First Opinion Podcast

Mathematics professor and author Manil Suri and physician and professor Daniel Morgan discuss false positives in diagnostic tests, the impact of rarity on accuracy, prenatal testing for rare diseases, and the lack of statistical education in medical schools.

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.

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.