First Opinion Podcast

Resident physician Sudhakar Nuti was almost too burnt out to write about burnout. He spent months working to find the energy to start his recent First Opinion essay on how the pandemic has aggravated the already dire mental health situation for many medical trainees around the country, including himself. "I feel like I've gone from doctor to debris," he wrote. Nuti joins "First Opinion Podcast" to further discuss how burnout happens during residency, and how the profession might address its systemic problems with systemic solutions.

Ever since medicine adopted a race-based formula to assess kidney health in the mid-2000s, some experts have spoken out against it & the life-threatening impact it has on Black patients.  Patients like Glenda Roberts, who long self-identified as Black, and who has lived with kidney disease for most of her adult life. The "Black correction" in the eGFR made it look like her kidneys were doing better than they actually were, which delayed her being worked up for a kidney transplant. Roberts and kidney specialist Vanessa Grubbs spoke this week about the impact this equation has had on patients' lives and whether the profession has truly reckoned with it.

Natalie Ma knows a lot about antibiotics. She's familiar with the consequences of antibiotic resistance and the side effects of these essential drugs from her work at Felix Biotechnology, the biotherapeutics company she cofounded. So it was particularly daunting when what she thought was a run-of-the-mill urinary tract infection wasn't abated by the standard antibiotics. The conversation stems from her First Opinion essay, "My company is developing new antibiotics. My resistant infection showed me we need them now." To hear more about antibiotic resistance, you can listen to episode #9 of the First Opinion Podcast with researchers David Hyun and Rachel Zetts on the far-reaching effects of these "superbugs."

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.