series. can forward on march 27, we tong together producers unpack trade secrets of science videos that reach millions of viewers. on april 24, we are going to probe coverage of behavior and misbehavior with psychologist.

and also an npr reporter. tonight, we consider a public matter of life and death. the hazards of american health care. bad doctors, medical mistakes, crushing costs, and a lack of transparency that too often shields them. we're going to conduct a media autopsy. towe go, i encourage you all offer your questions. use the microphone please so those of us who are watching you canan join and tweak your questions to us -- tweet your questions to us. tonight,conversation we are joined by one of the most influential voices in medical coverage.

narratore reporter and of the six part podcast dr. death. it is a tale of willful medical malpractice which at last count had been downloaded about 30 million times. tonight, afrom texas veteran award-winning freelance health and science writer and at a prize fore won excellence in medical science reporting from the council for the advancement of science writing. by her side is one of the nation's leading health care critics. he is a surgeon and professor from johns hopkins university. is also the author of the book unaccountable which explores the medical culture --t leaves surgical set

sponges inside patients, and he takes the wrong leg, and overdoses children because of sloppy handwriting. his forthcoming book which i am proud to have a copy of is called the price we pay. what broke american health care and how to fix it. it is coming out i believe in september. must-readls this a for every american and business leader. conducting is experiments in the public understanding of science and medicine. spurt to treat you as our -- first specimen slide. i want to ask you about your work with dr. death. this is the strangest assignment i have ever heard of. the story was already well reported.

the doctor in question had already been grabbed by the collar and brought to justice. assignment in this a podcasting company and you had no podcasting experience. how on earth did this come to be? completely fell in my left one day. i am a print reporter. contacted by the company that makes podcast. story ofheard the christopher dent from a previous podcast called dirty john. a listener emailed of them and said have you heard of christopher dent?

they had not. even though the story got a ton of media attention locally in had gottenarea, it some but not a lot of national attention. he was a back surgeon and as you might guess from the title of the podcast, not a very good one. >> he killed people. >> yes, two people. .e had a less than 40 patients more than 30 of them ended up injured. two of them died. they contacted me to tell the story about what happened. i am at reaction is print reporter. i don't know anything about telling an audience story. i know more now than i did. that was the first challenge of

trying to do this. will benefit -- was doing a story like having you tell a story people think they already know? the ending was out there. used our out from the first five minutes, anyone could google it and find out what happened. you didn't have that suspense that you do with some podcasts what you don't know what's going to happen. one tree was willing to take a chance on me. i took a chance on them. we had to trust each other to tell the story. they ended up being great and supportive. they are not a journalism organization. they work with journalists and since i did my part, they have

now worked with a lot of journalists. they are not a journalism organization and they don't pretend to be. yet they respect and support the tenants of journalism that let you tell a good story. >> i want to make sure i understand. this is not a clip job. they didn't ask you to go to google and pull down what had already been covered. they asked you to re-reported from scratch. >> yes. was clear given the scope of the story. i'm a freelancer. the hour.get paid by they asked me to commit months tellinghs of my time the story in a format i have never used. i had done an episode of this american life a few years ago. i knew nothing. i learned some working with them

life,e it this american they are so good at telling audio stories. that was a 30 minute episode. this was hours of content. >> out of that affect how you reported this? >> the reporting itself was the who you go toof for sources, where you get documents. that did not change. reporting is reporting no matter what platform you do it on. what did change is how you interview. how you ask questions. that was different. i signed off and getting it was going to be the same process of this american life where there was an audio producer there doing the recording. so i would do what i would normally do and someone else was

doing the recording and all would be well. a week imagine my terror after i agreed to do this when i get an emailed says ok here's the fedex tracking number for your recording equipment. used any recording equipment other than my phone before. x can you give us a quick thumbnail for those who have not heard this podcast? recommend that you do listen to it. can you give us a thumbnail of just how bad a bad doctor can be? questions a good because that's what i had established in the first episode. the first episode is pretty tough. it is somewhat graphic to describe because i thought to

understand of the story, you have to understand how bad a surgeon that he was. he was making mistakes that surgeons never make. for example, he was a back surgeon so he is putting hardware into a patient's back. it is supposed to be screwed into the bone. screw surgery, he put a into a back muscle and screwed it into this woman's muscle. he left a sponge inside one patient. head doctors tell me that didn't even seem to know basic anatomy. he had a habit of cutting arteries on patients. several times.is one of his patients who died, she bled to death. he was so bad that one dr. who

came along behind him and saw how bad he had done thought it had to be an imposter. no one could have finished medical school and been this bad. as someone could've come off the street and done this. that's how terrible he was. i want to conclude this little bit right here. how could a surgeon as in a and ,angerous as you have described is how could that dr. the allowed to harm dozens of patients before he is stopped? aren't there boards and procedures and reviews? >> that is the central question of the podcast. that this wasr not a story about him.

it is a story about our health care system. operated for almost two years in dallas and he was passed from hospital to hospital. there were safeguards that failed at every turn. that is the central question of the podcast is how did this happen? like a crime as podcast because he was convicted in a criminal court. this wasn't a whodunit. you knew who did it from the first podcast but it was wide. how did this happen? >> you have written a lot on this topic in the academic traditional medical press but also in the general press for us. in your first look accountable, it looked at this question of medical error. with any otheren

problem doctors or something unusual about this case? is this a problem that many hospitals wrestle with in your experience? >> thank you for having me here. it is great to be in a place that does great journalism. i love the dr. death podcast so much is that it tells a broader story of what is wrong with the accountability within the profession. most doctors are good people. they always try to do the right thing or the vast majority of the time are trying to do the right thing. the one struggle that those of us who write about quality and we evolved together as has beennd researchers

had he prevent sensationalism? you don't want to create hysteria out there. the publicist behind the books or the editors that throw the titles on the articles in the suddenly throw the most sensational thing out there and we are seen as christian -- creating hysteria. that has always been a challenge. even in the writeup about unaccountable referring to doctors kill people with sloppy handwriting. we don't use handwriting anymore. >> we have changed to electronic health records. the handwriting is still bad. dyingients are not really for that reason. there is a bermuda triangle in medicine of accountability. the hospitals will say it is the state medical boards that have to police this. the state medical boards will

say, it is really the hospital and their department chairs. what you have is a black hole, and then you have some case like the "dr. death story that really exposes not one individual, because the bad apples are out there, but that is not the majority. i justs that happen, and came back from a meeting of neurosurgeons. neurosurgeryl association invited me to be a keynote speaker. --a dinner before the speak the association, the doctor start talking, and they start to be very honest. or two, theyr start to unload and tell you this fee-for-service system that measures us and pays us by the

most spine operations or the most operations that we do is driving all of my partners to do unnecessary surgery. this is just this week. storytart telling me, after individual, after case, after patient with recommended no surgery who sees another one of their partners who says, i can help you. the problem realize in health care right now that dominates the field is not the one off. incentive structure that is resulting in a mass epidemic of inappropriate medical care. ofyou look at the number prescriptions doctors prescribed 10 years ago, it was 2.4 billion. last year it hit almost 5 billion. did disease double in 10 years? no, we have a crisis of appropriate is.

we are seeing patients where they are demanding things. ess problem of appropriaten is one of the biggest drivers of an industry that is now the number one industry in the united states. book, you make the point of discussing how difficult it is for patients and consumers, for you when you were not the practitioner, one being practiced upon, to get access to treatment costs and error incident rates, complications, infection rates and stuff. i saw a testimony of yours to congress a couple of years ago, where you said that there was something in the area of 150 different registers that track patient outcomes. a quarter of them we pay for. almost none of those outcomes are made public.

about badconversation medicine, not about the problem of bad medicine, but the problem of how come this story, which has been told so often, because forgive me, you are not the first medical writers to come across a bad doctor, and you are not the first doctor who is called attention to this. what it is -- what is it about the story that keeps us in a loop? is it just a transparency problem? laura: one of the cut -- martin: one of the complicating factor is that medicine is an art. stuff comes up. you want to tailor your treatment to an individual patient, their needs, and their goals. it is not a recipe. if we measure outcomes, we have got to factor in the complexity of the patient and their unique

situation, and their social situation, and how sick were they. that is what we call risk adjustment, and it is never really perfect. we have used that to an excuse to say let us not do any measurement. measurement is not aligned with any stakeholder. stakeholder says we need to measure every single operation that has ever been done and will be done with in this new device. when the robot came out, something that laura has written about, why were we not measuring the outcomes of every patient that had surgery with the robot from day one that it was produced. if we did, it would've taken 10 years for our research group to it ishe whistle and say, sometimes dangerous, it has no benefit in a whole host of operations and is costing more money than the standard treatment. not for every operation, but for many. we were not measuring our outcomes.

99% of health care is still unmeasured. go have a knee replacement at the hospital, they will not be tracking how you do at six months and a year. of the things to my point is that the instruments that we do have as patients are completely inaccurate and misrepresented, which is how do you find a doctor? you do the same way when you want to find a restaurant. robert: i'm to call you. you look online, and willof these rating tools consider that christopher dent, the vast majority of his patients ended up dead had or .5 stars on health grade. robert: you are kidding? laura: no, i have that screenshot. patients, one of the striking things is that all

of his patients thought that they were researching him, including the very last patient. he looked online, he searched every tool that he possibly could and found the patient testimonial, the equivalent of how did you do with you. he found those online, he found a video that looked like he had gotten an award, which turned out to be an infomercial, but as a patient, you do not know that. i the time that he was timerching him, -- by the that he was researching him, dent had over 18 patients in terrible shape. but from what we could tell, he did not do anything different than you or i or -- would do. he thinks he is finding goes into surgery with him. artery and vertebral sells them up. and he almost died. this,: you will reporting

and other people have reported this. you go to the hospital, and there was more than one, and what did they say? laura: that hospital has closed. it has closed. the other hospitals, in my story were not talking, as you might imagine. and i do not talking, not know. the big question is, these use,tes that all doctors he obviously had a carefully curated internet presence. the reviews, some of them were fake, and a lot of these online tools are a disservice to patients, because patients do not know that they can be manipulated, and can be scrubbed. -- and yet, that is all we have got. robert: i want to explore this

for a minute. as are a newbie podcaster. the story is well plowed, and developed. how did you proceed in your reporting? ?hat kinds of things did you do is it just the actuality of voices on tape? this: i had to decide and -- i had to decide assuming -- to tell it assuming that people know, or assume that people know nothing. i made a conscious decision to go into it fresh, and assume that people knew nothing. i was not going to pay attention to anything else that had been reported before. i made the decision because it had been reported before, in order to make the story worthwhile, i had to dig up information that had not -- that had not been. and i had to find things that had not been, and explore this

territory. it is how this happened. how these safeguards did not work. and, every safeguard that was in place, they all broke down. dent, he was an obvious outlier. of surgeonsority are good, capable people who care about their patients. yes, thank you, but it was of course you that worked out that the medical error is the third leading cause of death in the united states. of ratee are a lot doctors, we are not trying to malign the profession, and figure out why as journalists and as public intellectuals, he cannot somehow get the system whatever that is to respond in a useful way.

you do not need to defend, we get it. likel have doctors that we , trust, and respect. do not undercut your own work. decisiondid make a that i was going to assume that people were starting from ground zero. it, telling a podcast, started listening to a lot of podcasts after i got the assignment. i did not have a lot of the tools that other journalists telling stories have. for example, there were not going to be any plot twists. guilty,who you think is he really was guilty. there was not going to be a surprise ending, there was not going to be anything that a lot of podcasts have that keep them going. it was a story that you already think that you know. i knew that the one thing that i to to do was to report it

the degree that i could and get the information that i could, because that was the only thing that really i had going for me, the whole success of the story depended on. you might think you know the story, but you really do not know. of i had to dig out a lot stuff that nobody had ever heard. robert: and doing it while you are teaching yourself how to be a podcaster. laura: i still do not know a lot about making a podcast. robert: really? knack for lmsvl -- it. are aip and, martin, you trained servant -- surgeon. where do you find the time and energy to write three books,

two of which that you have mentioned. and how did you develop the reporting tools. one of these things is interesting about "the price we pay," it is not spoken from on high, policy boys. this is a a lot of on the ground reporting. what led you that way? i realize that there is a lot i do not know about journalism, and it is a humbling moment when a surgeon says, i have no idea what i am doing. i had that moment, so i have been talking to so many journalists over the years about their stories and research, and i was fascinated by the fact that you can have a two week deadline and put together a story of conflicts of interest or fraudulent interest 100 times faster than we can do in a two year study that goes into a peer

review in a journal that has a process. i the time it comes out it is outdated and the policymakers have passed laws. allen,ed out to marshall a health care reporter, a very seasoned reporter. he had done several pieces on patient safety and medical errors. i asked him, would you edit this book for me. edited,ntially not only but coached me through the process. example, ir discovered in one town in america that this hospital had sued half of the people in the small town for their unpaid medical bills and then chased them down and garnished their wages. these patients were devastated. and i realized, holy crab.

people do not live like me. i have a lot to be thankful for. i am a surgeon, and half of america has less than $300 in savings on hand. when they get a 600,000 -- when they get a $6,000 surprise bill, that is catastrophic. even though it kills me, and i spent countless weekends flying to towns in america, i think it was 22 towns by the time we were done with the book. , from his position, he is actually in new york and i'm in baltimore. he would be like have you traveled to new mexico yet. he said you need to get on the ground. i would be like, we have all of the data here. and he was like, you have to get on the ground. onould say i have cases

monday and surgery scheduled. so, getting on the ground i met one woman who invited me to her house. she is a single mom, two kids, and i cannot believe the conditions that she was living in. she told me the story of how her car was in the shop, she could not afford the $800 bill to get the car out of the shop, so she could not get to work. she worked two minimum-wage jobs and she was devastated by a $2000 bill when her kid had asthma and they went to the emergency room. pricing,, based on should not have exceeded $600. i could only get that on the ground. i learned so much on the ground, an ambulance company gouges patients. talking to insurance companies and doctors. i'm convinced that health care attracts good people, but we

have perverse incentives in the system is messed up. we have good people working in a bad system. when you talk to those people, they will tell you. how does a business by health insurance? with health insurance brokers. i did not know this existed, and they have their own conferences. i went to a conference, and you get a drink or two into them and they will tell you our system and our profession is messed up. we get paid kickbacks from health insurance companies so we do not always present all of the options to the businesses, and they are getting ripped off left and right. we are making a killing and it is the untold dirty secret of why health insurance is going up so high. i do not know whether or not that is true, but i heard it so many times from people on the ground, i was able to do a deep dive on how health insurance is sold to businesses and give them

guidance on how you should buy health insurance for your employees. and, pharmacy benefit plans. we had so much stuff that was like, oh my god, we have got to tell somebody. robert: you've got to tell somebody. there are a lot of scientists that want to reach out to the public directly about their work , maybe they have issues that they care about. there are all -- they are always a little nervous about doing this, because there is a widespread belief that there could be a professional cost to putting yourself as a researcher. is a show off, or, you are really telling tales. you are revealing the dirty secrets. i am wondering, you are not a journalist. you are a surgeon. you work by referrals.

you have hospital privileges, it is a network. has this cost you anything? is there a backlash because use keep -- you keep shooting your mouth off? martin: any time you write a book or an article, it will be perceived by some as self-promotional. especially if the media sensationalize is the topic and you get one that goes off on it and calls it something. i think there is a little bit of callrage that it takes to -- to talk frankly about this. i was talking to a prominent u.s. surgeon who just told me how he could not believe that another surgeon that he works close to openly says he only -- he doesn'tople unnecessary surgery, if they have a very favorable type of insurance that pays them well.

he said this openly. says that it is weighing on his ethics and consciousness. he is hearing this and struggling with it. i am saying -- i am thinking, talk to the department chair. it is so hard. i think one of the reasons why negotiated price transparency on what assurance -- insurance competencies -- companies are paying is that almost everyone speaking up on health care, all of the experts and the big panels are beholden to some giant special interest. i either work at a hospital and are beholden to the hospital, one of the three biggest lobbies in the united states, they are beholden to insurance companies. they are beholden to somebody, and you do not get the honest opinion. i know doctors who come up to me and say, i totally agree with

everything you are saying about the inappropriate care, i see it all the time, and i say why do not write something or say something. why don't you teach this to their students, and they are worried about their internal promotion. robert: are you? martin: i do not care. i am a cancer surgeon, i break bad news all the time. you only live once. you have got to speak truth. who is going to challenge the special interests. isn i met jennifer, she getting hammered by the system. people are getting crushed. americans are not seeking medical care for fear of being price gouge. if there is one thing in medicine that defines health care, it is the business model of price gouging have taken over. be at an ambulance, a lab tense -- test or however -- or whatever. people are getting gouged. one in five americans have

medical debt and collections. that is not who we are as a profession. when the polio vaccine was invented the inventor did not get a patent out on it because he said he wanted every child to get it. reportedere you have in quite dramatic detail. it is the absolute kind of worst case, nightmare scenario. and this is a local doctor, and in your hometown, in your backyard. i am wondering how the medical community, that stonewalled you when you were trying to report this, what kind of feedback did you get is the started to unfold? laura: oh my gosh. my inbox is still on fire with fromgot so many emails

that ran the gamut from people who said i cannot believe that anything like this ever happens, or i can totally see how this happens. , if i had to group the majority of responses, it would have to be from nurses. nurses, orot from north -- o.r. nurses. they say it is hard because of the power imbalance and it is hard when we see a doctor who we do not inc. should be operating, because a lot of times it is the surgeon and then the nurses and the surgeons operate by themselves. a lot of times they have a huge dilemma, and i heard from a lot of nurses who are like, we have been talking and we cannot stop talking about what we would do if we saw this, and we have had a lot of lively discussions

about how could we speak up and could we keep our jobs? who,rd from other doctors again who said this promptly a lot of discussion because of the surgeons pushing back against christopher dent they themselves had a lot of pushback at the time. go andhy do you let this why is this your problem? and other doctors policing themselves. i have heard from medical schools. robert: medical schools? got outemember this guy of residency and was operating straight out of residency. one of the big unanswered questions was how did he get out of residency? evenoday surgeon this bad finish a residency program? that question is still unanswered. a lot of residency director said how could this happen.

all walks of the medical community, i think one of the gratifying things is that i can tell you that there has been a lot of soul-searching, and i will tell you one of the most nervy -- moving stories. i do not to give any details that would reveal anything to drastically, but he had witnessed a bad surgeon, and he knew that this particular surgeon had been responsible, he thought, for patient death. and now that surgeon was at another hospital. cannot tell you how much your podcast affected me, soause this surgeon was terrible, and i knew he was terrible, and i never had the courage to say anything. in hearing these doctors who had the courage, he said that it affected me so much that i've

had to retire, because i cannot practice anymore because i am so guilt ridden. robert: let me ask you something. work for the dallas newspaper. one-off,st, it is a more or less. you tell the story once and you walk away. just at the moment when you are getting an awful lot of great tips and follow-up material that, in a different universe would be the source of many and a-up stories sustained reporting campaign to address this problem that we all agree is a huge national issue. of course it expresses itself locally as all things do. thisdo you do with all of wonderful follow-up material that you now have? other doctors, other hospitals?

laura: i have gotten tons. it would be depressing if i did not know that this was uncommon. the number of messages that i have received from people saying you really should look up -- look into this doctor. it is a lot. robert: what do you do with that? laura: in some cases it has been so bad that i contact local reporters at papers because i cannot do another six part hard cast -- podcast about another bad doctor. i have had conversations across the country with local reporters saying here is this tip from somebody, you should keep an eye on this doctor. it is hard because local papers, as you know, are struggling and do not have the manpower to do this. but i have had several conversations with local papers about doctors in their community, and i wanted to put them on their radar. follow-up.

and i do not want to do another story about another bad surgeon. i feel like that should be a job of someone locally to do it. and i had an advantage because that was local and in my backyard. it would be hard to report on one particular surgeon in cleveland, in a city that i did not live in and i did not have local contacts and i could not follow up and could not be on the ground. dilemma,t seems like a it is the thing. you do a big series and investigative project, you shake the tree and the fruit falls. and, you are not in a position to make use of the fruit. laura: no, but i have tried to pass the fruit onto people who can. robert: i think we have a question here. >> this is a question from someone on twitter who wants to know, you alluded to the fact that you are a freelancer and

taking on this project was not an easy call. how do you make freelancing work for you day-to-day? laura: that is a good question. freelancers ask that of themselves all the time. in terms of making the call to it -- podcast, freelancers have a terrible -- if you get freelancers together everyone has their horror story of work that they did that they were not paid for because they did work for some publication in the publication went out of his nest and they did not get paid -- for the business and it went out of -- went out of business and they did not get paid. declareinesses bankruptcy and reconstitute themselves and you are high and dry. theywas a new company and were asking me to commit a substantial amount of time to

do. i said, ok this is all well and good but i want to talk to your ceo and know how much money you have in the bank. robert: did you really? laura: oh yes. robert: you are a very practical person. laura: i said i want to talk to your ceo and i want you to tell me that -- how much money you have and i do not do this much work and then say that you do not exist anymore. they have gotten more successful in the past year. to their great credit, they said ok, and i talked to the ceo and found out how much money they had. and then, i signed onto the project. but, it is hard, and you have to have a mix of, i did not come up with this, but it is great advice. when you're freelancing, you want to -- and i have heard different numbers, but let us say it is the 5-1 rule.

if you are doing five stories, you want the one that you are really passionate about and the one that you enjoy and really want to do, even though you may or may not be getting enough money to live off of, and you have the four others that you are doing because your family has to eat. because your family has to eat. if you have that one that you are doing all the time that you are passionate about and you enjoy it, you diversify. you may not enjoy it. i would recommend you want to keep a variety of paying customers so that if you lose any particular one, you are not high and dry. the issue with the podcast is if i lost it, i was completely screwed. did you -- robert: did you have to negotiate movie rights? new toi was completely

the audio contract. so i did not do as much negotiating. i had no idea. i had no idea what was going into the project. i had no idea about any of this. i did not negotiate that much. it seemed reasonable to me. say that they were not out to take advantage of me. i was new to them too. when they did dirty john, they worked with christopher who was a reporter for the los angeles times. the los angeles times was paying his salary. they did not have to negotiate with an individual writer. i did not do that much negotiation. -- it isle, the doctor going to be made into a movie -- dr. death is going to be made into a movie and i don't get any of that. whent: there was an era

magazine stories were picked over by want to be producers heavily and podcasting has the next source for made-for-tv this that and the other. you had a question? abouthave been talking what journalists always do. we try to show they are part of a systemic problem. one thing that we are really bad at and it is hard enough to find those examples. it is amazing that laura found them. we are worse at writing about policy. big picture health care. this might be totally negative on my part but it feels like we may, in the next two years, be moving toward a very large

expansion of medicare, maybe. single-payer-ish. we should be writing about that. i think we really struggle. one of the reasons is it is not clear what that would mean for the quality of care. can you talk about that? would dr. death have had eight harder time killing his patients -- a harder time killing his patients if we had a single taxpayer system? >> thank you. laura: i can tell you that in this one situation, the question is how the income stream affects the care. i was conscious of the fact and i reported that in the story that one of the things that kept propelling him and enabling him to get a job was that he was a neurosurgeon. he was a neurosurgeon.

neurosurgeons make a lot of money for a hospital. one of the great quotes in there is i talked to a neurosurgeon in dallas about that. he was terrific and has been a round a long time -- around a long time. do hospitals keep hiring him even though there are all of these red flags. he said because i'm a cash cow. he just said that exactly. , i can't the question it would have stopped him sooner but i can say that a lot of the reason that he kept on practicing had to do with the fact that there was money to be made. he could bring in a lot of money. >> you've given it a lot of thought to the prescription cure.

say to answer that question? >> i would say to a group of rising journalists in health i would point you to a few health care journalists that have done a lot of work to figure out who is writing about who has newgs and ideas. i would say there are four health care journalists that have taken so much time to get to know me and our research. they have recent -- visited our research group. we have had long conversations. when i put out an idea, they will run it and test it. i think it is those deep relationships where journalists will come up with gold. again, it is on the ground groundit is -- on the work. it is building relationships.

one person i think is the expert on drug pricing. he has great ideas. there is a small group of journalists. love seeing people interested in journalism. we need more of it. what i would love to see is what we do in medicine, which we have hundreds of thousands of writers and researchers writing in a world that has like a two or three or five year lifetime and then journalism, which is very fact oriented, fact checking, get your evidence. there is editing but it is one week or one month or six month turnaround time. we are talking separately. there is a bunch of us who are trying to merge that divide. one of our struggles is the traditional editors of the medical journals. it is the internal promotions process where you get promoted

if you publish certain journals. we had a back and one of the top editors in the united states for a leading medical journal. the number two and number one in readership. watering down our peace and rewriting individual sentences. and taking out a sentence that says congress should repeal the 1987 amendment that makes policy benefit managers exempt from the sherman antitrust pack. they said we don't like to recommend legislative action and they cut it out even though it was in a commentary format. the reason i am afraid to say this with you in the public and with the cameras on is we are afraid of getting blackballed. we will find a place to publish it if the leading journals do not take it. we feel that we have to write in a certain way and that way has

not changed in 100 years. we can talk to the public. we don't have to do it in this robotic format. hardly anyone reads these things. we can write in the wall street journal. those have been some of the most effective articles where we have put out our research. i have told our team that this piece on hospital patients was going to be coming out. if the top medical journals do not take it, we will take it to the american people in the new york times and the wall street journal. thank you for doing journalism. if we had more health care journalists, we could have more accountability around 1/5 of the u.s. economy. ofre is an unlimited number sources. talk to the neurosurgeons. >> thank you. [laughter] >> let me ask. reporter for reasons.

i am interested in exploring medical issues and health care. where should i look? should i be turning? >> call one of the smartest policy minds in harvard and have lunch with him, he will say yes. these are our colleagues and they have great ideas. they have been on the ground. they know what the special interests need and want. it is not just pie in the sky. released, apart from us demanding transparency. medicare claims data saying if taxpayers pay for they deserve to see it. on sufficientta practice patterns. we can tell which dr. has a -- doctor has a practice pattern

that is extremely dated -- dangerous. we think holy crab, what do we do with this? no one has cut the data to look at individual practice patterns. brings a patient back? we have the names. what do we do with them? we need to write about that and the other 400 practice patterns. these doctors need help and accountability. let's start in a civil way. if they do not respond, maybe we talked about sending the names to the professional society and saying just so you know, who -- here are the top 10 most extreme doctors in this complication practice pattern that we see in the medicare data. we encourage you to address this with them. and create some accountability. >> i have another question from

twitter. journalism.ng about the new york times is waging a war against trump on the premise of truth. how do you qualify truth and what is the danger of defining what it is in particular situations? i, unfortunately, journalism has a great tradition. it is like medicine. an incredibly noble tradition. i know so many journalists that are so out to take trump down that they let that personal sense of patriotism they feel get into their writing. i have to be honest with you. i met with trump a few weeks ago. . met with secretary a czar i have been impressed at the responsiveness to some of these new ideas we have put out there. are thetions which pharmacy rebate. the so-called rebate. a federal rebate, it is a

kickback to the middleman. they call it a rebate because they think it is a nice thing. it is a kickback to the middleman. we explained it to them and they got it and they were on top of it. they announced no more kickbacks to middlemen. they want 100% of those rebates to go directly to the patient instead of the middlemen taking the money out of the system. we will see if it passes the legal challenges. they are listening and doing some really good stuff. there is good and bad and unfortunately, when we see some of these good announcements, i know too many health care journalists that are saying this makes trump look good so we will not cover it. i am seeing that bias. the wall street journal said the administration is going to push for total transparency of the negotiated prices that are paid at that amount from insurance companies to hospitals, totally lifting the bail on price

transparencies. cut waste, lower premiums, it got 1 wall st journal article. thank you for writing for the wall street journal. this is big news. it is gigantic. those are some things to keep in mind in health care journalism. >> do you see a difference? nora: what i see is journalist that i know, and we know a lot of journalists, no journalist that i know i don't reportould willingly anything that is wrong. like they would set out and do a story with an idea that what they were recording was not right or that their facts were wrong. the trap i can see and that i do falling intolists the trap of their own

confirmation bias. >> i wanted to ask you about that. please. laura: i see that, journalists who might think in their head i know the story. you get a tip on the story and you think this is it. therefore you find the facts and the individual facts might be true. i don't think any journalists would report facts that are incorrect if they knew it was incorrect. put the facts together and you can see the facts that support the narrative that you already believe and feed into that. and you publish your story. and you would have a story that notd be factually true but -- the individual facts might be true but the overarching truth

might not be. journalists know if realize that. i don't think most journalists would do it but i can see and i do see and i am sure we have read stories where journalists aren't constantly asking themselves what is an alternative x nation for what i'm seeing? i'm immunet saying to this. every person falls victim to their own confirmation bias. that is what i can see happening. individual facts would be true. and i don't know if a journalist would report facts that are not true. i could see things being pieced together in a way that is not true. is this a sort of pack journalism? laura: i think so. whenjournalism happens journalists might not ask the hard question.

to so muchn attempt be not be pack that you want to be edgy and report the story and you are reporting on the other side something that may not be true. i can see that. i can't see a journalist willingly reporting something that is not true. but i can see them being blinded by their own confirmation bias. questionets into dan's which is often times the difference between you, who is a policy person. but you are out doing journalistic things. you are out in the field and talking to people at health fairs. those are all journalistic techniques. but you are confident in your policy judgment. , i don't want to speak for you, but we are trained. tot is somebody else's job

come up with a solution. you did not answer dan's question which is why i would like to bring it back. are the things that we are talking about, these systemic flaws and medical error, are these baked into this system? and if we change the system to use the example dan put forward, a single-payer model, with those problems disappear? -- would those problems disappear? >> i am good at not answering questions directly. [laughter] >> single-payer is very attractive. especially right now because it cuts a lot of the middleman right out. >> they are the people you say are the problem. all of those things get eliminated instantly with a single-payer system. it is very attractive right now, especially with record levels

of waste. this is the problem with single-payer. 20 years into it, every country in the world invariably cannot resist a tightening of the belt a little more every year. you go down the road and it is a massively underfunded infrastructure. we have seen it with medicare. medicare is cut every year a little more. in the middle of the night, you pick up someone's appendix at 2:00 a.m.. to $30 -- $230. that used to be a $1000 case that gets cut every year. i don't think medicare for all is a lasting solution. it is a short-term immediate appeal. over time, let me give you a million times better alternative to medicare for all. make full price transparency,

including the negotiated prices for all shop will services totally transparent and let competition eliminate the waste. that is why i wrote the book the price we pay. i heard so many people in their as doingn say my job this is a total joke. competition, i would not need to exist. became 2018, health care the number one business in the united states. that is not something to be proud of. all not think medicare for is a real solution. andeed price transparency thanks to the wall street 's one article, they are considering total transparency of the actual negotiated prices so that you can see the real prices. not some jacked up artificial higherhat is 25 times

than what they would pay for the same service. if there is a joke going on, the joke is on the american patient jacking up a bill and having some secret. menu for you and you and you at a restaurant. there are not six menus. there is one menu. if we had that in health care, people could shop. >> can i ask a question? i wonder if people are aware of that. medicine think that operates under the normal rules of capitalism when it does not, because i have heard this .rgument this is a very popular thing. laura: i don't know if they realize it might have the illusion of capitalism but it is not really. how much awareness do you think people have of how much they pay

as a result? >> more and more thanks to health care journalists that are writing about the absurdities of a $40,000 rabies shot in stories like this. right now, the price transparency train has left the station. it has tremendous momentum. the american people love it. you'd -- who does not like transparency? there is an attempt to hijack it with this argument. people do not shop based on price. few people look at the prices. when they do, they picked the more expensive thing. that is a distracting conversation because even though only a fraction of the people ,ill use the price to shop proxies use the prices. employers who are shopping on your behalf use the prices. insurance companies are scoping

their network centers and using the prices. proxies use the prices. we are hearing an old argument from an old study that if you show somebody the price they are not paying, they pick the most extensive -- expensive thing. the average deductible in the united states is $5,000. people are starting to pay and some people look at prices and that will drive the market to change and then the proxies will drive the market to change. don't let anyone ever tell you price transparency is not going to work because people don't look at prices. if you went back to wonderfully and said i have this great story idea. price to do a podcast on transparency, would that happen? laura: it depends. you would have to find a way to that makes ity

relevant and engaging for people. there are reporters who do that. marshall allen, marshall the master at being able to tell policy stories in a way that makes them completely engaging to the people. so, i think yes. it would depend on how you tell it. how you tell the story. one reason journalists don't do it more is one, it is hard. it is hard to do this. , lessa lot of journalism and less of it is happening in local newsrooms. they don't have the resources. they don't have the time. they don't have the ability to be able to tell these stories of individual patients and how they are affected. to answer your question, i think yes. it depends on -- you would have to figure out a way to tell it in such a way that people are going to go past the first 15 minutes and not think this is boring.

>> was that a theoretical question? [laughter] >> it is not a theoretical question. the beginning, this is a much told story. there is no secret that america has a problem with the health care system, with costs and medical error. these are things that articulate brilliantlysts and medical journalists have well aired and discussed. and yet, we are still in the station and whether the train pulls out that way and goes to single-payer or it is the state board that certifies surgeons that need to be reformed, whatever. we seem to be stuck. journalist wants to change the world.

every health care policy analyst wants to change the world in a shape that they have in mind. it is curious to me why that seems to be so -- >> i can't answer that. i'm not a policy person. i don't know. i'm out there trying to tell the stories to get things to change. i am not in the business to make the changes. i don't know. it's a good question but i can't answer it. >> i am incredibly optimistic about the future of health care and it has nothing to do with the government. what we are seeing is employers fed up with the traditional way of doing business. they are doing direct contrasting desk contracting. -- contracting. we are seeing young people believe in holistic care that is good, primary care and not just overtreatment.

i am very optimistic about the future of health care. i think sometimes things have to totally shatter to start over. a lot of it is messaging. that is why i look up to journalists like laura. storytelling, good journalism all blendch needs to together. i agree. marshall allen does that well. we saw the uninsured in america, that problem got addressed rallying around one number. 44 million people. 44 million people had no health insurance. that galvanized people and the number is lower today. right now, we need to talk about the bubble. we need to talk about 24% of americans are avoiding medical care because of the fear of bills. we need to talk about changing our lexicon. most was i loved the the big short.

i loved it because it took a boring and complex subject, the financial crisis and made it understandable to an everyday person that knew nothing about that industry. that is what i try to do with the price we pay. i call it the big short for health care. all of the stop is so complicated, how do you present it in a way that is understandable? the banks were spending money they did not have. there is overcharging and there is lack of transparency in the money. the have a question in shadows that has emerged into the light. >> there are interesting things to fact check from tonight's event. i was curious about the classic journalistic problem when dealing with sources who have suffered from traumatic events. i was wondering if you could speak to that, especially with the personal medium of the voice

and what that was like in the reporting process for you? >> is a great question. laura: it is a great question and something i wrestle with. about us who write medicine, you have this dilemma andow do you talk to people you are regularly asking people you about the worst thing that has ever happened to them. how do you tell that story in a way that is respectful and does not exploit the pain that they feel. getting that balance right is extremely important. especially when i was doing a story like that, that is because what these people had been through was terrible. it was absolutely horrible what they had suffered. theirdid not want to use suffering for purposes of

entertainment. at the same time, you also had terrible a surgeon he was. if you will notice, the first episode is pretty intense. it is intense describing the details of what he did wrong and the suffering that he caused. on, there story goes is less and less of the details. about the patients after the first couple of episodes. his best friend ended up a quadriplegic. you did, i felt like not need to know the suffering of every patient after that. you did not need to know the details. that was one of my solutions. -- i agonized over how much do i say, how much do i

do? how much is enough to convey the suffering without crossing that line? the first episode, altogether, there were probably about 40,000 words over the whole script. the first episode was probably rewritten 10 or 12 times at least. it was rerecorded several times because we would go back and listen and walk that balance. i don't have a formula. i don't have an answer. i can tell you that it is something that i wrestle with and other reporters wrestle with. you don't want to exploit people 's pain. one thing i am conscious of and i try to do in my reporting and storytelling is we don't make someone the product of their pain. in other words, i always try to ask who were you before this happened? tell me about you, tell me about

your family, tell me about you as a person. i try to convey that i see you as an individual. i don't just see you as this thing that happened to you. and i try to convey that in the story. these are not props in your stories. they are human beings. the janet not doing malcolm think of seducing the --rce and getting them to laura: no. >> make them cry. laura: there are details that i leave out. and sometimes they are very compelling details. sometimes it feels too invasive. details about his relationship with his children. things that we had on tape about his own personal life details we did left out because not want to invade his

relationship with his children because it is not their fault. they are not the story. they are not what happened. something that we always have to be conscious of. it is something i have to be conscious of. i am not alone in that. it is a good question. that is something that as a journalist you go through your whole life. >> i have a question in the shadows from ivan, the cofounder of refraction watch at new york university. [laughter] >> called in the big guns. try, ifss it is ok if i you don't mind, to maybe get back to this question that i think you have asked twice. i will ask a third time and maybe i will ask it slightly differently like journalists do you mentioned the big short, i love the big short. what got me about the big short is at the very end, a lot of

people ask about this and don't remember it, there is a postscript and an epilogue at the top of the screen in text. i don't remember if it was bloomberg or reuters, they called them something different. it was almost 10 years later after the crash. everyone who graduated after 2010 will know this story. who washe sharpies hired at reuters came and wanted to do a story in class. it was about the fact that all of the evidence says the best way to treat heroin addictions among prisoners, they come into prison and they are addicted -- it could be any opioid -- is to

give them heroin. the evidence is pretty clear. it is not like there are thousands of studies but nobody debates that. he said i'm going to call the warden and say why on earth are you not giving heroin to prisoners? i said that is awesome, you should do that. but here is what you should also do. you should call the guy who is running against the legislator who was running on a platform of don't give heroin to prisoners and the guy running against him saying it is a good idea because the evidence says so. isant you to figure out who going to win that election. what we are up against is we do the great journalism. we write the great books. we hear the policy stories over and over.

and yet, actually translating -- actuallyes to translating evidence remains, as far as i'm concerned, one of the stubborn problems of journalism, of legislation, of worlds. how do we do that? to give a 10g you second version but how do we do that? we have known about this for a long time. what do we do? is that a question, sir? [laughter] >> what do you do? megaphone.ig you know what i mean. of a bigcommand voicebox. >> and i am not claiming that this is an evidenced taste way of going about it.

when laura was talking about all of these stories that you are now being told and people are emailing you and what have you, that is my life. farefraction watch, we hear more stories than we could ever do. even at our height, we could not do a fraction of them. i believe that is important to tell the stories of the vulnerable. tell the stories of the misconduct and the bad surgeon. i think that is important because what happens then is what you did which is that you call it the -- call the attention to a local reporter. we like to break the story and then i call someone at the local. sometimes they pick it up, sometimes they don't. i am happy when they give us

credit for stories. we all have our incentives. i think you have to do that. you also do have to do what you both do. is to connect those stories to the actual policy. marsha is one of them. i think we have to do that. that is what i am trying to do. i don't claim that that is a solution. quick answer, we have some questions behind you. >> not a quick one. >> he was one of the people i was referring to when i said we are try to bridge medical journals and journalism together. that is what other outlets are doing. unfortunately, we have become intoxicated with a false lexicon.

is evidence in a pyramid. guess what, you don't need a randomized controlled trial to prove a parachute works. we can learn more from outliers then we can from giant trials that are in the same ethnic or gender group. with brainpatient cancer that was a longtime survivor at johns hopkins. it turns out they had an infection. maybe it stimulated the immune system. we can learn more from that one patient. i think we use a false lexicon sometimes. -- you will be back at the ending of the big short. thee are stories like horrible messaging around hormone replacement therapy making inappropriate conclusions from a study that never made those conclusions. 90% of doctors will say it causes cancer even though it

does not. the studies in the new england journal of medicine misrepresented what is in the media. the doctors believe it. that is a giant thing that needs to be overturned and a good health care journalist can do that. that is one of the things that has high impact. have another question. >> i had a question about the media and television and how good of a job you think media producers for shows like grey's anatomy, how good of a job do they do in portraying these health issues? >> great question. >> after i wrote a book, i got a call saying they wanted to turn it into a tv series called the resident. .t is now in season two i

it is doing well in its ratings. it has done a good job of bringing certain issues to the general public. some of it is sensationalized. some of it is hollywood and a soap opera. some of it, because it is not accurate, they are delivering messages. it is about the good and the bad aboutseason three is medical billing. and predatory billing. overtreatment is in season one. we need to use every avenue out there. when obama went on the lake and asked-- late show and was why are you on the late show, he said some people will only get their information on avenues like this. we are running to the end. do you have a thought you would

like to add? just about how the fiction industry is doing highlighting this issues. laura: i really don't know. my daughter watches grey's anatomy. she might be able to. i have not really watched the shows. i can't speak on that at all. i think we have time for one more question. aboutid find an article transparency, not in the wall street journal. it was in nyt. if youarticle, it said are the only hospital in town, does it matter because the prices can be transparent but it is the only one. his transparency the only solution to this problem? only transparency the solution to this problem? >> we can call out gouging.

it is inconsistent with a hospital's nonprofit tax status. we have been calling hospital ceos that are engaging in degrees price gouging and saying we know exactly what is happening. .his is 1/10 the price for who we are as a profession. we are trying to create some accountability around this. as a journalist, how do you feel about transparency? [laughter] laura: i'm in favor of it. >> i'm in favor of it too. i think that we sadly have come to the end of this conversation although we still have an awful lot to talk about. beenwo of you have addressing something that has

been plaguing us for more than a generation and have given us something to think about and hope that there are solutions out there. both in ways to cover it and ways to fix it. for that, i think you both. [applause] >> tonight on c-span, a columbia university form on immigration policy, including dr. irwin, a pediatrics professor who met with immigrant parents separated from their children. here is a preview. for was at an ice facility women and men in el paso last september. i spoke to 42 women. almost all of them mothers. and almost none of them had seen their children in weeks. they had no idea when they would see their children. where they were.

they were limited to short phone calls, some with older children and some with their spouses. and i said to them, i had this recorded on my spy pad. i said would any of you, they are all in this group, would any of you not come to america if you knew that the consequences were going to be separation with their children, everyone of them said they would still have come. i asked them if their neighbors and friends would come here knowing they were going what you are going through. and every one of them said no. they would not have been deterred by these crazy policies. this horrible situation of a cruel policy that does not the president and stephen miller and jeff sessions wanted to. >> you can watch this form on

immigration policy and how to protect immigrant children at 8:00 p.m. eastern time on c-span , c-span.org and the c-span radio app. >> everybody ready. 1, 2, 3, go. annualay is the one 41st -- 141st annual white house easter. back.s a look blows]e

[laughter] >> i woke up before dawn this morning and when i got out, i saw the easter bunnies out here walking around. plotting their strategies for the day and getting ready. , [whistle blows]

♪ >> everybody ready?

[whistle blows] ♪ [indiscernible]

[cheers] on the whistle. [whistle blows]

♪ >> everybody ready? ready, set, go, ok? [whistle blows]

>> thank you, everybody. >> ready? nice to meet you. >> thank you.

>> watch this year's white house easter egg role monday morning on c-span. journalists from who were finalists for the annual goldsmith prize for investigative reporting. they broke stories on please corruption, -- police corruption, migrant family president trump's former attorney, michael cohen. nicco: good afternoon, ladies and gentlemen. i am the director of the shorenstein center here at the harvard kennedy school. it is my delight to welcome you all. it is great to see such a crowded room, to recognize these heroes of american journalism. we are here to celebrate the goldsmith awards for investigative journalism. i have with me here on the stage each of the finalists. we will have a discussion with them today about investigative reporting, aboow