First Opinion Podcast

Americans have a tendency to fixate on what's commonly thought of of as "a good death" — a peaceful, quiet passing that looks like falling asleep. But physician Joel B. Zivot and medical philosopher Ira Bedzow are cautious about how this preoccupation can shield people from the reality of death. When they read a recent report in JAMA on using medication to eliminate the "death rattle" — a soft moan or gargling sound sometimes made by people when death is near — they knew they needed to write about the dangers of curating death for the witnesses rather than focusing on those who are dying. This culture extends to state executions, in which people often injected with paralytics when they put to death. That makes these deaths easier for the witnesses, but not for those being executed.

When data shows that Asian Americans are faring better during the pandemic than other racial groups, physician and researcher Carlos Irwin A. Oronce knows that isn't the whole story. The first nurse to die from Covid-19 in Los Angeles was Filipinx, and more stories continue to emerge about the plight of Filipinx health care workers. Yet it's difficult to find any disaggregated data from within the Asian American racial group to back-up these stories, and Oronce says that needs to change.

Abortion access is being threatened across the country: Texas has come close to banning abortion as the Supreme Court prepares to take up a challenge to Roe v. Wade. While this has put much of the medical community on the defensive, many are looking ahead toward expanding access to medication abortion and having clinicians "step aside." This conversation is based on a First Opinion by physician Jennifer Karlin titled, "For abortion care, physicians may need to step aside to support patients."

Although billions of dollars have been poured into potential pharmaceutical cures for dementia, particularly Alzheimer's disease, none so far have been proven to slow or stop the disease from progressing. Yet even without an effective drug, incidence rates of dementia in the United States and several other countries have decreased since 1998. Why? Social changes like lower smoking rates and better education, along with better population-level health, have improved brain health.

This week, the show returns to a conversation with emergency physician Uché Blackstock about her decision to leave academic medicine. STAT's Usha Lee McFarling recently reported a stunning investigation about how white researchers have colonized research on health disparities and diversity over the past year. When racism persists in academic medicine and in research, it means that talented people like Uché will leave. Take a listen to her story and "First Opinion Podcast" will be back with a new conversation next week.

Research on excess body weight and obesity has long been predicated on the fundamental assumption that weight is gained based on a 'calories in, calories out' equation. If you consume more calories than you expend, you gain weight, right?  Science reporter Gary Taubes and reader-turned-friend Nick Gulino are among a growing faction that says it might not be so simple. As Gulino himself has experienced, this conventional paradigm often leads to a culture of fat-shaming and blame for heavy individuals.

The country is in a climate crisis, but it isn't an issue that can be left to the climate scientists — every disaster has consequences that reverberate through the health care system, often acutely affecting people of color, and particularly pregnant people and newborns. This week, flood disaster coordinator Emily Mediate and OB/GYN physician Neel Shah discuss how climate change will continue to wreak its worst havoc on our country's most vulnerable populations.

Alicia Zhou's son Davi was an early five years old when the pandemic started. Now, he's six and a half, entering the first grade. He's adjusted well to pandemic living as a young child, but Zhou says she's still worried sending him to in-person school. Luckily, as a chief science officer at a health technology company, she happens to be particularly qualified to advise schools on how that can happen safely. Zhou breaks down the risks and best precautions for this back-to-school season.

When the inventors of the iron lung wheeled their contraption into the hospital for the first time, they likely had one thing on their minds: saving the lives of children with polio. And they did. But there exists a darker side of these machines and their successors: people with persistent critical illnesses — like those with Covid-19 today — tethered to ventilators for weeks, if not longer, living in a "twilight existence" of being kept alive by a machine. This week, intensive care physician Hannah Wunsch explores the history of mechanical breathing, the countless lives it has saved, and the moral dilemmas it created that have only grown with the technology.

Bertrand Might was born with a rare disease that had never before been diagnosed, an odyssey that took four grueling years. He was 12 years old when he died last year — almost a decade older than physicians predicted he would live. This week on the First Opinion Podcast, Bertrand’s father, computer scientist Matthew Might, talks about how he used his coding skills to try to extend his son’s life, and how daring research projects could save lives across the country and around the world if the Biden administration’s proposed Advanced Research Projects Agency for Health (ARPA-H) comes to life.