Sarah DeSilvey: Creating Space for Healing

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 Sarah DeSilvey. But first, we always check in on current or hot topics in health and healthcare, and I’m having a hard time finding any news, Harlan, because it’s just such quiet time.‌

Harlan Krumholz: No, there’s nothing out there, Howie. Nothing. Nothing. Nothing.‌

Howard Forman: Very quiet.‌

Harlan Krumholz: All right, look, I’ve got two things I want to hit quickly, and one of them is around something that I didn’t really understand well enough and may have been... I was at dinner with some colleagues last night and I was talking about this. I realized I may not have been communicating this accurately. So, let’s get to it, right?‌

Howard Forman: Yup.‌

Harlan Krumholz: Here’s the question. Is the NIH budget being slashed? And I want to give people kind of a briefing of what’s really going on. So, you may have seen the headlines this week. Some of these headlines are talking about “NIH Budget Slashed by $18 billion,” or another one I saw was “Trump’s One Big Beautiful Bill Threatens U.S. Leadership.”‌

And the fear is real. The numbers are dramatic. But the truth’s a little more complicated. And I want to unpack this just a little bit, just so people can understand it—why the NIH is a spotlight, what people are talking about.‌

So, Howie, in the “Big Beautiful Bill,” and I think everyone, all our listeners must know what I’m talking about because it’s constantly everywhere, which is this Trump bill that passed the House is being debated in the Senate as we speak and that he’s been pushing so hard. How many times do they mention the NIH?‌

Howard Forman: I don’t think they do, because I think that comes out of appropriations.‌

Harlan Krumholz: Oh my god, that’s because you’re the smartest person on earth around—‌

Howard Forman: Is that true?‌

Harlan Krumholz: ... health policy.‌

Howard Forman: Is that the answer?‌

Harlan Krumholz: That is true.‌

Howard Forman: Okay.‌

Harlan Krumholz: So, I’ve been saying that this thing cuts the NIH. It doesn’t cut the NIH budget, but—‌

Howard Forman: No, it’s the next budget we’re worried about. It’s the appropriations.‌

Harlan Krumholz: Okay. So, let’s unpack this a little bit. What happened? The House passed this sprawling legislative package called the “One Big Beautiful Bill Act.” By the way, I always thought that’s what they’re just calling it on TV. It’s actually called “One—‌

Howard Forman: I know. I know.‌

Harlan Krumholz: ... Big Beautiful Bill Act.”‌

Howard Forman: It’s so embarrassing. I know.‌

Harlan Krumholz: It’s a—‌

Howard Forman: Yes.‌

Harlan Krumholz: ... blueprint for federal priorities, and it’s backed by the Trump administration’s 2026 budget proposal. That proposal, the budget proposal, which is aligned with the Big Beautiful Bill, includes a nearly 40% cut to the NIH from $47 billion to $27.9 billion. And it would also restructure the agency, collapsing the 27 institutes into just eight and eliminate—wait for it—10,000 research grants compared to 2025.‌

Now, this is the White House proposal. What the bill does is sets the framework for this to occur, but it doesn’t itself make the cut. That’s why Bhattacharya, the current director of the NIH, was testifying yesterday in the Senate as a prelude to discussions about what Congress is going to do.‌

So, they’ve got their own budget document that says that they think they’re going to put out about almost 2,000 fewer new grants, 8,000 fewer continuing grants, and cut about $350 million in training awards, and having the Common Fund, which is the fund that the director has control over to support big bold science across disciplines.‌

And even the indirect cost, the money that pays for lab space, we talked about this before, the electricity administrative support would be capped at 15%. But these are proposals right now.‌

Howard Forman: Right, right.‌

Harlan Krumholz: They’re not in the bill.‌

Howard Forman: Right.‌

Harlan Krumholz: But why are people worried? Because the Democrats and Republicans are expressing alarm about how this is going to undo years of congressional investment that Congress has continued in a bipartisan way to escalate the amount of investment and research in the U.S. That’s how we got to $47 billion. And this is going to unravel it if, following the Big Beautiful Bill, all of this comes to fruition.‌

Now, Congress does set the NIH budget, not the president. So, this budget proposal, no matter how sweeping, is just out of proposal and Congress still needs to pass actual spending bills. And like I said, this is for a long time had bipartisan support. So, it’s really not clear what’s going to happen.‌

But the One Big Beautiful Bill—and I’m only saying that because that’s the name of the bill—it sets the framework for cuts. And the administration, here’s the key, Howie, is already acting as if they’ve got the power to do this.‌

Howard Forman: Oh yeah, right. And—‌

Harlan Krumholz: So they’re holding up grants. These cuts are already occurring. So, just to finish, I’m curious of your feedback. The NIH funding has not been cut yet, but the moment matters because if these cuts go unchallenged, this will reshape American science. And this Big Beautiful Bill is setting the plate for this now discussion about the White House budget proposal. And gosh, you really got to watch this because this is going to be a turning point, could be a turning point.‌

Howard Forman: And there are legitimate cuts now. I mean, it is absolutely true that there are grants that have been halted in Year Two of Year Five. There have been grants that have either not been reviewed—‌

Harlan Krumholz: Yeah, that was the paper we published in JAMA, that research letter. So, $2 billion has been—‌

Howard Forman: Right, right. That’s right.‌

Harlan Krumholz: That was back then. Now, it’s more, and they’re different projections—‌

Howard Forman: It’s more.‌

Harlan Krumholz: ... but they’re all in the billions.‌

Howard Forman: And the delay even in processing grants is saving money for the government, at the expense of innovation. And—‌

Harlan Krumholz: And not even to mention the Harvard issue or the issue where they’ve actually just made a decision, “We’re not funding.”‌

Howard Forman: A blanket stop.‌

Harlan Krumholz: Yeah, we’re going to stop it right away.‌

Howard Forman: And I think it’s important for our listeners to understand that the payoff from types of investment like this are 10 or 15 years down the line. So, whatever we’re doing now, you might look and say, “Oh, but look, we’re going to save $150 billion over 10 years, and isn’t it better to save it there than to save it on the backs of somebody who otherwise becomes uninsured?”‌

But the hit to innovation in 10 or 15 or 20 years is enormous. And I think politically, one of the reasons why they think they can get away with this so well is the public doesn’t experience any pain in the short run and they may not even understand what they never got in the long run. Whereas Medicaid cuts will immediately come to hurt them at the ballot box come next November.‌

Harlan Krumholz: And this is just going to unravel generations of science. Like you said, I think it’ll have negative consequences even in the shorter run. And we will return to this because there’s a lot more to it. There’s initiatives to say that we should stop funding traditional centers and start going to other states. There’s a lot to ... Let me just get to the one other quick thing I just wanted to hit on.‌

Howard Forman: Yeah, sure.‌

Harlan Krumholz: So, we published a paper this week in JAMA Pediatrics, “Firearm Laws and Pediatric Mortality in the U.S.” I just wanted to highlight it because I thought it’s a cool thing for people to know about. So, do you know the number one cause of death among children and adolescents in the U.S.? It’s not cancer or car crashes.‌

Howard Forman: I thought it is firearms. I thought it is.‌

Harlan Krumholz: It’s firearms. It’s firearms. And that’s not true for any other peer nation. Firearms is the number one cause of death in the U.S. for children and adolescents. And so, we had a chance to work with Jeremy Faust, an amazing person.‌

And by the way, I really urge everyone to take a look at Inside Medicine. Jeremy is the go-to place for all the news that’s happening around the changes in policy—‌

Howard Forman: And breaking news.‌

Harlan Krumholz: ... right now.‌

Howard Forman: Really, it’s breaking news.‌

Harlan Krumholz: He’s doing a real ... whether you agree or disagree with him, he is bringing the information to folks in a way that almost no one else is. But we’ve been working together for a while. We worked a lot on long COVID stuff. But here we had access to the data in the U.S. around death certificates.‌

And in 2010, the Supreme Court ruled on this case called McDonald v. Chicago, whether the Second Amendment applies to state and local governments and whether we should be making it harder for them to restrict gun access. And after that ruling, states went in very different directions because they now could become more permissive about guns.‌

And so some states, as you might imagine, became very permissive. In other states, like Connecticut, of course we had the Sandy Hook experience, we’re continuing to hold the line on gun restrictions.‌

And so, we asked the question, did it make any difference at all? And the results were mind-blowing. In states that became the most permissive, there were more than 6,000 excess deaths among children from firearms between 2011 and 2023. In the permissive states, these were…now, if you took all of the the permissive states, just many more deaths.‌

But in the states that remained strict around firearms, there was no increase at all. And in four of them—California, New York, Maryland, Rhode Island—the rates of deaths actually declined. And most of these deaths weren’t accidental. They were homicides, suicides, tragedies in many cases. They were things that when a gun was readily available, then bad things can happen in impulsive ways and especially when you’re talking about kids.‌

And I think it’s just, we were illustrating the power of public policy that as you made these gun laws more permissive, there was, it seems, a cost that occurred with regard to these excess deaths. And, yeah, I mean the states have the right now to make those decisions, but there are young lives that were lost that might not have otherwise.‌

Howard Forman: A lot of these lives are suicides, right? Isn’t these—‌

Harlan Krumholz: That’s my point. It’s not like someone accidentally, but it’s actually impulsive acts because guns were available.‌

Howard Forman: Terrible.‌

Harlan Krumholz: Not that by the way... accidental deaths are also horrible.‌

Howard Forman: Right. And homicides are terrible, but suicides has always troubled me the most because—‌

Harlan Krumholz: Well, it’s these things that happen when a gun is available and people start, they act. I mean—‌

Howard Forman: Right, right.‌

Harlan Krumholz: Anyway, just wanted to share that. Anyway, let’s get on our guest. She’s going to be terrific.‌

Howard Forman: Oh, we got a nurse. Sarah DeSilvey is a rural family nurse practitioner with a doctoral degree and a member of the pediatric faculty at the University of Vermont’s College of Medicine. She co-led Addressing Social Needs Electronic Clinical Quality Measure, ECQM, at Yale Center for Outcomes Research and Evaluation, or CORE, which Harlan founded and directs, where she also served as a quality and informatics consultant.‌

In addition, she’s the director of Clinical Informatics for the Gravity Project, a national initiative developing data standards for social determinants of health in clinical care.‌

Dr. DeSilvey earned her BA from St. John’s College in Santa Fe before completing her Master of Science in Nursing from the University of Vermont and subsequently completing her Doctor of Nursing Practice at the Yale School of Nursing in 2020.‌

So, first of all, I want to welcome you to the podcast. I want to just say, because we’re going to get to a lot of different topics today, but I want to mention it is not infrequent that people reach out to Harlan and I and say, “We don’t have enough nurses on the podcast.” And part of the problem is that a lot of people don’t realize that a lot of the people we have are nurses, but they’re speaking about different topics.‌

You are both a practicing nurse practitioner as well as involved in a lot of health policy and health equity work. So at least we’re fulfilling one part of that mission. And as I’ve said to people, we’ll never have enough nurses, but we actually do have a good number of nurses on the podcast, including, upcoming, the dean of the Yale School of Nursing.‌

So, why don’t we start off?‌

Harlan Krumholz: And we love nurses. We love nurses. We think that the spirit of nursing, really connecting with people, listening, caring, investing in who the patient is, is something that should—‌

Howard Forman: And the community.‌

Harlan Krumholz: ... infuse medicine writ large in a much greater way. I mean, I think the spirit of nursing is so important. And, yeah, we’re committed.‌

Howard Forman: And in your case, you’re serving in rural communities and a lot of people I think don’t appreciate the absolute need for nurse practitioners for that matter or any types of clinicians in rural areas. They’re really underserved areas in so many ways from the primary care all the way up to specialty care.‌

I want to just hear your origin story of how you got involved in nursing care in rural communities and how that has informed the work that you continue to do.‌

Sarah DeSilvey: I love this is the first question. It’s such a lovely first question. So, again, I want to just pull through some of the philosophy and ethics that you were speaking to, Harlan. That’s a clear reason why I actually chose Yale School of Nursing for my doctorate is because those principles were so infused in that program. So, really grateful for calling that to light.‌

I had a kind of circuitous route to rural family practice. I was actually an organic farmer and a professor of farming for 15 years before I became a nurse practitioner. I lived in Montana. I was teaching at the University of Montana in Missoula. And it was actually meeting nurses in a complicated birth of my first child that I recognized that that was the way I was supposed to be involved in medicine.‌

I’m the daughter of a cardiologist who went to Yale. And he actually just retired this weekend at the age of 83. And so, I had thought medicine was my path, and then I met nurses, and I remember telling the career nurse as she was walking me to the hospital, I was in the hospital for some time. I looked at her, and I was like 27, 28. I said, “I think I know what I’m supposed to do next. I think I’m supposed to be a nurse.”‌

What nursing does best is hold all the fractured pieces for you as you heal. They create space for you, healing space, compassionate space. And I was so unwell when I met her after the birth of my son, and so was he. And she held ground for us with compassion and expertise and wisdom.‌

And I knew that I wanted to be a nurse. And I knew actually watching my dad, who’s a cardiologist, and my grandfather, my mom’s dad, who was a pediatrician, that I felt like actual primary care was my home because of the longevity of patient care and patient knowing.‌

And I literally worked for a few years to sell my farm to one of my students, came back to Vermont, where I grew up, put myself and my two kids through a nurse practitioner program at UVM and have been, without a doubt, 100% met in the daily work of taking care of rural families ever since I graduated.‌

I have the luck of, I call it “dream primary care,” taking care of the kinds of Vermonters I grew up around and taking care of many deep multigenerational families. There’s not a single person on my panel anymore that is not connected to somebody else. And so, most of my patients have at least four generations deep on my panel, and it’s just the best job ever.‌

I was talking actually with the chief medical officer at my dad’s retirement party, and we were describing why we love primary care so much, because he was a primary care provider too. And I mentioned and we agreed that it’s hard because it’s such an intense job, but it’s also a job where people tell you, “Thank you,” all day long and you know you matter and you know that you’re helping.‌

And I do a lot of pediatrics, and one of the phrases I use with parents is that purpose is protective. So, when kids are floundering or when things go off the rails, we try to work kind of from a Montessori approach of what the purpose is for the day and helping kids ground in that. And I without a doubt feel that primary care is protective for me. That’s why I still do it.‌

Howard Forman: Quick follow-up, just curious, is Missoula, Montana, considered rural or is it considered urban because it’s a city inside an extremely rural state? I’m always curious to know how we define these terms.‌

Harlan Krumholz: Oh my god, how did you come up with this question?‌

Howard Forman: Well, because, as you know, I am from a blended family with Montanans, and I need to know this now.‌

Sarah DeSilvey: Oh, yeah.‌

Harlan Krumholz: Oh, my god. So, you’re asking an expert in rural health how she ...‌

Howard Forman: Well, how do you define it? Yeah.‌

Harlan Krumholz: Oh, my gosh.‌

Sarah DeSilvey: Well, I think it’s actually a good question because it’s a moment, and I love that we’re talking about this, it’s actually a really good moment to talk about the role of rural primary care related to these anchor cities. The rural community of care in a clinical setting is built upon high-quality, maximized primary care to prevent the trip to town. The farmers I take care of do not want to go to the big city. We do as much as we can, but we also depend on the services of the city of mention.‌

So, Missoula itself, not rural, but it is within the care systems of so many deeply rural places around it. I mean, I—‌

Howard Forman: I figured, yeah.‌

Sarah DeSilvey: Yeah. And the same thing, deeply rural. And the same thing goes for up here in ... I work on the Canadian border. I live in Burlington, very similar, like centralized city, catchment area, academic medical center. But patients drive sometimes an hour to see me for primary care and then two hours to go if I have to send a specialty. So, we are interdependent.‌

Harlan Krumholz: Yeah, that was an amazing description of your current practice. I fear that this kind of practice is diminishing with regard to opportunities the way that the U.S. health care system is moving. But you’re speaking passionately about the value of this sort of connection with your patients and understanding across generations. That’s just amazing.‌

But I had the opportunity to meet you, and we had the privilege of working with you at CORE around another thing. So here you are, someone deeply invested in practice, and yet you are a national leader in an area that I think is so important.‌

I just want listeners ... I’m going to try to explain to them what this is. I want to raise this thing about the Gravity Project. So, if you’re listening, you may wonder, “Well, what the heck is the Gravity Project?” Well, so imagine you’re a doctor and your patient’s biggest risks aren’t really in the lab results but they’re in the context of their lives.‌

And so, they’re skipping meds to afford groceries or living in housing without heat or they’ve got personal struggles that are amplifying or even triggering the clinical problems. And the issue is that the electronic health records aren’t built to capture that information-standardized way so that it’s replete with information around the clinical stuff, but the real thing that’s powering the person’s problem can be missing.‌

So, what you did was to try to begin a national effort to create a shared language and digital standards so that doctors, nurses, hospitals, social workers, government programs can record this kind of information like social need, food insecurity, housing instability, transportation barriers. Maybe you can explain to people why is standard language the first step?‌

Sarah DeSilvey: So, the simplest way to state it is that healthcare and the information we create when we’re caring for patients is so complex and there’s so much of it that even if we see words in a note, if you’re a patient and you see a note on your portal or you get your discharge summary after a visit and it contains the diagnoses from that day, like “hypertension” or “diabetes,” there are codes. Just like when you learned about the library—I use the Dewey Decimal system often—just like when you studied library science in middle school, if you did. I had to, because that was part of our CORE thing. I don’t—‌

Harlan Krumholz: Our younger audience may not know what that is by the way, but—‌

Howard Forman: A real—‌

Sarah DeSilvey: I know. How can they? But they’re more familiar with code, so I’m hoping I can bridge it here. So, information we’re storing about people and generating about people telling stories is so complex that it gets simplified into sets of numbers and letters. And it gets simplified into sets of numbers and letters to be found later in the same care record, but also to be exchanged from one person to another.‌

So, if you are seeing your primary care provider and I am then sending you off to a heart doctor like my dad, I send surely a note, but I also send a lot of codes. I send the codes that represent the diagnoses or problems you have. I send codes that are all of the medications you’re on, there are codes to the surgical history you’ve had, anything, your family history, all of that information, your father’s heart attack, right? The hysterectomy, when you got your uterus taken out when you were 45. All of that information has to, because of how much information it is, get reduced to codes.‌

So very simply, before we created Gravity, there was just no code to name all of these critical things we knew were important to patients and providers. There was no way to state that a patient had food insecurity, transportation insecurity, or even if they were unhoused. All of these critical things that matter because you can imagine if you are leaving the hospital and you are unhoused and discharging to the street, there’s some pretty significant things we have to think about and take into mind to make sure you’re safe. And maybe we’re going to connect you to a hotel room to just make sure you recover stably.‌

So, for Gravity, all of those concepts and problems, whether it be the insecurities or even psychological stress, which was a driver, transportation issues, we just again did, as Harlan mentioned, incarceration status last fall. There wasn’t the language to name the problem, but there wasn’t even the language to name the treatment.‌

For instance, on family practice, every kid under three can get referred to the WIC program in my region I refer. But there was no code for WIC. So when I was trying to document that my patient was in WIC and I connected to them to it, I couldn’t, not in a way that was able to be found.‌

So, we’ve worked over the course of six years now, convening experts to name the problems the way that we’re supposed to name them. Name the goals a patient might have in the face of them because we work from a patient-centered perspective. Name the interventions. And we also build all of the questions and answers that people use to identify them.‌

So basically, it’s about storytelling, and I talk about storytelling all the time. We didn’t have the words to tell the stories we needed to tell before. And so, we had to make them.‌

Just a brief one more thing that I think is important too, when we think about things like trying to improve the quality of care, oftentimes those problems like diabetes are used within a principle called value-based care, which is basically trying to improve quality and reduce cost and aim for really measurable outcomes.‌

So, even as Harlan mentioned that we know that those social drivers and behaviors are driving like 80% of outcomes, not being able to name them meant that like a healthcare organization couldn’t direct care management funds to a patient who was food-insecure and had diabetes even if they knew that the food insecurity was driving the uncontrolled diabetes.‌

So, trying to think big picture too and ensure that we have the data needed to direct care to the right people from a population health perspective is partly what the Gravity origin story was as well.‌

Harlan Krumholz: And since you mentioned the WIC program, it’s just useful for our listeners to know, women, infants and children, what does that program provide?‌

Sarah DeSilvey: Yeah. So, the formal name is Supplemental Nutrition Assistance Program for Women, Infants, and Children. And it’s a program of the United States Department of Agriculture. So, it’s not even in the Health and Human Services Division.‌

And it is a program that centers skilled nurses and nutritionists in every county in the country. And it’s a focus on really improving the wellness of both pregnant individuals and young children. And so, if you are a kid aged zero to three, with your family, you go and get the support of a team that’s making sure that you have your right lead screening and you have your immunizations and you’re growing appropriately.‌

And they also subsidize food for low-income families. So they make sure that you have affordable formula and that if the parents breastfeeding that they have good nutritious vegetables and meals that are high-protein to make sure that mom is producing high-quality breast milk.‌

It’s an amazing program. It’s one of my favorites. And unfortunately, it’s one of the programs that right now, we’re all advocating for making sure stay in the budget proposals along with the base food stamps program, which is another USDA program which is for any qualifying family with income levels.‌

Harlan Krumholz: I just want to thank you for coming on. You’re such a delight. Your positive energy, your creativity, you’re someone who is deeply invested in clinical care and yet also in changing the national landscape. You’re a rare individual, and we at CORE have had the privilege of working with you, and we look forward to seeing your continued impact through all the work that you’re doing.‌

This infrastructure work cannot be underestimated. And as you suggested, it gets embedded. So then it just becomes part of the system. So it’s not about something that can be turned and overturned, it’s now we have an additional capability. We can document these things, and now we can build on top of it. Without it, it’s invisible. And yet, we all know it’s determinative for so many people. So, that’s why it’s so important.‌

So, I just want to salute you for doing it and thank you for coming on.‌

Howard Forman: And you’re a role model for nurses, for clinical care, for patients, for everybody.‌

Harlan Krumholz: For everybody. For everybody, yeah.‌

Howard Forman: Right. So, thank you.‌

Harlan Krumholz: Thank you.‌

Sarah DeSilvey: High praise from the both of you, who are heroes of mine. So, thank you so much.‌

Harlan Krumholz: Well, at least Howie, Howie is.‌

Sarah DeSilvey: Both of you. Thank you so much.‌

Howard Forman: Thanks for doing this.‌

Harlan Krumholz: All right, that was a terrific interview, Howie, but let’s now get to what I wait for on every show with bated breath. What’s Howie Forman going to say this week?‌

Howard Forman: Well, as I joked in the opening segment, there are a lot of topics that we could talk about, and you and I will have an upcoming episode without a guest. We’ll hit on at least the most important ones.‌

But for today, I wanted to talk about a report out of the CDC in their Morbidity and Mortality Weekly Report. And we’ve referenced this weekly newsletter occasionally on the podcast. And I think I’ve mentioned before, I have personally fond memories of subscribing to this in the early 1980s as a real hard copy delivered by the mailman, leaflet from the CDC. But it remains a great source of information on a host of public health topics. It’s freely available online.‌

We’ve talked previously also about congenital syphilis and in fact, Dave Chokshi last week briefly mentioned it. And on the podcast, Commissioner Juthani talked about this 17 months ago. I went and looked at that. Congenital syphilis, which is acquired by a fetus in utero, is a significant cause of perinatal mortality and morbidity. Stillbirth, early neonatal death, miscarriage, skeletal malformation, severe anemia, brain problems, all common occurrences in this population. All are entirely preventable if you screen for syphilis and treat it.‌

Primary prevention is obviously the best approach. But short of that, screening and treatment dramatically reduce ill effects. In 2023, 3,882 cases were reported. That’s the last year for which we have full data. And again, these are all entirely preventable. So, it may not be a huge number, but every single one of them should never have happened.‌

And this figure has increased dramatically from the 400s in 2013 to 918 in 2017, doubled again by 2019 and has doubled again now in 2023 though seemingly slowing growth a little bit now.‌

Nevada has the eighth highest incidence in the country among states and is the focus of this report. The investigators did a retrospective review of cases in Clark County, Nevada, to discover what missed opportunities existed. And during the five-year period of review, 195 infants were delivered with congenital syphilis.‌

Timeliness of testing and treatment predicts a good number of these cases, meaning that if you don’t test or treat, you have more cases. But what stood out in the report is that 57% of these pregnant patients presented to the emergency department, and the majority of these had no prenatal testing prior to the visit. And during the ED visit, more than half, not much more, but more than half, 53% received testing. But that also means a large number did not receive any testing.‌

The ED and other nontraditional points of entry into the healthcare system represent critical nexus points for diagnosing and ultimately referring or treating women who have syphilis. It likely goes without saying, and consistent with so much that we discussed with our guests today, that syphilis is much more likely in poor individuals, and we need to be able to identify these individuals first. And congenital syphilis, similarly, we should be looking for every opportunity to prevent this disease in our most vulnerable populations.‌

Harlan Krumholz: Week in, week out, Howie, you bring up these issues that there’s some simple things we can do that really can make a large-scale difference. They’re not about major investments, but they’re about trying to change our way of thinking and configuring a little bit around how we do the work and how we do the screening.‌

Howard Forman: That’s exactly it.‌

Harlan Krumholz: I love it. Last week, Rubella. This week, you’re talking about syphilis. These are things we should definitely be acting on, can make a huge difference. I really appreciate you for bringing these forward.‌

Howard Forman: Thank you.‌

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 social media including LinkedIn and Bluesky.‌

Harlan Krumholz: Yeah, we love feedback. Give it to us, rate us, help people find us, and we always enjoy hearing from our listeners.‌

Howard Forman: We really do. 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: And this podcast is sponsored by the Yale School of Public Health and the Yale School of Management. We are blessed to be working with superstar undergraduates, Gloria Beck and Tobias Liu. We have an amazing producer, Miranda Shafer. And I have a wonderful partner, Howie Forman.‌

Howard Forman: Me too. I’ve got it all back at you. I appreciate you, Harlan.‌

Harlan Krumholz: All right, talk to you soon, Howie.‌

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