Afib, AI Agents, and Other News

Harlan Krumholz: Welcome to Health & Veritas. I’m Harlan Krumholz.‌

Howard Forman: And I’m Howie Forman. We’re physicians and professors at Yale University. We’re trying to get close to the truth about health and healthcare, and this is one of our fun segments in the studio on College Street.‌

Harlan Krumholz: In the studio, it’s so good to see you, Howie.‌

Howard Forman: And we have special guests coming.‌

Harlan Krumholz: Oh my God, you look younger every time I see you.‌

Howard Forman: I really appreciate that.‌

Harlan Krumholz: Yeah, you do. Amazing.‌

Howard Forman: I’m almost going to look as young as you.‌

Harlan Krumholz: You’re not a super ager. You’re a super younger.‌

Howard Forman: I keep my skin lustrous by drinking lots of water. But do tell, why don’t we start off... This is one of the segments where we don’t have a single guest. We have special guests coming along later. What do you have for us to start?‌

Harlan Krumholz: Well, by the way, since I started calling you a “super younger,” I think I said “super ager” because, you seen our friend Eric Topol’s got a book coming out?‌

Howard Forman: Yeah. Absolutely. In fact, we have him on the schedule to talk about that book in a few months.‌

Harlan Krumholz: I think he’s orienting this book towards a real science-based approach. As I understand it, he’s got, I don’t know, tens of thousands of references. He digs into the facts. I love his SubStack. He really gets into the facts, and so it should be good to see.‌

Howard Forman: No, he is fantastic. And I think we’ve mentioned before, the Substack is called “Ground Truth.” It’s worth reading, but it is definitely written for a sophisticated science audience.‌

Harlan Krumholz: Yeah. I can’t wait until it comes out. It’s coming out in just a couple weeks. And then our friend Zeke Emanuel told us he’s got a book coming out.‌

Howard Forman: He’s got I think two books coming out.‌

Harlan Krumholz: But one about wellness.‌

Howard Forman: That’s right. Yeah.‌

Harlan Krumholz: Yeah. I think they all saw Peter Attia.‌

Howard Forman: You had a book about 20 years ago, about 15 years ago.‌

Harlan Krumholz: Oh, thank you for remembering.‌

Howard Forman: The heart.‌

Harlan Krumholz: I’m going to write a new one.‌

Howard Forman: You should.‌

Harlan Krumholz: Yeah, I’m going to write a new one.‌

Howard Forman: What was that called?‌

Harlan Krumholz: Hard work.‌

Howard Forman: What was the book called?‌

Harlan Krumholz: The book I wrote?‌

Howard Forman: Yeah.‌

Harlan Krumholz: Well, it was a guide to—‌

Howard Forman: “Guide to Your Heart.”‌

Harlan Krumholz: ... how to prevent heart disease.‌

Howard Forman: Right. It was something like “Guide to Your Heart.”‌

Harlan Krumholz: I can’t remember the name of it.‌

Howard Forman: Oh my God. I’m remembering; you’re not. Anyway, it was a great book. Yep.‌

Harlan Krumholz: It did sell 10,000 issues. I was very proud.‌

Howard Forman: You should be.‌

Harlan Krumholz: All right. I’ve got to work harder. I got to catch up with these guys. But yeah, there’s a lot of good books coming out. So what’s on your mind this week?‌

Howard Forman: Look, I wanted to talk a little about me as a patient, and you and I have talked about this, but we haven’t talked about this for our audience before. I’ve mentioned it as a glancing blow maybe. And that is that since 1990 I’ve had paroxysmal AFib, which I was 25 years old when I was first diagnosed. And it really disrupted my life in a lot of ways.‌

Harlan Krumholz: And paroxysmal, for people listening, this is intermittent atrial fibrillation. It’s not sustained. It’s not there all the time. And so we tend to use this word paroxysmal, but paroxysmal by the way is a wide range of things. So for you, what did “paroxysmal” mean? How often was it coming on?‌

Howard Forman: It varied by the year, but it could happen several times in a month. It could happen no times in a year. But when it happened, it was very indeterminate about how long it would last. And so I was always faced with the possibility of having to go on medications and/or being anticoagulated with, at that time, drugs that would have been much more debilitating, would have put me at risks of not just bruising but head bleeds and other problems.‌

Harlan Krumholz: Yeah. The interesting thing about paroxysmal AFib, I find, is that lots of people will dismiss it. Say, well, most of the time you’re not atrial fibrillation. I mean, there’s a decision about anticoagulation, but what they don’t realize is the cognitive load. Once this happens to someone, it’s always on their mind. Am I going to do something that’s going to trigger it? And people are trying to figure out what triggers it. “Oh my God, I ate soup today.” “It was cold.” And so the cognitive load is considerable.‌

Howard Forman: And it interferes with your life because if you don’t know where you’re going to be when it happens, you have to contemplate, could this happen when I’m on a trip with family? Could this happen when I’m in the middle of a call shift? Is it going to impact my ability to do what I need to do? It’s very distracting.‌

Harlan Krumholz: Yeah. And I think an example where sometimes in the medical profession we think, well, what’s the big deal? But actually for patients, this thing can be... so what did you do about it?‌

Howard Forman: For 23 years, I managed it by either converting spontaneously, which rarely happens, or going into the emergency room and getting—‌

Harlan Krumholz: Converting spontaneously means that you have atrial fibrillation, then suddenly—‌

Howard Forman: It just goes away.‌

Harlan Krumholz: It goes away.‌

Howard Forman: But more often than not, I went into the hospital, and I got cardioverted under anesthesia.‌

Harlan Krumholz: That means they shocked you.‌

Howard Forman: Correct.‌

Harlan Krumholz: I’m just saying. Not everybody’s in medicine here.‌

Howard Forman: No, absolutely. No, no. I’m happy that you’re saying it. And for those 23 years it was—‌

Harlan Krumholz: And how big a deal was it to get... I mean, they gave you, like you said, anesthesia. They knocked you out, so you didn’t feel the shock.‌

Howard Forman: Not at all. And it was a disruption to my day. I always had to figure out when I was going to go in and get cardioverted, because you’re going to go—‌

Harlan Krumholz: You never fainted with this.‌

Howard Forman: Never.‌

Harlan Krumholz: This was just, you just felt the symptom.‌

Howard Forman: I had in fact something called vagal AFib, which meant my rate was slower than average for AFib. I had also learned by the end that I could cardiovert myself by exercising, by getting my heart rate to go above the rate of this atrial atopic beat. There were a lot of things going on. I met an amazing cardiologist at Yale named Joe Akar about—‌

Harlan Krumholz: He’s one of my favorites. He’s terrific.‌

Howard Forman: He is terrific. And I met him about 13 years ago. He became my cardiologist, and he’s the first one to say, “You should have an ablation.” And I was like, “I’d rather start with meds finally.” I knew it was happening too often. And so I went on flecainide.‌

Harlan Krumholz: And what is an ablation?‌

Howard Forman: An ablation, which we’re going to get to, is—‌

Harlan Krumholz: I mean, I know what it is, but—‌

Howard Forman: I know. But for our listeners, it’s a scarring of the heart, in particular around the pulmonary veins, which is where these foci seem to start off and trigger that has seemingly been extremely effective in reducing the likelihood of getting sustained atrial fibrillation. So I put it off, I started on medications in 2013 and by—‌

Harlan Krumholz: I remember that.‌

Howard Forman: Yeah. And by the end of last year, I had gone from what was a low dose to what I considered to be a high dose of flecainide.‌

Harlan Krumholz: But it was working.‌

Howard Forman: Working very well, but the dose had been going up, and I knew that I was going to hit a point.‌

Harlan Krumholz: It was working. Why did you increase the dose?‌

Howard Forman: Oh, because it would stop working.‌

Harlan Krumholz: Oh, I see.‌

Howard Forman: You’d get to a point where it was breaking through more and more and more, and you’d go up in the dose. So you started 50 twice a day, and you’d go up to, for me, as a crazy person, 50 three times a day and came up with old permutations. By the end, I was taking about 200 milligrams a day. And while you could go a little higher than that, I’m a smallish person. And I felt like I was at the upper limit of what my body should tolerate based on the science that we knew. I committed to doing the ablation in October, and—October 26, in fact. And it has been enormously successful. I will say, when I think about it as someone who teaches about health policy, it’s an extremely expensive procedure, far more expensive than if I could have stayed on meds for the rest of my life. But it’s changed my life and made me far less worried about going to AFib every single day.‌

Harlan Krumholz: Well, and you are a winner. I mean, there are people who undergo this procedure and then the AFib comes back.‌

Howard Forman: That’s right.‌

Harlan Krumholz: And then they undergo it again. It comes back.‌

Howard Forman: That’s right.‌

Harlan Krumholz: So it’s all about probabilities.‌

Howard Forman: And I still think there’s a good chance that I’ll need a second procedure at some point in the future. But in terms of outcomes, in terms of how fast I recovered from it, in terms of my ability to carry on my life better than it was before, it’s really nice.‌

Harlan Krumholz: Yeah. Well, I’m glad you’re doing well.‌

Howard Forman: Yeah, no, so I just wanted our listeners to know that because AFib is like 5% of the population. As you get older, it’s more and more people. The majority of my immediate family members have had AFib by now.‌

Harlan Krumholz: Some genetic component.‌

Howard Forman: There’s got to be. Yep. So what do you got?‌

Harlan Krumholz: Well, yeah, I wanted to talk about a blog a friend of mine posted on LinkedIn yesterday, which people might find interesting. It was called “The Four AI Agents of Your Health.” Now, people are talking a lot about AI. We’ve talked a lot about AI, and people are talking about AI agents. I often think some people who aren’t familiar with the field might think, what the hell are AI agents? They represent applications that are specific for a certain function. There’s kind of a narrow thing. The foundational models like ChatGPT—‌

Howard Forman: Can do all a lot of things.‌

Harlan Krumholz: ... they’re for everything. And these are supposed to be optimized, honed for specific tasks, kind of putting the AI to work. So Carl Byers, who’s a partner at F-Prime Capital, and of course we’re friends, Steve Knight at F-Prime, and I do some consulting for them. He wrote a provocative post sort of laying out a framework about saying I think that AI could work, this AI agents can work, and we really should be thinking about it in four major buckets. And he said, “The first agent is an archivist.” This is the one who knows everything about you. It’s kind of the one that’s pulling together your history, your wearables, your genomics, your labs, and AI is ensuring that the record’s complete and organized and accessible. This is kind of some of the work I was—‌

Howard Forman: Is that something that’s commercially available? I mean, you had a company built around this, but is that something that is commercially available to an individual right now?‌

Harlan Krumholz: But it was my dream with the company—‌

Howard Forman: I know.‌

Harlan Krumholz: ... was that people could pull their data and would do this. So I really liked that. That’s the archive. So it’s actually pulling together the data and information. The second is a diagnostician basically in a traditional physician role who’s sort of powered by AI, looking at the patterns of information in your data and helping to sort of make predictions to help guide what should be done, making diagnoses, sort of updating your profile continuously. Imagine more information is coming in about you, and then it says this day, “Well, you’re on your way to X or Y” and helping to do that. The third was the planner who turns this sort of analysis. So the first was pulling the data together. The second was making sense of the data. The third is putting together plans for what you should do about the situation you have, given the situation you’re in. And it sort of turns the diagnosis into personalized plans.‌

It figures out what needs to happen next, your prescriptions, your screenings, your lifestyle medications, coordinates logistics based on your insurance, your network, even your travel schedule. And then the fourth one is called the guide. This is really your coach, your interpreter, your advocate.‌

Howard Forman: To get you to do?‌

Harlan Krumholz: This is the one speaking in plain language, helping you understand what your situation is and what you might want to do about it. Helps keeping you motivated.‌

Howard Forman: It sounds like the Apple Watch.‌

Harlan Krumholz: So anyway, I just thought this was very interesting. He also goes on to say that in the current healthcare system with proprietary data, fragmented care, fee-for-service incentives, workflows that resist innovation, it’s hard to see exactly how you get to where we could be from where we are today. But what I liked about it was, I really liked the construct, being able to think about it in these ways because if you’re thinking about building companies or you’re thinking about building innovation, these are four target areas where we could be doing a lot better, and the AI could help us.‌

Howard Forman: Yeah, no, that’s incredible. And I think what the public needs to understand is that our use case for AI is going to build tremendously over the next few years. And everybody’s talked about this as a theoretical thing in the past, and now we actually do have some use cases.‌

Harlan Krumholz: But the key will be not that you have AI, because AI almost is going to be commoditized. It’s that you figured out where it fits that actually improves outcomes, makes a difference, makes people feel better.‌

Howard Forman: Right.‌

Harlan Krumholz: And that’s going to be the key. And that’s why I like what Carl sort of did. He was pretty good at construct, where that might happen.‌

Howard Forman: It’s good when people can lay it out. Thank you. I wanted to briefly update people on measles right now. It’s in the news a lot, so I’m not going to spend too much time on it. But I want to point out there is bad news. There’s good news. The bad news is the outbreak is now over 800 cases nationwide.‌

Harlan Krumholz: 800 cases?‌

Howard Forman: And that’s the CDC number, which lags the individual states. So we’re probably well above that. And that doesn’t count the cases that we’ll never count.‌

Harlan Krumholz: And how many cases did we have five years ago?‌

Howard Forman: Six years ago, we had.... I have it written down actually, 1274. Six years ago, we had 1274. So we’re going to be way over that because based on everything I can tell from looking at the epi curve, we may be at the peak right now. So imagine that whatever we have right now, it’s going to double, at least double by the end of the year. But we’ll probably have more than that. And there are 27 states now with cases. The biggest outbreak remains this West Texas outbreak, which includes West Texas, New Mexico, and Oklahoma. But 24 other states have cases, some of which may be tied to this, we’re not sure. Many of which are international travelers, some of which are outbreaks that started with international travelers. And I will say, and I’m not meaning this to be political, but the recent cuts to the CDC and the moneys going to the states make it a lot harder for us to track this and mitigate it.‌

So we have to stay tuned. We have to watch, and we have to hope that the states themselves are continuing to be really aggressive in screening for this. But the good news is that we have not had more deaths in the last several weeks. We still have three nationally. And the other good news is, as I said, many of the recent cases that we’re learning about, many of the new states do seem to have started from an international traveler. So the Texas outbreak is not seeding multiple additional outbreaks far beyond Texas. So that’s, I think, relatively good news. And the other good news is that even though measles is not traditionally talked about as a seasonal virus, it is a respiratory spread virus and therefore you expect sort of late winter, early spring is when you would see the peak or the end of an outbreak. And I think that also bodes well for this. But as I said, 1274 is the number for 2019, 2126 is the number for 1992. And just as importantly, our country is considered to have eliminated measles as of 2000.‌

Almost certainly our elimination status will be over. We will be back to having endemic measles in the United States. And that’s very unfortunate. We had a 24-year run, and it’s probably over.‌

Harlan Krumholz: Yeah. Yeah. Thanks for bringing that... and we’ve had two deaths, right? Two deaths, you said.‌

Howard Forman: Two that the CDC has confirmed, an additional one that is believed to be measles-related.‌

Harlan Krumholz: Wow. Yeah, that’s tragic. Tragic. All right, well, let me pivot to something that for me is highlighting something special, both professionally and personally. I’ll start with a question. How much nutrition education did you get in medical school?‌

Howard Forman: I’m trying to think if I had, I did have a little bit because I had a community health course that emphasized social determinants of health. But really to your answer, almost nothing.‌

Harlan Krumholz: That’s really not much. People are starting to look at this more. There’s a “food is medicine” movement. Well, a new paper is just published in BMC Medical Education titled “Cooking with the Curriculum,” and it describes a pilot culinary medicine program at the University of Vermont’s Larner College of Medicine.‌

Howard Forman: It’s written by an author that we’re trying to get on the podcast, I want to point out.‌

Harlan Krumholz: I’ve got to get to that.‌

Howard Forman: Okay. I just want to make sure that you know that we’ve tried outreach already. We’re talking to their agent.‌

Harlan Krumholz: Okay. Well, and by the way, we’ve got a great group here. Nate Wood, I don’t know if you—‌

Howard Forman: I’ve heard of Nate.‌

Harlan Krumholz: ... in primary care is doing great work in culinary medicine. But this was developed by a group of medical students and yes, I’m proud to say the first author of this is my daughter, Sarah Krumholz.‌

Howard Forman: Yes.‌

Harlan Krumholz: Yeah. I’m so proud of her. So the program was rooted in a simple but powerful idea, that physicians are a trusted source of health advice, yet most of them receive very little training in nutrition. She happens to be a registered dietitian, has a master’s in nutrition before she went to medical school. So she was tuned in to this, that it wasn’t an area that was getting a lot of attention. I think the gap is striking given how we’re really growing to appreciate the role that diet plays in prevention and the management of chronic disease.‌

And we can talk a lot about what’s going on in D.C., but one of the things of highlighting diet is a good thing for chronic disease. So these students basically created a five-session course for first-year medical students, which really was trying to help equip them with skills and also for their personal lives too, how they could take care of themselves. And the results were pretty remarkable. Almost all of them when they finished the course said it improved their confidence in offering nutritional counseling. It positioned them better to talk with their patients, put them in a better position for their own lives. But I don’t know. Okay. It’s my daughter. I’m very proud dad.‌

Howard Forman: When you shared that with me, I told you right away I wanted to have her on the podcast. And it’s not because she’s your daughter, and it’s not because a medical student wrote about this, but she’s a subject matter expert. She’s an actual dietitian. She was able to introduce this into the curriculum there and to actually use science to communicate it further beyond that. I can’t wait until we get her on here. I hope she’ll be able to do that. I know she’s also a new mother and—‌

Harlan Krumholz: She is a new mom. Yeah, she’s doing great. And I would just say as a student and seeing her in medical school, the thing that impresses me most, her curiosity.‌

Howard Forman: That’s great.‌

Harlan Krumholz: She’s always asking questions, always trying to understand.‌

Howard Forman: Have no idea where she got that from.‌

Harlan Krumholz: She’s really good. All right, let’s go on.‌

Howard Forman: I’m going to tell you real quick, this will be my last segment, but real quick update on H5N1 because we have talked about it many times and it’s been many months since we talked. That’s, again, a bird flu, highly pathogenic avian influenza. We’re now well into a year of this mostly animal outbreak, but again, 64 human cases, one death, a 170 million birds dead from this and over a thousand dairy herds covering 17 states.‌

Harlan Krumholz: 170 million birds?‌

Howard Forman: Now you understand part of the reason why the egg prices have gone up so much.‌

Harlan Krumholz: My God.‌

Howard Forman: Yeah, no. I mean this has been impactful. And by the way, there are arguments to be made, like should we be slaughtering all the birds once they get infected? We’re basically slaughtering them to prevent further spread. Nobody knows the right answer because it’s a new thing. There is one very concerning thing that we learned in the last week. An 8-year-old child in Vietnam developed encephalitis related to this. That’s a brain swelling. So I do not want to minimize what this is, but the good news is that most of these numbers are actually slowing their growth. They’re not growing epidemically in any possible way. So while this remains a major threat, and we still might see a mutation that could allow it to transmit between humans, we are no further toward that outcome than we were when we first talked about it probably nine or 10 months ago.‌

Harlan Krumholz: Well, I’m glad to hear that, because you know, we got enough things going on in the world right now. I would just prefer not to have another pandemic come down the pike too.‌

Howard Forman: Me too.‌

Harlan Krumholz: Well, let alone I think we’re not as well prepared.‌

Howard Forman: I agree. I agree.‌

Harlan Krumholz: All right, we’ll kind of wrap up this section because we got something really special here at the end.‌

Howard Forman: Oh yeah. Special guests.‌

Harlan Krumholz: We have a very special thing at the end. With some good news, I know you’re going to love this. So I ran into this paper that was published in Nature Communications that brings into focus how physical exercise might protect the brain. Are you still exercising every day?‌

Howard Forman: I do about one hour.‌

Harlan Krumholz: Get on the bike.‌

Howard Forman: Get on an exercise bike, and I do yoga twice a week. So I try to do stuff.‌

Harlan Krumholz: Well, you’re going to love this story, then, because basically we all sort have this belief that exercise is good for us. But I’ve been really interested, this kind of also brings together another interest of mine, which is how the body handles brain waste. Have you been following this at all?‌

Howard Forman: No.‌

Harlan Krumholz: So we learned a lot about the lymphatic system when we were in sort of drainage of some of the parts of the immune system. But there’s a lymphatic system. You know about this? It sort of drains from the brain toxic materials that are developed. And there’s this idea and some evidence that the brain’s creating sort of waste products all the time. And that our ability to sort of transport it out of the brain through the CSF then out of the nervous system is related to our brain health. And that people who have trouble with this system and have buildup of the waste in the brain you know are more susceptible to issues around dementia and so forth. At least there’s evidence that the kind of things that are associated with dementia are more highly prevalent in people whose systems aren’t working as well.‌

So what the researchers did was they took a control group that had sort of exercised once, and they took another group where they had to go through an exercise regimen and then they were testing them and doing imaging and doing a whole range of different things. And really what they found was that only the long-term exercise—the kind of thing you do, Howie, not a single session—boosted the brain’s waste clearance capacity. That lymphatic flow, that really kind of cleanses the brain, improved and the size and flow through the meningiolymphatic vessels increased, suggesting that consistent exercise may literally enhance the brain’s housekeeping. I mean, who knows?‌

Howard Forman: I’ll take it, right.‌

Harlan Krumholz: But when these stories come out and they sort of reinforce my biases— ‌

Howard Forman: Exactly.‌

Harlan Krumholz: ...around good lifestyle, I tend to, this was a small study. The participants were young and healthy.‌

Howard Forman: I love it.‌

Harlan Krumholz: So the generalizing it, and it’s going to need to be validated, but this goes with a growing body of evidence that long-term physical activity does more than burn calories or build muscles. It may change the way the brain clears out debris. It may actually help you think clearer. If we’re going to try to help people live longer with more cognitive function, we’re going to tell them, don’t smoke, don’t drink, exercise, stay physically active, and keep your brain alive. Social interactions, challenging things. I mean, those are the things that are going to make the difference. Drinking in the end is not good. Smoking’s not good. Exercise is good. Social interaction, good. And challenge yourself to continue to solve problems or be in situations where you’re using your brain power, all those are good.‌

Howard Forman: Yeah, no. And look, we had last week our guest talking about cannabis and the effects in the brain and so probably don’t—‌

Harlan Krumholz: That’s also another thing.‌

Howard Forman: ... do that. Yeah.‌

Harlan Krumholz: If you care about that.‌

Howard Forman: Yep. Yep.‌

Harlan Krumholz: Howie, what a great session we’re going to have today.‌

Howard Forman: Oh, my God.‌

Harlan Krumholz: Our research assistants are here today. ‌

Howard Forman: Inès and Sophia.‌

Harlan Krumholz: It’s the research assistants day.‌

Howard Forman: I know, and we’ve worked with them so closely, but our listeners have not got to meet them. So today they get—‌

Harlan Krumholz: Sophia and Inès.‌

Howard Forman: Yes.‌

Harlan Krumholz: I hope you say their names correctly.‌

Howard Forman: Yeah, I think it’s—‌

Harlan Krumholz: It should be your turn to say them.‌

Howard Forman: You think so?‌

Harlan Krumholz: Yeah. All right, well, we have an exciting show today, Howie. ‌

Howard Forman: Look, I mean we’ve waited for this for a whole year. I don’t know why it was so difficult to schedule, but we finally—‌

Harlan Krumholz: I can tell you our ratings would’ve gone way up—‌

Howard Forman: Finally!‌

Harlan Krumholz: ... if we had included the two of them in our shows.‌

Howard Forman: We finally got Inès Gilles and Sophia Stumpf.‌

Harlan Krumholz: And I challenged Howie—‌

Howard Forman: In the room!‌

Harlan Krumholz: ... I said, “This is your turn to say their names.”‌

Howard Forman: Listen, I’ve been afraid all year, but I’ve listened to you and I’ve got it down, and I think it’s okay.‌

Harlan Krumholz: They’re being polite and not correcting you.‌

Howard Forman: It’s a complete, it’s a privilege and an honor to finally have you here. But let’s give them a chance to tell our audience a little bit. This is a chance for our audience to finally know them a little bit. And we’ve got a few little icebreaker questions that we’re going to read you. I’ll alternate with you, but each of you should answer each one. Since this is really all about us, what was your favorite episode on the podcast?‌

Inès Gilles: I can go first. I think my favorite episode—‌

Harlan Krumholz: You need to say who you are.‌

Howard Forman: That’s true.‌

Inès Gilles: This is Inès. I think an episode that holds a really, really special place in my heart is the first one I ever worked on, with Josh Geballe. I remember just being so starstruck by his work that he did with the state of Connecticut and his work leading their response to the COVID-19 pandemic. It was just so impressive and I was really excited to work on the podcast after that.‌

Howard Forman: It was. You got a lot of downloads. I remember that. We talked about that for a while.‌

Harlan Krumholz: Well, Josh is amazing.‌

Howard Forman: He is.‌

Harlan Krumholz: He’s terrific. He is someone who’s had experience in such a wide range of areas and we were lucky that he came to Yale. And that’s so cool that you felt that way.‌

Howard Forman: And he shares with you the connection as a Yale alum.‌

Harlan Krumholz: Yeah, yeah.‌

Sophia Stumpf: I think for me it was one of the first in-studio recording experiences. I think it was last fall. And it’s always super cool to just see the setups, you guys talking together.‌

Harlan Krumholz: Who are you again?‌

Sophia Stumpf: Oh, right. This is Sophia. And yeah, it’s always great to have you guys talk for the full hour. And just seeing the tech and seeing you guys interact is really fun. So yeah, those are my favorites.‌

Howard Forman: We appreciate anybody that thinks listening to us is of value, so we appreciate you as well.‌

Harlan Krumholz: How about if we want to appeal to a younger audience? What is it that would really... I mean, I know Howie intrinsically attracts a younger audience.‌

Howard Forman: Absolutely. I’m the TikTok generation.‌

Harlan Krumholz: You are. You are, indeed. But do you have thoughts about... I mean, is it hopeless for us or is there any chance that we could attract a younger audience?‌

Inès Gilles: I personally have friends who have come up to me and been like, “OMG, you work on Health & Veritas. I listen to them in the gym.” So I think you’re doing fine with a younger audience.‌

Harlan Krumholz: Okay, well that made my day. That made my day. I don’t know about you, Howie.‌

Sophia Stumpf: Well, I feel like the short snippets or the video snippets are always great to get more reach. I think you could do more of those.‌

Harlan Krumholz: I think Howie could go viral.‌

Sophia Stumpf: Yeah, I think so.‌

Harlan Krumholz: Yeah. He’s got the authority.‌

Howard Forman: Probably for getting into trouble.‌

Harlan Krumholz: It’s the quirkiness about Howie that really... I think people can’t avert their eyes. They want to hear what he’s got to say.‌

Howard Forman: It’s the fact that I’m willing to get into trouble that probably makes me potentially go viral. Let me ask you this, because to give our listeners a little flavor to this, you prepare what I call a dossier for every guest that we have. And that dossier is amazing. And to the credit of the students before you, they did a great job as well, but you took it up a notch in a few different ways. One of those is that you very often will suggest ideas for us about what we might ask that might be interesting to the two of you. And I love that. And we generally try to incorporate something like that in every one. But tell us a little bit about what it takes to create that document and what do you go to do it?‌

Sophia Stumpf: Sure. I can maybe start by giving a little bit of an overview of what goes into the document. The first thing that we usually have is a name pronunciation. Then we write a little bio about the accomplishments and research and sort of job description of the people that you’re interviewing on the podcast. And then we’ll find links to articles they’ve published online or research that they’ve done. And then we’ll also find some additional information. And I think Inès has some good stories about what constitutes the additional information section, but that can truly be anything. Maybe you want to elaborate on that.‌

Inès Gilles: Well, like I said earlier, I think it’s so awesome that you both know a lot of your guests already. So I take it as a personal challenge to try to find information that you don’t know about them. And I’ve definitely found myself digging through New York Times marriage announcements, trying to find fun facts, that kind of thing. But I think it’s such a cool assignment, right? Because you’re researching not only the work of this person but trying to find what they’re like as a person or what might be interesting to what threads might be interesting to pull out a little bit. I personally really enjoy starting at the Wikipedia dive and then going and looking at their research and then just trying to find whatever I can. I think it’s really special to get to know someone like that.‌

Harlan Krumholz: I want to make sure I don’t want to miss the opportunity in this for people just to get to know you a little bit better. Maybe you could just say a little bit about what’s your major, and I know that we had some whimsical questions here. Where do you like to study? What do you like about New Haven? Just give us a little sense of yourself.‌

Sophia Stumpf: Sure. I can start. Sophia here again. I’m a global affairs and econ double major, but interestingly I think a lot of my interests at Yale have sort of morphed into the healthcare sector. I work on this podcast. I also did some Tobin research that was public health–related for a while. And I mostly retired from my extracurricular activities as a senior at this point. But I used to be very involved in a teaching nonprofit that took students in New Haven and taught them about global affairs.‌

Harlan Krumholz: Where is your favorite place to study at Yale?‌

Sophia Stumpf: That’s a good question. I think the periodical or the periodical reading room in Sterling is awesome. I also like Tsai or even just working in my suite, which is awesome. Yeah.‌

Harlan Krumholz: And what’s your favorite thing to eat in New Haven?‌

Sophia Stumpf: What’s my favorite thing to eat? I really love Tibetan Kitchen. You guys should go there. It’s a really cute restaurant. They have good food. Awesome.‌

Harlan Krumholz: Inès.‌

Inès Gilles: This is Inès here. I’m a sociology major doing the concentration in health and society. I think it’s kind of aligned in a really interesting way with this podcast. Outside of working on the podcast, I work as a research assistant looking at the societal impact of anti-obesity drugs, more from the sociology perspective, which has also aligned really well with some of the topics that we’ve talked about on the podcast. And I’m also the manager of the Yale Glee Club this year.‌

Harlan Krumholz: Oh, wow.‌

Inès Gilles: So I spend a lot of time singing, which is really, really lovely. I guess my favorite study spot, unlike Sophia, I’ve only been to the periodical room once and it was not my truth. Sorry. But I love working in Kroon Hall, which is the environmental science building. It has—‌

Harlan Krumholz: I love that.‌

Inès Gilles: ... gorgeous lighting.‌

Harlan Krumholz: That’s incredible.‌

Inès Gilles: I’ve done many a podcast prep there. And I also love L&B Room and the Architecture Library.‌

Harlan Krumholz: I love the L&B Room, except I fall asleep in the chairs—when I was a student.‌

Inès Gilles: They’re so comfortable, yeah. You should go back. It’s really, really nice. They just redid it.‌

Howard Forman: One other thing I want to mention that you talked about in terms of what the job has been is you have had very meticulous succession planning getting Tobias ready and making Tobias be able to step into the shoes fairly seamlessly. And when I look at his document now, it has your fingerprints all over it. What has that been like, not just for the podcast, but what is that like in terms of thinking about your future and about generativity and how you’re able to transmit knowledge and help people and mentor people? Can you speak a little about that?‌

Inès Gilles: Yeah, I think one thing to say is, Jenny [Tan] did such a good job prepping us for this role, and I think we kind of had a really great sequence of increasing responsibility with her, even though it was a much shorter timeline. So I think we used a lot of the documents she gave us and kind of added our own spin or what we tried to add during our tenure as assistants. But it has been really interesting thinking about, okay, what’s important about what I’m doing to share with Tobias? And I think we just had a lot of conversations between us about what we thought were important because obviously we also do the work slightly differently, and it was interesting to find those differences too.‌

Sophia Stumpf: Yeah, I totally agree. And I think also just deciding on a timeline, deciding on, how do you onboard someone? What are the right times to give someone sort of the lay of the land but not try to bombard them with the full responsibility at the beginning? I think that was a good learning in terms of how do you slowly onboard someone into responsibility. I hope we did that well with him.‌

Howard Forman: I mean, based on the outcomes, you’ve done a great job.‌

Harlan Krumholz: I think we’re in great hands going forward. It’s really nice.‌

Sophia Stumpf: Awesome, awesome.‌

Howard Forman: We really mean it when we say that we could not have done this without you. The students make this place great. I should note, I told Harlan yesterday, both of you have received or are going to receive the award from Yale for being a superb student worker. Let’s face it, there’s got to be thousands of student workers here. So to receive that award means a lot. And it’s well deserved, so congratulations.‌

Harlan Krumholz: Yeah, thank you so much.‌

Howard Forman: Congrats on the graduation coming up.‌

Inès Gilles: Thank you guys so much.‌

Sophia Stumpf: Thank you for nominating us and this opportunity to work.‌

Howard Forman: You deserve it more than that.‌

Harlan Krumholz: For sure.‌

Inès Gilles: We’re very grateful.‌

Harlan Krumholz: All right, we’ll see how many downloads we get this week. Got to tell all the friends and family.‌

Howard Forman: We’re counting on you to get this viral.‌

Harlan Krumholz: Great.‌

Inès Gilles: Thank you.‌

Sophia Stumpf: Thank you.‌

Harlan Krumholz: That was so much fun. All right. They were great. So we’ll wrap it up. You’ve been listening to Health & Veritas with Harlan Krumholz and Howie Forman.‌

Howard Forman: So how did we do? To give us your feedback or to keep the conversation going, email us at health.veritas@yale.edu or follow us on any social media, including LinkedIn and Bluesky.‌

Harlan Krumholz: And give us feedback. We love hearing from you. We will respond. We’ll sometimes even bring it into the show, but yeah, we love feedback.‌

Howard Forman: Yeah. And we do get periodic feedback. We got someone giving us a response to an episode with James Hamblin last year. I was very happy to see that people are listening. And if you have questions about the MBA for Executives program at the Yale School of Management, reach out via email for more information or check out our website at som.yale.edu/emba.‌

Harlan Krumholz: Didn’t you have an amazing session last weekend with Jeff Sonnenfeld at the MBA program?‌

Howard Forman: For the program. I was not there, but the students got an amazing session. He brings in some of the most amazing guests.‌

Harlan Krumholz: Yeah, I love Jeff. He’s incredible. Yep. I heard he had a lineup of all-stars.‌

Howard Forman: Yes.‌

Harlan Krumholz: This podcast, we’re fortunate, is sponsored by the Yale School of Management and the Yale School of Public Health. And we’re very fortunate to work with two of the people you heard today, Inès Gilles, Sophia Stumpf. And we’re going to be bringing on Tobias Liu, who’s already working with us. Terrific student.‌

Howard Forman: And Gloria Beck.‌

Harlan Krumholz: And Gloria Beck. Sorry. Gloria Beck. Of course. So that’d be terrific. And we fortunate to work with an amazing producer, Miranda Shafer.‌

Howard Forman: We got to get her in the studio eventually.‌

Harlan Krumholz: We’ll get her in the studio soon. Got to. Talk to you soon, Howie.‌

Howard Forman: Thanks very much, Harlan. Talk to you soon. And congratulations to Inès and Sophia.‌

Harlan Krumholz: Congratulations, congratulations.‌