First Opinion Podcast

If you ask a chatbot how to cause a pandemic, it will suggest the 1918 influenza virus, according to researcher Kevin Esvelt. It will even tell you where to find the gene sequences online and where to purchase the genetic components. Esvelt is a biologist and MIT professor whose work has included altering the genes of mice to prevent the spread of Lyme disease. In a recent First Opinion essay, he wrote about how easy and inexpensive it has become to order genetic components that could be used to create harmful pathogens or toxins and how the biotech industry and government agencies must strengthen safety precautions to prevent this. Esvelt sat down with host Pat Skerrett to chat about the amazing things genetic technology can accomplish when used correctly, as well as the dangers of such technology in the hands of someone with bad intentions.

University of Pennsylvania oncologist and researcher Ezekiel Emanuel and Matthew Guido, a project manager in the Healthcare Transformation Institute, discuss their original research on tuition-free programs with former host Pat Skerrett, who is filling in while Torie Bosch is on maternity leave. They make the case that medical school debt is only one of many factors that influence new doctors to choose less-popular specialties and geographic locations for their residencies.

James Sulzer has spent his life tinkering with tools that help patients with neurological conditions. But after his 4-year-old daughter sustained a traumatic brain injury in 2020, his eyes were opened to how much his field was missing about the real experiences of families dealing with recovery. This week, Sulzer speaks with host Torie Bosch about the importance of centering patients in research and treatment.

Back in February, physician and advocate Joel Zivot wrote a First Opinion essay shortly after Kenneth Smith was executed using nitrogen gas in Alabama. In “A new Louisiana capital-punishment bill would fundamentally alter physician licensing,” Zivot argues against proposed bills in both Kansas and Louisiana that would allow “death by hypoxia.” Not only is this type of death cruel and painful, he argues, but such a bill would “effectively wrest control of physician conduct from medical boards.” Louisiana Gov. Jeff Landry signed the bill into law in early March. In this episode, Zivot speaks with host Torie Bosch about what it means for death to be cruel, why he believes the state has no business using medicine to kill.

De-Shaine Murray is working at the cutting edge of neurotechnology. As a postdoctoral fellow at Yale, he is developing a device to monitor the brain following traumatic brain injury or stroke. He is also trying to fight the long legacy of racism in neuroscience. He sees a direct line from racist pseudoscience like phrenology to disparities in neuroscience today, like how the texture of Black people’s hair can sometimes exclude them from clinical trials because electrodes are not designed for them. In 2021, he co-founded Black in Neuro, an organization dedicated to improving Black representation in neuroscience. This week, Torie spoke to him about how the past and present racism in neuroscience could be reflected in the future, especially as neurotechnology like brain implants become more common.

Manil Suri and Daniel Morgan are an unusual team: Manil is a mathematics professor and author, while Daniel is a physician and professor of epidemiology, public health, and infectious diseases. But they recently teamed up for a First Opinion essay, “Diagnostic tests for rare conditions present a mathematical conundrum,” in which they write about how the more rare a disease ease, the more likely a test will return a false positive. Host Torie Bosch spoke with Manil and Daniel about how false positives can cause major problems, how both physicians and patients misunderstand statistics, and how their work plays out in their own lives.

Before he joined Congress, Rep. Raul Ruiz, a Democrat from California, worked in another chaotic environment: the emergency department. Today, he says, he tries to bring his background in medicine and public health to policymaking. In particular, he has turned his attention to a shortage of infectious disease physicians that threatens U.S. preparedness for the next pandemic. Our conversation was based on his recent First Opinion essay, “The infectious disease doctor shortage threatens future pandemic preparedness.” Don’t forget to sign up for the First Opinion newsletter to read each week’s best First Opinion essays.

When Prozac first entered the psychiatry scene in in the late 80s, the profession was still Freud's territory. Meaning: it was considered by many a failure to take medication to cure depression. But that was all about to change, with early stewards like psychiatrist Peter Kramer, who refused to shy away from the new drug's potential. These days, he says that people take for granted all of the progress that's been made with antidepressant treatment. Kramer joins Torie to discuss how the country's relationship with antidepressants has changed since the publication of his book "Listening to Prozac." The conversation is based on his First Opinion, "What antidepressants are saying 30 years after the publication of ‘Listening to Prozac.'" Be sure to sign up for the First Opinion newsletter to read each week's best First Opinion essays.

Fifteen years ago, Mara Buchbinder and colleagues came up with the concept of the “patient in waiting.” The concept described a new category of patients created by cutting-edge testing for conditions that may never appear. The patient in waiting was, quite literally, someone who was waiting to see if they would become ill. Mara's husband, Jesse Summers, was diagnosed with metastatic colon cancer in 2021. It went into remission — but earlier this year, a test searching for disease recurrence came back weakly positive, suggesting that the cancer might be back but might not be. It put Jesse and Mara into a sort of limbo as they waited to see what the result meant.

This week, medical student Amelia Mercado and her professor J. Wesley Boyd talk about the stressors of medical training, privacy concerns within academic institutions, and how high insurance costs affect access to mental health care. The conversation is based on their co-authored First Opinion, "How medical schools are failing students who need mental health care."

The term "excited delirium" has been used for years by law enforcement and other first responders, including health care workers, to describe people who exhibit behavior that is considered "out of control." This diagnosis has been applied again and again, even posthumously, as a justification for extreme and sometimes deadly, interventions by law enforcement. It came up most recently in the trials of two police officers accused of causing the death of Elijah McClain, a Colorado man; both officers were acquitted this week. But excited delirium is not an evidence-based medical diagnosis. The American College of Emergency Physicians recently withdrew a 2009 white paper endorsing the concept, and California has banned it as a cause of death. Other states may follow suit. This week, we are joined by emergency phyisicians Utsha G. Khatri and Brooks Walsh, who speak about why the "excited delirium" label is both unnecessary and dangerous. Check out our episode of Color Code about "excited delirium" as well as a previous episode of the First Opinion Podcast on the topic. And sign up for the First Opinion newsletter.

Have you ever taken phenylephrine for a stuffed-up nose and then felt better? If so, you might have been perplexed when Food and Drug Administration experts recently said that that the drug — which is in some versions of DayQuil, Sudafed, and other medicines — is no more effective than a placebo. But to Michael H. Bernstein, an assistant professor of diagnostic imaging at the Warren Alpert Medical School of Brown University, it all makes sense. On this episode, Bernstein discusses the placebo effect and its counterpart, the “nocebo effect.”

In just two weeks, the brutality of the Israel-Hamas conflict has shocked the world. But one of its most heartbreaking aspects — the destruction of the already-struggling health care system in Gaza — is part of a decades-long pattern during war both in the region and around the world. Leonard Rubenstein is a distinguished professor of practice at the Johns Hopkins Bloomberg School of Public Health and author of “Perilous Medicine: The Struggle to Protect Health Care From the Violence of War.” On this episode of the First Opinion Podcast, we spoke about health care in war, the Geneva Conventions, and why it’s so difficult to hold those who break international law accountable.

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.