Forty percent of the time, oncology care is not being delivered in concordance with guidelines. FORTY PERCENT!

As our guest today explains, that’s not because of bad doctors. It’s because oncology care changes rapidly and because almost eighty percent of patients are being seen by a community oncologist, a physician who is responsible for treating ALL types of cancer, instead of a specialist. How can we address that? Well, as Dr. Yousuf Zafar explains, there are really three options.

1. The patient travels to an NCI Cancer Center to seek a second opinion. This is obviously expensive and inconvenient and out of scope for many patients.
2. The patient’s provider calls another oncologist in their network consult on the case. These relationships are critical but not universal.
3. We can formalize this provider-to-provider framework and have it paid for by a patient’s employer. This is the basis for AccessHope.

Today’s guest is a practicing oncologist and adjunct professor at Duke University, and chief medical officer at AccessHope, where he focuses on expanding access to expert cancer care for patients treated outside of academic centers. While National Cancer Institute Designated Comprehensive Cancer Centers deliver superior outcomes, they treat only 20 percent of cancer patients. Dr. Zafar is working to extend that expertise to the remaining 80 percent.

It’s rare that an article title alone makes me want to stop what I’m doing and read it, but that’s what happened when I saw the title of Jess Craig’s recent article, “Why More Doctors are Billing Their Patients Like it’s the 1920’s.”

In this article, and subsequently, our conversation here on the podcast, Jess explains what she means, citing the growing number of physician practices organized around the concept of direct pay. That is, the practice or physician determines a set cash price for their services and the patient pays that price out of pocket. This model may seem like we’re going backwards, to a time when health insurance didn’t exist, but in fact, it’s starting to be seen as one of the most progressive ways of managing rapidly inflating costs and concern about quality. While there are still questions around accessibility, as Jess points out, it may be one of the first advances we’ve seen in over a decade that could actually move the needle.

Jess Craig is a health reporter for Straight Arrow News (SAN). Prior to joining SAN, Jess worked as an infectious disease epidemiologist and health security technical advisor for international research institutes and US government agencies, including the CDC, USDA, and USAID. Jess worked as a freelance journalist for eight years, covering science, health, and world news for various outlets. She also served as a reporting fellow for NPR in 2020 and for Vox in 2024.

With the recent explosion of GLP-1 drugs, the war on obesity seems to have taken a new and potent turn, but many are concerned about the recidivism, the side effects, and our reenergized obsession with being thin.

Our guest today, Dr. Laure DeMattia, is a board certified family medicine physician and obesity specialist. For her, obesity is personal, as she has struggled her entire life with this chronic condition. In this episode, Dr. DeMattia breaks down for us how GLP-1 drugs work to hyperdrive weight loss, why that loss is rarely sustainable without long term use of the drugs, and her own philosophy outside of medication that helps her patients feel seen, heard, and safe. It’s both an educational conversation and a behind-the-curtains look at the obesity epidemic from someone on the front lines.

Dr. Laure DeMattia helps women stop blaming themselves for their physiology and find lasting health for over 20 years. Her dual perspective as both a doctor and a patient makes her uniquely compassionate, challenging the myth that willpower is the solution. Author of the book, The 4 Food Cues, Dr. DeMattia hosts her own YouTube channel, Navigating Obesity with Dr. D, where she offers a compassionate, realistic viewpoint about weight and weight loss.