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Hard Truths About Addiction | Keith Humphreys, PhD Oct 31, 2024

Show notes

Addiction is often misunderstood not just by the public, but also by clinicians. It challenges us as individuals, families, and communities. To understand addiction is to understand not only human behavior and neuroscience, but also social networks, public policies, and bioethics. Our guest on this episode, Keith Humphreys, PhD, is a psychologist who specializes in addiction and has served on the White House Commission on Drug Free Communities during the Bush administration, and as Senior Policy Advisor to the White House Office of National Drug Control Policy during the Obama administration. His research on recovery support systems like Alcoholics Anonymous and on the opioid crisis has shaped how we understand addiction recovery.

Over the course of our conversation, Dr. Humphreys shares how he became interested in addiction medicine, what happens to our brains when we become addicted, the difficulty of balancing interventions with a respect for patient autonomy, why social networks can be powerful tools in addiction recovery, possible solutions to the opioid crisis, and how clinicians can better establish trust with patients facing addiction.

In this episode, you’ll hear about:

2:36 - How Dr. Humphreys became interested in studying the psychology of addiction

4:34 - The neuroscience of addiction

9:15 - Whether addictive behavior is a matter of personal choice

16:27 - How clinicians can address patients who do not yet recognize their addiction as a problem

21:36 - What GLP-1 inhibitors can tell us about the mechanisms of addiction

26:07 - The benefits of peer support groups (like Alcoholics Anonymous) for addiction recovery

32:55 - Dr. Humphreys' work on drug policy

37:32 - The rise of the opioid crisis

43:05 - Policy models to address substance abuse

48:24 - How medical professionals who are struggling with addiction can seek help

51:25 - Dr. Humphreys' advice for clinicians on how to connect with patients who are struggling with addiction

Dr. Keith Humphreys can be found on Twitter/X at @KeithNHumphreys.

Visit our website www.TheDoctorsArt.com where you can find transcripts of all episodes.

If you enjoyed this episode, please subscribe, rate, and review our show, available for free on Spotify, Apple Podcasts, or wherever you get your podcasts. If you know of a doctor, patient, or anyone working in health care who would love to explore meaning in medicine with us on the show, feel free to leave a suggestion in the comments or send an email to info@thedoctorsart.com.

Social Contagion and the Foundations of a Good Society | Nicholas Christakis, MD, PhD, MPH Oct 24, 2024

Show notes

One of the most fascinating concepts in human health is the idea of social contagion, meaning that emotions, behaviors, and health outcomes can spread through social networks, much like infectious diseases. Examples in the medical literature abound: if a person becomes obese, their friends have a significantly higher chance of becoming obese — even their friends of friends have increased odds of becoming obese. Similarly, someone who quit smoking is likely to create a ripple effect through their social networks, influencing many more people to quit smoking. Social contagion affects life and death itself — after the death of a spouse, the surviving partner's mortality risk increases, and conversely, strong social networks are protective against early death.

Much of the groundwork of our understanding of the powerful health effects of social networks laid by Nicholas Christakis, MD, PhD, MPH, a physician-turned-social scientist who is the author of multiple best selling books, including Apollo's Arrow: The Profound and Enduring Impact of Coronavirus On the Way We Live (2020) in Blueprint: The Evolutionary Origins of a Good Society (2019).

In this episode, Dr. Christakis shares his remarkable path to medicine and sociology, beginning from witnessing his mother's struggle through serious illness, to his foray into palliative medicine, and finally to his life's work on the social, economic and evolutionary determinants of human welfare. We discuss the mechanisms by which social contagion functions, why modern medicine does a disservice to patients by atomizing their medical problems, how the COVID-19 pandemic illustrates the effects of social networks on public health, the philosophical implications of living an interconnected life, and why human beings are wired to build good societies through our capacity for love, friendship and cooperation.

In this episode, you’ll hear about

3:17 - Dr. Christakis’s path to medicine through witnessing his mother’s serious illness

15:05 - How Dr. Christakis became passionate about studying the effects of social networks

24:43 - How social networks affect an individual’s health

31:28 - The negative effects that COVID-19 restrictions had on patients and their loved ones

38:58 - The central thesis of Dr. Christakis’s 2019 book Blueprint: The Evolutionary Origins of a Good Society

50:38 - Dr. Christakis’s thoughts on how to live a meaningful life

Dr. Nicholas Christakis can be found on Twitter/X at @NAChristakis.

Visit our website www.TheDoctorsArt.com where you can find transcripts of all episodes.

How the Internet “Shallows” Your Mind | Nicholas Carr Oct 17, 2024

Show notes

Digital technologies have saturated our lives and there is no going back. Given this, it's worth pondering whether and how they are fundamentally reshaping our mind and our relationships.

A seminal work that explores these issues is the 2010 book The Shallows: What the Internet Is Doing to Our Brains, by journalist Nicholas Carr. In it, he argues that the internet is “shallowing” our brains, meaning that as we offload cognitive tasks to digital tools, our ability to read linearly, to absorb and immerse ourselves in complex information, is reduced. But more than that, the internet curtails our emotional depth and compassion, diminishing our humanity and rendering us more computer-like, as we process information in short bursts, skim for quick answers, and operate with frenetic attention spans. In Carr’s 2014 book The Glass Cage, he discusses how the increasing automation of tasks leads to a decrease in human agency, creativity, and problem solving capability.

In this episode, Carr joins us to discuss the neuroplasticity of the brain, the mechanisms by which digital technologies reduce our ability to think deeply, how the failures of electronic medical records illustrate the limitations of technology, what social media does to our relationships, the value of focused, reflective thought in a fast paced world, what we can all do to remain independent of technology, and more.

In this episode, you’ll hear about:

2:42 - Carr’s path to researching and writing about the human consequences of technology

5:38 - The central thesis of Carr’s 2010 book The Shallows

15:27 - Whether the cognitive impacts of digital technologies are reversible or permanent

21:18 - Whether society is better or worse off due to social media and the internet

25:38 - How modern technology has changed the medical profession

38:22 - Carr’s thesis for his upcoming bookSuperbloom

45:21 - How society can address the loss of focus and empathy that has occurred as a result of social media

Nicholas Carr can be found on Twitter/X at @roughtype.

Visit our website www.TheDoctorsArt.com where you can find transcripts of all episodes.

The Craft of Medical Storytelling | Anna Reisman, MD Oct 08, 2024

Show notes

Medicine is filled with stories that illustrate the most beautiful, devastating, hopeful, and consequential moments of life. But how do we capture these moments and transform them into everlasting lessons that guide us on our search for meaning? That's where the art of storytelling comes in.

Our guest on this episode is Anna Reisman, MD, director of the Program for Humanities in Medicine at the Yale School of Medicine. Dr. Reisman is not only a physician-writer whose essays have appeared in The Atlantic, The New York Times, and other major outlets. She has also dedicated her career to helping clinicians better reflect and write about their experiences.

Over the course of our conversation, we discuss how Dr. Reisman went from being an English major in college to working as a physician, her own experiences with burnout and what helped her overcome it, her approach to creative nonfiction writing, concrete ways that writing sharpens the mind of the physician, and more.

In this episode, you’ll hear about:

2:00 - Dr. Reisman’s path from English major to physician

3:45 - The scope of Dr. Reisman’s current work

8:22 - How Dr. Reisman became involved in medical humanities and how she created a writer workshop at Yale Medicine

14:19 - How writing and the medical profession goes hand in hand

22:49 - The VA Writes reflective writing group

27:56 - Teaching observational skills to medical students in today’s technology-forward landscape

30:25 - How to approach the writing process if you are new to writing

45:57 - What Dr. Reisman wishes she would have known at the beginning of her career

Dr. Anna Reisman can be found on Twitter/X at @annareisman.

A list of Dr. Reisman’s essays can be found on MuckRack.

Visit our website www.TheDoctorsArt.com where you can find transcripts of all episodes.

Burning Out on the COVID-19 Front Lines | Dhaval Desai, MD Oct 01, 2024

Show notes

During the first year of the COVID-19 pandemic, the phrase “Healthcare Heroes” echoed through hospital walls and city streets. For many people, this felt like an overdue acknowledgment of the difficult and important work that healthcare professionals carried out during the most devastating healthcare crisis the world had seen in a century. But this phrase can also be problematic, romanticizing the sacrifices of individual clinicians without addressing the systemic failures that put them at risk, overlooking the mental health struggles they experienced, and undermining healthcare environments that encourage reflection about respect and duty.

Our guest on this episode is Dhaval Desai, MD, a hospitalist at Emory Healthcare in Georgia and the author of the book Burning Out on the Covid Front Lines: A Doctor's Memoir of Fatherhood, Race, and Perseverance in the Pandemic (2023), in which he details his personal narrative as a healthcare leader and frontline physician fighting to hold his hospital together.

Over the course of our conversation, Dr. Desai shares why he decided to train in both internal medicine and pediatrics, how his experiences caring for his ailing father revealed the flaws of our healthcare systems, the nerve-wracking first few months of the COVID-19 pandemic, his own struggles as a leader, healer, father, and husband during a time of deep uncertainty, how we can all better connect with patients through even a few moments of shared humanity amid our busy days, and more.

In this episode, you’ll hear about:

2:36 - Dr. Desai’s path to medicine

5:05 - How a Med-Peds residency differs from other medical residency tracks

8:06 - How Dr. Desai’s personal experiences have shaped his approach to patient advocacy

11:53 - Dr. Desai’s personal and professional life leading up to the COVID-19 pandemic

18:46 - Dr. Desai’s opinion on why it is important for leaders to be able to express emotion

24:53 - How Dr. Desai used his leadership role to help his staff navigate the emotional turmoil of the pandemic experience

28:32 - Moments when Dr. Desai suffered heavily from burnout

34:47 - Stories of the isolating effects of COVID-19 in the ER

39:53 - Our society’s support of healthcare workers

46:19 - Advice for young clinicians on ensuring humanity stays central to their work

Dr. Dhaval Desai can be found on Instagram at @doctordesaimd and on X/Twitter @DrDesaiMDx.

In this episode, we discussed the New York Times article “I Couldn’t Do Anything: The Virus and an E.R. Doctor’s Suicide”

Visit our website www.TheDoctorsArt.com where you can find transcripts of all episodes.

At the Edge of Precision Medicine | Euan Ashley, MBChB, DPhil Sep 24, 2024

Show notes

Precision medicine — the approach to health care that involves tailoring medical interventions to an individual's genetic makeup, environment and lifestyle — promises to deliver the right treatment to the right person at the right time. From preventing diseases decades before they appear, to specially designed cocktails of cancer drugs, to genetic modification of rare diseases, many of these applications sound straight out of science fiction.

At the forefront of precision medicine and medical genomics is Euan Ashley, MBChB, DPhill, Chair of Medicine at Stanford University Medical Center. A cardiologist and intensive care physician by training, Dr. Ashley has pioneered the use of genetic sequencing to identify risk factors for heart disease and new treatments for rare diseases. He is also the author of The Genome Odyssey: Medical Mysteries and the Incredible Quest to Solve Them (2021).

Over the course of our conversation, we discuss his path from growing up in a small Scottish town to now working at the cutting edge of medicine, the excitement and fulfillment he experiences as a clinician in the cardiac intensive care unit, remarkable patient stories of healing and resilience, the future of precision medicine, why he is optimistic about the development of artificial intelligence, and more.

In this episode, you’ll hear about:

2:24 - Dr. Ashley’s path to medicine and to cardiology

7:19 - What life is like working in the CCU

21:34 - How the Undiagnosed Diseases Network was founded and what it does

33:22 - An overview of precision medicine

38:09 - The impact that genetic testing and genomic medicine is having on modern medicine and where it could go from here

45:00 - Dr. Ashley’s thoughts on how AI will change the field of medicine

51:40 - Making access to medical advancements in AI and genomics more equitable

1:04:39 - Dr. Ashley’s advice for healthcare professionals in training

Dr. Euan Ashley can be found on Twitter/X at @euanashley.

Visit our website www.TheDoctorsArt.com where you can find transcripts of all episodes.

From Gunshot Survivor to Trauma Surgeon | Joseph Sakran, MD, MPH Sep 18, 2024

Show notes

Joseph Sakran, MD, MPH was a teenager in a small town in Virginia when, in 1994, his life took a dramatic turn. At the age of 17, he was out with his friends after a high school football game when a nearby gunfight broke out and he was struck by a stray bullet in the throat. The bullet, tearing through his windpipe and a carotid artery, brought him to the razor edge of death before he was saved by trauma surgeons.

Thirty years later, Dr. Sakran is now a trauma surgeon who serves as Director of Emergency General Surgery at the Johns Hopkins Hospital in Baltimore and a vocal advocate of reducing firearm injury through public health initiatives at the state and national levels. Following the 2018 comment by the National Rifle Association that doctors should “stay in their lane” with regard to gun violence prevention, Dr. Sakran started the #ThisIsOurLane movement, mobilizing thousands of health care professionals to advocate for gun violence as a public health crisis.

Over the course of our conversation, Dr. Sakran shares his harrowing experience of being shot and what it was like to be confronted with imminent death, how his perspectives on and priorities in life changed after the incident, what goes on in his mind when he operates on victims of gun violence, how he connects with his patients over shared experiences of trauma, how all clinicians can be more empathetic with their patients, and why advocacy is integral to the work of a physician.

In this episode, you’ll hear about:

2:46 - How a personal tragedy set Dr. Sakran on the path to becoming a trauma surgeon

9:51 - How Dr. Sakran’s perspective on life was altered by his personal experience with gun violence

13:11 - How Dr. Sakran’s experiences informs his approach to speaking with patients and their loved ones during traumatic situations

19:09 - The importance of showing empathy to build rapport with patients and families

23:51 - What it is like to tend to victims of violence

29:26 - Addressing the public health crisis of gun violence in America

37:41 - How clinicians can become more involved in advocacy

45:32 - Dr. Sakran’s advice to future clinicians

Dr. Joseph Sakran can be found on Twitter/X at @josephsakran.

Visit our website www.TheDoctorsArt.com where you can find transcripts of all episodes.

The Link Between Love and Loss | Rachel Clarke Sep 10, 2024

Show notes

To the best of our knowledge, humans appear to be unique among animals in our awareness of mortality — at least in our capacity for existential reflection about death in an abstract, cultural, and symbolic sense. With this capacity comes profound psychological experiences, from our search for meaning, to our struggle with grief, to a yearning for the spiritual.

Our guest on this episode is Dr. Rachel Clarke, a palliative care physician based in the United Kingdom who entered medicine after an initial career in journalism. As she would discover, her love for language and storytelling has turned out to be one of the most important ways she helps patients heal in some of the most devastating moments of their lives. As a writer. Dr. Clarke is the author of multiple best selling books, including Dear Life: A Doctor's Story of Love and Loss (2020), Your Life in My Hands: A Junior Doctor's Story (2017), and Breathtaking (2021), which was adapted into a TV series of the same name. Her writing, imbued with both grace and grit, invites readers to confront difficult truths about mortality, suffering, and the inequities of the healthcare system, while also offering a vision of medicine that is as deeply human as it is healing. Over the course of our conversation, we discuss her journey to medicine by way of journalism, her reflections on the moral imperatives that drive her work, the power of storytelling in comforting patients, why suffering is inextricably connected to love, and more.

In this episode, you’ll hear about:

3:12 - Why Dr. Clarke switched careers from journalism to palliative care

9:46 - The challenge modern doctors and patients face when it comes to thinking about mortality

15:09 - Supporting a patient’s psychological suffering through conversation

20:31 - Grappling with what Dr. Clarke calls the “essential paradox of being a human being” — our awareness of mortality

33:41 - The experience of watching a person die and the reverence we hold for the bodies of the dead

43:05 - The doctor’s dual responsibilities of navigating both science and human emotions

Dr. Rachel Clarke is the author of four books, including most recently, The Story of a Heart (2024).

Dr. Clarke can be found on Twitter/X at @doctor_oxford.

Visit our website www.TheDoctorsArt.com where you can find transcripts of all episodes.

Food for Thought | David Perlmutter, MD Sep 03, 2024

Show notes

Modern medicine has long considered many neurodegenerative diseases such as Alzheimer's disease and Parkinson's disease to be immutably linked to the fate of certain unlucky individuals through yet-poorly understood genetic mechanisms. But increasingly, we are seeing evidence that some of our lifestyle choices, including our diet, physical activity, and relationships, may play a significant role in the development of, or protection against, these diseases. Our guest on this episode, David Perlmutter, MD, is a neurologist and writer whose immensely popular books, including Grain Brain: The Surprising Truth About Wheat, Carbs, and Sugar — Your Brain’s Silent Killers (2013), discuss why diets low in refined carbohydrates and high in fats, in addition to foods that nurture a healthy gut microbiome, may prevent cognitive decline.

Over the course of our conversation, we discuss Dr. Perlmutter's path from conventional neurology to moving towards a more functional and holistic approach to treating brain disorders, the importance of metabolic health in maintaining our cognitive capacities, how Dr. Perlmutter responds to critics of his non-conventional medical advice, why nutrition science is riddled with messy and conflicting findings and how we can better navigate through it all, what clinicians can do to better help their patients live well, and more.

Note: Some of Dr. Perlmutter’s ideas and recommendations have been the subject of debate and controversy within the medical community. While we believe in fostering open dialog and exploring diverse perspectives, the views expressed in this episode are those of Dr. Perlmutter and do not necessarily reflect the views or endorsements of this podcast. We encourage listeners to critically evaluate the information presented and work with qualified healthcare professionals when making any changes to their health and wellness routines.

In this episode, you’ll hear about:

3:11 - Dr. Perlmutter’s transition from conventional neurology to what he calls “preventative” neurology

8:43 - Dr. Perlmutter’s views on what constitutes a “disease” and the role of the doctor.

19:08 - Emerging science on the importance of metabolic health on brain health

25:17 - How scientific studies on preventative health can be (and have been) designed

34:56 - Why Dr. Perlmutter prioritizes health markers (such as HbA1c) over specific dietary recommendations when working with patients

42:21 - Dr. Perlmutter’s views on GLP-1 antagonists such as Ozempic and Mounjaro

50:36 - How Dr. Perlmutter has dealt with critics of his work

Dr. David Perlmutter is the author of eight books.

Dr. Perlmutter can be found on Twitter/X at @davidperlmutter.

Visit our website www.TheDoctorsArt.com where you can find transcripts of all episodes.

A Physician to the Soul | Miroslav Volf Aug 27, 2024

Show notes

What makes a life worth living? This question has animated great thinkers and faith traditions for millennia. Interestingly enough, in our time of rapid globalization, technological advancement, and material abundance, we often seem more unmoored from our conception of the self and its relation to the world than ever before.

Our guest on this episode, Miroslav Volf, has spent his life wrestling with this question of questions and helping others to do the same. Volf is a professor of theology at Yale Divinity School and founding director of the Yale Center for Faith and Culture, and his work explores the intersections of faith, identity, and public life. He is the author of more than 10 books, including the bestselling Life Worth Living: A Guide to What Matters Most (2023), based on one of the most popular courses at Yale University, which he co-teaches. The book, an inquiry into the nature of human flourishing, invites readers to consider wisdom drawn from various religious, philosophical, and literary traditions. He challenges the often superficial metrics of happiness promoted by modern society, urging readers to reflect deeply on the kind of life they want to lead — one that is not just pleasurable or successful by conventional standards, but that is positively shaped by adversity, contemplation, and interconnectedness.

In our conversation, we discuss how growing up as the son of a Pentecostal minister in Former Yugoslavia influenced Volf's relationship with Christian theology, why faith is a “comfortably difficult” thing, why “finding your authentic self” is a problematic concept in modern culture, how social media, divisive political currents, and the relentless drive for productivity distract us from what matters most, and the nobility in pursuing a richer, more intentioned, and just life.

In this episode, you’ll hear about:

3:12 - What Volf’s work as a systematic theologian entails, and key childhood experiences that shaped his relationship with faith

12:18 - The philosophical basis for the Yale class that inspired the book Life Worth Living

20:23 - Why Volf uses Smokey Bear as a representation of the pursuit of a meaningful life

26:53 - Shifting the focus of life from personal desires toward the quest to live by “truth”

40:38 - The inherent challenge in shifting focus away from “I, Me, and Mine”

45:49 - How the search for a meaningful life relates to the experiences of a medical professional

51:42 - Advice for how to add philosophical practices to a busy modern life

Miroslav Volf is the author of 17 books, including Life Worth Living (2023)

Past episodes discussed in this episode:

Episode 95: Shaping a Soul, Building a Self | William Deresiewicz

Episode 21: Pain, Pleasure, and Finding Balance | Anna Lembke, MD

Visit www.TheDoctorsArt.com for transcripts of all episodes. If you enjoyed this episode, please subscribe, rate, and review our show, available for free on Spotify, Apple Podcasts, or wherever you get your podcasts. If you know of anyone working in health care who would love to explore meaning in medicine with us on the show, send an email to info@thedoctorsart.com.

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