The Future of Medicine

Jyothi Tirumalasetty, MD, a Stanford Medicine allergist, immunologist, and researcher, joins The Future of Medicine to explain an overlooked source of health care emissions: the propellants used in many common asthma inhalers.

In this episode, Dr. Tirumalasetty explains how metered-dose inhalers, including many commonly prescribed albuterol inhalers, use hydrofluorocarbon propellants to deliver medication into the lungs. Most of the propellant ultimately enters the atmosphere, where it acts as a potent greenhouse gas. Depending on the inhaler, she says, the emissions from a single albuterol inhaler can be comparable to driving dozens of miles in a gas-powered car.

The conversation explores why reducing those emissions is more complicated than simply switching medications. Some patients need metered-dose inhalers, alternative devices may be more expensive or difficult to access, and treatment decisions must account for asthma control, cost, patient preference, and safety. Dr. Tirumalasetty emphasizes that patients should not stop using an inhaler because of its environmental impact without first talking with their physician.

Dr. Tirumalasetty and host Errol Ozdalga, MD, also discuss lower-emission inhalers, medication costs and access, and how health care can reduce emissions while keeping patient care first.

The episode closes with Dr. Tirumalasetty reflecting on her own unconventional career path – from nearly two decades of predominantly clinical work to a growing research program focused on inhalers, health care sustainability, and patient care — and why physicians can pursue new research questions at any stage of their careers.

Thank you for listening!
Call to action: If you enjoy The Future of Medicine, subscribe for more conversations with leading scientists shaping the next era of healthcare. Please rate and review the podcast to help others discover these important discussions. Share with friends and colleagues who are curious about how science becomes medicine.

Stanford hematologist and microbiome researcher Ami Bhatt, MD, PhD, joins The Future of Medicine to explore the microbes living in and on us—and how understanding their evolution could help scientists tackle hospital infections and develop new approaches to cancer therapy.

In this episode, Dr. Bhatt explains why the microbiome is far more dynamic than a collection of bacteria living in the gut. Microbes interact with our immune system and metabolism, but they also evolve rapidly in response to their environment. For patients undergoing treatments such as bone marrow transplantation, those changes can have serious consequences. Bhatt discusses research in which approximately 40% of bloodstream infections in a Stanford bone marrow transplant population could be traced back to microbes already living in the patients’ guts.

The conversation also explores why certain bacteria become particularly dangerous in hospitals. Bhatt describes “jumping genes” — pieces of DNA that can move within a genome — and her lab’s work investigating how this process may help Enterococcus faecium rapidly adapt and emerge as a hospital superbug.

Bhatt also reflects on the experiences that shaped her career, her commitment to patient-centered research, mentorship, and her work expanding access to cancer education through Global Oncology.

Thank you for listening!
Call to action: If you enjoy The Future of Medicine, subscribe for more conversations with leading scientists shaping the next era of healthcare. Please rate and review the podcast to help others discover these important discussions. Share with friends and colleagues who are curious about how science becomes medicine.

Ash Alizadeh, MD, PhD, a Stanford hematologist-oncologist and physician-scientist, joins The Future of Medicine for a conversation about cancer blood tests, DNA, early detection, and the growing ability to find traces of cancer that traditional scans may not yet reveal.

Alizadeh has helped pioneer approaches that search for tiny amounts of tumor DNA circulating in the bloodstream. In this episode, he explains the science in simple terms: as cells throughout the body die, fragments of their DNA enter the blood. Cancer cells can do the same. The challenge is finding those rare cancer signals amid an enormous amount of normal DNA — what Alizadeh describes as essentially a “needle in a haystack” problem.

The conversation explores two major possibilities for these technologies. One is detecting cancer in people who have not yet been diagnosed. Alizadeh discusses the promise of multi-cancer early detection tests, but also why showing that a test finds cancer sooner is different from proving that screening ultimately helps people live longer. He argues that these approaches may prove particularly useful when focused on people already at higher risk rather than trying to use a single test equally across dozens of cancers.

The second application may be closer to transforming cancer care: looking for molecular residual disease after treatment. Once doctors know the specific DNA changes within a person's tumor, a blood test can search for those same changes later, potentially revealing that cancer remains or is returning before it becomes visible on a scan. Alizadeh discusses how personalized DNA tests are already being studied and used across cancers including bladder, colon, lung, and breast cancer — and how emerging evidence could help doctors decide who needs additional treatment and who may be able to avoid unnecessary therapy.

Together, Alizadeh and host Euan Ashley explore what cancer DNA can tell us, where early detection still falls short, why finding residual disease could change treatment decisions, and what it may take to make cancer monitoring far more precise.

Thank you for listening!
Call to action: If you enjoy The Future of Medicine, subscribe for more conversations with leading scientists shaping the next era of healthcare. Please rate and review the podcast to help others discover these important discussions. Share with friends and colleagues who are curious about how science becomes medicine.

Ross L. Levine, MD, Chief Scientific Officer at Memorial Sloan Kettering Cancer Center, joins The Future of Medicine for a conversation about blood cancer, cancer genetics, and how a laboratory discovery can eventually lead to new treatments.

More than 20 years ago, Levine helped discover a genetic change in JAK2, a gene that plays an important role in controlling blood cell growth. When JAK2 is altered in certain ways, the signal that tells blood cells to grow can become stuck in the “on” position, contributing to a group of chronic blood cancers called myeloproliferative neoplasms. That discovery helped give doctors a new way to diagnose these diseases and helped pave the way for targeted drugs.

In this episode, Levine looks back on the moment he first saw the mutation in sequencing data and realized the finding could have immediate consequences for patients. He also explains why the first generation of JAK2-targeted drugs, while helpful for reducing symptoms and improving outcomes, generally does not eliminate the underlying cancer — and why researchers are now working on new approaches that may target the disease more effectively.

The conversation then expands to a bigger question: how much more is there still to learn from the genetic information contained in cancer cells? Levine describes how studying DNA from increasingly large numbers of patients continues to reveal unexpected patterns, new biological pathways, and possible treatment targets. He also discusses the growing importance of combining DNA data with other information, including how a cancer responds to treatment, how it changes over time, and what doctors can see in blood tests or under the microscope.

Thank you for listening!
Call to action: If you enjoy The Future of Medicine, subscribe for more conversations with leading scientists shaping the next era of healthcare. Please rate and review the podcast to help others discover these important discussions. Share with friends and colleagues who are curious about how science becomes medicine.

Clarence Braddock, MD, MPH, a nationally recognized medical educator and former Executive Vice Dean and Vice Dean for Education in the David Geffen School of Medicine at UCLA, joins Euan Ashley on The Future of Medicine to explore how we train future doctors, why changing long-established systems can be so difficult, and what leaders often misunderstand about creating meaningful change.

Braddock describes how experiences ranging from serving as a physician in the Navy to teaching trainees and studying conversations between doctors and patients shaped his thinking about what medicine asks of both clinicians and educators.

The conversation then turns to medical education itself. Braddock challenges assumptions that have shaped medical school for generations and discusses newer approaches, including simulation-based learning and a growing shift away from expecting physicians to function as encyclopedias of medical knowledge. As AI and other technologies increasingly bring information directly to the point of care, he argues that tomorrow’s doctors will need to become skilled and responsible consumers of knowledge.

Braddock and Ashley also examine the human side of organizational change. Drawing on lessons from major curriculum reforms, Braddock explains why the process of change can strain colleagues and institutions, and ultimately, why he concluded that how change happens can matter even more than what is changed.

Together, they discuss shared decision-making, the evolution of medical training, AI in medicine and what medical schools should be preparing their graduates to do in the decades ahead.

Thank you for listening!
Call to action: If you enjoy The Future of Medicine, subscribe for more conversations with leading scientists shaping the next era of healthcare. Please rate and review the podcast to help others discover these important discussions. Share with friends and colleagues who are curious about how science becomes medicine.