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.