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Inside the World of Outbreak Response | Syra Madad, DHSc, MSc, MCP Aug 22, 2024

Show notes

Most people shudder at the idea of an infectious disease outbreak — patients stricken with a mysterious illness, hospitals overflowing, and cities going into lockdown. But for Syra Madad, DHSc, MSc , MCP, rushing into such a scenario, donned in a hazmat suit, to control the chaos has been a dream since childhood. Today, she is an epidemiologist, biosecurity advisor, and a pathogen preparedness expert who serves as Senior Director of the System-Wide Special Pathogens Program at New York City Health and Hospitals, which operates the municipal health care system of New York City.

Over the course of our conversation, Dr. Madad shares what excites her about the work of infectious disease control, why she believes we have emerged from the Covid-19 pandemic worse prepared for the next pandemic, how scientists and doctors can better communicate with the public in the absence of clear data, the importance of utilizing trusted messengers in the community to fully deploy the power of public health, and more.

In this episode, you’ll hear about:

2:09 - How a movie led Dr. Madad to become an infectious disease preparedness expert

6:54 - An overview of Biosafety levels (BSL)

9:30 - Moments in Dr. Madad’s career when disease containment went well and moments when it did not.

12:27 - How Dr. Madad mentally and emotionally manages the heavy weight of often-lethal infectious diseases

18:05 - Dr. Madad’s opinion on how COVID-19 policies were handled

24:02 - Dr. Madad’s personal thoughts on the potential origins of COVID-19

26:55 - What concerns Dr. Madad most about future pandemics and how we can make positive steps toward recovering trust in science

35:40 - Dr. Madad’s advice for those considering a career in public health or infectious diseases

Dr. Syra Madad appears in the Netflix special Pandemic: How to Prevent an Outbreak.

Dr. Syra Madad can be found on Twitter/X at @syramadad.

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.

Finding the Right Words When It Matters Most | Shunichi Nakagawa, MD Aug 13, 2024

Show notes

For many physicians, having serious illness conversations with patients — talking about a dire prognosis or the futility of curative treatments — is one of the most daunting aspects of patient care. But to palliative care physician Shunichi Nakagawa, MD, these conversations are fundamentally about communicating the honest truth in an elegant, considerate, and humane way.

Dr. Nakagawa, the director of the Inpatient Palliative Care Service at Columbia University Medical Center, joins us in this episode to discuss both his unique personal journey, as well as his insightful approach to figuring out what really matters to patients during critical moments in their lives. He shares what it was like completing his surgical training in Japan, than coming to the United States with the hope of becoming a liver transplant surgeon, before having those hopes dashed when he found out he was ineligible to work as a surgeon in the US due to his hepatitis carrier status, and finally discovering his true calling in geriatrics and palliative care.

We also discuss cultural challenges in thinking about the end of life, why it is so difficult for physicians to communicate with their patients about serious illness, how clinicians ought to approach shared decision making, and why, when done well, this can be one of the most meaningful and rewarding parts of doctoring.

In this episode, you’ll hear about:

2:34 - How Dr. Nakagawa entered a career in medicine in Japan

5:33 - Dr. Nakagawa’s unique journey through medical training, from surgery to palliative care

16:25 - The three-stage process that Dr. Nakagawa follows when communicating challenging medical information to patients

28:10 - Delivering medical advice in a succinct way when speaking to patients and their family members

36:14 - Lessons on what works and what doesn’t work in sensitive patient communication

Dr. Shunichi Nakagawa can be found on Twitter/X at @snakagawa_md.

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

Impossible Foods — Feeding the Future | Pat Brown, MD, PhD Aug 06, 2024

Show notes

When Impossible Foods released its first product, the Impossible Burger, in 2016, it was met with equal parts curiosity, skepticism, and excitement. This plant-based “meat that bleeds” was seen as a novelty item. Today, Impossible Foods’ expanded line of offerings, from sausages to chicken nuggets to Italian meatballs, can be found in most American grocery stores at a price that rivals traditional meats.

The founder of Impossible Foods is Pat Brown, MD, PhD, a physician and molecular biologist who, after seeing the detrimental impact of animal farming on deforestation, water pollution, and greenhouse gas emissions, made it his ambitious mission to create a sustainable food system by reducing our reliance on animal agriculture. He set out to develop plant-based alternatives to meat that not only matched, but surpassed the taste and nutritional value of traditional meats, harnessing biochemistry to recreate the sensory experience and culinary qualities of meat at a molecular level.

In this episode, Dr. Brown joins us to share his early career path from clinical pediatrics to biochemistry research, along the way inventing the DNA microarray, now an essential laboratory tool used to measure the expression levels of thousands of genes. He then discusses the origins of Impossible Foods, the scientific breakthroughs that have propelled its success, and how he hopes to inspire a cultural shift towards more sustainable eating habits and ensure a healthier planet for future generations.

In this episode, you’ll hear about:

2:41 - How Dr. Brown was initially drawn to a career in medicine

7:54 - Why Dr. Brown chose to transition from clinical work to biomedical research

14:05 - How Dr. Brown’s drive to tackle the biggest problems of humanity led to the creation of Impossible Foods

24:19 - The scientific approach that Impossible Foods takes in creating its products

30:17 - Whether plant-based meats are too highly processed

38:40 - Dr. Brown’s vision for the future of food

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

A Dual Struggle of Dementia and Dignity | Dasha Kiper Jul 30, 2024

Show notes

Many people regard dementia as a fate worse than death, in large part because it strikes at the essence of our humanity — our memories, identity, and relationships with others. Unlike diseases that primarily afflict the body, dementia erodes the mind, leading to a gradual fragmentation and loss of self and autonomy.

The burden of this disease on caregivers also cannot be understated. Not only does dementia require comprehensive, long term care that addresses the afflicted individual’s cognitive, behavioral, and physical issues; witnessing a loved one's slow and irreversible decline often exerts an immense emotional toll on the caregiver. Additionally, the pervasive stigma and isolation associated with dementia can leave caregivers feeling unsupported and alone.

Our guest on this episode is Dasha Kiper, a clinical psychologist who works with caregivers to people with dementia. She's the author of Travelers to Unimaginable Lands: Stories of Dementia, The Caregiver, and the Human Brain (2023). The book explores the complex relationship between caregivers and dementia patients, which are frequently rife with heartbreak, guilt, frustration, helplessness and shame. Over the course of our conversation, Dasha shares her transformative personal experiences working as a caregiver, why caregivers deserve more empathy and understanding, ethical dilemmas over medical interventions and patient autonomy, navigating the distorted reality in the mind of a dementia patient, coping strategies for caregivers and healthcare professionals, and more.

In this episode, you’ll hear about:

3:13 - How Dasha “stumbled” into working as a live-in caregiver for a dementia patient while still in school

4:44 - How serving as a caregiver for a dementia patient shaped Dasha’s views of neurological illness

10:23 - Managing the “loss of shared reality” that often occurs between the caregiver and the dementia patient

23:45 - The added emotional toll that dementia can take on family members

32:46 - What human dignity means in the context of dementia care

36:55 - Fostering self-compassion as a clinician or caregiver by connecting with community

49:16 - Dasha’s advice for finding community support if you are a family caregiver

Dasha Kiper is the author of Travelers to Unimaginable Lands: Stories of Dementia The Caregiver and the Human Brain (2023).

Past episodes and works discussed in this episode:

Episode 62: Navigating my Father’s Alzheimer’s as a Doctor | Sandeep Jauhar, MD

My Father’s Brain: Life in the Shadow of Alzheimer’s by Sandeep Jauhar, MD

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

A Resolve to Save Lives | Tom Frieden, MD, MPH Jul 23, 2024

Show notes

There once was a time when indoor smoking was allowed in workplaces all across the United States, when trans fats were ubiquitous, and when fast food restaurants didn't have to post calorie information on their menus. That wasn't so long ago, and it's in large part thanks to the pioneering efforts of Tom Frieden, MD, MPH, Health Commissioner of New York City from 2002 to 2009, that these changes were made. Dr. Frieden’s city-wide initiatives during this time included steps to reduce tobacco use (by banning indoor smoking, increasing tobacco taxes, and aggressive anti-tobacco ads), to ban trans fats and mandate proper nutrition labeling in restaurants, and to rapidly expand screening for diabetes and HIV. All of these efforts have since been adopted nationwide and have gained practically universal acceptance by the public.

Prior to this, Dr. Frieden spearheaded tuberculosis control measures in New York City and India, drastically slashing rates of multidrug resistant tuberculosis. He was also director of the Centers for Disease Control and Prevention, during which time he led the CDC's response against the H1N1 influenza pandemic, the Ebola outbreak in West Africa, and the Zika virus epidemic. Most recently, he leads Resolve to Save Lives, an initiative aiming to prevent cardiovascular disease primarily through advocacy of lifestyle interventions.

Over the course of our conversation, Dr. Frieden shares his personal path to a career in infectious disease and public health, lessons learned from his work on tuberculosis control, striking the balance between curbing personal liberties and protecting community health, key insights into effective public health communication particularly when dealing with incomplete information or data, the evolution of the political and partisan nature of health policy, why preventing heart disease is so critical, and more.

In this episode, you’ll hear about:

3:00 - How a conversation with his father drew Dr. Frieden to a career in public health

5:40 - Dr. Frieden’s early work tackling tuberculous as a “management problem”

9:05 - Balancing individual rights with the health of the public

17:55 - The formula Dr. Frieden has used to choose which particular public health issues to focus on

28:08 - Strategies for effective health communication with the public

33:08 - The mission of Dr. Frieden's organization Resolve to Save Lives

39:16 - Dr. Frieden’s thoughts on how to navigate public health communications in the light of changing scientific knowledge

45:50 - The important lessons that Dr. Frieden learned from his patients about public health during his time as a clinician

Dr. Tom Frieden is the President and CEO of Resolve to Save Lives.

Dr. Frieden can be found on Twitter/X at @DrTomFrieden.

People and Work discussed in this episode:

Dr. Karel Styblo

Dr. Nancy Messenior’s February 2020 COVID address

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.

Breaking the Cycle of Intergenerational Trauma | Mariel Buqué, PhD Jul 16, 2024

Show notes

It is well documented that descendants of Holocaust survivors exhibit greater levels of anxiety, depression, and vulnerability. The trauma of domestic violence can ripple through generations, with maladaptive coping mechanisms and emotional instability perpetuating subsequent cycles of trauma and dysfunction. The brutal history of slavery in the United States is seen today in the form of persistent economic disparities and ongoing social injustices, affecting mental and physical health across generations. All of this, in various forms, is intergenerational trauma. Extending beyond the individual, the emotional and psychological wounds of this type of trauma embeds itself within the family lineage through behavioral patterns, emotional responses, and even biological alterations.

Our guest on this episode is Mariel Buqué, PhD, a health psychologist who specializes in helping individuals experiencing intergenerational trauma. Her book Break the Cycle: A Guide to Healing Intergenerational Trauma (2024) reveals the invisible threads that link the past and present and highlights the necessity for healing not just individuals, but entire family systems and communities. Over the course of our conversation, Dr. Buqué shares how she draws on her experiences as an Afro-Latina immigrant from the Dominican Republic in her work, how a health psychologist connects with patients, how intergenerational traumas happen and their devastating effects on individuals, families, friends, and community members, and more.

In this episode you’ll hear about:

2:00 - What drew Dr. Buqué to the field of psychology

5:19 - What health psychology is

8:40 - What occurs in a course of treatment with a psychologist

18:30 - An overview of intergenerational trauma

28:00 - The far-reaching effects of intergenerational trauma in society and how psychology can help unload the burden

35:50 - Breaking the cycle of intergenerational trauma

40:30 - The role of stigma in access to mental health care

45:10 - Dr. Buqué‘s approach to building trust with patients

48:28 - How all clinicians can better empathize and connect with their patients through trauma-informed care

Dr. Mariel Buqué is the author of Break the Cycle: A Guide to Healing Intergenerational Trauma (2024).

Dr. Buqué can be found on Instagram at @dr.marielbuque.

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

“Ubuntu” and the Soul of Medicine | Christian Ntizimira, MD Jul 09, 2024

Show notes

The Genocide Against the Tutsi, occurring in Rwanda between April-July 1994, was a devastating episode of mass violence in which nearly 1 million people were killed over a period of 100 days. Fueled by longstanding ethnic tensions, political power struggles, and a deep seated history of discrimination, the genocide saw members of the Tutsi ethnic group slaughtered indiscriminately by extremists of the Hutu ethnic group.

Growing up amid this chaos, Christian Ntizimira, MD witnessed some of humanity's most horrific atrocities. Instead of turning away, however, he chose to enter medicine, a profession that would allow him to address the immense suffering he saw. Today, Dr. Ntizimira is a palliative care physician and the founder and executive director of the African Center for Research on End of Life Care.

In this episode, Dr. Ntizimira joins us to share his personal experiences with the Rwandan Genocide, his journey to palliative medicine after initially exploring a career in surgery, what palliative care means to him, what it looks like to honor the dignity of a patient, how he advocates better access to palliative care and chronic illness care, and his unique approach to medicine rooted in “ubuntu,” a philosophy emphasizing the universal bond that connects all humanity that is best summarized by the phrase “I am because you are.”

In this episode, you’ll hear about:

2:45 - How Dr. Ntizimira’s experience as a young person during the Rwandan Genocide inspired him to become a physician, and how he eventually found himself drawn to palliative care

14:25 - Dr. Ntizimira’s distinction between “treating the disease” and “treating the person”

20:22 - How Dr. Ntizimira teaches doctors to fully conceptualize patients as people instead of focusing only on their medical ailments

25:50 - The heart of palliative care that transcends cultures

30:54 - The importance of presence in palliative care

38:27 - What “reconciliation” means in Dr. Ntizimira’s approach to palliative care

47:17 - “Ubuntu,” an African philosophy emphasizing a shared connection among humans, and how it can revolutionize how we care for patients

Dr. Christian Ntizimira is the author of The Safari Concept: An African Framework for End of Life Care.

Dr. Christian Ntizimira can be found on Twitter/X at @ntizimira.

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

A Philosophy of Grief | Mikołaj Sławkowski-Rode, PhD Jul 02, 2024

Show notes

Death and grief are much more “hidden” from society today than they once were. The medicalization of dying means that death now occurs more frequently in hospitals and care facilities than at homes. The secularization of society means that traditional religious or communal rituals surrounding death and mourning have diminished. The fast pace and optimistic lens of consumer culture means less contemplation of aging, mortality, and grief.

But Mikołaj Sławkowski-Rode, PhD, a professor of philosophy at the University of Warsaw and research fellow at Oxford University, argues that experiences of mourning and grief are crucial to the human condition. They allow us to foster empathy and connect with others’ suffering. They encourage us to reflect on how we value life, relationships, and the responsibilities we have towards others, both living and deceased. They revitalize communal rituals and practices, creating a sense of shared humanity.

Professor Sławkowski-Rode has written widely on the philosophical and ethical dimensions of mourning, grief, and memory, and his works have appeared in The New York Times as well as various academic publications. Over the course of our conversation, we discuss the nature of grief as a multifaceted emotional response, extending beyond a psychological state and reaching into existential realms; the role of memory in the grieving process; why love and grief are fundamentally inseparable; how the atomization of modern society affects our ability to mourn; and more.

In this episode, you’ll hear about:

3:20 - The focus of Sławkowski-Rode’s current work and what his day looks like as a philosopher

8:10 - The value of philosophy in society

12:42 - How Sławkowski-Rode became inspired to study grief

14:57 - Why grief has become more “hidden” in society over the past century

23:49 - How the “cult of individuality” leads our society to ignore aging and death

33:45 - How Sławkowski-Rode defines “human flourishing”

36:31 - How the atomization of modern society affects our ability to mourn

50:00 - Practical advices for clinicians on how to navigate grief and mourning for themselves and their patients

Mikołaj Sławkowski-Rode is the author of the New York Times op ed It’s OK to Never ‘Get Over’ Your Griefand numerous academic publications.

Dr. Sławkowski-Rode can be found on Twitter/X at @MikolajRode.

Works and past episodes discussed:

The Hours of Our Death by Philipe Aries

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

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

Encountering Suffering — A Live Discussion | Sunita Puri, MD and Jay Wellons, MD Jun 25, 2024

Show notes

For a profession like medicine in which suffering — be it physical, psychological, existential, or spiritual — is so commonly encountered and experienced, we have developed remarkably little shared vocabulary to talk about what suffering means. That is, if we even have the conversations at all.

In early June 2024, during the American Society of Clinical Oncology annual conference in Chicago, we hosted a live podcast event at Northwestern University's Feinberg School of Medicine, gathering Sunita Puri, MD and Jay Wellons, MD, MSPH to explore the great problem of suffering. Dr. Puri, a palliative care physician and author of the best selling book That Good Night: Life and Medicine in the 11th Hour (2019), last joined us on Episode 74: The Beauty of Impermanence. Dr. Wellons, a pediatric neurosurgeon at Vanderbilt University Medical Center and author of the memoir All That Moves Us: A pediatric neurosurgeon, His Young Patients and Their Stories of Grace and Resilience (2022), last joined us on Episode 28: The Brain and All That Moves Us.

The four of us, the guests and co-hosts, start by sharing our personal encounters with suffering, both in our patients and in ourselves, before discussing our philosophical approaches to and practical strategies for accompanying patients through suffering, managing spiritual distress, contextualizing our own humanity in these encounters, maintaining our own well-being, and searching for meaning amid these tragic moments, if it is possible. After our main discussion, we also answer audience questions about managing the sometimes unrealistic and complicated expectations patients have of clinicians, and the role of interfaith discussions among healthcare professionals.
We thank Kelly Michelson, MD, MPH and the Center for Bioethics and Medical Humanities at Northwestern University for making this event possible.

In this episode, you’ll hear about:

3:58 - Stories of confronting suffering, both in professional and personal contexts

29:02 - Practical tips for coping with suffering and uncertainty as a physician

31:53 - The importance of psychological safety in feeling and expressing your emotions as a physician

36:52 - Being present in the moment while accompanying patients through difficult times

40:00 - Helping doctors re-connect with the deeper reason of why they feel called to medicine

42:24 - The inexplicable relationship between love and loss

52:04 - The deep sense of meaning inherent in the work of a physician and what makes it “real”

54:41 - Q&A: How physicians can better navigate the challenging expectations patients have as well as medical skepticism

1:04:05 - Q&A: How we can better incorporate interfaith dialogue into medical training and practice

Dr. Jay Wellons is the author of All That Moves Us (2022) and can be found on Twitter/X at @JayWellons5.

Dr. Sunita Puri is the author of That Good Night (2019) and can be found on Twitter/X at @SunitaPuriMD.

Living Well Without Free Will | Robert Sapolsky, PhD Jun 18, 2024

Show notes

Most of us take free will for granted — from the biggest of life decisions to choosing an ice cream flavor, we are generally capable of freely deciding how to think and how to behave without outside influence. But Robert Sapolsky believes our decisions cannot be disentangled from our genetics, environment, and neurobiology. In other words, to him, free will does not exist.

Dr. Sapolsky, a neuroscientist and primatologist at Stanford University, is a leading thinker on the biology of stress, human behavior, neurodegenerative diseases, and the science of free will and determinism. He is the author of multiple bestselling books, including Why Zebras Don't Get Ulcers (1994), Behave: The Biology of Humans at Our Best and Worst (2017), andDetermined: A Science of Life Without Free Will (2023). His works have been featured widely in the popular press, from National Geographic to The New York Times.

Over the course of our conversation, Dr. Sapolsky presents his arguments against free will, along the way making detours through chaos and complexity theory, philosophy, ethics, and neuroscience. He shows how subtracting free will from the way culture thinks about crime, mental health, and human development have resulted in more humane health, justice, and educational systems. Finally, we contemplate together what human flourishing even means in the context of a life without free will.

His ideas have profound implications not just on our society, but also on our understanding of human nature, challenging our perceptions and provoking deep reflection on how we navigate the choices in our lives.

In this episode, you’ll hear about:

3:08 - How Dr. Sapolsky chose a career straddling both neuroscience and primatology

5:04 - The moment when Dr. Sapolsky realized he did not believe humans have free will

16:16 - How society becomes more humane when free will is factored out

23:29 - The deep implications that free will and determinism could have on criminology

34:13 - How a belief in a lack of free will can negatively affect motivation on a societal scale

43:11 - What does human flourishing look like in a world without free will?

48:07 - The best moments in life in which to utilize this understanding of free will

Dr. Robert Sapolsky has authored numerous publications, a full bibliography of his works can be found here.

Dr. Robert Sapolsky can be found on Instagram at @robert.sapolsky.

Works and past episodes discussed:

What’s Expected of Us by Ted Chiang

Episode 79: Transcendence in the Age of Science | Alan Lightman, PhD

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.

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