Intention to Treat

The ripple effects of U.S. anti-DEI policies extend far beyond individual labs: scientific discovery is slowing, early‑career investigators are reconsidering their futures, and the pipeline of medical school applicants is shifting in real time. A full transcript of this episode is available at https://www.nejm.org/doi/full/10.1056/NEJMp2601982.

The use of race in medicine is harming patients. What is being done to move away from these practices and to change a culture of medicine based on the false premise that race is biological? A full transcript of this episode is available at https://www.nejm.org/doi/full/10.1056/NEJMp2601981.

We now know that humans are more than 99.9% genetically alike. So why does medicine still link certain diseases to race? And what do genetics actually tell us about race, ancestry, and disease? A full transcript of this episode is available at https://www.nejm.org/doi/full/10.1056/NEJMp2601980.

How did a drug for congestive heart failure get approved and marketed for Black people only? A full transcript of this episode is available at https://www.nejm.org/doi/full/10.1056/NEJMp2601978.

The story of the pulse oximeter demonstrates that sometimes consideration of race is critical to diagnosis and treatment — as came starkly into light during the Covid-19 pandemic. A full transcript of this episode is available at https://www.nejm.org/doi/full/10.1056/NEJMp2601977.

Many Black veterans live below the poverty line, often struggling to manage their illnesses. As V.A. hospitals began to stop using race-corrected interpretation of Black patients’ spirometer readings, there was an epiphany: the race correction wasn’t just harming the health of Black patients, it was also hurting them financially. A full transcript of this episode is available at https://www.nejm.org/doi/full/10.1056/NEJMp2601976.

The history of race-based correction of lung-capacity measures can be traced to a pre–Civil War belief among slave owners that slaves had naturally inferior lung capacity. Despite work to show that race-corrected spirometers mask lung-disease severity in Black patients, the majority of U.S. hospitals still use them. A full transcript of this episode is available at https://www.nejm.org/doi/full/10.1056/NEJMp2601975.

Many clinical algorithms, including the eGFR test for kidney function, have actually had race baked into them and produce different results for Black patients. Most of us assume these algorithms are based on science, but what if the science is wrong? A full transcript of this episode is available at https://www.nejm.org/doi/full/10.1056/NEJMp2601974.

What happens when medicine gets race wrong? In a new 8-week series, The Race Equation confronts harmful assumptions about race in clinical medicine, why they endure, and what it will take to change. ​ ​Follow “Intention to Treat” on Apple Podcasts or wherever you get your podcasts.

New research using functional brain imaging reveals that many patients considered to be in a coma or vegetative state and who are unresponsive may actually be conscious and aware. A full transcript of this episode is available at nejm.org/doi/full/10.1056/NEJMp2408662.

The millions of people worldwide who are suffering from a vast array of disabling symptoms long after being infected with SARS-CoV-2 may eventually benefit from a new consensus definition of long Covid. A full transcript of this episode is available at nejm.org/doi/full/10.1056/NEJMp2407614.

In recent years, substantial progress has been made in developing brain-computer interfaces that could restore the ability of patients with neurodegenerative diseases and other conditions to communicate. A full transcript of this episode is available at nejm.org/doi/full/10.1056/NEJMp2407613.

As race-based diagnostic tools, such as pulse oximeters that function poorly on darker skin, continue to lead to inequitable care, a growing movement is working to weed them out of U.S. health care. A full transcript of this episode is available at nejm.org/doi/full/10.1056/NEJMp2407611.

A key measure of kidney function and a risk calculator for vaginal birth after cesarean delivery are among the many tools that have long contributed to health and health care inequities for Black patients. A full transcript of this episode is available at nejm.org/doi/full/10.1056/NEJMp2405797.

Claims that Black people had lower lung capacity than White people led to race-adjusted spirometry and poorer care for Black patients with lung disease. New equations are starting to change that. A full transcript of this episode is available at nejm.org/doi/full/10.1056/NEJMp2405796.

A new strain of H5N1 influenza is spreading in dairy cows in the United States. Will it cause an epidemic in humans? And what does our public health system need to do in order to be ready if it does? A full transcript of this episode is available at nejm.org/doi/full/10.1056/NEJMp2405795.

In the face of a growing childhood obesity epidemic, some parents and clinicians are turning to new tools such as GLP-1 receptor agonists. This episode explores the implications of that trend. A full transcript of this episode is available at nejm.org/doi/full/10.1056/NEJMp2400703.

This episode considers a new treatment for hypertrophic cardiomyopathy, the world’s most common inherited heart condition, which most affected people don’t even realize they have. A full transcript of this episode is available at nejm.org/doi/full/10.1056/NEJMp2400702.

This episode examines CAR T-cell therapy’s early successes, broader promise, and emerging risks, as the FDA considers reports of occasional secondary cancers. A full transcript of this episode is available at nejm.org/doi/full/10.1056/NEJMp2400701.

This episode explores the fastest-growing neurologic condition in the world, Parkinson’s disease. What have we learned in recent years, and where are the greatest hopes for the future? A full transcript of this episode is available at nejm.org/doi/full/10.1056/NEJMp2414003.

In this episode, parents who have lost children to gun accidents and physicians working for gun safety discuss the number-one killer of U.S. children and what doctors can do about it. A full transcript of this episode is available at nejm.org/doi/full/10.1056/NEJMp2314002.

This episode of “Intention to Treat” tells the story of the Freedom House Ambulance Service — a group of Black laypeople in Pittsburgh who underwent intensive training to become the first paramedics in the United States. [Originally aired on May 4, 2023.] A full transcript of this episode is available at nejm.org/doi/full/10.1056/NEJMp2303614.

Highlighting gaps in communication near the end of life, this podcast episode explores a new approach to preparing patients with serious illness and their families for all possible outcomes. A full transcript of this episode is available at nejm.org/doi/full/10.1056/NEJMp2314001.

In the second half of our podcast series on historical injustices, guests Evelynn Hammonds and David Jones examine the racism of post-World War II American medicine and its lessons for the present day. A full transcript of this episode is available at nejm.org/doi/full/10.1056/NEJMp2314000.

Over its 200-plus years, the Journal has sometimes published articles that have perpetuated injustices against various groups of people. A new Perspective series explores that history and its lessons. A full transcript of this episode is available at nejm.org/doi/full/10.1056/NEJMp2311329.

This episode examines Covid-19 variants that are currently circulating, recommendations for booster shots, and new treatments in the pipeline. A full transcript of this episode is available at nejm.org/doi/full/10.1056/NEJMp2311327.

This episode examines the need for and promise of xenotransplantation, considering first the plight of patients and then the progress being made by researchers. A full transcript of this episode is available at nejm.org/doi/full/10.1056/NEJMp2309946.

This episode explores the current state of research on the multiple likely mechanisms of Alzheimer’s disease as well as promising treatments and diagnostics. A full transcript of this episode is available at nejm.org/doi/full/10.1056/NEJMp2309944.

Host Rachel Gotbaum talks with a patient with early-onset Alzheimer’s disease and two dementia experts about frustrations with the current state of Alzheimer’s care. A full transcript of this episode is available at nejm.org/doi/full/10.1056/NEJMp2309485.

This episode explores long Covid, an often-disabling but unexplained syndrome of post-acute sequelae of SARS-CoV-2. How is it affecting millions of people, and what is being done about it? A full transcript of this episode is available at nejm.org/doi/full/10.1056/NEJMp2309483.

This episode peers into U.S. schools to examine a widespread but non–evidence-based approach to preparing children and staff for gun-violence incidents. A full transcript of this episode is available at nejm.org/doi/full/10.1056/NEJMp2308309.

In this episode, a patient with narcolepsy describes her rough, long road to diagnosis and treatment, and a researcher elucidates both the condition and a new therapeutic direction. A full transcript of this episode is available at nejm.org/doi/full/10.1056/NEJMp2308308.

Cardiologists now recognize that heart failure with preserved ejection fraction (HFpEF) may be caused by obesity. This episode of “Intention to Treat” examines new evidence that treating obesity can prevent HFpEF. A full transcript of this episode is available at nejm.org/doi/full/10.1056/NEJMp2307349.

People living with HIV have increased risk for cardiovascular disease (and other diseases of aging) earlier in life than those without HIV. In this episode of “Intention to Treat,” researcher Steven Grinspoon describes a new strategy for preventing collateral damage. A full transcript of this episode is available at nejm.org/doi/full/10.1056/NEJMp2307347.

Some types of pain have proven resistant to all available medications. In this episode of “Intention to Treat,” Rachel Gotbaum talks with a patient with neuropathic pain and a researcher exploring new sodium-channel blockers that offer promise for such patients. A full transcript of this episode is available at nejm.org/doi/full/10.1056/NEJMp2305759.

What is driving U.S. physicians out of primary care — and keeping trainees from going into it in the first place? In this episode of “Intention to Treat,” host Rachel Gotbaum explores the breakdown of the system and possible ways to save it. A full transcript of this episode is available at nejm.org/doi/full/10.1056/NEJMp2305758.

This episode of “Intention to Treat,” explores the crisis in primary care in the United States, as increasing numbers or primary care physicians leave the field — driven out by corporatization, growing time pressure, and the inability to form the relationships that enable good care. A full transcript of this episode is available at nejm.org/doi/full/10.1056/NEJMp2303852.

In this episode of “Intention to Treat,” host Rachel Gotbaum explores the story of a teenager who’s now in remission from previously relapsed lymphoblastic leukemia and talks with the investigator who developed the “off-the-shelf” CAR T cells that made her treatment possible. A full transcript of this episode is available at nejm.org/doi/full/10.1056/NEJMp2303851.

“Intention to Treat” host Rachel Gotbaum talks with patient Awilde Peña and oncologist Deb Schrag about a new approach to treating rectal cancer that sidesteps the need for radiation, thereby avoiding long-term side effects and preserving fertility. A full transcript of this episode is available at nejm.org/doi/full/10.1056/NEJMp2303850.

In this episode of “Intention to Treat,” Drs. Harvey Fineberg and Eric Rubin take stock of the failures and successes of the Covid-19 response and elucidate their lessons for combating the next major public health threat, whatever it may be. A full transcript of this episode is available at nejm.org/doi/full/10.1056/NEJMp2303615.

This episode of “Intention to Treat” tells the story of the Freedom House Ambulance Service — a group of Black laypeople in Pittsburgh who underwent intensive training to become the first paramedics in the United States. A full transcript of this episode is available at nejm.org/doi/full/10.1056/NEJMp2303614.

In this episode of “Intention to Treat,” host Rachel Gotbaum talks with patient Robert Schlamberg and Doctors Oladapo Yeku and Oliver Sartor about the option of watchful waiting in the care of men with early prostate cancer. A full transcript of this episode is available at nejm.org/doi/full/10.1056/NEJMp2303613.

In this episode of “Intention to Treat,” Maia Hightower and Isaac Kohane join host Rachel Gotbaum to explore the promise and hazards of artificial-intelligence and machine-learning tools for both clinical and administrative uses in medicine. A full transcript of this episode is available at nejm.org/doi/full/10.1056/NEJMp2301939.

In this episode of “Intention to Treat,” Anthony Fauci sits down with host Rachel Gotbaum to discuss his long career in infectious disease and public health, what has motivated him, and the lessons he has learned and taught along the way. A full transcript of this episode is available at nejm.org/doi/full/10.1056/NEJMp2300938.

In this episode of “Intention to Treat,” some of the people who have worked closely with “America’s Doctor,” Anthony Fauci, offer insights into his character, values, accomplishments, and adventures over his decades of service at the NIH. A full transcript of this episode is available at nejm.org/doi/full/10.1056/NEJMp2300937.

In this episode of “Intention to Treat,” a study participant and a long-time investigator of hallucinogenic drugs for psychiatric conditions illuminate the effects of psilocybin in patients with depression. A full transcript of this episode is available at https://www.nejm.org/doi/full/10.1056/NEJMp2300936.

In this episode of “Intention to Treat,” host Rachel Gotbaum takes us to Tennessee and Ohio, where new abortion bans are already harming patients and threatening their physicians. A full transcript of this episode is available at nejm.org/doi/full/10.1056/NEJMp2300935.

In this first episode of “Intention to Treat,” NEJM editor-in-chief Eric Rubin and his colleague at the FDA Vaccine Advisory Committee, Paul Offit, consider the achievements, limitations, and expectations of Covid vaccines. A transcript of this episode is available at nejm.org/doi/full/10.1056/NEJMp2300222.

From the New England Journal of Medicine, welcome to “Intention to Treat,” a podcast exploring the most complicated, perplexing, and fascinating issues facing medicine today. From groundbreaking research, to clinical advances, to personal stories from doctors and their patients, we give you a behind-the-scenes look at discoveries that are changing medical practice and provide you with the knowledge to thrive on the front lines of health care.