Podcast Summary: The Gist
Episode: Thomas Goetz: "Medicine works by helping some people a lot and most people not at all."
Date: January 27, 2026
Host: Mike Pesca (Peach Fish Productions)
Guest: Thomas Goetz, Award-Winning Science Journalist & Host of "Drug Story"

Overview of the Episode

This episode dives into the science, history, and societal impact of pharmaceutical drugs with journalist Thomas Goetz, whose new podcast "Drug Story" explores the origins and complexities of famous medicines. Host Mike Pesca and Goetz use the stories of Lipitor (a blockbuster statin drug) and EpiPen (life-saving allergy injector) to unpack how medicine advances, the risks of mass drug prescription, and the sometimes unintended consequences of medical advice and pharmaceutical industry practices.

Key Discussion Points & Insights

The Origins and Impact of Lipitor and the Framingham Study

• Franklin D. Roosevelt’s death and heart research

  • FDR died in office (age 64) of a stroke; he had extremely high blood pressure, which at the time was not fully understood or treated.
  • His death spurred the U.S. government to create institutions to study heart disease, leading to the famous Framingham Heart Study.
  • This decades-long study identified high blood pressure and cholesterol as risk factors for heart disease.
  • Quote: "FDR died. It was a national tragedy... And in 1948, his successor Harry Truman, signed a law creating the National Institutes of Blood and Heart Science that created a study that is still going on today, where they took the town of Framingham, Massachusetts..." (10:45)

• Discovery and Significance of Cholesterol as a Risk Factor

  • Cholesterol became recognized as a key contributor to heart disease, but it took decades for effective cholesterol-lowering drugs—statins—to be developed and approved.

Understanding ‘Number Needed to Treat’ (NNT)

• Concept and Implications of NNT

  • The NNT describes how many people must take a drug for one to benefit.
  • For Advil (painkiller), NNT is about 4—1 in 4 people benefits.
  • For Lipitor, the NNT is 100—99 out of 100 people don’t see measurable benefit in heart attack prevention, though many experience side effects.
  • Quote: "The number needed to treat is a very simple idea. It's how many people need to take the drug in order for one person to benefit." (16:38)
  • Quote: "You have to treat 100 people or 100 people have to take the drug in order for one to get a benefit." (17:39)

• Risks of Overprescription

  • Many statin users endure side effects (muscle/joint pain, potential increased risk of dementia), while few gain direct benefit.
  • The threshold for prescription has shifted lower over time, leading to more people taking statins and, by extension, exposing large populations to unnecessary medical risks.

The Problem of Medical Knowledge and Iteration

• Science as an Evolving Process
  • Recommendations change as studies and knowledge improve (e.g., changing guidance on when to get colonoscopies or PSA exams).
  • “Medicine is the science and art of groping towards the truth.” (19:29)
  • Lipitor and EpiPen both illustrate how early, well-intended advice and drug deployment can end up being sub-optimal once new data emerges.

EpiPen: From Allergies to Industry Practices

• Wrong Advice on Food Allergies

  • For years, the American Academy of Pediatrics advised parents to delay introducing peanuts to infants; eventually shown to increase allergies, not prevent them.
  • Quote: "But it turned out eventually... that was exactly the wrong advice. What is better is to expose your kids... as early as you can, like six months, to peanuts and other potential food allergies." (22:25)

• Pharma Practices: Lock-In and Pricing

  • EpiPen manufacturer capitalized on the allergy epidemic by pushing for two devices per patient and consistently raising prices.
  • Maintained market dominance ("lock-in") through broad training for school staff, making it impractical for schools to accept competitor/generic products.
  • Quote: "They took advantage of something economists call lock in... They generously created training programs free of charge for school nurses and teachers that trained them on how to administer the EpiPen." (26:01)

The Societal Conversation around Pharmaceuticals

• Pharmaceutical companies hold a paradoxical place in public opinion: vilified for profiteering yet credited with tremendous life-saving advances.
• The difficulty is not always a result of malicious intent, but often the slow, uncertain march of iterating scientific discovery.
• Quote: "The pharmaceutical companies have this weird status in our society in that they save millions of lives and are hated by millions of people... But at the same time the companies themselves—like I said, without them we'd be billions of people years shorter." (21:30)

Memorable Quotes & Moments

| Timestamp | Speaker | Quote | |-----------|----------------|----------------------------------------------------------------------------------------| | 09:52 | Mike Pesca | "Hey, I'm going to tell you the story of Lipitor. It wouldn't have done it for me until I heard the story on Lipitor and I said, holy shit, that's a crazy story." | | 10:45 | Thomas Goetz | "They had no idea what caused high blood pressure, or really whether it was bad or not." | | 16:38 | Thomas Goetz | "The number needed to treat is a very simple idea. It's how many people need to take the drug in order for one person to benefit." | | 17:39 | Thomas Goetz | "It's 100. Basically, you have to treat 100 people for one to get a benefit." | | 19:29 | Thomas Goetz | "Medicine is the science and art of groping towards the truth." | | 22:25 | Thomas Goetz | "But it turned out eventually... that was exactly the wrong advice." | | 26:01 | Thomas Goetz | "They took advantage of something economists call lock in... so they were all trained on the EpiPen. Now, there happened to be a generic device... but... schools would not let parents buy them and store them at the school because... the staff wasn't trained in it." |

Notable Timestamps

• 09:14 – Thomas Goetz introduced; Lipitor and FDR’s death
• 10:45 – The state of heart disease knowledge in FDR’s era, Framingham Study
• 13:46 – Timeline from discovery of cholesterol to use of statins
• 16:38 – Detailed explanation of Number Needed to Treat (NNT)
• 17:39 – NNT for Lipitor: 100
• 18:19 – Downsides and mass prescription side effects
• 19:29 – Medicine as “groping towards the truth”; evolving standards of care
• 22:25 – Food allergy advice and EpiPen history
• 24:43 – Pharma responses to changing health guidance: market adaptation and pricing
• 26:01 – How EpiPen achieved market dominance (“lock-in”)

Conclusion

Pesca and Goetz use vivid cases to illustrate how medicines that shape public health (Lipitor for cholesterol, EpiPen for allergies) emerge through scientific iteration, institutional response to tragedy, and complex interactions between medical advice and industry practice. The episode emphasizes the critical but often messy process by which health recommendations and drug use adapt, and considers how this process can both help and harm, individually and at scale. The tension between benefit, risk, and profit pervades the conversation—and underscores the need for nuance, skepticism, and humility in policy, practice, and personal health choices.