Hard Medicine

Ilana Yurkiewicz, MD
  • 5.0 (1)
  • Medicine
  • Updated Monthly

A show dedicated to solving medicine's hardest problems — one big question at a time. Hosted by Dr. Ilana Yurkiewicz, Stanford physician, professor, and journalist. ilanayurkiewiczmd.substack.com

Episodes

  1. Sep 2

    Is the Microbiome Responsible for the Rise in Chronic Disease?

    Certain chronic diseases are rising, and no one knows why. These include autoimmune diseases such as Crohn’s, metabolic conditions like diabetes, early-onset cancer, and even disorders of mental health. One unifying theory is the microbiome. This diverse community that lives among us has been blamed for everything and nothing. In this conversation, Dr. Yurkiewicz sits down with microbiology professor and leading microbiome researcher Dr. Justin Sonnenburg to understand what role the gut microbiome might play in the rise of chronic disease. They dissect important nuances: Is there real-world evidence the microbiome causes disease, or only correlates with it? Have mouse studies panned out in humans? And what changes can we make, as individuals and society, to repair generational damage to the gut microbiome? Is there a point of no return, and are we there now? 0:06 Opening Monologue: Is the Microbiome the Missing Link Between Environment and Disease? 2:05 What Is the Microbiome and Why Does It Matter? 7:38 Our Gut Microbiomes Have Deteriorated 15:01 What Ingredients Shape the Microbiome? 19:29 Real-World Evidence Linking the Microbiome to Disease 28:19 Can We Quantify Health Risks Posed by the Microbiome? 31:11 The “Brain-Gut Axis” 33:30 Is Young Adult Cancer Connected to the Microbiome? 36:15 Understanding Your Own Gut Health 41:26 Is It Ever Too Late for an Individual? 44:11 Is It Too Late for Society at Large? 46:45 Fecal Transplants: Where the Science Stands 49:33 Rapid Fire: Probiotics, Microplastics, and Myths 51:39 Is the Microbiome Responsible for the Rise in Chronic Disease? Get full access to Hard Medicine at ilanayurkiewiczmd.substack.com/subscribe

  2. Jul 23

    Can the President of the United States Fix Healthcare?

    Despite a majority of Americans reporting dissatisfaction with the U.S. healthcare system and agreeing it needs reform, very few presidents have been able to do it. In fact, according to longtime Washington insider and co-author of Whiplash Dr. David Blumenthal, advisors explicitly tell the president: Don’t go there. In this episode, Drs. Yurkiewicz and Blumenthal explore what power the most powerful person in this country has to enact meaningful reform. Through case studies of three administrations — Obama and the Affordable Care Act, Trump and the Covid pandemic, and Biden and the medical safety net — they unpack: What legislative and bureaucratic obstacles stand in the way? Are ideological differences between the left and right too wide to overcome? If a presidential candidate makes healthcare reform a key part of their platform, is it worth your vote? Can the president of the United States fix healthcare? 0:06 Opening Monologue: Who Has the Power to Enact Major Healthcare Reform? 2:18 Most Americans Want to Fix Healthcare — and Most Presidential Advisors Say Don’t 5:21 Obama Focuses on the Affordable Care Act 21:41 Did the President Break Electronic Medical Records? Can a Future President Repair Them? 28:46 Trump Faces the COVID-19 Pandemic 40:11 Biden Targets the Medical Safety Net 44:55 Rapid Fire: What’s the Next Whiplash? Is Bipartisan Agreement Possible? Is Loss of Trust Insurmountable? 47:50 Can the President of the United States Fix Healthcare? Get full access to Hard Medicine at ilanayurkiewiczmd.substack.com/subscribe

    Can the President of the United States Fix Healthcare?

  3. Jun 30

    What Parts of Longevity Medicine Are Real?

    What is longevity medicine, and how is it different from good primary care? That’s the first question Dr. Yurkiewicz asks her guest Dr. Hillary Lin, a longevity physician and entrepreneur. They get into how to separate hype from substance, what aspects of longevity medicine are evidence-based, and what hasn’t made it into medical guidelines but has emerging evidence behind its use. The purpose of this episode is not to debunk the myths and grifts of longevity medicine, of which unfortunately there are many. This is a conversation about what works to live longer, healthier lives. 0:06 Opening Monologue: Longevity Medicine as Personalized, Not Population-Based 3:03 What Is Longevity Medicine? 5:22 Understanding Your Cardiovascular Risk 22:22 Insulin Resistance: Tests, Treatments, and Continuous Glucose Monitors 29:18 Are GLP-1s the First Modern Longevity Medicine? 31:51 Four Lifestyle Pillars: Exercise, Diet, Sleep, and Mental Health 45:54 Reducing Dementia Risk 48:25 Do Supplements Work? 51:35 Democratizing Longevity Care and Overoptimizing 54:21 Rapid Fire: What Aren’t We Talking About Enough? What Are We Talking About Too Much? 56:12 What Parts of Longevity Medicine Are Real? Get full access to Hard Medicine at ilanayurkiewiczmd.substack.com/subscribe

  4. May 24

    Is Cancer Preventable?

    Cancer care still mostly revolves around one goal: chasing cure. But what if that approach is costing us thousands of lives and untold suffering? In this episode of Hard Medicine, Dr. Yurkiewicz speaks with Dr. Azra Raza, oncologist and author of The First Cell, about why cancer medicine still prioritizes treatment over prevention — and the paradigm shift needed to change that. They discuss what stands in the way: massive disparities in research funding, a health care system that flattens prevention into one-size-fits-all, and a medical culture favoring incremental advances over radical change. They also explore solutions, from targeting cancer precursors in the bloodstream to tailored screening for people at high risk. This is a conversation about cancer that is both deeply critical and optimistic. 0:06 Opening Monologue: From Treatment to Prevention — Cancer Needs a Paradigm Shift 2:49 Why Focus on Prevention? 8:33 Cancer Is Too Complex to Cure 14:45 95% of Cancer Drug Research Fails 18:47 What’s Wrong With Mouse Models? 27:40 Building Biobanks From Human Samples 30:18 The “Stentinel” 37:21 The Limits of One-Size-Fits-All Screening 44:43 Rapid Fire Q&A: Blood Tests for Early Detection, Full-Body MRIs, and Rising Cancers in Young Adults 50:31 Is Cancer Preventable? Get full access to Hard Medicine at ilanayurkiewiczmd.substack.com/subscribe

    Is Cancer Preventable?

  5. Apr 27

    How Can We Get Doctors Where They’re Needed Most?

    The U.S. has doctors, but they’re not distributed where the needs are greatest. We are in short supply of primary care physicians, especially in rural communities. In this episode, Dr. Yurkiewicz speaks with policy analyst Lawson Mansell about the incentives — largely from the government — that influence what doctors choose to practice and where. These incentives systematically steer doctors away from the medicine patients need most. They dissect several sources: payment that rewards episodic care over long-term relationships, outdated residency funding that favors hospitals over clinics, and underutilizing internationally trained physicians already living in the U.S. They also discuss hopeful initiatives, such as a bipartisan bill that would let Medicaid support a model known as direct primary care. How can policymakers rewrite incentives to reflect workforce needs? How can we help more doctors choose to practice where they’re needed most? 0:06 Opening Monologue: Where Doctors Go Is a Policy Choice 1:52 Why Are Primary Doctors Paid Less Than Specialists? 19:20 Lobbying from the AMA and Unintended Consequences 24:18 The Pipeline In: Residency Funding Is Outdated 39:39 Wasting International Physicians’ Time 45:26 Bipartisan Support for Direct Primary Care 51:04 How Do We Get Doctors Where They’re Needed Most? Get full access to Hard Medicine at ilanayurkiewiczmd.substack.com/subscribe

  6. Mar 23

    Can Medicine Make Peace With Dependence?

    What is dependence, and is medicine built to handle it? That’s the question at the center of this conversation between Dr. Yurkiewicz and Leah Libresco Sargeant, a writer and thinker. Sargeant’s latest book, The Dignity of Dependence, argues that society treats autonomy as the default, when in reality our lives are shaped by need. Does healthcare, of all places, fully accept this? They discuss the vulnerabilities that even healthcare struggles to hold — chronic illness, pregnancy, end-of-life — and the costs of treating these as exceptions: financial loss, employment discrimination, and compassion fatigue. What would it take for medicine to meet real human need? 0:06 Opening Monologue: Healthcare’s Blind Spots on Dependence 1:22 What Is Dependence? 2:29 Does Medicine Overlook Need? 7:22 What Economics Misses About Caregiving 10:14 Workplaces Don’t Accommodate Being Human 17:57 Nine Months of Illness: Failing to Account for Pregnancy 23:21 The Myth of the Invincible Clinician 29:02 The Range of Human Experience and Tradeoffs 36:45 The Dignity of End of Life 39:16 What Is Our Obligation When Quality of Life Is Irreversibly Lost? 44:08 Compassion Fatigue 46:25 Is Physician Aid in Dying Dignified? 55:30 Can Medicine Make Peace With Dependence? Get full access to Hard Medicine at ilanayurkiewiczmd.substack.com/subscribe

  7. Feb 10

    What Makes a Good Life with Stage IV Cancer?

    All of life, in a way, is decision-making with a deadline — paired with deep uncertainty about that deadline. For people living with stage IV cancer, both the deadline and its uncertainty are radically heightened. Cancer is one word, but it’s not one disease. Thanks to targeted therapies and evolving treatments, some people live for years with metastatic illness. They must make ongoing choices about work, relationships, and meaning, without knowing how many days they have or what those days will look like. In this episode of Hard Medicine, Dr. Yurkiewicz sits down with Dr. Bryant Lin, a primary care physician and clinical professor who was diagnosed with stage IV lung cancer just shy of his 50th birthday. How did he decide what to continue and what to let go? How much detail about prognosis did he seek? Does time itself pass differently when you know there’s less of it? 0:06 Opening Monologue: Living with Compressed Time 1:43 Life Before Cancer 4:01 Lung Cancer in Non-Smoking Asians 8:09 First Symptoms and Getting Diagnosed 18:27 How Much Did You Want to Know About Prognosis? 22:14 Making Decisions Under Uncertainty 27:42 Finding Joy and Passing Time 38:25 Choosing Hospice or Clinical Trials 41:29 Insurance Hell 50:20 “Sunshine” — What Makes a Good Life with Stage IV Cancer? Get full access to Hard Medicine at ilanayurkiewiczmd.substack.com/subscribe

  8. Jan 12

    Can Primary Care Be Saved?

    Despite being one of the only parts of American medicine that consistently improves outcomes, primary care is in crisis. In this episode, Dr. Yurkiewicz talks with Dr. Lisa Rotenstein, a primary care physician and health systems researcher, about why modern primary care leaves doctors both chronically overworked and functionally unavailable. They unpack the structural mismatches driving this crisis: payment for visits but not the work in between, patient practices in the thousands, and the ever-expanding burden of electronic medical records. They also explore solutions: What is the ideal team, and is AI part of it? What’s the right number of patients for one doctor to see? And is fee-for-service payment simply incompatible with primary care today? 0:06 Opening Monologue: Primary Care Is a Design Failure 2:01 The Good — Why Doctors Choose Primary Care 6:15 What’s Wrong with Primary Care? 8:47 Distorted Math: 2,500 Patients and 27-Hour Days 13:56 Electronic Medical Record Burdens 21:44 When “Part Time” is Full Time 24:43 Consequences of an Unsustainable System 27:09 Is Fee-for-Service Payment a Non-Starter? 31:00 The Ideal Team and Continuity 37:29 What AI Can and Cannot Fix 44:08 Direct Primary Care 48:34 Can Primary Care Be Saved? Get full access to Hard Medicine at ilanayurkiewiczmd.substack.com/subscribe

  9. Trailer

    Trailer: Hard Medicine

    Healthcare is one of our most important institutions. But it’s no secret it’s deeply broken. Hard Medicine is a monthly podcast tackling the hardest questions facing medicine today: Can primary care be saved? What does a good life look like with stage IV cancer? Why does it take months to see a doctor? Hosted by Ilana Yurkiewicz, MD, Stanford physician, professor, and journalist, and the author of Fragmented: A Doctor’s Quest to Piece Together American Health Care. First episode drops January 12. Get full access to Hard Medicine at ilanayurkiewiczmd.substack.com/subscribe

    Trailer: Hard Medicine

Trailer

About

A show dedicated to solving medicine's hardest problems — one big question at a time. Hosted by Dr. Ilana Yurkiewicz, Stanford physician, professor, and journalist. ilanayurkiewiczmd.substack.com

Information

  • Creator
    Ilana Yurkiewicz, MD
  • Years Active
    2025 - 2026
  • Episodes
    9
  • Rating
    Clean
  • Copyright
    © Ilana Yurkiewicz, MD
  • Show Website
    Hard Medicine