First Opinion Podcast

When Covid-19 began tearing across the U.S. in March 2020, Alex Goldstein started posting on Twitter the pictures and stories of people who had died from the disease.  Over two years later, as the U.S. marks the grim milestone of 1 million people dead from Covid-19, Goldstein is still at it. The account, @FacesOfCovid, has now memorialized more than 7,000 people.

Sickness can beget debt, which can then turn around and beget more sickness. That's the all-too-unfortunate cycle for people across the country who find themselves with overwhelming medical debt, the most common reason a debt collector might come after someone, with 1 in 5 households going into debt to pay for medical care. This week, Michelle Proser addresses ways to prevent medical debt and offers potential stopgaps that could help people get out of debt and into necessary, supportive health care environments.

Clinicians walk a tightrope when trying to help their patients with chronic pain. They want to be able to ease a patient's suffering with medication, but must be mindful of the risks of addiction. There are some non-medication treatments for pain, but they're often hard to access or not covered by insurance.  Finding the balance can be challenging and emotionally taxing. And in the wake of the opioid crisis, many clinicians tend to err on the side of caution and under-treat pain. This week, two physicians discuss how to treat chronic pain adequately and ethically.

The roll out of a new mental health crisis line for the entire U.S., is scheduled to happen on July 16 — the blink of an eye in bureaucratic time. People in mental health crises or their family members will soon be able to dial 988, instead of 911 or the harder-to-remember 800-273-8255, the number for the National Suicide Prevention Lifeline. The thinking is that calls to 988 will route people to the care they need instead of to law enforcement or emergency personnel with limited training in working with people in the midst of mental health crises. This week on the "First Opinion Podcast," Benjamin Miller probes at some more concerns: Who will be answering the calls? And does the system have the capacity to take care of callers right away?

When the Covid-19 pandemic began tearing across the country, it hit nursing homes hard. More than 200,000 residents and staff members at long-term care facilities have died from the disease. But as this week's guests point out, the care of nursing home residents and support for those providing that care have been long-standing issues. Jasmine Travers and David Grabowski discuss the current state of affairs in nursing homes across the country, the important progress that needs to be made, and key steps for making improvements.

As a psychiatrist, Christin Drake has to turn away potential new patients every day — there just aren’t enough hours in the day to take them on. She doesn’t relish the rejection, especially when it’s for another Black woman who is looking to find one of the few psychiatrists who shares that identity and experience. But with the mental health crises brought on by the pandemic and an aging, shrinking population of psychiatrists, the strain on Drake and her colleagues is getting worse. This week, she speaks about what’s causing a dearth of mental health clinicians across the country, why it’s so damaging, and what can be done to ease it.

For trans people who want to receive gender-affirming medical care such as hormone treatments or surgery, one requirement is often a diagnosis of "gender dysphoria," which the Diagnostic and Statistical Manual of Mental Disorders defines as deep psychological distress around one's gender. But not all trans people experience gender dysphoria. Many are just searching for the feeling of gender euphoria. This week, Dallas Ducar discusses issues around gender dysphoria and the need for trans-inclusive providers to take a holistic, person-based approach to care.

Like many of us, Tom Sequist had no idea what was about to happen as he began his new job as chief medical officer of Mass General Brigham hospital system in Boston during the first weeks of 2020. Through his position, he saw firsthand how Covid-19 tore through low-income communities like Chelsea, just north of Boston. From 2,000 miles away, he also saw how the virus ravaged the Taos Pueblo tribe in New Mexico that he is a member of. This week, Sequist talks about Indigenous health disparities, and the ways in which these two communities, which can feel worlds apart, were similarly vulnerable to the pandemic's deadly nature.

Sneha Dave has been living with a chronic disease for 17 years — almost her entire life. Diagnosed with ulcerative colitis when she was 6 years old, she has experienced firsthand the frustrating and often terrifying side effects of drugs that were not tested on people her own age. So when she sees Instagram posts and TikTok videos from pharmaceutical companies that are geared toward her generation, she bristles that many companies haven't bothered to include adolescents and young adults in clinical trials testing new medicines. In this episode, Pat talks with Sneha about the ways in which pharmaceutical companies and clinical research organizations should be reaching out to adolescents and young adults to include them in clinical trials.

It's a sad reality that people with diabetes know all too well: the price of insulin, a medicine they depend on to stay alive, has skyrocketed. Some people have trouble paying for insulin, forcing them to ration it or go without, which can be deadly. Alina Bills was diagnosed with diabetes when she was four, and can't remember life without it. Now age 26, she wrote a First Opinion essay about having to turn to social media to crowdsource insulin when she unexpectedly ran out and an extra vial would have cost her nearly $400 out of pocket.