Joseph A. Ladapo, MD, PhD, is a physician and health policy researcher whose primary research interests include assessing the cost-effectiveness of diagnostic technologies and reducing the population burden of cardiovascular disease. He is Associate Professor-in-Residence at the David Geffen School of Medicine and cares for hospitalized patients. Previously, he served as a faculty member in the Department of Population Health at NYU School of Medicine and as a Staff Fellow at the Food and Drug Administration.
Dr. Ladapo’s research program, funded by the NHLBI, NIMHD, and the Robert Wood Johnson Foundation, focuses on (1) patient-centered approaches to improving the health of individuals evaluated for coronary artery disease, and (2) behavioral economic interventions to promote sustainable cardiovascular health, including among adults with HIV. He also leads the health economic and quality of life evaluation of multiple NIH-funded randomized trials focused on cardiovascular disease and tobacco cessation. His national honors include the Daniel Ford Award for health services and outcomes research, and he was also a regular columnist for the Harvard Focus during medical school and residency, where he discussed his experiences on the medical wards and perspectives on health policy issues.
Dr. Ladapo graduated from Wake Forest University and received his MD from Harvard Medical School and his PhD in Health Policy from Harvard Graduate School of Arts and Sciences. He completed his clinical training in internal medicine at the Beth Israel Deaconess Medical Center.
- Joseph Ladapo, MDAssociate Professor-in-Residence at the David Geffen School of Medicine
Welcome to policy, Emma. A data focused conversation on tradeoffs.
I’m Kalev Core Value from the Saban Center for Policy at the University of Texas at Austin.
All right. So it’s a pleasure to have with us today dr. Joseph LaRocco from UCLA, professor
of medicine and also health policy. Thanks for joining me. And I
think I want to start like I’m asking a lot of our guests to go back to March
to the beginning of and perhaps even March. These were really happening on your end, given that you are in the house to see
bases and so on. But for a lot of us, that’s when we started really thinking hard about, okay, this is serious.
What do we need to do here? And and one of the first things I read from from from you
was already really facing very clearly the tradeoffs that we’re we’re facing
that point in time and put it in a way that I didn’t see coming from from
a lot of health officials in particular at that point. So I try to go back there. And that was where you think.
What was your sort of what what evidence you’re looking at, where the models are looking at and how you react to that point in time?
Yeah. Yeah. Well, thank you for that. And then in terms
of what I was thinking, what models, I think the big model at that
time that most people were citing versus the one out of out of England,
I forget the name the group right now. College. Yeah, exactly. Exactly. Yeah. And
you know, they did. I completely commend the job that they did. They got some things
wrong, which is like, you know, but it was still useful and it
was important to do something to give us some place to start. So
so that model did some things that were pretty dire based on the data
that they were using. And now we know that they overestimated mortality,
for example, they overestimated disease morbidity, which is totally
fine. You know, we know more now than we did then. And and
using that information, it painted a pretty dire picture,
but it’s really important to think about. About what we
are doing. You know why we’re doing it and where we’re headed with what we’re doing. And,
you know, I spend a lot I spend a lot of time, obviously, I spend a lot of time taking care of patients.
And I spent I fortunately have a background, a quantitative background, and
and took some extra years in med school to get a p._h._d. You know, in health
policy and mostly economics and statistics and decision analysis. So that
that was that was very helpful for me in sort of thinking through the problem and thinking.
And it also helped me, I think, think about the tradeoffs. So kind of
altogether, that’s what led me to my suggestion. And it was really clear that
our leaders had no idea what they were doing. I mean, if you remember, it’s kind of been almost
laughable. Like it was first, you know, groups no more than like hundred
and fifty then and this and that. And it’s just like when people are changing their
minds like that, they really. They don’t know what they
don’t know what they’re doing. Ultimate. That’s the bottom line. Which is fine. You know there was a certain
point in time. Yeah there was, there was. But I would say that
despite the challenge of the circumstances, there was a lot of information, too. We had a lot of
information from from China. And we also knew what the consequences of shutdowns would
be. I mean, you don’t need to talk to my three little wonderful boys and I
can talk to my oldest six. And and you can you can think through what the consequences
of, you know, school and, you know, and people not being able to work.
And so fear and hysteria and all that, all that that
can produce could be it’s not complicated concepts. And we don’t need to know anything about Cova
to be able to to be able to think about the consequences of some of our decisions.
So so so I you know, clearly it was it was difficult, clearly for a lot of people
to sort of see through and see through sort of the fog and the
haze and all that was happening. But it was still very clear what was
likely to happen with our decisions. So and so.
So that’s sort of what led me to write. So you I think that the main point
you were making that at that point in time was to say keep you walking down short, to give us time to prepare.
Our health capacity is going to come. And there’s too much already. Communities spread for us to stop
this. So I’ve seen this mercury. Right. With signs.
And what should be short looked down to perhaps even some time. But don’t make it short
so that people can have their lives back because otherwise I don’t you know, what’s the point? You know, we’re
where we’re heading and we live to live. That’s why we live. We don’t live to, you know,
to be fearful. And, you know, and not educate our kids and not be able
to pursue the things in life we want, which is not to say that
people shouldn’t be fearful or shouldn’t take whatever precautions they want.
It’s more just to say that that shouldn’t be forced on everyone. And so what was what was the
reaction of your colleagues, where your colleagues are? They have a similar reaction to the situation.
Is you or because I think unfortunately, those voices to me, at least my perception
those voices were somehow not as large as the voices
say stay at home, don’t dare to go out as long as it takes. Oh, man. Yeah, no question.
And that itself should give people pause. You know, over policy issues. I mean, over moral issues.
Are you my kids in background over moral issues? Now, we know there’s every reason to believe that,
you know, we can have uniform beliefs as a society. But over policy issues, it’s
usually not such a good idea. Everyone is saying the same thing and not really
allowing dissent. And there was definitely an atmosphere that was pushing
out dissent or at least was more hostile to it.
And and in my my
perspectives and my wife and I, we’re like on the same page. We’ve been on the same page the whole time.
And in general, my colleagues have not received it
particularly favorably. And that’s fine. You know,
although I struggle even then and I’m one of the things I do and I had
vias, other people that I work with to do is to really try and understand the opinions of other people
like you understand what I’m trying to very well understand what
I think is as the voice, what what
other people thought and why. And I think I understood why.
I struggle because it really should just just it was very obvious to me why? Because if basically
it meant, you know, their goal was to like to take a page
just to stop. KOVEN You know, that was their goal. Yes, that it won’t.
Well, that’s the thing. I think the the cost heart wasn’t really internalized.
It was just a psychopath, NASCAR. And and we’re seeing
that the costs have been have been more
than my mind can fathom. We hear the numbers about about unemployment
and we hear the numbers about higher rates of anxiety and depression. We
don’t see, you know, what’s happening with kids in particular
there. It’s ironic because they suffer they suffer the least from the disease. But there’s definitely
suffering the most from from what we’ve done about the disease, our response
and the loss of structure. And we’re really lucky. I personally know our kids.
We’ve been very careful not to sort of fill them with fear about the virus and things like that.
And they’ve been fine. They haven’t been getting a lot of great school education. We do what we can at home.
But, you know, a lot of a lot of children are undoubtedly suffering
greatly from the loss of the social connections and from the education. They don’t have a home just as as
as as good as ours home, really fortunate as ours in terms of, you know, access to things and so on.
Right. So you can see in some situations, student having a much harder time. And our kids are.
Yeah, yeah, yeah. Yeah. Not to mention all the young people who’ve lost an employment.
I think, you know, older people have sought savings in more and more
more of a nest to sort of, you know, be able to weather out the shutdowns and
probably have done better. But you know, they’ve suffered also from the social isolation.
But it’s it’s been it’s been quite costly. And and I think if we had
you know, it’s not that I want it. It’s obviously we
want to do as much as we can to prevent people from dying.
But we just we’ve really gone about it. A very fair, few fueled wait.
That just hasn’t served us. And it’s still here and we’ll continue
to be here. So let’s forward now then like to to to where we are. And
we learned a lot more about the disease. We’re all wrong in the sense of how how severe right
in mortality disease is. And thankfully, it’s not as bad as we thought.
And we are at a stage now where we have, at least in the US, a number different states opening up, people getting back slowly
to their lives and and in very stages across. That’s true for other countries as well.
Where do you see the state is moving forward now? What’s your sort of expectation of how this is going
to unfold? Yeah, I think that quite a lot. And, you know, with
this with the with the terrible killing of
George Floyd, that’s I think that’s also changed the dynamics because we’ve basically
gone from this environment where at least in some states, like in California,
there was tremendous sort of restrictions.
There’ve been tremendous restrictions from the governor in Los Angeles, from the mayor in
L.A. County on people’s activities and gathering all this stuff.
And to the protests of alone that opened a completely
blown out. And and it is a political component. You know, there are people
who tried to protest the shutdowns and they only were criticized on these protests are much larger.
And and and they are not they don’t face the
same criticism and they shouldn’t face the same criticism. In fact,
none of the protests should have faced criticism. Right. It’s people absolutely have a God
given right to express their opinions.
And and where they could get away with restrictions, they’ve gotten
away with them. And these protests have just blown that open. And they can’t. It makes it
much harder to get away with restrictions. So so so I think
what we’re what we’re going to see is is like this continued
shift of power from leadership back to the people, which is
great. And and so. And so
I mean, so I think in the public space that’s there are a lot of social advantages.
Is that because people need other people? That’s that’s that’s
how we work. That’s how we thrive. That’s how we find happiness. So. So that
part is good in terms of policy restrictions on workplaces
and, you know, gyms and, you know, whatever other locations, schools.
I think that, in fact, this again, this this is
the how things are transitioning with the protests,
with a lot of people just having a lot of fatigue from the shut downs and the restrictions.
You know, I think that there may be some room to see more kids back in school,
even in a place like L.A. that’s tried to be, you know, sort of on the
on the on the extreme off of really trying to cool things down and control things.
So I guess. Yeah. So those are my main. So. So then that’s the good side, I suppose, off
of. But how about the disease? Let’s. Now, given that what we learn and what
has been your experience, I guess lately in the house was, oh, wait, how are things progressing? Are you guys preparing
for a big wave or do you think it’s going to come or. Or what is the evidence you’re looking out to to
prepare for that? Yeah. Great. That’s a great question. I mean, I think the cream pieces
are going to keep increasing. And, you know, there
are already a lot of preparation has happened in our hospital and other hospitals for capacity.
So so that’s good. We also know even more now. So
we know the people who are really, really at risk. And that really points to people living in
nursing homes and skilled nursing facilities. And by the way, that doesn’t mean that they should not be
able to see other people. I think it just means that we need to think harder about how to
live with this. So maybe we need more frequent testing among their family members to visit them
or maybe, you know, the visits should happen outside or other changes should be made. But we
know a lot more. And in terms of a surge, I would be very
surprised to see that outside of New York City. Very, very surprised. The reason is
because we know so much now and people are voluntarily, voluntarily
doing stuff to reduce their risk like people are doing them. So I think
it’s unlikely that that we’ll see a surge. I imagine
I expect that pieces will continue to increase. There’s no escaping
that. Right. So, yeah, I don’t think so. You know, short of. I don’t think
so. I certainly pray we get really lucky and it disappears,
but I don’t think so. I think this is it’s here to stay at least for a while. Even after a
vaccine comes sales at its effect, it will continue to
be here. And just to close it up, as I know you’re short on time.
Have you seen improvements in the way you guys are able to treat patients? Is that something that we’re
learning as we go and we’re getting better at it or unfortunately, something that really
it is what it is and there’s not much we can do? Yeah, I think there have been improvements.
You know, there’s we’ve learned about crowning a patient’s position and them to improve their
respiration, to model, to cheer about the laying intubation. So
and some patients tolerating low levels of oxygen better than previously thought.
And, you know, and we’ve had some some favorable reports
in terms of drug efficacy for treatment. So that’s all pointing in the right
direction. And and and I would not be surprised
if we see even more another favorable agent. They’re just an unbelievable
number of clinical trials ongoing right now. So, you know, I I would
expect that we will find at least one or two more like robust.
Effective treatments for the condition, which would be great. That’s fantastic.
That’s so good and good, good, good high note to to to end this. Thank you for all that you’re
doing on the right as a day, I think are very, very helpful for me to read and I think to help people
understand different ways to think of this problem. And especially as people try to evaluate public policy like I do
and like my students in the class that I teach. And that’s always very important for us to focus on tradeoffs.
And you were you were there from the very beginning. So so thank you for that. All right. Thanks.
Thanks for. Thanks for listening to Policy McCombs.