Welcome to “Intention to Treat,” a podcast exploring the critical issues shaping medicine today. In a new 8-week series, The Race Equation, we confront harmful assumptions about race in clinical medicine—from diagnostic algorithms to guidelines—exploring how these practices took hold, why they endure, and what it will take to change them.
Hosted by health care journalist Rachel Gotbaum, the “Intention to Treat” podcast from the New England Journal of Medicine delves into groundbreaking research and clinical advances while sharing the personal stories from doctors and their patients, offering listeners a behind-the-scenes look at discoveries that are changing medical practice on the front lines of health care.
Listen to The Race Equation and follow “Intention to Treat” on Apple Podcasts or wherever you get your podcasts.
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The podcast delves into the history of race-corrected spirometers, tracing the belief in "naturally inferior" Black lung capacity back to slave owners and early "race science." Dr. Aaron Baugh's study shockingly revealed that these corrections mask the true severity of lung disease in Black patients, leading to delayed diagnoses and poorer outcomes. Despite new recommendations for race-neutral testing, implementation faces significant challenges, including physician reluctance, equipment costs, and political obstacles, underscoring the deep-seated nature of racial bias in medicine.
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.
