Podcasts about Aspirin

CardioNerds (Dr. Jenna Skowronski [Heart Failure Council Chair], Dr. Shazli Khan, and Dr. Josh Longinow) are joined by renowned leaders in the field of AHFTC (Advanced Heart Failure and Transplant Cardiology) and mechanical circulatory support, Dr. Jeff Teuteberg and Dr. Mani Daneshmand to continue the discussion of advanced heart failure therapies by taking a deep dive into the world of durable LVADs (Left Ventricular Assist Devices). In this episode, we will review the history of ventricular assist devices, the basics of LVAD function, selection criteria for LVAD therapy, and surgical nuances of LVAD implantation. Audio Editing by CardioNerds intern, Joshua Khorsandi. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. 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Pearls There have been significant advances in the field of MCS/LVAD therapy since the first implanted LVAD in the 1960s, to the first FDA approved device in the early 2000's, to now the HM3 LVAD, with the most important change being a centrifugal flow/magnetically levitated design that led to minimized hemocompatibility-related adverse events (HRAE's) (MOMENTUM 3 trial comparing HM2 and HM3).  The REMATCH trial in 2001 was a pivotal trial for LVAD therapy, demonstrating that in a population of patients with advanced HF (70% IV inotrope dependent), LVAD therapy significantly improved survival at both 1 and 2 years as compared to medical therapy alone.    MOMENTUM 3 trial was a landmark trial for the HM3 device, showing that in a population of end stage HF patients (86% inotrope dependent, 32% INTERMACS 1-2, and 60% DT strategy), 5-year survival with HM3 was 58% and HM3 had lower HRAE's compared with HM2.  There are both patient-specific factors and surgical considerations when it comes to candidacy for LVAD therapy.  RV function prior to LVAD is a key determinant for success post-LVAD  Many patients being considered for LVAD may not have robust RV function, however, predicting RV failure after LVAD is exceedingly difficult.   In general, it doesn’t matter how bad the RV may look on imaging; we care more about the pre-LVAD hemodynamics (look at the PAPi and RA/wedge ratio).   What happens in the OR may be the most important determinant of how the RV will do with the LVAD!  Notes Notes drafted by Dr. Josh Longinow.  1. Historical background of heart pumps and LVADs  LVAD Evolution   FDA approval year  2001  2008  2012  2017  Pump  HeartMate XVE   HeartMate II  Heartware HVAD  HeartMate III  Flow/Design Features  Pulsatile Technology   Continuous flow Axial design  Continuous flow  Centrifugal design  Continuous flow   Full MagLev + Centrifugal design  The 1960's ushered in the first ‘LVADs', when the first air-powered ‘LVAD' was implanted. It kept the patient alive for four days before the patient expired.   The first generation of LVADs were pulsatile pumps   The first nationally recognized, FDA approved LVAD was the HeartMate XVE (late 1990s to early 2000s, REMATCH trial). The XVE pump used compressed air (pneumatically driven) to power the pump.   Prior to the XVE, OHT was the standard of care for patients with advanced, end-stage heart failure.   The second and third generations of LVADs were non-pulsatile, continuous flow devices and included the HVAD, HM2, and HM3 devices.   MOMENTUM 3 was a landmark trial for the HM3 device, showing that in a population of sick patients with end stage HF (86% inotrope dependent, 32% INTERMACS 1-2, and 60% DT strategy), 5-year survival with HM3 was 58% and HM3 had lower HRAE's compared with HM2.   The only pump that is currently FDA approved for implant is the HM3, although other pumps are in clinical trials (BrioVAD system, INNOVATE Trial).  2. What are LVADs, and how do they work?   In simplest terms, the LVAD is a heart pump comprised of several key mechanistic components:   Inflow cannula  Mechanical pump   Outflow cannula  Driveline  Controller/Power source  The HM3 differs from its predecessors (HM2 and HVAD) in several key ways;   HM3 is placed intrapericardial whereas the HM2 was placed pre-peritoneal.   Perhaps most importantly, the HM3 is a fully magnetically levitated, centrifugal flow pump, whereas the HM2 is an axial flow device.  Axial flow pumps are not magnetically levitated, leading to more friction produced between the ruby bearing's contact with the pump rotors, and higher rates of hemocompatibility related adverse events (HRAEs, i.e. pump thrombosis) and the HM2 was ultimately discontinued in favor of the HM3 (MOMENTUM 3 trial).  3. What do the terms ‘Destination Therapy' (DT) or ‘Bridge to Transplant' (BTT) mean when it comes to LVADs?   When LVADs first came on the stage, EVERYONE was a BTT; these early pumps weren't designed for long term use (I.e. REMATCH Trial, Heartmate XVE)  Destination therapy means the LVAD was placed in leu of transplant because there are contraindications to transplant   REMATCH trial brought about the concept of “Destination therapy”, comparing outcomes in patients (with contraindications for transplant) who received an LVAD vs optimal medical therapy  Bridge to transplant means we are placing the LVAD in a patient who may not be a transplant candidate at this moment in time (is too sick, or conversely, not sick enough), but may be down the line   Bridge to recovery is another term used when the LVAD is being placed for a patient we think may have a recoverable cardiomyopathy  4. What are some factors we should consider when assessing a patient’s candidacy for LVAD, in general, and from a surgical perspective?   Patient factors   Older age might push us towards thinking LVAD rather than transplant  In general, age > 70 is the cutoff for transplant, but this is not a hard cut off and varies institution to institution    In general, think about things that help predict recovery after a major surgery; Frailty and Nutritional status are important, we try to optimize these prior to LVAD implant   Right ventricular function remains the Achilles heel of LV support  We know that needing temporary RV support post LVAD puts you on a different survival curve than patients who don’t need RVAD support  Studies have not been able to successfully predict who will develop RV failure after LVAD implantation  What happens in the time between when the patient goes to the OR and when they get back to the ICU is an important determinant who might develop RV failure post LVAD   Surgical techniques such as implanting the HM3 in the intra-thoracic cavity, rather than intra-pericardial may help maintain LV/RV geometry to help optimize the RV post LVAD   Surgical considerations for LVAD candidacy  Small, hypertrophied LV: HM3 inflow cannula is small, but small hypertrophied ventricles tend towards chamber collapse during systole causing suction, needing to run slower with lower flow rates  Chest size/diameter: pumps have gotten so small now, that for adults, these have become less of a consideration  BMI: low BMI used to be more of a concern with the older pumps due to where they were placed, and the relative size of the pump itself, not so much now with the smaller HM 3 pumps  Calcified LV apex: would increase risk of stroke, bleeding   Driveline tunneling becomes a concern in the super obese population, higher risk for driveline infections (might tunnel these driveline's shorter, and to a less fatty region of the abdomen, could even tunnel out the thoracic cavity in the super obese to limit skin motion)    5. Is there a role for MCS (i.e. temporary LVAD such as Impella) in pre-habilitation of patients prior to LVAD surgery?   The theory of being able to improve systemic perfusion, decongest the organs, and make the patient feel better prior to surgery makes sense, but becomes problematic due to the lack of a hard end point/time for prehabilitation which might risk delays in surgery   More likely that it can lead to delay in the surgery, with less-than-optimal benefit; you don't want to prolong the wait for surgery and increase the risk for complications prior to surgery    An Impella 5.5 is currently FDA approved for 2 weeks of support, not 2 months so timing is important to keep in mind  It’s unlikely that you will take a patient and convert them from a malnourished, cachectic person in 2 weeks’ time   6. Is there a role for LVAD therapy in the younger patient population? Should we be thinking of LVAD up front for these patients, with the goal of transplanting down the line?   Recovery may be more likely in certain populations, particularly younger females with smaller LV's; in those populations, perhaps bridge to recovery should be the focus, optimizing them on GDMT etc.   The replacement of transplant, with MCS (LVAD) in young patients has become a topic of discussion, because these pumps have become better and better, with the thinking that an LVAD could bridge a patient for 10 years or so, and they could get a transplant later   It is still a big unknown, but several concerns exist  Patients who get LVADs might end up with complications that become contraindication to transplant down the line (stroke, sensitization etc)   Patients and providers are more hesitant because of the more recent iteration for the UNOS criteria for OHT listing which no longer gives patients with an uncomplicated LVAD higher priority, and therefore they could end up waiting a longer time for a heart after undergoing LVAD  References Rose EA, Gelijns AC, Moskowitz AJ, et al. Long-term use of a left ventricular assist device for end-stage heart failure. N Engl J Med. 2001;345(20):1435-1443. doi:10.1056/NEJMoa012175  Mehra MR, Uriel N, Naka Y, et al. A Fully Magnetically Levitated Left Ventricular Assist Device – Final Report. N Engl J Med. 2019;380(17):1618-1627. doi:10.1056/NEJMoa1900486  Mancini D, Colombo PC. Left Ventricular Assist Devices: A Rapidly Evolving Alternative to Transplant. J Am Coll Cardiol. 2015;65(23):2542-2555. doi:10.1016/j.jacc.2015.04.039  Mehra MR, Goldstein DJ, Cleveland JC, et al. Five-Year Outcomes in Patients With Fully Magnetically Levitated vs Axial-Flow Left Ventricular Assist Devices in the MOMENTUM 3 Randomized Trial. JAMA. 2022;328(12):1233-1242. doi:10.1001/jama.2022.16197  Rose EA, Moskowitz AJ, Packer M, et al. The REMATCH trial: rationale, design, and end points. Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure. Ann Thorac Surg. 1999;67(3):723-730. doi:10.1016/s0003-4975(99)00042-9  Kittleson MM, Shah P, Lala A, et al. INTERMACS profiles and outcomes of ambulatory advanced heart failure patients: A report from the REVIVAL Registry. J Heart Lung Transplant. 2020;39(1):16-26. doi:10.1016/j.healun.2019.08.017  Mehra MR, Netuka I, Uriel N, et al. Aspirin and Hemocompatibility Events With a Left Ventricular Assist Device in Advanced Heart Failure: The ARIES-HM3 Randomized Clinical Trial. JAMA. 2023;330(22):2171-2181. doi:10.1001/jama.2023.23204  Mehra MR, Nayak A, Morris AA, et al. Prediction of Survival After Implantation of a Fully Magnetically Levitated Left Ventricular Assist Device. JACC Heart Fail. 2022;10(12):948-959. doi:10.1016/j.jchf.2022.08.002  Bhardwaj A, Salas de Armas IA, Bergeron A, et al. Prehabilitation Maximizing Functional Mobility in Patients With Cardiogenic Shock Supported on Axillary Impella. ASAIO J. 2024;70(8):661-666. doi:10.1097/MAT.0000000000002170 

We recently covered an SMFM abstract that was presented at the annual Pregnancy Meeting held in early February 2026. The authors were from my Alma Mater, UT Southwestern/Parkland Hospital. This was a well-done study comparing 162 milligrams aspirin to 81 milligrams of aspirin. The results were very encouraging! However, aspirin definitely has an awkward acumen. It would be wonderful if ALL the data just leaned in the same direction... but it doesn't! Enter our podcast family member, and my friend Alex. Alex sent me an incredible and insightful message which was a rebuttal to my Southwestern colleagues' findings. In this episode you'll hear Alex's rebuttal and clinical conundrum, and we will explain why these two seemingly paradoxical findings makes sense. Listen in for details.1. Khander, Amrin MD; Thomas, Charlene MS; Matthews, Kathy MD; Christos, Paul DrPH; Alcus, Claire BA; Alam, Tanvir BS; Bush, Leah BA; Deshmukh, Diksha BA; Chasen, Stephen T. MD; Riley, Laura E. MD; Skupski, Daniel W. MD; August, Phyllis MD, MPH; Malha, Line MD, MS. Comparison of 162 mg and 81 mg Aspirin for Prevention of Preeclampsia: A Randomized Controlled Trial. Obstetrics & Gynecology 147(1):p 87-96, January 2026. | DOI: 10.1097/AOG.0000000000006100

Send a textMajor bleeding remains the principal complication of oral anticoagulation. In patients with device-detected subclinical atrial fibrillation, the decision to anticoagulate requires careful balancing of stroke prevention against bleeding risk.In this episode of CLOT Conversations, Dr. Deborah Siegal discusses a prespecified subanalysis of the ARTESiA randomized clinical trial, recently published in JAMA Cardiology. ARTESiA demonstrated a 37% reduction in stroke and systemic embolism with apixaban compared to aspirin — but at the cost of increased major bleeding.This subanalysis goes deeper, examining the site, severity, and clinical course of bleeding events. Most bleeding was gastrointestinal and non-critical. Rates of intracranial and fatal bleeding were low and similar between treatment arms. The majority of events were not clinical emergencies, and many were defined by hemoglobin decline rather than catastrophic presentation.We explore what these findings mean for individualized risk assessment, the importance of modifiable bleeding risk factors such as NSAID use, and how physicians and patients can approach shared decision-making in subclinical AF.Abstract (subscription required for full paper): Siegal DM, Sticherling C, Healey JS, McIntyre WF, Christensen LS, Parkash R, Vanassche T, Conen D, Gold M, Granger CB, Nielsen JC. Major Bleeding With Apixaban vs Aspirin: A Subanalysis of the ARTESiA Randomized Clinical Trial. JAMA cardiology. 2025 Dec;10(12):1305-14.https://jamanetwork.com/journals/jamacardiology/fullarticle/2841075Support the showhttps://thrombosiscanada.caTake a look at our healthcare professional and patient resources, videos and publications on thrombosis from the expert members of Thrombosis Canada

Well, even though low dose aspirin has been recommended for the reduction of preeclampsia risk for many years, 2 controversies persist: 1. who should get it, and 2. the dose we should use. While the current US recommendation still focuses on 81 mg low dose aspirin, initiated after 12 weeks of gestation (based on risk factors), there's increased movement and growing data supporting both universal adoption and the higher dose of 162 mg. In this episode, we will briefly summarize brand new data out of UT Southwestern which was just published at the SMFM Annual Pregnancy meeting in Las Vegas. Listen in for details.1. https://www.smfm.org/news/new-studyroutine-aspirin-therapypreventsseverepreeclampsiainat-risk-populations2. ACOG CO 7433. The Effect of Aspirin on the Risk of Preeclampsia Based on the Fetal Medicine Foundation First Trimester Risk.4. Bujold E, Rolnik DL, Poon L, Syngelaki A, Wright D, Nicolaides KH. The effect of aspirin on the risk of preeclampsia based on the Fetal Medicine Foundation first-trimester risk. Am J Obstet Gynecol. 2025 Oct 31:S0002-9378(25)00808-7. doi: 10.1016/j.ajog.2025.10.032. Epub ahead of print. PMID: 41177290.

Commentary by Dr.  Jian'an Wang.

Contact us and share your opinionIn this episode we discuss the recent visit by BMA GPC Chair Katie Bramal-Stainer to a Derbyshire-Lincolnshire-Nottinghamshire LMC event. What were some of the questions in the room and what did we learn about contract timelines, content and the future of collective action for General Practice? We also discuss news stories covering some sudden and disruptive changes to GP Trainee assessment software, the shortage of yet another common drug (Aspirin!), and additional funding for cancer screening in areas of high deprivation.And… opportunities to join Gandhi and Andy at two upcoming eGPlearning events…GP5T11 Online GP Trainer Conference https://events.ringcentral.com/events/gp5t-11/registration PCNPlus26 Conference in Nottingham or online https://www.thcprimarycare.co.uk/pcnplus2026 Boost your triage skills with our dynamic 5-session live webinar course, tailored for primary care clinicians. Led by Dr. Gandalf and Dr. Ed Pooley, this comprehensive training covers all facets of remote patient triage—digital, on-call, and more. Gain practical knowledge, exclusive tips, and direct access to our experts through open Q&A sessions. Elevate your ability to manage primary care challenges effec Subscribe and hear the latest EPIC episode. Join Dr Mike as he shares how to get started and fly using EMIS to make your life easier with this clinical systembit.ly/EMIScourse

In this episode, Lyell K. Jones Jr, MD, FAAN, speaks with Aaron L. Berkowitz, MD, PhD, FAAN, who served as the guest editor of the February 2026 Neurology of Systemic Disease issue. They provide a preview of the issue, which publishes on February 2, 2026. Dr. Jones is the editor-in-chief of Continuum: Lifelong Learning in Neurology® and is a professor of neurology at Mayo Clinic in Rochester, Minnesota. Dr. Berkowitz is a Continuum® Audio interviewer and a professor of neurology in the Department of Neurology at the University of California, San Francisco, in San Francisco, California. Additional Resources Read the issue: continuum.aan.com Subscribe to Continuum®: shop.lww.com/Continuum Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @LyellJ Guest: @AaronLBerkowitz Full episode transcript available here Dr Jones: The human nervous system is so complex. You can spend your whole career studying it and still have plenty to learn. But the human brain does not exist in isolation. It's intricately connected with and reliant on other bodily systems. When those systems go awry, sometimes the first sign is in the nervous system. Today we will speak with Dr Aaron Berkowitz, an expert on the neurology of systemic disease, and learn a little about how these disorders can present and what we can do about it. Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about subscribing to the journal, listening to verbatim recordings of the articles, and exclusive access to interviews not featured on the podcast. Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum: Lifelong Learning in Neurology. Today, I'm interviewing Dr Aaron Berkowitz, who is Continuum's guest editor for our latest issue of Continuum on the neurology of systemic disease. Dr Berkowitz is a professor of clinical neurology at the University of California, San Francisco, and he has an active practice as a neurohospitalist and in outpatient general neurology---and, importantly, as a clinician educator. In addition to numerous teaching awards, Dr Berkowitz has published several books and also serves on our editorial board for Continuum. Dr Berkowitz, welcome. Thank you for joining us. Why don't you introduce yourself to our listeners?  Dr Berkowitz: Thanks, Lyell. As you mentioned, I'm a general neurologist and neurohospitalist here in San Francisco, California at UCSF and very involved in resident education as well. And I was honored, flattered and a little bit frightened when I received the invitation to guest edit this massive issue on the neurology of systemic disease. But I've learned a ton, and it's been great to work with you and the incredible authors we recruited to write for us. And I'm excited to have the issue out in the world.  Dr Jones: Yeah, me too. And you and I have talked about it before: you're one of a very small group of people who have guest edited multiple issues on different topics, right?  Dr Berkowitz: That's right. I did the neuroinfectious disease issue in… was it 2020? 2021? Something like that.  Dr Jones: Yeah. So, congratulations, more people have walked on the moon than done what you've done. And I'm looking forward to chatting, Aaron, and really grateful for your work putting together a fantastic issue. I think our listeners will appreciate that the nervous system does not function in isolation. It's important to understand the neurologic manifestations of diseases that originate within the brain, spinal cord, nerves, muscles, etc., but also the manifestations of diseases that begin in other systems and, you know, may masquerade as a primary neurologic disorder. So, it's obviously an important topic for neurologists, since many of these patients are receiving care in another setting, perhaps from another specialist. I almost think of this issue of Continuum as a handbook for the consultant neurologist, inpatient or outpatient. I don't know. Do you think that's a fair characterization of the topic? Dr Berkowitz: Absolutely. I completely agree with you. I think, yeah, many of us go into neurology interested in our primary diseases, whether it's stroke or Parkinson's or neuropathy or particular interest in neurologic symptoms, whether they're cognitive, motor, sensory, visual. And we quickly learn in residency, right? As you said, a lot of what we see is neurologic manifestations of primary diseases. So, I don't know how similar this is to other training programs. But it seemed like, if I'm remembering correctly, my first year of residency was mostly on primary neurology services, general stroke, ICU. And we moved into the consultant role more in the PGY-3 year the next year. And I remember explaining to students rotating with us on the consult services, this is actually much more complex in a way, because the patient has some type of symptom in a much broader and much more complicated context of multiple things going on. And I call it "neurology in the wild." There's, like, neurology of, this patient's had a stroke and we know they have a stroke and we're trying to figure out why and treat it. That's all interesting. But our question here, is there a stroke needle buried in this haystack of all of these medical or surgical complications? And learning what I call neurology of X, which is really what this issue is; as you said, that there's a neurology of everything. There's a neurology of cardiac disease. There's a neurology of the peripartum. There's a neurology of rheumatologic disease. There's every new treatment that comes out in oncology has a neurology we learn, right? There's a neurology of everything.  Dr Jones: There's a lot of axes, right? There's the heart-brain axis and the kidney-brain axis. And… I think we cover everything except the spleen-brain axis, which maybe that's a thing, maybe not. I'll probably hear from all the spleen fans out there. So, I want to do a little bit of an experiment. We're going to do something new today on the podcast. Before we get into the questions, we're going to start with a Continuum Audio trivia question. So, this will be a first time ever. Dr Berkowitz, we all know that chronic hyperglycemia, or diabetes, can lead to many neurologic and systemic complications and that optimal glucose control is our goal. For our listeners, here's the question: what neurologic complication can occur from correcting hyperglycemia too quickly? What neurologic complication can occur from correcting hyperglycemia too quickly? Stick around to the end of our interview for the answer. So, Aaron, let's get right to it. You had a chance to review all the articles in this issue on the neurology of systemic disease. What do you think in all of those is the most exciting recent development for patients who fit into this category? Dr Berkowitz: Yeah, that's a great question. I think we talked about when we were putting this issue together, right, a lot of the Continuum subspecialty topics; there should have been updates on particular disease diagnostics, treatments, new phenotypes. Whereas here probably a lot less has changed in primary heart disease, primary cancer. As I'd like to say to our students trying to excite them about neurology, most specialties have new treatments, but I can name a large number of new diseases, right, that have been discovered since we've been out of training. So, a lot of the primary medicine stays the same, and the neurologic complications stay the same. But probably the thing that many readers will want to keep handy and will probably be much in need of update again in three years are the neurologic complications of all the new cancer treatments. So, if we think back to I finished training just over ten years ago when a lot of the fill-in-the-blank-umabs were coming out, CAR T therapy, and we were starting to see a lot of neurology, I remember, related to these and telling the oncologists and they said, oh, you just wait. We are seeing at the conferences that there's a lot of neurology to these. And I feel like that is always a moving target. And I think we are seeing a lot of those and it's hard to keep up with which treatments can cause which complications, which syndromes and which severities require holding the treatment when you can rechallenge longer-term complications of CAR T cell therapies now that we've learned more about the acute complications. So, Amy Pruitt from Penn has written us a fantastic article for this issue that covers a lot of the updates there. And I learned a lot from that. I feel like that's the one that just like every time the carnioplastic diseases are reviewed in Continuum, it seems like the table is another page longer from your colleagues there in Rochester teaching us about new antibodies. And I feel like, for this issue, that's one of the areas that felt like there was a lot of very new content to keep up with since last time.  Dr Jones: That's good news, right? It's good that we have new immunotherapies for cancer, but it does lead to neurologic catastrophes sometimes, and it is a moving target, really rapid. So, you mentioned that just over ten years ago you finished your training and now we see a lot more of these complex immunotherapy-related neurologic complications. What about in the other direction? Are there any things that you see less commonly now in your practice than you might have seen ten years ago right when you were finishing training?  Dr Berkowitz: I would say no, I think. I think we're seeing a lot of new stuff, and we're still seeing a high volume of the classic consults we tend to get, whether that's altered mental status in a patient who's systemically ill; weakness or difficulty reading from the ventilator in a patient who's critically ill; patient has endocarditis and has a stroke hemorrhage or mycotic aneurysm, what do we do? Yeah, one of the parts that was really fun and educational editing this issue is, I really wanted to ask the experts the questions I find that are really troubling and challenging and make sure we could understand their perspective on things like the endocarditis consult, which I always feel like each time there's some twist that even though the question is what do we do about this stroke and/or hemorrhage and/or aneurysm and is surgery safe? It seems like each time I always feel like I'm reinventing the wheel, trying to really sort out how to think about this. And we have a great article from Alvin Doss at Beth Israel and Steve Feskey from Boston Medical Center. It covers a lot of cardiology, as you know, in that article about a great section on endocarditis where every time it came back for review, I would say, but what about this? This comes up. What about this? Can you explain how you think about this for our readers? I don't know. I'd be curious to hear your perspective. It sounds like we agree on what has become more common. I don't think anything in neurology seems to become less… Dr Jones: Well, no, I guess we haven't really solved anything, I guess we haven't cured any problem. But that's okay, right? I mean, it's building on an established foundation of experience and history in our field. And you know, we mentioned earlier that in many ways this issue is kind of like a neurology consultant's handbook. We did something a little different with it in that sense. In addition to you serving as the guest editor, you have authored an article in the issue. It touches on something that we've talked about a couple of times, and I'd be interested to hear you talk through it with our listeners a little bit on how to approach the neurologic consultation. Tell us a little more about that and your article and how you approached it.  Dr Berkowitz: Oh, yeah, thanks. Well, thanks first of all for inviting me to think about a sort of introductory article to this issue. And I was trying to think about what to write about because, as you've said and we've been talking about, no one could know every neurologic complication of every medical disease, treatment, surgery, hospital context. Probably many of us don't even know all the muscle diseases, right, within neurology. So how could we know all this stuff? And we need some type of manual from our colleagues that can explain, okay, I know this patient has inflammatory bowel disease and they've had a stroke. Is that- are these related? Are these unrelated? And I thought the articles kind of answer all of these questions. What would I say beyond this patient has disease X and is on drug Y? Well, look up in this issue disease X and see what the neurology can be, common and rare and how often it's associated, how often it's the presenting feature, how often it means the treatment is failing, etc. I thought, I'm not sure there's much to say there. That's about a paragraph. And I thought, well, let's think even more broadly about neurologic consultation. And as you know, I like to think about diagnostic reasoning and clinical reasoning. And we talk a lot about framing bias right? And I think that is very common in consultative neurology because we'll be told in the consult or in the page or E-consult or whatever it is, this is a blank-year-old blank with a history of blank on treatment blank. And right away your mind is starting to say, oh, well, the patient just had heart disease, or, the patient is nine months pregnant, or, the patient is on an immune checkpoint inhibitor. And whether you want to do it or not, your mind is associating the patient's neurology with that. And it's- even if we know we're framing or anchoring, it's hard to kind of pull away from that. And most of the time, common things being common, a patient with cancer develops new neurology, It's probably the cancer, the treatment, or sometimes a paraneoplastic syndrome. But I've definitely found if you do a lot of inpatient neurology and a lot of consults that you're seeing so much and you have no choice but to apply these heuristics, because you're seeing a lot of volume quickly and the patients are in the hospital or they're being closely followed and outpatient setting by another specialist. You presume if you didn't get it quite right the first time, it's going to come back to you. And there's a little bit of difficulty figuring out, this is a case, actually, of all the altered mental status in acutely ill patients I got today, this is the one I should dig deeper in that I think this could turn out to be a stroke or encephalitis as opposed to delirium. I felt like that I really haven't approached that except knowing that it's easy to fall into traps. And so, I started to think about framing bias. You know, we talked about if we become aware of our biases, right, we're better at not falling prey to them. But it's subconscious. So, we might be applying it without even realizing, or even saying, I might be framing this case the wrong way, you can go right on framing it the wrong way. So, I want to kind of get a little more granular on what types of framing biases actually are relevant, specifically, to the console setting. And so, I tried to come up with a few more specific examples and try to think about ways that we could at least have a quick, if our knee-jerk is to associate primary disease X that the patient has or primary treatment X with neurologic symptom Y, what's at least a quick counter-knee jerk to say, what if it could be something else? So, for example, one of them I call "low signal-to-noise ratio bias." Altered mental status in the acutely ill hospitalized patient. What would you say, Lyell? 99 out of 100- 99.9 out of 100, it's not a primary neurologic disease. Is that fair to say? Dr Jones: Very high, yep. I agree. Dr Berkowitz: Yeah. But could it be a stroke? Could it be non-convulsive status epilepticus, meningitis encephalitis? So, how do we sort of counteract low signal-to-noise ratio bias, acknowledging it exists, acknowledging most of the time there is a low signal-to-noise, that it's not going to be neurology---to just for example, use the time course. This is pretty acute. Have I convinced myself this is not a stroke or a seizure or an acute neurologic infection? And if I'm not sure at the bedside, should I err on the side of more testing? Or the "curbside bias," as I call when your colleague just sends you a text message on your phone, No need to even open the chart, Dr Jones. Patient had a cerebellar stroke. Incidental. They're here for something else. Aspirin, right? Just like a super tentorial stroke. And you might reply thumbs up. And then imagine you open the CT scan and it's a huge cerebellar stroke with fourth ventricular compression- and patient can hide a lot of stroke back there, might just have a little ataxia. You were curbsided and that framed you to think, oh, they asked me, is aspirin okay for a cerebellar stroke and I said yes, without realizing actually the question should have been posed is, how do you manage a huge stroke with mass effect in the posterior fossa? So, these types of biases, I come up with five of them, I won't go through all of them. I'm in the article to sort of acknowledge for the reader, most of the time it's going to be what you look up in this issue, but how to think about the times where it might not be and how to be more precise about what framing is and different types of framing that occur specifically in the consultant arena. Dr Jones: And I think the longer we practice, the more of those low-frequency exceptions that you see. And, you know, and then it sticks in our mind and sometimes the bias swings the other way; people, you know, think primarily about the low frequency. And so, it's tricky. And what I really enjoyed about that article, we started talking about this probably more than a year ago, and more than a year ago, I would say relatively few clinicians were using a now widely popular large language model for clinical decision-making; we won't name the model. And now I think most clinicians are using it almost every day, right? And I think it puts a premium on how to think and how to engage with the patient, and less about the facts and the lists that a lot of conventional medical education really is derived from. So, I really appreciate that article. We can pat ourselves in the back. We had some foresight to put it in the issue, and I think it's a great addition to it. Dr Berkowitz: Thank you. Dr Jones: So, the list of potential topics when we think about the neurologic manifestations of systemic disease, we tend to break it down by organ systems, right? But the amount of things that could end up in the issue is almost infinite. Is there anything that, when you were putting this issue together---either in terms of the topics or editing the articles---is there anything that you wanted to include, but we just didn't have room? Dr Berkowitz: I certainly won't say we covered everything, but I will say we were able to recruit a fantastic team of authors. And as you and I also talked about at the beginning, although you could say, we're doing the movement disorders issue, let's find all the top movement disorders folks who are expert specialists in this field, there's not really a neurohematologist or a neurogastroenterologist out here. So, you and I put our heads together to think of phenomenal general neurologists in most cases, some subspecialists who know a lot about this but were also excited to read a lot more about it and assemble the existing knowledge by the practicing neurologist for the practicing neurologist. And I think with that approach and letting folks have kind of, you know, I asked some specific questions. These are topics I hope you'll cover. These are vexing questions in this area. I hope you'll find some answers to how often can this neurology be the primary feature of this rheumatologic disease with no systemic manifestations and when should we look or as we mentioned, the complicated endocarditis consult. I won't say we covered everything. This could be, and is, textbook-sized, and there are textbooks on this topic. But I think on the contrary, authors came back and had sections on things that I might not have thought to ask- to cover. Dr Sarah LaHue, my colleague here at UCSF, I asked for an article, as traditionally in this issue, on the neurology of pregnancy in the postpartum state and included, I think probably for the first time in Continuum, a fantastic review of neurologic considerations in patients in menopause, which I'm not sure has been covered before. So, things that I wouldn't have even thought to ask for. Our authors came back with some fantastic stuff. And the ICU article by Dr Shivani Ghoshal, instead of focusing just on altered mental status in the ICU, weakness in the ICU---those are all in there---I also asked her to discuss complications of procedures in the ICU. How often do procedures in the ICU cause local neuropathies or vascular injury, these types of things. Dr Jones: Yeah, me too. And I guess that's a great advertisement, that there probably are things that we didn't cover, but if there are, we can't think of them. We've done as best as we can. So now let's come back to our Continuum Audio trivia question for our listeners. And I'll repeat the question: what neurologic complication can occur from correcting hyperglycemia too quickly? And I actually think there might be two correct answers to this one. Dr Berkowitz, what do you think? Dr Berkowitz: Yeah, I was thinking of two things. I hope these are the things you're thinking of as well. One is what I think used to be referred to as insulin neuritis, sort of an acute painful small fiber neuropathy from after the initiation of insulin, I think also called treatment-induced diabetic neuropathy or something of that nature. And then the other one described, defined and classified by your colleagues there in Rochester, the diabetic lumbosacral radiculoplexis neuropathy or Bruns-Garland syndrome or a diabetic amyotropy, I think, can also---if I'm not mistaken---also occur in this context; you should have weight loss in association with diet treatment of diabetes. But how did I do? Dr Jones: Yeah, you win the prize, the first-ever prize. There's no monetary value to the prize, but pride, I think, is a good one. Yeah, those were the two I was thinking of. The treatment-induced neuropathy of diabetes is really nicely covered in Dr Rafid Mustafa's article on the neurologic complications of endocrine disorders. It's a rare condition characterized by the acute/subacute onset of diffuse neuropathic pain and some usually some autonomic dysfunction. And it occurs when you have rapid and substantial reductions in blood glucose levels. And you can almost map it out. There was a study from 2015 which is referenced in the article, which found that a drop in hemoglobin A1c of 2 to 3% over three months confers about a 20% absolute risk of developing this treatment-induced neuropathy of diabetes, and a drop of more than 4%, more than 80% risk. So, very substantial. And then in the other---we see this commonly in patients with diabetic lumbosacral radiculoplexis neuropathy---they have the subacute onset of usually asymmetric pain and weakness in the lower limbs that tends to occur more frequently in patients who have had recent better control of their sugar. We can also see it in the upper limbs too. So, you get a perfect score. Dr Berkowitz, well done. Again, I want to thank you. I want to thank you for such a great issue, a great article to kick off the issue, and a great discussion of the neurology of systemic disease. Today I learned a lot talking today, I learned a lot reading the issue. Really grateful for your leadership of putting it together, pulling together a really great author panel, and I think it will come in handy not just for our junior readers and listeners, but also our more experienced subscribers as well. Dr Berkowitz: Thank you so much. Like I said, it was a big honor to be invited to guest edit this issue. I've read it every three years since I started residency. It's always one of my favorite issues. As you said, a manual for consultative neurology, and I learned a ton from our authors and really appreciate the opportunity to work with you and the amazing Continuum team to bring this from an idea, as you said, probably over a year ago to a printed issue. So, thanks again, Lyell. Dr Jones: Thank you. And again, we've been speaking with Dr Aaron Berkowitz, guest editor of Continuum's most recent issue on the neurology of systemic disease. Please check it out, and thank you to our listeners for joining today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. Thank you for listening to Continuum Audio.

Dr. Rupsa Boelig, a 2025 March of Dimes Discovery Research Grant winner and an Associate Professor of Obstetrics and Gynecology in the Division of Maternal Fetal Medicine at Philadelphia's Thomas Jefferson University, discusses her new study on the metabolism of aspirin in pregnant women with diabetes or a higher BMI. She hopes the study findings will shed light on whether these women may benefit from a higher aspirin dose to help prevent preeclampsia and/or preterm birth.

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Chief Medical Officer of Northwestern Medicine's Northwest region of hospitals Dr. Irfan Hafiz joins Bob Sirott to talk about myths concerning aspirin, the types of physical activities that could help prolong your lifespan, and technology that could help with the future of treating cancer. He also shares details about why it’s important to eat slower, […]

We unpack new studies that reshape how we counsel on VBAC after short intervals, update what we tell BRCA carriers about estrogen therapy, and explore how self-collected HPV tests can reduce screening gaps. We also question surgical marketing, workforce trends, and the shaky evidence behind aspirin dosing for preeclampsia.• Short interpregnancy interval as a VBAC risk factor, not a contraindication• Absolute uterine rupture rates in spontaneous vs induced labor• Estrogen therapy in BRCA carriers and treated gyn cancers• Cervical screening overuse and underscreening in insured populations• Self-collected HPV testing intervals and access benefits• OB-GYN workforce shortages and rural distribution gaps• Endometriosis surgery indications versus fertility claims• Robotics versus laparoscopy outcomes and training priorities• Aspirin dose trials, lack of placebo arms, and abruption signals• Reading statistics correctly and demanding better editorial standards0:00 Setting The Agenda: New Studies0:40 Short Interval Pregnancy And VBAC Risk3:10 Quantifying Uterine Rupture By Spacing8:10 Induction, Augmentation, And Rupture Math9:40 HRT In BRCA Carriers: New Evidence13:05 Estrogen After Gyn Cancers: Practice Gaps17:40 Cervical Screening: Overuse And Underscreening22:30 Self-Collected HPV Testing Guidance27:00 OB-GYN Shortages And Distribution33:20 Endometriosis Surgery And Fertility Claims41:20 Robotics Vs Laparoscopy: Outcomes And Training47:20 Aspirin Dosing For Preeclampsia: No Signal55:30 Interpreting Stats And Editorial Standards59:20 Closing Notes And Next StepsBe sure to check out thinking about obgyn.com for more information, and be sure to follow us on InstagramFollow us on Instagram @thinkingaboutobgyn.

For years, doctors have recommended taking Aspirin every day to help prevent heart attacks and stroke. Cardiologist Dr. Sonia Anand says that advice is still correct, but it only applies to certain patients. She cautions against taking too much Aspirin, because acetylsalicylic acid can increase the risk of bleeding in the stomach and brain.For transcripts of The Dose, please visit: lnk.to/dose-transcripts. Transcripts of each episode will be made available by the next workday. For more episodes of this podcast, click this link.

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-468 Overview: We first discussed aspirin use for primary prevention of cardiovascular disease in 2022 when the USPSTF recommended against it. In this follow-up episode, we review new trial data reinforcing that guidance and help you translate the evidence into safer prevention strategies. Build confidence in supporting patients with evidence-based approaches to reduce cardiovascular risk. Episode resource links: Aspirin, cardiovascular events, and major bleeding in older adults: extended follow-up of the ASPREE trial. Eur Heart J. 2025 Aug 12:ehaf514. doi: 10.1093/eurheartj/ehaf514. Epub ahead of print. PMID: 40796244. Guest: Robert A. Baldor MD, FAAFP   Music Credit: Matthew Bugos Thoughts? Suggestions? Email us at FranklySpeaking@pri-med.com The views expressed in this podcast are those of Dr. Domino and his guests and do not necessarily reflect the views of Pri-Med.

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-468 Overview: We first discussed aspirin use for primary prevention of cardiovascular disease in 2022 when the USPSTF recommended against it. In this follow-up episode, we review new trial data reinforcing that guidance and help you translate the evidence into safer prevention strategies. Build confidence in supporting patients with evidence-based approaches to reduce cardiovascular risk. Episode resource links: Aspirin, cardiovascular events, and major bleeding in older adults: extended follow-up of the ASPREE trial. Eur Heart J. 2025 Aug 12:ehaf514. doi: 10.1093/eurheartj/ehaf514. Epub ahead of print. PMID: 40796244. Guest: Robert A. Baldor MD, FAAFP   Music Credit: Matthew Bugos Thoughts? Suggestions? Email us at FranklySpeaking@pri-med.com The views expressed in this podcast are those of Dr. Domino and his guests and do not necessarily reflect the views of Pri-Med.

En este episodio abordo la farmacología en neurorrehabilitación del adulto desde una perspectiva clínica y realista, pensada especialmente para profesionales no médicos que conviven a diario con informes, pautas y nombres de fármacos sin disponer siempre de un marco claro para interpretarlos. Recorremos los principales medicamentos utilizados en patologías neurológicas frecuentes —ictus, lesión medular, esclerosis múltiple, enfermedad de Parkinson, ELA, distonías y traumatismo craneoencefálico— diferenciando entre tratamientos agudos, terapias modificadoras de la enfermedad y manejo farmacológico de secuelas. A lo largo del episodio explico de forma progresiva los mecanismos de acción, la base neurofisiológica y el estado actual de la evidencia, poniendo especial énfasis en qué fármacos realmente cambian el pronóstico y cuáles cumplen un papel fundamentalmente sintomático. El objetivo no es prescribir, sino entender mejor cómo la farmacología condiciona la recuperación, la participación en terapia y la toma de decisiones en neurorrehabilitación, con una mirada crítica y basada en la evidencia disponible. Referencias del episodio: 1.     Adams, M. M., & Hicks, A. L. (2005). Spasticity after spinal cord injury. Spinal cord, 43(10), 577–586. https://doi.org/10.1038/sj.sc.3101757 (https://pubmed.ncbi.nlm.nih.gov/15838527/). 2.     AFFINITY Trial Collaboration (2020). Safety and efficacy of fluoxetine on functional outcome after acute stroke (AFFINITY): a randomised, double-blind, placebo-controlled trial. The Lancet. Neurology, 19(8), 651–660. https://doi.org/10.1016/S1474-4422(20)30207-6 (https://pubmed.ncbi.nlm.nih.gov/32702334/). 3.     Angeli, C. A., Edgerton, V. R., Gerasimenko, Y. P., & Harkema, S. J. (2014). Altering spinal cord excitability enables voluntary movements after chronic complete paralysis in humans. Brain : a journal of neurology, 137(Pt 5), 1394–1409. https://doi.org/10.1093/brain/awu038 (https://pubmed.ncbi.nlm.nih.gov/24713270/). 4.     Bracken, M. B., Shepard, M. J., Collins, W. F., Holford, T. R., Young, W., Baskin, D. S., Eisenberg, H. M., Flamm, E., Leo-Summers, L., & Maroon, J. (1990). A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury. Results of the Second National Acute Spinal Cord Injury Study. The New England journal of medicine, 322(20), 1405–1411. https://doi.org/10.1056/NEJM199005173222001 (https://pubmed.ncbi.nlm.nih.gov/2278545/). 5.     Bracken, M. B., Shepard, M. J., Holford, T. R., Leo-Summers, L., Aldrich, E. F., Fazl, M., Fehlings, M., Herr, D. L., Hitchon, P. W., Marshall, L. F., Nockels, R. P., Pascale, V., Perot, P. L., Jr, Piepmeier, J., Sonntag, V. K., Wagner, F., Wilberger, J. E., Winn, H. R., & Young, W. (1997). Administration of methylprednisolone for 24 or 48 hours or tirilazad mesylate for 48 hours in the treatment of acute spinal cord injury. Results of the Third National Acute Spinal Cord Injury Randomized Controlled Trial. National Acute Spinal Cord Injury Study. JAMA, 277(20), 1597–1604 (https://pubmed.ncbi.nlm.nih.gov/9168289/). 6.     Cardenas, D. D., Ditunno, J. F., Graziani, V., McLain, A. B., Lammertse, D. P., Potter, P. J., Alexander, M. S., Cohen, R., & Blight, A. R. (2014). Two phase 3, multicenter, randomized, placebo-controlled clinical trials of fampridine-SR for treatment of spasticity in chronic spinal cord injury. Spinal cord, 52(1), 70–76. https://doi.org/10.1038/sc.2013.137 (https://pubmed.ncbi.nlm.nih.gov/24216616/). 7.     Chollet, F., Tardy, J., Albucher, J. F., Thalamas, C., Berard, E., Lamy, C., Bejot, Y., Deltour, S., Jaillard, A., Niclot, P., Guillon, B., Moulin, T., Marque, P., Pariente, J., Arnaud, C., & Loubinoux, I. (2011). Fluoxetine for motor recovery after acute ischaemic stroke (FLAME): a randomised placebo-controlled trial. The Lancet. Neurology, 10(2), 123–130. https://doi.org/10.1016/S1474-4422(10)70314-8 (https://pubmed.ncbi.nlm.nih.gov/21216670/). 8.     Dávalos, A., Alvarez-Sabín, J., Castillo, J., Díez-Tejedor, E., Ferro, J., Martínez-Vila, E., Serena, J., Segura, T., Cruz, V. T., Masjuan, J., Cobo, E., Secades, J. J., & International Citicoline Trial on acUte Stroke (ICTUS) trial investigators (2012). Citicoline in the treatment of acute ischaemic stroke: an international, randomised, multicentre, placebo-controlled study (ICTUS trial). Lancet (London, England), 380(9839), 349–357. https://doi.org/10.1016/S0140-6736(12)60813-7 (https://pubmed.ncbi.nlm.nih.gov/22691567/). 9.     EFFECTS Trial Collaboration (2020). Safety and efficacy of fluoxetine on functional recovery after acute stroke (EFFECTS): a randomised, double-blind, placebo-controlled trial. The Lancet. 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Rho-ROCK inhibition in the treatment of spinal cord injury. World neurosurgery, 82(3-4), e535–e539. https://doi.org/10.1016/j.wneu.2013.01.009 (http://pubmed.ncbi.nlm.nih.gov/23298675/). 13.  Fournier, A. E., Takizawa, B. T., & Strittmatter, S. M. (2003). Rho kinase inhibition enhances axonal regeneration in the injured CNS. The Journal of neuroscience : the official journal of the Society for Neuroscience, 23(4), 1416–1423. https://doi.org/10.1523/JNEUROSCI.23-04-01416.2003 (https://pubmed.ncbi.nlm.nih.gov/12598630/). 14.  Giacino, J. T., Whyte, J., Bagiella, E., Kalmar, K., Childs, N., Khademi, A., Eifert, B., Long, D., Katz, D. I., Cho, S., Yablon, S. A., Luther, M., Hammond, F. M., Nordenbo, A., Novak, P., Mercer, W., Maurer-Karattup, P., & Sherer, M. (2012). Placebo-controlled trial of amantadine for severe traumatic brain injury. The New England journal of medicine, 366(9), 819–826. https://doi.org/10.1056/NEJMoa1102609 (https://pubmed.ncbi.nlm.nih.gov/22375973/). 15.  Goodman, A. D., Brown, T. R., Krupp, L. B., Schapiro, R. T., Schwid, S. R., Cohen, R., Marinucci, L. N., Blight, A. R., & Fampridine MS-F203 Investigators (2009). Sustained-release oral fampridine in multiple sclerosis: a randomised, double-blind, controlled trial. Lancet (London, England), 373(9665), 732–738. https://doi.org/10.1016/S0140-6736(09)60442-6 (https://pubmed.ncbi.nlm.nih.gov/19249634/). 16.  Goodman, A. D., Brown, T. R., Edwards, K. R., Krupp, L. B., Schapiro, R. T., Cohen, R., Marinucci, L. N., Blight, A. R., & MSF204 Investigators (2010). A phase 3 trial of extended release oral dalfampridine in multiple sclerosis. Annals of neurology, 68(4), 494–502. https://doi.org/10.1002/ana.22240 (https://pubmed.ncbi.nlm.nih.gov/20976768/). 17.  Hurlbert, R. J., Hadley, M. N., Walters, B. C., Aarabi, B., Dhall, S. S., Gelb, D. E., Rozzelle, C. J., Ryken, T. C., & Theodore, N. (2013). Pharmacological therapy for acute spinal cord injury. Neurosurgery, 72 Suppl 2, 93–105. https://doi.org/10.1227/NEU.0b013e31827765c6 (https://pubmed.ncbi.nlm.nih.gov/23417182/). 18.  Johnston, S. C., Amarenco, P., Denison, H., Evans, S. R., Himmelmann, A., James, S., Knutsson, M., Ladenvall, P., Molina, C. A., Wang, Y., & THALES Investigators (2020). Ticagrelor and Aspirin or Aspirin Alone in Acute Ischemic Stroke or TIA. The New England journal of medicine, 383(3), 207–217. https://doi.org/10.1056/NEJMoa1916870 (https://pubmed.ncbi.nlm.nih.gov/32668111/). 19.  Kheder, A., & Nair, K. P. (2012). Spasticity: pathophysiology, evaluation and management. Practical neurology, 12(5), 289–298. https://doi.org/10.1136/practneurol-2011-000155 (https://pubmed.ncbi.nlm.nih.gov/22976059/). 20.  Kirkman, M. A., Day, J., Gehring, K., Zienius, K., Grosshans, D., Taphoorn, M., Li, J., & Brown, P. D. (2022). Interventions for preventing and ameliorating cognitive deficits in adults treated with cranial irradiation. The Cochrane database of systematic reviews, 11(11), CD011335. https://doi.org/10.1002/14651858.CD011335.pub3 (https://pubmed.ncbi.nlm.nih.gov/36427235/). 21.  Martinsson L, Hårdemark H, Eksborg S. Amphetamines for improving recovery after stroke. Cochrane Database Syst Rev. 2007 Jan 24;2007(1):CD002090. doi: 10.1002/14651858.CD002090.pub2. PMID: 17253474; PMCID: PMC12278358 (https://pubmed.ncbi.nlm.nih.gov/17253474/). 22.  Miller, T. M., Cudkowicz, M. E., Genge, A., Shaw, P. J., Sobue, G., Bucelli, R. C., Chiò, A., Van Damme, P., Ludolph, A. C., Glass, J. D., Andrews, J. A., Babu, S., Benatar, M., McDermott, C. J., Cochrane, T., Chary, S., Chew, S., Zhu, H., Wu, F., Nestorov, I., … VALOR and OLE Working Group (2022). Trial of Antisense Oligonucleotide Tofersen for SOD1 ALS. The New England journal of medicine, 387(12), 1099–1110. https://doi.org/10.1056/NEJMoa2204705 (https://pubmed.ncbi.nlm.nih.gov/36129998/). 23.  Mueller, B. K., Mack, H., & Teusch, N. (2005). Rho kinase, a promising drug target for neurological disorders. Nature reviews. Drug discovery, 4(5), 387–398. https://doi.org/10.1038/nrd1719 (https://pubmed.ncbi.nlm.nih.gov/15864268/). 24.  Nourbakhsh, B., Revirajan, N., & Waubant, E. (2018). Treatment of fatigue with methylphenidate, modafinil and amantadine in multiple sclerosis (TRIUMPHANT-MS): Study design for a pragmatic, randomized, double-blind, crossover clinical trial. Contemporary clinical trials, 64, 67–76. https://doi.org/10.1016/j.cct.2017.11.005 (https://pubmed.ncbi.nlm.nih.gov/29113955/). 25.  Paganoni, S., Hendrix, S., Dickson, S. P., Knowlton, N., Macklin, E. A., Berry, J. D., Elliott, M. A., Maiser, S., Karam, C., Caress, J. B., Owegi, M. A., Quick, A., Wymer, J., Goutman, S. A., Heitzman, D., Heiman-Patterson, T. D., Jackson, C. E., Quinn, C., Rothstein, J. D., Kasarskis, E. J., … Cudkowicz, M. E. (2021). Long-term survival of participants in the CENTAUR trial of sodium phenylbutyrate-taurursodiol in amyotrophic lateral sclerosis. Muscle & nerve, 63(1), 31–39. https://doi.org/10.1002/mus.27091 (https://pubmed.ncbi.nlm.nih.gov/33063909/). 26.  Schwab M. E. (2004). Nogo and axon regeneration. Current opinion in neurobiology, 14(1), 118–124. https://doi.org/10.1016/j.conb.2004.01.004 (https://pubmed.ncbi.nlm.nih.gov/15018947/). 27.  Shneider, N. A., Harms, M. B., Korobeynikov, V. A., Rifai, O. M., Hoover, B. N., Harrington, E. A., Aziz-Zaman, S., Singleton, J., Jamil, A., Madan, V. R., Lee, I., Andrews, J. A., Smiley, R. M., Alam, M. M., Black, L. E., Shin, M., Watts, J. K., Walk, D., Newman, D., Pascuzzi, R. M., … Bennett, C. F. (2025). Antisense oligonucleotide jacifusen for FUS-ALS: an investigator-initiated, multicentre, open-label case series. Lancet (London, England), 405(10494), 2075–2086. https://doi.org/10.1016/S0140-6736(25)00513-6 (https://pubmed.ncbi.nlm.nih.gov/40414239/). 28.  Stocchi, F., Bravi, D., Emmi, A., & Antonini, A. (2024). Parkinson disease therapy: current strategies and future research priorities. Nature reviews. Neurology, 20(12), 695–707. https://doi.org/10.1038/s41582-024-01034-x (https://pubmed.ncbi.nlm.nih.gov/39496848/).

A Podcast from Obstetrics & Gynecology highlighting the latest research and practice updates in the field. This episode features interviews with Drs. Amrin Khander and Line Malha, authors of "Comparison of 162 mg and 81 mg Aspirin for Prevention of Preeclampsia: A Randomized Controlled Trial," and Erin Chang and Dr. Emily S. Miller, authors of "Smartphone Applications to Support Perinatal Mental Health."

Joyce talks about:The detailed account of what it took to capture Venezuelan President, Maduro. The media's agenda and cherry picking of information. Iran's antigovernment protests.Illegal immigration and the democratic machine. President Trump speaking on his health and Aspirin. Sid Rosenberg joins the 850 WFTL family Saturdays at 8am!See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Aussortiert - Was passiert mit unseren alten Klamotten?; Warum werden Menschen Rassisten?; Stickoxide - noch immer problematisch?; Aspirin - was macht eine hohe Dosis á la Trump?; Ein Jahr nach Feuern in LA - Brandbekämpfung aus der Luft; Astrobiologie - gibt es anderes Leben da draußen im All?; Wer einmal lügt..... Wie schnell verspielen PolitikerInnen Vertrauen?; Moderation: Marlis Schaum. Von WDR 5.

Trump's daily high-dose aspirin habit is making headlines! We'll talk about how much aspirin is actually safe, what it does for your heart, and when a “little extra” can be risky. Then, we're turning to Oprah's GLP-1 journey and how she's changing the conversation on obesity and the science behind why experts now call it a disease, not a willpower issue.Next, we'll cover the nationwide recalls on common cold medicines and ground beef tied to E. coli contamination, plus what's behind the record U.S. measles spike and the Real Housewives of Atlanta (RHOA) star, Shamea Morton's chemical peel lawsuit. Come hang with us for the latest trending medical headlines and celebrity health news.This podcast is intended to be informational only.  It is not a medical consultation, nor is it personalized medical advice.  For medical advice, please consult your physician.#HealthHappyLifePodcast #DrFrita #DrFritaLIVE! #MedicalMondays #CelebrityHealthNews #MedicineInTheNewsHere are a few helpful resources to help on your journey to wellness:▶️ Subscribe so you will never miss a YouTube video.

In episode 1984, Jack and Miles are joined by comedian and host of Rebrand, Mort Burke, to discuss… Trump: People Say I’m Jealous But My Kink Is Just Karma, Benny Johnson: Venezuela Rigged The 2020 Election! So Yeah! Trump Health? John Krasinski Laid The Groundwork For Venezuela Attack and more! U.S. plan to ‘run’ Venezuela clouded in confusion Benny Johnson: Venezuela Rigged The 2020 Election! So Yeah! Trump Health? John Krasinski Laid The Groundwork For Venezuela Attack Jack Ryan clip about Venezuela gets viral amid capture of Nicolàs Maduro. Did ‘Jack Ryan’ Predict U.S.’ Venezuela Intervention? Co-Creator Carlton Cuse Reacts To Season 2 Clip Going Viral, Shares Hopes For “Stability And Peace” Amazon's 'Jack Ryan' TV series lambasted for promoting Venezuela 'invasion' Jack Ryan is the Latest TV Show to Film at CIA Headquarters How Does Amazon's 'Jack Ryan' Compare to Real Life at the CIA? LISTEN: 4 Raws by EsDeeKidSee omnystudio.com/listener for privacy information.

Dr. Kahn kicks off 2026 by reviewing recent media reports on aspirin use and dosing for the prevention of cardiovascular events in the President of the United States. Much of the coverage overlooks an important factor: the relationship between aspirin dose and body weight. Dr. Kahn examines data from multiple studies suggesting that, in some cases, only higher-dose aspirin was effective in preventing cardiovascular events. As always, listeners are encouraged to discuss aspirin use and dosing with their own medical team. Additional topics this week include the health impact of carryout meals, kidney function and cystatin C, statin use in patients with diabetes, the risks associated with tramadol, cold drink–induced atrial fibrillation, and recent health reports involving Chevy Chase and Jelly Roll. Dr. Kahn also invites listeners to join an upcoming group 5-day PROLON Fasting Mimicking Diet, supported by dietitians and health educators. Order your PROLON kit now at prolonlife.com/drkahn to be ready to participate.

Most men think ED is just a performance issue. It's not. It's one of the earliest warning signs of cardiovascular decline and it often appears years before chest pain, shortness of breath, or heart attack symptoms.Thank you to our sponsors! -EMR-Tek | https://www.emr-tek.com/DAVE and use code DAVE for 40% off.-GOT MOLD? | Go to http://gotmold.com/shop and use DAVE10 to save 10% and see what's in your air.Chapters00:00 - The “Legal Blue Pill” Myth & Hidden Danger00:57 - What ED Actually Is (Not the Commercial Version)01:45 - Circulation, Arteries & the Real Root Cause03:27 - The Problem with Relying on ED Pills05:03 - Treat ED as a Cardiovascular Symptom05:55 - Patterns That Reveal Vascular Decline07:10 - The ED–Heart Attack Countdown Window08:14 - How To Fix This Problem10:10 - Microdosing Cialis for Vascular Support10:45 - Aspirin as Another Option11:15 - Lifestyle Drivers of Vascular Damage & Solutions13:15 - Movement, Walking & Circulation Basics13:40 - The Mitochondria–Erection Connection15:00 - Recharging Mitochondria16:02 - Chronic Inflammation: The Silent Culprit17:17 - Smoking, Vaping, Obesity & Diabetes18:30 - How To Reduce InflammationResources: • Dave Asprey's Latest News | Go to https://daveasprey.com/ to join Inside Track today. • Danger Coffee: https://dangercoffee.com/discount/dave15 • My Daily Supplements: SuppGrade Labs (15% Off) • Favorite Blue Light Blocking Glasses: TrueDark (15% Off) • Dave Asprey's BEYOND Conference: https://beyondconference.com • Dave Asprey's New Book – Heavily Meditated: https://daveasprey.com/heavily-meditated • Upgrade Collective: https://www.ourupgradecollective.com • Upgrade Labs: https://upgradelabs.com • 40 Years of Zen: https://40yearsofzen.com Connect with Dave Asprey!Website: https://daveasprey.comTikTok: https://www.tiktok.com/@daveaspreyofficialInstagram: https://www.instagram.com/dave.asprey/Facebook: https://www.facebook.com/Daveaspreyofficial/X: https://x.com/daveaspreyYouTube: https://www.youtube.com/c/daveaspreybprThe Human Upgrade Podcast: Instagram: https://www.instagram.com/TheHumanUpgradePodcast/ Facebook: https://m.facebook.com/Thehumanupgrade/See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Drs Harrington and Gibson's annual review of cardiovascular medicine: ACS guidelines, antiplatelet management, GLP-1s, and ever lower LDL-C with drugs or even gene editing are among the highlights. This podcast is intended for healthcare professionals only. To read a transcript or to comment, visit https://www.medscape.com/author/bob-harrington New ACS Guidelines 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes https://doi.org/10.1161/CIR.0000000000001309 ACS Guideline Chair and Vice-Chair Discussion https://www.medscape.com/viewarticle/acs-guidelines-2025-key-points-chair-and-vice-chair-2025a100093l Antiplatelet/Antithrombotic Strategies Prasugrel Beats Ticagrelor in High-Risk Patients With Diabetes After PCI https://www.medscape.com/viewarticle/prasugrel-beats-ticagrelor-high-risk-patients-diabetes-after-2025a1000wbt Early Withdrawal of Aspirin after PCI in Acute Coronary Syndromes (NEO-MINDSET) https://www.nejm.org/doi/full/10.1056/NEJMoa2507980 Aspirin in Patients with Chronic Coronary Syndrome Receiving Oral Anticoagulation (AQUATIC) https://www.nejm.org/doi/full/10.1056/NEJMoa2507532 Bayesian Machine Learning Model Guiding Iterative, Personalized Anticoagulant Dosing Decision-Making : ENGAGE AF-TIMI 48 Trial Analysis https://doi.org/10.1016/j.jacadv.2025.102504 Factor XI Inhibitors Bristol Myers, J&J Stop Blood Clotting Drug Trial After Interim Review https://www.medscape.com/s/viewarticle/bristol-myers-j-j-stop-blood-clotting-drug-trial-after-2025a1000vqu Bayer's Asundexian Met Primary Efficacy and Safety Endpoints in Landmark Phase III OCEANIC-STROKE Study in Secondary Stroke Prevention https://www.bayer.com/en/us/news-stories/oceanic-stroke OAC-Naive Subgroup From OCEANIC-AF Published https://www.medscape.com/viewarticle/novel-blood-thinner-shows-promise-atrial-fibrillation-2025a10008lz GLP-1 and Myotrophic Drugs Lilly's Next-gen Drug Shows Greater Weight Loss Than Zepbound in Late-stage Trial (TRIUMPH-4) https://www.medscape.com/s/viewarticle/lillys-next-gen-drug-tops-zepbound-weight-loss-late-stage-2025a1000ys1 Amylin Analog Eloralintide Reduces Weight in Phase 2 Trial https://www.medscape.com/viewarticle/amylin-analog-eloralintide-reduces-weight-phase-2-trial-2025a1000uqf CRISPR and Lipid Lowering Patient-Specific In Vivo Gene Editing to Treat a Rare Genetic Disease https://www.nejm.org/doi/full/10.1056/NEJMoa2504747 Gene Therapy Shows Lipid Improvement but Raises Flags https://www.medscape.com/viewarticle/gene-therapy-shows-lipid-improvement-raises-flags-2025a1000uzw Phase 1 Trial of CRISPR-Cas9 Gene Editing Targeting ANGPTL3 https://www.nejm.org/doi/full/10.1056/NEJMoa2511778 Evolocumab in Patients without a Previous Myocardial Infarction or Stroke (VESALIUS-CV) https://www.nejm.org/doi/pdf/10.1056/NEJMoa2514428 Prehospital GLP IIb/IIIa Zalunfiban at First Medical Contact for ST-Elevation Myocardial Infarction (CELEBRATE) https://evidence.nejm.org/doi/full/10.1056/EVIDoa2500268 You may also like: Hear John Mandrola, MD's summary and perspective on the top cardiology news each week, on This Week in Cardiology https://www.medscape.com/twic Questions or feedback, please contact news@medscape.net

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-465 Overview: Many patients with coronary artery disease take aspirin, but how should clinicians navigate management when an anticoagulant is also needed? In this episode, we review indications for therapy, explore evidence on dual use, and discuss how to counsel patients on balancing cardiovascular benefits with the risks of combination therapy. Episode resource links: Lemesle G, Didier R, Steg PG, et al. Aspirin in Patients with Chronic Coronary Syndrome Receiving Oral Anticoagulation. N Engl J Med. Published online August 31, 2025. https://www.nejm.org/doi/full/10.1056/NEJMoa2507532 Guest: Alan M. Ehrlich, MD, FAAFP   Music Credit: Matthew Bugos Thoughts? Suggestions? Email us at FranklySpeaking@pri-med.com  

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-465 Overview: Many patients with coronary artery disease take aspirin, but how should clinicians navigate management when an anticoagulant is also needed? In this episode, we review indications for therapy, explore evidence on dual use, and discuss how to counsel patients on balancing cardiovascular benefits with the risks of combination therapy. Episode resource links: Lemesle G, Didier R, Steg PG, et al. Aspirin in Patients with Chronic Coronary Syndrome Receiving Oral Anticoagulation. N Engl J Med. Published online August 31, 2025. https://www.nejm.org/doi/full/10.1056/NEJMoa2507532 Guest: Alan M. Ehrlich, MD, FAAFP   Music Credit: Matthew Bugos Thoughts? Suggestions? Email us at FranklySpeaking@pri-med.com  

Early Discontinuation of Aspirin after PCI in Low-Risk Acute Myocardial Infarction (TARGET-FIRST)

Nutritionist Leyla Muedin details key aspects of supplement use and addresses frequently asked questions. Topics include the importance of targeted supplementation, the rationale behind personalized dosages, best practices for starting new supplements, and managing common issues like nausea and bright yellow urine. Leyla also explains why some supplements may cause gastrointestinal discomfort and provides guidance on how to adjust dosages for optimal results. Emphasis is placed on the benefits of pharmaceutical-grade supplements available on Fullscript and the necessity of regular blood tests to fine-tune supplementation.

Send us a textWelcome back Rounds Table Listeners! In our year-end episode, Drs. Mike and John Fralick discuss five important research studies published in 2025:Apixaban for Extended Treatment of Provoked Venous Thromboembolism (HI-PRO) (0:00 – 4:20)Tirzepatide for Heart Failure with Preserved Ejection Fraction and Obesity (SUMMIT) (4:21 – 9:30)Aspirin in Patients with Chronic Coronary Syndrome Receiving Oral Anticoagulation (AQUATIC) (9:31 – 15:03)Liberal fluid intake versus fluid restriction in chronic heart failure: a randomized clinical trial (FRESH-UP) (15:04 – 18:09)Phase 3 Trial of Semaglutide in Metabolic Dysfunction–Associated Steatohepatitis (ESSENCE) (18:10 – 23:49)The Good Stuff (23:50 – 25:27):Toronto Star Santa Claus Fund, Calgary Food Bank, The War Amps Questions? Comments? Feedback? We'd love to hear from you! @roundstable @InternAtWork @MedicinePods

Estimated reading time: 11 Minuten Im B2B-Vertrieb verkaufst du nicht "Features". Du verkaufst Klarheit, und du verkaufst Entscheidungssicherheit. Genau darum geht es hier: Bedarfsermittlung im B2B – nicht irgendwann, sondern planbar, sauber und wiederholbar. Statt nur zu hören, was der Kunde sagt, willst du verstehen, was wirklich dahintersteckt, damit du nicht am Symptom hängen bleibst. Gleichzeitig brauchst du den Blick fürs Buying Center, weil sonst der echte Entscheider unsichtbar bleibt. Und damit sind wir beim Kern: Entscheider identifizieren ist nicht „nice to have", sondern Pflicht, wenn du nicht in Endlosschleifen verkaufen willst. In meinem Gespräch mit Stephan Heinrich haben wir das auseinandergebaut und wieder zusammengesetzt. Du bekommst daraus einen Praxis-Guide, den du direkt in Discovery Calls, Qualifizierung und Angebot übernehmen kannst, sodass du weniger "Wir melden uns" hörst und mehr echte Entscheidungen auslöst. Und ja: Wir zeigen dir, wie du den Entscheider identifizieren-Job systematisch erledigst – weil gute Bedarfsermittlung genau dort gewinnt. Kundenergründung 3.0: Was sich im B2B für die Bedarfsermittlung geändert hat Viele Verkäufer machen heute denselben Fehler wie vor 15 Jahren – nur mit besserer Kamera: Sie springen zu früh in die Lösung, und oft sogar in Minute 3. Sobald PowerPoint läuft, verlierst du aber leicht die Gesprächsführung, weil der Kunde dann bewertet, während du lieferst. Genau deshalb musst du zuerst Problem und Prozess klären, und du musst frühzeitig den Entscheider identifizieren, bevor du in die Demo rutschst. Kundenergründung 3.0 akzeptiert drei harte Realitäten, und genau deshalb funktioniert sie so gut: Mehr Stakeholder: Du verkaufst selten an eine Person, sondern ans Buying Center. Mehr Risiko: Der Kunde entscheidet nicht nur für, sondern auch gegen den Status quo, und das fühlt sich intern riskant an. Mehr "No Decision": Viele Deals sterben nicht am Wettbewerb, sondern an Aufschieberitis, Unsicherheit oder fehlender Priorität. Die PowerPoint-Falle: Warum "früh präsentieren" deine Bedarfsermittlung zerstört Sobald du präsentierst, passiert Folgendes: Der Kunde lehnt sich zurück, du arbeitest, und er bewertet. Am Ende kommt dann oft der Satz: "Schicken Sie mal ein Angebot." Das klingt wie ein Kaufsignal, ist aber häufig nur ein höfliches "Ich will jetzt aus dem Call raus." Die Alternative ist simpel, aber nicht leicht: Du bleibst im Dialog, und du gräbst tiefer, damit am Ende wirklich Klarheit entsteht. Außerdem erkennst du dadurch viel früher, ob der Deal echt ist oder nur "mal schauen". Und du kannst nebenbei direkt den Entscheider identifizieren, statt später hinterherzulaufen. Bedarfsermittlung heißt heute: Entscheidung ermöglichen Der moderne Verkäufer ist nicht nur Problemlöser, sondern auch Entscheidungs-Architekt. Du hilfst dem Kunden, intern zu erklären, warum eine Veränderung nötig ist, und warum sie jetzt passieren muss. Gleichzeitig sorgst du dafür, dass die richtigen Menschen beteiligt sind, weil du sonst zwar diskutierst, aber nie abschließt – daher: Entscheider identifizieren. Warum wir etwas ändern müssen Warum wir es jetzt ändern müssen Warum wir es mit dieser Lösung ändern können Und wer dazu "Ja" sagen muss Das ist Kundenergründung 3.0. Und das ist Bedarfsermittlung, die wirklich Umsatz macht. Das wahre Problem finden: Vom Symptom zur Diagnose (Basis jeder Bedarfsermittlung) Ich nutze dafür gern ein Bild: Arzt vs. Apotheke. Der Kunde kommt rein und sagt: "Ich hab Kopfschmerzen." Wenn du jetzt direkt "Aspirin" verkaufst, bist du Apotheke, aber nicht Berater. Fragst du dagegen "Seit wann? Wo genau? Was war vorher, und was haben Sie schon probiert?", dann wirst du zum Arzt – und erst eine saubere Diagnose macht deine Bedarfsermittlung wertvoll. Für eine stabile Bedarfsermittlung brauchst du drei Ebenen, und jede Ebene baut auf der vorherigen auf: Ebene 1: Das Symptom (was der Kunde sagt) "Unsere Leads sind schlecht." "Unser Forecast wackelt." "Wir brauchen ein neues Tool." Ebene 2: Die Ursache (warum es passiert) Fehlt eine saubere Qualifizierung, oder fehlt ein gemeinsames Verständnis? Ist der Entscheidungsprozess unklar, und deshalb bleibt alles hängen? Gibt es keinen Champion, obwohl das Thema wichtig wäre? Ebene 3: Der Impact (was es kostet) Jetzt wird's spannend: Sobald du den Impact sauber machst, verändert sich das Gespräch, weil aus "nice to have" ein "müssen wir lösen" wird. Damit wird deine Bedarfsermittlung automatisch schärfer, und du hast außerdem einen klaren Aufhänger, um den Entscheider identifizieren-Part sauber anzustoßen. Fragen, die dich sofort tiefer bringen "Was passiert, wenn Sie das nicht lösen?" "Woran merken Sie das konkret – in Zahlen, Zeit oder Risiko?" "Was haben Sie bisher probiert, und warum hat's nicht gereicht?" "Wer merkt den Schaden am stärksten?" (Denn dort sitzt oft der Sponsor – und manchmal auch der echte Entscheider.) Merksatz: Bedarfsermittlung entsteht nicht durch "mehr reden", sondern durch Zusammenhänge, die der Kunde intern weitergeben kann. Schmerz in Euro: So wird Bedarfsermittlung messbar und wirksam Viele Verkäufer sind nett, und das ist grundsätzlich gut. Ohne Dringlichkeit gewinnt jedoch immer der Status quo, weshalb du in Richtung Entscheidung einen harten Schritt brauchst: Quantifizierung. Du machst keinen Druck, sondern du schaffst Klarheit, und dadurch wird auch deutlich, wer intern wirklich entscheiden muss – also: Entscheider identifizieren. Die Kosten der Nicht-Entscheidung Hilf dem Kunden nicht nur beim "Warum kaufen?", sondern auch beim "Warum NICHT warten?". Das gelingt, wenn du den Schaden greifbar machst und gleichzeitig die Logik sauber hältst: "Was kostet Sie das Problem pro Monat?" "Wie viele Stunden gehen dabei verloren, und wo genau?" "Welches Risiko tragen Sie, wenn das so bleibt?" Das Ziel ist nicht, den Kunden zu grillen, sondern ihm eine Rechnung zu geben, die er intern verwenden kann. Gute Bedarfsermittlung fühlt sich für den Kunden an wie: "Endlich versteht mich jemand." Critical Event: Warum jetzt? Wenn du Deals beschleunigen willst, brauchst du ein Ereignis, ein Datum oder einen Auslöser. Ohne dieses "Warum jetzt?" wird alles vertagt, obwohl das Problem real ist. Und wenn vertagt wird, verschwimmt fast immer auch, wer zuständig ist – deshalb: Entscheider identifizieren und Verantwortlichkeiten festzurren. "Was muss bis wann stehen – und warum genau dann?" "Was passiert, wenn Sie das Datum reißen?" "Welche internen Meilensteine hängen daran, und wer verantwortet sie?" Klärst du das nicht, bekommst du "Wir melden uns", und dann meldet sich: niemand. Preis ohne Drama: Obergrenze & Preis-Fragmentierung Viele Verkäufer trauen sich nicht über Geld zu reden, und dadurch entstehen falsche Erwartungen. Zwei saubere Wege, die Entscheidung zu erleichtern, sind: Obergrenze: Du nennst eine klare Decke (mit Pause), sodass der Kunde sofort einordnet. Beispiel: "Wenn Sie befürchtet haben, dass Sie 35.000 Euro investieren müssen: da liegen wir auf jeden Fall drunter." Fragmentierung: Du brichst den Preis auf eine verdauliche Einheit runter (pro Verkäufer/Monat oder pro Standort/Woche), damit es entscheidbar wird. Das ist keine Manipulation, sondern es reduziert Unsicherheit, und Unsicherheit ist der natürliche Feind jeder guten Bedarfsermittlung. Den echten Entscheider finden: Buying Center, Economic Buyer & Bedarfsermittlung Jetzt wird's politisch, aber im besten Sinne: Unternehmensrealität. In komplexen Deals gibt es selten "den Entscheider", sondern mehrere Rollen, und du musst sie trennen, damit deine Bedarfsermittlung nicht zur Blackbox wird. Kurz gesagt: Entscheider identifizieren ist dein Sicherheitsgurt im komplexen Vertrieb. Der Mythos "Mein Chef macht, was ich sage" Ich höre ständig: "Ich bin nah dran am Chef." Das ist gut, aber Nähe ist kein Unterschriftrecht. Wenn du nur mit Beeinflussern sprichst, bekommst du schöne Gespräche, jedoch keine Entscheidung. So fragst du den Entscheidungsprozess ab (ohne peinlich zu wirken) Diese Formulierung funktioniert fast immer, weil sie den Kunden schützt und dich gleichzeitig führt: "Damit ich Ihnen nichts Falsches baue: Wie wird so eine Entscheidung bei Ihnen typischerweise getroffen?" Danach gehst du strukturiert weiter, und zwar mit einer Decision Map, die intern tragfähig ist. Ziel: Nicht raten, sondern sauber Entscheider identifizieren: Decision Criteria: "Woran machen Sie die Auswahl fest, und was ist 'must have'?" Decision Process: "Welche Schritte kommen nach diesem Gespräch, und wann?" People: "Wer muss am Ende zustimmen – fachlich, finanziell und operativ?" Risiko: "Wer trägt den Ärger, falls es schiefgeht?" Der Entscheider-Test: Der Konditionalabschluss Jetzt kommt ein Hebel, der vielen Bauchschmerzen macht, aber brutal effektiv ist: der Konditionalabschluss. Das ist eine geschlossene Frage, weil du Klarheit willst und nicht Hoffnungen sammelst. "Wenn ich Ihnen das so zuschicke: sind wir dann auf dem Weg zur Entscheidung?" Warum ist das so stark? Weil du echte Informationen bekommst. Entweder es gibt ein Ja (mit Bedingungen), oder es gibt ein Nein (mit Gründen), und beides bringt dich weiter. Und vor allem zeigt es dir, ob du wirklich den Entscheider identifizieren-Schritt schon erledigt hast. Das Angebot als Entscheidungsdokument: "Heiratsantrag" statt PDF-Friedhof Ein Angebot ist kein Preisblatt, und es ist auch kein Roman. Es ist ein Entscheidungsdokument, das intern weitergeleitet werden kann, ohne dass du daneben sitzt. Damit das klappt, musst du vorher Problem, Impact und Rollen geklärt haben – inklusive "Entscheider identifizieren". Was in ein gutes B2B-Angebot gehört (und was nicht) Ich mag Angebote, die klar, kurz und intern verwertbar sind. Drei Bausteine reichen, wenn sie sauber sind: Ausgangslage: Was ist heute? (Symptom + Ursache, wie ihr es verstanden habt) Zielbild: Was soll danach besser sein? (Kennzahlen, Outcome, Nutzen) Hindernisse: Warum ging's bisher nicht? (Risiken, interne Blocker, fehlende Ressourcen) Erst dann kommen Lösung, Vorgehen, Investment und nächste Schritte. So wird aus Interesse eher eine Entscheidung, statt ein "Wir prüfen mal". Und ja: Eine saubere Bedarfsermittlung macht genau diesen Unterschied. Die stärkste Angebotsfrage überhaupt Wenn du nur eine Frage vor dem Angebot stellst, dann diese, weil sie alles fokussiert: "Was muss im Angebot stehen, damit Sie entscheiden können?" Damit baust du nicht dein Lieblingsangebot, sondern das Angebot, das intern durchkommt. KI-Boost: So machst du Bedarfsermittlung schneller und sauberer Fast alle Calls sind online, und das ist eine Chance, wenn du sie sauber nutzt. Mit Einwilligung kannst du Transkripte verwenden, sodass du besser zuhörst und trotzdem alles sauber dokumentierst. Gerade bei Stakeholdern hilft das, weil du Aussagen besser zuordnen kannst und schneller Entscheider identifizieren kannst. Transkript aktiv einschalten (und dadurch besser zuhören) "Ich würde gern das Transkript einschalten, damit ich Ihnen noch besser zuhören kann. Ist das für Sie okay?" Wichtig: Hol dir immer eine klare Zustimmung und beachte eure Regeln, weil Vertrauen die Basis ist. Wenn der Kunde nein sagt, ist das okay, und dann schreibst du klassisch mit. Vom Gespräch direkt ins Angebot (ohne Copy-Paste-Hölle) Mit einem sauberen Protokoll baust du in Minuten: Zusammenfassung in 7 Zeilen (Problem, Ursache, Impact, Ziel, Timeline) Decision Map (wer, wann, wie, womit) Risiken & Einwände (und wie du sie im Angebot vorweg nimmst) Das spart Zeit, und es reduziert Missverständnisse, sodass deine Bedarfsermittlung nicht nur schneller wird, sondern auch stabiler. Sales-Training als "Flugsimulator": schneller besser werden Ich liebe das Bild: Im Flugsimulator darfst du Fehler machen, während du im echten Flugzeug besser keine machst. Genau so ist Vertrieb, weshalb du Discovery und Decision Map trainieren solltest, bevor du Einwände übst. Und im Training kannst du gezielt üben, wie du den Entscheider identifizieren-Teil sauber, ruhig und ohne Druck formulierst. Quick Takeaways: Die wichtigsten Punkte zur Bedarfsermittlung Bedarfsermittlung gewinnt, wenn Problem, Impact und Entscheidungsweg glasklar sind. Geh vom Symptom zur Ursache, und mach danach den Impact in Euro, Zeit oder Risiko sichtbar. Kläre ein Critical Event, sonst gewinnt der Status quo, obwohl alle nicken. Baue eine Decision Map: Kriterien, Prozess, Rollen und Risiko-Träger. Entscheider identifizieren ist kein "später", sondern Teil der Bedarfsermittlung. Nutze den Konditionalabschluss, damit du Klarheit bekommst und nicht rätst. Mach dein Angebot zum Entscheidungsdokument, damit es intern funktioniert. Anleitung: Bedarfsermittlung im B2B in 9 Schritten (Discovery-Checkliste) So führst du Gespräche, die Problem, Impact und Entscheider sauber klären, damit eine Entscheidung möglich wird – und zwar ohne Präsentations-Falle und ohne endlose Follow-ups. Das ist Bedarfsermittlung, die im Alltag funktioniert. Eröffnung mit Erwartungsmanagement Sag kurz, wie ihr vorgeht: erst Kontext und Ziele, dann Entscheidungsweg und nächste Schritte – Demo später (wenn nötig). Symptom verstehen Lass den Kunden erzählen, und frag nach Beispielen, bevor du Lösungen ansprichst. Ursache finden Frag nach dem "Warum", und klär gleichzeitig, was bisher versucht wurde. Impact quantifizieren Euro, Zeit oder Risiko, damit Dringlichkeit entsteht und Entscheidungen logisch werden. Decision Map aufbauen Kriterien, Prozess und Rollen klären, damit du nicht rätst, sondern den Entscheider identifizieren kannst. Critical Event klären Bis wann muss was stehen, und was passiert, wenn nicht? Echten Entscheider identifizieren Frag nach Budget- und Freigaberechten, und klär, wer final "Ja" sagt. Ziel: Entscheider identifizieren statt hoffen. Entscheider-Test setzen Nutze eine klare Frage, damit du weißt, ob ihr wirklich vorankommt. Nächste Schritte verbindlich machen Termine, Verantwortliche und Deliverables festlegen, damit es nicht im Sande verläuft. FAQ: Häufige Fragen zur Bedarfsermittlung im B2B Was bedeutet Bedarfsermittlung im B2B? Bedarfsermittlung bedeutet, dass du Symptom, Ursache und Impact klärst und zusätzlich Entscheidungsweg und Rollen im Buying Center sichtbar machst, damit der Kunde intern entscheiden kann. Warum ist "Entscheider identifizieren" so wichtig? Weil viele Deals nicht am Produkt scheitern, sondern daran, dass niemand final verantwortlich ist. Wenn du den Entscheider identifizieren kannst, werden nächste Schritte klarer, und Entscheidungen fallen schneller. Wie frage ich den Entscheidungsprozess ab, ohne unangenehm zu wirken? Nutze eine Schutz-Formulierung wie: "Damit ich Ihnen nichts Falsches baue: Wie wird so eine Entscheidung bei Ihnen typischerweise getroffen?" Das wirkt professionell, weil es Klarheit schafft. Welche Fragen machen die Bedarfsermittlung besser? Fragen zu Impact und Dringlichkeit ("Was kostet das pro Monat?", "Warum jetzt?") und Fragen zur Decision Map ("Wer muss zustimmen?", "Woran wird entschieden?"). Wie nutze ich KI, ohne dass es komisch wirkt? Hol dir eine klare Zustimmung für Transkript/Mitschrift, erkläre den Nutzen ("damit ich besser zuhören kann"), und halte dich an eure Datenschutzregeln. Dann wird es normal und hilfreich.

Low-dose aspirin, often called baby aspirin, is one of the most commonly recommended medications in pregnancy today. But despite how frequently it's prescribed, many patients still ask the same questions: Why do I need it? Is it safe? When should I start or stop? And who actually benefits? In this episode, we take a clear, evidence-based look at baby aspirin in pregnancy—cutting through myths, confusion, and mixed messaging. In this episode, we cover: What "baby aspirin" actually is (dose, formulation, and how it works) Why it's recommended in pregnancy, especially for preventing preeclampsia Who should take it—including high-risk and moderate-risk patients When to start and when to stop (timing matters) What the research says about safety for both parent and baby Common concerns and misconceptions, including bleeding risk What to do if you're unsure or were told conflicting advice Why baby aspirin matters: Preeclampsia remains one of the leading causes of pregnancy complications worldwide. Decades of high-quality research now show that low-dose aspirin, started early in pregnancy for the right patients, can significantly reduce risk—with an excellent safety profile. For many patients, this simple intervention can make a meaningful difference in pregnancy outcomes. Who this episode is for: Pregnant patients wondering "Do I really need this?" Anyone with a history of preeclampsia, hypertension, infertility, IVF, or pregnancy complications Clinicians counseling patients on aspirin use Anyone navigating pregnancy advice that feels unclear or contradictory The takeaway: Baby aspirin isn't about doing more—it's about doing the right thing at the right time, guided by evidence and individualized care. If you've been prescribed baby aspirin—or think you might benefit—this episode will help you understand why it's recommended and how to take it with confidence.   Got something you want to share or ask? Keep it coming.  We love hearing from you. Email us or send a voice memo, and you might just hear it on the next episode. Don't forget to like, comment, and subscribe—your questions could be featured in our next episode! For additional resources and information, be sure to visit our website at Maternal Resources: https://www.maternalresources.org/. You can also connect with us on our social channels to stay up-to-date with the latest news, episodes, and community engagement: YouTube: Dive deeper into pregnancy tips and stories atyoutube.com/maternalresources . Instagram: Follow us for daily inspiration and updates at @maternalresources . Facebook: Join our community at facebook.com/IntegrativeOB Tiktok: NatureBack Doc on TikTok Grab Our Book! Check out The NatureBack Method for Birth—your guide to a empowered pregnancy and delivery. Shop now at naturebackbook.myshopify.com .  

Join Kate, Gary and Mark (Henry has the day off) as we discuss 3 useful new studies: colorectal cancer screening reminders, aspirin or clopidogrel for secondary prevention of CV events, and lipid lowering drugs and dementia risk

Alannah Connealy is a health entrepreneur and author redefining how the world understands wellness. She is the founder of Raena Health, a company dedicated to making hormone support simple, safe, and accessible. Alannah also co-wrote Celluverse, a groundbreaking book that explores cancer through the lens of cellular health and energy. Alannah helps unpack Dr. Ray Peat's bioenergetic approach. Learn why sugar powers cells, meat fuels metabolism, and stress (not cholesterol) harms the heart. Discover PUFA dangers and easy hacks like gelatin gummies and fruit-milk combos to exit "hibernation mode." From the Randle Cycle to cancer as stress response, get practical steps for energy, hormones, and family meals. Reclaim effortless vitality. Some Topics Covered: Keto burnout → pro-metabolic awakening Sugar as cellular fuel, not fat-maker Meat + gelatin: thyroid & anti-inflammatory Randle Cycle, PUFAs, and diabetes traps Aspirin for thyroid, inflammation, energy Cholesterol as protector, not villain Cancer as stress defense, not sugar crime Sponsored By: → CURED | Stack my 20% off code: CLAUDIA on the 10% off Tranquility Bundle! Visit curednutrition.com/claudia and use code CLAUDIA at checkout. → JASPR | Get $400 off for their Black Friday Sale. Just go to jaspr.co/claudia and use my code CLAUDIA → PIQUE | Wake up rested and stay hydrated all day. Get 20% off for life, a complimentary gift, and explore Pique's clean, pure-ingredient products at Piquelife.com/healingthesource. Resources: Check out Raena (discount code: HEALINGTHESOURCE10) for natural hormone support + testing Listen to Alannah's podcast, Celluverse (with Dr. Erin Leigh Connealy and Jess Donovan) Follow Alannah and Raena on Instagram Follow the host, Claudia, on Instagram, check out HealingTheSource.co & Elham's Liquid Gold 100% Organic Castor Oil, and enjoy her deep-dives on Substack

Join us as we review recent articles and news featured in The DIGEST #70, including PSA screening, acetaminophen and autism, COVID19 vaccines and cancer, and aspirin and anticoagulation in coronary artery disease. Fill your brain hole with a delicious stack of hotcakes! Featuring Drs. Paul Williams (@PaulNWilliamz), Nora Taranto (@norataranto), Rahul Ganatra (@rbganatra), Laura Glick (@lauraglick) and Matt Watto (@doctorwatto). Claim free CME for this episode at curbsiders.vcuhealth.org! Episodes | Subscribe | Spotify | Swag! |Mailing List | Contact | CME! Credits Written and Hosted by: Nora Taranto MD; Rahul Ganatra MD MPH, Laura Glick MD, Paul Williams, MD, FACP, Adam Cifu MD, Matthew Watto MD, FACP Cover Art: Rahul Ganatra, MD MPH Reviewers: Rahul Ganatra MD MPH; Paul Williams, MD, FACP, Matthew Watto MD, FACP; Sai S Achi MD, MBA, FACP Technical Production: Pod Paste Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Show Segments Intro, disclaimer Prostate Cancer Screening Acetaminophen and Autism COVID19 vaccines and cancer risk Aspirin and anticoagulation in coronary artery disease Outro Sponsor: Aura Frames For a limited time, save on the perfect gift by visiting AuraFrames.com to get $35 off Aura's best-selling Carver Mat frames by using promo code CURB at checkout. Sponsor: DoxGPT by Doximity Visit doxgpt.com  and see how it can simplify your clinical workflow, from patient care to paperwork.  Sponsor: Continuing Education Company Use promo code Curb30 to get 30% off all online courses and webcasts—just for Curbsiders Listeners. Visit CMEmeeting.org/curbsiders to learn more. Sponsor: Freed Use code: CURB50 to get $50 off your first month when you subscribe!

1872 gelingt es dem Chemiker Wilhelm Haarmann erstmals Vanillin aus Rindensaft von Bäumen herzustellen. Das macht Vanillin zum ersten synthetischen Duftstoff der Welt und seine Herstellung läutete gleichzeitig den Beginn der modernen Duft- und Aromastoffindustrie ein. Wir sprechen in der Folge über Vanille, Vanillin und warum der Vanillerostbraten nach Knoblauch schmeckt. //Erwähnte Folgen * GAG263: Lavoisier und die Entdeckung des Sauerstoffs – https://gadg.fm/263 * GAG444: Die Erfindung von Heroin und Aspirin – https://gadg.fm/444 * GAG284: "There is death in the pot" - Friedrich Accum und die Lebensmittelfälscher – https://gadg.fm/284 * GAG279: Muskat und Manhattan – https://gadg.fm/279 * GAG527: Botanik, Baret und Bougainville – https://gadg.fm/527 * GAG483: Bounty, Brotfrucht und die Rum-Rebellion – https://gadg.fm/483 // Literatur * Björn Bernhard Kuhse, Wilhelm Haarmann auf den Spuren der Vanille: Forscher, Unternehmer und Pionier der Riechstoffe, 2012. * Klaus Stanzl, Die Geburtsstätten der Riechstoffindustrie. Wie die organische Chemie eine Industrie erblühen lässt, 2024. //Aus unserer Werbung Du möchtest mehr über unsere Werbepartner erfahren? Hier findest du alle Infos & Rabatte: https://linktr.ee/GeschichtenausderGeschichte //Geschichten aus der Geschichte jetzt auch als Brettspiel! Werkelt mit uns am Flickerlteppich! Gibt es dort, wo es auch Becher, T-Shirts oder Hoodies zu kaufen gibt: https://geschichte.shop // Wir sind jetzt auch bei CampfireFM! Wer direkt in Folgen kommentieren will, Zusatzmaterial und Blicke hinter die Kulissen sehen will: einfach die App installieren und unserer Community beitreten: https://www.joincampfire.fm/podcasts/22 //Wir haben auch ein Buch geschrieben: Wer es erwerben will, es ist überall im Handel, aber auch direkt über den Verlag zu erwerben: https://www.piper.de/buecher/geschichten-aus-der-geschichte-isbn-978-3-492-06363-0 Wer unsere Folgen lieber ohne Werbung anhören will, kann das über eine kleine Unterstützung auf Steady oder ein Abo des GeschichteFM-Plus Kanals auf Apple Podcasts tun. Wir freuen uns, wenn ihr den Podcast bei Apple Podcasts oder wo auch immer dies möglich ist rezensiert oder bewertet. Wir freuen uns auch immer, wenn ihr euren Freundinnen und Freunden, Kolleginnen und Kollegen oder sogar Nachbarinnen und Nachbarn von uns erzählt! Du möchtest Werbung in diesem Podcast schalten? Dann erfahre hier mehr über die Werbemöglichkeiten bei Seven.One Audio: https://www.seven.one/portfolio/sevenone-audio

“Study” that's not even a study spreads panic about dubious melatonin-heart failure link; Should you ignore dr's advice to take powerful acid-blocking drugs? Novel implantable electrical pacemakers may bring relief to sufferers of severe constipation; Benefits of cocoa flavanols for heart, brain, athletic performance. Give the gift of healthy chocolate! Go to FlavaNaturals.com and use coupon code HOFFMAN20 for 20% off site-wide. Plus get free shipping on all orders over $30. 

Help people see why they need what you're offeringSee omnystudio.com/listener for privacy information.

Preeclampsia affects around 1 in 10 pregnancies, and increasingly we are learning new ways to lower risks. Here's how.In this episode, we are joined by OBGYN and maternal health leader Dr. Amanda P. Williams to talk about what every parent and perinatal professional should know about preeclampsia prevention, warning signs and treatment.Yes, this episode is all about safer pregnancies and healthier babies.You'll learn who's at higher risk, why low-dose aspirin and a home blood pressure cuff can be lifesaving, the postpartum warning signs that should never be ignored, and how doulas, partners, and families can advocate when it matters most - we even include scripts so you will know exactly what to say.Enjoy!Full show notes fourthtrimesterpodcact.comConnect with Dr Amanda P Williams LinkedIn | Instagram | Twitter | Stanford MedicinePreeclampsia Prevention Guides Guide for Parents from March of Dimes | Guide for Clinical Teams from March of Dimes | Low-dose Aspirin to Prevent Preeclampsia & Related Preterm Birth Initiative by CMQCCEssential at-home tools for pregnancy & postpartum Blood Pressure Cuff | AWHONN Post-Birth Warning Signs one-pager to hang on the fridgeWebinar for Health Professionals on Dec 4th 2025 Understanding Preeclampsia Risk and Low-Dose Aspirin – A Global and US PerspectiveLearn more California Maternal Quality Care Collaborative (CMQCC) | The State of Postpartum Maternal Health with Dr Amanda P Williams | Data-Driven Parenting With Dr Amanda P WilliamsOur favorite Fourth Trimester Books The First Forty Days: The Essential Art of Nourishing the New Mother | Becoming the Parent You Want to Be: A Sourcebook of Strategies for the First Five Years | Growing Together: Doula Wisdom & Holistic Practices for Pregnancy, Birth & Early Motherhood |

Review of aspirin's mechanism of action, indications, contraindications, and administration for patients with acute coronary syndrome (ACS) or stroke.Aspirin's mechanism of action & benefits for Acute Coronary Syndrome (ACS) patients.Contraindications and considerations for aspirin's use.The dose and route of administration of aspirin for ACS patients.The use of aspirin in the ACLS Stroke algorithm.Good luck with your ACLS class!Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor Free Prescription Discount Card - Get your free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vip/savePass ACLS Web Site - Other ACLS-related resources: https://passacls.com@Pass-ACLS-Podcast on LinkedIn

Faking It! A new trend is the unfortunate and fraudulent use of "Service Dog" credentials for owners wanting to bring their dogs into restaurants, airlines, and hotels. Pawtopia's Colleen Demling explains the problem and why the disabled suffer. Listen Now Aspirin and Pets Did you know that Aspirin can be toxic to your pet? Dr. Debbie dispels the myths about pain relief for your pet. Listen Now Josh Duhamel Guests Besides a flourishing acting career, Josh Duhamel spends a lot of time speaking for the animals. He has a web series and he's back to talk about it...and to flirt with the ladies. Listen Now A Shot To The Tail Don't be surprised if the next time your cat gets an injection, it's in the tail. Recent concerns have come up over treating rare but potentially deadly injection site sarcomas. Some vets then shifted the site to the hind legs, since an amputation, if necessary, would be easier and more successful. Listen Now Pet ONLY Apartments Octogenarian and Landlord Judy Guth only allows tenants with pets in her apartment complex. Is this discrimination? Judy doesn't care. And if one of her tenants loses their pet, she'll even take them out to dinner and then to the shelter to find another roommate. Listen Now Pet Spending At All Time High The American Pet Products Association reports we're shelling out nearly 60-Billion+ bucks a year on our animals. Research shows empty-nesters are now spending more on their four-legged children. Listen Now Read more about this week's show.

My guest is Dr. David Fajgenbaum, MD, professor of translational medicine and human genetics at the University of Pennsylvania. He explains how, unbeknownst to most doctors, many approved medications can successfully treat or even cure diseases other than the ones they are typically used to treat. He shares his story of escaping death from Castleman's disease by discovering a life-saving treatment using repurposed drugs that were approved for other purposes. Our conversation explores how researchers, physicians, and you—the general public—can explore novel treatments and cures to conditions the medical profession has deemed untreatable, including cancers. We also discuss the crucial role of mindset in battling diseases and the lesser-known use of compounds to promote health and longevity. Read the episode show notes at hubermanlab.com. Thank you to our sponsors AGZ by AG1: https://drinkagz.com/huberman Eight Sleep: https://eightsleep.com/huberman Rorra: https://rorra.com/huberman David: https://davidprotein.com/huberman Function: https://functionhealth.com/huberman Timestamps (0:00) David Fajgenbaum (4:06) Self-Agency in Healthcare; New Uses for Old Medicines (6:44) Other Uses of Aspirin & Viagra; Drug Development & Approved Use (8:53) Lidocaine & Breast Cancer; Pharmaceutical Companies & Incentives (11:36) Sponsors: Eight Sleep & Rorra (14:16) Pharmaceutical Companies, Patents & New Uses; Lithium (18:40) Tools: Finding Reliable Health Sources, Asking Questions & Disease Organizations; DADA2 Treatment (21:53) Medical Community & Connections; Integrated Medical Databases (24:36) Drug Repurposing, Thalidomide, Pembrolizumab (28:45) Medical Research Databases, Mapping Disease Connections (33:51) Every Cure Database & Programs, Bachmann-Bupp Syndrome; Colchicine & Heart Disease (37:57) Sponsors: AGZ by AG1 & David (40:41) David's Medical & Career Journey, Glioblastoma, Castleman Disease (49:10) Autoimmune Disease, Driven Personality, Stress & Immune System (52:52) Castleman Disease, Treatment, Chemotherapy (55:54) Physician Continuing Education, Santa Claus Theory of Civilization; Science Collaboration (1:03:32) Medical School, Relapse & “Overtime”, Finding a New Treatment, Rapamycin (1:12:46) Sport, Football & Resilience; Challenge & Personal Growth, Family (1:18:41) Sponsor: Function (1:20:29) Social Support; “Overtime”, Gratitude (1:23:19) Business School, Castleman Disease Treatment; Repurposing Drugs & AI (1:28:29) Drug Repurposing, POEMS Syndrome; Mitigating Risk (1:35:32) Nicotine, Compounds for Preventive Health; GLP-1 Agonists (1:40:51) Bioprospecting, Drug Development; AI, Prioritization & Novel Connections (1:46:18) Healthcare & Children; Hope, Action & Impact Circuit; Challenge & Super-Agers (1:52:50) Get Involved with Every Cure (1:56:20) Zero-Cost Support, YouTube, Spotify & Apple Follow, Reviews & Feedback, Sponsors, Protocols Book, Social Media, Neural Network Newsletter Disclaimer & Disclosures Learn more about your ad choices. Visit megaphone.fm/adchoices

This week, Gary, Kate, Mark and Henry discuss the optimal duration of anticoagulation after a provoked DVT, using low doses of mirtazapine or amitriptyline in adults with insomnia, whether a lower dose of semaglutide is still effective for weight loss, and adding aspirin for patients with coronary heart disease, a stent and who are also on a DOAC for another indication.Links:NICE Barrett Esophagus guideline: https://pubmed.ncbi.nlm.nih.gov/38553042/ Essential Evidence Plus: www.essentialevidenceplus.comDuration of anticoagulation: https://pubmed.ncbi.nlm.nih.gov/40888734/ Mirtazapine or amitriptyline for insomnia: ttps://pubmed.ncbi.nlm.nih.gov/39814428/ Lower dose semaglutide for obesity: https://pubmed.ncbi.nlm.nih.gov/40934115/ Adding aspirin: N Engl J Med . 2025 Oct 23;393(16):1578-1588https://pubmed.ncbi.nlm.nih.gov/40888725/

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter In this “Ask Me Anything” (AMA) episode, Peter revisits the “proven, promising, fuzzy, noise, nonsense” scale and applies it to a variety of popular topics. He begins with a refresher on what each category represents before classifying a range of interventions based on the strength of their supporting evidence. The conversation spans three main areas: drugs for geroprotection (including GLP-1 receptor agonists, SGLT2 inhibitors, methylene blue, and telomere-lengthening supplements), the use of low-dose aspirin for cardiovascular disease prevention, and strategies to improve muscle mass through optimal protein intake and follistatin gene therapy. This episode provides a clear, evidence-based overview for listeners seeking to understand where these popular health and longevity interventions stand on the spectrum of scientific credibility. If you're not a subscriber and are listening on a podcast player, you'll only be able to hear a preview of the AMA. If you're a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #76 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: A scale for evaluating scientific claims: proven, promising, fuzzy, noise, or nonsense [1:30]; Strong convictions, loosely held: the mindset that separates great scientists from the rest [7:30]; GLP-1 receptor agonists: are there benefits beyond improving metabolic health and promoting weight loss? [12:45]; GLP-1 drugs and the brain: exploring the potential cognitive benefits [18:45]; GLP-1 drugs and lifespan: examining the evidence for potential geroprotective effects [23:00]; Rapamycin and geroprotection: why it remains in the “promising” category [25:45]; SGLT2 inhibitors and their potential geroprotective effect [27:30]; Methylene blue: examining the evidence of an anti-aging effect [34:45]; Methylene blue's potential neuroprotective effects: limited and inconsistent evidence in humans, and the challenges of dosing and safety [41:15]; Telomeres: what they are, how they relate to aging, and why telomere-lengthening supplements lack credible scientific evidence [43:45]; Does the idea of targeting telomere length to extend lifespan have scientific merit? [50:15]; Low-dose aspirin for cardiovascular disease prevention: weighing its clot-prevention benefits against bleeding risks across different populations [55:00]; Rethinking the protein RDA: why most people need twice the recommended amount for muscle health [1:00:45]; Debunking the protein–cancer myth: why higher protein intake doesn't promote tumor growth [1:06:15]; The biology of follistatin and myostatin, and why follistatin gene therapy has become an emerging topic of interest for muscle growth [1:13:15]; Follistatin gene therapy for muscle growth: state of the evidence in animals and humans, and the technical challenges and regulatory barriers [1:17:00]; Why injectable follistatin is theoretically possible but impractical for real-world use [1:23:15]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

On February 4, 1941, Bronx police officers were called to the home of John and Catherine Pappas for a report of a homicide. Based on the evidence, detectives theorized that someone had been invited into the Pappas apartment while Catherine was home alone and that same someone had strangled her to death, then ransacked the apartment looking for valuables. To investigators the scene resembled a fairly straightforward robbery-homicide; however, to detective Ed Burns, there were elements of the crime scene that bore a striking similarity to another assault and robbery case he'd been assigned to just two weeks earlier in another part of the Bronx. What followed was an investigation that exploded in size from a single robbery-gone-wrong that resulted in a murder to a sprawling serial sexual assault case that would eventually involve more than eighty victims in eight states, all victimized by the same man. The hunt for the Aspirin Bandit is among the more remarkable cases in New York criminal history, not only because of the number of victims, but also because of the tremendous effort and coordination put forth to catch the killer—effort and coordination that, in 1941, was virtually unheard of.Thank you to the Amazing Dave White (of BRING ME THE AXE PODCAST) for research and writing assistance!ReferencesBrooklyn Eagle. 1941. "Papas slayer, faced by victims, confesses." Brooklyn Eagle, March 4: 1.Connor, Christine, and Elise Greven. 2017. "Gentleman Killer." A Crime to Remember. Janaury 3.Dillon, Edward, and Howard Whitman. 1941. "Cigarets, aspirin clues to woman's strangler." Daily News (New York, NY), February 6: 4.New York Times. 1941. "Alarm for burglar sent in Pappas case." New York Times, February 8: 32.—. 1941. "Cvek found guilty of Pappas murder." New York Times, May 20: 46.—. 1941. "Cvek tells court he killed in anger." New York Times, May 16: 24.—. 1941. "Mystery cloaks woman's murder." New York Times, February 6: 15.—. 1941. "Pappas strangler admits 15 crimes." New York Times, March 5: 1.—. 1941. "Slayer of woman 'rebukes' press." New York Times, March 8: 34.—. 1941. "Sun lamp halts trial." New York Times, April 22: 23.Rice, William. 1941. "Cvek a killer? No surprise to his relatives." Daily News (New York, NY), March 5: 4. Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Have you been told to take a daily baby aspirin to protect your heart?     What if that common advice isn't as beneficial—or safe—as it seems?     And, what if there was an even more effective dosing schedule of aspirin for those that want to partake?     I'll also share the natural alternatives we use in our practice to support heart health safely.     So join me on today's Cabral Concept 3476 to learn why other approaches may work better than daily baby aspirin.      Enjoy the show, and let me know your thoughts! - - - For Everything Mentioned In Today's Show: StephenCabral.com/3476 - - - Get a FREE Copy of Dr. Cabral's Book: The Rain Barrel Effect - - - Join the Community & Get Your Questions Answered: CabralSupportGroup.com - - - Dr. Cabral's Most Popular At-Home Lab Tests: > Complete Minerals & Metals Test (Test for mineral imbalances & heavy metal toxicity) - - - > Complete Candida, Metabolic & Vitamins Test (Test for 75 biomarkers including yeast & bacterial gut overgrowth, as well as vitamin levels) - - - > Complete Stress, Mood & Metabolism Test (Discover your complete thyroid, adrenal, hormone, vitamin D & insulin levels) - - - > Complete Food Sensitivity Test (Find out your hidden food sensitivities) - - - > Complete Omega-3 & Inflammation Test (Discover your levels of inflammation related to your omega-6 to omega-3 levels) - - - Get Your Question Answered On An Upcoming HouseCall: StephenCabral.com/askcabral - - - Would You Take 30 Seconds To Rate & Review The Cabral Concept? The best way to help me spread our mission of true natural health is to pass on the good word, and I read and appreciate every review!