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Episode 78
Duration 33:33
Elizabeth Arleo

Elizabeth Arleo: Advice for Working Mothers from a Women’s Health Specialist


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 closer to the truth about health and healthcare. This week we’ll be speaking with Dr. Elizabeth Arleo, but first we like to check in on current health news or what’s happening in medicine. And Harlan, what’s getting your attention today?

Harlan Krumholz: Yeah, I thought I’d just take a minute to talk about, again, these large language models, the ChatGPTs of the world. Last week was the HIMSS Conference, one of the largest conferences of health information technology, it was held in Chicago.

And they had a series of announcements. One of the announcements was that this ChatGPT, this interactive artificial intelligence system where you can basically pose just about any question and it comes back with reasonable responses in whatever level of English or any other language that you’re looking for. I mean, these things are just nothing short of remarkable, having been introduced just about six months ago. But that one of the major electronic health record companies, Epic Systems, one that we use at Yale, is going to start integrating this into the electronic health record and be able to let healthcare professionals use it to improve their workflows.

And look, this is something that’s going to transform the world. I think it’s really going to transform the world. And yeah, I’ve said this before, that I liken it to the very beginning of the internet when the very first browser came out, Mosaic, and all of a sudden you could understand how this conceptual thing, the internet, which was only accessible to specialists, could now be available to everyone—everyone. And we’ve been talking about AI for a long time, but in general, AI for the general public and for a lot of professions has been for very narrow tasks. Now we’re beginning to get what are really these foundational models, these AI systems that are capable of doing a wide range of things and helping people in a wide variety of areas, and the other fields are waking up. I saw just today PricewaterHouseCoopers is going to spend a billion dollars working with OpenAI, which developed ChatGPT, and Microsoft, which invested about $10 billion in OpenAI to build ChatGPT, to start reforming the way in which their business works. And I just say, this is going to be a juncture in history. It’s going to be a point where, as this goes on, it’s going to change dramatically the way in which work occurs and how people are helped and assisted in that kind of work.

We wrote a paper, we, a bunch of us. We had Eric Topol on the podcast, Eric was an author. Michael Moore from Stanford led this effort, and we published it in one of the top journals, Nature, and we titled it “Foundation Models for Generalist Medical Artificial Intelligence.” And we talked about that we are on the cusp of a big change, and that what’s going to be able to happen is a new paradigm for medical artificial intelligence, where we’re going to have these generalist medical AI models capable of carrying out a diverse set of functions that really have been built on a large amount of underlying data.

So the difference here is, we don’t build these for a specific task. What we do is feed in a ton of information, a ton of texts, a ton of data from a wide variety of sources. And because of the way this AI works—and it’s a bit black box-y, I mean, if you saw 60 Minutes with the CEO of Google, he basically said the problem is we actually don’t understand how they’re working—but when you put them in, you’re able to pose a wide variety of questions and be able to get help in a wide variety of areas. So your field, radiology, we’re talking about being able to generate reports, get annotations, to be able to improve the quality.

Well, you can hear me, I can go on and on about this, but our paper laid out a wide variety of use cases, ways that this is going to be applied now. Just to tell you, finally, when I was in clinic last weekend, we had a couple patients that had some mysterious set of symptoms, and I was with some medical students, I said, “Well, let’s pull up ChatGPT and see what it has to say.” And so we quickly put in, without any patient identifiers, but just saying, “A patient with X, Y, and Z in this age range,” and see what it came up with. And it was breathtaking. Immediately it came up with some really helpful ideas and suggestions, some of which we’d been talking about, some of which sparked us to think about other possibilities. And I think this is just scratching the surface of the beginning.

So you say what I’m thinking about a lot these days, I’m thinking about these foundational models, the way the world’s going to change and what it’s going to mean for medicine and healthcare, with also a lot of caveats. That we make sure that it’s used for good and we avoid any unintended adverse consequences as this begins to disseminate through the profession.

Howard Forman: Yeah. One of the points you made at the end, and I will say that paper—I hate to admit this—over my head there. It’s so much detail, it’s such a complicated area that there were parts of it that I had trouble understanding. The radiology part I thankfully understood.

But the conclusion, what you mentioned was one of the concerns I have, which is, will the progress happen so fast that it surpasses our ability to evaluate it in real time and our ability to monitor it. And I think that’s where the profession has to figure out how to put safeguards in place to make sure that people don’t become overly reliant on something that we know can occasionally go off course.

Harlan Krumholz: I actually believe it’s going to tip the balance of power within healthcare—now I’m departing from what we wrote—because it’s going to put patients in a better position. You’re going to be able to say, “Here’s a radiology report I got. Could you summarize this for me at a fifth-grade level—at a high school level—and translate this?”

Howard Forman: That’s very exciting, because there are many times someone comes to me and says, “What does this report even mean?” And these are doctors. I have doctors coming to me and saying, “What does this report mean?”

Harlan Krumholz: Yeah, yeah. If you’re not in the field, you’re not a specialist, the lingo and the jargon can throw you off.

Howard Forman: You should do better, and this helps.

Harlan Krumholz: Yep. Hey, let’s get onto the main part of the podcast and, Howie, why don’t you introduce our guest?

Howard Forman: Dr. Elizabeth Kagan Arleo is a Professor of Radiology at Weill Cornell Medical College and an attending radiologist at New York Presbyterian Hospital, specializing in women’s imaging. She’s a fellow of the Society of Breast Imaging and the editor-in-chief of the journal Clinical Imaging. Dr. Arleo’s research focuses on women’s imaging and women in radiology and medicine. She served as the president of the American Association of Women in Radiology in 2019 and is the founder and director of the mentorship program for Women in Radiology at New York Presbyterian Weill Cornell Medical College.

Dr. Arleo just recently published her first book titled First, Eat Your Frog: And Other Pearls for Professional Working Mothers. Dr. Arleo received her bachelor’s and medical degree from Yale and then completed her radiology residency and fellowship in Women’s Imaging at New York Presbyterian Hospital Weill Cornell Medical Center.

First, I just want to welcome you to the podcast. I’ve known you for probably close to 25 years now, and I followed your career very closely and I’ve been familiar with a lot of the work you did. And really until the book came out, I didn’t know that you were working on this book. And it’s a great book, it’s a great contribution. An area that people don’t talk enough about, which is what are the special challenges that women professionals face in advancing their careers and balancing it with the rest of their life.

And do you want to first explain this phrase, which I did not know about before, apparently attributed to Mark Twain I think, which is, “First eat your frog,” and what motivated you to write this book?

Elizabeth Arleo: Absolutely. First, thank you, Howie and Harlan, for the opportunity to be on Health & Veritas. And Howie, you haven’t just followed my career, you have been a hugely important mentor and sponsor in my career for yes, definitely over two decades. I did the same math.

I’ll say, First. Eat Your Frog comes from, as you said, a quotation attributed to Mark Twain that I’ve had posted on my office for years, way proceeding this book. The quotation is, “If it’s your job to eat a frog, it’s best to eat it first thing in the morning. And if it’s your job to eat two frogs, it’s best to start with the larger one.” Meaning it’s important to do the most important thing as early as possible in the day, week, or whatever timeframe that you’re dealing with.

And how does this help us as professional working mothers or professional working parents? Well, I think in two ways. One, it sets you up for success. Come what may, the most important thing is done. And secondly, it just lessens the mental load. The mental load being, what do we all carry, the list, the organizations, the things that we have to do to run our lives and the lives of those who are dependent on us.

Howard Forman: And just as a quick follow-up, you use a lot of aphorisms or quotes to motivate your chapters, but the chapters are much deeper than that. Really they’re about management philosophy for one’s career and how to operate in complex environments.

And one of the points is, don’t let perfect be the enemy of the good or the good enough. And I’m just wondering how that has motivated you, because quite honestly, you epitomize perfection. I mean, you do things meticulously and I know that you speak about telling your children to call you out when you use the word “perfect.” Tell us about that.

Elizabeth Arleo: Absolutely. “Don’t let the perfect be the enemy of the good,” is a quotation attributed to Voltaire, a French philosopher in the 1700s. This quotation I do not have hanging in my office because it is the one area, in the area of patient care, it’s the only area that I continue to strive for perfection, as close as perfection as humanly possible.

But otherwise, what I take it to mean, as a recovering perfectionist, is that if there’s a task at work, other than patient care or at home, instead of aiming for perfection, I try to be a satisficer. I’ll set criteria for something and once those criteria are met, then I’m done. Say I’m looking for a restaurant, New Haven, I want to hit, you know, thin-crusted pizza with good salads, in walking distance. And then once I hit BAR Pizza, I’m done. I’m not going to continuously scroll through, looking for the perfect restaurant, because the perfect restaurant doesn’t exist.

And it’s helpful to remind yourself that perfection doesn’t exist, because striving for the unattainable can lead to feelings of anxiety and depression. So don’t let the perfect be the enemy of the good. And if you listen to yourself and others, you’ll be shocked to see how often the word “perfect” just peppers all of our speech. And I think it just sets up unrealistic language, and verbiage is really important.

Harlan Krumholz: Elizabeth, really appreciate having you here. And I so value the idea that you’re giving voice to this issue. And as Howie says, too often it’s swept under the rug and people are expected just to be tough and sally forth and get through things. And to be able to have some advice and to know they’re not alone and to talk about what the realities are that people need to face, I think are really important.

By the way, and the frog thing, I always thought that that was “do the unpleasant thing first,” because I always thought that that was what that was associated with. But maybe it’s “do the most important thing” too. I think that’s a great title for the book. Go ahead, you wanted to say?

Elizabeth Arleo: You know what your frog is? When you contemplate your list of things, and if there’s one thing you knew if you got it done, you would feel like, “Ugh, I’m done. Now I can relax.” That’s your frog, if you’re having trouble identifying it.

Harlan Krumholz: Yeah, I think of, it’s like the thing I’m dreading doing and I should get it out of the way, but....

Elizabeth Arleo: Yes, yes. And that can be your frog too. For example, as a public service announcement, as a breast imager, the American College of Radiology and Society of Breast Imaging recommends annual screening mammography starting at 40 and continuing for as long as a woman is in good health. And yet screening is often associated with anxiety for many women—myself included, even as a breast imager.

So what I like to do is, I like to schedule my annual screening mammogram as early as possible in the month, week, and day that I’m having it done so that I set myself up for success, taking care of myself with physical screens. And I lessen the mental load; I don’t have to worry about it. If your frog is going to the dentist, then schedule your dentist for Monday morning at 7:30 a.m. and be done with it.

Harlan Krumholz: I was wondering what you think. One of the things that I tell people when I’m in the course of a mentoring discussion, especially ... you’re focusing on working mothers, that’s a particular group that is juggling a lot of things. And in an academic world, for example, we don’t often set concrete explicit goals for what would be enough this year. And the way it’s set up, it’s infinity. It’s like there’s no limit to the amount. “The more you do, the better you are. You should work harder, you should do more.”

I think that’s why a lot of people end up leaving the field and finding other areas because they never feel settled because of the way in which the culture exists. And I’m just wondering what you think about that. I mean, is that a thing? Am I doing the right thing in trying to help people to say, “Just identify your goals for this year, make them feasible. Let’s talk about that they’re reasonable, good. And then if you get that, great, great. That’s good, that’s good enough.”

Elizabeth Arleo: Yeah, absolutely. I mean, there’s certainly the concept of setting stretch goals. You’re stretching, but they’re also, you want to set yourself up for success by identifying goals that are reasonably achievable.

I agree with what you’re saying. I would say there’s both good and bad news about being a professional working mother, specifically in 2023. Many of us, myself included, grow up being told you could be anything you want to be. You can do anything you want to do. You could be a lawyer or a doctor, like I have. But the bad news is that still politically, economically, and I would say culturally at work, our country is just not fully set up to support women working in conjunction with motherhood. There’s still no—politically—U.S. federal law providing a right to paid family medical leave. Economically, high-quality childcare is hard to come by and very expensive. And culturally, there’s still a double bind at work for women. If you are too quiet and you don’t speak up about your achievements, you may be overlooked for promotion. Or if you speak up too much, then you’re viewed as too bossy and assertive.

And so even if you’re lucky enough to have the most supportive partner at home, it’s still a double whammy for women to navigate career and motherhood, should they go to— choose to do so.

Harlan Krumholz: And first I want to be clear that when I make that kind of mentoring advice, that’s not advice specific to working moms, for example, that I make that generally. But I just wonder, I feel that there’s just so much lip service to trying to make it better but we’re seeing very few substantive changes that actually can indeed make the environment, the culture, addressing the kind of issues that you’re talking about. I mean, do you think we’re making any progress?

Elizabeth Arleo: It’s a great question, and I think obviously changing the politics and economics of our country and our work culture will take time. Time which busy professional working mothers are already short on. So that’s why in this book, First, Eat Your Frog, I share eight lessons or “pearls of wisdom” that I’ve learned in the nearly decade and a half since I first became a professional working mother. Sort of the essential boiled down to help, that are easily actionable right now, like, first eat your frog.

Howard Forman: Can I pivot just a little bit to the topic of radiology, because you and I share that as a field. And about 18 years ago, maybe more, I wrote a paper with one of our medical students, who you probably knew at the time, about why women don’t go into radiology, basically, and they’re underrepresented compared to medical students overall. And they’re one of the most underrepresented fields, women are underrepresented in radiology throughout. It’s been chronic. It hasn’t changed much in two decades.

Can you give us some idea why that might be the case? Should we care about that, and if we should care about that, what could we do better?

Elizabeth Arleo: Absolutely. You’re absolutely right, Howie. That statistic of women, practicing radiologists are only about 25% female. And that statistics, which most recently comes from the ACR Human Resources Workforce Survey, has been without significant change in decades, to provide evidence support.

I think the reason for it, like most things, is probably multifactorial. One that I’ll hone in on, because I think it’s a myth that should be busted, is that radiology is not “patient-facing,” to use the current term. And come spend two seconds with me in breast imaging, and that’s just not the case. So there are subspecialties of radiology, breast imaging, pediatrics, interventional radiology, that are completely patient-facing. And I still practice both breast and body imaging because, in fact, it’s so patient-facing on a breast day, and so much of what we do is managing anxiety about screening and diagnosis and results, that I actually really welcome my body days, where I can just read on my own. That’s more the traditional model for a radiologist.

And yet, with the CARES Act and people getting their results right away on patient portals, I’m speaking to my body imaging patients all the time too. So with technology and accessibility of information, and especially in breast, pediatric, and IR radiology, we see patients, just like every field. And that’s one of the most gratifying, satisfying aspect of my career, for sure.

Howard Forman: Is there something we can do? I mean, are there things we can do to improve the numbers, or should we not worry about it?

Elizabeth Arleo: I think about it and worry about it because ... and shout-out to Dr. Michael Tal, an interventional radiologist at Yale, who is the reason that I am a radiologist. I started doing research with him after my second year of med school. And I saw through him that I could pursue my interest in women’s health through radiology.

And I am so satisfied in my professional career. It’s enabled me to be a professional working mother. I have three girls, ages 14, 11, and 6. And this subspecialty I’m so grateful to because it’s really provided me with a life I’m so satisfied with. So I want this for other women. And so I think we can do something about i—as I think we are, by having more women in leadership roles as examples of what the future generation can do and can be.

Harlan Krumholz: I’ll let you two radiologists debate how to improve the profession. I want to get back to this book because I think I’m really fascinated by it. And to me what you’ve done is to say, while we’re waiting, while we’re waiting for the system to change, there are things that people can do, equip themselves, strategies people can undertake. Because that’s just the way things are, to actually make it work better, make it work better for them.

And you said that as you reflected on this, there were a lot of pearls that you had and I just wonder what kind of advice you have. I’d really like to hear that.

Elizabeth Arleo: Three of my favorites are ... we’ve talked about two. First eat your frog; second, don’t let the perfect be the enemy of the good. And then my third favorite is, I think it’s really helpful to think about time in 168 instead of 24-hour chunks. The math, the equation is we all have 24 hours a day, seven days a week, equaling 168 hours. So the fact of the math is that even if you work 50 hours a week, which is more than most people, and you sleep 56 hours a week, which would be eight hours a night, which sounds like absolutely delicious to most professional parents, the fact of the math is, you still have over 60 hours after work and sleep for yourself and your family, your friends, and your community.

So it’s not accurate to say, “I don’t have time for something.” It just means it’s not a priority. And that’s fine, we all have different priorities. And to your point about goal-setting, it’s important to pause and take the time to think intentionally about what our priorities are because you can slot them in. And I think this really helps us as professional working parents because it lessens the pressure. In other words, while you can’t have it all or do it all within 24 hours—back to the math—is that when you think about it elongated 168, you do have at least 60 hours to slot in those priorities. And that’s very freeing.

Harlan Krumholz: I just wonder, given all the pressures on all sides, what was your work process to do this book? How did you sequester the time? Did you write a little bit every day? Did you just do it on the weekends? I mean, how did you approach this book?

Elizabeth Arleo: Yes, thank you. These are really pandemic pages. I wrote this book in Q1, in the first quarter of 2021, where it was such a hard time for the world, and especially for professional working mothers with school, for a lot of people, being run from home. And I find myself fortunately in the sandwich generation, I mean, taking care of not only younger children but elderly parents as well. It was another time where I felt so overwhelmed, as so many people in the world did, that I thought, “How am I going to survive this? I got to really boil it down to the essentials.” Writing has always been therapeutic for me.

And so I took the time each day and I wrote literally 30 days straight and then some more, but I wrote it in Q1 and revised it in Q2 of 2021. And I have a wonderful literary agent, who I also found through Yale, who helped connect me with my publisher. So writing’s always been therapeutic, and so it helped me clarify my essentials and what I hope will be helpful to others as well.

Harlan Krumholz: So it was really a sprint. You really had this inspiration that you needed to get through, right?

Elizabeth Arleo: I also participated in something called National Novel Writing Month in 2015. It’s a November program where, I don’t know if some people have heard of it, but you’re supposed to write 50,000 words in 30 days. Not perfect—again, don’t let the perfect be the enemy of the good—but just a draft. And I had always wanted to ... I didn’t write fiction, I wrote a family history because I really wanted to get that down while as many people in my family were around. And in doing that, I saw that I could write 1,667 words within an hour, because that’s how ... I was going to give myself an hour each day and done.

And that exercise, seven or eight years ago, was super helpful, because now when I’m looking, what’s the writing assignment, I know I can knock that out in an hour. Again, not perfect, but it’s a draft I can work with. And having done that once, I knew that I could do it again with something that I lived every day.

Howard Forman: We are five months away from another Breast Cancer Awareness Month, and that’s the one month of the year where everybody pays more attention, I’d say, to breast imaging and mammography and screening for breast cancer. But there’s so much innovation in that space that I don’t want to let you go today without having to actually speak to your professional layer of expertise. Can you give our listeners some recommendations for their own health, as well as what you see as being the greatest innovations going on right now in breast imaging and the detection of breast cancer?

Elizabeth Arleo: Absolutely. There’s a ton of innovation in radiology and in breast imaging in particular. And I’ll say that Yale is really out there as a player. Dr. Liane Philpotts just presented at ARRS [American Roentgen Ray Society] a few days ago an AI model showing near-complete agreement between radiologists for classifying breast density. And AI really is at the top of the list, not only in breast imaging radiology but the world in terms of innovation. So definitely AI. And Regina Hooley has two high-profile editorials in radiology in the past few months, so Yale Breast Imaging is really out there.

I’ll say, despite all this innovation and the excellence that AI is bringing for women, for patients, for anyone who’s listening, still, at this time, the number-one thing you can do is annual screening mammography, starting at 40, and continuing for as long as you’re in good health for the average risk woman. And I’ve studied the data. And I remember I got into this field of research when I was 32, it was 2009 and the U.S. Preventative Services Task Force modified their screening recommendations, pushing the start date later to age 50 and every other year [not every year]. And I just knew through my training, this is ridiculous. We see women with breast cancer in their forties all the time. So I thought, “Let me study this. And by the time I turn 40 eight years later, there’ll be no more controversy.”

Well, fast-forward, I’m 45 and there’s still controversy. Not among breast imagers, it’s very clear to us, but there’s still divergent guidelines, which are confusing not only for patients but also for our referring physicians. So bottom line, if you remember only one thing from this, aside from “first, eat your frog,” annual screening mammography starting at 40 for as long as you’re in good health.

Harlan Krumholz: That’s great. Well, Elizabeth, we can’t thank you enough for taking the time to be with us. We wish you the very best of luck with the book. I know it can do a lot of good, a lot of people will benefit from the kind of wisdom that you’re sharing. I’m just amazed by all the things you’re doing, actually. I mean, raising your family, very successful career, and now a published author, it’s terrific. And we so much appreciate you being here with us.

Elizabeth Arleo: Thank you so much for the opportunity. I really, really appreciate it.

Harlan Krumholz: Well, that was a terrific, terrific interview. I’m so glad that we had her on and, Howie, it’s so nice that you’ve been able to mentor people over a period of years and to see their careers really flourish and them to be doing so many different things.

Why don’t we get to pivot to your part of the podcast. What’s on your mind this week?

Howard Forman: Yeah. Right as the pandemic was hitting, other public health crises fell by the wayside. And one of them was the pandemic of e-cigarette use and abuse, particularly by adolescents and children. And the associated illnesses, most notably what is called EVALI, or “E-cigarette or vaping use-associated lung injury.” A very real pathology affecting the lungs.

And I can remember well, just before the first cases of COVID hit, we’ve been seeing very young people, and by very young, I mean under 40 generally, coming in with horrible-looking lungs seen on chest X-rays. And they had severe symptoms and a strong association with substantial vaping use. This apparently peaked in the summer of 2019, but we were still seeing a lot of cases right at the time that COVID hit.

To give you an idea of how much it was peaking at that time. The last big update from the CDC was February 25th, 2020, just as the pandemic is hitting. And here are just some highlights from that report. 2,807 acute cases and 68 deaths. Remember, these are young people, so we’re not dealing with 68 deaths among people who were likely to die in the next month anyway. These are 68 deaths in a population with a median age of 24. Two-thirds of them were male. And it turned out retrospectively that the main offending agent was actually an additive to the E-cigarettes known as vitamin E acetate, and that has subsequently been removed for the most part.

So in the midst of this health crisis, Juul, the company responsible for the most popular of the e-cigarette products, was separately identified as specifically marketing toward younger individuals. And not only selling flavors specifically targeting them but also using ever higher amounts of nicotine that would anchor or addict them for the future, creating a long-term market for themselves. Further, some of these doses actually put the users at immediate risk for true nicotine toxicity. Nicotine, as many people know, is lethal at a high enough dose, which is not a big dose, by the way.

So Juul withdrew all marketing around the same time and began a long process of settling claims with individual states and Native American tribes. Fast-forward to just a couple of weeks ago, mid-April, and Juul has now settled over $1 billion in claims, and they remain a vulnerable, if likely failing, enterprise. And they’re not the only player in this space. So the threats will remain, even if Juul goes out of business. And not to put too fine a point on it, but 3% of middle schoolers, 14% of high school students, reported using vaping products this year. And despite Juul’s pledge to avoid marketing to the youth market, a paper that came out of Australia in February of this year highlights that this remains a real and growing problem among their youth.

Let me just take a step backwards now, several years, maybe even over a decade. The original case for vaping and e-cigarettes has always been strongest as a means for those who are already addicted to cigarettes to transition away from the harmful effects of tar and possibly wean off nicotine, if they could. The evidence for this is supportive, but real risks remain for vaping. Even among adult populations, even in the most controlled settings. Regulations around vaping and e-cigarettes remain in place. They likely need to be strengthened if we’re going to avoid causing yet more harm to the youngest among us. It is an ongoing public health challenge. I don’t think we have all the information that we need, but it is something that we should continue to pursue and address it directly.

Harlan Krumholz: That’s great, Howie, thanks. 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, you can find us on Twitter.

Harlan Krumholz: I’m @hmkyale. That’s HMKYale. And Howie, I’m still now debating about this Twitter thing because—

Howard Forman: Oh my God, we should talk about this at greater length in a subsequent week. I want to just take a quick break right now to say that this is Jenny Tan’s final week serving us as our research assistant.

Harlan Krumholz: No! Say it’s not true, say it’s not true.

Howard Forman: It is true. It is true.

Harlan Krumholz: No.

Howard Forman: She’s going to graduate in four weeks, and we have a special gift for her that we will post online once she actually receives it. But she is graduating; we couldn’t be more proud of her. What she’s done for us is—

Harlan Krumholz: And for anyone who likes the podcast, they should know that you like it in part because of the contributions that Jenny has made. She’s helped us—

Howard Forman: In great part, in great part.

Harlan Krumholz: In great part.

Howard Forman: I mean, she keeps us in line.

Harlan Krumholz: And Miranda and Jenny.

Howard Forman: And Miranda, and Inez is joining us today and Sophia will be joining us in other weeks, and so we’ll welcome them at a future week. But I do want to say—

Harlan Krumholz: I don’t know, Howie we get such talented students. It’s extreme.

Howard Forman: I am lucky. I am a fortunate man. But Jenny has been a joy and I can’t thank her enough, so I just wanted to get that out there before we even get back to the podcast. Jenny, do you want to say just a couple of words?

Jenny Tan: Yeah, I just wanted to thank everyone on the Health & Veritas team. It’s been such a privilege working with you all and I have learned so much from Howie, Harlan and the amazing guests that you guys bring on. And I know Inez and Sophie are going to do great, and I will definitely stay tuned into the podcast.

Harlan Krumholz: That’s great.

Howard Forman: Thank you.

Harlan Krumholz: Thank you. Thank you.

Howard Forman: All right. And you can email us at Aside from Twitter and our podcast, I’m fortunate to be the faculty director of the healthcare track and founder of the MBA for Executives program at the Yale School of Management. Feel free to reach out via email for more information on our innovative programs, or you can check out our website at

Harlan Krumholz: Health & Veritas is produced with the Yale School of Management and now the Yale School of Public Health. And again, thanks to our researcher, Jenny Tan, and our producer, Miranda Shafer, I can never thank them enough. Talk to you soon, Howie.

Howard Forman: Thanks very much, Harlan, talk to you soon. Congratulations, Jenny.