In February 2012, Paul Volkman was sentenced to four consecutive terms of life imprisonment for his role in illegally prescribing and dispensing pain medications that resulted in the deaths of several individuals in his care. This was a remarkable case, both in terms of the lengthy sentence as well as the perpetrator. Paul Volkman was a highly-educated physician researcher, who earned both his MD and PhD and had decades of experience practicing medicine. How did he end up in a cash-only pain clinic in southern Ohio? In this TPWKY book club episode, journalist Philip Eil joins me to trace Volkman’s journey as outlined in Eil’s book Prescription for Pain: How a Once-Promising Doctor Became the “Pill Mill Killer”. Eil places Volkman’s actions in the broader context of the opioid epidemic and reflects on the lasting impact Volkman’s case has had on painkiller regulation and the communities most impacted by his crimes. Tune in for a fascinating conversation about what happens when a doctor decides he is above the law.

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For decades, it seemed like the appendix would go the way of 8-track players, pagers, and the phonograph. Outdated, obsolete, not worth keeping around. Surgeons performed appendectomies like it was spring cleaning - when in doubt, cut it out. But then the tides began to turn as medicine started to question the long-held belief that the appendix is a defunct organ (on a good day) or a ticking time bomb (on a very bad one). In this episode, we trace the story of the appendix from its earliest descriptions to the latest advancements in treatment of appendicitis. If you’ve ever wondered whether the appendix actually serves any function and what that function might be, then this is the episode for you!

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Among the many conditions that creep under your skin and make scratching irresistible, scabies alone holds the honor of being called simply “The Itch” for centuries. In this episode, we examine how the burrowing scabies mites cause this extremely uncomfortable sensation, what we can do to halt their progress, and how contagious they really are (less than you probably think). Today, the word scabies instantly conjures up images of the mite responsible for The Itch, but for centuries, medicine failed to make that connection, even when the proof was right in front of them and when traditional wisdom had long since known mite=scabies. Tune in to learn how the great scabies debate was finally resolved with a public demonstration, what role conscientious objectors played in scabies research during WWII, and where we are with scabies around the globe today.

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A mere 150 years ago, uttering the words “scarlet fever” was enough to strike fear into the hearts of many, especially parents of young children. For a brief period of time, this disease, caused by an infection with the bacterium Streptococcus pyogenes, reigned as a leading cause of childhood death in many parts of the world. It left its mark on gravestones, in public health decrees, in literature like the Velveteen Rabbit, but then something changed. The disease became milder, no longer the deadly threat it once was. But it didn’t go away entirely or lose its bite completely. In this episode, we examine the biology of scarlet fever and trace how it can make you sick before exploring its strange and tragic history. How did such a deadly disease change almost overnight, before any effective treatment was developed? And what can that tell us about its potential to change back? Tune in to find out.

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We really don’t give fungi the credit they deserve. Over the years of this podcast, we’ve covered only a handful of fungal pathogens, and pathogenic fungi themselves represent a teeny tiny proportion of the incredible diversity of fungal life on this planet. But with this book club episode, we’re attempting to correct this oversight, at least a little bit. Toxicologist and science writer Dr. Emily Monosson joins us to discuss her book Blight: Fungi and the Coming Pandemic. We chat about how fungal epidemics have shaped entire ecosystems, altered economies, and invaded hospitals. Despite the devastating impact pathogenic fungi have made, we still underappreciate their potential to cause harm in the future, as our climate changes, as our land use changes, and as globalization continues. In Blight, Monosson delivers an important reminder that we should use what we have learned about these historical outbreaks to limit the harm fungi may cause in the future. Tune in today to gain a new appreciation for this incredible group of organisms.

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That same little bottle of retinol serum sitting on your bathroom counter - how does it work? Does it actually work? Those are the questions we’re taking on in part two of our retinoids two-parter. The answers, as you might expect, are complicated. Because as it turns out, “retinoid” is a catch-all term for a bunch of different types of compounds, all of which work in slightly different ways. And on top of that, the testing required to demonstrate efficacy isn’t exactly held to the highest of standards. But we do the best with what we have to get to the bottom of this retinoid puzzle. Tune in to learn everything you ever wanted to know about retinoids.

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That little bottle of retinol serum sitting on your bathroom counter - what do you know about its history? This week, we’re digging deep into the man behind the medicine, renowned dermatologist Dr. Albert Kligman, and the unethical research he conducted at Holmesburg Prison in the mid-20th century. Kligman’s research program at Holmesburg spanned decades, involved dozens of experiments (including tretinoin) and thousands of individuals, received ample funding from public universities and many pharmaceutical companies, and was generally praised until it all came crashing down in the early 1970s. But, as we’ll discover, the unethical behavior persisted even after the program’s closure as Kligman fought to get tretinoin to market. The murky history of retinoids might be a bit too long to include on the label, but this episode forces us to consider the human cost of a household product and the importance of acknowledging that history.

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When the Massachusetts Institute of Technology admitted in 1999 that they had discriminated against women on its faculty, it sent shockwaves throughout institutions of higher learning across the country. In this TPWKY book club episode, Pulitzer Prize-winning journalist Kate Zernike joins us to discuss her book The Exceptions: Nancy Hopkins, MIT, and the Fight for Women in Science, which details the sequence of events that led sixteen scientists to demand the equality that had been denied to them for so long. Zernike, who was one of the reporters to break the story in 1999, centers this story on molecular biologist Dr. Nancy Hopkins, who, armed with a tape measure, brought this history of marginalization to light. Simultaneously personal and panoramic, The Exceptions carefully illustrates the sexism entrenched in higher education and academia and sends an important message: this problem is far from solved. Tune in for a fascinating discussion about an infuriating topic.

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Stiff person syndrome, like many rare diseases, does not get nearly the same amount of screen time or name recognition that other, more common diseases do. For many people, Celine Dion’s announcement of her diagnosis with the condition in 2022 marked the first time they had heard of it. This limited awareness surrounding stiff person syndrome marks just one of the many challenges keeping this disease and other rare disorders in the dark. In this episode, we attempt to shed some light on stiff person syndrome, exploring the complex biology, frustrating history, and hopeful future of this disease. Because while the field of stiff person syndrome research faces many hurdles, there are also so many individuals - researchers, patients, advocates - and organizations that fight to bring this and other rare disorders into the light. Tune in today!

Links:

National Organization for Rare Diseases

Genetic and Rare Diseases Information Center

Johns Hopkins Stiff Person Syndrome Center

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Five years ago, we asked you all to ask us anything, and you delivered. We answered dozens of listener questions, like how we first met, our favorite quarantinis, where we were in our career journeys, and so many more. But in the years since that first “ask us anything”, a lot has changed for both of us! So we’re coming back to you with the answers to more of your probing questions, like “what disease names would make good person names?”, “where are you in the world these days?”, “if you could have only one sandwich for the rest of your life, what would it be?” and a million more, ranging from serious to silly and everywhere in between. Tune in for a non-stop, self-indulgent Ask the Erins!

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