Howie and Harlan are joined by legal historian Paul Lombardo to discuss his work exploring the role of the legal and medical establishments in eugenics and sterilization in the United States. Harlan reports on his new research on post-vaccination syndrome, a constellation of chronic symptoms experienced by some people after getting the COVID-19 vaccine; Howie discusses the science behind a measles outbreak in Texas.

Links:

Anxiety in Academia

Yale Office of the President: Our commitment to our research mission

Post-Vaccination Syndrome

Harlan Krumholz: "Immunological and Antigenic Signatures Associated with Chronic Illnesses after COVID-19 Vaccination"

"Immune markers of post vaccination syndrome indicate future research directions"

Eugenics in America

U.S. Supreme Court: Buck v. Bell, 274 U.S. 200 (1927)

Paul Lombardo, New England Journal of Medicine: "'Ridding the Race of His Defective Blood'—Eugenics in the Journal, 1906–1948"

"Clarence Thomas tried to link abortion to eugenics. Seven historians told The Post he's wrong."

Paul Lombardo: Three Generations, No Imbeciles

In the Name of Eugenics

Paul Lombardo: "Republicans, Democrats, & Doctors: The Lawmakers Who Wrote Sterilization Laws"

Measles and Herd Immunity

"West Texas measles outbreak grows to 58 cases, including some people who said they were vaccinated"

"Supreme Court rejects challenge to Connecticut law that eliminated religious vaccination exemption"

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Howie and Harlan are joined by Deborah Rhodes, a Yale internist and the chief quality officer for Yale Medicine and Yale New Haven Health System. They discuss how she helped develop a better approach to scanning for breast cancer in women with dense breast tissue, and the obstacles to wide adoption. Harlan reports on the Trump administration's plan to slash indirect support for research; Howie explains the potential consequences of cuts to Medicaid.

Links:

Flu and Research Cuts

"Weekly US Influenza Surveillance Report: Key Updates for Week 5, ending February 1, 2025"

"This Is One of the Worst Flu Seasons in Decades"

"Court Pause on Trump Cuts to Medical Research Funds Is Expanded Nationwide"

"What National Institutes of Health funding cuts could mean for U.S. universities"

Harlan Krumholz: "The NIH's drastic cut to indirect cost rates is a critical threat to U.S. research infrastructure"

Breast-Cancer Screening

TED Talk by Deborah Rhodes: "A test that finds 3x more breast tumors, and why it's not available to you"

Deborah Rhodes: "A Survey of Patient Experience During Molecular Breast Imaging"

Mayo Clinic Breast Clinic: "How To Decide What To Do If You Have Dense Breasts On Mammogram"

Deborah Rhodes: "Dedicated dual-head gamma imaging for breast cancer screening in women with mammographically dense breasts"

Cleveland Clinic: Fibroglandular Density

Are You Dense?

"Evaluation of a Clinical Decision Support System for Imaging Requests"

Medicaid

"House Republicans release budget plan, with trillions in tax and spending cuts"

"Trump's return puts Medicaid on the chopping block"

"Red states likely to feel the pain of Medicaid cuts"

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Howie and Harlan discuss a breakthrough pain medication, studies on AI-assisted medicine, the explosion of sports gambling, and the health consequences of the shutdown of USAID.

Links:

A First-in-Class Painkiller

"F.D.A. Approves Drug to Treat Pain Without Opioid Effects"

"FDA Approves Novel Non-Opioid Treatment for Moderate to Severe Acute Pain"

"Peripheral Sodium Channel Blocker Could Revolutionize Treatment for Nerve Pain"

"Alabama to Beijing… and Back: The Search for a Pain Gene"

AI Screening

"Screening performance and characteristics of breast cancer detected in the Mammography Screening with Artificial Intelligence trial (MASAI): a randomised, controlled, parallel-group, non-inferiority, single-blinded, screening accuracy study"

"3D mammograms show benefits over 2D imaging, especially for dense breasts".

"The Robot Doctor Will See You Now"

USAID and Foreign Aid

"Trump and Musk move to dismantle USAID, igniting battle with Democratic lawmakers"

"What USAID does, and why Trump and Musk want to get rid of it"

"The Status of President Trump's Pause of Foreign Aid and Implications for PEPFAR and other Global Health Programs"

"The Case For Global Health Diplomacy"

The Super Bowl and Legalized Sports Gambling

"Super Bowl LIX: Betting By The Numbers"

"Americans expected to bet $1.39B legally on Super Bowl 2025"

"Record 68 million people plan on making Super Bowl bets"

"Gambling problems are mushrooming. Panel says we need to act now."

COVID and Flu

"The U.S. Is Having Its Mildest Covid Winter Yet"

"Estimated Vaccine Effectiveness for Pediatric Patients With Severe Influenza, 2015-2020"

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Howie and Harlan are joined by Lisa Rosenbaum, a cardiologist and the national correspondent for the New England Journal of Medicine, to discuss her writing illuminating critical topics in medicine. Harlan reports on the companies claiming to prevent illness through a non-invasive full-body scan; Howie explains the healthcare impact of the Trump administration's freeze of federal aid.

Links:

Body Scanning

"Neko Health raises $260M to expand body scan service, fund R&D"

Neko Health

"Kim Kardashian Promotes $2,500 Body Scan—Here's What To Know And Why Some Experts Warn Against It""

"Daniel Ek's body scanning startup hits £1.4 billion valuation with 100,000 people lining up to pay £299 for a health check"

"The rise and fall of Theranos: A timeline"

Lisa Rosenbaum

Lisa Rosenbaum: "Gray Matters: Analysis and Ambiguity"

Lisa Rosenbaum: Not Otherwise Specified podcast

Lisa Rosenbaum: "Beyond Moral Injury—Can We Reclaim Agency, Belief, and Joy in Medicine?"

Lisa Rosenbaum: "Being Well while Doing Well—Distinguishing Necessary from Unnecessary Discomfort in Training"

"The Case Against the Trauma Plot"

"The Rise of Therapy-Speak"

Lisa Rosenbaum: "On Calling—From Privileged Professionals to Cogs of Capitalism?"

"The Moral Crisis of America's Doctors"

The Ezra Klein Show: "Democrats are Losing the War for Attention. Badly."

IMDB: The Doctor

The New Administration

"Kennedy, Polarizing Pick for Health Secretary, Makes His Senate Debut"

"WATCH: Sen. Elizabeth Warren questions RFK Jr. in confirmation hearing"

"Trump aid freeze stirs chaos before it is blocked in court"

"Trump administration rescinds order attempting to freeze federal aid spending"

"Uncertainty Causes Chaos as Trump Threatens Funding Pause for Schools"

"Read the Memo Pausing Federal Grants and Loans"

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Howie and Harlan are joined by Susan Mayne, a Yale epidemiologist and the former director of the FDA's Center for Food Safety and Applied Nutrition, to discuss what the agency can and can't do to keep contaminants out of food and promote healthier eating habits. Harlan reports on the Trump administration's cancellation of multiple scientific meetings; Howie explains the administration's health-related executive orders.

Links:

Changes at the NIH

"Trump administration's abrupt cancellation of scientific meetings prompts confusion, concern"

"The Trump NIH Pick Who Wants to Take On 'Cancel Culture' Colleges"

Food Safety and the FDA

"Beyond Red Dye No. 3: Here's what parents should know about food colorings"

"FDA to Revoke Authorization for the Use of Red No. 3 in Food and Ingested Drugs"

U.S. Government Accountability Office: Regulation of Cancer-Causing Food Additives—Time for a Change

Nutrition Labeling and Education Act of 1990

FDA: Front-of-Package Nutrition Labeling

"Court ruling curbs unfounded claims for memory supplement"

FDA: Questions and Answers on Health Claims in Food Labeling

FDA Budget Summary

FDA: Closer to Zero: Reducing Childhood Exposure to Contaminants from Foods

FDA: Food Safety Modernization Act (FSMA)

Executive Orders

"Breaking Down All of Trump's Day 1 Presidential Actions"

KFF Morning Briefing

"Trump orders reflect his promises to roll back transgender protections and end DEI programs"

"Trump wants to pull the US out of the World Health Organization again. Here's what may happen next"

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Howie and Harlan are joined by Sachin Jain, CEO of the nonprofit Scan Health Plan, who argues that the managed care industry must dramatically reorient itself towards patient care. Harlan looks at the long-term health effects of the L.A. wildfires and an effort to replace the widely used body-mass index; Howie reflects on the growing mistrust of doctors and its connection to declining vaccination rates.

Links:

Wildfires and Health

"Los Angeles wildfires: Firefighters face several more critical hours of Wednesday's dangerous winds"

"Health Effects Attributed to Wildfire Smoke"

"Long-term exposure to wildfire smoke associated with higher risk of death"

Redefining Obesity

"Definition and diagnostic criteria of clinical obesity"

"Move aside BMI: There's a better way to define obesity, commission finds"

"New obesity definition sidelines BMI to focus on health"

"New Obesity Definition Challenges Current Use of B.M.I."

Toward a More Humane Managed Care Industry

Scan Health Plan

Sachin Jain: "The Path Forward for the Health Insurance Industry"

Sachin H. Jain: "The path forward for the US Health Insurance Industry begins with saying "We Are Sorry"

Sachin Jain: "In 2025, I urge you to start seeing things clearly"

Sachin Jain: "What It Really Takes to Listen to Patients"

"Lyft is driving patients to see their doctors and saving insurers big money"

Trust and Vaccinations

"Americans' Ratings of U.S. Professions Stay Historically Low"

"Childhood Vaccination Rates Were Falling Even Before the Rise of R.F.K. Jr."

"Falling Child Vaccinations"

Health & Veritas Episode 95 with Peter Hotez

"Meta to end fact-checking, replacing it with community-driven system akin to Elon Musk's X"

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Howie and Harlan discuss health and healthcare headlines, including misaligned incentives keeping medicine from its mission, burdensome out-of-pockets costs, ultraprocessed foods, and serving the growing population of cancer survivors effectively.

Links:

Vivek Murthy's parting letter to America

"Surgeon General Urges Americans to 'Rethink How We're Living Our Lives' in Closing Letter to the Country (Exclusive)"

Discontent with the Health System in the United States

"View of U.S. Healthcare Quality Declines to 24-Year Low"

"What We Know About the UnitedHealthcare C.E.O.'s Killing and the Suspect"

"Killing of UnitedHealthcare CEO brings resentment of the health care system to the fore"

"Out‐of‐Pocket Annual Health Expenditures and Financial Toxicity From Healthcare Costs in Patients With Heart Failure in the United States"

Bird Flu

"First Bird Flu Death in U.S. Reported in Louisiana"

"First H5 Bird Flu Death Reported in United States"

"H5N1 Bird Flu"

"Eyeing Potential Bird Flu Outbreak, Biden Administration Ramps Up Preparedness"

"What is the HMPV virus in China? The human metapneumovirus and its symptoms, explained."

"Respiratory Virus Activity Levels"

Alcohol and Cancer

"Alcohol and Cancer Risk"

"The cardioprotective association of average alcohol consumption and ischaemic heart disease: a systematic review and meta-analysis"

"Alcohol Exposure and Disease Associations: A Mendelian Randomization and Meta-Analysis on Weekly Consumption and Problematic Drinking"

"No level of alcohol consumption is safe for our health"

Cancer Survivorship

"Prevalence of cancer survivors in the United States"

Cancer Survivorship: Cancer.Gov

Ultra-Processed Foods

"Trans fat"

"Low-Grade Inflammation and Ultra-Processed Foods Consumption: A Review"

"The Power RFK Jr. Would Have Over Food"

Lawsuits: "Bad Behavior" on the Physician side

"Sixteen Cardiology Practices to Pay a Total of $17.7M to Resolve False Claims Act Allegations Concerning Inflated Medicare Reimbursements"

"CVS-owned insurer Aetna sues Radiology Partners alleging multiphase 'fraud scheme'"

Jimmy Carter

"Jimmy Carter, Peacemaking President Amid Crises, Is Dead at 100"

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Howie and Harlan are joined by Yale physician Dana Dunne, who leads a new coaching program designed to help medical students develop a lifelong orientation toward growth and building knowledge. Harlan reports on a new generation of AI that can diagnose patients more consistently than human doctors; Howie explains how the state of Connecticut wiped out medical debt for thousands of low-income residents.

Links:

AI Diagnosis

"Superhuman performance of a large language model on the reasoning tasks of a physician"

"Reasoning Foundations of Medical Diagnosis: Symbolic logic, probability, and value theory aid our understanding of how physicians reason" (1959)

Coaching Medical Students

Yale School of Medicine: The Yale System

Yale School of Medicine: Longitudinal Coaching Program

"Developing Master Adaptive Learners: Implementation of a Coaching Program in Graduate Medical Education"

"Risky Business: Psychological Safety and the Risks of Learning Medicine"

Amy C. Edmondson: Psychological Safety

Review: The Fearless Organization

Medical Debt

"Governor Lamont Announces Nearly 23,000 Connecticut Residents Will Have $30 Million in Medical Debt Erased Under First Round of State's Newly Launched Partnership With Nonprofit"

"CT cancels $30M in medical debt for thousands of residents"

"Disparities in Medical Debt Among U.S. Adults with Serious Psychological Distress"

"63% of workers unable to pay a $500 emergency expense, survey finds. How employers may help change that"

White House Fact Sheet: Biden-⁠Harris Administration Announces New Actions to Reduce Medical Debt and Address Illegal Medical Debt Collection Practices

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Howie and Harlan are joined by Jaewon Ryu, CEO of Risant Health, a nonprofit company that brings together integrated health systems with the goal of spreading the adoption of value-based care. Harlan reports from the annual Cardiovascular Clinical Trialists Forum on progress toward faster and more effective clinical trials; Howie reflects on the murder of UnitedHealthcare CEO Brian Thompson.

Links:

Clinical Trials

"Artificial Intelligence in Cardiovascular Clinical Trials"

Jaewon Ryu

Wikipedia: Integrated Delivery System

Geisinger: Fresh Food Farmacy

"Geisinger opens a new $5.8 million senior-focused primary care center in Pottsville"

"Kaiser Permanente Unit to Acquire North Carolina Hospital System"

"Value-Based Care: What It Is, and Why It's Needed"

The Killing of Brian Thompson

"What We Know About the UnitedHealthcare C.E.O.'s Killing and the Suspect"

"A Very Un-American Response to the Murder of Brian Thompson"

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Howie and Harlan are joined by Aaron Kesselheim, a physician, attorney, and public health expert, to discuss the shifting legal landscape for healthcare regulation and his experiences serving on an FDA advisory committee. Harlan reports on the growing evidence of widespread health impacts from microplastics; Howie provides an update on the bird flu outbreak.

Links:

Microplastics

"Landmark study links microplastics to serious health problems"

"Microplastics: Are we facing a new health crisis—and what can be done about it?"

"Microplastics are inside us all. What does that mean for our health?"

"Microplastics are everywhere—we need to understand how they affect human health"

"How do plastics, including microplastics and plastic-associated chemicals, affect human health?"

"The potential of micro- and nanoplastics to exacerbate the health impacts and global burden of non-communicable diseases"

Aaron Kesselheim

PORTAL: Program on Regulations, Therapeutics, and Law

"The End of Chevron Deference: What Does It Mean, and What Comes Next?"

"Biden Administration Proposes Covering Obesity Drugs In Medicare And Medicaid"

"Biden-Harris Administration Announces Medicare Advantage and Medicare Part D Prescription Drug Proposals that Aim to Improve Care and Access for Enrollees"

"3 Experts Have Resigned From An FDA Committee Over Alzheimer's Drug Approval"

X: Aaron Kesselheim's resignation letter

Congressional testimony of Aaron Kesselheim: "The Inflation Reduction Act of 2022: Reducing Excessive Spending and Supporting Patient Access to Brand-Name Drugs while Promoting Meaningful Innovation"

Congressional testimony of Aaron Kesselheim: "How the US Government Supports Meaningful Drug and Device Innovation: Funding Development of Transformative Therapies and Avoiding Excessive Prices for new Products with Limited Benefits"

Aaron Kesselheim: "US public investment in development of mRNA covid-19 vaccines: retrospective cohort study"

Harvard Online: Prescription Drug Regulation, Cost, and Access: Current Controversies in Context

New York Times Weddings/Celebrations: Jennifer Cohn, Aaron Kesselheim

Bird flu

CDC: USDA Reported H5N1 Bird Flu Detections in US Backyard and Commercial Poultry

CDC: H5 Bird Flu: Current Situation

"Bird Flu, Explained"

"California suspends distribution of Raw Farm raw milk products after bird flu detection"

"Canadian probe into teen's critical H5N1 infection finds no clear source"

USDA Economic Research Service: Farm Labor

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