Full Scope

Longevity Philosophy5 Big Ideas That Will Deliver More Years NOW The longevity space is filled with empty claims! For example:-              This supplement will extend your life (C15, spermidine, D3, fish oil, etc.)Truth: No supplement has ever been shown to extend human life in all comers (outside of a nutrient deficiency). If your Longevity provider has you on a supplement subscription for life extension…..you are being played.  -              This drug, peptide, hormone will extend lifeTruth: No drug, peptide, or hormone has ever been shown to extend lifespan in all comers in a human clinical research trial (outside of a specific clinical indication. E.g. hypertension [referred to as a mortality benefit]). Some commonly used “longevity treatments” like growth hormone, may even shorten life. -              AI will revolutionize longevity and we are close to longevity escape velocity.Truth: AI is revolutionizing data accumulation, handling, and analysis. However AI is yet to extend lifespan in humans at all. Until AI leads to any measurable life extension, this claim remains unproven. Until we can measurably slow aging (beyond proven lifestyle interventions), longevity escape velocity will remain in the realm of science fiction.Visit Fullscope.org or longetrics.org for the complete blog post.

Today we are going over the basics of DEXA. This will help patients understand the test and what is being measured. It will also help clinical providers understand this test better. Let's dive in! The BasicsDEXA stands for Dual Energy X-Ray Absorptiometry-              Xray machine used for analyzing body composition-              Great at telling the difference between bone, fat, and lean tissue (mostly muscle)-              Uses 2 xray beams of different energies for this, hence Dual (via subtracting attenuation coefficients….or something like that)-              Most studied and widely used tool for looking at bone density-              USPSTF recommends all women over age 65 get one-              But 65 is way to late to get your first DEXA. The Cliff of old age is already luming at that point.-              I recommend getting one in your 20s or 30s to get a baseline and to help plan for the future. This will give you decades to improve things like bone density or get more muscled.Check out FullScope.org or Longetrics.org for the complete blog posts.

Muscle is your bodies bank account. It is the currency of life. It is biological gold. Quote: “I lift weights, and I lift weights for 1 reason, to be strong” – Arnold Schwarzenegger DeadliftsDeadlift: Lifting a weight from the floor to hip level. We use this movement anytime we pick something up off the ground. Everyone should know this movement. Everyone should be able to deadlift their body weight, full stop (ideally much more) Max weight ever Deadlifted: Visit longetrics.org/blog or fullscope.org/blog for the complete blog post. 

Quote: “In movement, there is life” – Aristotle“Genius starts with the abs Max” – The Grinch Muscle is your bodies bank account. It is the currency of life. It is biological gold. Why Do People Need Nursing Homes?As a hospitalist I frequently have to place people in nursing homes. I estimate that the reason why >90% cannot live at home anymore…….NOT ENOUGH STRENGTH. Think: needs help standing, needs help walking, unable to go up steps, unable to lift a dinner plate, etc. Additionally, I have noticed that as soon as muscle goes, cognition follows. Want to maintain your independence as you age? Start by maintaining your physic (aka – muscle) Most people are concerned about having enough money for retirement. But, what people should be concerned about is having enough muscle. No-one can give this to you. It must be earned over years and decades. You cant just talk about it, you have to do it. – Arnold Schwarzenegger Strength peaks in our late 20s and early 30s. After this it declines by about 1-2% per year in most people. This decline is accelerated in the last 1 or 2 decades of life as we literally wither away. Functions of Skeletal Muscle-              Movement-              Posture, Stability, and Joint Health-              Metabolic Health -              Neurological and Brain Health -              Store of Nutrients and Protein-              Heat Production-              Circulation (particularly venous)-              Protection and Padding-              Communication (facial expressions, posture, gesturing, etc.)-              Attraction and Reproduction Did you know: The best way to prevent dementia is physical exercise.See https://www.longetrics.org/blog for the complete blog post

Quote: “The greatest wealth is health”- Virgil, Roman poet < 2000 years ago Higher VO2 Max = Much Lower Risk of Dying…….Get off your ass! Let's illustrate this point: ICU Patient68 year old man with diabetes type 2 presenting with weakness and shortness of breath found to have sepsis due to pneumonia. This man is critically ill with sepsis. His vitals:Heart Rate 150 (100% of estimated max heart rate: 220 – Age)Respiratory Rate 54 breaths per minutesSweating and looks exhausted. This man is literally fighting for his life. Can you see why fitness matters so much? How long can he hold on? Many of us will have to fight for our lives in this way at some point. FITNESS REALLY REALLY MATTERS The Gold Standard for measuring cardiorespiratory fitness = VO2 Max What is VO2 MaxVO2 Max = the maximum volume of oxygen that can be utilized per kilogram of body weight during maximal exertion Most often Expressed as: ml/kg/min (milliliters per kilogram of body weight per minute) [1ml = 1cm3] This is the gold standard for measuring cardiorespiratory fitness in medicine, exercise science, and research.  Humans range from of VO2 max of 5 (bedbound) to 90s (elite endurance athletes)Hummingbirds VO2 max = 600 ml/kg/minExercise training will improve VO2 MaxSo, I hope since listening to part 1 you have gotten “off your ass” Check out Longetrics.org or Fullscope.org for the complete post!

Title: VO2 Max, Part 1 This is just the 101 course: Quote: “If you don't make time for exercise, you will probably have to make time for illness”- Robin Sharma, Attorney, Writer, Consultant What is VO2 MaxPerhaps the most important metric for longevity and health in 2024V=Volume (actually volume per unit time in this case)O2= oxygenVO2 = volume of oxygen that can be utilized per unit timeVO2 Max = the maximum volume of oxygen that can be utilized during maximal exertion Most often Expressed as: ml/kg/min (milliliters per kilogram of body weight per minute) This is the gold standard for measuring cardiorespiratory fitness in medicine, exercise science, and research. The best way to measure VO2 max is with a cardiopulmonary exercise test (CPET test). This is performed by hooking a person up to a closed breathing circuit via a facemask and measuring both inhaled and exhaled O2 and CO2. Other methods for estimating VO2 Max also exist. We will discuss measuring VO2 Max more thoroughly in part 2. VO2 Max Record HoldersCheck out Longetrics.org or FullScope.org Blogs for the complete post

Title: Health Report Cards Quote: “what gets measured gets managed”- unknown source When you measure something you become aware of it and can objectively manage it.Potential Pitfalls: The right things must be measured. Measurement must be accurate. What is a Report Card:- an evaluation of performance Benefits of Report Cards: - attempts to measure strength and weaknesses- allows for awareness of weaknesses (so they can be targeted and improved)- provides objective measures of performance normalized to the rest of the group (lets one know exactly how they measure up)- allows outsiders to evaluate and make decisions Negatives of Report Cards- can hurt feelings (who fucking cares, life is tough, competitive, and requires constant improvement)- can leed to discrimination (of course….people, companies, and things with bad reports should be discriminated against). Discrimination = pressure to improve- the wrong things are often measured or given too much importance. If not, you will manage things that don't matter. Importance of asking the right questions.- the things measured may be wrong or inaccurate. This is a big deal! Measuring things inaccurately is probably worse than not measuring things at all- subject to the bias of those creating report cards. We all remember that teacher that just didn't seem to like us….. See the full post on the Longetrics.org blog

Title: Longevity Conferences (ARDD and Dublin Longevity) Quote: “Its not what you know but who you know”Said by many across multiple cultures Today we review:The Aging Research and Drug Discovery Conference in Copenhagen, DenmarkThe Dublin Longevity Summit in Dublin, Ireland 3 Plugs- keep moving until you find your place and your people- go to places where you can be useful and contribute- try not to lose what makes you, you along the way.  Hallmarks of Both Conferences- I highly recommend attending both of these events (and conferences in general)- Europe was a blast. People are out and about. The downtowns I went to were generally flourishing - Work Hard Play Hard – Lots of lectures, lots of late nights at the bar- All Day Every Day- Leaders in the field of Longevity Research (highly research focussed)- Research Focused, Less Clinical (but still some clinical content)- Startups and Funding/Funders was a big focus- Eccentric Personalities- Lots of Fun! Met a lot of great people See full blog post at fullscope.org and longetrics.org

Quote: “The best physician is also a philosopher” – Galen (Claudius Galenus) Reflection is key! What can I do better and why am I doing it in the first place? Harness failures as the great teachers that they are and constantly improve. Why this person is important:Roman and Greek Physician, Surgeon, and Philosopher (129-216 AD, 87 years). Used anatomy based care (from observing the corpses of dead gladiators) and this allowed him to outperform his piers.  Bags the Question: What are we not using right now in medical practice that will be obvious to future doctors that we should be using?- I think about bedside ultrasound in this light-I also think about capturing more exam data through photos, sound clips, and videos and then harnessing new technology and big data insights to learn things not previously known- photos, sound clips, and videos have so much more data than a written physical exam in a note. Philosophy Take: Asking the right questions is the keyIn a changing world, answers, like epidemiology, are always changing. So in some ways all we will ever have are questions. The Longevity PhysicianWe are going to talk about medical providers and physicians in this discussion. But the ideas may be useful for multiple other disciplines within healthcare. Everything from coaches, to personal trainers, physical therapists, pharmacists, etc. There is plenty of room for everyone in longevity and it will take a village to solve aging. See Fullscope.org for the complete post

Quote: “Death gives meaning to our lives. It gives importance and value to time. Time would become meaningless if there were too much of it”- Ray Kurzweil Too much time….. Why this person is important:Computer scientist, inventor, and futurist (one of the greatest of the modern era) What is Longevity-              Dictionary – long existence or service-              Medicine and Science – long duration of individual life What is Geroscience: -              Gero (Greek - old)-              A field of biomedical research that focusses on understanding the biology of aging and how aging contributes to disease-              Geroscience, geroscientist, geroprotective, gerontocracy, gerontophobia Why Longevity- Longer Life? People want to live longer and better? More time young. Not more time old.- live forever? Scares many. Plasticity of youth would be so important in this case- look good and do the things we love for longer? Yes! I believe: Longevity and understanding/controlling aging are key to human advancement and long-term success. See FullScope.org blog for complete post

Live Better, LongerA Longevity Physicians Secrets to Health and FulfillmentAvailable for free at: wondermedicine.comSee full written episode description on our blog available at:https://www.wondermedicine.com/wonder-medicine-blog4 Amazing Ways Ketamine Will Change Your BrainKetamine is an amazing medication. It is an anesthetic, painkiller, mental health treatment, and entheogen all wrapped into one. We have successfully treated hundreds of patients with depression, anxiety, PTSD, OCD, suicidal ideation, and addiction using ketamine at Wonder Medicine. Greater than 90% of the people we treat get better.  But, having the right plan for therapy will greatly increase your odds of success.  What is an Entheogen?An entheogen is a mind-altering substance that helps people develop spiritually. Ketamine causes a profoundly mind-altering experience that expands consciousness, understanding, and connectivity when used with intention in the right therapeutic setting.  Why do some Patients Not Respond to Ketamine? Some people do not respond to ketamine treatments. Most often there is an identifiable reason. Some of these reasons include:-       Abusing substances actively while undergoing therapy (e.g. going home and drinking a bottle or two of wine after therapy)-       Not enough treatments received (major illness requires more therapy, sometimes > 6 treatments for response)-       Trauma or Mindset roadblocks that prevent patients from continuing therapy.-       Some people just don't respond. This may be due to their underlying biology (estimated < 2%) Why do > 90% of Ketamine Patients Experience BenefitKetamine does 4 amazing things that help people get their lives back on track.

Executive Summary          The Longevity and Performance Program at Wonder Medicine is a physician directed-proactive healthcare program for high performing individuals. Its principle aims are health optimization, disease prediction and prevention, exceptional performance, emotional wellness, and longevity.            The program is anchored by a full day executive physical that we refer to as a program members “Biological Birthday”. On this day, program members subjective and objective biomarkers most strongly linked to health, performance, and longevity are collected and fed into a robust data structure. A report is then generated that predicts biological (functional) age and predicted death age. The report utilizes proprietary algorithms and technology to inform both patients and their care team regarding overall health status and disease risks. The Biological birthday is performed every year and information is tracked in real time so that any health issues can be identified at the earliest stage possible.            A multidisciplinary team including a physician, longevity coach, exercise physiologist, technician, registered nurse, and member concierge execute the program. This small team is in constant communication and reviews all patients as a group multiple times a year. Patients in the program will have encounters with each team member at least 3 to 5 times a year. These team members will know you and care deeply about your success.            Every year, program members have a 90-minute Longevity Visit with the physician. At this visit all data obtained is reviewed and a personalized longevity and performance plan is provided to be executed over the following calendar year.            Wonder Medicine is a research-based institution that runs clinical trials on all patients at all times with the goal of discovering those inputs that deliver exceptional longevity and performance. All program members have the opportunity to enroll in additional longevity focused clinical trials that include pharmaceuticals, nutraceuticals, regenerative therapeutics, and lifestyle protocols. Additionally, many chronic medications can be managed through the program. But optimizing mindset, behaviors, and environment to align with program member current and future goals is Wonder Medicine's principle aim.            Being enrolled in the program affords members several additional benefits and add on services. These include movement therapy, behavioral change therapy, additional testing, and discounts on all Wonder Medicine services including IV infusions, ketamine therapy, and aesthetic services.            If exceptional health, longevity, disease prevention, emotional wellness, and high performance are desired, this is the program for you. If data, research, and the advancement of knowledge in longevity are important to you, this is your Center. The Program is capped at 360 members every year so that outstanding attention, communication, and collaboration can be provided to all members. Wonder Medicine is healthcare that performs at the same level you do. Join today and become exceptional! Thanks,Bill Brandenburg, MD

Holiday SeasonOctober 31 – January 2ndHalloween to New Years-       Tough time of year-       Loved ones, memories of past loved ones, relationships gone bad, events, obligations, good memories, bad memories, and even trauma.-       Can be the best time of the year or a time of pain.-       Take care of yourself, set an example for loved ones, and double down on pro-longevity behaviors during this holiday season. RememberLongevity = Health over a lifetimeBy striving for longevity you must become the best, most-high performing version of yourself right now. Ok so 4 tips. Plus two very important bonus tips at the very end that you will not want to miss! See Wonder Medicine Blog for complete post at: https://www.wondermedicine.com/wonder-medicine-blog

Benjamin Franklin: “Search others for their virtues, thy self for thy vices”-             Poor Richards Almanac The best way to maximize longevity in 2023 is not a drug, supplement, or other high tech therapeutic; its Lifestyle medicine. Wonder Medicine specializes in the translation of longevity technologies into clinical practice. This includes things like rapamycin, exosomes, and metformin. But we would be misguiding you if we did not focus, first and foremost, on lifestyle. What is Lifestyle Medicine?Per the American College of Preventative Medicine: Lifestyle medicine is a medical approach that uses evidence-based behavioral interventions to prevent, treat and manage chronic disease. I would take this a step further even. For me, Lifestyle includes: 1.          Thoughts2.        Behaviors3.        Environment4.        The People Around Us With environment being particularly relevant and underappreciated in most medical settings. These 4 things drive both health and un-health. By optimizing these four things, a person can greatly extend both lifespan and health span.  Focusing on behaviors alone, will not be enough. This may be why conventional medicine downplays lifestyle changes. If you only address behaviors, changes don't happen, and as such, the strategy fails. But this is a shame because lifestyle changes are the only definitively proven way to extend the length of human life in 2023. From epidemiological studies, it appears that people who live a healthy lifestyle can add approximately twelve years to their life (range: 5-15 years).  Death at 88 instead of 76 years, most often accompanied by contraction of morbidity.  For the full post check out the Wonder Medicine Blog Available at: https://www.wondermedicine.com/wonder-medicine-blog

Dia de Los Muertos and Longevity The day of the Dead. What can the dead and this Mexican cultural holiday teach us about longevity?  Is there more to the story than candy, spooky witches, monsters, tricks, and treats. Let's find out What is day of the Dead?-       A holiday most often celebrated on Nov 1st or 2nd.-       Its strongest traditions and ties are to the Mexican culture.-       On Dia de los Muertos, people remember and honor their past loved ones.-       Representations of human skulls, marigold flowers, home alters with pictures of passed loved ones, pan de Muertos (the sharing of alimentacion or “nourishment”), are the hallmarks of this day. -       The roots are debated, but this tradition may date back to Aztecs society.-       Dia de los Muertos brings families and communities together, celebrates life, and death.-       I encourage you to Celebrate this magical holiday, Dia de los Muertos, along with all the fun and spookiness of Halloween, and depending on your beliefs, along with Christian traditions of All hallows eve (all Saints Day and All souls day – that actually has a similar message that just isn't really practiced in my experience)See complete blog post at: https://www.wondermedicine.com/wonder-medicine-blog

The 6 BIG Benefits of Longevity  Be a victim or conquer longevity. You must choose! Longevity-       Longevity Definition: Long existence or service -       Human longevity relates to both existence (remaining alive) and service (remaining useful).-       I strive for nothing less than long existence and long service for both my patients and myself My favorite part of Avatar II, Way of the Water:-       “Teach them our ways so they don't have to deal with the shame of being useless”-       It blows my mind how many people are ok with being useless to society in 2023 My hospitalized elderly patient: “Keep me alive doc”Me: “what makes you want to keep living”Patient: “I have grandkids” -       But these people cannot watch their grandkids because their health is too poor. In fact, they need assistance even to perform activities of daily living (ADL)-       Like avatars of the sea, I would find this inability to contribute meaningfully: shameful.-       Being useful is about more than just pride. It is about service to the community.-       Service is what life is all about. If you are unhappy with your life, I suspect this is huge part of the problem. Longevity is the Key-       By striving for longevity you are forced to become the best version of yourself right now.-       The best version of you, right now, will be able to live, thrive, and serve the longest.-       As such longevity, or as we call here, the Full Scope, is your best vehicle for health, extreme productivity, and service both now and in the futureSee Wonder Medicine blog for complete show notes.

Live to 100: Secrets of the Blue Zones-       2023 Netflix documentary, 4 episodes-       Based on the 2008 book: “The Blue Zones: Lessons for Living Longer from People Who've Lived the Longest.”-       By Dan Buettner, Journalist, National Geographic Explorer, New York Times Best SellerWhat is a Blue Zone-       Geographic location where people's life expectancies are much much higher than in other parts of the world-       A much higher percent of people live to 100 years of age than other areas. 4x more people than in the USA.Original 5 Blue Zones-       Started with Gianni Pes and Michael Poulain's 2004 paper: Identification of a geographic area characterized by extreme longevity in the Sardinia Island.-       Dan Buettner read this and then established 4 more Blue Zones with the help of epidemiologists (bluezones.com)-       SARDINA, ITALY-       OKINAWA, JAPAN-       NICOYA, COSTA RICA-       ICARIA, GREECE-       LOMA LINDA, CALIFORNIA, USA4x more likely to live to 100 than in the US. Life expectancies > 85 years, apposed to 76 years in the US.Dan Buettner's Theory on Why People in Blue Zones Live Longer-       CONNECT (INVEST IN RELATIONSHIPS MORE. KEEP FAMILY AROUND MORE, FRIENDS)-       OULOOK (DAILY RITUALS, FAITH, SHOW UP, PURPOSE VOCABULARY)-       MOVE NATURALLY, (GARDEN, WORK, WALK everywhere, sit on the floor),-       EAT WISELY (WHOLE FOODS, HEAVY PRODUCE, WINE, MODERATION)According to the US CIA, Singapore has the second highest life expectancy at birth in the world at 86.5 years (second to Monaco, 89.6 year average life expectancy, < 1 sq mile in the French Riviera, < 40k residents, tax haven, wealthiest location in the world, high performers flock to Monaco) SINGAPORE - Island in SE Asia. 2nd highest population density of any country in the world, globalized, one of four main languages is English. 283 square miles. 5.5 million residents.- 80% of people own CARS in the US. 11% of people own CARS in SINGAPORE, PUBLIC TRANSIT USED BY HALF THE POPULATION EVERY DAY. Build in natural scapes in cities, good city planning with lots of walkways, < 10% obesity, Low healthcare costs (in spite of living longer)- KEEP OLDER FAMILY MEMBERS OUT OF CARE HOMES - (NEEDS TO BE EARNED, HARDER IN THE USA per below)Singapore Physician Philosophy and how to live a long time.Why do you like being a doctor?1)    TREAT A PATIENT, FEEL JOY (enjoy the process)What advice would you give someone who wants to live a long time?2)    WORK HARD EVERYDAY, BE HONEST, HUMBLE (get to work)-       Work hard and enjoy the process. No wonder the people in Singapore are living longer…..their doctors are giving much better advice and generally enjoying their job as a physician.

We all have weaknesses. These weaknesses will eventually limit your life and longevity tremendously.Train these weaknesses out and become the best version of yourself.See full notes at: https://www.wondermedicine.com/wonder-medicine-blog

Blog post about this podcast available at: https://www.wondermedicine.com/wonder-medicine-blogThree Things to improve your longevity today. 1.     Exercise-       Stop pretending to care about longevity or health if you are not exercising-       Bodies in motion stay in motion, bodies that stop, soon stop forever-       Plus the best way to keep your brain health and prevent dementia is to exercise regularly.-       Build your bank account of muscle and movement reserve-       Your job is not exercise. Walking is not enough unless your are elderly. But even then you should be strength training as well-       Dynamic movements through big ranges of motion always better. Don't limit yourself-       Be results driven. Measure strength, VO2 max, and other objective metrics.-       Avoid injury by starting slow and progressing slow, injuries are killers as we get older.-       Learn how to fall-       Focus on Eccentric strength as well as concentric, stop dropping the weights.  -       You will only be is strong as your weakest component and this will be your Achilles heal when you age, so stop ignoring it and fix it. Stop skipping leg day-       If you would talk to our exercise physiologist, Callie, ditch the chair 2.     Sleep-       Give yourself 8 protected every night. Don't stress if you cant sleep the whole 8 hours-       Living a healthy lifestyle will improve sleep. Do more during the day. Think and move more, vigorous exercise and light exposure early in the day can really help-       Give your kids more time, particularly in the morning-       Avoid z drugs, benzos, alcohol-       Cannabis, makes you wake up more groggy, less REM sleep, people often require more sleep to feel the same amount rested 3.     Perseverance with positivity-       I have asked every person above 90 I have taken care of their secret to longevity. I am over 300 people at this point. 90+ percent of the time they either say “keep moving” or “stay positive.-       Toughen up, life is hard-       Work, retirement is a killer, work gives people meaning and keeps the brain active.-       Force yourself to do hard things that are uncomfortable, cold plunge. -       Lean into all your weakness always-       Don't give up.  

Overview-       new 10-to-20-minute podcast every Monday-       the science, philosophies, and actional information around health, longevity, and performance-       meant to help listeners become the highest performing individual possible-       Increase your lifespan, healthspan, and view your life through the full scopeSee a blog about this episode at: https://www.wondermedicine.com/wonder-medicine-blog Disclaimer-       Free content, no adds, no junk, just the facts-       This podcast does not create a provider patient relationship between the listener and the full scope team.-       This podcast is not intended to treat, diagnose, or cure your personal medical problem.-       If you want professional medical advice, check out Wonder Medicines Longevity and Performance Program

Death is coming for you, me, and all of this.If you seek Longevity, stop avoiding this, assess your risks, and make a plan.Blog post about this podcast available at: https://www.wondermedicine.com/wonder-medicine-blogHow to assess death-       What are my current medical problems, risks, and exposures. Advanced diagnostics and biomarkers can help with this. But just asking some simple questions like:a.     What medical problems do I have?b.     How is my current level of fitness and where will it likely be in the final 1 to 2 decades of my life on my current trajectory.c.     What do my behaviors put me at risk of dying from (e.g. smoking tobacco or junk food addiction = multiple forms of cancer.d.     What environmental risks am I exposed to (e.g. polluted air = COPD and lung cancer)-       How have genetically related family members have died. These people share your genetics and often times your environment. They are a window into your own mortality.a.     What things have killed my 1st and 2nd degree relatives?b.     At what age did these problems begin and at what age did they result in death.c.     Do I have a genetic predisposition to certain medical problems?-       What things am I most worried about regarding death. People have strong intuitions that when trained can be incredibly accurate. Intuition is simply your brain analyzing a huge amount of data and coming to a conclusion that seems as if it came from a higher knowledge or being. The brain is a powerful supercomputer.  If program members are worried about something, I am worried too, full stop. Granted, if someone is worried about everything due to severe anxiety they are essentially worried about nothing. If you goal is everything, it will in fact become nothing by default.

SummaryPhosphocreatine is a molecule that can recharge ADP into ATP. This provides energy to skeletal muscle and the brain. Dietary and supplemental creatine can raise the bodies stores of phosphocreatine, providing additional energy. In this podcast, we discuss creatine, what is is, how it works, why it is useful, and how to supplement it. Morbidity and MortalityAfter age 30, most people loose around 5% of their muscle mass per decade. Six million people in the United States are diagnosed with Alzheimer's dementia and this number is increasing every year. As such, preserving muscle and brain function are cornerstone of all anti-aging strategies. StoryCreatine was first discovered in muscle in 1832. For over 100 years, it has been known that supplementing creatine increases phosphocreatine levels in skeletal muscle. Since the early 1990s, creatine has been marked as a dietary supplement. The use of creatine has become extremely popular over the last 3 decades and its potential benefits to cognitive and nerve function have only recently been explored/discovered. Key Points1. Creatine is a small amino acid like, nitrogenous molecule found in skeletal muscle and the brain.2. Creatine is phosphorylated to phosphocreatine by creatine kinase. Phosphocreatine can then transfer a phosphate to ADP, making ATP. ATP is a molecule that is the main source of energy for the body.3. Improved strength, bone health, cognitive function, recovery from TBI, heart health, and improvements in triglyceride are often seen with creatine supplementation.4. Supplementing 5 to 10g of creatine a day should be considered in many individuals, including non-athletes. Creatine has an excellent track record for safety, but possible side effects will be discussed.5. Muscle cramps are common when taking creatine. Stay hydrated and consume adequate salt. Be careful not to overuse your muscles or injure yourself when taking creatine. References-        Forbes SC, Cordingley DM, Cornish SM, Gualano B, Roschel H, Ostojic SM, Rawson ES, Roy BD, Prokopidis K, Giannos P, Candow DG. Effects of Creatine Supplementation on Brain Function and Health. Nutrients. 2022 -       Creatine. Wikipedia.-       de Souza E Silva A, Pertille A, Reis Barbosa CG, Aparecida de Oliveira Silva J, de Jesus DV, Ribeiro AGSV, Baganha RJ, de Oliveira JJ. Effects of Creatine Supplementation on Renal Function: A Systematic Review and Meta-Analysis. J Ren Nutr. 2019 -       Aguiar AF, Januario RS, Junior RP, et al. Long-term creatine supplementation improves muscular performance during resistance training in older women. Eur J Appl Physiol. 2013-       Chilibeck PD, Chrusch MJ, Chad KE, Shawn Davison K, Burke DG. Creatine monohydrate and resistance training increase bone mineral content and density in older men. J Nutr Health Aging. 2005-       Groeneveld GJ, Beijer C, Veldink JH, Kalmijn S, Wokke JH, van den Berg LH. Few adverse effects of long-term creatine supplementation in a placebo-controlled trial. Int J Sports Med. 2005 Introduction 2023

SummaryMetabolic syndrome is a medical condition characterized by unhealthy and markedly deranged metabolism. Over 50% of United States adults have metabolic syndrome and another 40% are at risk of developing it (90% of US adults!). Metabolic syndrome is the great killer of our time, a global pandemic, and the leading risk factor for most all major chronic diseases. StoryChronic diseases are contagious. This is because thoughts and behaviors are contagious. As fast food companies, ultra-processed food, soda and other sugar sweetened beverages, and the American lifestyle spreads around the globe, so too does metabolic syndrome. Key Points1 Metabolic syndrome is both caused by and can be cured by the way a person lives their life (behaviors).2. Insulin resistance, unhealthy cholesterol, high blood pressure, and weight gain are symptoms of metabolic syndrome.3. The risk of multiple chronic diseases including diabetes, heart attacks, strokes, and even cancer is increased in those with metabolic syndrome.4. Avoiding ultra-processed foods, exercising regularly, sleeping adequately, and managing stress are the best ways to prevent and treat metabolic syndrome. References-https://www.nhlbi.nih.gov/health/metabolic-syndrome/diagnosis- Lustig, Robert. Metabolical: The Lure and Lies of Processed Food, Nutrition, and Modern Medicine. Harper Wave, 2021.- Saklayen MG. The Global Epidemic of theMetabolic Syndrome. Curr Hypertens Rep. 2018 - Lemieux I, Després J-P. Metabolic Syndrome:Past, Present and Future. Nutrients. 2020- Shi TH, Wang B, Natarajan S. The Influence ofMetabolic Syndrome in Predicting Mortality Risk Among US Adults: Importance ofMetabolic Syndrome Even in Adults With Normal Weight. Prev Chronic Dis. 2020.- https://www.heart.org/en/health-topics/metabolic-syndrome/symptoms-and-diagnosis-of-metabolic-syndromeIntroduction 2023

SummaryWhat is your plan for medical care as you get older? Most people don't know. While 87% of people say they want to die at home, just under half of people do. In this episode we discuss goals of care, comfort care, palliative care, hospice, code status and more. Morbidity and MortalityMedical errors are the 3rd leading cause of death in the United States (sorry healthcare team…its true). As people get older, sicker, and frailer, their chances of being hurt by healthcare increase dramatically. At some point for everyone, the benefits of aggressive medical care are outweighed by the risks. StoryIn 1900 the average life expectancy in the United States was 47.3 years. By 2019, life expectancy had increased to 78.8 years. This was largely due to public health measures like clean water, lifesaving antibiotics, and vaccines. However, life expectancy is now trending down-ward.  Key Points1. Comfort care is when the main goal of care is person's quality of life2. Palliative care is a medical discipline that helps people cope mentally, physically, and spiritually with severe illness. People on aggressive medical and comfort care can utilize palliative care.3. Code Status concerns a patient's wishes when they are dead. It has nothing to do with their medical care while alive.4. Hospice is a program centered around comfort care for those persons expected to live < 6 months. It is under-utilized and our current medical incentives push people away from it.  References-       Connor SR, Pyenson B, Fitch K, Spence C, Iwasaki K. Comparing hospice and nonhospice patient survival among patients who die within a three-year window. J Pain Symptom Manage. 2007 Mar;33(3):238-46. -       https://hospicefoundation.org/Hospice-Care/Hospice-Services-       Hughes MT, Smith TJ. The growth of palliative care in the United States. Annu Rev Public Health. 2014;35:459-75. doi: 10.1146/annurev-publhealth-032013-182406. PMID: 24641562.-       Gomes, B., Calanzani, N., Gysels, M. et al. Heterogeneity and changes in preferences for dying at home: a systematic review. BMC Palliat Care 12, 7 (2013)-       Adair T-       Who dies where? Estimating the percentage of deaths that occur at home-       BMJ Global Health 2021-       QuickStats: Percentage of Deaths, by Place of Death — National Vital Statistics System, United States, 2000–2018. MMWR Morb Mortal Wkly Rep 2020-       Makary MA, Daniel M. Medical error-the third leading cause of death in the US. BMJ. 2016-       Google searches and numerous sites describing “comfort care”, “palliative care”, “End of life care”

Sycamore is a physician staffing and independent locums company that encourages physicians to run their career like a business. Price transparency, low fees, direct contracts, and aligned incentives set Sycamore Health apart from other physician staffing companies. In this interview, I discuss medicine, health, business, and more with Sycamore CEO, Larson Hicks. This episode covers my thoughts and opinions on several different topics.Please enjoy. More medical knowledge episodes coming soon! Thanks again,Bill Brandenburg, MD

Alcohol Withdrawal, Part 2SummaryDrinking alcohol (specifically ethanol) on a regular basis leads to alcohol dependence. When alcohol dependent persons stop drinking, they experience withdrawal. Withdrawal from alcohol is very dangerous and should be managed aggressively in order to prevent long term complications and death. This podcast will teach you the ins and outs of recognizing and managing alcohol withdrawal both in the inpatient and outpatient setting.Morbidity and MortalityAlmost 100,000 people die every year from ETOH abuse in the United States alone. It is not known how many people die a year from alcohol withdrawal. If delirium tremons develops, it is estimated that about 25% of people will die without treatment.StoryEver drink too much at night and then wake up suddenly at 5am feeling wide awake? Ever feel inner tension, agitation, or heart palpitations after a long party weekend with friends? If so, you have experienced symptoms of alcohol withdrawal.Key Points1. Tachycardia, tachypnea, hypertension, hyperthermia, tremors, anxiety, and GI upset are the hallmarks of alcohol withdrawal.2. Severe symptoms may include hallucinations, delirium, seizures, and death3. Vitamin and electrolyte repletion are critical for sick alcohol dependent patients.4. Aggressively treating withdrawal by slowly coming off alcohol or using medications like barbiturates, benzodiazepines, and other CNS depressants can be lifesaving. Use medication liberally in this setting!References-Saitz M, Mayo-Smith MF, Redmond HA, Bernard DR, Calkins DR. Individualized treatment for alcohol withdrawal. A randomized double-blind controlled trial. JAMA 1994- Grant BF, Goldstein RB, Saha TD, et al. Epidemiology of DSM-5 Alcohol Use Disorder: Results From the National Epidemiologic Survey on Alcohol and Related Conditions III. JAMA Psychiatry. 2015- https://www.who.int/news-room/fact-sheets/detail/alcohol- Newman RK, Stobart Gallagher MA, Gomez AE. Alcohol Withdrawal. - In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441882/- Nisavic M, Nejad SH, Isenberg BM, Bajwa EK, Currier P, Wallace PM, Velmahos G, Wilens T. Use of Phenobarbital in Alcohol Withdrawal Management - A Retrospective Comparison Study of Phenobarbital and Benzodiazepines for Acute Alcohol Withdrawal Management in General Medical Patients. Psychosomatics. 2019 - Wikipedia, alcohol withdrawal syndrome- Personal experience treating ETOH withdrawal in the inpatient and outpatient setting  

SummaryDrinking alcohol (specifically ethanol) on a regular basis leads to alcohol dependence. When alcohol dependent persons stop drinking, they experience withdrawal. Withdrawal from alcohol is very dangerous and should be managed aggressively in order to prevent long term complications and death. This podcast will teach you the ins and outs of recognizing and managing alcohol withdrawal both in the inpatient and outpatient setting. Morbidity and MortalityAlmost 100,000 people die every year from ETOH abuse in the United States alone. It is not known how many people die a year from alcohol withdrawal. If delirium tremons develops, it is estimated that about 25% of people will die without treatment. StoryEver drink too much at night and then wake up suddenly at 5am feeling wide awake? Ever feel inner tension, agitation, or heart palpitations after a long party weekend with friends? If so, you have experienced symptoms of alcohol withdrawal. Key Points1. Tachycardia, tachypnea, hypertension, hyperthermia, tremors, anxiety, and GI upset are the hallmarks of alcohol withdrawal.2. Severe symptoms may include hallucinations, delirium, seizures, and death3. Vitamin and electrolyte repletion are critical for sick alcohol dependent patients.4. Aggressively treating withdrawal by slowly coming off alcohol or using medications like barbiturates, benzodiazepines, and other CNS depressants can be lifesaving. Use medication liberally in this setting! References-Saitz M, Mayo-Smith MF, Redmond HA, Bernard DR, Calkins DR. Individualized treatment for alcohol withdrawal. A randomized double-blind controlled trial. JAMA 1994- Grant BF, Goldstein RB, Saha TD, et al. Epidemiology of DSM-5 Alcohol Use Disorder: Results From the National Epidemiologic Survey on Alcohol and Related Conditions III. JAMA Psychiatry. 2015- https://www.who.int/news-room/fact-sheets/detail/alcohol- Newman RK, Stobart Gallagher MA, Gomez AE. Alcohol Withdrawal. - In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441882/- Nisavic M, Nejad SH, Isenberg BM, Bajwa EK, Currier P, Wallace PM, Velmahos G, Wilens T. Use of Phenobarbital in Alcohol Withdrawal Management - A Retrospective Comparison Study of Phenobarbital and Benzodiazepines for Acute Alcohol Withdrawal Management in General Medical Patients. Psychosomatics. 2019 - Wikipedia, alcohol withdrawal syndrome- Personal experience treating ETOH withdrawal in the inpatient and outpatient setting

This is a conversation I had with Justin Cotton, host of the Policy not Politics podcast. It does not contain any medical knowledge. But it is a thought provoking conversations about my opinions regarding healthcare policy. Please enjoy. This will be the final episode of Full Scope season 2. I am going to take a hiatus for a couple of months in order to focus on Wander Medicine Clinic and Old Dougs Plaza.  Full Scope will return with a season 3 though! Thanks for listening.

SummarySleep is the most important thing a person can do for themself. Getting 8 hours of quality sleep equals better cognition (thinking), better body function, less disease, and a longer lifespan.  Morbidity and MortalityAt least 20% of automobile accidents have been linked to sleep deprivation. Teenagers that start school earlier get lower test scores than those who start later. Doctors make more errors and kill more people when sleep deprived. Without sleep, a person will die. Other AnimalsAll known animals sleep. Some bats sleep almost 20 hours a day, while giraffes sleep < 2 hours a day. Birds and marine mammals can sleep half of their brain at a time.  Key Points1. Sleep is a physiologic state that consists of various stages including light sleep, deep sleep, and REM sleep.2. Most all people need > 7 hours of sleep a night to function optimally. Many of us are functioning sub-optimally and undermining our longevity through a lack of sleep.3. Many medical diseases effect sleep. Being unhealthy appears to be both a cause of bad sleep as well as an effect of getting suboptimal sleep.4. Improving sleep starts with improving lifestyle. Paying attention to light exposure is also very important. Grounding, cognitive behavioral therapy, certain types of sound, and sleep hygiene can also be useful. Many supplements can be helpful as well. Medications should be used as a last resort to help with sleep. References-       Walker, Matthew. Why We Sleep; Unlocking the Power of Sleep and Dreams. Scribner. 2017-       Troynikov O, Watson CG, Nawaz N. Sleep environments and sleep physiology: A review. J Therm Biol. 2018 -       Lowe CJ, Safati A, Hall PA. The neurocognitive consequences of sleep restriction: A meta-analytic review. Neurosci Biobehav Rev. 2017 -       Owens JA, Weiss MR. Insufficient sleep in adolescents: causes and consequences. Minerva Pediatr. 2017 -       https://courses.drhyman.com/sleep-course-own-       Getting a Good Night's Sleep. NIH. https://www.nia.nih.gov/health/good-nights-sleep-       Brain Basics: Understanding sleep. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Understanding-Sleep-       Stages of Sleep. https://www.sleepfoundation.org/how-sleep-works/stages-of-sleep-       How much do animals sleep. https://faculty.washington.edu/chudler/chasleep.html-       https://www.nih.gov/news-events/nih-research-matters/gene-identified-people-who-need-little-sleep 

SummarySleep is the most important thing a person can do for themself. Getting 8 hours of quality sleep equals better cognition, better body function, less disease, and a longer lifespan.  Morbidity and MortalityAtleast 20% of automobile accidents have been linked to sleep deprivation. Teenagers that start school earlier get lower test scores than those who start later. Doctors make more errors and kill more people when sleep deprived. Without sleep, a person will die. StoryAll known animals sleep. Some bats sleep almost 20 hours a day, while giraffes sleep < 2 hours a day. Birds and marine mammals can sleep half of their brain at a time.  Key Points1. Sleep is a physiologic state that consists of various stages including light sleep, deep sleep, and REM sleep.2. Most all people need > 7 hours of sleep a night to function optimally. Many of us are functioning sub-optimally and undermining our longevity through a lack of sleep.3. Many medical diseases effect sleep. Being unhealthy appear to be both a cause for bad sleep as well as an effect of getting suboptimal sleep.4. Improving sleep starts with improving lifestyle. Paying attention to light exposure is also very important. Grounding, cognitive behavioral therapy, certain types of sound, and sleep hygiene can also be useful. Many supplements can be helpful as well. Medications should be used only as a last resort to help with sleep. References-       Walker, Matthew. Why We Sleep; Unlocking the Power of Sleep and Dreams. Scribner. 2017-       Troynikov O, Watson CG, Nawaz N. Sleep environments and sleep physiology: A review. J Therm Biol. 2018 -       Lowe CJ, Safati A, Hall PA. The neurocognitive consequences of sleep restriction: A meta-analytic review. Neurosci Biobehav Rev. 2017 -       Owens JA, Weiss MR. Insufficient sleep in adolescents: causes and consequences. Minerva Pediatr. 2017 -       https://courses.drhyman.com/sleep-course-own-       Getting a Good Night's Sleep. NIH. https://www.nia.nih.gov/health/good-nights-sleep-       Brain Basics: Understanding sleep. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Understanding-Sleep-       Stages of Sleep. https://www.sleepfoundation.org/how-sleep-works/stages-of-sleep-       How much do animals sleep. https://faculty.washington.edu/chudler/chasleep.html-       https://www.nih.gov/news-events/nih-research-matters/gene-identified-people-who-need-little-sleep

SummarySleep is the most important thing a person can do for themself. Getting 8 hours of quality sleep equals better cognition (thinking), better body function, less disease, and a longer lifespan.  Morbidity and MortalityAt least 20% of automobile accidents have been linked to sleep deprivation. Teenagers that start school earlier get lower test scores than those who start later. Doctors make more errors and kill more people when sleep deprived. Without sleep, a person will die. StoryAll known animals sleep. Some bats sleep almost 20 hours a day, while giraffes sleep < 2 hours a day. Birds and marine mammals can sleep half of their brain at a time.  Key Points1. Sleep is a physiologic state that consists of various stages including light sleep, deep sleep, and REM sleep.2. Most all people need > 7 hours of sleep a night to function optimally. Many of us are functioning sub-optimally and undermining our longevity through a lack of sleep.3. Many medical diseases effect sleep. Being unhealthy appears to be both a cause of bad sleep as well as an effect of getting suboptimal sleep.4. Improving sleep starts with improving lifestyle. Paying attention to light exposure is also very important. Grounding, cognitive behavioral therapy, certain types of sound, and sleep hygiene can also be useful. Many supplements can be helpful as well. Medications should be used as a last resort to help with sleep. References-       Walker, Matthew. Why We Sleep; Unlocking the Power of Sleep and Dreams. Scribner. 2017-       Troynikov O, Watson CG, Nawaz N. Sleep environments and sleep physiology: A review. J Therm Biol. 2018 -       Lowe CJ, Safati A, Hall PA. The neurocognitive consequences of sleep restriction: A meta-analytic review. Neurosci Biobehav Rev. 2017 -       Owens JA, Weiss MR. Insufficient sleep in adolescents: causes and consequences. Minerva Pediatr. 2017 -       https://courses.drhyman.com/sleep-course-own-       Getting a Good Night's Sleep. NIH. https://www.nia.nih.gov/health/good-nights-sleep-       Brain Basics: Understanding sleep. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Understanding-Sleep-       Stages of Sleep. https://www.sleepfoundation.org/how-sleep-works/stages-of-sleep-       How much do animals sleep. https://faculty.washington.edu/chudler/chasleep.html-       https://www.nih.gov/news-events/nih-research-matters/gene-identified-people-who-need-little-sleep  

SummaryAcute care in the United States is considered to be among the best in the world. But do not be fooled. Healthcare is widely considered the third leading cause of death in the US. Additionally, we have considerable room for improvement in the care of our acutely sick patients. This podcast reviews some of the “low hanging fruit” to improve our inpatient systems. These improvements have largely been ignored in my experience. This podcast represents my experiences and opinions. It is not medical advice and I do not cite any sources.  Morbidity and MortalityNone of the hospitals I have ever worked at have prioritized sleep. As sleep is necessary for healing and proper immunity, this is a tragedy. Key Points1. Sleep is completely overlooked in the hospital; we often keep patients up all night.2. Hospital food is not the food I recommend my patients eat. As food is medicine. This is a big problem.3. Hospitals offer patients little time outside and almost no natural sunlight. We almost never allow them contact with the earth.4. We are so afraid of falls that we prevent patients from mobilizing. This is a huge detriment to them. ReferencesPersonal experience working at over 30 rural and urban hospitals across 3 regions in the United States over the last 10 years.

SummaryDiversity in ecology and genetics appears to be a very good thing. The human species has a genetic pool (all the gene variants from all the humans alive) that is diverse and protective for our species. Human bodies and all other multi-cellular organisms also host diverse arrays of micro-organisms that our essential to health.  Morbidity and MortalityAntibiotics, pesticide, cesarean sections, baby formula, monocrops, processed foods, disconnection with nature, other pharmaceuticals like proton-pump inhibitors, and other factors have all contributed to a mass extinction of the human gut microbiome. It is estimated that humans have lost 50% of our microbial diversity in the last few hundred years. StoryMicrobial fossils isolated from 1000 year old poop shows 38% novel species (now extinct) Key Points1. Human bodies are an ecosystem2. A diverse ecosystem is associated with health. Dysbiosis is associated with numerous chronic diseases.3. The food we eat and the way we live our lives has profound effects on our microbiotia and health.4. In the absence of a genetic disease, our microbiome contributes more to our health than our own genes. References- Tu P, Chi L, Bodnar W, et al. Gut Microbiome Toxicity: Connecting the Environment and Gut Microbiome-Associated Diseases. Toxics. 2020;8(1):19. Published 2020 Mar 12. doi:10.3390/toxics8010019- Blaser MJ. The Past and Future Biology of the Human Microbiome in an Age of Extinctions. Cell. 2018 - Manor O, Dai CL, Kornilov SA, Smith B, Price ND, Lovejoy JC, Gibbons SM, Magis AT. Health and disease markers correlate with gut microbiome composition across thousands of people. Nat Commun. 2020- Chichlowski M, Shah N, Wampler JL, Wu SS, Vanderhoof JA. Bifidobacterium longum Subspecies infantis (B. infantis) in Pediatric Nutrition: Current State of Knowledge. Nutrients. 2020;12(6):1581. Published 2020 - https://www.the-scientist.com/features/neanderthal-dna-in-modern-human-genomes-is-not-silent-66299- https://www.genome.gov/about-genomics/fact-sheets/Genetics-vs-Genomics- https://www.genome.gov/about-genomics/fact-sheets/Comparative-Genomics-Fact-Sheet- https://academic.oup.com/jhered/article/108/6/671/3836924- Satoh, M; Kuroiwa, T (September 1991). "Organization of multiple nucleoids and DNA molecules in mitochondria of a human cell". Experimental Cell Research. 196 (1): 137–140. - https://www.cancer.gov/news-events/cancer-currents-blog/2020/colorectal-cancer-rising-younger-adults- Seneff, S. Toxic Legacy: Howe the Weedkiller Glyphosate is Destroying our Health and the Environment. 2021https://www.cdc.gov/ncbddd/autism/data.html 

SummaryDiversity in ecology and genetics appears to be a very good thing. The human species has a genetic pool (all the gene variants from all the humans alive) that is diverse and protective for our species. Human bodies and all other multi-cellular organisms also host diverse arrays of micro-organisms that our essential to health.  Morbidity and MortalityAntibiotics, pesticide, cesarean sections, baby formula, monocrops, processed foods, disconnection with nature, other pharmaceuticals like proton-pump inhibitors, and other factors have all contributed to a mass extinction of the human gut microbiome. It is estimated that humans have lost 50% of our microbial diversity in the last few hundred years. StoryMicrobial fossils isolated from 1000 year old poop shows 38% novel species (now extinct) Key Points1. Human bodies are an ecosystem2. A diverse ecosystem is associated with health. Dysbiosis is associated with numerous chronic diseases.3. The food we eat and the way we live our lives has profound effects on our microbiotia and health.4. In the absence of a genetic disease, our microbiome contributes more to our health than our own genes. References- Tu P, Chi L, Bodnar W, et al. Gut Microbiome Toxicity: Connecting the Environment and Gut Microbiome-Associated Diseases. Toxics. 2020;8(1):19. Published 2020 Mar 12. doi:10.3390/toxics8010019- Blaser MJ. The Past and Future Biology of the Human Microbiome in an Age of Extinctions. Cell. 2018 - Manor O, Dai CL, Kornilov SA, Smith B, Price ND, Lovejoy JC, Gibbons SM, Magis AT. Health and disease markers correlate with gut microbiome composition across thousands of people. Nat Commun. 2020- Chichlowski M, Shah N, Wampler JL, Wu SS, Vanderhoof JA. Bifidobacterium longum Subspecies infantis (B. infantis) in Pediatric Nutrition: Current State of Knowledge. Nutrients. 2020;12(6):1581. Published 2020 - https://www.the-scientist.com/features/neanderthal-dna-in-modern-human-genomes-is-not-silent-66299- https://www.genome.gov/about-genomics/fact-sheets/Genetics-vs-Genomics- https://www.genome.gov/about-genomics/fact-sheets/Comparative-Genomics-Fact-Sheet- https://academic.oup.com/jhered/article/108/6/671/3836924- Satoh, M; Kuroiwa, T (September 1991). "Organization of multiple nucleoids and DNA molecules in mitochondria of a human cell". Experimental Cell Research. 196 (1): 137–140. - https://www.cancer.gov/news-events/cancer-currents-blog/2020/colorectal-cancer-rising-younger-adults- Seneff, S. Toxic Legacy: Howe the Weedkiller Glyphosate is Destroying our Health and the Environment. 2021https://www.cdc.gov/ncbddd/autism/data.html

SummaryIdaho entered a state wide crisis mode on Sept 16, 2021.  Alaska has since followed. Many other state are also being hit hard. In this podcast, I discuss crisis care, leadership, and how front line healthcare workers have lost complete control of the healthcare industry. Morbidity and MortalityIn September of 2021, approximately 700,000 people have died from COVID19 in the United States. Worldwide at least 4.5 million have died (likely more). I am not sure how many front line healthcare workers have left the job or been pushed out, but it seems like a lot! Key Points1. In crisis standards of healthcare, the focus shifts from taking care of individual patients to prioritizing care for a population of patients due to scarce resources and the need to prevent as much morbidity and mortality as possible.2. At first, this can be fun and exciting as red tape disappears. However, when decisions have to be made about who receives care and who does not, the fun quickly fades away.3. During times of crisis, communications lines must be increased greatly to facilitate effective operations.4. Crisis represents an opportunity to view things through a new light as it forces us to understand the most important parts of what we do.5. Additionally, crisis represents an unprecedented opportunity for training6. Front line healthcare workers have lost complete control of our industry and this has contributed significantly to an unhealthy and unhappy workforce. References-       Giroir and Kadlec. Rapid Expert Consultation on Crisis Standards of Care for the Covid19 Pandemic. The National Academies of Sciences, Engineering, and Medicine. 2020.-       https://coronavirus.idaho.gov/wp-content/uploads/2020/10/Crisis-Standards-of-Care-Plan_Final_Posted_Signed.pdf-       Personal Experience

SummaryDiversity in ecology and genetics appears to be a very good thing. The human species has a genetic pool (all the genes variants from all the humans alive) that is diverse and protective for our species. Human bodies and all other multi-cellular organisms host diverse arrays of micro-organisms that our essential to health.  Morbidity and MortalityAntibiotics, pesticide, cesarean sections, baby formula, monocrops, processed foods, disconnection with nature, other pharmaceuticals like proton-pump inhibitors, and other factors have all contributed to a mass extinction of the human gut microbiome. It is estimated that humans have lost 50% of our microbial diversity in the last few hundred years. StoryMicrobial fossils isolated from 1000 old poop shows 38% novel species (now extinct) Key Points1. Humans bodies are an ecosystem2. A diverse ecosystem is associated with health. Dysbiosis is associated with numerous chronic diseases.3. The food we eat and the way we live our lives has profound effects on our microbiotia and health. References- Tu P, Chi L, Bodnar W, et al. Gut Microbiome Toxicity: Connecting the Environment and Gut Microbiome-Associated Diseases. Toxics. 2020;8(1):19. Published 2020 Mar 12. doi:10.3390/toxics8010019- Blaser MJ. The Past and Future Biology of the Human Microbiome in an Age of Extinctions. Cell. 2018 - Manor O, Dai CL, Kornilov SA, Smith B, Price ND, Lovejoy JC, Gibbons SM, Magis AT. Health and disease markers correlate with gut microbiome composition across thousands of people. Nat Commun. 2020- Chichlowski M, Shah N, Wampler JL, Wu SS, Vanderhoof JA. Bifidobacterium longum Subspecies infantis (B. infantis) in Pediatric Nutrition: Current State of Knowledge. Nutrients. 2020;12(6):1581. Published 2020 - https://www.the-scientist.com/features/neanderthal-dna-in-modern-human-genomes-is-not-silent-66299- https://www.genome.gov/about-genomics/fact-sheets/Genetics-vs-Genomics- https://www.genome.gov/about-genomics/fact-sheets/Comparative-Genomics-Fact-Sheet- https://academic.oup.com/jhered/article/108/6/671/3836924- Satoh, M; Kuroiwa, T (September 1991). "Organization of multiple nucleoids and DNA molecules in mitochondria of a human cell". Experimental Cell Research. 196 (1): 137–140. - https://www.cancer.gov/news-events/cancer-currents-blog/2020/colorectal-cancer-rising-younger-adults- Seneff, S. Toxic Legacy: Howe the Weedkiller Glyphosate is Destroying our Health and the Environment. 2021

SummaryWe have been taught to not skip meals, make carbohydrates the most abundant macronutrient we consume, and to snack throughout the day. Sadly, this all appears to be wrong. Fasting exists in many forms and growing evidence suggests it is essential to health. We are all spending way too much time fed and not enough time fasting. Want to stimulate autophagy? Then eat less, exercise more, and feel better! Morbidity and MortalityObesity rates have more than tripled worldwide since 1975. Over 50% of people in the United States are now obese and 30% or more have metabolic syndrome. Houston, we have a problem! StoryJesus fed for 40 days in the desert during what we now call Lent. Islamic peoples celebrate Ramadan, a remembrance of Mohamad's 1st revelation. During this holy month, Islamic people do not eat during the daylight hours. Buddhist monks fast during religious retreats and the Buddha did not eat food after lunch. For a time fasting fell out of favor, but it is coming back, and just in time. Key Points1. Autophagy is biological process that allows cells to recycle nutrients and get rid of harmful waste. It is essential for health and best stimulated through fasting.2. By fasting and/or limiting carbohydrate intake, mammals enter ketosis. Ketosis is marked by the mobilization of stored fat for nutrition, the synthesis of glucose from glycerol and amino acids, as well as the usage of ketones for nutrition. Maintaining the body in a state of ketosis is beneficial for the treatment of metabolic syndrome.3. Metabolic syndrome is marked by obesity, hypertension, high bad cholesterols, low good cholesterols, high blood sugar, and high insulin levels. It predisposes individual to heart disease, cancer, and numerous other health problems. It is the great killer of our time.4. Fasting and sleep are the best way to stimulate autophagy. Autophagy is essential to health, and we are increasingly understanding the link between autophagy and longevity. References-       Yoshinori Ohsumi. What is Autophagy. Lecture. Molecular Frontiers Symposium, Tokyo. 2017.-       Chung KW, Chung HY. The Effects of Calorie Restriction on Autophagy: Role on Aging Intervention. Nutrients. 2019;-       Hwangbo DS, Lee HY, Abozaid LS, Min KJ. Mechanisms of Lifespan Regulation by Calorie Restriction and Intermittent Fasting in Model Organisms. Nutrients. 2020-       Ros M, Carrascosa JM. Current nutritional and pharmacological anti-aging interventions. Biochim Biophys Acta Mol Basis Dis. 2020-       Wikipedia, Autophagy, Intermittant Fasting, ketosis-       Colman RJ, Anderson RM. Nonhuman primate calorie restriction. Antioxid Redox Signal. 2011-       Gershuni VM, Yan SL, Medici V. Nutritional Ketosis for Weight Management and Reversal of Metabolic Syndrome. Curr Nutr Rep. 2018-       Moore JX, Chaudhary N, Akinyemiju T. Metabolic Syndrome Prevalence by Race/Ethnicity and Sex in the United States, National Health and Nutrition Examination Survey, 1988–2012. Prev Chronic Dis 2017

SummaryPlanet earth is being destabilized as a result of human activity. Over half of the habitable land on earth is now used for human agriculture, 40% of our forests have been cut down, and humans now move more rock and sediment than any natural process. If we do not act quickly, it is likely that our planet will become unable to support human civilization as we know it.  Morbidity and Mortality70% of our crops rely on insect pollinators, but insect populations are collapsing. 40% of the human population live on the coast and could be underwater within 100 years. Deserts are expanding, forests are diminishing, wild fish stocks and wild animals have lost over 50% of their mass in just 40 years, and human health is at an all-time low. StoryIf humans act now and with great conviction, we can potentially avoid a catastrophe. But the window for action is closing rapidly. Key Points1. The earth is warming. In 50 years, the temperature has increased 1.1C, more than in the previous 10,000 years.2. There is a mass extinction under way. The loss of species affects our own health. Even the micro-organisms that live on our body and promote health are becoming extinct.3. New chemicals are hurting human health. Governments are all too willing to protect chemical companies over the health of people.4. Eating healthy plant-based foods, supporting organic regenerative agriculture, protecting and expanding wild lands, planting trees and native plants, not using products that cannot be reused or recycled, and stopping all our carbon emissions by 2050 could save the planet. 5. If we can do these things, our own health will improve, and we will assure a safe planet to live on for future generations. References-       Steffen et al. Planetary boundaries: Guiding human development on a changing planet. Science. 2015.-       Rockstrom and Attenborough. Breaking Boundaries – The Science of Our Planet. 2021. Netflix-       Chemicals in the Environment – Dehumanizing Humanity. 2017. Royal College of London. https://www.youtube.com/watch?v=oq2K1IvRf8M-       Environmental Working Group. https://www.ewg.org/research/pollution-people-       Meyer and Lemery. Health Implications of Environmental Change. Ch 121. Aurerbach's Wilderness Medicine.-       Experience as a medical doctor and naturalist

SummaryPlanet earth is being destabilized as a result of human activity. Over half of the habitable land on earth is now used for human agriculture, 40% of our forests have been cut down, and humans now move more rock and sediment than any natural process. If we do not act quickly, it is likely that our planet will become unable to support human civilization as we know it.  Morbidity and Mortality70% of our crops rely on insect pollinators, but insect populations are collapsing. 40% of the human population live on the coast and could be underwater within 100 years. Deserts are expanding, forests are diminishing, wild fish stocks and wild animals have lost over 50% of their mass in just 40 years, and human health is at an all-time low. StoryIf humans act now and with great conviction, we can potentially avoid a catastrophe. But the window for action is closing rapidly. Key Points1. The earth is warming. In 50 years, the temperature has increased 1.1C, more than in the previous 10,000 years.2. There is a mass extinction under way. The loss of species affects our own health. Even the micro-organisms that live on our body and promote health are becoming extinct.3. New chemicals are hurting human health. Governments are all too willing to protect chemical companies over the health of people.4. Eating healthy plant-based foods, supporting organic regenerative agriculture, protecting and expanding wild lands, planting trees and native plants, not using products that cannot be reused or recycled, and stopping all our carbon emissions by 2050 could save the planet. 5. If we can do these things, our own health will improve, and we will assure a safe planet to live on for future generations. References-       Steffen et al. Planetary boundaries: Guiding human development on a changing planet. Science. 2015.-       Rockstrom and Attenborough. Breaking Boundaries – The Science of Our Planet. 2021. Netflix-       Chemicals in the Environment – Dehumanizing Humanity. 2017. Royal College of London. https://www.youtube.com/watch?v=oq2K1IvRf8M-       Environmental Working Group. https://www.ewg.org/research/pollution-people-       Meyer and Lemery. Health Implications of Environmental Change. Ch 121. Aurerbach's Wilderness Medicine.-       Experience as a medical doctor and naturalist 

SummaryPlanet earth is being destabilized as a result of human activity. Over half of the habitable land on earth is now used for human agriculture, 40% of our forests have been cut down, and humans now move more rock and sediment than any natural process. If we do not change our behavior quickly, it is likely that our planet will become unable to support human civilization as we know it.  Morbidity and Mortality70% of our crops rely on insect pollinators, but insect populations are collapsing. 40% of the human population live on the coast and could be underwater within  just 100 years. Deserts are expanding, forests are diminishing, wild fish stocks and wild animals have lost over 60% of their mass in just 40 years, and human health is at an all-time low. StoryIf humans act now and with great conviction, we can potentially avoid a catastrophe. But the window for action is closing rapidly. Key Points1. The earth is warming. In 50 years, the temperature has increased 1.1C, more than in the previous 10,000 years.2. There is a mass extinction under way. The loss of species affects our own health. Even the micro-organisms that live on our body and promote health are becoming extinct.3. New chemicals are hurting human health. Governments are all too willing to protect chemical companies over the health of people.4. Eating healthy plant-based foods, supporting organic regenerative agriculture, protecting and expanding wild lands, planting trees and native plants, not using products that cannot be reused or recycled, and stopping all our carbon emissions by 2050 could save the planet. 5. If we can do these things, our own health will improve, and we will assure a safe planet to live on for future generations. References-       Steffen et al. Planetary boundaries: Guiding human development on a changing planet. Science. 2015.-       Rockstrom and Attenborough. Breaking Boundaries – The Science of Our Planet. 2021. Netflix-       Chemicals in the Environment – Dehumanizing Humanity. 2017. Royal College of London. https://www.youtube.com/watch?v=oq2K1IvRf8M-       Environmental Working Group. https://www.ewg.org/research/pollution-people-       Meyer and Lemery. Health Implications of Environmental Change. Ch 121. Aurerbach's Wilderness Medicine.-       Experience as a medical doctor and naturalist  

SummaryExposure to warm environments can cause a number of heat-related illnesses including muscle cramps, heat rash, edema, syncope, heat exhaustion, and heat stroke. All of these issues are preventable. Early recognition of heat stroke is paramount for improving survival. Cool patients with cold water immersion. Morbidity and MortalityApproximately 600 deaths occur every year in the United States related to heat. It is a leading cause of death in high school athletes. Mortality from heat stroke approaches 10% even in modern times.  StoryAs many as 53 children die every year from heat related vehicle entrapment in the United States. Most of these cases are due to people forgetting the child was in the car. The second leading cause is children getting into unattended cars. Always know where your baby or child is and keep your unattended car locked. A record-breaking heat wave in Europe in 2003 killed at least 30,000 people, mostly elderly. Taking cool baths throughout the day could have prevented many of these deaths. Key Points1. Risk factors for heat illness include older age, dehydration, impaired cooling capacity, lack of acclimatization, poor fitness, lack of sleep, chronic health issues, and obesity. 2. Temperature, wind, humidity, and solar radiation all effect the thermal strain felt by any individual.3. Heat exhaustion is common and characterized by fatigue, thirst, weakness, anxiety, and dizziness. Heat stroke is much more severe and can be distinguished from exhaustion by the presence of altered coordination, balance, and/or mentation. 4. Rapid cooling is the most important treatment for heat stroke. Cold water emersion is the gold standard for lowering body temperature.  References-       Lipman et al. WMS Practice Guidelines for the Prevention and Treatment of Heat-Related Illness. Wild & Env Med. 2014.-       O'Brien et al. Clinical Management of Heat-Related Illnesses. Ch. 13. Auerbachs, Wilderness Medicine. -       Gaudio FG, Grissom CK. Cooling Methods in Heat Stroke. J Emerg Med. 2016-       Wikipedia – Heat Stroke-       Personal experience as a physician and athlete

SummaryRadon is a radioactive element that accumulates in homes and buildings. It is the second leading cause of lung cancer worldwide. All homes should be tested for radon, and if above actions levels (US - 4 pCi/L), a radon mitigations strategy (getting rid of the radon) should be utilized.   Morbidity and MortalityRadon is often the largest contributor to an individual's background radiation dose and is considered the leading environmental cause of cancer mortality. Worldwide, between 3 and 14% of lung cancers are due to radon in any giving country depending on smoking prevalence and background radon levels. In the United States approximately 21,000 lung cancer deaths are attributed to radon every year.  StoryBefore 1984 radon was only thought to be a risk in uranium mines. That year Stanley Watras, and engineer was starting a job at Limerick nuclear power plant in Pottstown, Pennsylvania. Prior to nuclear fuel being added to the plant, Watras began setting off radiation detectors meant to keep workers safe. Each day he was setting machines off in spite of decontamination. An investigation was undertaken and Watras's home was found to have a huge amount of radiation, 2,700 pCi/L.  The source was determined to be radon. This amount of radon was the equivalent in lung cancer risk to smoking hundreds of packs of cigarettes a day. Watras's family was moved out and the EPA began extensive testing. After this, the risk of radon in the home was recognized. Key Points1. Radon is chemical element 86. It is radioactive and gives off an ionizing alpha particle due to its inherent chemical instability.2. This alpha particle is a helium atom with high energy and speed. If inhaled, ingested, or injected, alpha particles are harmful to human health.3. Radon is colorless, odorless, and tasteless. All homes should be tested for is presence as it cannot be sensed.4. There are several proven methods to reduce the level of radon in the home. As such, lung cancer due to radon inhalation is preventable. References-       Wikipedia – Radon, alpha decay-       Field et al. Residential radon gas exposure and lung cancer: the Iowa Radon Lung Cancer Study. Am J Epidemiol. 2000-       Hill et al. Radon in homes and risk of lung cancer: collaborative analysis of individual data from 13 European case-control studies. BMJ. 2005 Jan 29;330(7485)-       Health Risk of Radon. EPA. https://www.epa.gov/radon/health-risk-radon-       https://www.epa.gov/sites/production/files/2016-02/documents/2013_consumers_guide_to_radon_reduction.pdf-       Radon and Health. https://www.epa.gov/sites/production/files/2016-02/documents/2013_consumers_guide_to_radon_reduction.pdf-       Rella, Joseph. Ch. 128. Radiation. Goldfrank's Toxicology. 2019. 

SummaryYellow Fever is a viral tropical disease. It is most prevalent in equatorial Africa (90%) and South America (10%). No specific treatments exist but it can be prevented with a highly affective vaccine. The disease is spread via mosquito vectors (arbovirus). Yellow refers to the jaundice that occurs in severe infection from liver damage. Bleeding (hemorrhagic fever) and kidney damage are other severe manifestations. Morbidity and MortalityAbout 5% of people infected with the Yellow Fever virus will die. Foreign visitors to endemic countries are at the higher risk of severe infection if exposed. Hemorrhagic fever, liver failure, and other organ failures can lead to shock and death. It is very difficult to know how many infections occur annually but the WHO estimates about 200,000 (likely many more). Epidemics periodically occur and usually have worse than normal case fatality rates. StoryYellow fever outbreaks plagued the America's in the 18th and 19th centuries, having been introduced from Africa just few hundred years prior. The Yellow Fever Epidemic of 1793 killed 9% of the residents in Philadelphia. Many, including George Washington, fled the city. Yellow Fever has plagued the US military for years before the 17D vaccine was discovered in 1937 by Max Theiler (Noble Prize).  Key Points1.  Yellow fever is endemic to equatorial Africa and South America, but strangely not Asia.2.  People living and traveling to these areas should be vaccinated with the 17D live attenuated yellow fever vaccine.3.  Fever, chills, headache, and myalgias are common. A minority of cases progress to liver failure and hemorrhage.  About half of cases that progress will be fatal4. Treatment is supportive. As such, prevention with vaccine, vector control, and avoiding mosquito bites is very important. Avoid blood thinners and anti-platelets. References-       Keystone et al. Travel Medicine, 4th Ed. Elsevier 2019. Ch. 12. Torresi and Kollaritsch. Recommended/Required Travel Vaccines.-       Farrar et al. Manson's Tropical Diseases, 23rd Ed. Elsevier 2014. Ch. 14. Young et al. Arbovirus Infection.-       Wikipedia. Yellow Fever, Yellow Fever Vaccine-       WHO, Yellow Fever. https://www.who.int/news-room/fact-sheets/detail/yellow-fever-       Vaccine Information Statement. CDC. https://www.cdc.gov/vaccines/hcp/vis/vis-statements/yf.pdf.-       Thomas R. E. (2016). Yellow fever vaccine-associated viscerotropic disease: current perspectives. Drug design, development and therapy, 10, 3345–335

SummaryYellow Fever is a viral tropical disease. It is most prevalent in equatorial Africa (90%) and South America (10%). No specific treatments exist but it can be prevented with a highly affective vaccine. The disease is spread via mosquito vectors (arbovirus). Yellow refers to the jaundice that occurs in severe infection from liver damage. Bleeding (hemorrhagic fever) and kidney damage are other severe manifestations. Morbidity and MortalityAbout 5% of people infected with the Yellow Fever virus will die. Foreign visitors to endemic countries are at the higher risk of severe infection if exposed. Hemorrhagic fever, liver failure, and other organ failures can lead to shock and death. It is very difficult to know how many infections occur annually but the WHO estimates about 200,000 (likely many more). Epidemics periodically occur and usually have worse than normal case fatality rates. StoryYellow fever outbreaks plagued the America’s in the 18th and 19th centuries, having been introduced from Africa just few hundred years prior. The Yellow Fever Epidemic of 1793 killed 9% of the residents in Philadelphia. Many, including George Washington, fled the city. Yellow Fever has plagued the US military for years before the 17D vaccine was discovered in 1937 by Max Theiler (Noble Prize).  Key Points1.  Yellow fever is endemic to equatorial Africa and South America, but strangely not Asia.2.  People living and traveling to these areas should be vaccinated with the 17D live attenuated yellow fever vaccine.3.  Fever, chills, headache, and myalgias are common. A minority of cases progress to liver failure and hemorrhage.  About half of cases that progress will be fatal4. Treatment is supportive. As such, prevention with vaccine, vector control, and avoiding mosquito bites is very important. Avoid blood thinners and anti-platelets. References-       Keystone et al. Travel Medicine, 4th Ed. Elsevier 2019. Ch. 12. Torresi and Kollaritsch. Recommended/Required Travel Vaccines.-       Farrar et al. Manson’s Tropical Diseases, 23rd Ed. Elsevier 2014. Ch. 14. Young et al. Arbovirus Infection.-       Wikipedia. Yellow Fever, Yellow Fever Vaccine-       WHO, Yellow Fever. https://www.who.int/news-room/fact-sheets/detail/yellow-fever-       Vaccine Information Statement. CDC. https://www.cdc.gov/vaccines/hcp/vis/vis-statements/yf.pdf.-       Thomas R. E. (2016). Yellow fever vaccine-associated viscerotropic disease: current perspectives. Drug design, development and therapy, 10, 3345–335

This episode discusses my OPINIONS regarding Direct Primary Care. It is not intended to provide medical knowledge. Just an interesting discussion! SummaryDirect Primary Care (DPC) is a new movement in primary care designed to improve the provider patient relationship, accessibility of providers to their patients, and transparency of pricing. At its core, it is defined by patients or their employers paying for primary care directly. This is in opposition to using medical insurance or another third party like the government. This new model is growing and has the potential to disrupt healthcare in an amazing way. Morbidity and MortalityUnited States healthcare is bankrupting people and companies at alarming rates. This is because healthcare costs are out of control. As financial security is a more important driver of health than access to medical care, I question whether the United States healthcare system actually helps more people then it hurts. DPC realigns incentives and seeks to control costs. This puts the breaks on healthcare spending. Key Points1.     DPCs often utilize affordable subscription-based care. Patients can often call their providers directly whenever medically needed. 2.     DPC providers take on about ½ to ¼ of the patients in traditional primary care. This allows them more time with patients and improves care.3.     DPC offices know the cost of everything they recommend, as such expensive treatments, medications, and diagnostics are appropriately avoided.4.     DPC doctors practice a broader scope of care than traditional primary care doctors. This prevents communications errors and adds value to consumers as the more providers someone sees the more expensive care gets.5.     Employers who use DPC save money on total healthcare expenses. One study of 10 clinics found a 20% reduction in total healthcare expenses, 40% less emergency department visits, and 26% less hospitalizations compared to traditional care.6.     DPC is thriving in spite of medical insurance and healthcare policies that undermine it. Imagine how successful it could be with the support of legislation. References-       Personal experience as a primary care physician that has worked in traditional insurance based primary care clinics as well as owns and operates Wander Medicine clinic, a DPC in Boise, ID.-       Millman Inc. Direct Primary Care: Evaluating a New Model Of Delivery and Financing. 2020. Available at: https://www.soa.org/globalassets/assets/files/resources/research-report/2020/direct-primary-care-eval-model.pdf  

BackgroundUnited States healthcare costs the most of any country in the world. Unfortunately, the health of our population and quality of care provided does not support the cost. We offer the worst healthcare value in the entire world (Value = Cost/Quality)! This has to change for the sake of ourselves and our children. The changes needed are simple. But, change is difficult because so many people are making so much money off of our toxic system.This podcast is not meant to provide clinical medical knowledge. It represents the opinions of the author. It is intended to stimulate thought and conversion. Some of the major problems are:1.     Lack of Transparency in Pricing2.     Insurance for Every Part of Medical Care (It should not be called insurance anymore)3.     Businesspeople that Provide no Additional Value4.     Regulations that are out of Date, Add Complexity, and Provide No Value5.     Poor Communication by Design6.     Drugs and Diagnostics that are Obscenely High Priced7.     Upside Down Provider Workforce8.     Fear and Defensive MedicineAsk yourself everyday as a provider:Would I make such a recommendation to someone in my own family?Would I want myself to be my own doctor? 9.     Upside Down Incentives Regarding Wellness and Disease Prevention10.  Lack of accessibility of providers when patients need them the most Some of my solutions are:1.     Mandate that all healthcare entities make prices fully transparent2.     Provide medical insurance products that only cover catastrophic care on the individual and group insurance markets. These must be affordable, like 50$ a month or less for young healthy people.3.     Kick most of the businesspeople (suits) out of healthcare. Keep only those individuals who add value.4.     Modernize regulations to reduce regulatory burden. 5.     Mandate that EMRs communicate with each other using a universal API.6.     Start paying the same prices for diagnostics and therapeutics that the rest of the developed world pays.7.     Incentivize primary care so that the smartest people enter this field and subsequently practice an extremely broad scope of care.8.     Stop worrying about being sued and start doing what is right for patients.9.     Incentivize preventative medicine and public health by paying for them10.  Develop systems were doctors are available to their patients in times of need. E.g. Direct Primary Care (coming next episode)  

SummarySpace is a hostile environment. Microgravity, radiation, temperature extremes, vacuums, isolation, and forces related to takeoff and landing are just a few of the hazards faced by astronauts and other space voyagers. Humans have been capable of leaving planet earth for just 60 years. Since that time, we have learned a lot about how to keep humans safe and healthy in space. However, our knowledge remains primitive. To become multiplanetary, physicians, scientists, engineers, and other disciplines will need to take space medicine to the next level. This will be the greatest preventative medicine challenge ever undertaken. Morbidity and MortalitySpace can kill you in 1000 different ways. Explosions, lethal radiation doses, and environmental control failures can all result in fatality. Those who spend long amounts of time in space can have long term vision issues, higher rates of cancer, and back problems. Longer space flight missions, and those outside of the earth’s magnetosphere will pose much higher risks to human in space. StoryGetting things into space is getting cheaper. Adjusted for inflation (to year 2000), the price to put 1 kg into low earth orbit was about $85,000 in 1981. In 2019 that number had fallen to $951/kg or 1% of the cost from 40 years prior. Prices continue to get cheaper and space continues to become more accessible. Key Points1. Microgravity has a number of adverse effects including motion sickness, muscle and bone loss, and cardiovascular changes.2. Ionizing radiation is a huge problem is space that we have no idea how to solve3. The psychological and human factor components can never be understated, even when picking the best humans available.4. Humans need to become multiplanetary in order to assure the long-term survival of our species. We also need to bring the rest of life on earth with us. Space medicine is booming as a result of the booming space industry. References-       Green et al. Handbood of Aviation and Space Medicine. 2019-       Hodkinson PD, Anderton RA, Posselt BN, Fong KJ. An overview of space medicine. Br J Anaesth. 2017 -       Wikipedia- Karman Line, Armstrong limit, Space Medicine, Ionizing Radiation, Geocorona, etc.-       https://www.nasa.gov/feature/nasa-station-astronaut-record-holders-       https://www.futuretimeline.net/data-trends/6.htm-       Belavy et al. Disc herniations in astronauts: What causes them, and what does it tell us about herniation on earth?. Eur Spine J 25, 144–154 (2016)

SummarySpace is a hostile environment. Microgravity, radiation, temperature extremes, vacuums, isolation, and forces related to takeoff and landing are just a few of the hazards faced by astronauts and other space voyagers. Humans have been capable of leaving planet earth for just 60 years. Since that time, we have learned a lot about how to keep humans safe and healthy in space. However, our knowledge remains primitive. To become multi-planetary, physicians, scientists, engineers, and other disciplines will need to take space medicine to the next level. This will be the greatest preventative medicine challenge ever undertaken. Morbidity and MortalitySpace can kill you in 1000 different ways. Explosions, lethal radiation doses, and environmental control failures can all result in fatality. Those who spend long amounts of time in space can have long term vision issues, higher rates of cancer, and back problems. Longer space flight missions, and those outside of the earth’s magnetosphere will pose much higher risks to human in space. StoryGetting things into space is getting cheaper. Adjusted for inflation (to year 2000), the price to put 1 kg into low earth orbit was about $85,000 in 1981. In 2019 that number had fallen to $951/kg or 1% of the cost from 40 years prior. Prices continue to get cheaper and space continues to become more accessible. Key Points1. Microgravity has a number of adverse effects including motion sickness, muscle and bone loss, and cardiovascular changes.2. Ionizing radiation is a huge problem is space that we have no idea how to solve3. The psychological and human factor components can never be understated, even when picking the best humans available.4. Humans need to become multiplanetary in order to assure the long-term survival of our species. We also need to bring the rest of life on earth with us. Space medicine is booming as a result of the booming space industry. References-       Green et al. Handbood of Aviation and Space Medicine. 2019-       Hodkinson PD, Anderton RA, Posselt BN, Fong KJ. An overview of space medicine. Br J Anaesth. 2017 -       Wikipedia- Karman Line, Armstrong limit, Space Medicine, Ionizing Radiation, Geocorona, etc.-       https://www.nasa.gov/feature/nasa-station-astronaut-record-holders-       https://www.futuretimeline.net/data-trends/6.htm-       Belavy et al. Disc herniations in astronauts: What causes them, and what does it tell us about herniation on earth?. Eur Spine J 25, 144–154 (2016)

SummaryDrowning is defined as respiratory impairment caused by submersion in a liquid media. There are 3 outcomes; death, death with long term morbidity, and death without long term morbidity. Children are at particularly high risk. Over half of adult drowning involve alcohol. Most drownings are preventable. Morbidity and MortalityDrowning victims struggle to stay above water or may just be unconscious. Eventually rising blood CO2 levels trigger a breath. This leads to aspiration.  Eventually hypoxia develops leading to tissue injury. This leads to hypoxic brain injury and finally death if the victim is not rescued. Worldwide, at least 500,000 people die a year from drowning, mostly in developing nations. Drowning is the leading cause of death in children age 1 to 4 years. StoryWhen New Zealand was first being settled by European colonizers, so many people died trying to cross rivers that drowning became known as the New Zealand Death. Alcohol, dangerous beaches, and flash floods also contributed to the increased incidence of drowning deaths. Key Points1. Children, men, having a low income, being African American, having seizures, being elderly with health problems, inability to swim, and substance use are all risk factors for drowning.2. learning to swim, being honest about swimming ability, using the buddy system, putting physical barriers around pools, having proper supervision, and using proper flotation devices can all prevent drowning.3. Rescuers should be careful to not become a second victim. Remembering scene safety as well as the phrase reach, throw, row, go is very important.4. Resuscitation should start with 2 good rescue breaths followed by high quality CPR. Remove wet clothing and begin warming the drowning victim immediately.5. BIPAP and intubation are often utilized in the hospital setting for symptomatic drowning victims with significant pulmonary edema. Be sure to drain the stomach with and nasogastric tube to prevent further aspiration. Asymptomatic drowning victims are usually observed for 4 to 8 hours before they are allowed to return home. References-       Auerbach’s Wilderness Medicine, 7th Ed. Chapters on Marine Medicine. Ch 69-78 (1530-1794). 2017-       Schmidt et al. WMS Practice Guidelines for the Prevention and Treatment of Drowning. 27(236-251). 2016.-       Uptodate.com. Submersion Injuries-       Wikipedia. drowning, free diving blackouts, etc-       CDC and WHO websites-       The New Zealand Death. Available at: https://ricky1871.wordpress.com/2013/06/14/376/-       Personal Experience as an EMT and physician

SummaryFor thousands of years indigenous Americans have used hallucinogenic mushrooms in religious ceremonies as entheogens. These mushrooms are now known to contain psilocybin, a small molecule with profound mind-altering properties. While many cultures have understood the therapeutic potential of psilocybin for thousands of years, most modern countries are only now accepting psilocybin’s potential as medicine. Morbidity and MortalityThe profound mind-altering effects of psilocybin should not be under-estimated and have led to many fatal accidents. However, psilocybin is very safe from a purely toxicological standpoint. The LD50 (dose at which half of people die) is estimated to be 6g or 1000 times the normal recreational dose. Most all reported psilocybin fatalities have involved significant co-ingestions. StoryThe Aztecs called hallucinogenic mushrooms “tonanacatl” meaning “God’s Flesh”. In 1519 when Spain conquered the Aztec Empire, they banned cultural practices like the use of hallucinogenic mushrooms. Years later, in 1970 the United Nations required all member nations to ban psilocybin. However, this attitude is finally changing. Oregon became the first state to legalize psilocybin in 2020. However, it remains federally illegal. Key Points1. Psilocybin is a small molecule found in the fruiting bodies (mushrooms) of hundreds of species of fungi around the world2. It is very similar to the neurotransmitter serotonin and is an agonist at various serotonin receptors, most importantly 5HT2A.3. Though it is currently DEA schedule 1, psilocybin has numerous potential health benefits, most notably in the treatment of multiple psychiatric disorders like depression and substance abuse.4. Those who have ever used psilocybin are probably less likely to commit violent crimes and often report enduring beneficial effects. Feeling of interconnectedness with other people, nature, and the universe are regularly reported by users.5. Some things I forgot to say in the podcast: - Make sure you get psilocybin from a trustworthy source. Fake and adulterated products are very common. - Calling a friend or loved one can be a great way to get through a "bad trip"- Everyone has a different metabolism. Some will get profound effects from a small dose while other may need larger doses.- Micro-dosing (taking about 1/10 a normal dose) is often done on an almost daily basis to help with depression, anxiety, and to improve creativity. Think about it like a daily antidepressant. This is a sub-hallucinogenic dose. References-       Johnson, M. W., & Griffiths, R. R. (2017). Potential Therapeutic Effects of Psilocybin. Neurotherapeutics:14(3), 734–740. -       Hendricks PS, Crawford MS, Cropsey KL, Copes H, Sweat NW, Walsh Z, Pavela G. The relationships of classic psychedelic use with criminal behavior in the United States adult population. J Psychopharmacol. 2018;32(1):37-48. -       Neavyn MJ and Carey JL. Hallucinogens. GoldFrank’s Toxicology. 2019.-       Wikipedia. Psilocybin, Psilocin, Serotonin, Psilocybin Decriminalization in the United States.-       https://www.dea.gov/drug-scheduling-       Mandrake K. The Psilocybin Mushroom Bible: The Definitive Guide and Growing and Using Magic Mushrooms. 2016.

SummaryG Force is a measure of acceleration, or a change in velocity and/or direction. All of us experience 1Gz, while standing on earth. However, military fighter pilots may have to perform under 9Gz. Such large G Forces can lead to loss of consciousness (G LOC) and even death. G Force Tolerance is a measure of how many Gs a person can withstand prior to loosing consciousness. Many factors can affect a person’s tolerance for Gs.Morbidity and MortalityG Forces prevent blood from reaching the brain causing loss of consciousness. If you are flying a fighter jet this can lead to collisions or vulnerability to attack. If G Forces are sustained during G LOC, permanent brain damage, and then death will occur. Humans can handle incredible high G forces for short periods of time.G Force Tolerance Thresholds for Severe Injury for Short Duration Exposures | Axis | G Force | +Gz | 25G | -Gz | 15G | +Gx | 50G | -Gx | 45G | +- Gy | 12GTaken from Green’s, Handbook of Aviation and Space Medicine. 2019.StoryFlight Surgeons and Aerospace Medicine researchers in the first half of the 20th century regularly used themselves as guinea pigs in physiologic tests. US Air Force Col. John Stapp, MD PhD took this idea to the extreme. He made rocket sleds at a New Mexico military base to test human tolerance for G Forces. On Dec. 10, 1954, after several runs (26 on himself), Stapp broke the land speed record traveling 662 mph, sustaining 46.2 Gx. Key Points1. The danger of any G Force depends on the direction of force relative to the body, magnitude of the force, rate of onset, and duration sustained.2. Subscripts are used to identify the direction of force relative to the body. +Gz travels from head to toe; - Gz travels from toe to head; + Gx travels from chest to back; - Gx travels from back to front; + Gy travels from right to left; - Gy travels from left to right.3. g is the acceleration due to gravity on earth, equal to 9.8 m/sec/sec. G = acceleration/g. Therefore 10Gs = 98 m/sec/sec. A person feeling 10Gs would feel 10x heavier and their heart would have to pump blood the equivalent of 10 time the normal distance in order to reach the brain.4. +Gz Forces cause blood to pool in the legs. This prevents blood from entering the brain. If gradual in onset, G forces will eventually cause vision loss, followed by blackout, and then loss of consciousness (G LOC). Rapid onset G forces may lead straight to blackout.5. G tolerance, refers to a human’s capacity to sustain G Forces without G LOC. G tolerance is different for everyone. For example, +Gz tolerance ranges from 2.7 to 7.8 (mean 4.7) for most people.6. Several factors can improve G tolerance. Examples include anti-G straining maneuvers, G suits, reclining the pilots seat, proper hydration, proper nutrition, drugs, physical fitness, and proper training.7. -G immediately preceding +G will lower G tolerance significant. For instance, push-pull aviation maneuvers (nose diving the plain and then trying to pull up quickly) is particularly dangerous for G-LOC.References- Green, Gaydos, Hutchison, Nicol. Handbook of Aviation and Space Medicine. CRC Press. 2019- Mackowski. Testing the Limits, Aviation Medicine and the Origons of Manned Space Flight. 2006- Wikipedia. G Force, G Suit, High G Training, AGSM- Youtube. Multiple videos showing centrifuges, John Stapps Sled, and fighter pilots- Tesch PA, Hjort H, Balldin UI. Effects of strength training on G tolerance. Aviat Space Environ Med. 1983 Aug;54(8):691-5. PMID: 6626076.