First Opinion Podcast

Since the early days of the pandemic, long Covid has haunted us: Even a mild acute infection might leave you with life-altering consequences. While research suggests long Covid rates are falling, it still affects millions. But what if long Covid isn't the right way to think about what those people are going through? This week, Torie spoke with Steven Phillips and Michelle A. Williams, authors of a recent First Opinion essay titled, “Long Covid is a new name for an old syndrome.” They discuss the history of post-infectious disease syndrome, what rethinking long Covid might mean for research, and the ways the health care system fails chronically ill patients.

After physically debilitating cancer treatment, Laurie Brunner encountered another medical hurdle: She had developed lymphedema that required surgery, but her BMI was over the cutoff. To receive the necessary treatment, she would have to lose weight. I spoke with Laurie and her physician Jody Dushay about how the ongoing shortages of GLP-1 medications are creating logistical and medical problems. Our conversation was based on Jody's recent First Opinion essay, “How the Wegovy shortage is making life impossible for my patients — and for me.”

We're popping into your feed on a Sunday because we wanted to share an episode of The Nocturnists: Post-Roe America. You may have already heard the First Opinion Podcast interview with Ali Block, an abortion provider and executive producer of The Nocturnists, and Nikki Zite, an OB/GYN in Tennessee. (If you haven't listened yet, please do!) On this episode of The Nocturnists, you'll hear more from Nikki, Ali, and other doctors trying to navigate reproductive health landscape after the end of Roe.

Physicians Alison Block and Nikki Zite knew what they were getting into when they became abortion providers early in their medical training. Family planning has long been a politicized, divisive area of medicine. And even though they knew that Roe v. Wade — the 1973 Supreme Court case that protected abortion access across the country — was being threatened, it still hit them hard when that ruling was actually overturned in June 2022.

From our colleagues at Globe Opinion comes a new podcast: Say More. Say More, hosted by Globe columnist Shirley Leung, is all about exploring our backyard for the cultural trends, scientific discoveries, and breakthrough startups that are shaping the nation.

Stephanie W. Edmonds and Ginny L. Ryan are both doctors. Edmonds, a registered nurse, has a Ph.D., while Ryan is a traditional M.D. But as part of a fight over “scope creep” in health care, many medical doctors might bristle at the idea of calling Edmonds “doctor.” In the last episode of the season, Edmonds and Ryan speak about the health care hierarchy, why calling health care workers by their first names might help patients, the tendency for physicians to mock "noctors," and much more.

"You can't pour from an empty cup" is what registered nurse Tara Rynders learned the hard way after two decades of work and one heartbreaking, life-threatening experience of being a critical care patient herself. Before that experience, she'd always found found that dance, play, and other types of movement helped her express and heal from the trauma she encountered and held in her body every day. After recovering from her experience as a patient, she brought that to several other nurses in a workshop.

Duchenne muscular dystrophy is a devastating disease and, until very recently, was one without much hope. When Hawken Miller was diagnosed at age 5, the physician told his parents to enjoy the time they had with him, as there wouldn't be much. Over 20 years later, Miller is a journalist and content strategist for CureDuchenne, an organization started by his mother when he was diagnosed, and new treatment is on the horizon. Last month, the FDA approved a new gene therapy from Sarepta Therapeutics that will provide hope for many patients and families. The new drug, however, has its limitations — it's only approved for children age 4-5, for example. Miller joined the podcast to discuss how this drug may change lives, what more needs to happen, and what his personal experience has been living with Duchenne.

Physician and professor Jason Karlawish argues that new promising drugs like lecanemab, an anti-amyloid antibody expected to be approved by the FDA July 6, will introduce complicated issues into the field of Alzheimer's care. These medications require a great deal of testing and patient monitoring, trained physicians, and other resources in a system that is already stretched thin.

Drug shortages are a growing problem in the U.S., and a shortage of live-saving cancer drugs has reached crisis levels. Oncologist Kristen Rice explains that drug shortages have been happening for several years but have been getting progressively worse in the last few months. Oncologists are facing critical shortages of common, generic cancer medications and have even begun to ration care for certain patients who are able to delay treatment, according to Rice.

Under the Affordable Care Act, health insurers are required to cover all costs associated with preventive care — including PrEP, or pre-exposure prophylactic treatment for HIV. But now all preventive care coverage is under threat, thanks to a lawsuit filed by employers who believe they shouldn't be required to pay for care that violates their religious beliefs. While coverage for PrEP access largely unchanged as the court case makes its way through the legal system, Richard Hughes IV, a partner with the law firm Epstein Becker Green, says that protecting the status quo isn't enough.

Just days after the end of Roe v. Wade, Caitlin Bernard, an OB/GYN in Indiana, told the Indianapolis Star a heartbreaking story: She had recently been asked to perform an abortion on a 10-year-old Ohio girl who had been raped. In late May, the Indiana Medical Licensing Board held a hearing on Bernard. While they did not revoke her license, they fined Bernard $3,000 and issued a letter of reprimand, saying that by speaking out, she had violated the 10-year-old girl's privacy. This week, Gabriel Bosslet and Tracey Wilkinson, who are both friends and colleagues of Bernard, talk about her story, its lessons for physicians, and why advocacy is a professional responsibility.

When a loved one is living with serious substance use disorder and refuses to get help, sometimes it seems like the only solution is to force them into it. In many states, people can be “arrescued” — that is, forced under penalty of law into a treatment program that is nearly identical to being incarcerated, down to orange jumpsuits. But Sarah Wakeman, an addiction medicine physician, says that while she understands the love that makes people see involuntary treatment as a solution, it doesn't actually work.

The high cost of cancer treatment in the U.S. is literally killing people. “Over a quarter of cancer patients delay medical care, go without care, or make changes in their cancer treatment because of cost,” Ezekiel J. Emanuel, an oncologist and co-director of the Health Care Transformation Institute at the University of Pennsylvania, wrote in a recent First Opinion essay. But Emanuel says there's a solution: Cancer patients shouldn't have to pay any out-of-pocket costs for their treatment, especially in the first (and typically most expensive) year after diagnosis.

We've all had the experience of a clinician staring at screen while asking us sensitive questions to fill out our electronic health records. But that frustrating experience is made even worse by a new trend in health care. As Sanjay Basu wrote in a recent First Opinion, hospitals are using so-called "screen and refer" systems to identify people with social needs, like those who are experiencing domestic violence or hunger. The idea is that workers ask patients about their needs, then refer them to organizations such as food banks that can help. But according to Basu, a primary care provider, these well-intended efforts are instead dehumanizing and ineffective for patients, and burdensome for the organizations buried by referrals.

As an oncologist, Jennifer Lycette gets to know her patients particularly well. She's doubtful that artificial intelligence could replace that personal connection, but new research based on, of all things, Reddit Q&As, says otherwise. New study findings raised questions about the potential for using chatbots, like ChatGPT, to help physicians answer questions submitted from patients through electronic medical records — a task that can take hours of stolen, rushed time between appointments at the clinic.

Alex Rosenblat is particularly careful when it comes to her digital privacy. She requests to fill out paper forms instead of digital ones; she documents and tracks what she signs. But even her diligence can't always save her. Rosenblat recently spent months retracing her digital steps after Phreesia, a company that collects demographic information, claimed to have her authorization to share her data — authorization she knew she hadn't consented to. This week, Rosenblat talks to host and editor Torie Bosch about tracking down her own information and the amorphous harm caused by invasions of privacy.

In training to become a physician, medical residency can be a grueling period. Now, medical residents across the country have begun fighting to unionize their ranks. In Boston, residents at Massachusetts General Brigham — a major medical system — recently garnered enough votes to file for a union election. In her first episode as host of the "First Opinion Podcast," editor Torie Bosch speaks to two MGB residents, Minali Nigam and David Bernstein, with differing opinions on the best next step forward for their cohort.

After two years as host of the First Opinion Podcast and many more as the founding editor of STAT's expansive, authoritative First Opinion platform, Pat Skerrett put down his editing pen and microphone to start a new chapter: retirement. But before he left, he sat down with Torie Bosch, who has just joined STAT as our new First Opinion editor.  They chatted about hopes for the section, editorial pet peeves, and the vampire bats of Costa Rica.

When Ken Duckworth was a child, his family didn't talk about mental health, especially not his father's bipolar disorder. It was an untouchable topic, but Duckworth knew his father shouldn't be seen as a lost cause. Instead, his father and others like him might actually have critical expertise on how to navigate the world with mental illness — expertise they gained not through books and studying but through lived experience.

In a special event as part of STAT's Open Doors initiative, the "First Opinion Podcast" was recorded live this week in front of an audience with returning guest Jay Baruch. Not long after being a guest on the first episode of the "First Opinion Podcast" in February 2021 on the many stories he's written for STAT in his time working as an emergency room physician, Baruch penned a letter to his boss spelling out his intention to leave medicine behind. But the simple act of writing the letter transformed his understanding of his work and hooked him back in.

The idea that the narrowing gap between Covid-19 deaths among white Americans and Americans of color represents a racial equity success story is being bandied about. Not so fast, says Nathan T. Chomilo, a pediatrician and internist at the University of Minnesota Medical School. This conversation emerged from the First Opinion essay "Covid-19 is an inverse equity story, not a racial equity success story" that was written by Marina Del Rio, Chomilo, and Neil A. Lewis, Jr.

As states begin to receive money from the multitude of lawsuits and settlements the opioid makers and distributors have agreed to pay, the number of overdose deaths in the country continue to increase, reaching an all-time high in 2021. Researcher Linda Richter worries that not enough of the settlement funds, upward of $22 billion, are going toward early-stage prevention measures.

Terry Wilcox's grandmother lived in an isolated house at the top of a hill overlooking the magical mountains and valleys of the Ozarks until, as she tells it, "the day we literally had to drag her off of it." Home health care services have helped keep Wilcox's family healthy and safe — and reduce her stress — but they aren't equally accessible to everybody. Wilcox, a co-founder and CEO of the nonprofit advocacy group Patients Rising, discusses how that uneven ground is now being further threatened by Medicare's proposal for deep cuts and clawbacks to payments made during the pandemic for home health care.

After years of deliberation, the FDA recently announced a new set of rules it proposes to regulate claims on food packaging that a product is "healthy." The most basic rule: the product must actually contain food, not just ingredients. This may seem intuitive, but as professor and nutrition policy expert Marion Nestle points out, the food industry works hard to sell their products. This week, Nestle explains the purported intentions behind the confusing food labels, and how it all got so complicated in the first place.

It took the U.S. Supreme Court just seven days last June to set back public health by 50 years. Several cases before the court this term could continue that assault. This week, law professor Lawrence O. Gostin explores how these cases — some of which are not explicitly about public health — might worsen the myriad health inequalities that became so evident throughout the Covid-19 pandemic.

Modern wheelchairs with standing technology have amazing capabilities that can be game-changing for wheelchair users looking to take care of themselves independently whenever they can. This week, two wheelchair users, Paul Amadeus Lane and Jim Meade, talk about how shortsighted it is that Medicare — the primary health insurer for older adults as well as for many people with spinal cord injuries, muscular dystrophy, ALS, and other long-term disabilities — doesn't cover the cost of wheelchairs equipped with these technologies because they aren't "primarily medical in nature."

The Supreme Court's decision to overturn Roe v. Wade opened the door to allow states to ban or severely restrict abortion. But as biotech CEO Aoife Brennan and her colleagues are coming to realize, it will also affect how — and perhaps where — clinical trials are conducted. This week on the "First Opinion Podcast," Brennan, of Synlogic, talks about how the Supreme Court's ruling is forcing people involved in clinical research to rethink something as simple as pregnancy tests, which had once been taken for granted, and plan for the possibility that research sponsors and study sites will be required to share pregnancy and outcome data with state officials.

Polio has exploded back into Americans' consciousness after being out of the spotlight in the U.S. for half a century or so: In late summer, it paralyzed an adult in New York state, and the poliovirus has been detected in New York City's wastewater. This week on the "First Opinion Podcast," doctors Sallie Permar and Jay Varma make the case that pediatricians are the frontline for fending off this "old foe," but they need help.

Christopher Hartnick never expected his work as a doctor to intersect with political discussions about abortion and the right of pregnant people to make choices about their own bodies. Yet as a pediatric ear, nose, and throat physician who specializes in treating babies and children who have difficulty breathing, he's had up-close looks at how prospective parents make life-or-death decisions over the course of a pregnancy. This week, Hartnick discusses a risky procedure performed at birth for which parents must choose, at multiple stages, whether to prioritize the mother's life or the child's.

During his long career as a pediatric oncologist and cancer researcher, William Woods thought highly of the FDA's work evaluating and approving new cancer drugs. But his opinion of the agency changed when he was diagnosed with amyotrophic lateral sclerosis, or ALS, a progressive disease that damages nerves in the brain and spinal cord. This week on the "First Opinion Podcast," Woods talks about living with ALS, and watching what he sees as the glacial pace of approving an experimental ALS drug called AMX0035.

The number of children who become orphans because of Covid-19 rises each week: over 10.5 million children around the world have lost a parent or other caregiver living in the home, a staggering and heart-breaking figure. For comparison, it took 10 years years to create as many orphans as Covid-19 created in just two years.  Seth Flaxman and Susan Hillis have been tracking this grim statistic as part of their work with Global Reference Group on Children Affected by Covid-19. These losses can reverberate for years. This week, Flaxman and Hillis discuss the trials of children who have lost parents during the pandemic, and what can be done to help keep them safe and healthy.

For two decades, nurses have been considered the most trustworthy professionals in the country, above physicians. Yet the rigid hierarchy within hospitals and health systems places physicians at the top, creating a fraught power dynamic and a double standard when it comes to discipline. This week, nurses and educators Michelle Collins and Cherie Burke discuss this double standard as it relates to the recent cases of a former nurse and another former physician.

When Covid-19 began tearing across the U.S. in March 2020, Alex Goldstein started posting on Twitter the pictures and stories of people who had died from the disease.  Over two years later, as the U.S. marks the grim milestone of 1 million people dead from Covid-19, Goldstein is still at it. The account, @FacesOfCovid, has now memorialized more than 7,000 people.

Sickness can beget debt, which can then turn around and beget more sickness. That's the all-too-unfortunate cycle for people across the country who find themselves with overwhelming medical debt, the most common reason a debt collector might come after someone, with 1 in 5 households going into debt to pay for medical care. This week, Michelle Proser addresses ways to prevent medical debt and offers potential stopgaps that could help people get out of debt and into necessary, supportive health care environments.

Clinicians walk a tightrope when trying to help their patients with chronic pain. They want to be able to ease a patient's suffering with medication, but must be mindful of the risks of addiction. There are some non-medication treatments for pain, but they're often hard to access or not covered by insurance.  Finding the balance can be challenging and emotionally taxing. And in the wake of the opioid crisis, many clinicians tend to err on the side of caution and under-treat pain. This week, two physicians discuss how to treat chronic pain adequately and ethically.

The roll out of a new mental health crisis line for the entire U.S., is scheduled to happen on July 16 — the blink of an eye in bureaucratic time. People in mental health crises or their family members will soon be able to dial 988, instead of 911 or the harder-to-remember 800-273-8255, the number for the National Suicide Prevention Lifeline. The thinking is that calls to 988 will route people to the care they need instead of to law enforcement or emergency personnel with limited training in working with people in the midst of mental health crises. This week on the "First Opinion Podcast," Benjamin Miller probes at some more concerns: Who will be answering the calls? And does the system have the capacity to take care of callers right away?

When the Covid-19 pandemic began tearing across the country, it hit nursing homes hard. More than 200,000 residents and staff members at long-term care facilities have died from the disease. But as this week's guests point out, the care of nursing home residents and support for those providing that care have been long-standing issues. Jasmine Travers and David Grabowski discuss the current state of affairs in nursing homes across the country, the important progress that needs to be made, and key steps for making improvements.

As a psychiatrist, Christin Drake has to turn away potential new patients every day — there just aren't enough hours in the day to take them on. She doesn't relish the rejection, especially when it's for another Black woman who is looking to find one of the few psychiatrists who shares that identity and experience. But with the mental health crises brought on by the pandemic and an aging, shrinking population of psychiatrists, the strain on Drake and her colleagues is getting worse. This week, she speaks about what's causing a dearth of mental health clinicians across the country, why it's so damaging, and what can be done to ease it.

For trans people who want to receive gender-affirming medical care such as hormone treatments or surgery, one requirement is often a diagnosis of "gender dysphoria," which the Diagnostic and Statistical Manual of Mental Disorders defines as deep psychological distress around one's gender. But not all trans people experience gender dysphoria. Many are just searching for the feeling of gender euphoria. This week, Dallas Ducar discusses issues around gender dysphoria and the need for trans-inclusive providers to take a holistic, person-based approach to care.

Like many of us, Tom Sequist had no idea what was about to happen as he began his new job as chief medical officer of Mass General Brigham hospital system in Boston during the first weeks of 2020. Through his position, he saw firsthand how Covid-19 tore through low-income communities like Chelsea, just north of Boston. From 2,000 miles away, he also saw how the virus ravaged the Taos Pueblo tribe in New Mexico that he is a member of. This week, Sequist talks about Indigenous health disparities, and the ways in which these two communities, which can feel worlds apart, were similarly vulnerable to the pandemic's deadly nature.

Sneha Dave has been living with a chronic disease for 17 years — almost her entire life. Diagnosed with ulcerative colitis when she was 6 years old, she has experienced firsthand the frustrating and often terrifying side effects of drugs that were not tested on people her own age. So when she sees Instagram posts and TikTok videos from pharmaceutical companies that are geared toward her generation, she bristles that many companies haven't bothered to include adolescents and young adults in clinical trials testing new medicines. In this episode, Pat talks with Sneha about the ways in which pharmaceutical companies and clinical research organizations should be reaching out to adolescents and young adults to include them in clinical trials.

It's a sad reality that people with diabetes know all too well: the price of insulin, a medicine they depend on to stay alive, has skyrocketed. Some people have trouble paying for insulin, forcing them to ration it or go without, which can be deadly. Alina Bills was diagnosed with diabetes when she was four, and can't remember life without it. Now age 26, she wrote a First Opinion essay about having to turn to social media to crowdsource insulin when she unexpectedly ran out and an extra vial would have cost her nearly $400 out of pocket.

Science journalist Faye Flam explores medical information in part by unpacking the three-hour exchange about Covid-19 between scientist-turned-misinformant Robert Malone and Spotify podcaster Joe Rogan. Flam points out the holes in Malone's logic and how listeners can be aware of similar politically motivated tactics. "People are foregoing vaccines that would save their lives and people are actually dying because they didn't get vaccinated," Flam said. "So I think the consequences of misinformation are enormous for people in this pandemic."

Two years into the pandemic and in the midst of the latest hospital staffing crisis, nurses have finally gotten the country's attention when it comes to burnout and attrition within the country's most trusted profession. And it's an important shift, because nursing is in trouble. This week, nurse and researcher Jane Muir describes some of the issues that are nudging more and more nurses to trade staff positions for jobs as travel nurses, or to leave nursing entirely, and offers ways to retain staff nurses. She says hospital systems need to put cash toward the nurses who make those systems so profitable. First Opinion Podcast is technically on a break! We'll have one more episode next month before we're back to our weekly schedule in March.

We started the "First Opinion Podcast" in February 2021 because we knew there was incredible value in the perspectives shared by our essay contributors.  We'd hoped there could be added value in sharing those perspectives through real, in-depth conversations too. Now a little under one year and 43 conversations later, we've been thrilled by the results. To celebrate our last podcast of the year I sat down with producer Theresa Gaffney to look back at some of the year's most memorable moments, both on- and off-the-record.

Alison Singer learned how to advocate for a child with autism by watching her mother do it for her brother. When Singer had her own child with autism, Jodie, she immediately got involved with the activist community. But Jodie's condition doesn't look like the kind seen in television shows like "Atypical" or "Love on the Spectrum." She needs special support 24 hours a day. This week on the "First Opinion Podcast," Singer breaks down why she believes the use of the overarching label "autism spectrum disorder" fails to take people like Jodie into account, and why she's pushing for a new, more specific label: "profound autism."

If there was one moment that led Kathleen Bachynski to a career studying the public health significance of sports injuries and violence, it was blowing out her knee in three places as a high school soccer player. And after years of documenting the many ways that football in particular can harm young players, she's got one rule: no full-body collision sports for kids. This week, she discusses the risks taken by youths in one of the country's most revered sports.

It can be hard to fathom that anyone other than you might own your information. But they do. Everything from what's in your electronic medical record to the average jogging speed recorded on an app may be someone else's property. For a profit, the magic is in the aggregate. On an individual scale, it's valuable information that paints a full picture of health for individuals and their health care providers. Juhan Sonin and Annie Lakey Becker explain why it's important to fight for patient ownership of health data across the country and the world.

Diseases like smallpox, measles, and dysentery killed two-thirds of the 1 million people who died in the Civil War. “Chronic diarrhea” and the stigma of smallpox scars plagued soldiers and others for decades afterward. And while Americans no longer depend on digging ditches for latrines, we're still struggling with faith in national public health measures, racial disparities in health care, and more. Medical historian Jonathan S. Jones discusses the epidemics of the Civil War and the lessons learned and forgotten.

Resident physician Sudhakar Nuti was almost too burnt out to write about burnout. He spent months working to find the energy to start his recent First Opinion essay on how the pandemic has aggravated the already dire mental health situation for many medical trainees around the country, including himself. "I feel like I've gone from doctor to debris," he wrote. Nuti joins "First Opinion Podcast" to further discuss how burnout happens during residency, and how the profession might address its systemic problems with systemic solutions.