First Opinion Podcast

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80: Is the medical system ready for Alzheimer's drugs that work? Jul 05, 2023

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Physician and professor Jason Karlawish argues that new promising drugs like lecanemab, an anti-amyloid antibody expected to be approved by the FDA July 6, will introduce complicated issues into the field of Alzheimer's care. These medications require a great deal of testing and patient monitoring, trained physicians, and other resources in a system that is already stretched thin.

79: Cancer drug shortages should be causing more outrage Jun 28, 2023

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Drug shortages are a growing problem in the U.S., and a shortage of live-saving cancer drugs has reached crisis levels. Oncologist Kristen Rice explains that drug shortages have been happening for several years but have been getting progressively worse in the last few months. Oncologists are facing critical shortages of common, generic cancer medications and have even begun to ration care for certain patients who are able to delay treatment, according to Rice.

78: How to save PrEP access — and even expand it Jun 21, 2023

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Under the Affordable Care Act, health insurers are required to cover all costs associated with preventive care — including PrEP, or pre-exposure prophylactic treatment for HIV. But now all preventive care coverage is under threat, thanks to a lawsuit filed by employers who believe they shouldn’t be required to pay for care that violates their religious beliefs. While coverage for PrEP access largely unchanged as the court case makes its way through the legal system, Richard Hughes IV, a partner with the law firm Epstein Becker Green, says that protecting the status quo isn’t enough.

77: Physicians have an obligation to get into "good trouble" Jun 14, 2023

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Just days after the end of Roe v. Wade, Caitlin Bernard, an OB/GYN in Indiana, told the Indianapolis Star a heartbreaking story: She had recently been asked to perform an abortion on a 10-year-old Ohio girl who had been raped. In late May, the Indiana Medical Licensing Board held a hearing on Bernard. While they did not revoke her license, they fined Bernard $3,000 and issued a letter of reprimand, saying that by speaking out, she had violated the 10-year-old girl’s privacy. This week, Gabriel Bosslet and Tracey Wilkinson, who are both friends and colleagues of Bernard, talk about her story, its lessons for physicians, and why advocacy is a professional responsibility.

76: Why forced treatment can't fix substance use disorder Jun 07, 2023

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When a loved one is living with serious substance use disorder and refuses to get help, sometimes it seems like the only solution is to force them into it. In many states, people can be “arrescued” — that is, forced under penalty of law into a treatment program that is nearly identical to being incarcerated, down to orange jumpsuits. But Sarah Wakeman, an addiction medicine physician, says that while she understands the love that makes people see involuntary treatment as a solution, it doesn’t actually work.

75: Ezekiel J. Emanuel explains why cancer patients shouldn’t pay out-of-pocket costs May 30, 2023

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The high cost of cancer treatment in the U.S. is literally killing people. “Over a quarter of cancer patients delay medical care, go without care, or make changes in their cancer treatment because of cost,” Ezekiel J. Emanuel, an oncologist and co-director of the Health Care Transformation Institute at the University of Pennsylvania, wrote in a recent First Opinion essay. But Emanuel says there’s a solution: Cancer patients shouldn’t have to pay any out-of-pocket costs for their treatment, especially in the first (and typically most expensive) year after diagnosis.

74: How 'screen and refer' systems fail to help patients May 24, 2023

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We've all had the experience of a clinician staring at screen while asking us sensitive questions to fill out our electronic health records. But that frustrating experience is made even worse by a new trend in health care. As Sanjay Basu wrote in a recent First Opinion, hospitals are using so-called "screen and refer" systems to identify people with social needs, like those who are experiencing domestic violence or hunger. The idea is that workers ask patients about their needs, then refer them to organizations such as food banks that can help. But according to Basu, a primary care provider, these well-intended efforts are instead dehumanizing and ineffective for patients, and burdensome for the organizations buried by referrals.

73: Do chatbots have more time to be empathetic than physicians? May 17, 2023

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As an oncologist, Jennifer Lycette gets to know her patients particularly well. She’s doubtful that artificial intelligence could replace that personal connection, but new research based on, of all things, Reddit Q&As, says otherwise. New study findings raised questions about the potential for using chatbots, like ChatGPT, to help physicians answer questions submitted from patients through electronic medical records — a task that can take hours of stolen, rushed time between appointments at the clinic.

72: The coercion built into medical privacy consent forms May 10, 2023

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Alex Rosenblat is particularly careful when it comes to her digital privacy. She requests to fill out paper forms instead of digital ones; she documents and tracks what she signs. But even her diligence can't always save her. Rosenblat recently spent months retracing her digital steps after Phreesia, a company that collects demographic information, claimed to have her authorization to share her data — authorization she knew she hadn't consented to. This week, Rosenblat talks to host and editor Torie Bosch about tracking down her own information and the amorphous harm caused by invasions of privacy.

71: Two medical residents debate their hospital's unionization drive May 03, 2023

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In training to become a physician, medical residency can be a grueling period. Now, medical residents across the country have begun fighting to unionize their ranks. In Boston, residents at Massachusetts General Brigham — a major medical system — recently garnered enough votes to file for a union election. In her first episode as host of the "First Opinion Podcast," editor Torie Bosch speaks to two MGB residents, Minali Nigam and David Bernstein, with differing opinions on the best next step forward for their cohort.

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