Bio(un)ethical

#21 Bryan Carmody: Are doctor shortages real?

In this episode we speak with Dr. Bryan Carmody, pediatric nephrologist and associate professor of pediatrics at Eastern Virginia Medical School. We talk about whether America really faces a doctor shortage, why people in areas with plenty of doctors still struggle to access care, whether proposed solutions can address the access problems many patients face, and how AI may affect these problems in the near future. (00:00) Our introduction (04:03) Rethinking the doctor shortage narrative (09:00) The AMA and the AAMC (16:11) Shortage of 187,000 physicians by 2037 (25:20) Physician misallocation (38:19) Financial incentives create barriers to care (48:19) Why not train more physicians? (56:18) How to make places more desirable for physicians to work in (1:14:01) Profit over placement in hospitals (1:25:12) The AI elephant in the room Used or referenced: * Bryan Carmody’s Sheriff of Sodium YouTube Channel [https://www.youtube.com/@sheriffofsodium] and Blog [https://thesheriffofsodium.com/] * Leah Pierson, “The AMA can help fix the health care shortages it helped create” [https://petrieflom.law.harvard.edu/2022/03/15/ama-scope-of-practice-lobbying/] * Medford-Davis et al., “The physician shortage isn’t going anywhere” [https://www.mckinsey.com/industries/healthcare/our-insights/the-physician-shortage-isnt-going-anywhere] * Walensky and McCann, “Challenges to the future of a robust physician workforce in the United States” [https://www.nejm.org/doi/full/10.1056/NEJMsr2412784] * HRSA Health Workforce, Physician Workforce: Projections, 2022-2037 [https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/physicians-projections-factsheet.pdf] * HRSA Health Workforce, State of the Primary Care Workforce, 2024 [https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/state-of-the-primary-care-workforce-report-2024.pdf] * Gudbranson, Glickman, and Emanuel, “Reassessing the data on whether a physician shortage exists” [https://jamanetwork.com/journals/jama/article-abstract/2613209] * Connors, “2025 Doctor Job Outlook: Why Go Locum Tenens?” [https://www.bartonassociates.com/blog/physician-job-outlook-why-go-locum-tenens/#:~:text=Physicians%20have%20a%20low%20unemployment,of%203.7%25%20in%20January%202024.] * Auerbach, Buerhaus, and Staiger, “Implications of the rapid growth of the nurse practitioner workforce in the US” [https://www.healthaffairs.org/doi/10.1377/hlthaff.2019.00686] * National Commission on Certification of Physician Assistants, “PA Profession Surges in Last Decade” [https://www.nccpa.net/news/pa-profession-surges-in-last-decade/] Bio(un)ethical is a bioethics podcast written by Leah Pierson and Sophie Gibert, with editing and production by Ambedo Media (previous production support by Audiolift.co). Our music is written by Nina Khoury and performed by Social Skills. We are supported by a grant from Amplify Creative Grants.

#20 Rachel Fraser: How your social world shapes what you know

In this episode we speak with Dr. Rachel Fraser, Associate Professor of Philosophy at MIT, about whether experiences of oppression can yield special insights, whether these insights can be shared with members of dominant groups, and what implications this has for policymaking. (00:00) Our introduction (03:39) Interview begins (03:43) Historical roots of standpoint epistemology (27:38) Situated knowledge: What kind of knowledge depends on social position? (41:03) What kind of knowledge depends on social position? (46:04) Does standpoint theory stereotype or essentialize people? (53:19) Epistemic advantage: Does oppression give you special insight? (1:01:20) Is standpoint theory objectionably self-fulfilling? (1:10:51) Can members of dominant groups access the same insights? (1:16:12) Does standpoint theory apply to moral knowledge? (1:27:25) Implications: Should we defer to oppressed people about the social world? (1:31:33) The value of diversity within epistemic communities (1:37:58) Methods for democratizing decisions in bioethics (1:41:20) The role of qualitative knowledge in policy making Used or referenced: * Bio(un)ethical, “Emily Largent and Govind Persad: Is bioethics ok?” [https://www.biounethical.com/episodes/episode/7bd958f2/19-emily-largent-and-govind-persad-is-bioethics-ok] * Bio(un)ethical, “Danielle Allen: Should laypeople make health policy decisions?” [https://www.biounethical.com/episodes/episode/7944cccb/10-danielle-allen-should-laypeople-make-health-policy-decisions] * Bio(un)ethical, “Sarah McGrath: Are there moral experts?” [https://www.biounethical.com/episodes/episode/7c066e5d/13-sarah-mcgrath-are-there-moral-experts] * Kristen Intemann, “25 Years of Feminist Empiricism and Standpoint Theory” [https://www.jstor.org/stable/40928656] * Emily Tilton and Briana Toole, “Standpoint Epistemology and the Epistemology of Deference” [https://philarchive.org/archive/TILSEA-2] * Kristina Rolin, “The Bias Paradox in Feminist Standpoint Epistemology” [https://muse.jhu.edu/pub/63/article/209437/pdf] * The Good Fight with Yascha Mounk, “You Just Won’t Understand!” [https://www.persuasion.community/p/-you-just-wont-understand] Bio(un)ethical is a bioethics podcast written by Leah Pierson and Sophie Gibert, with editing and production by Ambedo Media (previous production support by Audiolift.co). Our music is written by Nina Khoury and performed by Social Skills. We are supported by a grant from Amplify Creative Grants.

#19 Emily Largent and Govind Persad: Is bioethics ok?

In this episode, we speak with two leading bioethics scholars about the state of bioethics today. Dr. Emily Largent is the Emanuel and Robert Hart Associate Professor of Medical Ethics and Health Policy and the Chief of the Division of Medical Ethics at the University of Pennsylvania Perelman School of Medicine. Dr. Govind Persad is an Associate Professor at the University of Denver Sturm College of Law and our first returning guest on Bio(un)ethical. With Emily and Govind, we consider critiques of bioethics coming from inside and outside of the field. In light of our recent survey of US academic bioethicists, we discuss who bioethicists are, how they are trained, and how they can better promote ethical decision-making in medicine, science, and public health. (00:00) Our introduction (05:16) Interview begins (09:27) Who counts as a bioethicist? (20:18) The credentialing problem (30:43) Critiques from outside bioethics: Why are people mad? (42:17) Protectionist vs. progress-oriented bioethics (53:26) The field’s major wins (57:31) Critiques from inside bioethics: Variable research quality (1:03:29) Financial barriers to entry (1:05:18) Lack of demographic and ideological diversity (1:11:53) Should bioethicists’ views mirror the public’s? Used or referenced: * Leah Pierson et al., “Bioethicists Today: Results of the Views in Bioethics Survey [https://pubmed.ncbi.nlm.nih.gov/38709117/]” * Leah Pierson, “Becoming a bioethicist is expensive. That’s a problem [https://petrieflom.law.harvard.edu/2021/11/05/becoming-a-bioethicist-is-expensive-thats-a-problem/]” * Leah Pierson, “We need to evaluate ethics curricula [https://petrieflom.law.harvard.edu/2022/02/02/we-need-to-evaluate-ethics-curricula/]” * Tom Chivers, “How many lives has bioethics cost? [https://unherd.com/2021/12/how-many-lives-has-bioethics-cost/]” Bio(un)ethical is a bioethics podcast written by Leah Pierson and Sophie Gibert, with editing and production by Ambedo Media (previous production support by Audiolift.co). Our music is written by Nina Khoury and performed by Social Skills. We are supported by a grant from Amplify Creative Grants.

#18 David Thorstad: Evidence, uncertainty, and existential risk

In this episode, we speak with Dr. David Thorstad: Assistant Professor of Philosophy at Vanderbilt University, Senior Research Affiliate at the Global Priorities Institute, and author of the blog, Reflective Altruism. We discuss existential risks–threats that could permanently destroy or drastically curtail humanity’s future–and how we should reason about these risks under significant uncertainty. (00:00) Our introduction (09:32) Interview begins (14:32) The longtermism shift (23:17) Framework for objections to longtermism (29:47) Overestimating existential risk: population dynamics (36:06) Overestimating existential risk: cumulative vs. period risk (39:44) Overestimating existential risk: ignoring background risk (42:14) The time of perils hypothesis (46:11) When and where should philosophers speculate? (1:09:02) Extraordinary claims require extraordinary evidence (1:21:44) Regression to the inscrutable and the preface paradox (1:30:07) The tendency to quantify Used or referenced: * David’s blog, Reflective Altruism [https://reflectivealtruism.com/] * Thorstad, “Three mistakes in the moral mathematics of existential risk [https://www.dthorstad.com/_files/ugd/74503b_a70d1d498455475eb4e01c25bcd7e59d.pdf]” * Thorstad, “High risk, low reward [https://philpapers.org/archive/THOHRL.pdf]” * Thorstad, “Against the singularity hypothesis [https://globalprioritiesinstitute.org/wp-content/uploads/David-Thorstad-Against-the-singularity-hypothesis.pdf]” * Parfit, Reasons and Persons [https://academic.oup.com/book/12484] (p. 453) * MacAskill, What We Owe The Future [https://www.utilitarianism.com/macaskill-whatweowethefuture.pdf] * Ord, The Precipice [https://theprecipice.com/] * Berger, Open Philanthropy, “Our Progress in 2023 and Plans for 2024 [https://www.openphilanthropy.org/research/our-progress-in-2023-and-plans-for-2024/]” * 80,000 Hours, “What are the world’s most pressing problems? [https://80000hours.org/problem-profiles/]” * Maule (EA Forum), “Historical EA Funding Data [https://forum.effectivealtruism.org/posts/ZbaDmowkXbTBsxvHn/historical-ea-funding-data]” * Elsey and Moss (EA Forum), “EA Survey: Cause Prioritization [https://forum.effectivealtruism.org/s/FxFwhFG227F6FgnKk/p/sK5TDD8sCBsga5XYg]” * Ord (EA Forum), “The Precipice Revisited [https://forum.effectivealtruism.org/posts/iKLLSYHvnhgcpoBxH/the-precipice-revisited]”  * Greaves and MacAskill, “The case for strong longtermism [https://globalprioritiesinstitute.org/wp-content/uploads/The-Case-for-Strong-Longtermism-GPI-Working-Paper-June-2021-2-2.pdf]” * EA Critiques Podcast, “Astronomical Value, Existential Risk, and Billionaire Philanthropy with David Thorstad [https://critiquesofea.podbean.com/e/astronomical-value-existential-risk-and-billionaires-with-david-thorstad/]” * Forecasting Research Institute, “Results from the 2022 Existential Risk Persuasion Tournament [https://forecastingresearch.org/news/results-from-the-2022-existential-risk-persuasion-tournament]” * Coleman et al., “Beliefs about the end of humanity: How bad, likely, and important is human extinction [https://osf.io/preprints/psyarxiv/qn7k5_v1]?” * Turner et al. (NeurIPS), “Optimal policies tend to seek power [https://openreview.net/forum?id=l7-DBWawSZH]” Bio(un)ethical is a bioethics podcast written by Leah Pierson and Sophie Gibert, with editing and production by Ambedo Media (previous production support by Audiolift.co). Our music is written by Nina Khoury and performed by Social Skills. We are supported by a grant from Amplify Creative Grants.

#17 Rochelle Walensky: How can we fix American public health infrastructure?

In this episode, we speak with Dr. Rochelle Walensky, former director of the Centers for Disease Control and Prevention (CDC). We discuss the state of American public health infrastructure, the challenges it faces, and what we can do to improve it. (00:00) Our introduction (03:45) Interview begins (09:32) Core challenges: Maintaining and growing the workforce (18:41) Core challenges: Standardizing and modernizing data systems (28:01) Core challenges: Reorganizing laboratory systems (30:32) The problem of fragmentation (44:55) Tradeoffs in communication; “following the science” (52:57) Biggest lessons learned (1:00:37) Public health infrastructure in the US vs. elsewhere (1:07:34) Paths forward: public investment (1:09:42) Paths forward: H5N1 and the scope of CDC’s authority (1:15:32) Advice for aspiring public health professionals Used or referenced: * Lin et al., “A Single Mutation in Bovine Influenza H5N1 Hemagglutinin Switches Specificity to Human Receptors [https://www.science.org/doi/10.1126/science.adt0180]” * Johns Hopkins, “Bird Flu is Raising Red Flags Among Health Officials [https://publichealth.jhu.edu/2025/bird-flu-is-raising-red-flags-among-health-officials]” * Walensky, “What I Need to Tell America Before I Leave the CDC [https://hcuuf.org/Portals/0/Documents/MeetingMaterial/FutureArticles/20230627-NYT-CDC%20Director%20Rochelle%20Walensky%20Shares%20a%20Message%20About%20Covid%20and%20Public%20Health.pdf]” * Berger and Walensky, “Reflecting on ACP’s Position Paper for Public Health: A View From the CDC Lens [https://www.acpjournals.org/doi/10.7326/M23-1455]” * Zhang et al., “Physician Workforce in the United States of America: Forecasting Nationwide Shortages [https://pmc.ncbi.nlm.nih.gov/articles/PMC7006215/]” * Harvard Chan School Department of Epidemiology, “The 175th Cutter Lecture on Preventive Medicine with Rochelle Walensky, December 8, 2023 [https://www.youtube.com/watch?v=pfdUk7gMFo4&ab_channel=HarvardChanSchoolDepartmentofEpidemiology]” * Leonhardt, “Follow the Science? [https://www.nytimes.com/2022/02/11/briefing/covid-cdc-follow-the-science.html?unlocked_article_code=1.sU4.lZce.VajvGzR_L2wu&smid=url-share]” * Mann, “NPR Exclusive: US Overdose Deaths Plummet, Saving Thousands of Lives [https://www.npr.org/2024/09/18/nx-s1-5107417/overdose-fatal-fentanyl-death-opioid]” * Tin, “Obesity Rate in US Adults No Longer Growing, New CDC Data Suggests [https://www.cbsnews.com/news/obesity-rate-us-adults-cdc-data-map/]” * CDC Moving Forward [https://stacks.cdc.gov/view/cdc/148653] report * (Howard Koh survey) Leider et al., “The Exodus of State and Local Public Health Employees: Separations Started Before and Continued Throughout [https://www.healthaffairs.org/doi/10.1377/hlthaff.2022.01251]” * New England Journal of Medicine: Uyeki et al., “Highly Pathogenic Avian Influenza A(H5N1) Virus Infection in a Dairy Farm Worker [https://www.nejm.org/doi/full/10.1056/NEJMc2405371]” Bio(un)ethical is a bioethics podcast written by Leah Pierson and Sophie Gibert, with editing and production by Ambedo Media (previous production support by Audiolift.co). Our music is written by Nina Khoury and performed by Social Skills. We are supported by a grant from Amplify Creative Grants.