Bio(un)ethical

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 roomUsed or referenced:Bryan Carmody’s Sheriff of Sodium YouTube Channel and BlogLeah Pierson, “The AMA can help fix the health care shortages it helped create”Medford-Davis et al., “The physician shortage isn’t going anywhere”Walensky and McCann, “Challenges to the future of a robust physician workforce in the United States”HRSA Health Workforce, Physician Workforce: Projections, 2022-2037HRSA Health Workforce, State of the Primary Care Workforce, 2024Gudbranson, Glickman, and Emanuel, “Reassessing the data on whether a physician shortage exists”Connors, “2025 Doctor Job Outlook: Why Go Locum Tenens?”Auerbach, Buerhaus, and Staiger, “Implications of the rapid growth of the nurse practitioner workforce in the US”National Commission on Certification of Physician Assistants, “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.

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 makingUsed or referenced:Bio(un)ethical, “Emily Largent and Govind Persad: Is bioethics ok?”Bio(un)ethical, “Danielle Allen: Should laypeople make health policy decisions?”Bio(un)ethical, “Sarah McGrath: Are there moral experts?”Kristen Intemann, “25 Years of Feminist Empiricism and Standpoint Theory”Emily Tilton and Briana Toole, “Standpoint Epistemology and the Epistemology of Deference”Kristina Rolin, “The Bias Paradox in Feminist Standpoint Epistemology”The Good Fight with Yascha Mounk, “You Just Won’t 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.

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”Leah Pierson, “Becoming a bioethicist is expensive. That’s a problem”Leah Pierson, “We need to evaluate ethics curricula”Tom Chivers, “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.

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 quantifyUsed or referenced:David’s blog, Reflective AltruismThorstad, “Three mistakes in the moral mathematics of existential risk”Thorstad, “High risk, low reward”Thorstad, “Against the singularity hypothesis”Parfit, Reasons and Persons (p. 453)MacAskill, What We Owe The FutureOrd, The PrecipiceBerger, Open Philanthropy, “Our Progress in 2023 and Plans for 2024”80,000 Hours, “What are the world’s most pressing problems?”Maule (EA Forum), “Historical EA Funding Data”Elsey and Moss (EA Forum), “EA Survey: Cause Prioritization”Ord (EA Forum), “The Precipice Revisited” Greaves and MacAskill, “The case for strong longtermism”EA Critiques Podcast, “Astronomical Value, Existential Risk, and Billionaire Philanthropy with David Thorstad”Forecasting Research Institute, “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?”Turner et al. (NeurIPS), “Optimal policies tend to seek power”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.

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 professionalsUsed or referenced:Lin et al., “A Single Mutation in Bovine Influenza H5N1 Hemagglutinin Switches Specificity to Human Receptors”Johns Hopkins, “Bird Flu is Raising Red Flags Among Health Officials”Walensky, “What I Need to Tell America Before I Leave the CDC”Berger and Walensky, “Reflecting on ACP’s Position Paper for Public Health: A View From the CDC Lens”Zhang et al., “Physician Workforce in the United States of America: Forecasting Nationwide Shortages”Harvard Chan School Department of Epidemiology, “The 175th Cutter Lecture on Preventive Medicine with Rochelle Walensky, December 8, 2023”Leonhardt, “Follow the Science?”Mann, “NPR Exclusive: US Overdose Deaths Plummet, Saving Thousands of Lives”Tin, “Obesity Rate in US Adults No Longer Growing, New CDC Data Suggests”CDC Moving Forward report(Howard Koh survey) Leider et al., “The Exodus of State and Local Public Health Employees: Separations Started Before and Continued Throughout”New England Journal of Medicine: Uyeki et al., “Highly Pathogenic Avian Influenza A(H5N1) Virus Infection in a Dairy Farm Worker”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.

In this episode, we speak with Dr. Quayshawn Spencer, Robert S. Blank Presidential Associate Professor of Philosophy at the University of Pennsylvania, about what race is, why he’s a radical racial pluralist, and what this could imply in science and medicine.(00:00) Our introduction(11:23) Interview begins(20:21) Methodology: What are philosophers of race trying to do?(32:05) From aspiring physician-scientist to philosopher of race(41:08) Becoming a realist about race(44:44) Human continental populations and the OMB racial classification scheme(1:00:43) The national meaning of “race” in US racial discourse(1:12:35) Why not be a pure social constructionist?(1:17:04) Implications: racial inequalities(1:20:59) Implications: diversifying clinical trials(1:39:46) Pluralizing race talkUsed or referenced:Spencer, “A Radical Solution to...”Spencer, “A More Radical Solution...”Glasgow, Haslanger, Jeffers, and Spencer, What is Race?Haslanger, Resisting RealityOMB, “About OMB’s Interagency Technical...”Schwartz et al., “Why Diverse Clinical Trial...”AMA Press Release: “New AMA policies recognize...”AMA Policy on Civil and Human Rights: “Elimination of Race as a Proxy...”Wikipedia: “Blood quantum laws,” “Atlantic slave trade,” “Nazi racial theories,” and “Native American Genocide in...” History: “How Native Hawaiians Have...”Karp, “Redlining and Lead Poisoning”Borrell et al., “Race and Genetic Ancestry...”Jih et al., “Using appropriate body mass...”Haam et al., “Diagnosis of Obesity”Chang Sun et al., “Genetics of Body Fat Distribution”Block, “How Heritability Misleads About Race”Herrnstein and Murray, The Bell CurveÁsta, Categories We Live ByBio(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.

In this episode, we speak with Dr. Jeff McMahan, Emeritus Sekyra and White’s Professor of Moral Philosophy at Oxford University, about whether germline gene editing is ever morally preferable to embryo selection and whether and when we should control the genetic outcomes of our children.(00:00) Our introduction(06:48) Interview begins(10:06) Same-child choices and different-child choices(27:24) Against the comparative view(31:25) Against the impersonal view(38:33) In favor of the two-tier view(45:47) Implications for genetic counseling(50:08) Other objections to gene editing(51:36) Treatment versus enhancement(56:55) Is it morally permissible to control our children’s genes?(1:02:44) Disability and wellbeing(1:07:50) The social model of disability(1:21:09) Reproductive technologies and injusticeUsed or referenced:Jeff McMahan and Julian Savulescu, “Reasons and Reproduction: Gene Editing and Genetic Selection”Jeff McMahan, “Causing Disabled People to Exist and Causing People to Be Disabled”Elizabeth Barnes, “Disability and Adaptive Preference”Jan Narveson, “Moral Problems of Population”Eric Lander et al., “Adopt a Global Moratorium on Heritable Genome Editing”Francis Collins, “NIH Director on Human Gene Editing: ‘We Must Never Allow Our Technology to Eclipse Our Humanity’”Inmaculada de Melo-Martin and Sara Goering, “Eugenics,” in the Stanford Encyclopedia of PhilosophyThe Genetic Literacy Project’s Global Gene Editing Regulation Tracker: China and the United StatesSara Reardon, “Gene Edits to ‘CRISPR Babies’ Might Have Shortened Their Life Expectancy”David Cyranoski and Heidi Ledford, “Genome-Edited Baby Claim Provokes International Outcry”Gary Marchant, “Global Governance of Human Genome Editing: What Are the Rules?”Rob Stein, “New US Experiments Aim to Create Gene-Edited Human Embryos”American College of Obstetricians and Gynecologists, Committee on Genetics, “Preimplantation Genetic Testing”Manuel Viotti, “Preimplantation Genetic Testing for Chromosomal Abnormalities: Aneuploidy, Mosaicism, and Structural Rearrangements”Cleveland Clinic Health Library: Treatments & Procedures: IVF (In Vitro Fertilization)Tom Hurka, 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.

In this episode, we speak with researcher and physician Dr. James Diao about when and why race should be included or excluded from clinical algorithms. We focus on his work evaluating the implications of including race as a variable in two clinical algorithms: one used to assess lung function, and another used to assess cardiovascular disease risk.(00:00) Our introduction(05:10) Interview begins(09:47) Criteria for the inclusion/exclusion of race of clinical algorithms(16:23) Inclusion of race in lung function equations(27:04) Estimated racial disparities in lung disease classification(31:37) Estimated racial disparities in access to social services and healthcare(37:44) The PREVENT equations for cardiovascular risk(47:44) Anticipated impact on statin recommendations(57:22) Estimated changes in statin eligibility by race(1:10:03) Whether we should exclude race from clinical algorithms by default(1:20:36) Common themes and failure modesUsed or referenced:Diao et al., “Implications of Race Adjustment in Lung-Function Equations”Diao et al., “Projected Changes in Statin and Antihypertensive Therapy Eligibility with the AHA PREVENT Cardiovascular Risk Equations”Nwamaka Eneanya, Wei Yang, and Peter Reese, “Reconsidering the Consequences of Using Race to Estimate Kidney Function”MDCalc ASCVD risk calculatorMDCalc CHA2DS2-VASc Score for Atrial Fibrillation Stroke Risk calculatorMDCalc Preventing Risk of Cardiovascular Disease EVENTs (PREVENT) calculatorNational Cancer Institute Breast Cancer Risk Assessment ToolDarshali Vyas, Leo Eisenstein, and David Jones, “Hidden in Plain Sight–Reconsidering the Use of Race Correction in Clinical Algorithms”Emma Pierson, “Accuracy and Equity in Clinical Risk Prediction”CDC “Health, United States Spotlight: Racial and Ethnic Disparities in Heart Disease”Roni Caryn Rabin, “Race Cannot Be Used to Predict Heart Disease, Scientists Say”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.

In this episode, we speak with Dr. Sarah McGrath, professor of philosophy at Princeton University. We discuss whether and when it makes sense to defer to others about the answers to moral questions, whether moral deference is any less appropriate than deference in other domains, like math or science, and whether we have reason to think bioethicists are moral experts.(00:00) Our introduction(04:28) Interview begins(08:02) Varieties of moral deference: pure versus impure(12:39) Outline of Sarah’s view and argument(20:58) The (ir)relevance of meta-ethics (what ethics is and where it comes from)(41:13) How to identify moral experts(50:37) Are utilitarians likely to be moral experts?(52:32) Does education in moral philosophy make you an expert?(1:01:18) Practical implications: endowing bioethicists with authority(1:14:55) Why talk of optimism and pessimism is misguidedMentioned or referenced:Sarah McGrath, Moral Knowledge (especially Chapter 3)Sarah McGrath, “The Puzzle of Pure Moral Deference”David Enoch, “A Defense of Moral Deference”Peter Singer, “Ethical Experts in a Democracy”Christine Korsgaard, The Sources of NormativityA.J. Ayer, Language, Truth, and LogicGilbert Ryle, “On Forgetting the Difference Between Right and Wrong”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.

In this episode, we speak with Dr. David Wendler, Head of the Section on Research Ethics in the Department of Bioethics at the National Institutes of Health Clinical Center and philosopher by training. We discuss the ethics of pediatric research: how much risk we should expose kids to in research; what we should do when the federal research regulations don’t make sense; and what was and wasn’t wrong with the Kennedy Krieger Lead Abatement Study.(00:00) Our introduction(05:25) Interview begins(13:56) How risky can pediatric research be?(32:38) What counts as “minimal risk”? Risks of daily life standard(45:28) Understanding research participation as a charitable activity(49:48) Why the rules say we can expose kids to more risk when they don’t stand to benefit(1:00:05) How to interpret research regulations when they are flawed(1:03:42) Do kids need to understand altruism to assent to research?(1:12:49) Should there be laws governing pediatric research?(1:20:40) David’s take on the Kennedy Krieger Lead Abatement StudyMentioned or referenced:US pediatric research regulations: HHS/OHRP 45 CFR 46 Subpart DNIH Inclusion Across the LifespanCreating Hope Act of 2011/2012Pediatric Research Equity Act of 2003Mott Poll Report: Is my child’s medicine FDA-approved?Hwang et al., “Completion Rate and Reporting of Mandatory Pediatric Postmarketing Studies Under the US Pediatric Research Equity Act”Grodin and Glantz, Children as Research Subjects: Science, Ethics, and LawWendler and Shah, “Should Children Decide Whether They Are Enrolled in Nonbeneficial Research?”Shah et al., “How do institutional review boards apply the federal risk and benefit standards for pediatric research?” [note: we refer to this as a 2008 study, but it was actually published in 2004]Wendler and Forster, “Why we need legal standards for pediatric research”Grimes v. Kennedy Krieger Institute, Inc. (Court of Appeals of Maryland)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.