Intention to Treat

NEJM Group

Welcome to “Intention to Treat,” a podcast exploring the critical issues shaping medicine today. In a new 8-week series, The Race Equation, we confront harmful assumptions about race in clinical medicine—from diagnostic algorithms to guidelines—exploring how these practices took hold, why they endure, and what it will take to change them.

Hosted by health care journalist Rachel Gotbaum, the “Intention to Treat” podcast from the New England Journal of Medicine delves into groundbreaking research and clinical advances while sharing the personal stories from doctors and their patients, offering listeners a behind-the-scenes look at discoveries that are changing medical practice on the front lines of health care.

Listen to The Race Equation and follow “Intention to Treat” on Apple Podcasts or wherever you get your podcasts.

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20 episodes
Avg 24 min
English

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S2 · E8
June 24 · 28 min
The Attack on Equity in Medicine
The ripple effects of U.S. anti-DEI policies extend far beyond individual labs: scientific discovery is slowing, early‑career investigators are reconsidering their futures, and the pipeline of medical school applicants is shifting in real time. A full transcript of this episode is available at https://www.nejm.org/doi/full/10.1056/NEJMp2601982.
S2 · E7
June 17 · 24 min
Is Change Possible?
The use of race in medicine is harming patients. What is being done to move away from these practices and to change a culture of medicine based on the false premise that race is biological? A full transcript of this episode is available at https://www.nejm.org/doi/full/10.1056/NEJMp2601981.
S2 · E6
June 10 · 26 min
The Myth of Race and Genetics
We now know that humans are more than 99.9% genetically alike. So why does medicine still link certain diseases to race? And what do genetics actually tell us about race, ancestry, and disease? A full transcript of this episode is available at https://www.nejm.org/doi/full/10.1056/NEJMp2601980.
S2 · E5
June 3 · 25 min
BiDil — The Story of the Black Pill
How did a drug for congestive heart failure get approved and marketed for Black people only? A full transcript of this episode is available at https://www.nejm.org/doi/full/10.1056/NEJMp2601978.
S2 · E4
May 27 · 26 min
When Race Matters
The story of the pulse oximeter demonstrates that sometimes consideration of race is critical to diagnosis and treatment — as came starkly into light during the Covid-19 pandemic. A full transcript of this episode is available at https://www.nejm.org/doi/full/10.1056/NEJMp2601977.
S2 · E3
May 20 · 24 min
Money and Misdiagnosis
Many Black veterans live below the poverty line, often struggling to manage their illnesses. As V.A. hospitals began to stop using race-corrected interpretation of Black patients’ spirometer readings, there was an epiphany: the race correction wasn’t just harming the health of Black patients, it was also hurting them financially. A full transcript of this episode is available at https://www.nejm.org/doi/full/10.1056/NEJMp2601976.
S2 · E2
May 13 · 31 min
How Did Race Get Into Lung Testing?
The history of race-based correction of lung-capacity measures can be traced to a pre–Civil War belief among slave owners that slaves had naturally inferior lung capacity. Despite work to show that race-corrected spirometers mask lung-disease severity in Black patients, the majority of U.S. hospitals still use them. A full transcript of this episode is available at https://www.nejm.org/doi/full/10.1056/NEJMp2601975.
S2 · E1
May 6 · 32 min
Meet the Equation
Many clinical algorithms, including the eGFR test for kidney function, have actually had race baked into them and produce different results for Black patients. Most of us assume these algorithms are based on science, but what if the science is wrong? A full transcript of this episode is available at https://www.nejm.org/doi/full/10.1056/NEJMp2601974.
April 27 · 2 min
Intention to Treat | Season 2: The Race Equation (Trailer)
What happens when medicine gets race wrong? In a new 8-week series, The Race Equation confronts harmful assumptions about race in clinical medicine, why they endure, and what it will take to change. Follow “Intention to Treat” on Apple Podcasts or wherever you get your podcasts.
S1 · E38
Sep 25, 2024 · 25 min
Brain Injury and Consciousness
New research using functional brain imaging reveals that many patients considered to be in a coma or vegetative state and who are unresponsive may actually be conscious and aware. A full transcript of this episode is available at nejm.org/doi/full/10.1056/NEJMp2408662.
S1 · E37
Sep 11, 2024 · 26 min
What Exactly Is Long Covid?
The millions of people worldwide who are suffering from a vast array of disabling symptoms long after being infected with SARS-CoV-2 may eventually benefit from a new consensus definition of long Covid. A full transcript of this episode is available at nejm.org/doi/full/10.1056/NEJMp2407614.
S1 · E36
Aug 14, 2024 · 22 min
Restoring Lost Speech
In recent years, substantial progress has been made in developing brain-computer interfaces that could restore the ability of patients with neurodegenerative diseases and other conditions to communicate. A full transcript of this episode is available at nejm.org/doi/full/10.1056/NEJMp2407613.
S1 · E35
Jul 31, 2024 · 25 min
Race-Based Diagnosis, Part 3
As race-based diagnostic tools, such as pulse oximeters that function poorly on darker skin, continue to lead to inequitable care, a growing movement is working to weed them out of U.S. health care. A full transcript of this episode is available at nejm.org/doi/full/10.1056/NEJMp2407611.
S1 · E34
Jul 24, 2024 · 23 min
Race-Based Diagnosis, Part 2
A key measure of kidney function and a risk calculator for vaginal birth after cesarean delivery are among the many tools that have long contributed to health and health care inequities for Black patients. A full transcript of this episode is available at nejm.org/doi/full/10.1056/NEJMp2405797.
S1 · E33
Jul 3, 2024 · 27 min
Race-Based Diagnosis, Part 1
Claims that Black people had lower lung capacity than White people led to race-adjusted spirometry and poorer care for Black patients with lung disease. New equations are starting to change that. A full transcript of this episode is available at nejm.org/doi/full/10.1056/NEJMp2405796.
S1 · E32
Jun 19, 2024 · 19 min
Are We Prepared for Bird Flu?
A new strain of H5N1 influenza is spreading in dairy cows in the United States. Will it cause an epidemic in humans? And what does our public health system need to do in order to be ready if it does? A full transcript of this episode is available at nejm.org/doi/full/10.1056/NEJMp2405795.
S1 · E31
Jun 5, 2024 · 25 min
Treating Obesity in Kids
In the face of a growing childhood obesity epidemic, some parents and clinicians are turning to new tools such as GLP-1 receptor agonists. This episode explores the implications of that trend. A full transcript of this episode is available at nejm.org/doi/full/10.1056/NEJMp2400703.
S1 · E30
May 15, 2024 · 24 min
New Hope for a Common and Deadly Heart Condition
This episode considers a new treatment for hypertrophic cardiomyopathy, the world’s most common inherited heart condition, which most affected people don’t even realize they have. A full transcript of this episode is available at nejm.org/doi/full/10.1056/NEJMp2400702.
#29
Apr 24, 2024 · 25 min
CAR T-Cells and Safety Signals
This episode examines CAR T-cell therapy’s early successes, broader promise, and emerging risks, as the FDA considers reports of occasional secondary cancers. A full transcript of this episode is available at nejm.org/doi/full/10.1056/NEJMp2400701.
S1 · E28
Apr 3, 2024 · 26 min
Progress for Parkinson's?
This episode explores the fastest-growing neurologic condition in the world, Parkinson’s disease. What have we learned in recent years, and where are the greatest hopes for the future? A full transcript of this episode is available at nejm.org/doi/full/10.1056/NEJMp2414003.

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