The Future of Medicine

Odette Harris, MD, MPH, Professor of Neurosurgery and the Paralyzed Veterans of America Professor of Spinal Cord Medicine at Stanford, joins The Future of Medicine for a conversation about concussion, traumatic brain injury, and what it takes to change how medicine thinks about the brain. The conversation was recorded in front of a live Medicine Grand Rounds audience.

Dr. Harris has spent her career arguing that concussions should be understood as brain injuries, not minor bumps. She explains her work with the National Academies of Sciences, Engineering, and Medicine to rethink how these injuries are labeled and treated. She also describes how research with the NFL is helping inform safety protocols in other sports. Her message for parents is practical: the children who come to her clinic are more often soccer players, divers, volleyball players, and cheerleaders than football players. She adds that every sport carries some risk, and families deserve better data to make decisions.

She also discusses her research on women with traumatic brain injury in the military. Because so few women were in the studies, their experiences were often lost in the data. When her team examined them directly, they found high rates of depression and balance-related problems that were not being addressed. Women veterans were also having a harder time returning to work and daily life, even though they were better educated than their male counterparts.

Dr. Harris reflects on her own path, from immigrating to the U.S. from Jamaica, to Dartmouth, to Stanford Medical School and neurosurgery training at a time when very few women entered the field. She describes the mentor who told her to "go where you can write the script." That advice led her to spend her Van Wagenen Fellowship studying brain injury in Jamaica. There she found that death rates from brain injury were the same as in wealthier countries. The differences were in how quickly patients died and how well survivors recovered. She also shares stories from her recent Dartmouth commencement address and what it means to have the Congress of Neurological Surgeons name a lectureship in her honor.

Together, Dr. Harris and Euan Ashley discuss concussion science, fairness in medical research, and why the future of brain injury care depends on asking better questions.

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Pascal Geldsetzer, MD, PhD, Assistant Professor of Medicine in Primary Care and Population Health at Stanford, joins The Future of Medicine to discuss a striking line of research: evidence that shingles vaccination may reduce the risk of dementia.

Geldsetzer and his team study “natural experiments” — real-world situations that can allow researchers to get closer to determining cause and effect without conducting a traditional randomized clinical trial. In the case of shingles vaccination, age-based eligibility rules created unusually comparable groups of people: those born just before a cutoff were not eligible for the vaccine, while those born just after it were.

Using these natural experiments, Geldsetzer’s team has found evidence across several countries that shingles vaccination is associated with a substantial reduction in dementia risk. In one analysis, the researchers estimated that vaccination reduced the risk of dementia over seven years by about 20%. Similar patterns have appeared across different datasets and health systems, as well as in studies examining mild cognitive impairment and outcomes among people already living with dementia.

The conversation explores why a vaccine designed to prevent shingles might affect the brain. Geldsetzer discusses possible roles for the virus that causes chickenpox and shingles, inflammation, blood vessel health, and broader effects of vaccination on the immune system. He also explains an important open question: much of the strongest evidence comes from an older live-attenuated shingles vaccine, so additional research is needed to understand whether newer shingles vaccines have similar effects on dementia.

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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.

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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.

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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.