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- [00:03]
A
This is Drug Story. I'm Thomas Goetz. Today we're dropping in a bonus episode. This is a conversation that I had recently with stat, the superb publication about health and medicine. If you are in the business of health and medicine, you probably already know all about stat. For more than a decade, they have been doing fantastic reporting from the frontiers of biotech and public health and policy, and STAT really has been a key source source for Drug Story. I get a lot of pharma news and inside industry reporting there, so I was honored to talk with STAT's Tory Bosch for their first opinion podcast, and I thought that the Drug Story audience would appreciate this conversation. If you're curious what inspired the idea for this show or have a notion about the bigger ideas behind this show, or you wonder why I think everyone should get a degree in public health, well, you'll get some of that backstory here. And meanwhile, we are indeed still working on season two. When we can, we will pop other bonus episodes in here just like this one, just to remind you that we still exist before our big reveal of season two later this year. Okay, thank you for listening. And here's my conversation with stat.
- [01:23]
B
Whether It's Ambien or WeGovy, Iverbectin or fluoride, every drug in your medicine cabinet or advertised on TV has a story behind it. Not just how it came to be, but how it ends up affecting society in unexpected ways, big or small. Welcome to the First Opinion podcast. I'm Tori Bosch, editor of First Opinion. First Opinion is stat's home for big, bold ideas from healthcare providers, researchers, patients, and others who have something to say about medicine's most important and interesting topics. This season, we're focused on the intersection of medicine and culture. And today I'm speaking with Thomas Goetz. He's a journalist, an entrepreneur, and the host of the new podcast Drug Story. After a quick break, I'll bring you our conversation about public health, parasites and big pharma. Thomas Goetz, welcome to the First Opinion Podcast.
- [02:29]
A
Thank you for having me, Tori.
- [02:31]
B
So congratulations on your new podcast. For anyone who has unfortunately not listened to it yet, can you tell us a little bit about the premise?
- [02:40]
A
Sure. Well, just what the world needs in other podcasts. But I had this idea that I could not shake, which was that there's a whole world of health and medicine behind the drugs we take, that in every drug, every medication, that there is a much larger story to tell about health and medicine and society and business and economics. And so this idea of using one drug at a Time to tell larger stories about disease and health in society and how we got there, like how these diseases emerged, how we recognize them, how we diagnose them. It just became to me a very powerful way to help people understand both the promise of medicine and medicines, but also the limitations of, of medicine and medicines to solve what can sometimes be larger social problems. And so that is what I try to do. And every episode is a different drug. And that lets you get into all sorts of different things, from depression to obesity to autoimmune disorders, whatever it is. As I always say, there are a lot of drugs out there. And so there's a near infinite way of telling the story of human civilization through the prism of drugs.
- [04:03]
B
Yeah. And you sort of format or structure each episode in this really neat way. Can you tell us a little bit about the three parts?
- [04:10]
A
Oh, sure. So. So yeah. So I was thinking, okay, well, if I want to tell the story of a disease and diseases and, and treatments, how do you structure it? So I stole a page from the best, which in this case is this American Life, which always does, you know, every episode in a series of acts. Being a English major, and I was drawn to the idea of like structure. And so I came up with this three not. It's not brilliant. It's pretty obvious. There's the diagnosis, the prescription, and then side effects. So the diagnosis is a way to explain the disease. What is the actual disease in play and how did that emerge over the years? The prescription is about the drug where we actually talk about how the disease is treated largely through the one drug. And then side effects is not so much the immediate so called adverse effects or adverse events of the drug itself, so much as the larger social consequences or contextual consequences of using X drug on Y disease. And so side effects, basically it's a rhetorical device or a narrative device, this 3x structure that lets me go lots of different places. It lets me go to ancient Babylonia or to the halls of congress or to inside marketing departments at pharma companies. But it's enough of a structure to kind of tell the story. And it turned out it's a useful device.
- [05:42]
B
Yeah. I have to confess that on the recent Ivermectin episode, I did not make it past the diagnosis. It was a little hard to listen to the tales of parasites, I think.
- [05:56]
A
Oh, oh, well, so the parasites, I mean, Ivermectin, that was a great example of like, you know, what the disease that the drug was originally created or discovered to work on, which is parasitic infections in that idea of prescription. All of a sudden the idea came, well, can we repurpose the drug? Which is a great idea, a great kind of use of pharmaceutical drugs. Some repurposing has opened the door to all sorts of new uses and new treatments and new help for people. But in the case of Ivermectin, it's in many ways the hope for repurposing rather than the actual effect of repurposing, at least to date, in terms of COVID and maybe even cancer.
- [06:43]
B
I'll go back to the side effects for sure. The part where you're talking about a parasite whose name escapes me, largely because I don't want to have nightmares about it. A parasite that replaced its host's tongue.
- [06:56]
A
Oh, yeah.
- [06:56]
B
And then starts to, like, live as a tongue in its host.
- [07:00]
A
Yeah. Oh, yeah. Well, it's a fish, to be clear. It's not a human. That's not a human parasite. Nevertheless, yeah, that's my favorite parasite because it's. It is the nightmare scenario of what a parasite could do and does. And, yeah, it eats the tongue and then takes the place right in the mouth, right inside the fish's mouth and does all the work that a tongue does, but takes a little off the top for itself.
- [07:24]
B
We need to connect to Disney about the next Finding Nemo movie. This seems like a great premise to me. Yes, yes. So as much as I could keep talking about that. So, you know, you recently, alongside the debut of Drug Story, which we should say just started in January. Is that right? January. So alongside the debut of the show back in January, you wrote a really compelling essay for first opinion and stat about how Americans expect too much from drugs. So I wonder if you could elaborate on that a little bit and how that idea might animate your approach to the show.
- [08:05]
A
Right. So I was glad for the opportunity to write this because this is an idea that had been bouncing around my head for years, really, which is it really starts from the perspective of the patient when they go into the doctor's office with a concern and oftentimes get a diagnosis and get a prescription. And so many times the patient leaves with that prescription and I'm pretending I'm holding a piece of paper, but it's probably on their phone and they think it's going to solve their problems. Right. The expectations, the hope is so high for that prescription to be the solve for their ills, but in reality, it doesn't work that way. It oftentimes is not the solution. Oftentimes it's. That prescription is only the first step on this series of trial and error and adjustments and titration and other medications that they have to try. The prescription is rarely the solution. And in fact, the prescription can create its own body of complexity and side effects, not just in the body, but in terms of can you afford the drug, Is it something that works with the other medications you're supposed to be taking, et cetera, et cetera. So it's the first step into another world of complexity. And so I was really curious about this tension between what oftentimes is the hope. I mean, it's actually great. The best example is the drug commercials that the director of consumer advertising that are allowed. They kind of come in two parts. The first part is the. The dark clouds parting and the sun shining through, and the patient. The people have a new world of opportunity and promise and health. And then comes the second half of the drug where it's the. It's the very fast talking about all those side effects and all those problems and consequences that were not intended. And so that duality between what we want out of the drug and what the reality is, I think is something that, you know, we as a society just. Just are so hopeful and so. So desirous of a positive outcome, but it's a lot more complicated than that. And so that. That was really what I was trying to get it get at. And I think that that goes back, you know, all the way to. I mean, I think of Romeo and Juliet, you know, when. When at the end of Romeo and Juliet, Romeo goes to the apothecary to get that the. The drug that will put Juliet into a deep trance for a couple days so that they can escape together and run away and live their life happily ever after. Well, it doesn't work that way. Right. Romeo and Juliet is a tragedy. The drug does not work. But they want it to be a magic potion and. Well, actually, it. It does work.
- [11:03]
B
The drug sort of does work, though. Right. And it's.
- [11:05]
A
Yeah, the drug works.
- [11:06]
B
Yeah, I mean, not. Not used as directed.
- [11:09]
A
Yes, exactly. Not used as directed. And Romeo jumps the gun thinking that she's actually died, et cetera, et cetera. But, yeah, so the disconnect between our hopes and the reality is really what I was trying to get at.
- [11:19]
B
And so the show really captures that as well. You know, I'm thinking about the recent episode on Ambien, which began with a really fascinating sort of historical look at insomnia as a modern creation. And it does seem that you seem to be focused, at least initially, on these drugs. That really intersect with the ails of modern life. Right, so insomnia, obesity, addiction. Is that sort of a special area of interest to you?
- [11:49]
A
Well, I'm a public health guy, so those are all kind of what are often called the social determinants of disease or sometimes the commercial determinants of disease. So I'm very interested in those areas. I'm also interested in the way they've been described as mismatched diseases where our bodies were evolved to do X, Y or Z, and then the world we built is not, is not the world that our bodies were evolved to inhabit. And then you have commercial forces like the food industry or, or the, the electronics industry forcing other things into the equation that, that kind of make things very complicated. And, and so, so we're basically not using our body as directed, if you will. And so then we come up with drugs like Ambien, which, which can be very effective, but also can, you know, teasing out the, the effect from some of the consequences can be, can be really challenging. So I, I think I was, I've always been interested in this idea of, you know, how deeply does the problem go, how deeply does the, does the disease go go in terms of going back and back and back to like obesity is a great example. It's not just a problem with hyper ultra processed foods, but it's also a problem with the cheapness and ubiquity of grain, which is a, which was one of the greatest inventions in the last hundred years was scientific, industrial agriculture was allowed to feed billions of people, but it also made grain really cheap and so that, you know, you can follow the trajectory. So I, I, I, I think that is one of the fun. Well, I say fun to me, it's, it's compelling, it's a compelling story that helps hopefully helps the listeners of, of the podcast understand their world a little better and understand kind of how we got to the, the disease in, in question a little more thoroughly.
- [13:55]
B
Yeah. And so, you know, for years before the podcast, you were a reporter reporting largely on health, is that right?
- [14:01]
A
Yeah, I was technology and business journalist and then I was executive editor at Wired and then I got my MPH at Berkeley because I observed that I saw around the corner to the future of journalism and it did not look bright. And so I figured, okay, I better get, I better get a little more expertise under my noggin. So that was public health.
- [14:24]
B
I have definitely looked at the MPH program at Johns Hopkins late at night, imagining what my future might look like. So I identify with that. How do you Think having an MPH has changed your approach to journalism?
- [14:40]
A
Oh, well, I mean, it ultimately transformed my career. I think what it did for me was I am very keen to understand systems and structures and contexts that to me is like, if you can make those invisible structures visible, it helps me understand the world and hopefully it'll help people understand the world. And so that's what public health is in many ways. It's understanding the context of disease, the other forces beyond the healthcare system that, that manifest in disease or, or health or illness, and then just thinking about how you make a. Make sense of that mess. So epidemiology as a, as a science is, is trying to turn the cacophony of everyday life into something that you can, you can parse it enough to understand, maybe causation. And so those rules and rule sets, I think, have been very powerful to me in telling stories that help people, again, make sense of their lives, make sense of the challenges they face in terms of their health decisions, their medical options and so on. To me, those are concerns and issues that are as prominent as climate change for modern society. Those are the crisis. Great opportunities, but also the. Maybe our largest, some of our largest problems.
- [16:13]
B
Should more journalists be getting masters of public health?
- [16:18]
A
Well, I encourage everyone to get a master's in public health, especially MDs, you know, the MDs who I know, including my own sister, who have gone ahead and gotten the mph. It kind of opens dimensions and multidimensional universes by which, you know, you don't just think about one patient, you think about whole, whole populations of patients, or better yet, not just patients, but people. I feel like it's an incredibly powerful degree and a very powerful kind of frame of reference for journalists. I think it's powerful because public health is so many different things. It's everything from healthcare, healthcare administration, hospital systems, economics, to biotechnology, epidemiology. It gets complicated fast, but. But I find that for anybody who's considering it, I always am like, yeah, go ahead, try to do it as fast as possible. And I mean, I was very lucky. I took it. My. The program I was in was the interdisciplinary MPH at Berkeley, which, which meant you took a little bit of everything across the public health menu. And that, that was very helpful to me as a journalist, just so I have a passing ability to understand or to start to think about some of these deeper questions, like infectious disease. Right? Like, that's another area where it turns out that it matters. It's good. It's good to know a little bit about something about infectious disease.
- [17:51]
B
These days, for sure. So ahead of our conversation, I was looking through your old author page on Wired, and I think this is from when you were executive editor. I was really struck by a feature from 2007 titled the Thin Pill. 75 million Americans may have something called metabolic syndrome. How Big pharma turned obesity into a disease, then invented the drugs to cure it. Do you remember writing that story very clearly?
- [18:17]
A
Oh, yeah. I forget the name of the drug, but it was a, it really was the, in many ways, the precedent for GLP1s. And at that time, it was, you know, that was seven years before the American Medical association recognized obesity as a disease. And it was also this idea that, you know, medicine as a treatment for obesity had a lot of promise, but it also would be a very fundamental shift in how society thought about this disease or about this condition and how we, we can use or might use medicines to address it. I, I have to read that again. I have to. I probably was more skeptical of the idea of using drugs to treat it than I would be today. But, but I think it was an example of kind of trying to use this lens of enough, enough public health to, to think about medicine. So, yeah, it's, it's an old saw I've been, I've been sawing at, for, for a while, I guess.
- [19:13]
B
Yeah, I mean, so I found it super interesting to read. I, I vaguely remember reading it at the time, I want to say, and I think I was just sort of interested in comparing it to your coverage of WeGovy, which I think talked some in somewhat similar terms about the idea of obesity as a disease and a pill to cure it. And as you say, with the wired piece from 2007, you did seem so much more skeptical than in discussing it, albeit with, of course, lots of nuance on drug story. So I was wondering if you could maybe talk a little bit about your thinking about the topic and how that's changed, as sort of indicated by your writing about it.
- [19:57]
A
One of the things that I've really come to appreciate in the last, since I got my MPH, since 2007, say the last 20 years, 20 years of covering health and digital health and medicine and technology is how so much of health is this tension that is actually a very fundamental American tension between personal responsibility and a common good or a greater good. And in many ways, the kind of issue of obesity is a great example of that tension. So there's a lot of emphasis on personal responsibility, free will, personal choice when it comes to what we eat. Right. And the idea that diet and exercise are up to you. And I think that is true to some extent. We do have choices there. But there are also greater structures and systems at work that I think 20 years ago I was not giving enough heed or paying enough credit to the idea of a common good. The idea that there are these larger systems that are often being manipulated by. By commercial interests like the food industry, and manipulated on an individual basis. Basically taking advantage of our ability to make choices to basically entice us to make what turned out to be bad choices. And I think you see that right now a lot with, with Maha and the, the emphasis on personal choices, personal responsibility and the, the reality in some ways the real attack on the idea of actually there is a common good and there is an obligation of government, of regulators, of our health infrastructure to protect our citizens and to create some standards of. And access to standards of health and medicine. And, and obviously that's always been. That goes back over 100 years in this country. That is an enduring tension in our medical care and in our country at large. But I do think it has come out and is really brought to the fore in the debate around GLP1s and obesity. And my 2026 self actually believes that GLP1s are actually. They don't solve the problem. They are not a solution to our social problem of an increasing rate of obesity. Our social problem of bad food being so prevalent and so cheap and being subsidized by the government. If the government is subsidizing agriculture on the one hand, why do we expect personal choice? We should have some government on the other side too, maybe trying to protect us from some of those, some of those. The effects of those subsidies. Anyway, I feel like it's a great example of where we actually need to, especially now, this idea of a common good and a common health and an expectation of all of our citizens to be able to live a healthy life, you know, to have healthy food, to have healthy water, to have safe streets. These are the basic protections of government and they have massive health implications. And they are structures and systems that unfortunately are under attack and being questioned in ways that they never had been in the last hundred years. Sorry about that rant.
- [23:47]
B
No, it was fantastic because as you were talking, I was thinking so much about your first opinion essay about extra expecting too much from drugs. And in some ways then it feels like it's less that Americans expect too much from drugs individually, though of course, I'm sure we do. But more that the system, as you're discussing, expects the drug to fix the system's problems. Right, so. Or the problems created by the system. Right, so the system creates the problem of obesity and then creates a pillow to solve it, rather than fixing the big system.
- [24:22]
A
Yeah, which is, I mean, you know, it's totally true. I mean, the EpiPen, the first episode of the podcast, is a great example of that. Right. We there was this creation of a, of a drug delivery system that, you know, can deliver a treatment for allergy very quickly and effectively. And everyone with food allergies now carries not just one, but two EpiPens, which is great. But why is there such an upsurge in food allergies in the United States or in Western nations? What's going on with the way we eat in our immune systems? That has changed? Well, it turns out that the guidelines for almost 20 years from the American Pediatric association were exactly wrong in recommending that parents minimize the their infants, young babies, exposure to potentially allergic foods, peanuts, milk, eggs, what have you. And so we created those guidelines, created or helped create, I should be careful, my words helped create an epidemic of food allergies that was driven by human decisions and by well intentioned policies that were fundamentally flawed, misguided understanding of what, of what actually is happening in our immune systems, which is an incredibly complicated system. But I think the fact that we have a drug now to treat those conditions or to treat the anaphylactic shock or anaphylactic reaction, it's wonderful. But it is a great example of how the certitude that we might have around our recommendations or guidelines or policies in health and medicine are always subject to change, are always subject to new science and new understanding. Medicine is a science through the vessel of human understanding and the limits of human understanding. You know, that's the playing field on which medications will always be kind of out there.
- [26:24]
B
Absolutely. So I have a two year old and I will never forget trying to convince her to drink pureed salmon when she was seven months old to try to stave off any future fish allergies on our pediatrician's recommendation. She was not interested.
- [26:40]
A
That is dedication.
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B
I tried.
- [26:42]
A
Show me a 7 month old who would be.
- [26:44]
B
Lots of them, apparently. So as we start to wrap up, where is drug story heading next?
- [26:52]
A
Well, I just finished the first segment, so it was incredibly gratifying. It took me a year to come up with 10 episodes and I put it out not really knowing what was going to happen with it. And it's been thrilling to see so many people respond to it. And for a brief window of time. It outranked Oprah on Apple podcasts. And I have a screenshot of it and everything. It'll be on my gravestone. But it's really been thrilling to see that there is an audience for stories about not just medicines. But the secret is it's really about public health. It's really about like these again, these structures and systems of the human layer and how we, how we treat and think about disease. And a lot of people like those stories. So that's wonderful and I'm incredibly gratified that, that it has been a success. So I'm gonna do a second season and I have a list of 330 drugs. As I always like to say, There are over 3,000 drugs behind a typical pharmacist counter. So there are a lot of drugs out there that have stories and that kind of open the door to these kind of human levels of understanding. So I have another 30 that I'm going to cut down and hopefully before the end of the year, my goal is before the end of 2026, I'll start a second season. I should say I'm doing this independently. I have distributor or production company, so it's all done. I'm out there shopping my own show to get sponsors and support. So if I can get a couple of those pieces in place, then we'll have another episode or another season by the end of 2026. And like I haven't done insulin and diabetes, I haven't done ADHD and Adderall. I want to talk about Humira and autoimmune disorders. I have this amazing three part miniseries on fortified foods. Iodine in salt and, and vitamin D and milk and folic acid in flour. And they're just, they've just added folic acid to corn masa, which is, I'm excited about that. So these are all amazing stories to tell that I believe will continue to bring the story of, of health and medicine to, to more and more people. So I'm excited about that second season.
- [29:18]
B
Well, I can't wait. It's just such a fun show to listen to in terms of bridging, as you say, kind of the big picture public health with individual stories and wild anecdotes which always make for some compelling listening. So thank you so much for the show and thanks for coming on the First Opinion podcast.
- [29:37]
A
Thank you, Tori. Thank you to Stat News. I'm a loyal subscriber and I hope to get the chance to contribute again.
- [29:44]
B
And thank you for listening to the First Opinion podcast. It's produced by Hyacinth Empanado. Alyssa Ambrose is the Senior producer and Rick Burke is the Executive Producer. You can share your opinion about the show by emailing me@first opinionstatnews.com and please leave a review or rating on whatever platform you use to get your podcasts. Until next time, I'm Tori Bosch, and please don't keep your opinions to yourself.
- [30:09]
A
Sam.