The Dose

Montgomery, Alabama's capital, is known as the birthplace of gynecology. It's a brutal history, as the field's "founding father," J. Marion Sims, advanced his work through the experimentation on enslaved women and babies. Artist and health care activist Michelle Browder has forced a reckoning with this legacy with one clear goal — we need to talk about the mothers. On the newest episode of The Dose podcast, host Joel Bervell talks to Browder about her efforts to honor Sims's victims — the names of only three of whom we know today: Anarcha, Betsey, and Lucy. They also discuss Browder's work to channel the painful legacy of the past into a healthier future for Black women and their babies, as she prepares to open a midwifery clinic and birthing center as well as a national education center for medical students.

This year in the United States, an estimated 2 million people will receive a new cancer diagnosis, and a growing proportion will be younger adults and people of color. Many of these cases could be prevented — nearly 60 percent of colorectal cancers, for example, could be avoided with early detection. Physician and UCLA researcher Dr. Folasade May is trying to understand why cancer screening rates are lagging, and what we can do to get people these potentially lifesaving tests. In the newest episode of The Dose podcast, host Joel Bervell talks to Dr. May about what might be behind the rise in colorectal cancer among younger people, the barriers to widespread cancer screening — especially for underserved communities — and her work empowering people to save their lives. This episode kicks off a new series of conversations with leaders at the forefront of health equity.

Overtreatment is a big problem in American health care. The proliferation of unnecessary medical tests and procedures not only harms patients but costs the United States billions of dollars every year. Between 2019 and 2021, Medicare spent as much as $2.4 billion on unnecessary coronary stents alone. At some hospitals, it's estimated that more than half of all stents are unwarranted. For this week's episode of The Dose podcast — the latest in our series on the affordability of health care — host Joel Bervell talks to Vikas Saini, M.D., a cardiologist and the executive director of the Lown Institute, a think tank that examines overspending and overtreatment in the health care system. Dr. Saini unpacks how health care practices are misaligned with patient needs and discusses strategies for "rightsizing" U.S. health care.

Health care is a $4.3 trillion business in the United States, accounting for 18 percent of the nation's economy. It should come as no surprise then that the industry has become attractive to private investors, who promise cost savings, expanded use of technology, and streamlined operations. But according to Yale University's Howard Forman, M.D., "most private equity money does seem to be making matters worse rather than better." One issue is that investors chase the healthiest and most profitable patients, undermining another kind of equity — health equity — in an already deeply unequal health care system. In the latest episode of The Dose podcast, host Joel Bervell charts a wide-ranging discussion with Dr. Forman, a professor of radiology and biomedical imaging, public health, management, and economics, about private equity's growing role in American health care. This is the second episode of our new series of conversations about health care affordability.

Nearly one in five Americans has medical debt. Black households are disproportionately affected, carrying higher amounts of debt at higher rates. Berneta Haynes, senior attorney with the National Consumer Law Center, describes Black Americans' medical debt burden as a continual cycle fed by higher rates of chronic illness and lower rates of wealth. As a result, many are left without savings or family resources to tap into when faced with an unexpected medical bill. Join host Joel Bervell on the newest episode of The Dose podcast, where he talks to Haynes about the history of medical debt and efforts to ease pressure on the families and communities hit hardest, including the Consumer Financial Protection Bureau's initiative to change what kinds of medical debt can show up on a person's credit report. This episode kicks off a new series of conversations about affordability, including everything from the role of private equity in health care to why Americans pay more for care than any other high-income country.

Forty-four percent of U.S. women now live with some form of heart disease, a number that's been climbing steadily over the past decade. And although it's the leading cause of death among women, just 14 percent of cardiologists are women. This week on The Dose podcast, host Joel Bervell interviews cardiologist Martha Gulati, M.D., associate director of the Barbra Streisand Women's Heart Center at Cedars-Sinai Heart Institute in Los Angeles and president of the American Society for Preventive Cardiology. She talks about women's historical exclusion from clinical trials for heart disease, why sex and gender matter in the search for better treatments, and the persistent gaps in women's cardiology care and research — especially related to women of color. "In cardiology, we are still thinking about men more than we are about women," Dr. Gulati says.

Even though the U.S. has the highest maternal mortality rate of any developed country, federal programs that have been proven to improve maternal health outcomes are often the target of budget cuts. This week on The Dose podcast, guest host Rachel Bervell speaks with Dr. Jamila Taylor, president and CEO of the National WIC Association, the nonprofit voice of the federal program that provides nutritious foods to more than 6.3 million women, infants, and children. They discuss the potential policy and funding solutions that can advance health for women, especially women of color. Their conversation ranges from the debt ceiling legislation's impact on WIC to the pending "Momnibus" package of measures for improving health equity and quality of care for Black mothers. "Those essential programs are always the first to be on the chopping block," Taylor says. "That's something that we really need to change in our approach to funding."

Research shows that Black women and other women of color experience the worst health outcomes of any group in the United States — regardless of income level. On The Dose podcast this week, host Joel Bervell talks to public health innovator Ashlee Wisdom, founder of a digital platform that connects women of color to culturally competent health care providers. Black people make up 13 percent of the U.S. population but less than 6 percent of physicians, making it difficult for Black patients to connect with Black doctors. As Wisdom, founder of Health in Her HUE, explains, technology can be a tool for bridging that access gap until the physician workforce becomes more diverse. A new focus, she says, is fibroids, an oft-misdiagnosed condition in Black women that can lead to referrals for invasive interventions like hysterectomies. The health care system, Wisdom says, is starting to put things in place. "We're seeing people shift away from the status quo and think about ways that they can learn how to provide culturally competent care."

This week on The Dose podcast, host Joel Bervell talks to Michelle Morse, New York City's first-ever chief medical officer. Starting in her role at the height of the COVID pandemic, Dr. Morse quickly understood the importance of establishing strong connections between the health department and the city's health care providers to help close gaps in equity, choose where to focus resources, and coordinate testing and vaccination efforts. In a wide-ranging conversation, Dr. Morse talks about Black New Yorkers' disproportionately high rates of premature death, having racism declared a public health crisis in New York City, using community health workers to reach people where they live, and tracking the connection between wealth gaps and health outcomes. She also discusses the use of race in clinical algorithms that have "solidified racial inequities instead of trying to fix them and end them." Listen, and subscribe wherever you get your podcasts.

On this week's episode of The Dose, host Joel Bervell talks with Dr. Fatima Cody Stanford about obesity: its history, including the racist origins of the body mass index (BMI), as well as the flawed science, misperceptions, and stigma that people with obesity encounter. Stanford, who's based at Massachusetts General Hospital, calls obesity "a really complex, multifactorial, relapsing, remitting chronic disease." She discusses genetic differences that account for the prevalence of obesity in racial and ethnic minority communities, the financial profitability of the weight loss and pharmaceutical industries, and the biases and dangerous risks of misdiagnosis that patients with obesity face every day at doctors' offices.