Diagnosing Racism: How One Med Student Sparked a Big Change

JOEL BERVELL: Congratulations! I mean, it’s a big day for you. Literally, I went to go stalk your social media first so I could be like, okay, do I say congratulations? I’m just like, you got this, you know?

NAOMI NKINSI: Smart move, smart move. But yeah, I got the good email, so I’m very happy.

JOEL BERVELL: Yay. I’m so proud of you.

NAOMI NKINSI: Thank you.

JOEL BERVELL: You’re glowing right now. You look not stressed at all. I’m so jealous. All right, let’s get started.

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JOEL BERVELL: Hey, everyone. It’s a new season of The Dose and we’re launching a new look. My name is Joel Bervell, and I’m here to host four episodes on health equity. I’m a medical student, and I’m currently on an orthopedic research fellowship at Johns Hopkins University. I graduate from Washington State University School of Medicine in 2024.

You may have already met me on TikTok or Instagram, and if not, consider this your invitation to see what I’m up to over there. I’m known as the “Medical Mythbuster,” now with over 120 million views on my videos that tackle the hidden history of medicine, racial disparities, and biases in health care.

So thanks for having me and I promise I’ve extraordinary guests lined up for a series of compelling conversations that you won’t hear anywhere else. So let’s go.

My guest on this episode is Naomi Nkinsi. When Naomi arrived at the University of Washington School of Medicine just four years ago, she noticed something lots of medical students of color have noticed, including myself. Part of the learning for medical students requires absorbing decades of information about disparities and outcomes for Black and brown people. Well, Naomi also noticed, like a lot of us have, that the images of Black patients in her lectures were very different from the kinds of images she saw of white patients. And she noticed that diagnostic equations, like the eGFR equation that’s used to measure kidney functioning, were racially biased and just wrong. So Naomi spoke up, pushed back, and her activism has led to huge differences nationwide in medicine — and we’ll hear about it.

But why is medical school like that? In medical school we encounter teaching that honestly has racism baked into it and for a long time it’s gone unnoticed and sometimes unchallenged. Part of it is because we’re constantly evaluated by professors, upper-class peers, and attending physicians. And our success depends on doing things the right way. Questioning the curriculum and the culture of medical school is often not done for those exact reasons. But Naomi has questioned and challenged norms, and she’s had an enormous impact in the real world. How the GFR test is now administered is changing, and hundreds of thousands of patients will be touched by that.

And so it’s my great pleasure to welcome to The Dose, Naomi Nkinsi. Welcome to the show and congratulations on finding out that you matched.

NAOMI NKINSI: Thank you so much, Joel. It’s an absolute pleasure to be here and it’s an absolute pleasure to be here knowing that I’ve matched into residency.

JOEL BERVELL: Yes, you can sit back, relax a little bit more. So I’m going to just jump straight into the questions. So like me, you’re one of the few Black medical students in your med school class — you’re one of five; I was one of two in my class. And medical schools in the United States is traditionally a predominantly white space. So no surprises there. But I know you had some surprises when you went in for your first lectures and the Powerpoints you went to. I’m wondering if you can take us back to that first moment of being in medical school and realizing that it wasn’t made for people who looked like us.

NAOMI NKINSI: Yeah, so I think for me, when I went into medicine, I always thought medicine would be kind of, in a sense, an equalizer, right? The human body, you can look at it objectively, you can do your anatomical dissections, et cetera. Obviously I knew that there was going to be racism, but what I wasn’t prepared for was how that racism is directly taught to medical students to enact into their own communities.

So one of the examples of this is: one of the first blocks of my medical school career, we were learning about different genetic syndromes that have physical characteristics in patients. And I noticed very clearly that there was a difference in the way that the Black patients were portrayed as compared to the white patients. So, for example, the white patients, all the images of them where their family photos, their school photos, we could see all the clear manifestations of their genetic syndrome, but their humanity was maintained. In contrast, we were also shown images of Black families with genetic syndromes. And one of them that really stood out to me was this image of a mother and her two children in their underwear, backs faced to us. They looked like they were dirty. It reminded me of an image that I would see in a history textbook discussing chattel slavery.

And to me just that contrast of how Black people were portrayed compared to white people, it was so obvious. And sitting there as one of the only Black people in my class, I was like, this is how the medical system views me. This is how my professors see me. I sit here every day and I’m seen as less than human. And that’s when I started speaking out because I was like, there’s no way I’m going to let this stand for all four years of medical school.

JOEL BERVELL: Absolutely. I love that story of actually speaking up because a lot of students don’t do that. But I’m curious, how did that series of incidents around those images impact your impressions as a first-year medical student?

NAOMI NKINSI: Yeah, I mean it was a moment in time where I realized that not only am I going to have to be . . . I already knew from my parents that I have to be twice as good as all the other classmates in order to get half amount of the respect. But I also knew that I had to be twice as good because somebody has to be looking out for people that look like me when they go into the health care setting. So I felt an additional sense of pressure that I have to be the voice for all the Black community in order to speak up for us and the kind of health care that we deserve.

And then additionally, there was the pressure that as one of the few Black students, I was very visible. I was one-third of the Black female class population in the Seattle cohort. So the sense that I had to be perfect in every other way because I was being so outspoken. I knew that if I’m going to be someone that speaks up about racism, I have to have all my other bases covered. I can’t afford to do badly on exam. I can’t afford to do badly on clinical clerkships because everyone’s eyes are going to be looking at me.

That particular experience in speaking out actually went really poorly. So I had emailed the professor to discuss the images. I even offered to look for new images, and the response was very negative. I actually got a very long email from him where it was obvious that he had been offended by me pointing out that the images that he was using were racist. He started talking about how we use a lot of medicine from Nazi scientists and am I speaking out against that as well? And I was like, whoa, how did this go from me asking you to change new images to now we’re talking about Nazis?

The result was that the next day in lecture, he had this whole monologue about racism and about how he’s not racist and nobody in the class knew what was going on because these were private conversations between him and I. So everyone was looking around like, what is happening, but it was very much directed at me. And this started kind of a year-long process just because I reported that one incident, it was a whole year before that whole issue was resolved.

JOEL BERVELL: Wow.

NAOMI NKINSI: Yeah. So you can see how exhausting it becomes.

JOEL BERVELL: Absolutely. And I’m so happy you talk about that because about, one, the pressures of being a Black medical student, of being one of the only feeling like you have to do well on everything. But then also the response that we as students sometimes get when we try to change the system, denial or trying to push it off or saying, “Are you fighting for everything?” And I feel like so many professors do that. So props to you for sticking with it. And with that behind you, how did you then decide to go on to speak about the kidney diagnostics lecture? You’ve just let us know that it didn’t go well the first time, yet you still kept fighting. So how did that unfold?

NAOMI NKINSI: Yeah, I think the reason I kept speaking up was because for me it felt worse to not say anything. It was really, really emotionally straining to sit in class every day and hear about how people that look like me are viewed as inferior, hear about how our lab diagnostics are different, our health outcomes are different, and not be able to say something because it was also this sense that if I don’t say anything, no one else is going to say anything, and then everyone’s going to believe that these kind of myths about Black people are true. So that was one thing where the days I didn’t say anything, I felt worse than when I did.

The other was because I had already been outspoken, I already had the reputation of the angry Black student. Other classmates already viewed me as unprofessional. I know they talked about it with each other because I heard about it. Other professors already viewed me as a troublemaker. So I was like, my reputation . . . I’m already being viewed negatively because I’m speaking out. So if I already have that reputation, then I should just keep speaking out because it’s not going to get worse, you know? And at the same time, recognizing that because I was known for speaking out, I had to make sure that everything else, all my other ducks were in a row. I had to make sure that I was still getting the passing grades in order to have the privilege to be able to say something.

JOEL BERVELL: Absolutely. So tell us about that day. What happened when you were sitting in class and you learned about the GFR equation, or how did you even come to learn about it?

NAOMI NKINSI: Yeah, that day, it was an interesting day. Our school has a flipped model, so we do our reading beforehand, before going to lecture. So I had learned and read about the eGFR and I remember reading about it in our course materials and thinking this doesn’t make sense that there would be a different calculation if someone is Black. We had done our anatomy lab. I knew that kidneys didn’t look any different. I couldn’t find any pathway where melanin played a role in the kidneys. So I started reading more about how this equation came to be, and that’s when I really learned that the reason that there was a Black coefficient for eGFR was because of the belief that Black people had more muscle mass. So I’m someone that grew up running track and field in high school. I’ve heard all the “Black people have more muscles” joke. So to me I was like, this is something that is so blatantly racist, and I don’t understand how it’s something that continues to be in our health care system.

So in class that day, the professor was giving a lecture about eGFR, he brought it up briefly and said, “We do a correction if the patient is Black, there’s a lot of science approving this and that’s just the way it’s done.” And he was kind of ready to move on. So I raised my hand because they always say, if you have a question, you should ask. I was like, all right, well, I’ve got some questions. So I raised my hand and I was like, “Can you tell me exactly why Black people have to have this adjusted value? Because to me it doesn’t make sense. And from my reading, it looks like this adjustment was made because of the belief that Black people have more muscles.” And he really couldn’t answer that question.

So I just pressed forward and I said, “Well, think about it this way. If I am a Black person and I get a kidney transplant from a white person, which eGFR equation would you use? Is that kidney now Black because it was inside me or is it white because it came from a white person?” How Black does someone have to be to get the Black coefficient? For people that are mixed race? Who gets to decide whether the person is Black? Is it the physician deciding? Is it the patient self-reporting? And then when you look at papers showing that in other parts of the world, we don’t use that same coefficient. I’m from the Democratic Republic of Congo, so my kidneys somehow needed to be corrected for when I moved to the U.S. Somehow they became completely different.

So it just didn’t make sense. And the response that I got from the professor was actually very poor. This was a pretty large lecture because it was a mix with the dental students and the medical students. So there were students that were complaining that I was being disruptive. The professor was complaining that I was being disruptive, and they ended the lecture. And then we got an email from our school administrators, from the deans, saying that they would be holding a second lecture to talk about racism because there were so many disruptions from the first lecture.

JOEL BERVELL: Wow.

NAOMI NKINSI: So then we had an impromptu second lecture, and the deans were there, very prominently in the front row. And I was like, okay, everyone’s watching. They’re making a very big deal out of this. And I thought, well, now everyone’s here, so let me just keep asking the same questions so everybody gets to hear them. And the result of that, actually there was a nephrologist there by the name of Dr. Bessie Young, who . . . she was actually brought in to counter my questioning. And over the course of my discussions with her during this lecture and afterwards she actually was like, “Oh, wait, this is a problem.”

JOEL BERVELL: Yeah. Wow.

NAOMI NKINSI: So from there, it was a matter of getting faculty allies, so getting people in nephrology and family medicine, et cetera, and laboratory medicine. Because what I learned from this experience is that it’s one thing for a medical student to say something, especially at that point, this was the first block of my first year of medical school. So I feel like people were very hesitant to listen to me because they felt that it was offensive that a first-year medical student was making claims that what they were doing was wrong, that what they’d been doing for decades was incorrect. And it was another thing for them to hear it from their own faculty members.

JOEL BERVELL: Absolutely. And I just want to take a second to pause and just applaud you for how incredible you were, that even in that moment where you didn’t know how things were going to go or the professors pushing back, that you kept with what you believed in. And I remember similar to you, when I was sitting inside my class and heard about GFR, I was just like, what in the world? That’s crazy that we have . . . and for me it’s the fact that it’s a Black versus a non-Black population.

NAOMI NKINSI: Exactly.

JOEL BERVELL: Right? Like there’s no other race, it’s only Black people that for some reason, like you said, it makes it assumed all Black people are different for some reason. And the only thing that it really comes down to was the muscle mass that it was kind of being built off of. But I think it’s so fascinating. I think there’s so much power in medical students like yourself actually stepping up and talking about it.

I’m curious, how did those experiences then change your approach to your own education over the next few years?

NAOMI NKINSI: Yeah, it changed a lot. I’m from an immigrant background. You learn from your parents that education is everything. You listen to your professors, you are there to gain knowledge from them. It changed the way I view the people that are tasked with educating me. So for me, now when I learn something, I do my own work to gain more information about the background. How are these tests that we’re learning? How are they developed, et cetera? It also made me realize that the people that are teaching us, they don’t know everything. They also were taught with that same doctrine of, you’re a medical student, you learn what we’re teaching you, you accept it as fact, and you don’t question it. So then they teach us that same kind of flawed information.

And what I think I learned from this is that it’s always, always, always good to question what you’re being taught. It’s always good to dig and learn more information and to also recognize that as a student you also have a lot to offer to your professors. The pedagogy of medical school where it’s kind of they say jump and we’re supposed to say how high, I think is so backwards. Medical students come from a variety of different backgrounds. I came from a pretty strong research background. I have a lived experience background. We have a lot to offer to our professors, but they have to be willing to listen and actually learn.

JOEL BERVELL: Absolutely.

NAOMI NKINSI: And for me, I’m like, well, when I’m an attending, I have to be ready to listen and learn too, because I’m sure there’s things that the younger generation of medical students are going to point out to me. So I have to be able to reciprocate that.

JOEL BERVELL: And I remember an article that was published in Nature. I was hoping you could share a little bit about what happened there.

NAOMI NKINSI: Yeah. This was a very frustrating situation where I played a major role in changing eGFR calculations at my institution. And I later found out that some of the people that I think were the most vocal against my change or the most vocal against me speaking up, ended up publishing a paper about the changes in eGFR. I found out about it on Twitter, which was very upsetting. It’s one of those instances that I think a lot of outspoken students of color can relate to, where once what you’re saying goes from being unpopular to people recognizing that it’s true and it gets picked up and people are congratulating it, congratulating the institution, history is rewritten very quickly, in the sense that now you almost have the sense that everyone thought that this was a good thing to change. Everyone believed that eGFR shouldn’t be race corrected.

So for me, it felt like a slap in the face that this was something that I really put myself on the line for. I risked my medical career, I risked my spot at the medical school, to speak up on this and then to not even be really acknowledged or involved in the work moving forward. But I think that’s a lesson to other people to show that institutions will try to rewrite history and you have to just be willing to speak up and say your piece and have people that are in your corner that are willing to say, “Hey, this isn’t actually how it happened.”

JOEL BERVELL: I want to go back to that moment too, of what you’re talking about with the changes that are happening, because I think we glossed over how you not just brought up a problem, but you actually saw that through and were instrumental getting it changed. So could you talk to us a little bit about what does the GFR equation look like today and how you think your role being so outspoken impacted it getting changed?

NAOMI NKINSI: Yeah. So today we have a new GFR equation. It’s called the 2021 CKD-EPI equation. So that is what clinicians are supposed to use to calculate someone’s GFR. It does not include a race coefficient. So the University of Washington Hospital system made that change in 2020 and then several other hospital systems followed suit. What then happened following this is myself and other students launched a campaign via social media and public-facing media. So for myself speaking on NPR, CNN, MSNBC, doing South by Southwest with you, another very public-facing media to tell the public this is what we’re using to calculate GFR. If you’re Black, your GFR calculation is being altered and this is what we should be moving to.

So I began working with an organization that was created by students. It’s called the Institute for Healing and Justice in Medicine. And we really recognized that individual changes in hospital systems isn’t sustainable for the movement that we’re trying to make. It’s one thing for individual hospital systems to make a change. What we really needed to happen is that the governing bodies of kidney medicine make an official change so that the hospital systems that are unwilling to move and follow the science are now pressured by their governing bodies to do so.

So we were able to meet with the chief medical officer of the National Kidney Foundation. We were able to get involved in discussions with them in selecting members for a task force to reinvestigate the use of race. We also sent several letters to members of Congress to talk about the use of race-based medical algorithms. And the result was that the National Kidney Foundation and the American Society of Nephrology did their own research, put together a task force, and they found that the use of race correction in calculations of eGFR was inappropriate and not scientifically sound. So now the official recommendation is that all hospital systems move toward the non-race-corrected eGFR.

And I think the even bigger change that happened earlier this year is the change to the wait lists for kidney transplantations. So following the recommendations of the National Kidney Foundation and the American Society of Nephrology, the governing body for organ donations announced that they will be recalculating the wait lists for Black patients who had their eGFR calculated using the race coefficient. So what we’re hoping to see is that more Black people are going to qualify for kidney transplants, and additionally, more Black people will qualify for health care coverage, for specialist coverage for other medications that where you need to have a certain eGFR value to qualify.

JOEL BERVELL: That’s incredible.

NAOMI NKINSI: Yeah, it’s huge.

JOEL BERVELL: I mean, you are a medical student who led this to happen nationwide. And I think about that a lot that you’ve now opened up the doors for 3.3 million more Black Americans to be able to see a specialist to potentially get a kidney transplant if they need it, to have their GFR seen for who they are and not by their race. And I think that’s absolutely incredible what you’ve done. I brag about you all the time.

NAOMI NKINSI: It’s like my crowning achievement. I think this really came full circle for me in my last year of school where my mom was diagnosed with fibromuscular dysplasia, which it’s a disorder of the blood vessels and one of the blood vessels that it impacts is the renal arteries. And in order to track people’s disease progress, you have to track their eGFR. So being able to go to clinic visits with my mom and see that her eGFR is not race calculated, I know that her disease is being tracked accurately, that . . . I just had tears in my eyes. I remember she had told her doctor, “My daughter made that change. She’s the one that changed the eGFR.”

JOEL BERVELL: Wow.

NAOMI NKINSI: It kind of goes back to what I was saying earlier where when you’re one of the few in your class, you sit there and you think, this is how they’re going to treat my family. This is how they’re going to treat my loved ones. And now to be able to have that tangible change where I know that this treatment is directly impacting someone that I love. It’s been huge.

JOEL BERVELL: Why do you think you’ve been able to have that impact when there was people before that may not have been able to?

NAOMI NKINSI: Yeah, eGFR is not new news, right? People have talked about race correction eGFR for a while now. I can think of Dr. Vanessa Grubbs who’s been talking about this for years now. I think one of the reasons why this change happened so rapidly is an unfortunate combination of multiple things. One, there was the COVID pandemic where more and more people were concerned about the type of health care they were getting. Specifically, more and more Black people were concerned about the unequal health care that they were getting. And more and more people were online. I think also with kind of this “racial awakening” that the United States had, following the deaths of Breonna Taylor and Ahmed Aubrey, I think more people were willing to talk about racism and specifically racism in medicine. And I think our generation of medical students who are so much on social media and online, we were able to really push that conversation forward.

So I think that is what kind of brought this more to people’s attention. It was one of those stories where it was very easy to point out the racism because of that calculation, very blatantly saying if they’re Black, multiply it by X value, that it was something that was easy for the media to explain to the general population, as opposed to other aspects of racism, like the images that are used, for example, that are harder for people to conceptualize why that’s racist.

JOEL BERVELL: Absolutely. I remember when I first made my GFR equation on TikTok, I just felt like, like you said, it was so easy to get that point across because it was very tangible. And when you have something like this that’s easily seen, it allows people to have an entry point into understanding how disparities in medicine get weaved into things. How do you think med schools should be evolving now?

NAOMI NKINSI: Yeah, I think so much of med school, as we discussed earlier, is top down, where the professors are kind of the beacon of all knowledge. I would love to see medical schools evolve such that students have more power. And what I mean by that is that students don’t have to feel like they’re risking everything in order to speak up when they see something is wrong. I want med schools to be more open and have more discussions about racism. I know some of the feedback that I got when I talked about racism in classes was that, “Well, we’re here to learn about science. We’re here to learn about medicine. Why do you have to bring race into everything?” It’s because race has been brought into everything. I’m not the one that put race in the GFR. You guys are the ones that did that. Now you don’t want to talk about it?

So I think we need to evolve to be able to have more honest conversations. I would also, I mean this is even a second conversation, learning that representation isn’t everything. It’s great to have more Black students in medical school, but if there’s no structures there to actually provide us with support, it’s almost doing a disservice to people to bring them in, have them beaten down, treated poorly, and come out of it thinking maybe they’re right, maybe I don’t have a place in medicine, maybe I don’t have a place in health care.

JOEL BERVELL: That’s so important, what you just said. And I think about the pathway before you get into medical school. There’s that so how do you actually get introduced into the field of STEM? But then there’s, when you’re in there, like you’re talking about, are they actually supporting you? Are they doing things to make sure that you feel seen? That students that have traditionally not been in institutions like that are supported? But then also what comes afterwards, right? How are you engaging people to help come back in if they need to, to support the people that were there? Or how are you making sure that people continue beyond? So I think all of that is really, really important. And I also think about the hidden curriculum, and I’m curious if you could talk about that a little bit.

NAOMI NKINSI: Yeah, I mean, the hidden curriculum in medicine is this idea that there are certain ways that you’re supposed to interact with professors. There’s certain things that you’re supposed to do that are not spoken, but somehow everyone knows that you’re supposed to do them. So you’re expected to do research for different specialties. Not everyone knows that they’re supposed to do research and not everyone has connections to get research.

Other areas of hidden curriculum are the way that you interact with your professors. For me, I have people in my family that are in medicine, so I feel like I had a little bit of an easier time, but it was difficult to figure out who exactly is an ally and who isn’t. I think especially as a student of color, now, especially that white people are afraid to be called racist more than they’re afraid to be racist, that it’s hard to find allies that are actually there for you. So finding professors that are willing to have your back in those tough moments and not just kind of behind the scenes, finding people that are able to speak up for you when something’s happening and not just come up to you afterwards and say, “I’m so sorry that happened to you. I’m hoping to learn and grow from this experience.” I’m like, okay, learn and grow, but what does that do for me in the moment?

JOEL BERVELL: Yeah. How did you find allies inside your institution, especially when there is so much pushback against you? And I guess what advice would you have for students that are feeling like they can’t find an ally at their institution?

NAOMI NKINSI: Yeah, so the way I went about it was actually by going to office hours, oddly enough, which sounds like an odd recommendation. But for specific units that I was having a lot of trouble with, I would meet with those professors repeatedly because what it did is, one, it showed them that I was invested in their lectures, I was invested in learning. And then in those repeated meetings, they were able to get to know me as a person, and I could kind of feel out, is this someone that I can actually go to and talk to when I’m having issues? So one of my allies is someone that I met because I was having a hard time with the pulmonology curriculum, and I went to see him every day after exam to walk through these are the issues I had with the exam.

Other ways are to look for professors that are already doing the work. So what I mean by that is people that are already involved in pathway programs for minority students, et cetera, because you know that they are willing to stick up for students of color, they’re willing to create opportunities for them. And it can be tricky because again, when I say when representation doesn’t always mean support, it’s not always the people of color that are higher ups at your institution that are going to be the ones that are supportive of you. Sometimes they’re the ones that are going to do the most damage. I think it’s an issue with, as you move up in academia, there’s more and more pressure to maintain the status quo as opposed to trying to change it.

JOEL BERVELL: When we look to the next five to 10 years of where medical schools can go in order to be more inclusive, in order to actually tackle equity issues, in your ideal world, what would medical schools be doing to prepare future doctors for the world that’s out there?

NAOMI NKINSI: Yeah. I think this starts with changing the pre-reqs for medical school. So many of the pre-reqs are focused on the hard science, which is critically important to be a physician, but patients don’t come to us in a vacuum. They’re members of their community. They have families. In order to be a physician that can serve these patients, we need to have a better understanding of the social determinants of health and the other things that impact that individual’s health and a community’s health. So requiring more public health–based courses before going into medical school, I think would be really useful. Requiring more sociology courses, more courses to understand the roles that racism, sexism, homophobia, et cetera, ableism have played into medicine.

I think when we’re in medical school, having courses on the history of medicine. So we’re taught all of these exams and labs and all of these facts that some of them we won’t even ever use, but we are almost never taught about how these were actually developed and how medicine has not always been . . . has frequently, actually, been on the wrong side of history. And because of that, I think we’re prone to repeating it. So having a history of medicine course that students are required to take, I think would also help.

I would also say that in order to achieve greater equity, I mean the cost of applying to medical school and going to medical school is ridiculous. There’s no reason why people should be taking out loans just to apply to school. So reducing those costs and also reducing the cost of actually being a student, because by doing that, actually we’re preselecting who is able to be in this field, and that limits the kind of perspectives that we have access to.

JOEL BERVELL: Well, I’m hoping that someone listening to this will be taking those pieces of advice because that was so salient, and I think you hit on all the different levers that we need to be hitting on in order to improve health equity.

Naomi, I want to say thank you so much for talking to me today on The Dose. You are incredible, amazing. And everyone, so Naomi graduates from the University of Washington School of Medicine in May.

NAOMI NKINSI: Yes.

JOEL BERVELL: And today she just found out that she’s officially heading to residency for family medicine.

NAOMI NKINSI: Yes.

JOEL BERVELL: We know she’s going to be a great doctor.

NAOMI NKINSI: Great. Thank you so much for having me. It was an absolute pleasure.

JOEL BERVELL: Yeah, thank you. And as always, please tweet if you like anything you heard. Give us a shout-out if you have ideas for the podcast. Once again, I’m Joel Bervell. Thanks for listening to The Dose, a podcast of the Commonwealth Fund. See you next time.

This episode of The Dose was produced by Jody Becker, Mickey Capper, and Naomi Leibowitz. Special thanks to Barry Scholl for editing, Jen Wilson and Rose Wong for art and design, and Paul Frame for web support. Our theme music is “Arizona Moon” by Blue Dot Sessions. If you want to check us out online, visit thedose.show. There you’ll be able to learn more about today’s episode and explore other resources. That’s it for The Dose. I’m Joel Bervell, and thank you for listening.