First Opinion Podcast

When Jason Karlawish started working with dementia patients in the late ’90s, there often wasn’t much he could offer them. “I gave them a diagnosis,” he told me on this week’s episode of the “First Opinion Podcast,” but had limited medications to prescribe. Now Karlawish — who is STAT’s Neurotransmissions columnist; a professor of medicine, medical ethics, health policy, and neurology at the University of Pennsylvania; co-director of the Penn Memory Center; and executive producer of the “Age of Aging” podcast — says a revolution is taking place in dementia care, thanks to diagnostics that are removing uncertainty and treatments that actually have some effect.

Celena Lozano's son Benny, who turned 5 in November, loves trains, trucks — anything that goes. He also has a rare disease, PURA syndrome. Earlier this year, when headlines announced that a child with a different rare disease, known as Baby KJ, had been treated using CRISPR in a major breakthrough, Celena, a neuroscience Ph.D. candidate, found that many in the PURA community had major questions, with comments like “This happened in just six months. When will this be available for our PURA kids?” appearing on Facebook groups. Celena and STAT reporter Jason Mast joined the podcast to discuss why CRISPR for PURA syndrome is particularly difficult, what it’s like to be both a rare disease parent and a scientist, and how crucial parents are to research.

As science journalist Melanie D.G. Kaplan describes in her new book, “Lab Dog,” tens of thousands of beagles are used in the U.S. for medical research, testing chemical safety, and more. In “Lab Dog,” Melanie goes on a journey with her beloved adopted beagles, Hammy, a retired research dog, to find out where he came from. Along the way, she explores the ways that dogs contribute to medical research, the potential and limitations of substitutes for animals in the lab. In this episode, we discuss the ethics of animal research, Hammy’s story, the U.S. government’s attempt to move away from animal research, and why the number of beagles used in lab research has dropped from 70,000 when she adopted Hammy to 40,000 today.

In the wake of the pandemic, North Dakota, like many states, suddenly saw a splintering of opinion around vaccines. “Not only was I concerned about the decline of vaccinations, but I was even more concerned about the fabric of communities,” Sandy Tibke, executive director of the Foundation for a Healthy North Dakota, said on the this week’s podcast. So she teamed up with Josh Gryniewicz of Odd Duck, a communications consultancy. Together, they crisscrossed North Dakota, hosting listening sessions on health-related topics that went well beyond vaccines. On this episode of the “First Opinion Podcast,” host Torie Bosch spoke with Sandy and Josh about their work and the lessons it offers others in public health.

James Watson, who won the Nobel Prize for co-discovering the structure of DNA, died last week at the age of 97. He was a scientific giant, but in the final two decades of his life, he falsely stated that women and Black people are, as populations, not as smart as white men. Nancy Hopkins knew Watson better than most, having first worked with him when she was just an undergraduate. She is a retired MIT professor known for her work on zebrafish as a cancer model, and for her advocacy on behalf of women in science. Today, she is trying to reconcile her “lifelong friend,” the Watson one who encouraged her and other women to go into molecular biology, with the one who emerged late in life.

On TV, CPR looks like a miracle: a few light pushes on the chest, a couple of assisted breaths, and the person sputters back to life. “CPR has been represented in the media and TV shows and all of these other places as a relatively innocuous intervention with high rates of success from which people recover with little problem,” Jason Wasserman said on this episode of the “First Opinion Podcast.” In fact, it can be physically damaging—broken ribs, punctured lungs — and painful. And for patients who are already medically frail, it often fails. So sometimes, particularly with patients clearly at the end of life, doctors might do something that isn’t often discussed outside of medical circles: the slow code. That’s when they intentionally move slowly, or don’t put as much effort into CPR as would be necessary to revive someone. On this episode of the podcast, guest host Alex Hogan spoke with Wasserman and Parker Crutchfield about a recent special issue of the journal Bioethics that they edited on the slow code and a related op-ed they wrote for First Opinion. They discussed the ethical conundrum of the slow code, the response to their work from medical professionals, and why it’s particularly important to have this discussion now. “Beyond the physical or material harms that can be associated with CPR,” Wasserman said, “we can think about what we might call dignitary harms, just harms of disrespect to the person and to the body. And I think these are especially poignant when we’re talking about futile or medically inappropriate CPR that we’re doing.” Their conversation was also based on a recent episode of the new video series “STATus Report.” Be sure to sign up for the weekly “First Opinion Podcast” on Apple Podcasts, Spotify, or wherever you get your podcasts. Get alerts about each new episode by signing up for the “First Opinion Podcast” newsletter. And don’t forget to sign up for the First Opinion newsletter, delivered every Sunday.

Vaccine hesitancy isn’t new, Seth Berkley points out. “The first vaccine was smallpox vaccine,” he said on this week’s episode of the “First Opinion Podcast,” “and right after they were first used, there were wood cuttings of people with cows’ horns growing out of their heads because the virus was isolated from cows.” Berkley is the former head of Gavi, the Vaccine Alliance, a co-founder of COVAX, and author of the new book “Fair Doses: An Insider’s Story of the Pandemic and the Global Fight for Vaccine Equity.” On this episode of the podcast, we discussed what went right and wrong with the response to Covid — and preparing for the next pandemic.

One night, an ad on Reddit caught Jake Eberts’ eye. Using graphics from the classic video game “The Oregon Trail,” it said something like, “You have died of dysentery. Help us prevent dysentery by joining this vaccine study.” Eberts was intrigued. For $7,300 (and out of a sense of altruism), he joined a study on a shigellosis vaccine that required him to be exposed to the bacteria that causes the disease. On this episode of the “First Opinion Podcast,” we speak with Eberts, who is now on the board of the nonprofit 1Day Sooner, and Jill Fisher, a professor of social medicine at the University of North Carolina. We discussed how pay for healthy volunteers works, why institutional review boards are reluctant to raise rates, and the ethical conundrums that come with paying people to get sick.

When podcast host Torie Bosch asked Richard Besser — the president and CEO of the Robert Wood Johnson Foundation and former acting CDC director — how he feels about the CDC under the Trump administration, he was frank. “It’s absolutely heartbreaking,” he said. On this episode of the “First Opinion Podcast,” Besser joined to discuss vaccine policy, reaching out to conservative media, finding common ground with MAHA, the connection between democracy and health, and more. “I used to think that I couldn't be surprised,” he said, “but it seems like just about every day something comes out of the Department of Health and Human Services that to me is absolutely against the best interests of people's health, makes no sense, and yet it keeps on coming.”

When Joy Lisi Rankin’s mother was diagnosed with breast cancer, she made a decision many people, especially her doctors, did not understand: She decided to forgo treatment. On this episode of the “First Opinion Podcast,” Rankin, oncologist Samyukta Mullangi, and host Torie Bosch discuss difficult choices around cancer care, how oncologists should respond to patients who don’t want recommended treatment, and the emotional weight this all puts on patients, families, and doctors alike.

When Morgan McSweeney first started doing science communication on social media during Covid, he sometimes felt a little embarrassed by it. Now, as he wrote recently for STAT, he has found that “a casual one-minute video about immunology racks up orders of magnitude more views in an hour than my published research papers could accumulate in ten lifetimes.” McSweeney, aka Doctor Noc, is a social media influencer with 4 million followers across platforms and a Ph.D. in pharmaceutical sciences and immunology. This week he joins First Opinion Podcast host Torie Bosch to talk about his approach to cutting through the noise of social media with real, honest science.

First Opinion Podcast is coming back on Wednesday Oct. 1 This fall, the podcast will continue to bring you thoughtful, challenging, personal, and provocative ideas from the smartest thinkers in medicine. Among others, you’ll hear from someone who willingly contracted dysentery, two people who spearheaded a successful pro-vaccine campaign in a red state, and a PhD with almost 2 million followers on Instagram.

Today, we’re sharing a special episode from the new miniseries “The C-Word: Stories of Cancer” from Say More, a podcast from The Boston Globe Opinion. In the first part of this series, host and award-winning columnist Shirley Leung talks for the first time about her breast cancer diagnosis. She opens up about the personal and professional impact of her illness, and why now felt like the right time to tell her story. Follow Say More wherever you get your podcasts: https://link.chtbl.com/SayMore?sid=stat

Paul Knoepfler of the UC Davis School of Medicine has a bit of a hobby: keeping track of stem cell clinics operating in the U.S. He estimates that there are 1,000-2,000 in the U.S. alone, offering unproven treatments using adult stem cells. On the season finale of the podcast, he and Torie discuss how to balance safety and efficacy, why Health and Human Services Secretary Robert F. Kennedy Jr. is such a fan of stem cells, how the FDA can support the biotech industry, the forceful marketing of cord blood banking companies, and much more — including how to build a dragon using CRISPR.

Anna and Jordan Rathkopf met in Prague at an ’80s nightclub. While music brought them together, another creative outlet soon became central to their relationship: Anna began teaching Jordan about photography, which later became his career. Years later, they were living in Brooklyn with their young son when Anna was diagnosed with breast cancer. The morning after the phone call that changed their lives, “We saw cameras on the table, looked at each other, and I think we both just understood instantly that this was something we both were going to need to lean on to help get through it,” Jordan told me on this episode of the “First Opinion Podcast.” This conversation was inspired by their dual First Opinion essays, in which each discusses how the photographs said what they could not put into words.

From our friends at KFF Health News, Chief Washington Correspondent Julie Rovner gathers top reporters to discuss the latest health and health policy news.  Check out this episode and if you like it, be sure to give them a follow.

Pretty much everyone in the U.S. agrees that the American health care system is not working for patients. The disagreement comes over what to do about it. On this episode, law professor Charles M. Silver proposes that the U.S. should have a market-based system, just as we do for many other sectors of the economy. Insurance would still play a role, but a far more limited one. He discusses with editor Torie Bosch what this system would look like for health care consumers, how Social Security offers a model, and how realistic the proposal actually is.

No one goes to medical school because they want to type quickly while listening to patients talk. But that’s what practicing medicine means for many today: fingers flying over the keyboard to log data. Later, they will use that information to create a note for the patient’s file. Technology now offers a solution to this problem in the form of the AI ambient scribe, which records the encounter between physician and patient and then generates the summarizing note for the patient’s file. On this episode of the “First Opinion Podcast,” I spoke with two doctors, one who has embraced the AI scribe and another who is reluctant to use it. While part of me hoped they would have a knock-down, drag-out debate, it was instead a deeply thoughtful conversation about privacy, patient-physician rapport, burnout, and much more.

In the 19th century, medical schools were desperate for corpses from which their students could learn. Grave robbers would sell bodies; sometimes, janitors, students, or even instructors would dig up corpses themselves. Today’s medical students don’t have to go into cemeteries themselves, but schools still struggle to find cadavers that are both ethically sourced and affordable. So many are deciding to forgo the use of cadavers to teach students about human anatomy. First-year medical student Nadir Al-Saidi was disappointed to learn that his school was going to join that group. He joins the podcast to discuss what he has learned in the cadaver lab, and why technology can’t replace the real thing.

When a person with dementia gets something fundamental wrong — the year it is, your relationship to them — it can be difficult to know what to do. Do you correct them and risk upsetting them? Is it a lie or unethical to go along with it? Ted Johnson, who chairs the Department of Family and Preventive Medicine at the Emory School of Medicine, says that playing along is not only OK; it’s often the best thing for both the patient and the caretaker. In the past three years, Johnson and his colleagues have trained 1,500 care partners on how to use basic improv skills.