Public Health On Call

Treatment for substance use disorders during pregnancy is effective, and recommended by experts in many cases. But outdated, and often misinformed, policies have led to babies being taken by child welfare agencies because their parents was on anti-addiction medication. Two Johns Hopkins experts in opioid policy, Sachini Bandara and Alex McCourt, talk with Lindsay Smith Rogers about these laws impacting pregnant people and their families, the role of child removal in the opioid epidemic, and what needs to be done to bring a public health lens to the issue. Check out our previous episode on treating substance use disorders during pregnancy here.

When patients don't feel heard by their doctors, there's an erosion of trust that can lead to serious health consequences—even if clinicians have their patients' best interests in mind. Dr. Mary Catherine Beach, who studies patient-provider communications, talks with Stephanie Desmon about what can happen when patients don't feel heard, interventions to teach providers better listening skills, and how bias comes into play.

How we talk about disability frames the way we view the importance of access. The Accessible Stall podcast co-hosts Emily Ladau and Kyle Kachadurian talk about disability a lot in episodes covering everything from pre-peeled fruit and lingerie to health care and ableism. Today, they join the podcast to talk with Lindsay Smith Rogers about why authentic representation of disability is so critical to designing policies and spaces that serve everyone. To explore the resources recommended in this episode, visit the links below: Demystifying Disability: What to Know, What to Say, and How to be an Ally by Emily Ladau Disability Visibility: First-Person Stories from the Twenty-First Century by Alice Wong Being Heumann: An Unrepentant Memoir of a Disability Rights Activist by Judith Heumann, with Kristen Joiner Loud Hands: Autistic People, Speaking by Julia Bascom Squirmy and Grubs (YouTube channel)

An estimated 97,000 Black women and girls have gone missing or been murdered in the US in the last year—which represents about 40% of all missing persons. These women and girls are often viewed as criminals or runaways and not victims or survivors, which can hamstring efforts to find and support them. Dr. Tiara Willie, gender-based violence researcher, and Dr. Kamila Alexander, a nurse and trauma researcher, talk with Dr. Josh Sharfstein about the first organized effort to focus long overdue attention on this problem, which was recently launched in Minnesota, and its implications for the nation.

Starting in January, 2024, every family with a new baby in Flint, Michigan will be eligible to receive cash payments for the first year of life. Dr. Mona Hanna-Attisha, the pediatrician who exposed the Flint water crisis in 2014, and Luke Shaefer, Michigan public policy professor, talk with Dr. Josh Sharfstein about how this effort came together and what it hopes to accomplish. Professor Schaefer's new book is The Injustice of Place. Learn more at flintrxkids.com

The Johns Hopkins Bloomberg School of Public Health's Institute for Global Tobacco Control was founded in 1998, and since then it has become a global leader in the efforts to end the tobacco epidemic. To highlight the Institute's 25th anniversary, Joanna Cohen, director of IGTC, and founding director Jonathan Samet talk to Stephanie Desmon about the past, present, and future fight against tobacco. Check out the video version of the podcast here.

A major bankruptcy case of Purdue Pharma—the makers of Oxycontin—now sits with the Supreme Court. How did it get there, and what's at stake? Andy Dietderich, an expert in bankruptcy law and co-head of finance and restructuring at New York law firm Sullivan and Cromwell, talks with Dr. Josh Sharfstein about the case, the Sackler family's involvement, and what a SCOTUS decision could mean for future settlements.

Extreme heat, wildfires, hurricanes, and more are driving huge changes for emergency managers like Chas Eby, the deputy executive director of the Maryland Department of Emergency Management. Eby talks with Stephanie Desmon about an "all-hazards" approach for emergency management agencies, and their work to be better problem solvers when it comes to what climate change is expected to bring in the future. They also discuss how to increase the capabilities of communities to make them more resilient.

Daily health care operations in the US account for 8.5% of all greenhouse gas emissions. Shanda Demorest is a cardiac nurse and Associate Director of Climate Engagement and Education at Health Care Without Harm. She takes Dr. Josh Sharfstein on a virtual tour of a hypothetical hospital, pointing out opportunities for sustainability. They discuss how, despite a lack of regulation, health care systems are making pledges to reduce emissions—and how individual clinicians and patients can help the cause.

There's a bit of detective work that has to go into investigating outbreaks of foodborne illnesses, and your local health department plays a key role. Cari Sledzik, an epidemiologist in the Office of Acute Communicable Diseases at the Baltimore City Health Department, talks with Dr. Josh Sharfstein about what goes into piecing together a potential outbreak and what happens once the source is found. To round out this Food Safety Education Month episode, she also shares some tips for how people can avoid foodborne illnesses. Learn more about how to lower your chances of getting sick with the FDA's Food Safety Education Month resources.

Methadone is a gold star treatment for opioid use disorder but it's heavily regulated at the federal level, making it hard for patients to get and even harder for doctors to prescribe. Dr. Brian Hurley, president of the American Society of Addiction Medicine, talks with Lindsay Smith Rogers about the process of getting methadone, how its regulatory roots in legislation from the 1970s contribute to its stigma, and what's being done and what more could be done to streamline prescribing so that the patients who need the life-saving medication can actually get it.

Hundreds of thousands of people were exposed to dust, debris, carcinogens, and trauma at the three sites of the 9/11 terrorist attacks in the immediate aftermath and then the years following. In 2011, Congress created The World Trade Center Health Program to provide health care monitoring and treatment for certified health conditions at no cost to people directly affected. Dr. John Howard, director of the National Institute for Occupational Safety and Health at the CDC which oversees the program, talks with Dr. Josh Sharfstein about the history, the extensive list of covered conditions, and the process through which people can apply to be part of the program—even if they don't have any diagnosed medical condition at this time. Learn more here: https://www.cdc.gov/wtc/apply.html

Many of us only hear about the juvenile justice system from the news in 30-second snippets. But Sam Abed, acting director of the Department of Youth Rehabilitation Services in Washington DC, has more to say. Abed talks with Dr. Josh Sharfstein about his work with juvenile justice and what he most wants people to know about the system and the young people who come through it.

Throughout the pandemic, a few medical professionals spread false and misleading information about COVID-19 and even touted potentially harmful "treatments" to their patients. But did they face consequences? Journalist Lena Sun talks with Dr. Josh Sharfstein about her Washington Post report looking at how medical professional boards handled—or dismissed—complaints about these doctors.

Part two of this series features Dr. Daniel Grossman, an obstretrician and gynecologist, and Dr. Katrina Kimport, a sociologist in Obstetrics, Gynecology, and Reproductive Sciences at the University of California at San Francisco. They talk with Dr. Josh Sharfstein about their research documenting cases where patients were denied proper medical care because of abortion restrictions—even when the care was unrelated to a pregnancy. They discuss how being forced to deny proper medical care can cause catastrophic health problems and trauma for pregnant people and their loved ones, as well as distress for the medical professionals involved. For part one of the series, check out episode 656. Read the report here: https://www.ansirh.org/sites/default/files/2023-05/Care%20Post-Roe%20Preliminary%20Findings.pdf

In part one of a two part series, Johns Hopkins demographic researcher Suzanne Bell talks with Lindsay Smith Rogers about a new report quantifying the impacts of Texas's SB8, an extremely restrictive abortion bill that passed in 2021. They discuss how empirical evidence can help to illuminate the consequences of major legislation. Read more: https://publichealth.jhu.edu/2023/analysis-suggests-2021-texas-abortion-ban-resulted-in-nearly-9800-extra-live-births-in-state-in-year-after-law-went-into-effect

Massive deadly fires, bleached coral reefs, extreme heat, ocean temps topping 100 degrees….have we reached a tipping point in climate change? Johns Hopkins planetary scientist Dr. Ben Zaitchik returns to the podcast to talk with Stephanie Desmon about recent headline-grabbing climate events and whether or not they signal a critical threshold for the health of the planet. They discuss how we can collectively approach mitigation and planning for climate change and why it can be short-sighted to see climate change as an existential crisis for humans.

Legalizing medical cannabis may have paved the way for recreational use in many states, but what is actually known about cannabis as a medical treatment? Dr. Johannes Thrul, a Johns Hopkins substance use researcher, talks with Lindsay Smith Rogers about why there are huge gaps in research of the risks and benefits of cannabis, and how legalization might create new opportunities to finally get some answers.

Principal Matt Hornbeck of Hampstead Hill Academy, an award-winning public K-8 school in Baltimore City, returns to the podcast to talk with Dr. Josh Sharfstein about gearing up for school. They discuss how students fared academically last year—and how the school is preparing to address chronic absenteeism and mental health challenges this fall.

As life expectancy slips in the US, what can we do differently to improve overall well-being and health? For one thing: start paying for health care differently. Dr. Mai Pham, physician and president and CEO of the Institute for Exceptional Care, talks with Dr. Josh Sharfstein about a new report from the National Academy of Medicine on the opportunity of innovation in payment: What if health insurance covered social needs? What if primary care clinicians were paid for extra time to help those patients who need support the most? What if health care institutions saw their role as broadly promoting health?

Outdoor air quality is a major concern but what about the safety of the air we breathe indoors in public spaces like schools and offices? Dr. Gigi Gronvall of the Johns Hopkins Center for Health Security returns to the podcast to talk with Stephanie Desmon about the threats of poor indoor air quality including spreading infectious diseases and particulate matter, and a new framework for states to consider how to mandate clean, filtered air in public spaces to keep people safe. Read more about the importance of indoor air quality and what states can do to improve it: https://publichealth.jhu.edu/2023/regulating-indoor-air-quality

During the pandemic, it became clear that America's vast and complex food system has weak spots and needs help from farm to table to be more resilient to shocks and stressors. Elsie Moore, a Johns Hopkins PhD candidate and researcher at the Center for a Livable Future talks with Dr. Josh Sharfstein about this "resiliency concept" and how some jurisdictions are thinking through their capacity to make sure food is available during emergencies from extreme weather and global unrest. Learn more about the Center for a Livable Future's Food System Resilience Planning Guide. https://clf.jhsph.edu/about-us/news/news-2022/new-food-system-resilience-planning-guide-helps-cities-prepare-disruptions

Last summer, Lifeline transitioned away from a 10-digit national suicide prevention number to the three-digit 988 line in hopes of making it easier for people experiencing a mental health crisis to call and text. One year after its launch, guest host Dan Gorenstein of the Tradeoffs podcast talks about the crisis line's successes and where it's fallen short.

More than three years after COVID first shuttered schools, researchers are taking stock of how children are doing academically. Hopkins biostatistician Elizabeth Stuart speaks with Stephanie Desmon about their research about learning gaps and why it's so important to invest in regaining lost ground while still letting kids be kids. She also explains how this data can help inform difficult policy decisions like school closures in the event of another public health emergency.

What can we learn from depictions of pandemics in films and series like The Last of Us, I Am Legend, and Contagion? Dylan George, director of the new Center for Forecasting and Outbreak Analytics at the CDC, recently participated in a panel at Awesome Con to discuss these and other depictions of dystopian realities in media. Dr. George talks with Dr. Josh Sharfstein about what these iconic pieces got right, where they took some creative liberties, and what they reveal about gaps in our own public health systems and abilities to respond.

If a product is available for sale, it's probably safe. Right? Not so fast. Taplines podcast host Dave Infante talks with Dr. Josh Sharfstein about Four Loko, the popular caffeinated alcoholic drink from a decade ago, and his role as Deputy Commissioner of the FDA during the agency's analysis of the safety of the beverage. This podcast was originally released by VinePair and the full video can be seen here: https://vinepair.com/taplines-podcast/four-loko/

ChatGPT has lots of potential for use in public health, but how well does it actually perform? Public Health On Call intern Caroline Wang and Lindsay Smith Rogers discuss three potential uses—seeking personal medical advice, public health research for students, and as a practical resource for practitioners. They go over some specific prompts and analyze what the chatbot does well and where it's limited. Caroline is a Masters of Health Science student at the Johns Hopkins Bloomberg School of Public Health studying clinical epidemiology and has been an intern for the podcast since March 2020.

Earlier this month, a WHO group declared that aspartame, a synthetic sweetener found in everything from breath mints to diet sodas, is a possible carcinogenic. While more data is needed to confirm the link, there is research showing that artificial sweeteners are not, as we thought, "metabolically inert" and do actually impact our gut health which can impact our overall health. In this episode from the archives, Hopkins microbiologist Dr. Jotham Suez talks with Dr. Josh Sharfstein about the complexities of our microbiomes, why taking probiotics may not "reset" our systems after antibiotics, and how artificial sweeteners can cause imbalances that upset the trillions of microorganisms that keep us healthy. (This episode was originally released on September 1, 2021.) Learn more: https://publichealth.jhu.edu/2022/the-microbiome-and-your-health

Virologist Dr. Andy Pekosz returns to the podcast to talk with Stephanie Desmon about shots, shots, shots! Updated COVID vaccines, how the flu vaccine might perform this year, and a new RSV vaccine are all in the mix. They discuss when each of these vaccines may roll out and how there's potential to head off another "tripledemic" winter.

After last year's "tripledemic" of flu, COVID, and RSV, we're all wary of what this coming year might bring. Infectious disease epidemiologist Dr. David Dowdy returns to the podcast to talk with Lindsay Smith Rogers lessons learned, what can be expected as of right now, and potential impacts from new vaccines and treatments, like the game-changing antibody that protects kids from RSV, are entering the mix. Tl;dr: Get vaccinated for everything as soon as you're able to and we might be in better shape for the years to come.

There's a paradox in sci-fi movies: Even in the most futuristic, technologically advanced societies depicted in film, main characters often die because of a lack of basic medical care. Two movie fans, Johns Hopkins ICU physician Dr. Jack Iwashyna and his son, Sage, talk with Dr. Josh Sharfstein about some scenes in the Star Wars and Aliens franchises and how they can be used to appreciate the gaps that remain in health care today.

For Disability Pride Month, Dr. Stephanie Van, a Johns Hopkins rehabilitation physician and founder of YouTube's @‌ThisAbilityClinic, talks with Lindsay Smith Rogers about her work as a pain management specialist and disability advocate. They discuss how she helps patients with newly acquired disabilities and what she's learned about the disability community in the process, as well as what needs to change from the individuals to industries to make the world a little more inclusive. This episode is also available as a video here: https://youtu.be/T2PUYFOBVYk Learn more about disability and accessibility with the resources recommended in this episode by Dr. Van: Hashtags to follow on social media: #Disability, #Accessibility, #DisabilityVisibility Read or listen: Demystifying Disability by Emily Ladau This episode was co-produced by Aliza Rosen

In early June, a major Ukranian hydroelectric dam was destroyed. The situation is incredibly complex with widespread fallout and the potential for long-term public health risks. WHO incident manager Dr. Heather Papowitz talks with Stephanie Desmon about why the situation is so precarious, what the major concerns are, and how humanitarian efforts are coordinated and prioritized.

Over the last decade, research has established strong connections between hearing loss and cognitive decline in older people. Now, a new study presents compelling evidence that hearing aids could actually help slow that decline, especially for people at risk of dementia. Dr. Frank Lin, director of the Cochlear Center for Hearing & Public Health at Johns Hopkins, talks with Stephanie Desmon about the newest research and why the evidence bolsters the case for making sure older adults can (and should) access hearing aids and the support they need about how best to use them.

In the last decade, a record number of pedestrians were killed by cars. The problem is complex and lacking a singular cause or solution. Jeff Michael, now a researcher at the Johns Hopkin Center for Injury Research and Policy, spent 30 years with the National Highway Traffic Safety Adminstration. He talks with Stephanie Desmon about the rise in pedestrian deaths and some of the possible causes, looking to Sweden as a model for rethinking our roads, and why despite hundreds of deaths a day, preventing road fatalities still gets short shrift in the overall conversation of transportation safety.

Many lifetime mental health issues emerge during adolescence, but equipping youths with strategies and skills to work through trauma, anxiety, and depression can be key to preventing problems from snowballing. Johns Hopkins Center for Adolescent Health director Dr. Tamar Mendelson talks with Stephanie Desmon about working with Baltimore City schools to develop a successful program called RAP Club (Relax, Aware, Personal rating) to teach youths mindfulness and other strategies to combat the impacts of stress and trauma. Read more here: ​​https://publichealth.jhu.edu/2023/rap-club-promoting-adolescent-mental-health-in-schools

With 64 million people enrolled, billions of dollars in payouts, and millions of clinicians and health systems in the mix, it's hard to see how Medicare policies translate to the doctor's office or the bedside. But Medicare director Dr. Meena Seshamani, an ear, nose, and throat surgeon and a health economist, is working to change that. Dr. Seshamani talked with Dr. Josh Sharfstein about improving Medicare on a large scale while making it more accessible and helping individual patients live better, healthier lives.

Public health has a long history of activism in social movements and new overlaps took hold in the last few years with COVID-19 and social unrest. In Vital Talks, a podcast from Vital Strategies, Shelley Hearne returns to the podcast along with former Bloomberg School deans Al Sommer and Mike Klag and colleagues to consider the challenges of the current moment and talk about how the field of public health can work differently towards a healthier world. Learn more about Vital Strategies here: https://www.vitalstrategies.org/

Shortages of lifesaving drugs—the result of failures at every step of complex supply chains—have far-reaching impacts on patients, providers, and the broader field of medicine. Hopkins oncologist Dr. Amanda Nickles Fader and policy researcher Dr. Mariana Socal talk with Dr. Josh Sharfstein about the broader systems problem resulting in the shortages of a vast range of drugs and how it's changing treatment protocols and the patient experience.

A new committee in Maryland is charged with a big undertaking: investigating deaths by suicide to help inform prevention efforts. Mental health expert and committee member Dr. Holly Wilcox talks with Stephanie Desmon about how they'll gather data, which includes psychological autopsies, digital health care records, social service agency data and more, and gives some examples of how similar committees in other states have used data in innovative ways to inform interventions. Learn more: https://publichealth.jhu.edu/2023/investigating-the-why-of-suicide

Philanthropy is a critical part of global public health but funding cycles, donor preferences, and other systems can fundamentally impact organizations and cause mission creep. Vital Talks, a podcast from Vital Strategies, digs into current funding trends and features conversations with leaders from the Lwala Community Alliance and the Center for Effective Philanthrophy about hopes for a better funding landscape and new financing models to ensure organizations can deliver on their missions. Learn more about Vital Strategies here: https://www.vitalstrategies.org/

Mosquitoes are excellent hunters. Anopheles gambiae—the mosquito in sub-Saharan Africa that spreads malaria—in particular loves to feast on humans and, it turns out, relies heavily on peoples' scent to track them. Hopkins researcher Conor McMeniman talks with Stephanie Desmon about his team's new study looking at the molecular components of human scent that are most attractive to mosquitoes, and how learning more about these alluring scent signatures could help in the fight against malaria.

Alcohol plays an outsize role in gun deaths and a new study finds that alcohol misuse can be a better predictor of future violence than any other risk factors. Josh Horwitz and Silvia Villarreal of the Johns Hopkins Center for Gun Violence Solutions talk with Lindsay Smith Rogers about this connection and a set of new recommendations that include limiting access to guns for people with alcohol-related convictions and in places where alcohol is consumed. Read more about the report here: https://publichealth.jhu.edu/2023/new-report-offers-policy-recommendations-to-address-alcohol-use-as-risk-factor-for-gun-violence

Dr. Phyu Phyu Thin Zaw was a research scientist at Myanmar's ministry of health before she emigrated to teach global health at Hong Kong University. After the military coup in 2021, she and many of her friends and colleagues felt unsafe returning to Myanmar and some even had their passports blacklisted. Thin Saw talks with Dr. Josh Sharfstein about her experience, what happens when doctors and researchers are forced to flee in conflict situations, and what the scientific community can do to help those in exile.

Workplace wellness goes beyond safe offices to consider how employees can live healthy and productive lives at home while being focused on work at work. Hopkins health and productivity management expert Ron Goetzel talks with Lindsay Smith Rogers about this unique aspect of public health where the business community and public health collaborate on the psychosocial, organizational, and environmental facets of health at work—and how ensuring that people get to live healthy and joyful lives outside of work is a necessity in business. https://www.jhsph.edu/research/centers-and-institutes/institute-for-health-and-productivity-studies/

Active shooter and lockdown drills are part of a broader spectrum of emergency preparedness but there are differing levels of effectiveness and risks. Katelyn Jetelina, aka "Your Local Epidemiologist," talks with Stephanie Desmon about the benefits and real harms of these activities and why she does have hope that we will make progress with gun violence solutions, though at a "snail's pace." They also discuss the wide-ranging ripple effects of violence beyond the victims such as community-level mental health impacts.

Redlining and other discriminatory practices represent structural racism in housing. Efforts to counter the legacy of this injustice include voucher programs that help people move out of areas of poverty into "opportunity neighborhoods." Hopkins researcher Craig Pollack talks with Stephanie Desmon about evidence that these programs improve childhood asthma. They discuss opportunities to help people both through relocation and by improving conditions where they are. Read the study here:https://jamanetwork.com/journals/jama/article-abstract/2804846

In the frenzy of research for COVID-19 prevention and treatment, there were many disagreements about what really did—or didn't—work. The nature of the debates reveals a broader problem in how data are interpreted in medicine. Dr. Arturo Casadevall and Dr. Josh Sharfstein discuss the nature of evidence and Dr. Casadevall's new paper, Misinterpretation of Clinical Research Findings and COVID-19 Mortality. You can read the paper here: https://www.acpjournals.org/doi/full/10.7326/M23-0737?af=R

Having honest conversations with kids about the climate crisis doesn't have to be distressing. Climate scientist Heather Price talks with Stephanie Desmon about her work with www.talkclimate.org, an organization that collects age- and developmentally appropriate resources for talking about climate change with people of all ages, from birth to adult.

With huge parts of the eastern seaboard covered in a thick hazy smoke from Canadian wildfires, we're re-releasing an episode from September 2020 with air pollution expert Dr. Kirsten Koehler. In this episode, Dr. Koehler and Dr. Josh Sharfstein discussed how the massive West Coast forest fires raging at the time were affecting people's health. Their conversation about particulate matter and its impacts on respiratory health, and how to protect yourself, is just as relevant today in yet another air quality emergency.