Bess Stillman (email) is a doctor at the Mayo Clinic and writes at Everything Is An Emergency. She is also an excellent storyteller who uses her skills to convey the hectic and at times heart wrenching experiences one faces as an ER doctor. Bess is married to Jake Seliger, who in 2022 was diagnosed with squamous cell carcinoma. She has written a three-part series about the struggles that she and Jake have faced getting him into clinical trials. On the podcast, Bess describes the maddening and cruelly irrational processes that dying patients must go through in order to find access to treatments that might help them. The conversation covers the nightmare of dealing with ClinicalTrials.gov, the requirement that an individual travel across state lines to even know if they are eligible for a trial, and how the government continues to exercise paternalism on the behalf of patients who have no other options other than to take a drug that has not yet been proven to work. Bess also discusses policy ideas she would like to see implemented, and finally shares some stories from her time as an ER doctor.

The themes touched on here will be familiar to those who have read about the “invisible graveyard” that the FDA is responsible for. Yet even listeners who know about the utter lack of interest in patient well being normally shown by federal agencies will find themselves shocked by the degree to which bureaucratic procedures with few plausible benefits govern the lives of sick individuals who want nothing but to get some extra time on this earth and help move science forward. For dealing with the clinical trial system in its current state, Bess is currently trying to figure out ways to assist oncologists and patients in being able to navigate the process at HelpMeFindAClinicalTrial.com. And hopefully by telling her story, she can help inspire much needed reforms to the system.

Rob Henderson joins the podcast to talk about his book Troubled: A Memoir of Foster Care, Family, and Social Class. The conversation starts with a discussion about the recent controversy in which Rob was unable to find a book store that would host his launch. Rob also shares insights into his writing style, which focuses on conveying his experiences in a matter-of-fact way rather than dwelling on his internal emotional state. Richard then questions him about the story of his biological parents, and whether he would ever want to reconnect with them, particularly the Korean grandfather who started out as a police detective and then struck it rich as the owner of a fertilizer company. The two go on to discuss other aspects of Rob’s life story, including what the friends he grew up with think of his success, what it was like in the military, including stints in Qatar and Kyrgyzstan, and when he began questioning elite narratives surrounding issues like the importance of family stability and personal responsibility. Finally, Rob talks about what is next for him now that the book promotion tour is winding down.

Romina Boccia is the director of budget and entitlement policy at the Cato Institute, where she writes about government spending, the debt problem, and entitlement reform. She also has a Substack called the Debt Dispatch that you can subscribe to here.

Romina joins the podcast to discuss available paths to deal with the coming entitlement crisis. One potential way to get politicians out of making tough choices is to create a debt commission that takes responsibility for unpopular reforms. Romina has written about using the model of the BRAC commission, which was relied on to close down military bases at the end of the Cold War.

The conversation also touches on the politics of debt, how policymakers are thinking about these issues, Paul Ryan as an unappreciated hero of our time, and much more. Near the end, Romina reflects on her career as a DC policy-wonk, and why she is motivated to help ensure that America continues to be the land of opportunity. If we don’t get entitlements under control, it could potentially degrade our entire way of life. For more discussion on this topic and the difficult choices our leaders will soon be facing, see the previous CSPI podcast with Brian Riedl.

Listen to the podcast with Romina here or watch the video on YouTube.