This Podcast Will Kill You

This pandemic has certainly taken its toll on all of us, but one group that has been particularly hard hit are those who have been on the front lines, continuing to take care of patients even when PPE was running low or nonexistent, even when there were no more ICU beds available. During both non-pandemic and pandemic times, physicians and other healthcare workers experience a tremendous deal of stress and pressure that can lead to depression, isolation, anxiety, moral injury, and other mental health issues. In this episode of our Anatomy of a Pandemic series, we seek to understand the factors contributing to the prevalence of these mental health issues among healthcare workers, the stigma that often prevents the seeking of treatment, the role that the COVID-19 pandemic has played in exacerbating these issues, and the ways in which the medical system has done or can do better. We are very excited to be joined by Michael Myers, MD (interview recorded March 29, 2021), psychiatrist and Professor of Clinical Psychiatry at SUNY-Downstate Health Sciences University in Brooklyn, NY and author of several books, including his latest, Becoming a Doctors’ Doctor: A Memoir.

As always, we wrap up the episode by discussing the top five things we learned from our expert. To help you get a better idea of the topics covered in this episode, we’ve listed the questions below:

1. How did you become interested in the field of physician mental health, and what made you choose to pursue it?
2. Can you talk us through some of the challenges healthcare workers face and what impact they have on their mental health? Does this field experience things such as depression, anxiety, substance abuse, and suicide at higher rates than the general public?
3. What does the stigma surrounding mental illness look like in the medical field and how does it contribute to the high rate of mental health issues in healthcare workers?
4. Can you talk a bit about where these mental health issues among healthcare workers originate and how each step of medical training and beyond contributes to the problem?
5. How much of this is a problem unique to the US and how much of it is universal?
6. What are some of those changes you have seen throughout your thirty-five year career as a psychiatrist primarily treating other physicians? How have we gotten better, and what are the areas in which we have failed to make improvements?
7. How do these public health crises, especially COVID-19, amplify the issues that physicians are already facing in terms of mental health?
8. Can you talk a bit about the “healthcare heroes” narrative and how damaging it can be?
9. What is some of the fallout you think we can expect to see in the long-term from the COVID-19 pandemic?
10. As family members or friends or partners of healthcare workers, what are worrying signs that we can look out for? How do we recognize these signs in ourselves as well?
11. For those who maybe have friends or partners or family members who are frontline health workers, what are some of the ways in which we can help and provide meaningful support during these times as well as in non pandemic times?
12. What do you feel are the biggest failings of the medical system in terms of emotional and mental health support for those in medicine? How can we begin to change things? What role should medical school play? Hospitals? Other physicians?

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In this classic TPWKY episode we travel down rivers and into worm-laden nodes as we take a look at the complex world of Onchocerca volvulus, the vector-borne parasite that causes river blindness. Join us as we learn why the name ‘river blindness’ captures only one dimension of the devastation caused by this parasite, how the short evolutionary history of this worm is at once surprising and enlightening, and why grasping the disease ecology of this system has been crucial in successful control efforts. As a bonus, if you tune in, you’ll get to hear how on earth The J. Geils Band fits into this story and the integral role that dog digestion has played in the history of this parasite.

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The COVID-19 pandemic has disproportionately impacted racial and ethnic minorities, especially here in the United States. Higher infection, hospitalization, and death rates due to COVID-19 have been observed for historically marginalized groups, and the harmful effects stem beyond those relating to health, with higher unemployment and food and housing insecurity also reported. Yet these disparities did not emerge anew from this current pandemic; rather, this pandemic has served to amplify existing structural inequalities in the healthcare, educational, legal, and housing systems, among others. In this episode of our Anatomy of a Pandemic series, we explore the deeply entrenched roots of racial disparities in the US, how our narrow focus on outcomes often fails to capture the complex causes of inequalities, and ways in which we can begin to work towards health equity in this country. We are so thrilled to be joined by Harriet Washington (@haw95) (interview recorded March 10, 2021), writer and medical ethicist, whose groundbreaking work on this subject through books such as Medical Apartheid, A Terrible Thing to Waste, Carte Blanche, and others has led to much-deserved critical acclaim.

As always, we wrap up the episode by discussing the top five things we learned from our expert. To help you get a better idea of the topics covered in this episode, we’ve listed the questions below:

1. Can you tell us a bit about your new book, Carte Blanche: The Erosion of Medical Consent, and what inspired you to write it?
2. Although health disparities have been around forever, it was only within the last few decades that the term itself was coined, and it’s often only vaguely defined. Would you mind describing what we mean when we talk about health disparities?
3. Can you talk a bit about how it’s not just being able to go to a doctor or afford a doctor, but how things like access to education, chronic stress, and environmental justice interact with and compound each other when it comes to health disparities?
4. What are some of the different ways that we measure health disparities? 
5. Can you talk about why it is important to understand the context of these disparate outcomes? 
6. Can you talk about the disproportionate impact that COVID-19 has had on communities that were already facing significant barriers to healthcare?
7. How has the narrative of ‘race-based medicine’ shown up in discussions of the disproportionate impact of COVID-19 on certain groups of people?
8. How can we increase health equity in this country? What can we do at an individual level to help, and what are some policies at the state or national level that could help narrow this gap?
9. How can the medical establishment work to earn back the trust of these communities that we have historically disenfranchised (and in many ways continue to disenfranchise) when it comes to health?

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Of the many topics our podcast has covered in the past, from smallpox to scurvy, vaccines to birth control and beyond, one factor has linked nearly all of them: HeLa cells. These cells and the woman from whom they were taken have often remained behind the scenes in the coverage of these topics, but they have nevertheless been absolutely fundamental in the development of technologies, the advancement of knowledge, and the discussions of ethics, ownership, and informed consent. In this week’s episode, we want to do more than acknowledge the contribution of Henrietta Lacks and her cells to the field of biomedical science. We want to explore what it is about HeLa cells and other cell lines that makes them ‘immortal’. We want to learn what Henrietta was like as a person. We want to ask how it was possible for her cells to be taken from her without her consent or knowledge. And we want to share the tremendous impact Henrietta and her cells have made and continue to make on our world in so many ways.

For more information about the Henrietta Lacks Foundation, check out the website.

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We’re over a year into the COVID-19 pandemic, and our understanding of this virus and the disease it causes has grown immensely. And while we’ve learned so much about the spectrum of disease severity, the wide array of symptoms, and the effectiveness of various treatments, there is still so much we are discovering about this illness. In this installment of our Anatomy of a Pandemic series covering the COVID-19 pandemic, we review what we currently know about the disease caused by the SARS-CoV-2 virus as well as emerging questions such as what exactly is long COVID or how well do vaccines work against the new variants? To take us through this massive topic, we enlisted the help of two experts, Dr. Krutika Kuppalli (@KrutikaKuppalli), infectious diseases physician and assistant professor at the Medical University of South Carolina (also featured in Ch. 3: Control of this series), and Dr. Jason Kindrachuk (@KindrachukJason), assistant professor and Canada research chair in molecular pathogenesis and emerging viruses at the University of Manitoba (interview recorded March 16, 2021). As always, we wrap up the episode by discussing the top five things we learned from our experts. To help you get a better idea of the topics covered in this episode, we’ve listed the questions below:

1. How much does the infectious dose, or the amount of virus a person is exposed to, play a role in whether they will get the disease and/or how severe the disease might be?
2. How soon after being exposed does someone become infectious and how does that infectivity change over the course of infection?
3. How much does infectiousness or viral shedding vary across disease severity? Are people who are severely infected more contagious than those who are asymptomatic?
4. Could you walk us through the spectrum of COVID-19 in terms of symptoms or clinical observations, touching on first asymptomatic, then mild, then moderate or severe cases? What proportion of cases are severe vs mild vs asymptomatic?
5. How much do symptoms or the general course of disease vary from person to person? How predictable is this virus?
6. Can you talk about some of the lingering effects of infection and how frequently long COVID seems to occur?
7. How has our estimate of the case fatality rate changed over this pandemic?
8. Can you talk about some of the risk factors that seem to be associated with severe infections? Is there any link between blood type and risk of infection?
9. What do we know about pregnancy and infection with COVID-19? Do risks regarding pregnancy vary depending on when during pregnancy someone may be exposed or infected? 
10. What do we know about the duration or nature of immunity and the risk of reinfection?
11. How has treatment for COVID-19 cases changed throughout this pandemic? Are we any better at treating patients with severe cases now than we were eight or so months ago?
12. What do we know at this point about the vaccine candidates in terms of their effectiveness against new variants that have emerged? What does it mean if these vaccines are slightly less effective against some variants than others?
13. What do the latest studies show about vaccines preventing asymptomatic as well as symptomatic infection?
14. What is something you hope to take away from this pandemic, either on a personal level or as a society?

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Despite being one of the earliest recognized genetic diseases, many aspects of Huntington’s disease remain shrouded in mystery. This stems in part from our limited grasp on how our own minds work but also from the dark history of Huntington’s disease and the shame and silence that accompanied it for so long. In this episode, we attempt to bring what we know about Huntington’s disease into the light, to talk frankly about the characteristics and progression of this hereditary disease, the role of eugenics in creating and promoting the stigma surrounding it, the ethical considerations surrounding genetic testing, and the medical and scientific advancements that give us reason to hope. And we are so grateful to the provider of our firsthand account for sharing their perspective on what it’s like to be diagnosed with this disease. Tune in for all this and more.

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Don’t be daunted by the length of this disease name or just how difficult it looks to pronounce. By the end of the episode, you’ll be saying it right along with us, and bonus, you’ll also be armed with a whole bunch of excellent trivia about this fascinating fungal disease. In this episode, we dive right into all things coccidioidomycosis, also known as Valley fever, which also happens to be the first human fungal pathogen we’ve covered. We’ll walk you through its unusual dual natured lifecycle, its somewhat recent but surprisingly rich history, and the present threat it poses, especially in light of climate change and the United States prison system. This fungus is much more amongus than you may have suspected. We are also so lucky to be joined by Tori, who shared with us her firsthand account of contracting this fierce fungus.

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The world of human papillomaviruses is vast and varied, and causing cervical cancer is just one of the many roles these viruses can take on. From their carcinogenic tendencies to their more benign wart-forming ways, this episode explores what these tiny viruses have taught us about how our bodies prevent cancer, how imaginative old timey cures for warts can be, how slow acceptance of the facts and a failure in marketing led to a delayed and impaired vaccine uptake, and so much more. You could say we’re covering all aspects of this highly-requested topic, warts and all. The historical stigma of cancer as a “woman’s disease”? Check. What’s actually inside a wart? Check. The possible origins of a mythical creature? Check. The massive disparity in vaccine access between high- and low-income countries? Check. Tune in to hear it all.

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From the first skin grafts to the future of 3D printed organs, the science of organ transplantation has always seemed like something out of a sci-fi novel. How on earth can an organ from one person be removed and successfully placed into another person? Who first attempted such a monumental feat, and how long did it take for trial and error to become trial and success? Our episode this week seeks to answer these questions and so many more as we tackle the massive topic of organ transplantation. We begin by examining the immunological nitty gritty of transplant science and follow that up with the long and storied history of transplants. We round things out with a look at the numbers, which show the unfortunate reality that demand far outpaces availability, a reality that may soon be improved with innovative approaches towards bioengineering. And we are so excited to be joined by two fantastic guests, Carol Offen and Dr. Elizabeth (Betsy) Crais, who share their stories of what it’s like to donate or receive a kidney. 

Carol, who is a NKF Kidney Advocacy Committee member, has a great website that includes many resources where you can learn more about kidney donation as well as keep an eye out for Carol and Betsy’s book, The Greatest Gift: The Insider’s Guide to Living Kidney Donation. You can also follow Carol on Twitter (@CarolOffen) and through heradvocacy page on Facebook. We will also post additional links for where to learn more about organ donation and advocacy work on our website.

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Here’s a pop quiz for all of you: what disease makes you sweat profusely, run a slight fever, develop body aches and a pounding head and then makes you drop dead within hours of symptom onset? If you answered “I have no idea”, you passed! Because we haven’t a clue either. In this episode, we attempt to tease apart the mysterious sweating sickness, which struck only five times in the 1400s and 1500s in England, leaving in its wake terror, confusion, and a trail of bodies. Although the sweating sickness has not been seen since (or has it?), scientists and scholars continue to investigate this mysterious illness and propose various pathogens as the likely causative agent. Tune in to hear us go through the most popular explanations to see if we can form our own consensus on ‘the sweat’.

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