Lisa Rosenbaum: Medicine, Well-Being, and Victimhood

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. Our guest today is Dr. Lisa Rosenbaum. But first, we always want to check in on some hot topic in health and healthcare. And so Harlan, what do you have today?‌

Harlan Krumholz: Howie, like usual, there are so many hot topics, but I did notice that Neko Health... You know how hard it is to raise money these days, by the way. It’s really, really hard. Neko Health raised $260 million to expand their body scan surface, this preventive healthcare program they have. So I wanted to talk a little bit about this because you’re a radiologist and you’re so smart.‌

Howard Forman: But I want to hear more about it, because they don’t do real imaging. So I’m curious to know what you think about this.‌

Harlan Krumholz: This is really so amazing... so imagine you could step into a sleek, futuristic clinic. It’s scanned from head to toe in minutes, walk out with a complete assessment of your health, and bam, tell you exactly what’s going to happen to you. We have people like Kim Kardashian swearing by things like this, not Neko Health, but she was endorsing another and investors pouring hundreds of millions of dollars into this stuff.‌

You’ve got Neko Health, Prenuvo, that’s what Kim Kardashian was doing. There’s a whole range of them out there. Now they’ve had this idea that as we enter this consumer health period era of healthcare, that there’s a lot of people who are avid to live forever and think that they can take this into their own hands and by getting these kinds of scans, they can help it. It was founded by Daniel Ek, who’s a Swede, who was the founder and CEO of Spotify. He did this with Hjalmar Nilsonne. So the co-founder, they’re the co-founders of this company. And they say “shift healthcare from reactive to preventive,” which of course is a great idea, but you’re right, it’s not simply like a CAT scan. They use 70 sensors to non-invasively scan, the body detecting skin changes.‌

They say cardiovascular risk. This is all from their material, cardiovascular risk markers, a whole range of things. And here’s the thing, want to know about the demand? They say they’ve got over a hundred thousand people on their wait list, 10,000 scans completed. And like I told you, they just raised $260 million to give them a valuation of $1.8 billion. $1.8 billion. And so they are saying that about 1% of the people that come through have got something that they think saved their lives. Again, this isn’t peer review, it’s not it being “we got to sort of figure this out,” but they’re saying this is how it works, and here’s the kicker. This isn’t just a one-time scan. Eighty percent of their customers prepay for their next scan because the idea is that this is thriving on uncertainty. And I don’t know, people are starting with annual scans, so what are they going to do? Start doing monthly scans. It’s like, Netflix model for your body. You’re going to take a subscription model to be able to get these sequential scans. And I’m just wondering, what do you think about this?‌

Howard Forman: I just thought, this is going to be the greatest fraud since Theranos. I think they’re not actually doing imaging inside the body. They’re doing topography, so they’re looking for moles on the skin. Every time they find the mole that might be abnormal, they can claim it’s a potential life-saving finding. They’re otherwise doing about a dozen little lab tests, which reminded me of Theranos. They’re checking your hemoglobin A1C, they’re checking your glucose, other things, some cardiovascular markers, they’re checking your blood flow and a few vessels. I just thought, they’re charging $370 in a country where the average physician is paid less than a nurse practitioner. So the model might work in Sweden, and somehow they’re making it work in London. But the reality is that when you raise a few hundred million dollars, you can lose a lot of money on the product while you try to figure things out. And I don’t see any world in which they can make this scalable and profitable and actually useful. And I think as you said, it’s just a fad for the moment.‌

Harlan Krumholz: Well, you say that... I don’t know, a hundred thousand people on the wait list. I think it’s a pure cash business right now. And the question is, do enough people have discretionary income that they’re willing to spend on something like this? And is there enough evidence? Can they—‌

Howard Forman: I would spend 370 for it, but that’s only because I know I’m buying something that’s costing them probably $600. And so at the moment, it’s just fun to be part of the experiment. And I think there are a lot of rich people that would.‌

Harlan Krumholz: You know when it was founded?‌

Howard Forman: About two years ago?‌

Harlan Krumholz: Yeah, 2023. 2023, now $1.8 billion raising—‌

Howard Forman: Yeah. No, no, it’s crazy. But it shows, and we’ll talk about this maybe in the outro, but it just shows how popular opinion can be extremely popular.‌

Harlan Krumholz: And I think the appetite for people to do something to help promote their health, the irony is, of course, we can’t control blood pressure. There are not enough people who actually have indications for statins who are taking them. All the things that we know that work for pennies, we can’t seem to get people onto. But then all of a sudden the new technology gets a great demand.‌

Howard Forman: I’m very skeptical, but I love following things like this. The only thing that seems interesting to me is the sort of topography of your body getting in there naked or at least scanning on the surface of the skin to look for moles. If that’s effective, I’d be curious to see how well that works. And dermatologists—‌

Harlan Krumholz: Of course, no one’s ever shown this skin exam by dermatologists actually.‌

Howard Forman: Exactly. Yeah.‌

Harlan Krumholz: Anyway, well, let’s keep our eyes on it. ‌

Hey, let’s get to our guest, Lisa Rosenbaum. She is amazing. I really look forward to hearing from her today.‌

Howard Forman: Dr. Lisa Rosenbaum is the national correspondent for The New England Journal of Medicine, the writer in residence for the Smith Center for Outcomes Research at the Beth Israel Deaconess Hospital in Boston, where she also practices cardiology and she holds a faculty appointment at the Harvard Medical School. Her writing centers on the psychology, sociology, and ethics of medicine and healthcare, and has covered a wide variety of topics from physician burnout and patient autonomy to conflicts of interest and vaccine hesitancy. She’s also written for The New Yorker and The New York Times. She received her bachelor’s degree from Stanford.‌

She got her MD degree from UCSF before completing an internal medicine residency at the Massachusetts General Hospital. She was a Robert Wood Johnson Clinical Scholar from 2012 to 2014. And so first I want to just welcome you to the podcast, and I have a lot of questions about how you got to where you are right now. But I’m really curious, among the large number of physicians who write and do all lay publications of one type or another, you are unique in having a primarily physician audience. I mean, your New England Journal of Medicine writing is targeted at a very sophisticated healthcare audience. What got you motivated to do that, to start off with?‌

Lisa Rosenbaum: Well, first of all, hi, and thank you so much for having me. And I apologize that my voice is a little bit hoarse. So what motivated me to write for a physician audience? I think that I grew up in a physician family, and I think the profession is extremely dear to me. And so I think there is an opportunity when you’re writing for a physician audience to really target everything you write toward, how do we improve this profession? How do we maybe sometimes save this profession, especially in the last decade as there’s just a sense of decline, at least in certain aspects of the profession. Insofar as I think lots of doctors are unhappy, I think a lot of the public is unhappy with our healthcare system. So I just cherish the opportunity to have that platform where I can address some of these bigger issues facing medicine that I think would be harder to address to a lay audience.‌

I think the other part, though, is less about my ambition, just about where I fit in. And I had the opportunity to spend a year at the New England Journal in 2012, or maybe it was 2011 and I was their editorial fellow for a year. The editorial fellowship has since really evolved, but at the time, it was more unformed. And so I, alongside Daniela Lamas, who does write for The New York Times now and for TV shows. We were the fellows together, and she... God, she taught me so much about how to write and report. I didn’t really have any repertorial background. And she had been the editor at The Harvard Crimson, so she had real journalistic chops. And so together that year, we did some reporting.‌

I learned a lot, but I also really got to know the editors at the New England Journal, and it’s just an exceptional work environment. And I guess one thing I’ll add is that even from the outset, I think Jeff Drazen, who was the one who was editor-in-chief at that time and then ended up hiring me, he really gave me tremendous autonomy. So I think that’s a really rare thing for a writer to have where I just sort of come to my editors and say, “Look, this is what I’m thinking about. It’s sort of a mess in my head right now, but will you let me just try it out?” So it’s something that I feel extremely lucky to have.‌

Harlan Krumholz: What’s your process, because... I mean, I admire your pieces so much, and I’m just curious, what’s your process? How does it work? How do you find a topic and then what do you do? I mean, how does it work?‌

Lisa Rosenbaum: That’s such a great question. So yeah, my process, I think... I get asked this a lot and I always try to figure out where do I get ideas in the first place? And so I guess, for instance, I wrote a series about medical training that came out earlier... oh, yes, we’re 2025. So it came out last year. And there were lots of things that made me want to write that series. First, I just sensed that there was a vibe shift in the hospital, in our educational environment. Something had changed in terms of how we were educating trainees, how we were educating medical students, perhaps how much we were focusing on well-being. And it felt like a cultural shift was under way. And so a couple other things happened. One is I started noticing... I used to look at Twitter. I don’t anymore, unless somebody sends me something to look at.‌

But it was a time that I was still looking at Twitter a lot, and I started noticing that the debate about whether medicine was a job or a calling was going on, but that trainees were enraged when people would say that it was a calling. And that seemed new to me and something that we as a profession really needed to pay attention to. Then I think COVID... we’ve never really dealt with COVID in terms of how many things changed in the culture of medicine during COVID. And one thing that I really was struck by is that there was this opportunity or a moment that I thought we were all going to emerge as heroes.‌

And I realized on the other side that so many people came out the other side in the profession feeling like they had been hurt by it, really, really hurt by it, for understandable reasons. But that there was just a broader sense of a harm had been inflicted, and I wanted to understand this harm. And I felt like that part of it played into what I was seeing in terms of attitudes around work also, that there was this need, this burgeoning need to mitigate harms imposed upon us. Yeah.‌

Harlan Krumholz: Let me just to probe a couple quickly. One, so when you’ve got this idea and you’re running with it and getting multiple input, how long does it take for you to do these pieces?‌

Lisa Rosenbaum: I wrote four pieces and we did a podcast series. It took me 18 months.‌

Harlan Krumholz: Eighteen months. That’s wow.‌

Lisa Rosenbaum: I am so slow.‌

Harlan Krumholz: So a lot of your pieces intersect. So for example, talking about the issue about training, you wrote this piece that’s part of that, “Beyond Moral Injury.” Can we reclaim agency belief and joy in medicine? And you said something that, I wondered how that was received, but it was just so eloquently stated concisely, but clearly: “What if improving our own well-being sometimes means spending more time at work rather than less?” And the craft of it, I appreciate it. I mean, being able to capture that so succinctly, it’s a great quotable quote. But as you’re working, when you write something like that, do you recognize it as being important? And by the way, did you get a lot of pushback on that?‌

Lisa Rosenbaum: I got a ton of pushback, a ton, probably more than I’ve ever gotten. I was exquisitely anxious about it. Actually, when you say the line back to me, I get anxious and then I already am thinking, oh, no. Should I have made clear that people obviously were harmed by COVID? These are such tough things to talk about, but I spend a lot of time, this goes back to your other question about process. I spend a lot of time reading not about medicine but about culture and society. And what seemed clear to me in this societal discourse about well-being is a complete absence of discussion or reliance upon psychological literature about what well-being actually means. And then without that understanding, I think what had leaked into the culture of medicine was this idea that well-being means taking care of myself.‌

And it seemed so ironic for a profession that is meant to tend to the well-being of others, that this is how we’ve come to understand well-being. So I think that as loaded as that question felt, and I did focus it because it was tied to an anecdote about somebody, a friend of mine actually now, Kathleen McFadden, who had written this incredible thread about going back to seeing a patient at the end of the day after this horrible day at work. But she had insinuated in that thread, that I was so moved by, that the discussions around burnout and well-being have this implicit assumption that we should spend less time at work, and that is a source of happiness.‌

Harlan Krumholz: Well, and I promise you, Howie, I’m going to let you have the next one. Let me just follow up on one last thing, because here’s another quote I jotted down that I just wanted to give us your reflection on, which is—it’s about engaging in your work. That’s what you’re talking about now, but you also wrote this sentence: “We can’t address the factors actually compromising trainee well-being if we can’t separate them from the cultural factors, rewarding declarations of being unwell.”‌

I understand that. Actually, it has great clarity for me, but I can also imagine that people didn’t receive that necessarily well, even though it may be a hard truth to talk about.‌

Lisa Rosenbaum: Right. No, and this is the locus of my anxiety because that’s exactly what I was getting at too. What I started to talk about, I was seeing in culture at large outside of medicine, that we were celebrating victimhood, and I didn’t understand that. And there was something happening on social media, wherever you talked about any mistreatment or perceived harm, it would be met with so much attention and love and embrace. And I thought that was strange and something that we needed to understand. And then as I was trying to process it and what it meant for medicine, I came across a couple really interesting things about it. So one was this thing, “The Case Against the Trauma Plot,” which is a piece of literary criticism in The New Yorker, where the book critic Parul Sehgal, who I just adore, she talks about how there’s been this spate of fiction and TV that is all focused on a person’s identity, is based on their deepest traumas and wounds.‌

And she talks about how that’s flattening to the characters, but that gives them a source of moral authority. And I felt like when I read that, I finally understood the mechanism of action, which is to say, this is happening. We all feel this happening. We’re all scared, which is what you are asking about the pushback, because part of this is being so scared to point it out. But the reason that this is so difficult to talk about is because those who feel aggrieved have this implicit moral authority. And so that was just one example in her work. Meanwhile, there were more pieces like in The New York Times... oh, no, no, I think it was in The New Yorker, another one that I love called “The Rise of Therapy-Speak.”‌

But just how we’re all speaking in this kind of Instagrammable language about gaslighting and all of our traumas and how it’s come to seem meaningless, which goes back to the quote that you mentioned. Because I do think that people, and this is where the nuance comes in, and it’s hard in soundbites, but God, people among us are suffering. And I don’t just mean our patients. I mean, the workforce is suffering, trainees are suffering. People have debilitating mental illness. People experience racism and misogyny and all these things that we need to address. But when everything is a trauma or a grievance, it becomes very difficult to make those important distinctions and preserve the rigors of training. So that was my ambition.‌

Howard Forman: Yeah, incredibly done.‌

Harlan Krumholz: You talked about the anxiety you experienced when people were attacking you or attacking your work at least. And it’s not that it’s happened just once. It happens, I think frequently, not you in particular, but I think good writers are able to get people to take different sides of it. It’s very easy to preach to the choir. In fact, I think it’s very easy to write articles that every physician will just get up there and raise their arm in victory and cheer on what you’re writing. It’s much more challenging to get people to look in the mirror a little bit and reflect and think about things from different angles. How are you able to continue to motivate yourself to be willing to take the slings and arrows from others when you take on these challenging topics? Because much of what you write about is challenging. It’s not rah-rah, it’s not about, of course, we need more funding for sub-Saharan Africa HIV treatment. It’s about topics that have nuance and that may not be comfortable for people. How do you deal with that, and how do you manage it internally for yourself?‌

Lisa Rosenbaum: Well, I think on some level, it’s like anything where you just... I don’t even know if it’s a choice or if it’s just who I am, what I’m drawn to, and that I would get bored if I wrote things that people just wanted to hear. That that just holds no interest to me, and I obviously... I mean, at this point, I wake up in the morning and I can’t wait to write. I mean, I’m so lucky for that, and I’m so passionate about it. And so I think for me, it seems pretty clear that if I were to write a piece about how everybody’s burned out that would make people feel validated, for instance, that would be exquisitely boring for me. And the training series, I think, gave me more anxiety than any other thing I’ve written. And I think that’s because I don’t want to hurt people.‌

So there’s one thing to write things that challenge ideas and ask people to think, but it’s another to hurt people you care about. And so I really worried about hurting trainees. I care about them so much. And so I think that was the source of anxiety. And you said when you asked me the question, makes you anxious when everybody’s coming at you, I actually... in those moments, I’m often actually fine. Sometimes it’s when you see people misconstruing what you’ve done so blatantly, you don’t even feel that bad. But I just worried about my relationships with people I care about, and I always do. And so I think in those instances, I turned to my process. I look to reviewers. I look to my editors. I look to friends I trust to be like, “How offensive is this? Am I done when this comes out?” And I really thought, before the series came out, I was like, I probably should move to Europe or something. But I’ll also say sometimes I think I come off maybe as more... like stronger than I actually am. The other thing I think that really helps me and you’ll understand as physicians, is that the stakes when I take care of patients are so much higher than my own reputation when I write. And so I think that really it creates this relativity in my life where if I hurt a patient, I can’t live with myself, but if I write something and somebody’s mad or offended, who cares? Comparatively. And I think that really helps me.‌

Harlan Krumholz: I want to give you just a couple of minutes to talk more about the role that your grandfather played in developing you both as a physician and a writer. Because it sounds like from our prior discussions and from listening to your podcast that he’s played a big role. Can you tell us a little bit about that?‌

Lisa Rosenbaum: Yeah. I mean, he was probably the most... I mean, my parents are pretty influential in my life too, but my grandfather was uniquely influential. So my grandfather was a rheumatologist in Portland, Oregon, and he was just like a wonderful human. And he got laryngeal cancer when he was in his ’70s, and he was treated and cured. But when he went back to practicing medicine after, he found that he could no longer tolerate practicing medicine the way it was being practiced, having been a patient, having been on the other side. And it’s really interesting... So he wrote a book about it called A Taste of My Own Medicine. It was an autobiography, but as the title suggests, it was about the doctor becoming the patient. And I think that conceit has become a little trite since, but at the time, it was more unusual. And Disney actually ended up buying the rights to the book and made it into the movie, The Doctor.‌

So he had this whole second career as doctor/writer, and one of the interesting things to me now when I go back to his book, which I do from time to time, is that in the 1980s when he wrote the book, he was writing about the corporatization of medicine. He was writing about insurance. He was writing about how the business of medicine corrupted our professionalization. And so those themes are timeless in many ways. But anyway, The Doctor got made, and then I guess 15 years later, I got into medical school and there are six of us grandkids. And now my sister’s also a physician, but at the time, I was the first to go into medicine. And so he decided then that he’d raised a lot of questions in his book, but now he wanted to answer the questions and he wanted to answer them with me.‌

And so he started writing our book. He called it “our book.” He called it a textbook of medicine for doctors and their patients. And he sent me these letters in the mail, like endless letters and stories that he had collected over his years to which I was meant to respond. And I never responded as I was supposed to because at the same time as this was happening... well, first of all, I was a busy medical student, but second of all, he did start to get... he had Parkinson’s disease and developed a little bit of dementia, and it was hard to follow the thread. There were so many stories and everybody started having the same name, and I couldn’t bring it together. And sometimes he would just tell me a joke from lunch at his assisted living facility. But I think at some point, I realized that the point was not having a point.‌

And by that I mean, somehow he had held on to the stories of these people whose lives he had been part of for 50 years in practice. And so that carrying their stories was actually the point, as opposed to whatever I was going to respond to. And I think that has shaped me both as a doctor and as a writer. So I think the writing bug... my grandfather loved an audience. He loved an audience more than I love an audience. And so when I get scared, which is a lot, particularly around public speaking, I think of him and how much he would’ve just enjoyed having all those people listening to him. But I think I carry the way that he practiced medicine. And so to go back to the first question about why write for the New England Journal, it’s because I see the journal still is playing this pivotal role in how doctors understand the world.‌

And I feel like I carry this torch. It’s a privilege, but it’s a torch that understands what medicine could be. And he gave me that. I mean, my parents gave me that too. And now what I found as I went through training, countless other doctors gave me that too, as I watched how they practice. But yeah, my grandfather is very much alive inside of me. He died a couple weeks, I think before I finished residency at ’94. And I think the other thing my grandfather gave me that I really wish I could give to more people in medicine is just an appreciation of joy for the sake of joy. And so I think he really took me out of the rat race. Because he showed me what it felt like to do something that was meaningful to me without any external rewards. And by that I mean, he was always asking me, “Do we have anything in press? Are we getting things published?” You know what I mean? At a time in my life where I needed to get things published, I needed to advance my career. But what was most meaningful to me was the time I had with him, just sitting... I would sit next to him and try to take notes while he just gushed with stories. And so I think I’ve always... It clarified for me that I needed to do something that I truly loved, even if it wasn’t what medicine expected of me, which was probably to do research and have a more traditional career.‌

Harlan Krumholz: Well, we are really fortunate to have you, and it is great to hear your grandfather through your voice, so he does live on, and thank you for everything you do for medicine, for us.‌

Howard Forman: Terrific podcast. Yeah.‌

Lisa Rosenbaum: Thank you.‌

Howard Forman: You remind me of the importance of the narrative. I sometimes tell people we’re the stories we tell each ourselves and how we frame our lives and those stories. And you’re right, you’re just reminding us, I think, of the power of story and anyway, it’s really great. Thank you.‌

Harlan Krumholz: Thank you.‌

Lisa Rosenbaum: Thank you so much for having me.‌

Harlan Krumholz: Howie, that was a terrific interview. I’m so glad we had her on.‌

Howard Forman: She’s great. She’s just great.‌

Harlan Krumholz: But now let’s get to another favorite part of the show for me, which is hearing what’s on your mind this week.‌

Howard Forman: Yeah, so look, there are new presidential administrations that do not make major health news during the first days in office. This is not one of them. There’s been a lot of news, and I hope that you and I can help our listeners understand some of the more meaningful news breaks. So even as we’re taping this, Robert F. Kennedy Jr. is in the midst of the first of two consecutive days of hearings for his nomination to be Secretary of Health and Human Services. Unlike many other nominees, the Secretary of Health and Human Services goes through two hearings, one by the Senate Finance Committee and one by the Senate Help Committee. And I believe it’s only the latter vote that actually matters for the nomination. And then we’ll probably see a full Senate vote. Because I imagine it will come out of committee. It has not been an easy hearing.‌

I listened to a little over an hour of it and followed some of the write-up about the remainder. He gets applause and positive attention for looking to help America tackle chronic disease, obesity problems in our evaluation of food products. He comes across as a deer in the headlights when talking about Medicare, Medicaid, or Medicare Advantage. I mean, you have to watch it to believe it. He says things that are completely inane, and this is $2 trillion of our healthcare economy. So it’s not something you can ignore. He had a very challenging exchange with Elizabeth Warren, who was just asking him to promise not to make money off of his public service, which is not necessarily a fair question, but he wasn’t able to answer it.‌

And he comes across as a conspiracy theorist who so believes in his own conspiracies that he can’t even acknowledge that he ever gets anything wrong. So that’s really problematic. But if not for the hearings, you and I would spend this entire segment talking about the Trump administration’s effort to stall or pause federal grants and other payments for some undetermined period of time. And this is enormously consequential, possibly affecting trillions of dollars. And even with a judge halting this until February 3rd, the uncertainty that already has disrupted individuals and institutions, it’s going to continue.‌

Harlan Krumholz: You know, Howie, that the administration just rescinded the order?‌

Howard Forman: Just rescinded what? Say it again.‌

Harlan Krumholz: They just rescinded the order.‌

Howard Forman: Yeah, no, no. And it doesn’t matter. So I was going to go on to say, it, it doesn’t even matter whether this particular order has full force or not, because some places can absorb it, other places, the uncertainty alone is sort of the goal. It’s making people scramble to change their mission, to change—‌

Harlan Krumholz: But I’m just saying not only has the judge held it up, but they just like five minutes—‌

Howard Forman: Removed it.‌

Harlan Krumholz: Rescinded it.‌

Howard Forman: Yeah. I believe that because... nobody believed that this could sustain itself because it really bumps up against the ability of the executive branch to overrule the legislative branch.‌

Harlan Krumholz: Well, I believe the major thing was it was so broad-based that there were going to be so many people pushing back about this. It wasn’t like, “Hey, we’re going after X. They were going after A to Z.”‌

Howard Forman: And that’s not even it, right? Because we know that also multiple hearings, multiple review panels are on hold right now, people have been told not to travel for meetings over the next few weeks. Institutions, including our former guest, Katherine Baicker, Provost in the University of Chicago, told her own institution to stall some future spending plans until they have this figured out. The chaos is the point right now. And it’s not good for science because scientists rely on some reliable, sustainable flow of funds to continue doing their good work.‌

Harlan Krumholz: But if your strategy is to disrupt and you want to give people’s attention and whatever you do is probably going to be less than this, but now you’ve said... you know this from business school, you anchor a negotiation. So now you’ve anchored it at this extreme level. Isn’t it a good negotiation ploy? I mean, you got everyone talking about it. Everyone was paying attention to sucking oxygen out of everything else, and now anything short of this will seem like, yeah, that’s not... He’s anchored the discussion.‌

Howard Forman: I think the public will eventually come to realize that this is a poor execution of policy. I do think that people are... There’s a small group that will say, yeah, this is what we voted for Trump for, is to disrupt and to get these elites to start to listen to him. I think most people like to think that the government should operate day in and day out. Their checks should be written, jobs should be done, their nutritional supplements should be... The food that’s made available to them through the SNAP program should be there for them. Their community health center shouldn’t be worried about whether they can stay open for an extra day. I think those things matter a lot to people. The fact that Medicaid, which was not even apparently an intended target, was disrupted yesterday, I think is a good example of that. One in four people in this country are on Medicaid.‌

Harlan Krumholz: Yeah, I think that was a glitch. I mean, that wasn’t a policy decision, at least as far as I can tell.‌

Howard Forman: I think it was a side effect of this because they were so poor in communicating this that I think that state and local Medicaid programs wanted to make sure they got their money in before the door shut.‌

Harlan Krumholz: I think what’s going to be very interesting is to see the polling after this. To see if you’re right, that people are starting to be unhappy about this or whether or not it’s actually galvanizing. He did what he said he was going to do. He was going to kick butt—‌

Howard Forman: I agree. Look, a guy next to me on the train going down to watch a celebration of his boss being put in office this past week told me that you can’t complain about Trump not doing what he said. Everything he’s done, he said. And in some way, everything, right down to the pardons, is what he said.‌

Harlan Krumholz: Yeah. My hunch about this was that this was also not just so much about how you could save money, but implementing the point of view. If there’s not going to be any DEI, then we’re going to make sure that there’s nothing government’s funding that’s got DEI in it. And then that this pause was an attempt to try to do that, that they have certain... what they were talking about, like green energy and things like that. There were several things in that OMB memo that’s... I thought that that’s what this was an attempt to do. Like you said, I think the fact that it was so disruptive to so many constituencies made it impossible to maintain. But that’s where I felt this was going, that this was about cleansing the government’s support of things that he felt—‌

Howard Forman: There’s a lot still to go on, though. I mean, I would tell our listeners to be cautious having any comfort in rescinding an offer or even putting a new order in. Because I think that disruption of our entire government is the goal right now, and that will affect people.‌

Harlan Krumholz: Yeah. Yeah. What are you doing personally about it? Are you writing about it or what are you doing?‌

Howard Forman: I’m doing a podcast with my closest friend at Yale and trying to communicate this as much as possible. I’ve been communicating on LinkedIn, occasionally on Bluesky. I did a panel on Monday with a couple of our colleagues at the School of Management to talk about how to think about this. I was really thankful that two of the people were very, very proactive about telling individuals how they can activate themselves and work within communities and help. And I think we all should be a resource, if not for... As you well know, my mother just had hip surgery today, but if not for that, I was going to go on one of our local channels to talk about what the impact of these things can be. And I know that people are reticent to talk about this on public channels, but I’m totally willing to do that if it helps people understand it better.‌

Harlan Krumholz: Well, I think you’re a great educator, and you should do that. I don’t want to gloss over the part that we definitely want to send our best regards to your mother. She has broken her hip. She’s a wonderful, wonderful person. You’re a wonderful son, but these are personal events that actually end up overshadowing everything else as you’ve got to tend to family issues.‌

Howard Forman: Absolutely. So wishing her the best.‌

Harlan Krumholz: 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 of social media, including Bluesky and LinkedIn right now.‌

Harlan Krumholz: Yeah, and we’re avid for your feedback. We love it. We appreciate hearing pro and con, any different kind of views. And by the way, if you rate us, that helps people find us, and we appreciate that too.‌

Howard Forman: We certainly do. 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 the website at som.yale.edu/emba.‌

Harlan Krumholz: Health & Veritas is produced to the Yale School of Management, the Yale School of Public Health. Thanks to our researchers, Inès Gilles, Sophia Stumpf, Tobias Liu, and to our producer, Miranda Shafer. Amazing, amazing people who help us every week to do a good job.‌

Howard Forman: Absolutely.‌

Harlan Krumholz: Talk to you soon, Howie.‌

Howard Forman: Thanks very much, Harlan. Talk to you soon.‌