#398 - Dr. Sheri Fink on the Ethics of Survival and Redefining Care for Trisomy 18

Hello friends 👋

Dr. Sheri Fink, Pulitzer Prize-winning correspondent for The New York Times and author of Five Days at Memorial, joins us for a compelling discussion on the ethics of survival. Dr. Fink, an MD-PhD, discusses her recent article "Noah is Still Here," which chronicles one family's journey with Trisomy 18—a condition once universally deemed incompatible with life. She and Eli explore the shifting paradigms of care, the tension between medical prognosis and parental hope, and the "two truths" clinicians must hold when counseling families in the grey zone. A must-listen for anyone navigating complex bioethics in the NICU.

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Short Bio:  Dr. Sheri Fink is a Pulitzer Prize-winning journalist, Emmy-nominated television producer and the author of the New York Times bestselling nonfiction book Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital about choices made in the aftermath of Hurricane Katrina. She is at work on a book about the global Covid pandemic and is a 2025 John Simon Guggenheim Memorial Foundation Fellow.

Fink’s work has often explored the impact of crises on health care and is informed by her background as an MD and former relief worker in disaster and conflict zones (she also holds a PhD in neuroscience).

Five Days at Memorial, the recipient of eight book awards, was based on an article investigating patient deaths at Memorial Medical Center. Co-published by ProPublica and the New York Times Magazine, the article won both a Pulitzer Prize and National Magazine Award. Fink is also a producer of the Five Days at Memorial limited series on Apple TV+.

As a news reporter, Fink extensively covered the Covid pandemic and, earlier, the Ebola outbreak in West Africa, sharing Pulitzer Prizes in 2021 and 2015 with New York Times colleagues. Fink’s investigation into how the Ebola epidemic began in Sierra Leone and why it wasn’t stopped in time — for the PBS Frontline episode Outbreak — received an Emmy nomination for outstanding research in 2016.

Fink’s first foray into television producing was as a co-creator and an executive producer of the Emmy-nominated Netflix documentary television series Pandemic: How to Prevent an Outbreak (2020). Filmed the year prior to the Covid-19 pandemic, it featured the intertwining stories of scientists and doctors around the world fighting to stop the next outbreak and warning that we were not prepared. Her first book, War Hospital: A True Story of Surgery and Survival, is about medical professionals under siege during the genocide in Srebrenica, Bosnia-Herzegovina.

Fink has lectured on topics ranging from emergency preparedness to journalism and is an adjunct associate professor in the Department of International Health and Sustainable Development at the Celia Scott Weatherhead School of Public Health and Tropical Medicine at Tulane University.

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The transcript of today's episode can be found below 👇

Eli (00:02.866) And hello, everybody. We are back with a very special episode of Neo News. We are here with Dr. Sheri Fink to discuss a truly breathtaking article that she wrote, the latest of many breathtaking articles that she's written. I will not do her bio justice, but Dr. Fink has written for everywhere about everything all at once. Famously, she has written about conflicts, as well as—probably most well known at least in some of the circles that I walk in—about her work related to Memorial Hospital in New Orleans in the wake of Katrina. That became an article in ProPublica and then a book called Five Days at Memorial, which won God knows how many awards. And then I think it was also adapted to the silver screen, so it had a video adaptation too. These days Sheri is writing for The New York Times Magazine, which is where her latest article titled "Noah is Still Here" ran. Dr. Fink, thank you so much for joining us.

Sheri Fink (01:16.867) It is a delight to be with you. My main gig right now is writing a book about the COVID pandemic.

Eli (01:25.794) Ooh, I don't know anything about that subject. It'll be nice to learn about that.

Sheri Fink (01:29.211) We are all experts in that, I think. Every human on earth.

Eli (01:34.528) Yeah, every time that I get to use my delightful, soft, unlimited rolls of toilet paper, I just have such gratitude that we are not there anymore. Anyway, Dr. Fink or Sherry—may I call you Sherry? Is that OK?

Sheri Fink (01:53.851)Please.

Eli (01:54.63)And Sherry, I think it'd be useful for our audience here, who are predominantly neonatologists from all across the globe, but also lots of other clinicians who participate in the care of babies and families in the NICU, for you to just share a little bit about your journey, which obviously has been quite an interesting one.

Sheri Fink (02:13.732) Sure. And hi, neonatologists and associated people interested in the subject. It's wonderful to join you. I started out doing an MD-PhD at Stanford, which is where you are. Is that right?

Eli (02:29.602)That is true, yeah.

Sheri Fink (02:31.406) It was actually a really fun place to do the MudPhud because we didn't have grades. I think it's still that way. Not that we didn't study, but we also formed a lot of good bonds. It was a good med school experience. And then my career took a different path. As you pointed out, after getting my degrees, I was doing humanitarian aid for a while and pursuing an interest in what was happening in the Balkans. It was the early days of email and I linked up with some med students at the time who were basically becoming war doctors. There were wars in the former Yugoslavia at the time, and I developed an interest. I ended up writing a book about some of these incredible healthcare providers who worked in, sadly, the conditions that we see in many war zones now, where even medicine had come under attack. I'm making this a long story, but I started to want to write and share insights from what I was learning and ultimately became a writer and a journalist. I did a little bit of humanitarian medical assistance myself along the way. That's the story. Does that make sense? It's a career path that I always say to trainees: you can never really plan for where your career takes you necessarily.

Eli (04:11.566) Yeah. And we will definitely get into some of those elements. There is so much to discuss. I have to say, based on the MudPhuds that I know at Stanford, God bless them. They are not forming covalent bonds. It's like bonds involving, I don't know, a lot of red cups. A lot of red cups, a lot of liquids which I don't think are pipette fluids. Anyway, it sounds like a fun time to be a MudPhud at Stanford.

Sheri Fink (04:37.85)Really?

Eli (04:40.59) So, I do want to get into the meat of the story here. This article is about Trisomy 18, and in particular one child, one family with Trisomy 18, documenting their story and what that tells us about this condition, and perhaps by way of Trisomy 18, thinking about other conditions with similar features. What made you interested in Trisomy 18 and what kind of reporting were you trying to learn?

Sheri Fink (05:19.108) Well, it actually goes back to one of the stories that you mentioned, the Hurricane Katrina story, which was about a hospital that was in the city of New Orleans after the levees failed and the city filled with water. It took days for rescue and most of the hospitals lost their power and their backup power. This was a famous case for those who haven't heard the story, where a doctor and two nurses were arrested and accused of ending the lives of their patients in really dire circumstances of heat and prolonged wait for rescue. They declared their innocence, but it was a big story at the time. I set out to understand what actually happened there. Why were people even talking about ending lives? How did it get so desperate and what can we learn from that? Thus the article and the book, and then it was an Apple TV+ series that just came out a couple of years ago. So you can still stream that if you're in for something very serious. Obviously not a happy story, but I think there's a lot we can learn from looking at crises in healthcare.

That sounds nothing like Trisomy 18. So where's the connection? The connection is that shortly after that article came out many years ago now, a mother contacted me, the mother of a child with Trisomy 13. She said, "You know, most of the patients where there was this controversy over what happened to them—why did they get injected with comfort medications and why did they all die? Was this mercy, was this murder?" She said these were mostly older patients. You will be glad to hear all of the NICU babies were rescued first out of that hospital in New Orleans. But she said, "My baby had Trisomy 13 and I'm an engineer. I didn't really know anything about it, but she ended up getting comfort medications and I wasn't really given the full story." Come to find out later that she had some difficulty breathing and there really wasn't an effort to resuscitate her. So she said, "I thought you might be interested in this case and in the larger question of these babies born with Trisomy 13 and Trisomy 18. And by the way, the standard of care is starting to shift."

I was interested. When I went to medical school many years ago now, I won't say exactly how long. Of course, we were just told there was nothing to be done. It was a lethal condition. The standard of care, if there was one, clearly tended not to do any interventions. Maybe that had even been seen as unethical in a syndrome where the life expectancy was expected to be hours or days. But I started looking at it and it was interesting because families in the age of the internet were finding one another who had children with the conditions who had been the rare survivors. Then there were efforts to try modern medical interventions and some clinicians were willing to try. It turned out that more and more evidence was accumulating in the medical literature that in fact, life could be extended. There could be improved health and improved cognitive abilities in what had been seen as extremely dire in all aspects. This is, for those who don't know, a syndrome where multiple organs would be affected: heart defects, morphological changes, and also profound intellectual disabilities and shortened lifespans.

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But over time, there was a shift. Patients, and in particular their families, were pushing in some cases to have interventions that any child born with a heart defect or with respiratory distress would get in the NICU, say, resuscitation, for example. There were some studies showing that they really felt that their children had happy lives, even if they weren't verbal, let's say, and that they contributed to their families. So I was interested for many years in exploring this. It's a very long story as to why it took so long to publish a story. I decided, and my editors at The New York Times Magazine thought, that what would make for an interesting story would be to closely follow one patient's story. But they were interested in both the parent side and the child side, as well as in the clinician side. In this particular case, the parent is a clinician. She's an obstetrician-gynecologist named Dr. Jacqueline Vavides. So we really enter this story with her pretty typical view of this diagnosis. Then she herself, when she's pregnant, learns that her child will have Trisomy 18. And it goes from there: from her considering it to be lethal to not planning to do any interventions, not planning to have a C-section, for example, during childbirth if there's distress, all the way to ending up making some decisions about very invasive treatments.

Eli (11:54.626) Yeah. I mean, it's interesting that you say the story starts with her pregnancy. Because my read of where the story starts gets to this fundamental question of prognosis and quality of life. I think the third or the fourth paragraph is this big honkin' chunky paragraph about her giving nebs to Noah. And you're kind of sitting there reading in excruciating detail as she struggles to give these nebs, which obviously he needs. And then it seems like five minutes later that siblings get home and they eat pizza and watch a movie. I wonder, how do you hold these two truths? At once as a doctor, as a reporter, and then reflecting on what you were hearing from everybody you interviewed for the story—that this kind of diagnosis can at once confer morbidity, perhaps suffering, which is something that several of the clinicians mentioned, but also great happiness. How do you hold those two truths up at once? For clinicians who are thinking about speaking with families about what the future may look like—we had one of these kids on our unit in the very recent past where we struggled with this—how in the world can you communicate both of those things at once in a way that has equipoise?

Sheri Fink (13:28.398) Yeah, I think that's the real challenge for physicians. And I think the article gets at that. That's a huge part of the whole story because for many years there weren't treatments. If you decide that this is a dire, lethal, no quality of life, burdensome life, you as a physician, if you view it that way, you will be counseling your patients that way. Then it actually becomes a self-fulfilling prophecy. There are a lot of quotes in the literature with Trisomy 18 stating that to some extent, patients were dying immediately because they weren't being resuscitated. So of course they're going to die if they have respiratory issues. So yes, now we know from the research that these lives can in some cases be extended, not always. But then there's that question of, what is that life like? And I guess that's what you're saying.

It is difficult. This wasn't the only family I followed. I actually followed many over many years. We were filming an episode of a TV series that the Times used to have called The Weekly. It was interrupted by COVID. But we actually followed a couple of patients from prenatal diagnosis all the way through the NICU just to see what would happen. I saw the neonatologists at these hospitals really struggling with that question that you just asked, and how to guide patients and families. In particular, it's tough. But I guess my point going back to what you asked is that especially prenatally and even in the NICU, it's important to have good communications and to really try as best as you can to not impose your own values, because for each family this diagnosis will mean something different. It's very clear that the majority of families choose either to terminate, if that's an option, or comfort care at birth. But there are some families who really want interventions and go into that informed, especially because there are now support groups. I think one of the ones that I've had a lot of exposure to and that has a lot of good information, tries to be non-judgmental, tries to provide peer-reviewed evidence, and has a medical advisor, is the support organization for Trisomy 13, 18, and other disorders called SOFT. I think it's trisomy.org. There's a whole section there for professionals. Obviously, they have support groups for patients. They have peer support. For families that are willing to or struggling through those difficult decisions that can come up in the NICU as they face questions over interventions and what life might look like, I would say that those would be good resources.

And it's really important for physicians to keep up with the latest. For example, two of the big professional societies, one for thoracic surgeons, another for pediatricians, have both come out within the last year to year and a half with pretty detailed guidelines that hadn't really existed before to guide you as a clinician. Because of course, this is a rare diagnosis and you won't necessarily have had a lot of patients with it before. So those would be good resources too, where you can give the clinical side and answers and statistics to the extent that there are some now. There is some evidence to guide decision-making on that purely medical level.

Eli (18:15.704) Well, it's interesting you say that because I think one of the studies that you cite says, "Few of the studies were particularly robust and the percentage of babies who reached their first birthday differ drastically from three to well over 50%." Possibly because of variations in access to care and "perspectives and values affecting the care provided." So when you look at a confidence interval from three to well over 50%, it begs the question: there are studies on this, but how much can you really be guided by any single one of these studies? And how do you even begin to integrate those into your care?

Sheri Fink (18:50.319) It's super difficult with this rare condition, and there is some interest in improving the quality of the studies and doing more meta-analyses. There's a group I mentioned briefly in the article called the Trisomy Collaborative. I think they're issuing calls for proposals. If you're interested in advancing this field, you can apply for a grant. But it makes it super hard. I agree with you. I think those statistics really do show the power of a physician's guidance, because how you counsel your patients will have a lot to do with the choices that they make. And that's probably very uncomfortable for physicians, too, who want to be sensitive to what a family's values are.

It can be very helpful. I think one of the scenarios where I've seen this work best—and again, I've spent years really interested in this, and I've talked to doctors all over the country and followed a lot of families—is when families who do want to consider interventions get a multidisciplinary evaluation at a fetal care center where they get to know as much about what the fetus's likely issues will be. Although it's a very serious syndrome in all cases, there are different ways that it manifests. Some kids will have, for example, much more complex cardiac anomalies than others. To the extent that the families can go have these meetings with the neonatology team, but also cardiology and others. These hospitals tend to have more experience with Trisomy 13 and 18 diagnoses. Sometimes those families choose to have their babies at a center that is both willing to intervene and able to intervene. The problem with that is then it becomes a question of access. If these families can only get this type of care at a few places and nobody else—no other physicians—really have much experience, that can be a problem as well. But I have tended to see it work better in that scenario when a family does want to have interventions.

And then the other thing that's super important is communication. To the extent that you might have a palliative care team that is not just about end of life—like a perinatal palliative program. They have all different kinds of names, and some are moving away from "palliative" into other ways that they call it. Basically, a program of physicians who are passionate, and social workers and other types of professionals, who really have an interest in helping families navigate life-limiting diagnoses and these decisions at the start of life. Trisomy 13 and 18 aren't the only ones you see in neonatology. Those programs seem to be of great value as well in just helping that communication proceed and helping to promote trust. Because where things are a lot messier is where the family is feeling like their child isn't valued, and then they don't trust the team when the team says, "This intervention won't be helpful in this situation." The goal being to just help that family feel good in their decisions, and help you as a clinician feel that even though we don't have great data, you are making the best possible decisions based on the values of that family and with the best possible knowledge that we have right now. But it's hard, I'm sure, in your case. Maybe you want to talk a little more about that. Each of these cases is very individual and it can be very difficult to navigate.

Eli (24:09.166) Yeah. Each of these cases comes with its own complexity. The case we had certainly rhymes with the cases you document here. Interestingly, a week before this ran, I'm sure you saw it, the American Academy of Pediatrics came out with a statement on management and care of infants with Trisomy 13 or 18. Just to quote from that, it says, "Although the presence of Trisomy 13 or Trisomy 18 impacts prognosis for survival and long-term outcomes and cannot be disregarded in complex decision-making, there are no ethical justifications for universal principle-based differential treatment based solely on these genetic diagnoses." And then they go on to saying that care should be tailored individually, which is exactly what you say.

One of the really interesting challenges that I felt reading the story is you also describe Jacqueline and Vince's interaction at the fetal care center with the palliative care team. They are basically asked to run through the birth plan, which is something that a lot of us may do. You say: "Would they monitor his heartbeat during labor? If that monitoring reveals signs of distress, should he undergo a C-section? Would they resuscitate?" All these sorts of questions that a lot of us are used to asking. Interestingly, regarding Jacqueline's interpretation, it sounds like she told you, including as a healthcare provider herself, "For Jacqueline, considering such explicit questions was jarring. She left feeling like, 'How much do I love my kid?'" What, if anything, did you glean from all these conversations about not only the things we say, but how we can say them in a way that leaves families feeling empowered, like they have a semblance of control or at least a set of contingency plans, and not feeling judged?

Sheri Fink (26:10.776) Yeah, that's so important. I think the other ethical principle that one keeps seeing in the literature these days is that families should be supported in any decision that they make. In other words, you can ethically support intervention as well as non-intervention, which is probably the more common choice. There is a danger in a family feeling like if they choose not to go for every intervention, they could feel like, "I'm choosing to not fight for my child." That might be how some families feel, but others should be supported in deciding that the burdens of treatment for their child would be much greater than the benefits. We also have to look at the support for families, especially these days with special education not being supported as much or Medicaid being cut. It's already quite a struggle in some states for these families who choose to have interventions, or whose children do end up living longer, to get the services that they need. Every family is in a different position. They're in different financial positions. They have siblings to think about in all ways. You can see families feel that these children—there used to be a knee-jerk reaction that this would be a burden on siblings. That is how some people feel, but others, like Jacqueline and all of the families I've met, feel that the children bring something positive to their families as well. It's all to say that I'm all over the place because families are all over the place. The whole point being that non-judgmental support of these families is super important. Clinicians, to the extent that you can be open and elicit what their values are, and then support them in their journeys and not be judging them for either choosing to intervene or choosing to provide comfort or to terminate... I think that's really where most of the experts in this field and the families themselves seem to think their hopes lie.

Eli (29:17.27) Yeah, absolutely. I think another thing that we are alluding to, but haven't said explicitly yet, is trust in medicine and how we can try to gain and maintain people's trust, especially in circumstances like this where they're going to have so many interactions with the healthcare system. There is some really interesting discussion of trust in the article. It's certainly something that we've discussed previously on Neo News. It strikes me that there's this fundamental tension between the traditional medical system and the YouTube videos that all of these families we know are watching. Interestingly, you document a moment where Vince, Noah's father, found a YouTube video of a toddler with Trisomy 18. It conjures to mind for me a political ad: there's all these horrifying things that the healthcare system told them. And then at the end of the video, it sounds like you get some footage of this child thriving. Families in that moment can only imagine leaving, closing that tab, and thinking, "Someone told me that the survival rate is somewhere between zero and 100%. Probably closer to zero and 99% in the case of a 'fatal illness.' But you watch that video and you're like, how could you not believe the survival rate is a hundred percent?"

You document later in the story another family, the family of a child named Andriana Hope, for whom a doctor says, "This is a family that had lots of interactions with the healthcare system and ultimately ended up redirecting cares in ways that were out of touch with the way the medical team had recommended." One of the doctors who provided care to that family said, "They were an example of a couple who developed an inability to communicate with and trust in their medical team." And that as soon as a doctor predicted that a fetus wouldn't make it to term, or gave a life-limiting prognosis, that quote: "The family has the first solid evidence that people have lied to them." I have to say this resonates deeply with me because the child that we cared for, I remember, actually did really well in the immediate perinatal period. Ultimately, mom came back to the NICU as soon as she was able, out of the C-section, and I sort of caught her in the hallway and she said, "I told you so." I said, "I'm so glad you were right." But in that moment, I could feel that we were a little bit on a knife's edge in terms of whether she was going to continue to trust the medical team and feel like the medical team was on her side, despite what we had told her in advance about what we expected, or whether she was going to feel that the medical team had ulterior motives or values that were out of touch with hers. So trust, YouTube, these conversations—how did you think about it?

Sheri Fink (33:04.172) Yeah. I saw it over and over again. The families who had kids who did survive longer, or even who didn't, but almost every family who had some interaction with the medical community among families who wanted interventions, felt at some point that there was a sense of bias against them. That clinicians used words that made them feel discriminated against, like "lethal" or the phrase that was so common: "incompatible with life." That was one that they heard a lot. Online and in these groups, families are giving support to other families and they're telling these stories. So if the family themselves didn't hear it personally, they'll hear it from other people in the support group that clinicians told them there was no chance of survival or that this would destroy their family.

So this is out there. It is real. I do believe that families have heard that and that was the orientation that a lot of clinicians had and may still have. A lot of clinicians probably can't imagine wanting to try to extend the lives of children with many physical and intellectual disabilities. There's still that bias in our society. Or maybe that clinician saw another family really struggle for many years with a child who was medically complex and they would feel guilty not trying to prepare a family for that. What I'm trying to say is some of it is stuff that we can try to do better and need to do better. I'm saying "we," but I'm not practicing clinically—you guys who are in there interacting with families, and us, those of us who write about it. There needs to be better communication. There needs to be efforts to avoid giving a family an impression that this child isn't valued.

Some will be out of your control. Either there's this larger feeling of lack of trust in medicine and in science these days, or it could be nothing that you and your team did, but something that the families hear about on the internet. And they really do arrive in fight mode. The families who decide "We want to give our baby every chance just like any other baby, we're going to go and see what the medical problems are and what the potential treatments are and go step by step." But those families will often be really prepared for a fight because they've heard about a lot of other kids who aren't being afforded these interventions. So it is really tough. I think to the extent that you can acknowledge that that's out there, really listen and elicit the family's values, maybe get palliative involved or social work or whatever other modalities, and just try your best to build that trust. Also know that it is really hard these days.

Eli (36:30.646) Yeah. One of the things that I'm curious about—my understanding from some of my friends who are at the Times is that there's encouragement for you guys to read and engage with the comments, which sounds like a nightmare to me. I try to just go under a rock and lie in fetal position after I publish, hoping that no one asks me for corrections or anything. What, if anything, did you learn from the conversation that followed this article? What feedback have you gotten?

Sheri Fink (37:09.444) Well, as you might've seen, I got very involved answering questions. I have wanted to do this story for well over a decade and it was very sad to me that we were quite far along in the article and in that TV episode right before COVID hit. Then as the one MD on the news staff, I was immediately the COVID reporter in hospitals where there are many, many COVID reporters. The Times covered the pandemic very well—everybody chipped in. So sadly that article never was published back years ago. So I was very excited to engage with readers.

What I learned was pretty much as I expected. There were many, I would say probably the majority of people who felt like they wanted to write—and there were hundreds of comments—a lot of them were quite judgmental of Jacqueline, the physician-mom. Even though I had tried to do what I could to just really let her tell her story and the medical team, and just to tell it almost decision by decision as they faced each choice along. Noah is five years old now. There were still people who just judged her and thought... I think that was maybe expected, but there are quite a lot of people who just couldn't get their minds around expending medical resources on a child where that child would never speak or may or may not walk, certainly will never be able to care for themselves on their own, and not seeing a value to the family—which Jacqueline and her other kids do feel that Noah is greatly valued in their family. And then there were lots of interesting medical aspects that we got into in the discussion. Were there some that stuck out to you?

Eli (39:42.126) No, because I didn't go that far. I got trauma just scrolling. My God. Yeah, never. I would never. I already have therapy as frequently as it can humanly fit in my schedule. Listen, you grow up with a New York mom who's a psychiatrist and you basically pop out of the womb, you breastfeed, and then you start your first therapy session.

It was kind of how it goes. Well, listen, I have one other question I'd love to pose to you before we go. One of the things that you and I have talked about a little bit offline is the role potentially that journalism can serve in these broader conversations around physician advocacy. You're a physician. You don't practice clinically, but certainly you've gone through lots and lots of training. Journalism is a platform, even if it is explicitly objective and aims not to take a position, certainly at first and really not ever at a place like The New York Times. How do you think about, and how would you communicate with trainees who might be listening to this conversation about ways in which they can get involved in conversations about things like care for individuals with Trisomy or any other condition? What role does journalism serve as an outlet to try to, if not advocate for either side on big issues, take big issues head on and bring them back into the public?

Sheri Fink (41:49.285) Well, first of all, I really like how you asked the question because there is a difference between journalism and advocacy. I think that gets blurred or people aren't clear on it because we have a lot of opinion. There's a whole side of public communication that is about opinion, and newspapers have long had opinion sections and those writers are separate from the news writers. So yes, when I went into journalism and this type of journalism, I committed to try to approach every story with it as objectively as possible. We have many discussions and debates until the cows go home about whether that's even feasible. But I do believe it is a valuable objective to be objective. In other words, it may not be possible, but it's important to try. It's important to have journalism and journalists who take that seriously. My colleagues really do. To the extent that even many political reporters do not vote because they truly don't join political parties. So journalism and advocacy are separate things, or there's a type of journalism that is separate from advocacy or opinion type of journalism. And that is the journalism that I try to do.

But I will say two things to your question. I'm a physician by training and I do feel that one of the things that appealed to me about journalism was being able to bring to light or address larger issues. When you're a clinician, you see the same problems over and over. Some physicians get involved in research because they want to cure the disease. Others might really just love treating the individual patients.

When it comes to advocacy as physicians, one of the things that's really interesting when you look at the history of medicine is that there was a time not that long ago where it was really considered uncouth for a doctor to be involved in politics or advocacy. I think one of the turning points was the story of IPPNW, the International Physicians for the Prevention of Nuclear War, which just had the Nobels announced as you and I are recording this. They won the Nobel Peace Prize some years ago. In his acceptance speech, Dr. Bernard Lown—you can look him up, he's a really fascinating individual in the history of medicine—basically said something like: "We physicians who shepherd life from birth to death... not only should we speak out when it comes to something that affects the potential life of everyone"—we're talking nuclear war here—"it's not only OK for us to advocate, but actually it's really our duty to do so." So he's essentially linking the duty of a physician in the clinic to the duty of a physician to speak up more broadly about issues that threaten human life or health. So I think now, obviously, physicians are more involved in speaking out. One thing that you have is that you see things that most other members of society never get to see unless they're affected by a particular clinical issue. So you can get involved in writing and podcasting as you have, or more explicit forms of advocacy, but I think it is more accepted now to see that link.

Eli (46:24.63) Yeah. And also as you and I are recording, certainly we're in the middle of a government shutdown. There appear to be lots of additional rounds of firings and rehiring and who knows where all of that is going to land. But all of that to say, there are fewer institutional voices talking about health and guiding people on health than ever before. I don't know where you stand on this, Sheri, but certainly it feels like in that deafening silence—which of course is not just in the setting of the government shutdown, but also with some of the executive orders freezing communication between agencies—perhaps the role of physicians and pediatricians specifically, and neonatologists even more so as really the gateway or the re-entry of families into the healthcare system, is vital. Maybe we have that responsibility to speak with and on behalf of our patients more than ever.

I think maybe that is a good place for us to end. Dr. Sheri Fink with The New York Times, thank you so much for taking the time. We will post the article in our show notes. Thank you so much, Dr. Fink, for taking the time.

Sheri Fink (48:01.573) Thank you so much. It was wonderful to speak with you.