The Future of Everything

Today, we're re-releasing my conversation with psychiatrist Anna Lembke on the future of addiction. Whether its substances, screens, or work itself, addiction in some form touches nearly all of our lives either directly or through someone we care about. Anna breaks down the dopamine mechanisms behind addiction of all kinds, from opioids to social media to, in her own case, romance novels, and shares what actually works in recovery, including exercise and structured abstinence. Whether you're thinking about screen habits, substance use, or just how to build healthier routines, this one's well worth another listen.

Have a question for Russ? Send it our way in writing or via voice memo, and it might be featured on an upcoming episode. Please introduce yourself, let us know where you're listening from, and share your question. You can send questions to thefutureofeverything@stanford.edu.

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Stanford Profile: Anna Lembke

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Chapters:

(00:00:00) Introduction

Russ Altman introduces Anna Lembke, a professor of psychiatry and behavioral sciences at Stanford University.

(00:01:52) Defining Addiction

Why addiction involves compulsive use despite harm, even when the behavior seems ordinary.

(00:03:31) Romance Novels and Harm

How Lembke’s own reading habit became a case study in subtle addiction.

(00:05:49) Dopamine and the Addicted Brain

What repeated dopamine spikes do to reward pathways and withdrawal symptoms.

(00:08:34) Seeing the Problem

How naming a compulsive habit can make it visible and open the door to change.

(00:10:34) Addiction Medicine Today

How the opioid epidemic changed medical training and addiction awareness.

(00:12:48) Russ Altman’s “Addictions”

Russ details his own dopamine habits for the audience.

(00:14:37) Exercise and Hormesis

Why movement, effort, and discomfort can help restore healthier dopamine patterns.

(00:17:22) Dopamine Fasting

The self-intervention Dr. Lembke used & her potential cross-addictions.

(00:21:22) Vulnerability to Addiction

Why genetic risk, family history, and drug of choice shape addiction vulnerability.

(00:22:53) The Opioid Epidemic

How prescription opioids, heroin, and fentanyl shaped three waves of crisis.

(00:24:51) Fentanyl and Overdose Risk

Why counterfeit pills and fentanyl exposure can be lethal even for new users.

(00:26:28) Treating Opioid Addiction

Why medications like methadone and buprenorphine help restore stability.

(00:28:17) The Future of Addiction

Why Lembke sees addiction as a long-term challenge across drugs, media, and food.

(00:29:22) Conclusion

 

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Psychologist Russ Poldrack is a mind reader of sorts, but not in the traditional sense of the word. Instead, he makes movies of blood flow in the brain using functional MRI to draw insights into the function of specific regions of the brain to decipher how they control behavior. In one example, Poldrack has shown how people with obsessive-compulsive disorder have enhanced “salience networks” that turn on when surprising things happen. This finding could have “very profound” outcomes in diagnosis and treatment, Poldrack tells host Russ Altman in this wide-ranging exploration of the implications and the ethics of functional neuroimaging on Stanford Engineering’s The Future of Everything podcast.

Have a question for Russ? Send it our way in writing or via voice memo, and it might be featured on an upcoming episode. Please introduce yourself, let us know where you're listening from, and share your question. You can send questions to thefutureofeverything@stanford.edu.

Episode Reference Links:

Stanford Profile: Russ Poldrack

Poldrack Lab website: http://poldracklab.org

The MyConnectome project: https://www.myconnectome.org/

Stanford Center for Open and Reproducible Science: https://datascience.stanford.edu/cores

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Chapters:

(00:00:00) Introduction

Russ Altman introduces guest Russ Poldrack, a professor of psychology and of psychiatry and behavioral science at Stanford University.

(00:03:15) Path into Neuroimaging

How Poldrack moved from cognitive psychology into functional MRI research.

(00:04:18) Functional MRI

How MRI can be used to track brain activity.

(00:06:59) Mapping Brain Activity

How tasks and behaviors are linked to patterns of brain activation.

(00:08:02) Resting Functional MRI

How resting scans revealed large-scale brain networks.

(00:09:00) Brain Networks and Behavior

How the brain controls stopping, switching, and habits.

(00:10:34) Layers of Brain Organization

Why neuroimaging studies the brain across multiple scales.

(00:13:04) Individual Brain Differences

How shared brain networks vary across individuals.

(00:13:34) Scanning Himself

Why Poldrack repeatedly scanned his own brain.

(00:15:47) Mapping One Brain Deeply

How repeated scans revealed reliable individual brain patterns.

(00:18:59) Neuroimaging and Mental Health

How brain network differences may relate to depression and OCD.

(00:21:42) Reproducibility in Brain Imaging

How larger and deeper data sets improve reliability.

(00:24:51) Analytic Variability

Why the same data can produce different conclusions.

(00:26:39) Multiverse Analysis

How testing many analyses helps identify stable findings.

(00:27:55) Open Science

How data sharing and standards improve transparency.

(00:30:29) Privacy and Brain Data

How researchers protect participants when sharing neuroimaging data.

(00:32:17) Future In a Minute

Rapid-fire Q&A: neuroimaging, reproducibility, and AI in science.

(00:33:22) Conclusion

 

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Prior to becoming an anesthesiologist, Alyssa Burgart trained in bioethics. She now counts herself among a growing number of certified clinical bioethicists who help doctors, nurses, patients, and their families handle ethically complex medical decisions at the bedside. Bioethicists are critical to care, Burgart argues, helping patients facing difficult choices to clarify personal values and weigh a complex array of risks and benefits, as well as emotions and familial, cultural, and religious norms. While much of her work is in pediatrics and maternal-fetal cases, she also studies how moral distress and moral injury impact clinicians, contributing to burnout among doctors and nurses. Having a strong ethical community brings resilience to these challenging environments, Burgart tells host Russ Altman in this episode of Stanford Engineering’s The Future of Everything podcast.

Have a question for Russ? Send it our way in writing or via voice memo, and it might be featured on an upcoming episode. Please introduce yourself, let us know where you're listening from, and share your question. You can send questions to thefutureofeverything@stanford.edu.

Episode Reference Links:

Stanford Profile: Alyssa Burgart

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Chapters:

(00:00:00) Introduction

Russ Altman introduces guest Alyssa Burgart, a professor of anesthesiology and perioperative pain at Stanford University.

(00:03:16) Path into Bioethics & Anesthesiology

How Burgart became a bioethicist and then chose anesthesiology.

(00:05:18) What Bioethics Means

How bioethics helps connect medical decisions to values, risks, and benefits.

(00:07:03) Making Hard Decisions Manageable

How ethics consultation helps clinicians act with integrity.

(00:08:33) Ethics Consults

A detailed explanation of hospital ethics services 

(00:12:23) Pediatric Ethics

Examples of Dr. Burgart’s work with children, families, and clinicians

(00:15:45) Culture, Faith, and Trust

Navigating cultural and religious differences as a bioethicist.

(00:17:57) Family Decision-Making

How ethics consultants help families and care teams honor a patient’s voice.

(00:21:55) Moral Injury

What is moral injury and how do clinicians specifically experience it?

(00:24:52) Institutional Betrayal

Why barriers like policies, laws, and denied approvals can create moral strain.

(00:26:37) Moral Distress

What is moral distress and how does it manifest itself in healthcare.

(00:28:28) Moral Residue

When clinicians experience repeated moral strain and cannot recover between incidents.

(00:29:33) Treating Moral Injury & Distress

Strategies for helping clinicians manage these parts of their work.

(00:33:54) Future In a Minute

Rapid-fire Q&A: clinical bioethics, human dignity, and moral resilience.

(00:36:15) Conclusion

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These days, AI is everywhere, and it’s increasingly hard to separate the gains from the slop. With that in mind, we're re-releasing my conversation with Stanford Law professor Daniel Ho on the future of AI and the law. When we look for applications where AI can deliver measurable benefit, the legal profession stands out, both for its potential gains in efficiency and equity, and for how much is at stake if we get it wrong. Dan's research — from using AI to identify racist property covenants buried in county deed records, to mapping obsolete regulations that waste thousands of hours of government time — shows what's possible when the technology is applied with rigor and purpose. If you’re curious about how AI can serve both justice and good governance, this one is well worth another listen.

Have a question for Russ? Send it our way in writing or via voice memo, and it might be featured on an upcoming episode. Please introduce yourself, let us know where you're listening from, and share your question. You can send questions to thefutureofeverything@stanford.edu.

Episode Reference Links:

Stanford Profile: Dan Ho

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Chapters:

(00:00:00) Introduction

Russ Altman introduces guest Dan Ho, a professor of law, political science, and computer science at Stanford University.

(00:02:19) Path into Legal AI

How Ho’s background shaped his interest in law, and technology.

(00:03:35) What Lawyers Do

What makes law a complex domain for AI.

(00:05:28) Legal Hallucinations

When AI  performs well and when it fails. 

(00:07:52) Searching Legal Records in California

How AI can help identify outdated, harmful, or legally important material.

(00:10:28) Scaling Redaction

How a model accelerated a process that overwhelmed county recorder offices.

(00:13:04) Legal Reform at Scale

How AI has supported legal reform by scanning massive bodies of law.

(00:15:02) STARA & The City of San Francisco

How AI was used to go through San Francisco’s code and clean up reporting.

(00:20:53) Outdated Obligations

How “regulatory sludge” takes the time & resources of the public service

(00:25:02) Open vs. Closed AI

The differences and associated risks of the different AI systems.

(00:30:58) Legal Chatbots

Why legal chatbots are promising but risky.

(00:33:42) Conclusion

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Dr. Karen Adams, obstetrician/gynecologist and Farwell Family Director of the Stanford Program in Menopause and Healthy Aging, studies menopause and, perhaps more importantly, perimenopause – the critical years preceding it. During this time, hormone-related symptoms like mood instability, sleep disruption, hot flashes, and joint pain can be severe even though periods continue. Adams explains that perimenopausal symptoms are often misdiagnosed and improperly treated. She says hormonal therapies are safe and effective in perimenopause and menopause, and can even have heart and bone benefits. “Menopause is inevitable, but suffering is not,” Adams tells host Russ Altman on this episode of Stanford Engineering’s The Future of Everything podcast.

Have a question for Russ? Send it our way in writing or via voice memo, and it might be featured on an upcoming episode. Please introduce yourself, let us know where you're listening from, and share your question. You can send questions to thefutureofeverything@stanford.edu.

Episode Reference Links:

Stanford Profile: Karen Adams

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Chapters:

(00:00:00) Introduction

Russ Altman introduces guest Karen Adams, a professor of obstetrics and gynecology at Stanford University.

(00:02:11) Path into Menopause Medicine

How Adams built one of the first clinical programs focused on women over 40.

(00:04:19) Menopause and Perimenopause

What menopause is and how the hormonal transition often begins years earlier.

(00:06:19) Beyond Hot Flashes

The wide range of symptoms that can appear during perimenopause.

(00:11:09) Pregnancy Risk During Perimenopause

Why contraception can still matter until a full year without a period.

(00:11:11) Unpredictable Symptoms

Why perimenopausal symptoms can be harder to recognize than PMS.

(00:13:37) Hormone Therapy

How treatment differs during perimenopause and after menopause.

(00:22:57) The Women’s Health Initiative

What the landmark hormone therapy study showed.

(00:27:53) Sexual Health and Vaginal Estrogen

Why local estrogen can safely treat genitourinary symptoms for many women.

(00:30:36) Future In a Minute

Rapid-fire Q&A: menopause care, women’s health, and better clinical support

(00:32:58) Conclusion

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