Podcasts about The BMJ

What is death anxiety?  We spend the first 15 minutes of the podcast addressing this question.  And maybe this was unfair to our guests, the fabulous dynamic duo of palliative psychiatrists Dani Chammas and Keri Brenner (listen to their prior podcasts on therapeutic presence and the angry patient).  After all, we invited them on to our podcast to discuss death anxiety, then Eric and I immediately questioned if death anxiety was the best term for what we want to discuss! Several key points stood out to me from this podcast, your key points may differ: The “anxiety” in “death anxiety” is not a pathological phenomenon or a DSM diagnosis;  it references an existential concern that is fundamental to the human experience .  To me,” awareness of mortality” might be a better term, but in fairness, the idea of “death anxiety” was coined well before the formal establishment of “anxiety disorders.” The ways in which death anxiety manifests in our patient's choices and behaviors varies tremendously, and our responses as clinicians must be individualized. There is no “one size fits all” approach. In one example Dani discusses, a pain level of 1.5/10 might be overwhelming, because for a patient  in remission from cancer any pain might signal return of cancer.  Some manifestations of death anxiety can be debilitating, others lead to tremendous personal growth, connection to others, and a drive toward finding meaning in their illness experience.   Death anxiety impacts us as clinicians, not only through countertransference, that word that I still can't define (sorry Dani and Keri!), but also through our own unexamined fears about death. As clinicians who regularly care for people who are dying, we might find ourselves becoming “used to” death. Is this a sign that we are inured to the banality of death, and less able to empathize with the death anxiety experienced by our patients or their families? Or could it reflect our acceptance of the finitude of life, prompting us to live in the present moment? Perhaps it is something else entirely. The key is that looking inwards to understanding our own unique relationship with mortality can deepen our ability to authentically accompany the experiences of our patients. I mean, don't fear the reaper, right?  Sorry, no cowbell in my version, but you do get my son Kai, home from college, on guitar for the audio only podcast version. Here are some resources for listeners wanting to learn more about this topic: Books: Yalom ID. Existential Psychotherapy. New York, NY: Basic Books; 1980. Yalom ID. Staring at the Sun: Overcoming the Terror of Death. San Francisco, CA: Jossey-Bass; 2008. Solomon S, Greenberg J, Pyszczynski T. The Worm at the Core: On the Role of Death in Life. New York, NY: Random House; 2015. Becker E. The Denial of Death. Free Press; 1973. Articles: Emanuel LL, Solomon S, Chochinov HM, et al. Death Anxiety and Correlates in Cancer Patients Receiving Palliative Care. J Palliat Med. 2023;26(2):235-243. Chochinov HM, McClement SE, Hack TF, et al. Death anxiety and correlates in cancer patients receiving outpatient palliative care. J Palliat Med. 2023;26(12):1404–1410. doi:10.1089/jpm.2022.0052. Clark D. Between hope and acceptance: the medicalisation of dying. BMJ. 2002;324(7342):905–907. doi:10.1136/bmj.324.7342.905. Vess M, Arndt J, Cox CR, Routledge C, Goldenberg JL. The terror management of medical decisions: The effect of mortality salience and religious fundamentalism on support for faith-based medical intervention. J Pers Soc Psychol. 2009;97(2):334–350. Menzies RE, Zuccala M, Sharpe L, Dar-Nimrod I. The effects of psychosocial interventions on death anxiety: A meta-analysis and systematic review of randomized controlled trials. J Anxiety Disord. 2018;59:64–73. doi:10.1016/j.janxdis.2018.09.00 Brown TL, Chown P, Solomon S, Gore G, De Groot JM. Psychosocial correlates of death anxiety in advanced cancer: A scoping review. Psychooncology. 2025;34(1):45–56. doi:10.1002/pon.70068. Tarbi EC, Moore CM, Wallace CL, Beaussant Y, Broden EG, Chammas D, Galchutt P, Gilchrist D, Hayden A, Morgan B, Rosenberg LB, Sager Z, Solomon S, Rosa WE, Chochinov HM. Top Ten Tips Palliative Care Clinicians Should Know About Attending to the Existential Experience. J Palliat Med. 2024 Oct;27(10):1379-1389. doi: 10.1089/jpm.2024.0070. Epub 2024 Mar 28. PMID: 38546453.  

According to research published in The BMJ in 2002, around 40% of people experience some age-associated memory impairment after reaching 65. Thankfully only 1% of those affected will then go on to have dementia each year. But still, it's important to be aware of how effective your memory is, whatever your age. An impairment can be a sign of cognitive decline, which becomes more likely the older we get. How does our memory actually work? What happens when we have a memory lapse then? In under 3 minutes, we answer your questions! To listen to the last episodes, you can click here: ⁠Can you really lose weight by walking?⁠ ⁠Can you improve your relationship by learning your love language?⁠ ⁠Are you spending more on groceries due to stretchflation?⁠ A podcast written and realised by Joseph Chance. First Broadcast: 11/9/2024 Learn more about your ad choices. Visit megaphone.fm/adchoices

If you're anything like me, you've probably looked back and thought, “Why didn't I know this 10 years ago?” That's exactly what today's chat is about - my top five health game-changers I wish I had embraced earlier. Whether you're 25 or 75, these insights can shift the needle in how you feel, look, and thrive. From nutrition tracking without guilt to finally getting that high-quality protein in, these tips aren't about restriction - they're about empowerment. I'm opening up about what's worked, what didn't, and why strength training, ditching the processed stuff, and even allowing yourself to be hungry can be revolutionary. This one is packed with real-life examples, scientific backing, and simple steps to get started without getting overwhelmed. What we're tackling: Track your food with intention, not shame. Ditch skinny, build strong with progressive overload. Prioritize protein without obsessing. Phase out processed foods gradually. Embrace hunger and stop snacking aimlessly. Meditation App : Simply Being App Get Weekly Health Tips:  thrivehealthcoachllc.com Let's Connect:@‌ashleythrivehealthcoach or via email: ashley@thrivehealthcoachingllc.com Podcast Produced by Virtually You! Sources: Tracking Nutrition Burke, L. E., Wang, J., & Sevick, M. A. (2011). Self-monitoring in weight loss: A systematic review of the literature. Journal of the American Dietetic Association, 111(1), 92–102. https://doi.org/10.1016/j.jada.2010.10.008 Raber, M., Patterson, M., & Jia, W. (2021). A systematic review of the use of dietary self-monitoring in behavioral weight-loss interventions: Current practices and future recommendations. Public Health Nutrition, 24(17), 5885–5913. https://doi.org/10.1017/S1368980021002381 Prioritizing High-Quality Protein Holt, S. H. A., Brand Miller, J. C., Petocz, P., & Farmakalidis, E. (1995). A satiety index of common foods. European Journal of Clinical Nutrition, 49(9), 675–690. Ortinau, L. C., Culp, J. M., & Hoertel, H. A. (2014). Effects of high-protein vs. high-fat snacks on appetite control, satiety, and eating initiation in healthy women. Nutrition Journal, 13, 97. https://doi.org/10.1186/1475-2891-13-97 Dhillon, J., Craig, B. A., Leidy, H. J., Amankwaah, A. F., Jacobs, A., Jones, B. L., & Jones, J. B. (2016). The effects of increased protein intake on fullness: A meta-analysis and its limitations. Journal of the Academy of Nutrition and Dietetics, 116(6), 968–983. https://doi.org/10.1016/j.jand.2016.01.003 Zhu, R., et al. (2021). Effect of a high-protein, low-glycemic index diet on hunger and weight maintenance: Results from the PREVIEW study. Frontiers in Nutrition, 8, 649928. https://doi.org/10.3389/fnut.2021.649928 Strength Training vs. Cardio Saeidifard, F., Medina-Inojosa, J. R., West, C. P., & Lopez-Jimenez, F. (2019). The role of resistance training in the prevention and management of chronic disease. European Journal of Preventive Cardiology, 26(5), 505–515. https://doi.org/10.1177/2047487318822333 Momma, H., et al. (2022). Muscle-strengthening activities and risk of all-cause and cause-specific mortality: A systematic review and meta-analysis of cohort studies. British Journal of Sports Medicine, 56(10), 755–763. https://doi.org/10.1136/bjsports-2021-105061 Cutting Ultra-Processed Foods Monteiro, C. A., Cannon, G., Levy, R. B., Moubarac, J. C., Louzada, M. L., Rauber, F., ... & Jaime, P. C. (2019). Ultra-processed foods: What they are and how to identify them. Public Health Nutrition, 22(5), 936–941. https://doi.org/10.1017/S1368980018003762 Srour, B., et al. (2019). Ultra-processed food intake and risk of cardiovascular disease: Prospective cohort study (NutriNet-Santé). BMJ, 365, l1451. https://doi.org/10.1136/bmj.l1451 Mindful Hunger / Fasting Bruce, L. J., & Ricciardelli, L. A. (2016). A systematic review of the psychosocial correlates of intuitive eating among adult women. Appetite, 96, 454–472. https://doi.org/10.1016/j.appet.2015.10.012 Longo, V. D., & Panda, S. (2016). Fasting, circadian rhythms, and time-restricted feeding in healthy lifespan. Cell Metabolism, 23(6), 1048–1059. https://doi.org/10.1016/j.cmet.2016.06.001

Last December, The BMJ published an investigation into the 2009 PLATO trial - exposing serious problems with that study's data analysis and reporting.  Our follow up investigation has shown that those data problems extend to other key supporting evidence in AstraZeneca's initial application to regulators. Peter Doshi, senior editor in the BMJ's Investigations unit, and Rita Redberg, cardiologist and Professor of Medicine at UCSF and former editor of JAMA Internal Medicine, join us to explain what this means for scientific integrity, and trust in the FDA's approval processes.   Also in this episode. A group of international authors are arguing that weightloss advice given in primary care might actually be doing more harm than good - it's ineffective and potentially reinforces damaging stigma.  To explain why they came to that conclusion we're joined by Juan Franco editor in chief of BMJ EBM, and a practicing GP in Germany, and Emma Grundtvig Gram, from the Centre for General Practice at the University of Copenhagen Reading list Doubts over landmark heart drug trial: ticagrelor PLATO study Ticagrelor doubts: inaccuracies uncovered in key studies for AstraZeneca's billion dollar drug Beyond body mass index: rethinking doctors' advice for weight loss

In this episode of RAPM Focus, Editor-in-Chief Brian Sites, MD, speaks with RAPM Editor Ryan D'Souza, MD, and Nasir Hussain, MD, following the October 2024 publication of “Hidden Influence? Unmasking Conflicts of Interest from Randomized Clinical Trials on Spinal Cord Stimulation for Chronic Pain.” Let's set the stage first. Spinal cord stimulation, or SCS, is a therapy that involves implanting a device that sends electrical signals to the spinal cord, aiming to disrupt pain signals before they reach the brain. It's a rapidly evolving field with a lot of promise, but it also attracts substantial investment from medical device companies. Now, when we talk about conflicts of interest, or COIs, we're referring to situations where a researcher's personal interests, particularly financial ones, have the potential to cloud their professional judgment and influence the outcomes of their research. Think of it this way: if a researcher is financially tied to a company that makes a specific SCS device, might they be more inclined to see their research results in a favorable light? That's the concern. Dr. Ryan D'Souza is an associate professor and pain medicine physician at Mayo Clinic. He is the Director of Neuromodulation, and Director of the Inpatient Pain Service. He serves on the Board of Directors of the North American Neuromodulation Society and also serves in leadership roles for ASRA Pain Medicine. Dr. D'Souza has authored over 150 peer-reviewed publications and serves on several editorial boards. Dr. Nasir Hussain is a pain medicine physician and anesthesiologist at the Ohio State University. He is an assistant professor, associate program director for the anesthesiology residency, and assistant program director of the chronic pain fellowship. Dr. Hussain has authored over 110 peer-reviewed publications in leading journals in the field, and has presented his work nationally at several conferences. *The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner's judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others. Podcast and music produced by Dan Langa. Find us on X @RAPMOnline, LinkedIn @Regional Anesthesia & Pain Medicine, Facebook @Regional Anesthesia & Pain Medicine, and Instagram @RAPM_Online.

Meningitis remains a major global health threat, with an estimated 2.5 million cases each year; of these, one in six results in death and one in five in long-term disabilities. Although meningitis “can strike anyone, anywhere in the world,” outbreaks disproportionately impact low- and middle-income countries, where diagnostic and treatment resources are limited. In efforts to address this, WHO launched its first-ever guideline on meningitis diagnosis and management in April this year. In this episode of Communicable, hosts Emily McDonald and Marc Bonten are joined by two experts directly involved in creating the guideline, Lorenzo Pezzoli and Nicolò Binello (WHO), as well as Jacob Bodilsen (Aalborg University), clinician-researcher and Chair of ESCMID's Study Group for Infectious Diseases of the Brain (ESGIB). The guests offer a firsthand look behind the guideline's development, review key recommendations for diagnosis and treatment - including the use of lumbar puncture, antibiotics, and chemoprophylaxis – and discuss how these fit into various clinical settings. This episode was edited by Kathryn Hostettler and peer reviewed by Ljiljana Lukić of University Hospital for Infectious Diseases in Zagreb, Croatia. The executive producer of Communicable is Angela Huttner. TermsCRP, C-reactive proteinGDG, Guideline Development GroupLiterature WHO guidelines on meningitis diagnosis, treatment and care. April 2025. https://www.who.int/publications/i/item/9789240108042Defeating meningitis by 2030: a global road map. June 2021. https://www.who.int/publications/i/item/9789240026407Olie SE, et al. Validation and clinical implementation of cerebrospinal fluid C-reactive protein for the diagnosis of bacterial meningitis: a prospective diagnostic accuracy study. Lancet Reg June 2025. DOI: 10.1016/j.lanepe.2025.101309Coldiron ME, et al. Single-dose oral ciprofloxacin prophylaxis as a response to a meningococcal meningitis epidemic in the African meningitis belt: A 3-arm, open-label, cluster-randomized trial. PloS Med 2018. DOI: 10.1371/journal.pmed.1002593Hasbun R, et al. Computed tomography of the head before lumbar puncture in adults with suspected meningitis. N Engl J Med 2001. DOI: 10.1056/NEJMoa010399Glimåker M. Lumbar puncture in adult bacterial meningitis: time to reconsider guidelines? BMJ 2013, DOI: 10.1136/bmj.f361

Brystkræft og blodpropper fylder igen i debatten om prævention – og dine patienter følger med.I dette afsnit af Almenmedicinsk Sommerradio undersøger vi, hvad to nye studier faktisk viser om risikoen ved hormonel prævention.Gæsterne er Anne Møller og Anne Holm. Begge praktiserende læger og seniorforskere ved forskningsenheden for almen praksis København, Slagelse, Køge. Disse studier gennemgås i samtalen: (08.10) Hormonspiral og risiko for kræft - Svensk registerstudie:Huan Yi, Naiqi Zhang, Jimiao Huang, Ying Zheng, Qiu hua Hong, Jan Sundquist,Kristina Sundquist, Xiangqin Zheng, Jianguang Ji. Association of levonorgestrel‑releasing intrauterine device with gynecologic and breast cancers: a national cohort study in Sweden. Am J Obstet Gynecol. 2024 Oct;231(4):450.e1–450.e12. doi:10.1016/j.ajog.2024.05.011.(19.28) Moderne p-piller og risiko for blodpropper - Dansk registerstudie:Yonis H, Løkkegaard E, Kragholm K, Granger CB, Møller AL, Mørch LS, Torp‑Pedersen C, Meaidi A. Stroke and myocardial infarction with contemporary hormonal contraception: real‑world, nationwide, prospective cohort study. BMJ. 2025;388:e082801. doi:10.1136/bmj‑2024‑082801

Helen MacDonald and Juan Franco are back to examine the newest in evidence based medicine.   In this episode: gabapentinoids are medications routinely prescribed for treating epilepsy and nerve pain. But, they come with side effects; among them - dizziness, cognitive impairment, and a dent to motor coordination - as well as an increase in suicidal ideation for the patient. Seena Fazel is professor of forensic psychiatry at University of Oxford and joins Juan to discuss a new paper tracking the association of self-harm and gabapentinoids use in Sweden.   Meanwhile, GRADE is a fundamental tool for clinicians to assess the quality of evidence for medical interventions. But, the sheer number of recommendations in the GRADE series can be overwhelming. Gordon Guyatt is a distinguished professor of medicine at McMaster University in Canada, and an early figure in the rise of evidence based medicine. He joins Helen to reflect on the future of EBM, and how the new Core GRADE system can cut through the noise.   Reading list:   1. Associations between gabapentinoids and suicidal behaviour, unintentional overdoses, injuries, road traffic incidents, and violent crime: population based cohort study in Sweden 2. Why Core GRADE is needed: introduction to a new series in The BMJ  

¿La glucosamina realmente ayuda con el dolor articular o es solo otro suplemento sobrevalorado? En este episodio te explico qué dice la ciencia actual, quién podría beneficiarse de tomarla, quién debería evitarla y por qué tantas veces viene acompañada de condroitina. Además, te cuento sobre los suplementos para las articulaciones que han recibido alertas sanitarias por parte de COFEPRIS. Así que dale play, porque tu salud articular lo vale. Búscanos en: Spotify - https://spoti.fi/2PLIXFV Apple podcast - https://apple.co/31XRnfT Google podcast - https://bit.ly/3fN4YPf Ivoox - https://bit.ly/2QbM1LT y en YouTube búscanos como NutriEat Contigo https://bit.ly/32dTtbI ¡suscríbete y activa la campanita para que te lleguen todas las notificaciones! Dudas, comentarios o sugerencias...¡Escríbenos! L.N Carla Paola AM ⚕ Envíame un WhatsApp 55 6325 6115. Búscame en Facebook, X e Instagram como @Nut.CarlaPaola #NutrieatContigo ----------------------- Bibliografía Li, Z. H., Gao, X., Chung, H. F., Zhang, X., Tan, Y. T., Wang, Y., ... & Lv, J. (2019). Association of regular glucosamine use with all-cause and cause-specific mortality: a large prospective cohort study. BMJ, 365, l1628. https://doi.org/10.1136/bmj.l1628 Clegg, D. O., Reda, D. J., Harris, C. L., Klein, M. A., O'Dell, J. R., Hooper, M. M., ... & Williams, H. J. (2006). Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis. New England Journal of Medicine, 354(8), 795-808. https://doi.org/10.1056/NEJMoa052771 Wandel, S., Jüni, P., Tendal, B., Nüesch, E., Villiger, P. M., Welton, N. J., ... & Reichenbach, S. (2010). Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network meta-analysis. BMJ, 341, c4675. https://doi.org/10.1136/bmj.c4675 National Center for Complementary and Integrative Health (NCCIH). (2023). Glucosamine and Chondroitin for Osteoarthritis. U.S. Department of Health & Human Services. https://www.nccih.nih.gov/health/gluc... MedlinePlus. (n.d.). Glucosamine. U.S. National Library of Medicine. Retrieved May 6, 2025, from https://medlineplus.gov/druginfo/natu... Comisión Federal para la Protección contra Riesgos Sanitarios (COFEPRIS). (2022). Alerta sobre productos engaño que utilizan ajo con supuestas cualidades curativas. https://www.gob.mx/cofepris/articulos... Comisión Federal para la Protección contra Riesgos Sanitarios (COFEPRIS). (2021). Alerta sobre comercialización ilegal del producto Artri Ajo King. https://www.gob.mx/cofepris/articulos...

Flere kvinder i overgangsalderen ønsker hormonbehandling – ofte inspireret af medier, private klinikker og veninder.Men hvad er det rigtige svar, når de spørger: “Er det farligt?"I dette afsnit af Almenmedicinsk Sommerradio dykker vi ned i to store studier om blodpropper og brystkræft og ser nærmere på, hvad evidensen faktisk viser.Gæsterne er Anne Møller og Anne Holm. Begge praktiserende læger og seniorforskere ved forskningsenheden for almen praksis København, Slagelse, Køge. Disse studier gennemgås i samtalen: (21.42) Hormonbehandling og hjertekarsygdom - Svensk registerstudie:Johansson T, Karlsson T, Bliuc D, Schmitz D, Ek WE, Skalkidou A, Center JR, Johansson Å. Contemporary menopausal hormone therapy and risk of cardiovascular disease: Swedish nationwide register based emulated target trial. BMJ. 2024;387:e078784. doi:10.1136/bmj-2023-078784. https://www.bmj.com/content/387/bmj-2023-078784(36.00) Hormonbehandling og brystkræft - Norsk registerstudie:Støer NC, Vangen S, Singh D, Fortner RT, Hofvind S, Ursin G, Botteri E. Menopausal hormone therapy and breast cancer risk: a population-based cohort study of 1.3 million women in Norway. Br J Cancer. 2024 Jul;131(1):126–37. doi:10.1038/s41416-024-02590-1. (nature.com, pubmed.ncbi.nlm.nih.gov)

Send us a textHey my beautiful friends –This week's conversation was sparked by a funny little tech discovery and a box I mailed — both of which got me thinking about food in a new way. You know how people are always quick to tell you what not to eat? Well, this week we flip the script. I'm sharing thoughts from my own journey and a coach that made me laugh and think — and you'll hear why his words still stick with me to this day. We're keeping things simple, kind, and grounded in something real. I'm not handing out rules, I'm sharing a mindset and maybe even a little inspiration for your next grocery run or packed lunch. And as always, we'll close with a little heart lift — this one from Michael Pollan, who said, “Eat food. Not too much. Mostly plants.”Come hang out with me, and let's talk about what loves us back. References:1.    Zhang & Talalay, Frontiers in Nutrition, 20232.    Liu, Nutrients, 20233.    Viguiliouk et al., Obesity Reviews, 20234.    Jenkins et al., AJCN, 20245.    Estruch et al., The Lancet Diabetes & Endocrinology, 20236.    Guasch-Ferré et al., BMJ, 20237.    Yao et al., Nutrients, 20238.    Harvard Nurses' Health Study Update, 20239.    Anderson et al., AJCN, 202410.Simopoulos, Frontiers in Endocrinology, 202311.Ye et al., Nutrients, 202312.Sonnenburg et al., Cell Metabolism, 202413.Mozaffarian et al., AJCN, 202314.Mastrocola et al., Appetite, 202315.Pollan, M. (2009). In Defense of FoodLet's go, let's get it done. Get more information at: http://projectweightloss.org

❤️ Bonjour,Dans cet épisode, découvrez :✅ Les 5 meilleures stratégies naturelles pour faire baisser le LDL-cholestérol :

Send us a textA/Prof Seye Abimbola explores how global health as a concept reinforces colonial power structures and argues for decentering Western institutions in health governance. His critique reveals how aid flows primarily benefit donor countries while creating dependencies that hinder meaningful health system development in recipient nations.• The term "global health" itself is problematic, describing an industry with colonial roots rather than a truly global approach to health• Much international aid functions as "tied aid," where donor countries require recipients to purchase overpriced products from them, limiting actual benefits• 84% of major global health organizations are headquartered in wealthy nations, perpetuating knowledge hierarchies and power imbalances• Historical colonial medical interventions like brutal sleeping sickness campaigns continue to impact health outcomes and trust in healthcare today• Prestigious biomedical journals marginalize qualitative research, reinforcing knowledge hierarchies that privilege Global North perspectives• True decolonization requires addressing not just authorship imbalances but ensuring research questions and methodologies serve local needs• The withdrawal of USAID funding presents both challenges and opportunities for African nations to reimagine health systems on their own termsCheck out Dr. Abimbola's book "The Foreign Gaze: Essays on Global Health" available open access, which further explores how knowledge practices in global health often serve foreign interests rather than addressing local needs.We also discussed Kyobutungi C, Okereke E, Abimbola S. After USAID: what now for aid and Africa? BMJ 2025; 388 :r479 doi:10.1136/bmj.r479 Undisciplinary - a podcast that talks across the boundaries of history, ethics, and the politics of health. Follow us on Twitter @undisciplinary_ or email questions for "mailbag episodes" undisciplinarypod@gmail.com

Hello everyone! Thanks to Tom's holiday and Stuart's job we weren't able to record this week, so we've put out a classic paid episode to tide you over. We hope this goes some way to scratching your Studies Show itch.Most people think it's obvious that you should wear a helmet when cycling. It might save your life if you fall off and hit your head. Duh.But over the years, many contrarian arguments have pushed back against this seemingly-obvious point. What if people engage in “risk compensation”, where they cycle more dangerously because they know they're wearing a helmet? What about if encouraging helments puts people off cycling so they miss the health benefits?In this March 2024 episode of The Studies Show, Tom and Stuart try to work out who's right.Show notes* The original 1975 study on what's become known as the “Peltzman Effect”: risk compensation (in this case about car safety)* Potential evidence for risk compensation in AIDS* Claims of risk compensation relating to mask-wearing at the start of the COVID-19 pandemic* The eye-tracking study on helmet-wearing, which used the Balloon Analogue Risk-Taking lab task* n=27 study on helmets and cycling with one hand on the handlebar* Study on risk compensation with the following confusing structural equation model diagram:* Academic cycles around and records thousands of cars passing him while he's either wearing or not wearing a helmet* Forbes article about the statistical controversy over these data* Bizarre study on how motorists “dehumanize” cyclists* Could helmets make “rotational injuries” worse?* Cochrane review on cycle helmets and injuries from 1999* Ben Goldacre and David Spiegelhalter on cycle helmets - “uncertainty… is unlikely to be substantially reduced by further research”* Systematic review on helmet use and injuries from 2016* Review of meta-analyses from 2023* 2006 BMJ article finding “no clear evidence” that mandating cycle helmets reduces injuries* Negative correlation between cycle numbers and helmet usage, across different countriesCreditsThe Studies Show is produced by Julian Mayers at Yada Yada Productions. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.thestudiesshowpod.com/subscribe

No episódio de maio do podcast Salão Azul, os consultores da BMJ analisam os principais desdobramentos do cenário político nacional. Em pauta, a crise provocada pelo decreto do IOF, os atritos entre o Congresso Nacional e o Executivo, e os bastidores da corrida eleitoral para 2026. Temas abordados: O decreto do IOF e o risco de queda via Projeto de Decreto Legislativo (PDL) A tensão entre o Congresso e o Ministério da Fazenda O desgaste político de Fernando Haddad A articulação de lideranças como Hugo Motta e Davi Alcolumbre Avanço da CPI do INSS e seus impactos institucionais Reorganizações partidárias e novas federações políticas As movimentações para as eleições de 2026 Pré-candidaturas de Ratinho Jr., Eduardo Leite, Ronaldo Caiado e Michelle Bolsonaro O papel estratégico do PSD e a disputa no campo do centro político Participação de: Érico Koyama (Consultor de Análise Política – BMJ) Gabriela Santana (Head de Engajamento – BMJ) Ariel Camon (Coordenador de Estados e Municípios – BMJ)

SHOW NOTESWhat impact does surgery have on the body?Intentional trauma Physiological response Psychosocial impact StressWhen we think about surgery, it's essential to understand that it triggers a significant reaction in the body known as the 'stress response.' This response is a complex interplay of hormonal and metabolic changes directly linked to the degree of tissue damage during surgery. It can intensify if there are any complications after the operation. Let's break it down: The whole process starts when the hypothalamic-pituitary-adrenal axis, or HPA axis, kicks into gear. This leads to a surge in hormones like cortisol, growth hormone, glucagon and catecholamines. These hormones are important because they help the body cope with stress by boosting energy availability and adjusting other bodily functions.Ebb phase (0-48hrs)Increased catabolism of stored glycogen (glycogenolysis)Suppression of insulin secretion → transient hyperglycemiaIncreased catecholamines, cortisol, and inflammatory cytokines (IL-6, TNF-α)Flow phase (3-10 days)Hypermetabolism (increased BMR)Increased protein catabolism → muscle breakdown (to provide amino acids for tissue repair and immune function)Increased lipolysis (fat breakdown) for energySustained insulin resistance → continued hyperglycemiaEnhanced GNG Pro-inflammatory response → increased cytokines and acute-phase protein productionIn the initial stages after surgery, the body releases a wave of pro-inflammatory cytokines. These cytokines jumpstart the healing process by promoting inflammation, which is important for healing surgical wounds. However, to keep this inflammation from going overboard, the body soon follows up with anti-inflammatory cytokines.These inflammatory processes have widespread effects across the body. For example, they can influence how the hypothalamus regulates body temperature or how the liver produces certain proteins that help fight infection and aid in wound healing.But here's where it gets even more interesting: other hormones like glucagon, cortisol, and adrenaline also play a role in modulating these responses. They can affect everything from your blood sugar levels to how your cardiovascular system handles the stress.So, why is all this important? Well, by understanding and managing these responses effectively, we can significantly improve how patients recover from surgery. It's all about helping the body maintain balance during a time when it's incredibly vulnerableDisruption of Metabolic Homeostasis: Surgery often disrupts the body's normal metabolic balance, notably through insulin resistance, where cells fail to respond effectively to insulin, leading to 'diabetes of the injury.' Insulin Resistance and Hyperglycemia: Insulin resistance can cause high blood sugar levels, significantly increasing the risk of surgical complications and mortality. Post-surgery, the body may enter a catabolic state, breaking down muscle instead of fat, which impairs wound healing, weakens the immune system, and reduces muscle strength. Increased Risks for Vulnerable Groups: Elderly, diabetics, and cancer patients are particularly at risk due to their compromised metabolic and inflammatory states. These groups have less physiological reserve, leading to pronounced catabolic states and increased risk of severe post-operative complications. Impact on Recovery and Outcomes: The metabolic chaos from insulin resistance to protein loss not only delays recovery but also exacerbates risks of infection and other complications. Effective management of these changes is crucial for improving surgical outcomes and ensuring that patients thrive post-surgery.ERAS helps to mitigate these by Surgery isn't just about the physical repair or removal of tissue; it triggers a cascade of stress responses in the body that can complicate recovery. These include everything from the psychological impacts of anxiety and the physiological effects of fasting to direct tissue damage and the systemic reactions to it, such as fluid shifts and hormonal imbalances.Key Components of ERAS:Comprehensive Care: ERAS isn't just a single technique but a suite of practices designed to address every aspect of the patient's journey — before, during, and after surgery. This approach aims to minimise the stress responses by controlling pain, reducing fasting times, optimising fluid management, and promoting early mobility.Minimising Fasting: One traditional practice that ERAS revises significantly is the preoperative fasting rule. Old guidelines that required fasting from midnight before surgery are now replaced with more lenient, evidence-based practices that allow intake of clear fluids up to two hours and solids up to six hours before surgery. This change helps maintain normal blood glucose levels, reduces stress, and decreases the body's shift into a catabolic (muscle-degrading) state.Nutritional Optimisation: ERAS protocols emphasise the importance of not entering surgery in a depleted state. By allowing a carbohydrate-rich drink shortly before surgery, patients are better hydrated and less anxious, which in turn reduces insulin resistance and preserves muscle mass — critical factors in speeding up recovery post-surgery. Post-operatively, oral nutrition may be delayed by the medical team until bowel function returns, typically taking close to a week. This delay is stated to reduce postoperative complications such as abdominal distension and nausea/vomiting.For the first several days post surgery fluids of limited nutritional value such as water are provided to patient until tolerance is established leading to insufficient nutrition intake during this time increasing the risk of malnutrition. The ERAS protocol promotes early oral intake within 24 hours post surgery departing from traditional fasting practices. Research suggests that between 40-50% of surgical patients have some degree of malnutrition. Pre-operative malnutrition is an independent predictor of poor post-operative outcomes. Therefore addressing malnutrition is a key component of the ERAS protocol.Immune-Enhancing Diets: Post-surgery nutrition is just as crucial. ERAS encourages diets rich in nutrients that bolster the immune system and enhance wound healing. This includes omega-3 fatty acids, which help modulate the inflammatory response; arginine, which supports protein synthesis and tissue growth; glutamine, which is vital for cellular health and recovery; and nucleotides, which are essential for rapid cell division and immune function .Immuno-nutrition is a specialised medical nutrition therapy that has been shown to adjust the body's inflammatory response: It incorporates specific nutrients like omega-3 fatty acids, arginine, polyunsaturated fatty acids, and nucleotides. It's typically recommended starting 5-7 days before surgery and continuing post-operatively for over 7 days or until oral intake meets at least 60% of the patient's nutritional requirements.How can we use this info to optimize surgical outcomes?Patient education Early nutrition pre and post surgery - Minimise fasting time What is ERAS? How does it differ from traditional care/practice?Introduced by Henrik Kehlet in 1997, the Enhanced Recovery After Surgery (ERAS) protocol has revolutionised surgical practices by optimising perioperative care. A key aspect of ERAS is its interdisciplinary approach, involving healthcare professionals from various specialties to minimise surgical stress and facilitate recovery. What is malnutrition?Malnutrition, is defined as an involuntary reduction in body weight, muscle mass and physical capabilities, affects up to 65% of surgical patients and can worsen during hospital stays. Enhancing nutritional status and promoting functional nutrition therapy is essential, even forpatients without evident malnutrition, particularly when prolonged perioperative oral intake challenges arise. Addressing malnutrition is essential for preventing surgical complications, prolongedhospital stays and higher healthcare costs. What are the benefits of ERAS for the patient?It has been shown that the key physiological benefits include:-enhances the body's anabolic processes-promotes wound healing, which is critical for patient recovery.-Reduces the risk of nutritional depletion-Minimises insulin resistance, a common issue post-surgery, allowing for better blood sugar control and improved metabolic function.-Reduce protein catabolism-And lowers the risk of pressure injuries, which can develop due to extended immobility after surgery.What are the benefits of ERAS from a healthcare perspective? From a healthcare perspective, ERAS has been shown to-shorter length of hospital stay for patients,-Lower risk of ICU transfer rates-reduce readmission rates-And all of these improvements lead to lower healthcare costs, not just for the hospital but for the overall healthcare system, as fewer complications and shorter stays reduce the financial strain.Step 1: Screen & StrengthenIf you've lost any weight unintentionally in the lead up to surgery, or been eating poorly because of a reduced appetite, you may be at risk of malnutrition and it's really important to address this prior to surgery. Research suggests that between 40-50% of surgical patients have some degree of malnutrition. Pre-operative malnutrition is an independent predictor of poor post-operative outcomes. Addressing malnutrition is a key component of the ERAS protocol and why it's effective in improving surgical outcomes for patients.Book an appointment with a dietitian who can guide you on appropriate dietary changes to minimise muscle loss, build you up and optimise nutritional status and stores pre-op. A well-nourished body tolerates surgery better, heals faster, has a stronger immune system to fight infection, and experiences fewer complications.Step 2: Consider Immunonutrition If you're planned for major surgery, especially certain cancer and abdominal surgeries, consider the use of an immunonutrition supplement in the 5-7 days pre op. These are the supplements loaded with arginine, n3s, glutamine and nucleotides to support the immune system and reduce inflammatory responses, potentially leading to fewer infections and better recovery.Step 3: Build Your Strength & Energy Stores prior to surgery Carb load with food in the days leading up to surgery - think that big bowl of pasta a footy player would have the night before the grand final. ERAS protocols have significantly reduced or eliminated long periods of "nil by mouth" (NBM) before surgery.Ask your surgical team exactly when you need to stop eating solid food – it might be much later than you think, often around 6 hours before surgery for a light meal. For clear fluids, it could be as little as 2 hours before!We'll make the most of every second to prevent unnecessary dehydration, hunger, anxiety, and preserve your body's energyStep 4: The Pre-Surgery Carb Load using clear fluidsMany ERAS protocols include a special carbohydrate-rich drink taken a few hours before surgery. Your hospital may provide this, but if they don't, we can organise orders for you or point you in the right direction.  It's usually a clear, sweet drink. Think of it as topping off your fuel tank right before the 'race'."These have been shown to reduce post-operative insulin resistance (which can slow healing), help maintain muscle strength, can reduce nausea, and improve overall wellbeing. It basically tells your body it's in a 'fed' state, not a 'starvation' state, heading into surgery.This is best done with tailor made medical nutrition drinks as they come prepped with the correct doses of maltodextrin-polymer carbs and a lower osmolality than other solutions, which essentially means they gentler on your gut and better for gastric emptying so they don't linger in your gut during surgery. Always follow surgical instructions, but ideally we're aiming for 100 grams of carbohydrate the night before surgery and about 50 grams of carbohydrate in clear fluids approximately 2 hours before anesthesia. This might look like 4 x 200ml drinks the night before, and 2 the morning of surgery If you can't access these drinks, apple or cranberry juice are reasonable replacements.  Drop us an email or message or give us a call if you'd like advice on where to get pre-op and immunonutrition supplement drinks. Then we move on to post op and Step 5 which is aiming to eat early.  ERAS encourages starting to eat and drink as soon as it's safe after surgery – often within hours, not days!As soon as your team says it's okay, try sipping water, then progress to other clear fluids, and then light foods as tolerated. Even small, frequent amounts help. This helps to stimulates your gut to start working again, reducing the risk of ileus – a slow, sleepy bowel, provides energy for healing, and can help you feel more normal, faster.If you haven't been told you can eat or drink, keep asking the question! You are your best advocate! Another tip that can help here is step 6:  Chew GumIf your team allows it, start chewing sugar-free gum several times a day once you're able. It sounds simple, but it can be surprisingly helpful in mimicking eating even when you're not allowed to, and can stimulate your digestive system to return to usual function sooner and reduce the risk of ileus.Step 7 is to Nourish to Heal This is where we bring in our good friend protein to optimise tissue repair and recovery Include protein rich food at each meal, and chat to us if you're finding this difficult because there are plenty of hacks if you're not feeling up to chicken breast and steak! And finally step 8 is to Listen to Your BodyWhile ERAS encourages early eating, we always want you to be tuned in to your body's cues and speaking up to your medical team and us if something doesn't feel right. There are plenty of interventions that can be used to keep you comfortable while still optimising your nutrition to get the best outcomes from surgery. Weimann, A., Braga, M., Carli, F., Higashiguchi, T., Hübner, M., Klek, S., et al. (2021). ESPEN practical guideline: Clinical nutrition in surgery. Clinical Nutrition, 40(7), 4745-4761.Weimann, A., Braga, M., Carli, F., Higashiguchi, T., Laviano, A., Ljungqvist, O., et al. (2017). ESPEN guideline: Clinical nutrition in surgery. Clinical Nutrition, 36(3), 623-650.Gustafsson, U. O., Scott, M. J., Schwenk, W., Demartines, N., Roulin, D., Francis, N., et al. (2019). Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations: 2018. Clinical Nutrition, 38(2), 576-586. (Note: The ERAS® Society website, erassociety.org, is the primary source for the most current and comprehensive suite of procedure-specific guidelines.)Ljungqvist, O., Scott, M., & Fearon, K. C. (2017). Enhanced Recovery After Surgery: A review. JAMA Surgery, 152(3), 292-298.Thiele, R. H., Raghunathan, K., Brudney, C. S., Campos, S., Candiotti, K., Chaves, S., et al. (2016). American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on perioperative fluid management in adults. Perioperative Medicine, 5, 26. (Note: This is an example of ASER/POQI consensus; look for other relevant POQI statements on specific surgical procedures and their nutritional components.)Soon, K., Levy, G. M., Cusack, L. A., Varma, S., & Nicholson, G. A. (2020). The effect of preoperative carbohydrate loading on patient outcomes in elective surgery: A systematic review and meta-analysis. Systematic Reviews, 9(1), 254.Lewis, S. J., Egger, M., Sylvester, P. A., & Thomas, S. (2001). Early enteral feeding versus "nil by mouth" after gastrointestinal surgery: systematic review and meta-analysis of controlled trials. BMJ, 323(7316), 773-776.Osland, E. J., Hossain, M. A., Khan, S., & Memon, M. A. (2014). Effect of timing of oral feeding on patient outcomes after elective colorectal surgery: A systematic review and meta-analysis. Journal of Gastrointestinal Surgery, 18(5), 1039-1051.Braga, M., Gianotti, L., Nespoli, L., Radaelli, G., & Di Carlo, V. (2002). Nutritional approach in malnourished surgical patients: a prospective randomized study. Archives of Surgery, 137(2), 174-180.Marimuthu, K., Varadhan, K. K., Ljungqvist, O., & Lobo, D. N. (2012). A meta-analysis of the effect of combinations of enhanced recovery after surgery (ERAS) interventions on postoperative outcomes. Annals of Surgery, 255(4), 640-649.

Listener feedback on sports “disqualification,” big digoxin news, Brugada syndrome, another positive finerenone study, and unblinded transcatheter trials are discussed by John Mandrola, MD, in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I Listener Feedback JACC EP Paper https://www.jacc.org/doi/10.1016/j.jacep.2025.03.013 II Digoxin News DIGIT HF Baseline Characteristics paper https://doi.org/10.1002/ejhf.3679 DIGIT HF Rationale paper https://pmc.ncbi.nlm.nih.gov/articles/PMC6607489/ Dig trial https://www.nejm.org/doi/full/10.1056/NEJM199702203360801 DECISION trial https://onlinelibrary.wiley.com/doi/full/10.1002/ejhf.3428 Ziff et al BMJ meta-analysis https://www.bmj.com/content/351/bmj.h4451 III Brugada Syndrome Gomes et al https://doi.org/10.1093/europace/euaf091 IV Another Finerenone Substudy Published FINEARTS-HF trial substudy, Bhatt, A et al https://doi.org/10.1016/j.cardfail.2025.05.006 FINEARTS HF Main paper https://www.nejm.org/doi/full/10.1056/NEJMoa2407107 TOPCAT https://www.nejm.org/doi/full/10.1056/NEJMoa1313731 TOPCAT regional variation Circ paper https://www.ahajournals.org/doi/10.1161/circulationaha.114.013255 V Another Opinion on Unblinded Transcatheter Intervention Trials Kaul https://eurointervention.pcronline.com/article/unblinded-trials-of-transcatheter-interventions-with-subjective-endpoints-what-are-the-implications You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

A Lancet study warns of consequences for HIV prevention if PEPFAR loses funding, potentially millions of new pediatric HIV cases and increased AIDS-related deaths. Medicare Part D is highlighted, with research linking subsidy loss to higher mortality rates. A report from BMJ notes a 3.1% decline in U.S. drug overdose deaths, signaling a possible peak in the fentanyl crisis.

Recent escalations in the ever simmering tension between India and Pakistan brought us closer to conflict - conflict between two nuclear powers. For a long time doctors have campaigned for nuclear disarmament, and Chris Zielinski, president of the World Association of Medical Editors, makes the case for returning WHO's mandate to measure the potential impact of nuclear war. Also the militarization of the region is detrimental to the health and wellbeing of the populations in both India and Pakistan. co-chairs of The BMJ's South Asia editorial board, Sanjay Nagral and Zulfiqar Butta, explain why a focus on the daily material and health needs of citizens is the way to change political rhetoric in the region. Gordon Guyatt, distinguished professor at McMaster University, was one of the people responsible for starting GRADE - which is a structured system for assessing the quality of evidence in systematic reviews and clinical practice guideline. Gordon thinks that process has become too complicated - so he's now championing “Core GRADE”. He joins us to explain why.   Reading list Ending nuclear weapons, before they end us Why Core GRADE is needed: introduction to a new series in The BMJ

You are capable of radical change. If you aren't convinced that you can create change in your life, take Aimee's story about how her hen became a rooster (seriously, just listen in and it'll make sense). Beyond that chicken talk, this episode is focused on our human potential for change and healing. We'll touch on neuroplasticity, epigenetics, and the motivational role of hope. We think you'll come away with a better understanding of how you're wired for change and can intentionally steer it towards greater wellbeing.  If you enjoyed this episode, please rate and review us wherever you listen to your favorite podcasts!  Sources and Notes: Joy Lab Program: Take the next leap in your wellbeing journey with step-by-step practices to help you build and maintain the elements of joy in your life. Emotional Inertia: Feeling Dull & Disconnected [Joy Lab ep. 207] Zhang, X., et al. (2023). Overview of Avian Sex Reversal. International journal of molecular sciences, 24(9), 8284. https://doi.org/10.3390/ijms24098284 Bian, Z., et al. (2024). Genetic predisposition, modifiable lifestyles, and their joint effects on human lifespan: evidence from multiple cohort studies. BMJ evidence-based medicine, 29(4), 255–263. https://doi.org/10.1136/bmjebm-2023-112583 Weger, U. W., & Loughnan, S. (2013). Mobilizing unused resources: using the placebo concept to enhance cognitive performance. Quarterly journal of experimental psychology (2006), 66(1), 23–28. https://doi.org/10.1080/17470218.2012.751117 Head to YouTube to see Haley's new spurs (16:28) Closing poem excerpt: Emily Dickinson, "Hope is the Thing With Feathers." Full transcript here. Please remember that this content is for informational and educational purposes only. It is not intended to provide medical advice and is not a replacement for advice and treatment from a medical professional. Please consult your doctor or other qualified health professional before beginning any diet change, supplement, or lifestyle program. Please see our terms for more information. If you or someone you know is struggling or in crisis, help is available. Call the NAMI HelpLine: 1-800-950-6264 available Monday through Friday, 10 a.m. – 10 p.m., ET. OR text "HelpLine" to 62640 or email NAMI at helpline@nami.org. Visit NAMI for more. You can also call or text SAMHSA at 988 or chat 988lifeline.org.

C'est une question que beaucoup se posent au moment de passer au rayon boulangerie : faut-il choisir le pain blanc, moelleux et classique, ou le pain complet, souvent jugé plus rustique ? D'un point de vue nutritionnel, la réponse est claire : le pain complet est généralement meilleur pour la santé. Voici pourquoi.Le pain blanc est fabriqué à partir de farine raffinée, dont on a retiré le son (la couche extérieure du grain) et le germe (la partie nutritive). Ce procédé donne une texture plus légère, mais prive le pain de fibres, vitamines et minéraux essentiels. À l'inverse, le pain complet est issu de farine intégrale, contenant toutes les parties du grain. Résultat : il est bien plus riche en nutriments.Selon les données de l'Agence nationale de sécurité sanitaire de l'alimentation (ANSES), 100 grammes de pain complet contiennent en moyenne 6 à 7 g de fibres, contre 2 à 3 g seulement pour le pain blanc. Or, les fibres jouent un rôle clé dans la régulation du transit intestinal, la satiété (ce qui aide à limiter le grignotage) et même dans le contrôle de la glycémie. En ralentissant la digestion, elles évitent les pics de sucre dans le sang que provoque souvent le pain blanc.Une étude scientifique publiée dans le British Journal of Nutrition en 2017 par Y. Benítez-Páez et ses collègues a démontré que la consommation régulière de pain complet améliore la diversité du microbiote intestinal, ce qui est associé à un système immunitaire plus robuste et à une réduction des inflammations chroniques. Les chercheurs ont suivi deux groupes de participants pendant 8 semaines : ceux qui mangeaient du pain complet ont vu une augmentation significative de certaines bactéries bénéfiques, comme Bifidobacterium et Lactobacillus, par rapport au groupe pain blanc.De plus, les céréales complètes sont associées à une réduction du risque de maladies cardiovasculaires. Une méta-analyse de 2016 publiée dans The BMJ, regroupant 45 études, a montré qu'une consommation élevée de céréales complètes (dont le pain complet) est liée à une diminution de 22 % du risque de maladie cardiaque et à un taux de mortalité global réduit.Cela dit, il faut rester vigilant : tous les pains "complets" ne se valent pas. Certains pains industriels utilisent de la farine blanche enrichie de son, ce qui ne reproduit pas les bienfaits du grain entier. Privilégiez les pains portant la mention "farine complète" ou "farine intégrale", de préférence bio, et fabriqués par des boulangers artisanaux.En résumé, pour votre santé digestive, cardiovasculaire et métabolique, le pain complet l'emporte haut la main sur le pain blanc. Hébergé par Acast. Visitez acast.com/privacy pour plus d'informations.

In this podcast accompanying the May issue (https://dtb.bmj.com/content/63/5) of DTB, David Phizackerley (DTB Editor) welcomes Syba Sunny (DTB Clinical Editor) to the podcast. Syba provides an overview of her role with DTB, discusses her previous work as a Consultant Microbiologist and talks about areas of interest for future DTB articles.  The editorial (https://dtb.bmj.com/content/63/5/66) discusses a paper in The BMJ which proposed offering a polypill containing rosuvastatin, hydrochlorothiazide, amlodipine and losartan to all people in the UK over the age of 50 years to reduce the risk of heart attacks and strokes. A DTB Select item (https://dtb.bmj.com/content/63/5/68) summarises the results of  a small study that assessed whether cytisinicline (cytisine) plus behavioural support was more effective than behavioural support alone for vaping cessation. The main article (https://dtb.bmj.com/content/63/5/74) is the first of two articles on the medical management of ADHD and there will be a longer discussion and an interview with the author in the June podcast.   Please subscribe to the DTB podcast to get episodes automatically downloaded to your mobile device and computer. Also, please consider leaving us a review or a comment on the DTB Podcast iTunes podcast page. If you want to contact us please email dtb@bmj.com. Thank you for listening.

Welcome to the Hot Topics podcast from NB Medical with Dr Neal Tucker. In this edition, we look at three new pieces of research.First, in the BMJ, a paper exploring whether a GP-led psychological intervention can help PTSD symptoms in our patients after ICU. Could this also be successful for other forms of trauma?Second, in the Lancet, research looking at whether semaglutide can improve walking distance in patients with diabetes and intermittent claudication.Finally, in the BJGP, can a practice-led physical activity intervention improve symptoms in survivors of cancer? Will anyone actually want to do it? The answer, and who, may surprise you.ReferencesPoor by Katriona O'SullivanBMJ PTSD paperLancet GLP1ra and PADBJGP Physical activity and cancer survivorsMoving Medicinewww.nbmedical.com/podcast

China was declared malaria free in 2021 - and we'll hear how persistence was key to their success, and what new technologies are available to help the rest of the world become malaria free, from Regina Rabinovich, director of the Malaria Elimination Initiative at the Barcelona Institute for Global Health.  Sonia Saxena, professor of primary care at Imperial College London, and Miguel O'Ryan, dean of the medical faculty of the University of Chile join Kamran to talk about what broke academic medicine, and why it's time for a revolution. New research shows that data from retracted papers is still having an alarming effect on clinical practice. Chang Xu, Hui Liu, and Fuchen Liu from the Naval Medical University in Shanghai, and Suhail Doi from Qatar University, join us to talk about their study which has maped retracted papers impact on systematic reviews and clinical guidelines.    Reading list Malaria control lessons from China Vision 2050: a revolution in academic medicine for better health for all Investigating the impact of trial retractions on the healthcare evidence ecosystem (VITALITY Study I) - An example of the BMJ's approach to updating metaanalysis after a study retraction 

Send us a textDescription: An immersive reading of A Hymn to God the Father by John Donne with reflection on medical errors and confession. Website:https://anauscultation.wordpress.comWork:A Hymn to God the Father by John DonneWilt thou forgive that sin where I begun,         Which was my sin, though it were done before?Wilt thou forgive that sin, through which I run,         And do run still, though still I do deplore?                When thou hast done, thou hast not done,                        For I have more.Wilt thou forgive that sin which I have won         Others to sin, and made my sin their door?Wilt thou forgive that sin which I did shun         A year or two, but wallow'd in, a score?                When thou hast done, thou hast not done,                        For I have more.I have a sin of fear, that when I have spun         My last thread, I shall perish on the shore;But swear by thyself, that at my death thy Son         Shall shine as he shines now, and heretofore;                And, having done that, thou hast done;                        I fear no more.References:Wu AW. Medical error: the second victim. The doctor who makes the mistake needs help too. BMJ. 2000 Mar 18;320(7237):726-7. doi: 10.1136/bmj.320.7237.726. Finkelstein A, Brezis M, Taub A, Arad D. Disclosure following a medical error: lessons learned from a national initiative of workshops with patients, healthcare teams, and executives. Isr J Health Policy Res. 2024 Mar 11;13(1):13.Rodziewicz TL, Houseman B, Vaqar S, et al. Medical Error Reduction and Prevention. [Updated 2024 Feb 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499956/Institute of Medicine (US) Committee on Quality of Health Care in America. To Err is Human: Building a Safer Health System. Kohn LT, Corrigan JM, Donaldson MS, editors. Washington (DC): National Academies Press (US); 2000. PMID: 25077248.

Welcome to Episode 45 of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants! Show Notes for Episode 45 of “The 2 View” – All things toxicology: the intoxicated patient, propranolol overdose and suicide, snake bites, and a special guest. Segment 1 – The intoxicated patient Kaufman J, Fitzpatrick P, Tosif S, et al. Faster clean catch urine collection (Quick-Wee method) from infants: randomised controlled trial. BMJ. The BMJ. Published April 7, 2017. https://www.bmj.com/content/357/bmj.j1341 Kraaijvanger N, Raven W, van Dijken T, Gresnigt F. The PIRATE mnemonic: providing a structured approach in the care for intoxicated patients at the emergency department. Int J Emerg Med. Educational Advances in Emergency Medicine. BMC: Part of Springer Nature. Published March 1, 2024 https://intjem.biomedcentral.com/articles/10.1186/s12245-024-00606-4 Thiessen P. A simple new technique for collecting urine in infants. Thischangedmypractice.com. The University of British Columbia. Faculty of Medicine: This Changed My Practice (TCMP) by UBC CPD. Published November 18, 2015. https://thischangedmypractice.com/new-technique-for-collecting-urine-in-infants/ Van Oyen A, Barney N, Grabinski Z, et al. Urine Toxicology Test for Children With Altered Mental Status. Aap.org. Pediatrics. Case Reports. American Academy of Pediatrics: Dedicated to the Health of All Children. Published October 6, 2023. https://publications.aap.org/pediatrics/article/152/5/e2022060861/194346/Urine-Toxicology-Test-for-Children-With-Altered?autologincheck=redirected Segment 2 – Propranolol overdose and suicide Khalid MM, Galuska MA, Hamilton RJ. Beta-Blocker Toxicity. In: StatPearls. StatPearls Publishing. NIH: National Library of Medicine – National Center for Biotechnology Information. Published July 28, 2023. https://www.ncbi.nlm.nih.gov/books/NBK448097/ Srettabunjong S. Fatal Self-Poisoning With Massive Propranolol Ingestion in a Young Male Physician. Am J Forensic Med Pathol. PubMed®. NIH: National Library of Medicine – National Center for Biotechnology Information. Published September 2017. https://pubmed.ncbi.nlm.nih.gov/28691951/ Segment 3 – Snake bites Rohl S, Meredith M, Anderson, T, et al. Comparing the Use of Crotaline-Polyvalent Immune Fab (Ovine) Versus Observation in Children. Pediatric Emergency Care: Dedicated to the Care of the Ill or Injured Child. Lww.com. Published November 2024. https://journals.lww.com/pec-online/abstract/2024/11000/comparingtheuseofcrotalinepolyvalentimmune.19.aspx Snake bites. Wikem.org. WikiEM. Last edited March 17, 2021. https://wikem.org/wiki/Snake_bites Toxicology resources Goldfrank LR, Flomenbaum NE, Howland MA, et al. Goldfrank's Toxicologic Emergencies. 8th ed. McGraw-Hill Medical; 2006. Katz K, O'Connor A, Amaducci AM. EMRA and ACMT Medical Toxicology Guide: 2nd Edition.; 2022. National Poison Data System. Poisoncenters.org. America's Poison Centers: Treatment, Education, Prevention. Accessed April 9, 2025. https://poisoncenters.org/national-poison-data-system Poison Control: National Capital Poison Center. Poison.org. Accessed April 9, 2025. https://www.poison.org/ Segment 4 – Special guest: Nancy Denke, DNP, ACNP-BC, FNP-BC, FAEN, CEN, CCRN, of Arizona Linkedin.com. Accessed April 9, 2025. https://www.linkedin.com/in/nancy-denke-dnp-acnp-bc-fnp-bc-faen-a62851 Nancy Denke, DNP, ACNP-BC, FNP-BC, FAEN, CEN, CCRN, of Arizona. ENA Hall of Honor. Published July 26, 2024. Accessed April 9, 2025. https://hall-of-honor.org/nancy-denke PodBean Development. Talking Toxicology: A Recipe for Disaster (Nancy Denke). BCEN & Friends Podcast. PodBean. Published March 7, 2023. https://bcenandfriends.podbean.com/e/talking-toxicology-a-recipe-for-disaster-nancy-denke/ *Recurring Sources * Center for Medical Education. Ccme.org. http://ccme.org The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com Trivia Question: Send answers to 2viewcast@gmail.com Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to. Be sure to listen in and see what we have to share!

The focus of today's episode with Mercedes Pollmeier is to get you familiar with the starting point of strength training for your climbing journey. She discusses the top injuries of climbers and why they may happen. Build body awareness by learning which muscles are engaged while climbing, and also learn how to properly press, pull, hinge, squat, and let's not forget your core. Mercedes is here to drop the knowledge about what to prioritize for strength training, while improving mobility and reducing risk of injury. Leave a comment below about what you've noticed in your strength training & how it's shown up in your climbing! Join Modus Training with this 3 month membership special! https://www.modusathletica.com/offers/C5hDL5aq If you'd like to work one-on-one with me, visit my website for more details https://www.modusathletica.com/coaching Intro To Training Masterclass is free way to work with me: https://www.modusathletica.com/masterclass 00:00:32 Common climbing injuries 00:03:08 Climbing Technique 00:05:25 Cause of Injury 00:06:44 Engaged muscles00:09:17 What should we prioritize 00:13:32 Strength exercises 00:21:22 Recap 00:22:52 A question for YOU Here's the Research Study: Grønhaug, Gudmund. “Self-reported chronic injuries in climbing: who gets injured when?.” BMJ open sport & exercise medicine vol. 4,1 e000406. 17 Jul. 2018, doi:10.1136/bmjsem-2018-000406

Chris and Cristina chat with Dr. Ian Wallace, an Assistant Professor of Anthropology at the University of New Mexico, where he is the director of the Human Physical Activity Lab. As an Evolutionary Anthropologist, Ian's work focuses on how humans evolved to use their bodies and explores the costs and benefits of modern physical activity patterns for our health. He is particularly interested in populations transitioning from non-industrial to industrial and post-industrial contexts. Ian earned his Ph.D. in Anthropology in 2013 from Stony Brook University, where his dissertation examined how physical activity and genetics determine limb bone structure. Following graduate school and an initial postdoctoral position at Stony Brook, he completed his postdoctoral training in the Department of Human Evolutionary Biology at Harvard and started his own lab at UNM. There, he focuses on measures of locomotor biomechanics and their ties to the health and function of the musculoskeletal system. Recently, his fieldwork has focused on the Indigenous peoples of Peninsular Malaysia. In particular, he is interested in how their lifestyles are changing with the rapid expansion of industries, the market economy, and urban areas across Malaysia, as well as how these changes affect their health and risk of disease. ------------------------------ Find the papers discussed in this episode: Wallace, I. J., Worthington, S., Felson, D. T., Jurmain, R. D., Wren, K. T., Maijanen, H., Woods, R. J., & Lieberman, D. E. (2017). Knee osteoarthritis has doubled in prevalence since the mid-20th century. Proceedings of the National Academy of Sciences of the United States of America, 114(35), 9332–9336. https://doi.org/10.1073/pnas.1703856114 Wallace, I. J., Lea, A. J., Lim, Y. A. L., Chow, S. K. W., Sayed, I. B. M., Ngui, R., Shaffee, M. T. H., Ng, K. S., Nicholas, C., Venkataraman, V. V., & Kraft, T. S. (2022). Orang Asli Health and Lifeways Project (OA HeLP): a cross-sectional cohort study protocol. BMJ open, 12(9), e058660. https://doi.org/10.1136/bmjopen-2021-058660 ------------------------------ Contact Dr. Wallace: Website: https://www.ianjwallace.com/; E-mail: iwallace@unm.edu ------------------------------ Contact the Sausage of Science Podcast and Human Biology Association: Facebook: facebook.com/groups/humanbiologyassociation/, Website: humbio.org, Twitter: @HumBioAssoc Chris Lynn, Host Website: cdlynn.people.ua.edu/, E-mail: cdlynn@ua.edu, Twitter:@Chris_Ly Cristina Gildee, Co-host, SoS Co-Producer, HBA Junior Fellow Website: cristinagildee.org, E-mail: cgildee@uw.edu

In this episode of RAPM Focus, executive editor Steven Cohen, MD, discusses the September 2024 publication of “Current state of the pain medicine match: perspective and an eye to the future,” with Meredith Barad, MD, Anuj Aggarwal, MD, and Lynn Kohan, MD. This letter explores the rationale behind reassessing the NRMP's utility for pain medicine, examining historical and current trends, and considering the implications of withdrawing from the match. Despite a recent decline in applicants and an increase in unfilled positions, the APPD advocates for continued participation in the match. The match ensures equitable and stable recruitment, preventing the chaotic pre-match environment of competitive, early offers. Data from similar specialties highlight the pitfalls of non-match systems, such as increased applicant pressure and reduced program visibility. The APPD supports maintaining the NRMP match while implementing reforms like preference signaling to address evolving challenges. The APPD aims to preserve the match's benefits and ensure a stable future for pain medicine fellowship recruitment. Dr. Barad is a clinical associate professor in anesthesiology (pain) and neurology at Stanford. She is the co-director of the Stanford Facial Pain Program and focuses on headache and facial pain. She completed her undergraduate work at the University of Texas at Austin and graduated from Stanford University Medical School in 2003. After her internship at Santa Clara Valley Medical Center in San Jose, CA, she went on to a neurology residency and pain fellowship at Stanford. She is board certified in neurology, headache, and pain. She is the associate division chief of education and program director for the pain fellowship. She is the current president of the American Pain Program Directors. She serves as the chair of the headache and facial pain special interest group for the American Academy of Pain Medicine and is on the editorial board of Pain Medicine. Dr. Aggarwal is a clinical assistant professor of anesthesiology and the associate program director of the pain medicine fellowship at Stanford University, where he specializes in headache and orofacial pain. In addition to his work in pain medicine, he helps lead the teaching of medical students serving as director of pharmacology and as associate director for the Science of Medicine.  Dr. Kohan is a professor of anesthesiology and pain medicine at the University of Virginia. She is the division chief and the chronic pain program director. She serves on the board of directors for national pain societies including ASRA Pain Medicine. *The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner's judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others. Podcast and music produced by Dan Langa. Find us on X @RAPMOnline, LinkedIn @Regional Anesthesia & Pain Medicine, Facebook @Regional Anesthesia & Pain Medicine, and Instagram @RAPM_Online.

Helen MacDonald and Juan Franco are back, magnifying glasses in hand, to take a closer look at what's happening in evidence based medicine.   In this episode: the NHS increasingly relies on physician associates to plug some of its leaks. But, what do academic studies show about the effectiveness of these newest healthcare team members? Trish Greenhalgh is professor of primary healthcare at the University of Oxford, and she tells us about her meta-study reviewing the evidence.   Meanwhile, chronic back pain can be debilitating. When it's at its worst, patients are eager for treatments. But, what is the true effectiveness of spinal injections to alleviate pain? Jane Ballantyne is a retired professor of pain medicine. She discusses where interventions go wrong, and how new recommendations for pain management reflect the best evidence.   Finally, Helen and Juan face uncertainty. A new research methods and reporting paper published in the BMJ takes a critical look at clinical prediction models. What does the evidence tell clinicians about how to behave when outcomes can't be exact?   Reading list: Physician associates and anaesthetic associates in UK: rapid systematic review of recent UK based research. Spinal interventions for chronic back pain Uncertainty of risk estimates from clinical prediction models: rationale, challenges, and approaches

A new type of drug for one of the most common types of breast cancer is now going to be available in the NHS in England. In Wales, the drug is approved for use but its funding is still to be decided, and the drug hasn't been approved for use in Scotland and Northern Ireland yet. Some 3,000 women a year could benefit after a clinical trial showed it can slow the progression of the disease. Nuala McGovern discusses how the drug works and who could benefit with Dr Liz O'Riordan, a former breast cancer surgeon who herself has had breast cancer and is currently in remission.Emily MacGregor is a music historian and trombonist. After the sudden death of her father, a jazz guitarist, she found she wasn't able to bear the sound of music. The very thing that once connected them became a source of pain and silence. In her new book, While the Music Lasts, she explains how she reconnected with her father through the pieces left on his music stand, from tangos to Handel, Cádiz to Coltrane. She joins Nuala to talk about how she learnt to navigate grief and how she discovered the joy of music again.Between 2021 and 2022 the number of women having abortions rose by 17%. A recent study in the BMJ reported that, amongst women having abortions, the number of women using hormonal contraception fell from 18.8% in 2018 to 11.3% in 2023. Over the same period, the number of women undergoing abortions who were not using any contraception when they conceived went up by 14%. So are women turning their backs on hormonal contraceptives? Does this change lie with the contraceptives themselves, women's access to contraception or could there be other factors like the increase in the use of fertility apps? Nuala speaks to Dr Paula Briggs, Consultant in Sexual & Reproductive Health, and journalist Barbara Speed.In 2014, the Church of England passed the necessary laws to allow women to become bishops. For some, this was a controversial decision. In an attempt to smooth that change the five guiding principles were introduced which allowed those who felt unable to accept women's ministry to flourish within the church. Now WATCH, Women and the Church, are calling for those provisions to be removed. Nuala speaks to Reverend Martine Oborne, Chair of WATCH, and Dr Ros Clarke, Associate Director of Church Society. Presenter: Nuala McGovern Producer: Emma Pearce

Welcome to the Hot Topics podcast from NB Medical with Dr Neal Tucker. In this episode, we are joined by Dr Stephen Bradley, lead author of a new paper published in the BJGP looking at rates of CXR use in general practice and how this influences lung cancer stage at diagnosis and mortality. He discusses the findings of his research and how this might influence our practice. In other research, we look at a new paper in the BMJ on orthostatic HYPERtension - yes, you read that correctly - does treatment help, and does it really matter in the first place? And from the Lancet, research looking at the role of urodynamic studies in women with refractory overactive bladder - does it improve outcomes, or should it be stopped?ReferencesBMJ Orthostatic hypertension and BP treatmentBMJ OH editorialLancet Refractory overactive bladder & urodynamic studiesBJGP CXR in GP & lung cancer staging and mortalitywww.nbmedical.com/podcast

Send us a textGrab your trainers, your dog lead, your gardening clothes or a cuppa and join us for some free CPD as we have another relaxed round up of recent Red Whale primary care Pearls of wisdom.  In the first of two episodes this month, Fiona and Nik discuss: Anabolic steroid use. Body image concerns and pursuing an increasingly muscular appearance is becoming a growing issue, particularly for men and boys. Nature… so important that we should prescribe it? Yes! Special guest Hussain Al-Zubaidi joins us to talk about the power of nature and green social prescribing in transforming patient health.Listen as soon as you can to ensure you have full access to all the free resources. The rest of the Pearls from March will be covered next week along with a new best intentions story to put a smile on your face.Anabolic steroid useBJGP 2015;65:626 BJGP 2024;74(741):187 BMJ 10-minute consultation (BMJ 2016;355:i5023) Green social prescribingThe National Academy for Social Prescribing:Full toolkit on green social prescribing RCGP - parkrun practice initiative VideosRed Whale Knowledge - green social prescribing Send us your feedback podcast@redwhale.co.uk or send a voice message Sign up to receive Pearls here. Pearls are available for 3 months from publish date. After this, you can get access them plus 100s more articles when you buy a one-day online course from Red Whale OR sign up to Red Whale Unlimited. Find out more here. Follow us: X, Facebook, Instagram, LinkedInDisclaimer: We make every effort to ensure the information in this podcast is accurate and correct at the date of publication, but it is of necessity of a brief and general nature, and this should not replace your own good clinical judgement, or be regarded as a substitute for taking professional advice in appropriate circumstances. In particular, check drug doses, side-effects and interactions with the British National Formulary. Save insofar as any such liability cannot be excluded at law, we do not accept any liability for loss of any type caused by reliance on the information in this podcast....

Jacob och Wille gästas denna vecka av allmänläkaren och forskaren Minna Johansson. Minna har de senaste åren fört en kamp för alla allmänläkare i Sverige för att de ska få lägga vårdens resurser på saker som är bevisat att faktiskt hjälpa deras patienter på ett effektivt vis samtidigt som det ökar chanserna för att den del de får av våra skattepengar ska räcka till. Framför allt har hon genom debatter i flera olika miljöer på ett bra sätt argumenterat för att vården idag lägger för mycket av sina resurser på åtgärder som påstås vara förebyggande men som i själva verket saknar evidens för att göra någon större nytta. Samtidigt som de har undanträngningseffekter på annan vård som gör att det blir svårare för de som faktiskt är sjuka att snabbt får den hjälp de behöver. Du kan till exempel läsa de här två artiklarna i läkartidningen, Det vetenskapliga stödet för fysisk aktivitet på recept är inte starkt och Livsstilsråd kan skada och tränga undan annan vård enligt forskare. Minna har också en bra artikel i BMJ där hon för fram begreppet Time Needed to Treat som en betydelsefull parameter när man ska välja behandling inom vården, Sacrificing patient care for prevention: distortion of the role of general practice. För hennes forskning och arbete för att låta allmänläkare lägga mer av sin tid på saker som spelar större roll har Minna de senaste åren bland annat fått pris som ”Årets allmänläkarvän” av Svenska distriktsläkarföreningen och ”Årets Lejon” av Svensk förening för allmänmedicin. På Tyngre Träningssnacks instagram kan du hitta bilder relaterat till detta och tidigare avsnitt. Hålltider (00:00:00) Introsnack (00:02:52) Introsnack - om Willes nya hund (00:06:40) Veckans gäst, Minna Johansson, allmänläkare occh forskare (00:08:25) Forskning som ett utlopp för frustrationen som kan uppstå när man jobba kliniskt på vårdcentral (00:10:58) Livsstilsråd är inte alltid önskade och även när de förmedlas på ett bra vis har de tveksam nytta (00:13:17) Problemet med undanträningseffekter när vården inte får prioritera själv (00:14:32) Time Needed to Treat som en viktig del att beakta när vi väljer vård (00:20:37) Ett beteende som är ett folkhälsoproblem ska bekämpas men kanske inte med individuella samtal (00:26:56) Det är lätt att bli lurad kring hur stor effekten för råd är om man jobbar med det privat (00:32:18) Socialstyrelsens levnadsvaneråd inom vården är enormt tidskrävande och har minimal effekt (00:36:21) Krav på att vården ska göra ineffektiva saker är en del av orsakerna till dagens problem (00:39:44) Vården behöver en struktur som tydligt ger prioriteringar till vården efter effekt och betydelse (00:42:00) Evidensen för att goda råd inom vården har effekt är ofta dålig (00:49:11) Ska man ha personer med lägre lön och kortare utbildning som ger råden istället? (00:54:26) Sociala medier och trender påverkar våra politiker som i sin tur tror på enkla lösningar (00:59:10) Interventioner från samhället som påverka allas liv är oftast mycket mer effektivt som förebyggande åtgärd (01:05:03) Att ge råd kan få negativa konsekvenser med (01:07:42) Som vårdgivare är det ofta svårt att veta exakt vad som orsakar vad och gissningar kan tolkas fel (01:13:52) Vården kan göras mer effektiv

In this conversation, Andressa Sleiman discusses her journey into behavior analysis and its applications in healthcare, focusing on the importance of clear communication and the integration of behavioral science in improving patient outcomes. She elaborates on the teach-back method, its effectiveness in enhancing patient understanding, and contrasts it with traditional behavioral skills training. The discussion also touches on the role of organizational behavior management in healthcare settings and the potential of AI to improve practices and outcomes.   Watch the video of this conversation here!  https://youtu.be/9wjure8_eHE   Continuing Education Credits (https://www.cbiconsultants.com/shop) BACB: 1.0 Learning IBAO:  1.0 Learning QABA: 1.0 General We also offer certificates of attendance! Follow us! Instagram: https://www.instagram.com/behaviourspeak/ Bluesky: https://bsky.app/profile/benreiman.bsky.social.bsky.social LinkedIn:  https://www.linkedin.com/in/behaviourspeak/ Contact: Dr. Andressa Sleiman asleiman@fit.edu https://www.fit.edu/faculty-profiles/s/sleiman-andressa/ Links: Nicole Gravina https://people.clas.ufl.edu/ngravina/ Performance Ally https://www.performanceally.com/   Articles Referenced: Radhakrishnan, N. S., Lukose, K., Cartwright, R., Sleiman, A., Matey, N., Lim, D., LeGault, T., Pollard, S., Gravina, N., & Southwick, F. S. (2022). Prospective application of the interdisciplinary bedside rounding checklist 'TEMP' is associated with reduced infections and length of hospital stay. BMJ open quality, 11(4), e002045. https://doi.org/10.1136/bmjoq-2022-002045 Felipe A, Vats A, Sleiman A, et al. Using intern-led quality improvement to reduce readmissions for specialty service patients within an academic medical center. Glob J Qual Saf Healthc. 2021; 4:70–76. https://doi.org/10.36401/jqsh-20-38 Gravina, N., Sleiman, A., Southwick, F.S., Matey, N., Harlan, E., Lukose, K., Hack, G. and Radhakrishnan, N.S. (2021), Increasing adherence to a standardized rounding procedure in two hospital in-patient units. Jnl of Applied Behav Analysis, 54: 1514-1525. https://doi.org/10.1002/jaba.865 Qureshi A, Vats A, Jenkins N, et al. When Is My Care Team Rounding? A Simple Signage Intervention to Increase Awareness of Rounding Times. Journal of Patient Experience. 2021;8. https://doi.org/10.1177/23743735211007358 Sleiman, A.A., Gravina, N.E. and Portillo, D. (2023), An evaluation of the teach-back method for training new skills. Jnl of Applied Behav Analysis, 56: 117-130. https://doi.org/10.1002/jaba.966     Behaviour Speak Podcast Episodes on Related Topics Episode 19: Health, Fitness, Nutrition and Coaching Through a Behavior Analytic Lens with Wes Lowery https://www.behaviourspeak.com/e/episode-19-health-fitness-nutrition-and-coaching-through-a-behaviour-analytic-lens-with-wes-lowery-ms-bcba-lba/ Episode 33:  Addressing Substance Use Disorders, Poverty, and AIDS Prevention Using Behavioral Science with Dr. Shrinidhi Subramaniam https://www.behaviourspeak.com/e/episode-33-addressing-substance-use-disorders-poverty-and-aids-prevention-using-behavioural-science-with-dr-shrinidhi-subramaniam-phd-bcba-d/ Episode 35: Staff Training and Supervision with Dr. Dennis Reid https://www.behaviourspeak.com/e/episode-35-staff-training-and-supervision-with-dr-dennis-reid-phd-bcba-d/ Episode 110: Contingency Management with Dr. Bethany Raiff https://www.behaviourspeak.com/e/episode-110-contingency-management-with-dr-bethany-raiff/

Neste episódio, nosso host, Érico Oyama, recebe Gabriela Rosa, Head de Jurídico Tributário, e Leandro Barcelos, Gerente de Comércio Internacional, para discutir temas de grande relevância no cenário atual: as mudanças nas medidas tarifárias do governo Trump e os avanços do PL do Imposto de Renda. Com a qualidade técnica que só a BMJ pode oferecer, este episódio apresenta uma análise aprofundada e atualizada sobre as movimentações políticas e econômicas globais. Ouça agora e fique por dentro das principais discussões que moldam o futuro!

Ingrid Froeher apresenta um caso de dor lombar e púrpura para Joanne Alves e Caio Bastos.Referências: Knezevic, Nebojsa Nick et al. “Low back pain.” Lancet (London, England) vol. 398,10294 (2021): 78-92. doi:10.1016/S0140-6736(21)00733-9Antonov, Dimitar et al. “The rash that becomes purpuric, petechial, hemorrhagic, or ecchymotic.” Clinics in dermatology vol. 38,1 (2020): 3-18. doi:10.1016/j.clindermatol.2019.07.036Jarvik, Jeffrey G, and Richard A Deyo. “Diagnostic evaluation of low back pain with emphasis on imaging.” Annals of internal medicine vol. 137,7 (2002): 586-97. doi:10.7326/0003-4819-137-7-200210010-00010Downie, Aron, et al. "Red flags to screen for malignancy and fracture in patients with low back pain: systematic review." Bmj 347 (2013).https://doh.wa.gov/sites/default/files/legacy/Documents/2700/Coag.pdf?uid=62fc9e6dde835Bannow, Bethany Samuelson, and Barbara A Konkle. “How I approach bleeding in hospitalized patients.” Blood vol. 142,9 (2023): 761-768. doi:10.1182/blood.2021014766Novotny, Richard W et al. “Palpable Purpura.” American family physician vol. 109,3 (2024): 265-267.https://www.tadeclinicagem.com.br/guia/321/amiloidose-manifestacoes-clinicas-e-diagnostico/

US President Donald Trump promises a significant tariff announcement on April 2. We gathered a team of experts to discuss how the looming threats of tariffs from the Trump administration may affect Brazil and reshape relations between the United States and Brazil — not just in the short-term future but also in the long run. Panelists:Tony Harrington, former US ambassador to Brazil. Founding Principal of Albright Stonebridge. He was previously Chair of the President's Intelligence Oversight Board and currently serves as Chair of the Wilson Center Brazil Institute. Kellie Meiman Hock, senior counselor at McLarty Associates and a board member of the Inter-American Dialogue. A former US Foreign Service Officer, she served in Porto Alegre, São Paulo and Recife in Brazil, as well as at the Office of the US Trade Representative in the Executive Office of the President as Director for Brazil and the Southern Cone.Welber Barral, founding partner of BMJ, is an expert in international trade and investment with over 30 years of experience. He served as Brazil's Secretary of Foreign Trade between 2007 and 2011 and has acted as an arbitrator in Mercosur and WTO disputes. He currently advises Fiesp and presides over IBCI, the Brazilian Institute of Foreign Trade.This episode is exclusive for premium subscribers and subscribers of Explaining Brazil Plus on Apple Podcasts.Support the show

Save 20% on all Nuzest Products WORLDWIDE with the code MIKKIPEDIA at www.nuzest.co.nz, www.nuzest.com.au or www.nuzest.comThis week on the podcast, Mikki speaks to Nina Teicholz, Ph.D.—science journalist, bestselling author of The Big Fat Surprise, and Executive Director of The Nutrition Coalition.In this conversation, Nina sheds light on one of the most under-acknowledged crises in public health: the fragile scientific foundation of the U.S. Dietary Guidelines. In essence, nutrition science continues to shape national policy despite being built on weak, inconsistent, and sometimes fundamentally flawed evidence.They discuss a recent paper published in the American Journal of Clinical Nutrition, which found the systematic reviews used to support the guidelines to be of “critically low quality”. Nina breaks down why this matters, how key types of research have been excluded, and why the process lacks transparency and rigour. They explore how industry influence, institutional bias, and intellectual legacy all contribute to a status quo that continues to recommend reductions in red meat and saturated fat—despite the absence of robust evidence to support these claims.Nina also explains how these guidelines, which legally shape everything from school lunches to military rations, may be doing more harm than good when it comes to public health—particularly in the face of rising rates of obesity, diabetes, and heart disease.If you've ever wondered why nutrition policy seems out of sync with both emerging science and common sense—or what it would take to fix it—this is an episode not to miss.Nina Teicholz Ph.D. is a science journalist and author of the New York Times bestseller, The Big Fat Surprise. She's been a pioneer in challenging the conventional wisdom on saturated fats, vegetable (seed) oils, the health halo around the Mediterranean diet, and the reliability of the U.S. national dietary guidelines. Her work has been favorably reviewed by top medical journals, including the Lancet, and her own writing has been published in academic journals such as the BMJ, Nutrients and a journal of the National Academy of Sciences as well as media outlets such as the New York Times, Wall Street Journal, the Atlantic and Economist. Teicholz has also appeared on most major TV networks and many podcasts, from NPR to Joe Rogan. She is a graduate of Stanford and Oxford Universities, and in 2024, she received a Ph.D. in nutrition focused on evidence-based nutrition policy. For years, she ran a non-profit called the Nutrition Coalition aimed at updating the US dietary guidelines with the current science. Her work can now be found in a column on Substack called “Unsettled Science.”Teicholz has no commercial ties and has never received support from any industry for her work. Curranz Supplement: Use code MIKKIPEDIA to get 20% off your first order - go to www.curranz.co.nz  or www.curranz.co.uk to order yours Contact Mikki:https://mikkiwilliden.com/https://www.facebook.com/mikkiwillidennutritionhttps://www.instagram.com/mikkiwilliden/https://linktr.ee/mikkiwilliden

Bespoke care and concierge care are both innovative approaches to healthcare, but they serve different purposes.   By the Editor-in-Chief, Concierge Medicine Today.   Words are my passion. While I'm not perfect at grammar (obviously!), I do manage every now and then to string a few thoughts together that resonate with some Physicians out there. I'm also intrigued by how our culture repurposes and rebrands words to promote specific narratives and ideas. And, ever since Mrs. Nielson, my 8th-grade Advanced Language Arts teacher, told me, “You have a gift; keep writing,” I've loved using words. I'm smitten by the science of language and constantly on a hunt to learn the new ways our words are being reused, rebranded, refined and redefined by our culture.   One term worth revisiting is “bespoke.”   If you're not familiar with it in the healthcare context, let me explain. The word ‘bespoke' is probably more familiar to our European healthcare audience than our North American audience and that's okay.   To summarize, I'll do what you might be doing right now, ‘Googling' it.

Join Executive Producer and Host Shravani Durbhakula, MD, MPH, MBA, and Co-Host Mustafa Broachwala, DO, for a pivotal episode of the Pain Matters Podcast where we address the recent BMJ publication, “Common interventional procedures for chronic non-cancer spine pain: a systematic review and network meta-analysis of randomized trials,” and the associated guideline. Steven Cohen, MD, Feinberg School of Medicine Northwestern University, Lynn R. Kohan, MD, University of VA Medical School, Zachary McCormick, MD, University of Utah, Nathaniel M. Schuster, MD, University of California, San Diego, Daniel Larach, MD, MS, MA, Vanderbilt University, Hance Clarke, MD, FRCPC, PhD, University of Toronto and President of the Canadian Pain Society, Hemant Kalia, MD, MPH, FIPP, Invision Health, and present diverse perspectives on the publication's claims and the systematic review and meta-analysis methods behind it.In this episode, you'll learn:The podcast underlines the necessity for comprehensive, unbiased systematic reviews and meta-analyses to inform clinical guidelines effectively.Experts caution against the misinterpretation of studies and the potential consequences for policy and access to interventional pain procedures.Advocates call for unified efforts in the pain medicine community to pursue legislative and regulatory reforms that align with current evidence and patient needs.The conversation underscores the pivotal role of personalized patient care and clinically validated techniques in improving outcomes and preserving practice legitimacy.The podcast highlights the risk of reducing access to viable interventional pain treatments if skewed interpretations of data shape healthcare policies.Tune in to discover how these leading experts address the controversies, advocate for robust clinical evidence, and highlight the urgent need for unified advocacy in shaping practical, patient-centered guidelines.Be sure to subscribe so you don't miss our next episode.Reference:  Wang X, Martin G, Sadeghirad B, Chang Y, Florez I D, Couban R J et al. Common interventional procedures for chronic non-cancer spine pain: a systematic review and network meta-analysis of randomised trials BMJ 2025; 388 :e079971 doi:10.1136/bmj-2024-079971

From pay restoration, to making sure there are enough training posts for resident doctors, the BMA has been busy. In this podcast, Kamran Abbasi, the editor in chief of The BMJ, spoke to Phil Banfield, chair of the BMA's council.   They talk about the ongoing pay discussions, how the BMA is working with the new government - touching on both speciality training places, and the role of physician assistants. The conversation also covers the BMA's changing strategy, which aims to empower local members to take on the fights they care about, and how the organisation is linking both their trade union and professional activities.

Dr. Gary Null provides a commentary on "Universal  Healthcare"       Universal Healthcare is the Solution to a Broken Medical System Gary Null, PhD Progressive Radio Network, March 3, 2025 For over 50 years, there has been no concerted or successful effort to bring down medical costs in the American healthcare system. Nor are the federal health agencies making disease prevention a priority. Regardless whether the political left or right sponsors proposals for reform, such measures are repeatedly defeated by both parties in Congress. As a result, the nation's healthcare system remains one of the most expensive and least efficient in the developed world. For the past 30 years, medical bills contributing to personal debt regularly rank among the top three causes of personal bankruptcy. This is a reality that reflects not only the financial strain on ordinary Americans but the systemic failure of the healthcare system itself. The urgent question is: If President Trump and his administration are truly seeking to reduce the nation's $36 trillion deficit, why is there no serious effort to reform the most bloated and corrupt sector of the economy? A key obstacle is the widespread misinformation campaign that falsely claims universal health care would cost an additional $2 trillion annually and further balloon the national debt. However, a more honest assessment reveals the opposite. If the US adopted a universal single-payer system, the nation could actually save up to $20 trillion over the next 10 years rather than add to the deficit. Even with the most ambitious efforts by people like Elon Musk to rein in federal spending or optimize government efficiency, the estimated savings would only amount to $500 billion. This is only a fraction of what could be achieved through comprehensive healthcare reform alone. Healthcare is the largest single expenditure of the federal budget. A careful examination of where the $5 trillion spent annually on healthcare actually goes reveals massive systemic fraud and inefficiency. Aside from emergency medicine, which accounts for only 10-12 percent of total healthcare expenditures, the bulk of this spending does not deliver better health outcomes nor reduce trends in physical and mental illness. Applying Ockham's Razor, the principle that the simplest solution is often the best, the obvious conclusion is that America's astronomical healthcare costs are the direct result of price gouging on an unimaginable scale. For example, in most small businesses, profit margins range between 1.6 and 2.5 percent, such as in grocery retail. Yet the pharmaceutical industrial complex routinely operates on markup rates as high as 150,000 percent for many prescription drugs. The chart below highlights the astronomical gap between the retail price of some top-selling patented pharmaceutical medications and their generic equivalents. Drug Condition Patent Price (per unit) Generic Price Estimated Manufacture Cost Markup Source Insulin (Humalog) Diabetes $300 $30 $3 10,000% Rand (2021) EpiPen Allergic reactions $600 $30 $10 6,000% BMJ (2022) Daraprim Toxoplasmosis $750/pill $2 $0.50 150,000% JAMA (2019) Harvoni Hepatitis C $94,500 (12 weeks) $30,000 $200 47,000% WHO Report (2018) Lipitor Cholesterol $150 $10 $0.50 29,900% Health Affairs (2020) Xarelto Blood Thinner $450 $25 $1.50 30,000% NEJM (2020) Abilify Schizophrenia $800 (30 tablets) $15 $2 39,900% AJMC (2019) Revlimid Cancer $16,000/mo $450 $150 10,500% Kaiser Health News (2021) Humira Arthritis $2,984/dose $400 $50 5,868% Rand (2021) Sovaldi Hepatitis C $1,000/pill $10 $2 49,900% JAMA (2021) Xolair Asthma $2,400/dose $300 $50 4,800% NEJM (2020) Gleevec Leukemia $10,000/mo $350 $200 4,900% Harvard Public Health Review (2020) OxyContin Pain Relief $600 (30 tablets) $15 $0.50 119,900% BMJ (2022) Remdesivir Covid-19 $3,120 (5 doses) N/A $10 31,100% The Lancet (2020) The corruption extends far beyond price gouging. Many pharmaceutical companies convince federal health agencies to fund their basic research and drug development with taxpayer dollars. Yet when these companies bring successful products to market, the profits are kept entirely by the corporations or shared with the agencies or groups of government scientists. On the other hand, the public, who funded the research, receives no financial return. This amounts to a systemic betrayal of the public trust on a scale of hundreds of billions of dollars annually. Another significant contributor to rising healthcare costs is the widespread practice of defensive medicine that is driven by the constant threat of litigation. Over the past 40 years, defensive medicine has become a cottage industry. Physicians order excessive diagnostic tests and unnecessary treatments simply to protect themselves from lawsuits. Study after study has shown that these over-performed procedures not only inflate costs but lead to iatrogenesis or medical injury and death caused by the medical  system and practices itself. The solution is simple: adopting no-fault healthcare coverage for everyone where patients receive care without needing to sue and thereby freeing doctors from the burden of excessive malpractice insurance. A single-payer universal healthcare system could fundamentally transform the entire industry by capping profits at every level — from drug manufacturers to hospitals to medical equipment suppliers. The Department of Health and Human Services would have the authority to set profit margins for medical procedures. This would ensure that healthcare is determined by outcomes, not profits. Additionally, the growing influence of private equity firms and vulture capitalists buying up hospitals and medical clinics across America must be reined in. These equity firms prioritize profit extraction over improving the quality of care. They often slash staff, raise prices, and dictate medical procedures based on what will yield the highest returns. Another vital reform would be to provide free medical education for doctors and nurses in exchange for five years of service under the universal system. Medical professionals would earn a realistic salary cap to prevent them from being lured into equity partnerships or charging exorbitant rates. The biggest single expense in the current system, however, is the private health insurance industry, which consumes 33 percent of the $5 trillion healthcare budget. Health insurance CEOs consistently rank among the highest-paid executives in the country. Their companies, who are nothing more than bean counters, decide what procedures and drugs will be covered, partially covered, or denied altogether. This entire industry is designed to place profits above patients' lives. If the US dismantled its existing insurance-based system and replaced it with a fully reformed national healthcare model, the country could save $2.7 trillion annually while simultaneously improving health outcomes. Over the course of 10 years, those savings would amount to $27 trillion. This could wipe out nearly the entire national debt in a short time. This solution has been available for decades but has been systematically blocked by corporate lobbying and bipartisan corruption in Washington. The path forward is clear but only if American citizens demand a system where healthcare is valued as a public service and not a commodity. The national healthcare crisis is not just a fiscal issue. It is a crucial moral failure of the highest order. With the right reforms, the nation could simultaneously restore its financial health and deliver the kind of healthcare system its citizens have long deserved. American Healthcare: Corrupt, Broken and Lethal Richard Gale and Gary Null Progressive Radio Network, March 3, 2025 For a nation that prides itself on being the world's wealthiest, most innovative and technologically advanced, the US' healthcare system is nothing less than a disaster and disgrace. Not only are Americans the least healthy among the most developed nations, but the US' health system ranks dead last among high-income countries. Despite rising costs and our unshakeable faith in American medical exceptionalism, average life expectancy in the US has remained lower than other OECD nations for many years and continues to decline. The United Nations recognizes healthcare as a human right. In 2018, former UN Secretary General Ban Ki-moon denounced the American healthcare system as "politically and morally wrong." During the pandemic it is estimated that two to three years was lost on average life expectancy. On the other hand, before the Covid-19 pandemic, countries with universal healthcare coverage found their average life expectancy stable or slowly increasing. The fundamental problem in the U.S. is that politics have been far too beholden to the pharmaceutical, HMO and private insurance industries. Neither party has made any concerted effort to reign in the corruption of corporate campaign funding and do what is sensible, financially feasible and morally correct to improve Americans' quality of health and well-being.   The fact that our healthcare system is horribly broken is proof that moneyed interests have become so powerful to keep single-payer debate out of the media spotlight and censored. Poll after poll shows that the American public favors the expansion of public health coverage. Other incremental proposals, including Medicare and Medicaid buy-in plans, are also widely preferred to the Affordable Care Act or Obamacare mess we are currently stuck with.   It is not difficult to understand how the dismal state of American medicine is the result of a system that has been sold out to the free-market and the bottom line interests of drug makers and an inflated private insurance industry. How advanced and ethically sound can a healthcare system be if tens of millions of people have no access to medical care because it is financially out of their reach?  The figures speak for themselves. The U.S. is burdened with a $41 trillion Medicare liability. The number of uninsured has declined during the past several years but still lingers around 25 million. An additional 30-35 million are underinsured. There are currently 65 million Medicare enrollees and 89 million Medicaid recipients. This is an extremely unhealthy snapshot of the country's ability to provide affordable healthcare and it is certainly unsustainable. The system is a public economic failure, benefiting no one except the large and increasingly consolidated insurance and pharmaceutical firms at the top that supervise the racket.   Our political parties have wrestled with single-payer or universal healthcare for decades. Obama ran his first 2008 presidential campaign on a single-payer platform. Since 1985, his campaign health adviser, the late Dr. Quentin Young from the University of Illinois Medical School, was one of the nation's leading voices calling for universal health coverage.  During a private conversation with Dr. Young shortly before his passing in 2016, he conveyed his sense of betrayal at the hands of the Obama administration. Dr. Young was in his 80s when he joined the Obama campaign team to help lead the young Senator to victory on a promise that America would finally catch up with other nations. The doctor sounded defeated. He shared how he was manipulated, and that Obama held no sincere intention to make universal healthcare a part of his administration's agenda. During the closed-door negotiations, which spawned the weak and compromised Affordable Care Act, Dr. Young was neither consulted nor invited to participate. In fact, he told us that he never heard from Obama again after his White House victory.   Past efforts to even raise the issue have been viciously attacked. A huge army of private interests is determined to keep the public enslaved to private insurers and high medical costs. The failure of our healthcare is in no small measure due to it being a fully for-profit operation. Last year, private health insurance accounted for 65 percent of coverage. Consider that there are over 900 private insurance companies in the US. National Health Expenditures (NHE) grew to $4.5 trillion in 2022, which was 17.3 percent of GDP. Older corporate rank-and-file Democrats and Republicans argue that a single-payer or socialized medical program is unaffordable. However, not only is single-payer affordable, it will end bankruptcies due to unpayable medical debt. In addition, universal healthcare, structured on a preventative model, will reduce disease rates at the outset.    Corporate Democrats argue that Obama's Affordable Care Act (ACA) was a positive step inching the country towards complete public coverage. However, aside from providing coverage to the poorest of Americans, Obamacare turned into another financial anchor around the necks of millions more. According to the health policy research group KFF, the average annual health insurance premium for single coverage is $8,400 and almost $24,000 for a family. In addition, patient out-of-pocket costs continue to increase, a 6.6% increase to $471 billion in 2022. Rather than healthcare spending falling, it has exploded, and the Trump and Biden administrations made matters worse.    Clearly, a universal healthcare program will require flipping the script on the entire private insurance industry, which employed over half a million people last year.  Obviously, the most volatile debate concerning a national universal healthcare system concerns cost. Although there is already a socialized healthcare system in place -- every federal legislator, bureaucrat, government employee and veteran benefits from it -- fiscal Republican conservatives and groups such as the Koch Brothers network are single-mindedly dedicated to preventing the expansion of Medicare and Medicaid. A Koch-funded Mercatus analysis made the outrageous claim that a single-payer system would increase federal health spending by $32 trillion in ten years. However, analyses and reviews by the Congressional Budget Office in the early 1990s concluded that such a system would only increase spending at the start; enormous savings would quickly offset it as the years pass. In one analysis, "the savings in administrative costs [10 percent of health spending] would be more than enough to offset the expense of universal coverage."    Defenders of those advocating for funding a National Health Program argue this can primarily be accomplished by raising taxes to levels comparable to other developed nations. This was a platform Senator Bernie Sanders and some of the younger progressive Democrats in the House campaigned on. The strategy was to tax the highest multimillion-dollar earners 60-70 percent. Despite the outrage of its critics, including old rank-and-file multi-millionaire Democrats like Nancy Pelosi and Chuck Schumer, this is still far less than in the past. During the Korean War, the top tax rate was 91 percent; it declined to 70 percent in the late 1960s. Throughout most of the 1970s, those in the lowest income bracket were taxed at 14 percent. We are not advocating for this strategy because it ignores where the funding is going, and the corruption in the system that is contributing to exorbitant waste.    But Democratic supporters of the ACA who oppose a universal healthcare plan ignore the additional taxes Obama levied to pay for the program. These included surtaxes on investment income, Medicare taxes from those earning over $200,000, taxes on tanning services, an excise tax on medical equipment, and a 40 percent tax on health coverage for costs over the designated cap that applied to flexible savings and health savings accounts. The entire ACA was reckless, sloppy and unnecessarily complicated from the start.    The fact that Obamacare further strengthened the distinctions between two parallel systems -- federal and private -- with entirely different economic structures created a labyrinth of red tape, rules, and wasteful bureaucracy. Since the ACA went into effect, over 150 new boards, agencies and programs have had to be established to monitor its 2,700 pages of gibberish. A federal single-payer system would easily eliminate this bureaucracy and waste.    A medical New Deal to establish universal healthcare coverage is a decisive step in the correct direction. But we must look at the crisis holistically and in a systematic way. Simply shuffling private insurance into a federal Medicare-for-all or buy-in program, funded by taxing the wealthiest of citizens, would only temporarily reduce costs. It will neither curtail nor slash escalating disease rates e. Any effective healthcare reform must also tackle the underlying reasons for Americans' poor state of health. We cannot shy away from examining the social illnesses infecting our entire free-market capitalist culture and its addiction to deregulation. A viable healthcare model would have to structurally transform how the medical economy operates. Finally, a successful medical New Deal must honestly evaluate the best and most reliable scientific evidence in order to effectively redirect public health spending.    For example, Dr. Ezekiel Emanuel, a former Obama healthcare adviser, observed that AIDS-HIV measures consume the most public health spending, even though the disease "ranked 75th on the list of diseases by personal health expenditures." On the other hand, according to the American Medical Association, a large percentage of the nation's $3.4 trillion healthcare spending goes towards treating preventable diseases, notably diabetes, common forms of heart disease, and back and neck pain conditions. In 2016, these three conditions were the most costly and accounted for approximately $277 billion in spending. Last year, the CDC announced the autism rate is now 1 in 36 children compared to 1 in 44 two years ago. A retracted study by Mark Blaxill, an autism activist at the Holland Center and a friend of the authors, estimates that ASD costs will reach $589 billion annually by 2030. There are no signs that this alarming trend will reverse and decline; and yet, our entire federal health system has failed to conscientiously investigate the underlying causes of this epidemic. All explanations that might interfere with the pharmaceutical industry's unchecked growth, such as over-vaccination, are ignored and viciously discredited without any sound scientific evidence. Therefore, a proper medical New Deal will require a systemic overhaul and reform of our federal health agencies, especially the HHS, CDC and FDA. Only the Robert Kennedy Jr presidential campaign is even addressing the crisis and has an inexpensive and comprehensive plan to deal with it. For any medical revolution to succeed in advancing universal healthcare, the plan must prioritize spending in a manner that serves public health and not private interests. It will also require reshuffling private corporate interests and their lobbyists to the sidelines, away from any strategic planning, in order to break up the private interests' control over federal agencies and its revolving door policies. Aside from those who benefit from this medical corruption, the overwhelming majority of Americans would agree with this criticism. However, there is a complete lack of national trust that our legislators, including the so-called progressives, would be willing to undertake such actions.    In addition, America's healthcare system ignores the single most critical initiative to reduce costs - that is, preventative efforts and programs instead of deregulation and closing loopholes designed to protect the drug and insurance industries' bottom line. Prevention can begin with banning toxic chemicals that are proven health hazards associated with current disease epidemics, and it can begin by removing a 1,000-plus toxins already banned in Europe. This should be a no-brainer for any legislator who cares for public health. For example, Stacy Malkan, co-founder of the Campaign for Safe Cosmetics, notes that "the policy approach in the US and Europe is dramatically different" when it comes to chemical allowances in cosmetic products. Whereas the EU has banned 1,328 toxic substances from the cosmetic industry alone, the US has banned only 11. The US continues to allow carcinogenic formaldehyde, petroleum, forever chemicals, many parabens (an estrogen mimicker and endocrine hormone destroyer), the highly allergenic p-phenylenediamine or PBD, triclosan, which has been associated with the rise in antibiotic resistant bacteria, avobenzone, and many others to be used in cosmetics, sunscreens, shampoo and hair dyes.   Next, the food Americans consume can be reevaluated for its health benefits. There should be no hesitation to tax the unhealthiest foods, such as commercial junk food, sodas and candy relying on high fructose corn syrup, products that contain ingredients proven to be toxic, and meat products laden with dangerous chemicals including growth hormones and antibiotics. The scientific evidence that the average American diet is contributing to rising disease trends is indisputable. We could also implement additional taxes on the public advertising of these demonstrably unhealthy products. All such tax revenue would accrue to a national universal health program to offset medical expenditures associated with the very illnesses linked to these products. Although such tax measures would help pay for a new medical New Deal, it may be combined with programs to educate the public about healthy nutrition if it is to produce a reduction in the most common preventable diseases. In fact, comprehensive nutrition courses in medical schools should be mandatory because the average physician receives no education in this crucial subject.  In addition, preventative health education should be mandatory throughout public school systems.   Private insurers force hospitals, clinics and private physicians into financial corners, and this is contributing to prodigious waste in money and resources. Annually, healthcare spending towards medical liability insurance costs tens of billions of dollars. In particular, this economic burden has taxed small clinics and physicians. It is well past the time that physician liability insurance is replaced with no-fault options. Today's doctors are spending an inordinate amount of money to protect themselves. Legions of liability and trial lawyers seek big paydays for themselves stemming from physician error. This has created a culture of fear among doctors and hospitals, resulting in the overly cautious practice of defensive medicine, driving up costs and insurance premiums just to avoid lawsuits. Doctors are forced to order unnecessary tests and prescribe more medications and medical procedures just to cover their backsides. No-fault insurance is a common-sense plan that enables physicians to pursue their profession in a manner that will reduce iatrogenic injuries and costs. Individual cases requiring additional medical intervention and loss of income would still be compensated. This would generate huge savings.    No other nation suffers from the scourge of excessive drug price gouging like the US. After many years of haggling to lower prices and increase access to generic drugs, only a minute amount of progress has been made in recent years. A 60 Minutes feature about the Affordable Care Act reported an "orgy of lobbying and backroom deals in which just about everyone with a stake in the $3-trillion-a-year health industry came out ahead—except the taxpayers.” For example, Life Extension magazine reported that an antiviral cream (acyclovir), which had lost its patent protection, "was being sold to pharmacies for 7,500% over the active ingredient cost. The active ingredient (acyclovir) costs only 8 pennies, yet pharmacies are paying a generic maker $600 for this drug and selling it to consumers for around $700." Other examples include the antibiotic Doxycycline. The price per pill averages 7 cents to $3.36 but has a 5,300 percent markup when it reaches the consumer. The antidepressant Clomipramine is marked up 3,780 percent, and the anti-hypertensive drug Captopril's mark-up is 2,850 percent. And these are generic drugs!    Medication costs need to be dramatically cut to allow drug manufacturers a reasonable but not obscene profit margin. By capping profits approximately 100 percent above all costs, we would save our system hundreds of billions of dollars. Such a measure would also extirpate the growing corporate misdemeanors of pricing fraud, which forces patients to pay out-of-pocket in order to make up for the costs insurers are unwilling to pay.    Finally, we can acknowledge that our healthcare is fundamentally a despotic rationing system based upon high insurance costs vis-a-vis a toss of the dice to determine where a person sits on the economic ladder. For the past three decades it has contributed to inequality. The present insurance-based economic metrics cast millions of Americans out of coverage because private insurance costs are beyond their means. Uwe Reinhardt, a Princeton University political economist, has called our system "brutal" because it "rations [people] out of the system." He defined rationing as "withholding something from someone that is beneficial." Discriminatory healthcare rationing now affects upwards to 60 million people who have been either priced out of the system or under insured. They make too much to qualify for Medicare under Obamacare, yet earn far too little to afford private insurance costs and premiums. In the final analysis, the entire system is discriminatory and predatory.    However, we must be realistic. Almost every member of Congress has benefited from Big Pharma and private insurance lobbyists. The only way to begin to bring our healthcare program up to the level of a truly developed nation is to remove the drug industry's rampant and unnecessary profiteering from the equation.     How did Fauci memory-hole a cure for AIDS and get away with it?   By Helen Buyniski   Over 700,000 Americans have died of AIDS since 1981, with the disease claiming some 42.3 million victims worldwide. While an HIV diagnosis is no longer considered a certain death sentence, the disease looms large in the public imagination and in public health funding, with contemporary treatments running into thousands of dollars per patient annually.   But was there a cure for AIDS all this time - an affordable and safe treatment that was ruthlessly suppressed and attacked by the US public health bureaucracy and its agents? Could this have saved millions of lives and billions of dollars spent on AZT, ddI and failed HIV vaccine trials? What could possibly justify the decision to disappear a safe and effective approach down the memory hole?   The inventor of the cure, Gary Null, already had several decades of experience creating healing protocols for physicians to help patients not responding well to conventional treatments by the time AIDS was officially defined in 1981. Null, a registered dietitian and board-certified nutritionist with a PhD in human nutrition and public health science, was a senior research fellow and Director of Anti-Aging Medicine at the Institute of Applied Biology for 36 years and has published over 950 papers, conducting groundbreaking experiments in reversing biological aging as confirmed with DNA methylation testing. Additionally, Null is a multi-award-winning documentary filmmaker, bestselling author, and investigative journalist whose work exposing crimes against humanity over the last 50 years has highlighted abuses by Big Pharma, the military-industrial complex, the financial industry, and the permanent government stay-behind networks that have come to be known as the Deep State.   Null was contacted in 1974 by Dr. Stephen Caiazza, a physician working with a subculture of gay men in New York living the so-called “fast track” lifestyle, an extreme manifestation of the gay liberation movement that began with the Stonewall riots. Defined by rampant sexual promiscuity and copious use of illegal and prescription drugs, including heavy antibiotic use for a cornucopia of sexually-transmitted diseases, the fast-track never included more than about two percent of gay men, though these dominated many of the bathhouses and clubs that defined gay nightlife in the era. These patients had become seriously ill as a result of their indulgence, generally arriving at the clinic with multiple STDs including cytomegalovirus and several types of herpes and hepatitis, along with candida overgrowth, nutritional deficiencies, gut issues, and recurring pneumonia. Every week for the next 10 years, Null would counsel two or three of these men - a total of 800 patients - on how to detoxify their bodies and de-stress their lives, tracking their progress with Caiazza and the other providers at weekly feedback meetings that he credits with allowing the team to quickly evaluate which treatments were most effective. He observed that it only took about two years on the “fast track” for a healthy young person to begin seeing muscle loss and the recurrent, lingering opportunistic infections that would later come to be associated with AIDS - while those willing to commit to a healthier lifestyle could regain their health in about a year.    It was with this background that Null established the Tri-State Healing Center in Manhattan in 1980, staffing the facility with what would eventually run to 22 certified health professionals to offer safe, natural, and effective low- and no-cost treatments to thousands of patients with HIV and AIDS-defining conditions. Null and his staff used variations of the protocols he had perfected with Caiazza's patients, a multifactorial patient-tailored approach that included high-dose vitamin C drips, intravenous ozone therapy, juicing and nutritional improvements and supplementation, aspects of homeopathy and naturopathy with some Traditional Chinese Medicine and Ayurvedic practices. Additional services offered on-site included acupuncture and holistic dentistry, while peer support groups were also held at the facility so that patients could find community and a positive environment, healing their minds and spirits while they healed their bodies.   “Instead of trying to kill the virus with antiretroviral pharmaceuticals designed to stop viral replication before it kills patients, we focused on what benefits could be gained by building up the patients' natural immunity and restoring biochemical integrity so the body could fight for itself,” Null wrote in a 2014 article describing the philosophy behind the Center's approach, which was wholly at odds with the pharmaceutical model.1   Patients were comprehensively tested every week, with any “recovery” defined solely by the labs, which documented AIDS patient after patient - 1,200 of them - returning to good health and reversing their debilitating conditions. Null claims to have never lost an AIDS patient in the Center's care, even as the death toll for the disease - and its pharmaceutical standard of care AZT - reached an all-time high in the early 1990s. Eight patients who had opted for a more intensive course of treatment - visiting the Center six days a week rather than one - actually sero-deconverted, with repeated subsequent testing showing no trace of HIV in their bodies.   As an experienced clinical researcher himself, Null recognized that any claims made by the Center would be massively scrutinized, challenging as they did the prevailing scientific consensus that AIDS was an incurable, terminal illness. He freely gave his protocols to any medical practitioner who asked, understanding that his own work could be considered scientifically valid only if others could replicate it under the same conditions. After weeks of daily observational visits to the Center, Dr. Robert Cathcart took the protocols back to San Francisco, where he excitedly reported that patients were no longer dying in his care.    Null's own colleague at the Institute of Applied Biology, senior research fellow Elana Avram, set up IV drip rooms at the Institute and used his intensive protocols to sero-deconvert 10 patients over a two-year period. While the experiment had been conducted in secret, as the Institute had been funded by Big Pharma since its inception half a century earlier, Avram had hoped she would be able to publish a journal article to further publicize Null's protocols and potentially help AIDS patients, who were still dying at incredibly high rates thanks to Burroughs Wellcome's noxious but profitable AZT. But as she would later explain in a 2019 letter to Null, their groundbreaking research never made it into print - despite meticulous documentation of their successes - because the Institute's director and board feared their pharmaceutical benefactors would withdraw the funding on which they depended, given that Null's protocols did not involve any patentable or otherwise profitable drugs. When Avram approached them about publication, the board vetoed the idea, arguing that it would “draw negative attention because [the work] was contrary to standard drug treatments.” With no real point in continuing experiments along those lines without institutional support and no hope of obtaining funding from elsewhere, the department she had created specifically for these experiments shut down after a two-year followup with her test subjects - all of whom remained alive and healthy - was completed.2   While the Center was receiving regular visits by this time from medical professionals and, increasingly, black celebrities like Stokely Carmichael and Isaac Hayes, who would occasionally perform for the patients, the news was spreading by word of mouth alone - not a single media outlet had dared to document the clinic that was curing AIDS patients for free. Instead, they gave airtime to Anthony Fauci, director of the National Institute of Allergies and Infectious Diseases, who had for years been spreading baseless, hysteria-fueling claims about HIV and AIDS to any news outlet that would put him on. His claim that children could contract the virus from “ordinary household conduct” with an infected relative proved so outrageous he had to walk it back,3 and he never really stopped insisting the deadly plague associated with gays and drug users was about to explode like a nuclear bomb among the law-abiding heterosexual population. Fauci by this time controlled all government science funding through NIAID, and his zero-tolerance approach to dissent on the HIV/AIDS front had already seen prominent scientists like virologist Peter Duesberg stripped of the resources they needed for their work because they had dared to question his commandment: There is no cause of AIDS but HIV, and AZT is its treatment. Even the AIDS activist groups, which by then had been coopted by Big Pharma and essentially reduced to astroturfing for the toxic failed chemotherapy drug AZT backed by the institutional might of Fauci's NIAID,4 didn't seem to want to hear that there was a cure. Unconcerned with the irrationality of denouncing the man touting his free AIDS cure as an  “AIDS denier,” they warned journalists that platforming Null or anyone else rejecting the mainstream medical line would be met with organized demands for their firing.    Determined to breach the institutional iron curtain and get his message to the masses, Null and his team staged a press conference in New York, inviting scientists and doctors from around the world to share their research on alternative approaches to HIV and AIDS in 1993. To emphasize the sound scientific basis of the Center's protocols and encourage guests to adopt them into their own practices, Null printed out thousands of abstracts in support of each nutrient and treatment being used. However, despite over 7,000 invitations sent three times to major media, government figures, scientists, and activists, almost none of the intended audience members showed up. Over 100 AIDS patients and their doctors, whose charts exhaustively documented their improvements using natural and nontoxic modalities over the preceding 12 months, gave filmed testimonials, declaring that the feared disease was no longer a death sentence, but the conference had effectively been silenced. Bill Tatum, publisher of the Amsterdam News, suggested Null and his patients would find a more welcoming audience in his home neighborhood of Harlem - specifically, its iconic Apollo Theatre. For three nights, the theater was packed to capacity. Hit especially hard by the epidemic and distrustful of a medical system that had only recently stopped being openly racist (the Tuskegee syphilis experiment only ended in 1972), black Americans, at least, did not seem to care what Anthony Fauci would do if he found out they were investigating alternatives to AZT and death.    PBS journalist Tony Brown, having obtained a copy of the video of patient testimonials from the failed press conference, was among a handful of black journalists who began visiting the Center to investigate the legitimacy of Null's claims. Satisfied they had something significant to offer his audience, Brown invited eight patients - along with Null himself - onto his program over the course of several episodes to discuss the work. It was the first time these protocols had received any attention in the media, despite Null having released nearly two dozen articles and multiple documentaries on the subject by that time. A typical patient on one program, Al, a recovered IV drug user who was diagnosed with AIDS at age 32, described how he “panicked,” saw a doctor and started taking AZT despite his misgivings - only to be forced to discontinue the drug after just a few weeks due to his condition deteriorating rapidly. Researching alternatives brought him to Null, and after six months of “detoxing [his] lifestyle,” he observed his initial symptoms - swollen lymph nodes and weight loss - begin to reverse, culminating with sero-deconversion. On Bill McCreary's Channel 5 program, a married couple diagnosed with HIV described how they watched their T-cell counts increase as they cut out sugar, caffeine, smoking, and drinking and began eating a healthy diet. They also saw the virus leave their bodies.   For HIV-positive viewers surrounded by fear and negativity, watching healthy-looking, cheerful “AIDS patients” detail their recovery while Null backed up their claims with charts must have been balm for the soul. But the TV programs were also a form of outreach to the medical community, with patients' charts always on hand to convince skeptics the cure was scientifically valid. Null brought patients' charts to every program, urging them to keep an open mind: “Other physicians and public health officials should know that there's good science in the alternative perspective. It may not be a therapy that they're familiar with, because they're just not trained in it, but if the results are positive, and you can document them…” He challenged doubters to send in charts from their own sero-deconverted patients on AZT, and volunteered to debate proponents of the orthodox treatment paradigm - though the NIH and WHO both refused to participate in such a debate on Tony Brown's Journal, following Fauci's directive prohibiting engagement with forbidden ideas.    Aside from those few TV programs and Null's own films, suppression of Null's AIDS cure beyond word of mouth was total. The 2021 documentary The Cost of Denial, produced by the Society for Independent Journalists, tells the story of the Tri-State Healing Center and the medical paradigm that sought to destroy it, lamenting the loss of the lives that might have been saved in a more enlightened society. Nurse practitioner Luanne Pennesi, who treated many of the AIDS patients at the Center, speculated in the film that the refusal by the scientific establishment and AIDS activists to accept their successes was financially motivated. “It was as if they didn't want this information to get out. Understand that our healthcare system as we know it is a corporation, it's a corporate model, and it's about generating revenue. My concern was that maybe they couldn't generate enough revenue from these natural approaches.”5   Funding was certainly the main disciplinary tool Fauci's NIAID used to keep the scientific community in line. Despite the massive community interest in the work being done at the Center, no foundation or institution would defy Fauci and risk getting itself blacklisted, leaving Null to continue funding the operation out of his pocket with the profits from book sales. After 15 years, he left the Center in 1995, convinced the mainstream model had so thoroughly been institutionalized that there was no chance of overthrowing it. He has continued to counsel patients and advocate for a reappraisal of the HIV=AIDS hypothesis and its pharmaceutical treatments, highlighting the deeply flawed science underpinning the model of the disease espoused by the scientific establishment in 39 articles, six documentaries and a 700-page textbook on AIDS, but the Center's achievements have been effectively memory-holed by Fauci's multi-billion-dollar propaganda apparatus.     FRUIT OF THE POISONOUS TREE   To understand just how much of a threat Null's work was to the HIV/AIDS establishment, it is instructive to revisit the 1984 paper, published by Dr. Robert Gallo of the National Cancer Institute, that established HIV as the sole cause of AIDS. The CDC's official recognition of AIDS in 1981 had done little to quell the mounting public panic over the mysterious illness afflicting gay men in the US, as the agency had effectively admitted it had no idea what was causing them to sicken and die. As years passed with no progress determining the causative agent of the plague, activist groups like Gay Men's Health Crisis disrupted public events and threatened further mass civil disobedience as they excoriated the NIH for its sluggish allocation of government science funding to uncovering the cause of the “gay cancer.”6 When Gallo published his paper declaring that the retrovirus we now know as HIV was the sole “probable” cause of AIDS, its simple, single-factor hypothesis was the answer to the scientific establishment's prayers. This was particularly true for Fauci, as the NIAID chief was able to claim the hot new disease as his agency's own domain in what has been described as a “dramatic confrontation” with his rival Sam Broder at the National Cancer Institute. After all, Fauci pointed out, Gallo's findings - presented by Health and Human Services Secretary Margaret Heckler as if they were gospel truth before any other scientists had had a chance to inspect them, never mind conduct a full peer review - clearly classified AIDS as an infectious disease, and not a cancer like the Kaposi's sarcoma which was at the time its most visible manifestation. Money and media attention began pouring in, even as funding for the investigation of other potential causes of AIDS dried up. Having already patented a diagnostic test for “his” retrovirus before introducing it to the world, Gallo was poised for a financial windfall, while Fauci was busily leveraging the discovery into full bureaucratic empire of the US scientific apparatus.   While it would serve as the sole basis for all US government-backed AIDS research to follow - quickly turning Gallo into the most-cited scientist in the world during the 1980s,7 Gallo's “discovery” of HIV was deeply problematic. The sample that yielded the momentous discovery actually belonged to Prof. Luc Montagnier of the French Institut Pasteur, a fact Gallo finally admitted in 1991, four years after a lawsuit from the French government challenged his patent on the HIV antibody test, forcing the US government to negotiate a hasty profit-sharing agreement between Gallo's and Montagnier's labs. That lawsuit triggered a cascade of official investigations into scientific misconduct by Gallo, and evidence submitted during one of these probes, unearthed in 2008 by journalist Janine Roberts, revealed a much deeper problem with the seminal “discovery.” While Gallo's co-author, Mikulas Popovic, had concluded after numerous experiments with the French samples that the virus they contained was not the cause of AIDS, Gallo had drastically altered the paper's conclusion, scribbling his notes in the margins, and submitted it for publication to the journal Science without informing his co-author.   After Roberts shared her discovery with contacts in the scientific community, 37 scientific experts wrote to the journal demanding that Gallo's career-defining HIV paper be retracted from Science for lacking scientific integrity.8 Their call, backed by an endorsement from the 2,600-member scientific organization Rethinking AIDS, was ignored by the publication and by the rest of mainstream science despite - or perhaps because of - its profound implications.   That 2008 letter, addressed to Science editor-in-chief Bruce Alberts and copied to American Association for the Advancement of Science CEO Alan Leshner, is worth reproducing here in its entirety, as it utterly dismantles Gallo's hypothesis - and with them the entire HIV is the sole cause of AIDS dogma upon which the contemporary medical model of the disease rests:   On May 4, 1984 your journal published four papers by a group led by Dr. Robert Gallo. We are writing to express our serious concerns with regard to the integrity and veracity of the lead paper among these four of which Dr. Mikulas Popovic is the lead author.[1] The other three are also of concern because they rely upon the conclusions of the lead paper .[2][3][4]  In the early 1990s, several highly critical reports on the research underlying these papers were produced as a result of governmental inquiries working under the supervision of scientists nominated by the National Academy of Sciences and the Institute of Medicine. The Office of Research Integrity of the US Department of Health and Human Services concluded that the lead paper was “fraught with false and erroneous statements,” and that the “ORI believes that the careless and unacceptable keeping of research records...reflects irresponsible laboratory management that has permanently impaired the ability to retrace the important steps taken.”[5] Further, a Congressional Subcommittee on Oversight and Investigations led by US Representative John D. Dingell of Michigan produced a staff report on the papers which contains scathing criticisms of their integrity.[6]  Despite the publically available record of challenges to their veracity, these papers have remained uncorrected and continue to be part of the scientific record.  What prompts our communication today is the recent revelation of an astonishing number of previously unreported deletions and unjustified alterations made by Gallo to the lead paper. There are several documents originating from Gallo's laboratory that, while available for some time, have only recently been fully analyzed. These include a draft of the lead paper typewritten by Popovic which contains handwritten changes made to it by Gallo.[7] This draft was the key evidence used in the above described inquiries to establish that Gallo had concealed his laboratory's use of a cell culture sample (known as LAV) which it received from the Institut Pasteur.  These earlier inquiries verified that the typed manuscript draft was produced by Popovic who had carried out the recorded experiment while his laboratory chief, Gallo, was in Europe and that, upon his return, Gallo changed the document by hand a few days before it was submitted to Science on March 30, 1984. According to the ORI investigation, “Dr. Gallo systematically rewrote the manuscript for what would become a renowned LTCB [Gallo's laboratory at the National Cancer Institute] paper.”[5]  This document provided the important evidence that established the basis for awarding Dr. Luc Montagnier and Dr. Francoise Barré-Sinoussi the 2008 Nobel Prize in Medicine for the discovery of the AIDS virus by proving it was their samples of LAV that Popovic used in his key experiment. The draft reveals that Popovic had forthrightly admitted using the French samples of LAV renamed as Gallo's virus, HTLV-III, and that Gallo had deleted this admission, concealing their use of LAV.  However, it has not been previously reported that on page three of this same document Gallo had also deleted Popovic's unambiguous statement that, "Despite intensive research efforts, the causative agent of AIDS has not yet been identified,” replacing it in the published paper with a statement that said practically the opposite, namely, “That a retrovirus of the HTLV family might be an etiologic agent of AIDS was suggested by the findings.”  It is clear that the rest of Popovic's typed paper is entirely consistent with his statement that the cause of AIDS had not been found, despite his use of the French LAV. Popovic's final conclusion was that the culture he produced “provides the possibility” for detailed studies. He claimed to have achieved nothing more. At no point in his paper did Popovic attempt to prove that any virus caused AIDS, and it is evident that Gallo concealed these key elements in Popovic's experimental findings.  It is astonishing now to discover these unreported changes to such a seminal document. We can only assume that Gallo's alterations of Popovic's conclusions were not highlighted by earlier inquiries because the focus at the time was on establishing that the sample used by Gallo's lab came from Montagnier and was not independently collected by Gallo. In fact, the only attention paid to the deletions made by Gallo pertains to his effort to hide the identity of the sample. The questions of whether Gallo and Popovic's research proved that LAV or any other virus was the cause of AIDS were clearly not considered.  Related to these questions are other long overlooked documents that merit your attention. One of these is a letter from Dr. Matthew A. Gonda, then Head of the Electron Microscopy Laboratory at the National Cancer Institute, which is addressed to Popovic, copied to Gallo and dated just four days prior to Gallo's submission to Science.[8] In this letter, Gonda remarks on samples he had been sent for imaging because “Dr Gallo wanted these micrographs for publication because they contain HTLV.” He states, “I do not believe any of the particles photographed are of HTLV-I, II or III.” According to Gonda, one sample contained cellular debris, while another had no particles near the size of a retrovirus. Despite Gonda's clearly worded statement, Science published on May 4, 1984 papers attributed to Gallo et al with micrographs attributed to Gonda and described unequivocally as HTLV-III.  In another letter by Gallo, dated one day before he submitted his papers to Science, Gallo states, “It's extremely rare to find fresh cells [from AIDS patients] expressing the virus... cell culture seems to be necessary to induce virus,” a statement which raises the possibility he was working with a laboratory artifact. [9]  Included here are copies of these documents and links to the same. The very serious flaws they reveal in the preparation of the lead paper published in your journal in 1984 prompts our request that this paper be withdrawn. It appears that key experimental findings have been concealed. We further request that the three associated papers published on the same date also be withdrawn as they depend on the accuracy of this paper.  For the scientific record to be reliable, it is vital that papers shown to be flawed, or falsified be retracted. Because a very public record now exists showing that the Gallo papers drew unjustified conclusions, their withdrawal from Science is all the more important to maintain integrity. Future researchers must also understand they cannot rely on the 1984 Gallo papers for statements about HIV and AIDS, and all authors of papers that previously relied on this set of four papers should have the opportunity to consider whether their own conclusions are weakened by these revelations.      Gallo's handwritten revision, submitted without his colleague's knowledge despite multiple experiments that failed to support the new conclusion, was the sole foundation for the HIV=AIDS hypothesis. Had Science published the manuscript the way Popovic had typed it, there would be no AIDS “pandemic” - merely small clusters of people with AIDS. Without a viral hypothesis backing the development of expensive and deadly pharmaceuticals, would Fauci have allowed these patients to learn about the cure that existed all along?   Faced with a potential rebellion, Fauci marshaled the full resources under his control to squelch the publication of the investigations into Gallo and restrict any discussion of competing hypotheses in the scientific and mainstream press, which had been running virus-scare stories full-time since 1984. The effect was total, according to biochemist Dr. Kary Mullis, inventor of the polymerase chain reaction (PCR) procedure. In a 2009 interview, Mullis recalled his own shock when he attempted to unearth the experimental basis for the HIV=AIDS hypothesis. Despite his extensive inquiry into the literature, “there wasn't a scientific reference…[that] said ‘here's how come we know that HIV is the probable cause of AIDS.' There was nothing out there like that.”9 This yawning void at the core of HIV/AIDS “science" turned him into a strident critic of AIDS dogma - and those views made him persona non grata where the scientific press was concerned, suddenly unable to publish a single paper despite having won the Nobel Prize for his invention of the PCR test just weeks before.  10   DISSENT BECOMES “DENIAL”   While many of those who dissent from the orthodox HIV=AIDS view believe HIV plays a role in the development of AIDS, they point to lifestyle and other co-factors as being equally if not more important. Individuals who test positive for HIV can live for decades in perfect health - so long as they don't take AZT or the other toxic antivirals fast-tracked by Fauci's NIAID - but those who developed full-blown AIDS generally engaged in highly risky behaviors like extreme promiscuity and prodigious drug abuse, contracting STDs they took large quantities of antibiotics to treat, further running down their immune systems. While AIDS was largely portrayed as a “gay disease,” it was only the “fast track” gays, hooking up with dozens of partners nightly in sex marathons fueled by “poppers” (nitrate inhalants notorious for their own devastating effects on the immune system), who became sick. Kaposi's sarcoma, one of the original AIDS-defining conditions, was widespread among poppers-using gay men, but never appeared among IV drug users or hemophiliacs, the other two main risk groups during the early years of the epidemic. Even Robert Gallo himself, at a 1994 conference on poppers held by the National Institute on Drug Abuse, would admit that the previously-rare form of skin cancer surging among gay men was not primarily caused by HIV - and that it was immune stimulation, rather than suppression, that was likely responsible.11 Similarly, IV drug users are often riddled with opportunistic infections as their habit depresses the immune system and their focus on maintaining their addiction means that healthier habits - like good nutrition and even basic hygiene - fall by the wayside.    Supporting the call for revising the HIV=AIDS hypothesis to include co-factors is the fact that the mass heterosexual outbreaks long predicted by Fauci and his ilk in seemingly every country on Earth have failed to materialize, except - supposedly - in Africa, where the diagnostic standard for AIDS differs dramatically from those of the West. Given the prohibitively high cost of HIV testing for poor African nations, the WHO in 1985 crafted a diagnostic loophole that became known as the “Bangui definition,” allowing medical professionals to diagnose AIDS in the absence of a test using just clinical symptoms: high fever, persistent cough, at least 30 days of diarrhea, and the loss of 10% of one's body weight within two months. Often suffering from malnutrition and without access to clean drinking water, many of the inhabitants of sub-Saharan Africa fit the bill, especially when the WHO added tuberculosis to the list of AIDS-defining illnesses in 1993 - a move which may be responsible for as many as one half of African “AIDS” cases, according to journalist Christine Johnson. The WHO's former Chief of Global HIV Surveillance, James Chin, acknowledged their manipulation of statistics, but stressed that it was the entire AIDS industry - not just his organization - perpetrating the fraud. “There's the saying that, if you knew what sausages are made of, most people would hesitate to sort of eat them, because they wouldn't like what's in it. And if you knew how HIV/AIDS numbers are cooked, or made up, you would use them with extreme caution,” Chin told an interviewer in 2009.12   With infected numbers stubbornly remaining constant in the US despite Fauci's fearmongering projections of the looming heterosexually-transmitted plague, the CDC in 1993 broadened its definition of AIDS to include asymptomatic (that is, healthy) HIV-positive people with low T-cell counts - an absurd criteria given that an individual's T-cell count can fluctuate by hundreds within a single day. As a result, the number of “AIDS cases” in the US immediately doubled. Supervised by Fauci, the NIAID had been quietly piling on diseases into the “AIDS-related” category for years, bloating the list from just two conditions - pneumocystis carinii pneumonia and Kaposi's sarcoma - to 30 so fast it raised eyebrows among some of science's leading lights. Deeming the entire process “bizarre” and unprecedented, Kary Mullis wondered aloud why no one had called the AIDS establishment out: “There's something wrong here. And it's got to be financial.”13   Indeed, an early CDC public relations campaign was exposed by the Wall Street Journal in 1987 as having deliberately mischaracterized AIDS as a threat to the entire population so as to garner increased public and private funding for what was very much a niche issue, with the risk to average heterosexuals from a single act of sex “smaller than the risk of ever getting hit by lightning.” Ironically, the ads, which sought to humanize AIDS patients in an era when few Americans knew anyone with the disease and more than half the adult population thought infected people should be forced to carry cards warning of their status, could be seen as a reaction to the fear tactics deployed by Fauci early on.14   It's hard to tell where fraud ends and incompetence begins with Gallo's HIV antibody test. Much like Covid-19 would become a “pandemic of testing,” with murder victims and motorcycle crashes lumped into “Covid deaths” thanks to over-sensitized PCR tests that yielded as many as 90% false positives,15 HIV testing is fraught with false positives - and unlike with Covid-19, most people who hear they are HIV-positive still believe they are receiving a death sentence. Due to the difficulty of isolating HIV itself from human samples, the most common diagnostic tests, ELISA and the Western Blot, are designed to detect not the virus but antibodies to it, upending the traditional medical understanding that the presence of antibodies indicates only exposure - and often that the body has actually vanquished the pathogen. Patients are known to test positive for HIV antibodies in the absence of the virus due to at least 70 other conditions, including hepatitis, lupus, rheumatoid arthritis, syphilis, recent vaccination or even pregnancy. (https://www.chcfl.org/diseases-that-can-cause-a-false-positive-hiv-test/) Positive results are often followed up with a PCR “viral load” test, even though the inventor of the PCR technique Kary Mullis famously condemned its misuse as a tool for diagnosing infection. Packaging inserts for all three tests warn the user that they cannot be reliably used to diagnose HIV.16 The ELISA HIV antibody test explicitly states: “At present there is no recognized standard for establishing the presence and absence of HIV antibody in human blood.”17   That the public remains largely unaware of these and other massive holes in the supposedly airtight HIV=AIDS=DEATH paradigm is a testament to Fauci's multi-layered control of the press. Like the writers of the Great Barrington Declaration and other Covid-19 dissidents, scientists who question HIV/AIDS dogma have been brutally punished for their heresy, no matter how prestigious their prior standing in the field and no matter how much evidence they have for their own claims. In 1987, the year the FDA's approval of AZT made AIDS the most profitable epidemic yet (a dubious designation Covid-19 has since surpassed), Fauci made it clearer than ever that scientific inquiry and debate - the basis of the scientific method - would no longer be welcome in the American public health sector, eliminating retrovirologist Peter Duesberg, then one of the most prominent opponents of the HIV=AIDS hypothesis, from the scientific conversation with a professional disemboweling that would make a cartel hitman blush. Duesberg had just eviscerated Gallo's 1984 HIV paper with an article of his own in the journal Cancer Research, pointing out that retroviruses had never before been found to cause a single disease in humans - let alone 30 AIDS-defining diseases. Rather than allow Gallo or any of the other scientists in his camp to respond to the challenge, Fauci waged a scorched-earth campaign against Duesberg, who had until then been one of the most highly regarded researchers in his field. Every research grant he requested was denied; every media appearance was canceled or preempted. The University of California at Berkeley, unable to fully fire him due to tenure, took away his lab, his graduate students, and the rest of his funding. The few colleagues who dared speak up for him in public were also attacked, while enemies and opportunists were encouraged to slander Duesberg at the conferences he was barred from attending and in the journals that would no longer publish his replies. When Duesberg was summoned to the White House later that year by then-President Ronald Reagan to debate Fauci on the origins of AIDS, Fauci convinced the president to cancel, allegedly pulling rank on the Commander-in-Chief with an accusation that the “White House was interfering in scientific matters that belonged to the NIH and the Office of Science and Technology Assessment.” After seven years of this treatment, Duesberg was contacted by NIH official Stephen O'Brien and offered an escape from professional purgatory. He could have “everything back,” he was told, and shown a manuscript of a scientific paper - apparently commissioned by the editor of the journal Nature - “HIV Causes AIDS: Koch's Postulates Fulfilled” with his own name listed alongside O'Brien's as an author.18 His refusal to take the bribe effectively guaranteed the epithet “AIDS denier” will appear on his tombstone. The character assassination of Duesberg became a template that would be deployed to great effectiveness wherever Fauci encountered dissent - never debate, only demonize, deplatform and destroy.    Even Luc Montagnier, the real discoverer of HIV, soon found himself on the wrong side of the Fauci machine. With his 1990 declaration that “the HIV virus [by itself] is harmless and passive, a benign virus,” Montagnier began distancing himself from Gallo's fraud, effectively placing a target on his own back. In a 1995 interview, he elaborated: “four factors that have come together to account for the sudden epidemic [of AIDS]: HIV presence, immune hyper-activation, increased sexually transmitted disease incidence, sexual behavior changes and other behavioral changes” such as drug use, poor nutrition and stress - all of which he said had to occur “essentially simultaneously” for HIV to be transmitted, creating the modern epidemic. Like the professionals at the Tri-State Healing Center, Montagnier advocated for the use of antioxidants like vitamin C and N-acetyl cysteine, naming oxidative stress as a critical factor in the progression from HIV to AIDS.19 When Montagnier died in 2022, Fauci's media mouthpieces sneered that the scientist (who was awarded the Nobel Prize in 2008 for his discovery of HIV, despite his flagging faith in that discovery's significance) “started espousing views devoid of a scientific basis” in the late 2000s, leading him to be “shunned by the scientific community.”20 In a particularly egregious jab, the Washington Post's obit sings the praises of Robert Gallo, implying it was the American scientist who really should have won the Nobel for HIV, while dismissing as “

A Texas child's measles-related death, the first in the U.S. since 2015, highlights rising cases amid declining vaccination rates. AstraZeneca's Serena 6 trial found camizestrant, delayed disease progression in HR-positive HER2-negative breast cancer. A BMJ study found no link between GLP-1 receptor agonists and increased suicidality in diabetes patients. The CDC reports an 80% decline in high-risk cervical precancers, confirming HPV vaccination success.

Last episode we described the literature showing no survival benefit to patients with the AutoPulse device. Fear not, I wasn't ignoring the LUCAS, I just felt it deserved it's own episode. We'll cover the LINC and PARAMEDIC randomized controlled trials and the secondary analysis of LINC in shockable rhythms. I switched to a new production process using a new mic (Rode NT1) and started using ecamm to record. Yes, I know there is a bit of AV dysynchrony.. I'm working on it. I still have a lot to learn about ecamm but am optimistic about it. Citations on LUCAS device:1. Rubertsson S, Lindgren E, Smekal D, Östlund O, Silfverstolpe J, Lichtveld RA, Boomars R, Ahlstedt B, Skoog G, Kastberg R, et al.: Mechanical Chest Compressions and Simultaneous Defibrillation vs Conventional Cardiopulmonary Resuscitation in Out-of-Hospital Cardiac Arrest: The LINC Randomized Trial. JAMA. 2014;January 1;311(1):53–61.2. Perkins GD, Lall R, Quinn T, Deakin CD, Cooke MW, Horton J, Lamb SE, Slowther A-M, Woollard M, Carson A, et al.: Mechanical versus manual chest compression for out-of-hospital cardiac arrest (PARAMEDIC): a pragmatic, cluster randomised controlled trial. The Lancet. 2015;385(9972):947–55.3. Hardig BM, Lindgren E, Östlund O, Herlitz J, Karlsten R, Rubertsson S: Outcome among VF/VT patients in the LINC (LUCAS IN cardiac arrest) trial—A randomised, controlled trial. Resuscitation. 2017;June;115:155–62. Citations on Jeff's Tamiflu Rant1. Jefferson T, Jones M, Doshi P, Spencer EA, Onakpoya I, Heneghan CJ: Oseltamivir for influenza in adults and children: systematic review of clinical study reports and summary of regulatory comments. BMJ. 2014;348:g2545.2. Jefferson T, Jones MA, Doshi P, Del Mar CB, Hama R, Thompson MJ, Onakpoya I, Heneghan CJ: Risk of bias in industry-funded oseltamivir trials: comparison of core reports versus full clinical study reports. BMJ Open. 2014;4(9):e005253.3. Jefferson T: The Tamiflu Story: Why We Need Access To All Data From Clinical Trials. Open Knowledge Foundation Blog. FAST25 | May 19-21, 2025 | Lexington, KY

In this episode of the BMJ's Medicine and Science podcast, editor-in-chief Kamran Abbasi discusses the urgent need to tackle disinformation in health, especially in the context of the US, with Heidi Larson and Martin McKee from the London School of Hygiene and Tropical Medicine.    We also hear from Jane Ballentyne, professor of anaesthesia and pain medicine at the University of Washington, about new guidelines that strongly recommend against the use of spinal injections for chronic pain - and why that recommendation might be hard for some patients and doctors to hear.   Finally, we revisit the progress made in addressing racism in UK medical schools over the past five years with Gareth Iacobucci, The BMJ's assistant news editor.   Running order 01:44 Defining Misinformation and Disinformation 04:08 Vaccines and Misinformation 05:38 Strategies to Combat Disinformation 10:04 Denialism and Its Implications 16:21 BMJ Rapid Recommendations on Spinal Injections 26:27 Racism in Medical Schools: An Update   Reading list Spinal interventions for chronic back pain Racism in medical schools: are things improving?

Can you believe we made it all the way to episode 300? Well, we decided to cap off the event by revisiting a topic that was in the headlines way back when the three of us started in the field of behavior analysis…and sadly is STILL a topic of discussion: Vaccines and autism. And while the findings are in the title (they don't), we review the research as to why there is still any discussion on the matter and reflect on whether approaching the anti-vaccine debate from a purely scientific findings lens might be playing into an ableist narrative that paradoxically feeds the misinformation discourse. Thanks to everyone for supporting our show for all these years (and special thanks to everyone who joined us at our live recording!). This episode is available for 1.0 LEARNING CEU. Articles discussed this episode: Ahearn, W.H. (2010). What every behavior analyst should know about the “MMR causes autism” hypothesis. Behavior Analysis in Practice, 3, 46-52. doi: 10.1007/BF03391757 Deer, B. (2011). How the case against the MMR vaccine was fixed. The BMJ, 342:c5347. doi: 10.1136/bmj.c5347 Taylor, L.E., Swerdfeger, A.L., & Eslick, G.D. (2014). Vaccines are not associated with autism: An evidence-based meta-analysis of case-control and cohort studies. Vaccine, 32, 3623-2629. doi: 10.1016/j.vaccine.2014.04.085 Alvik-Harju, C. (2024). Finding more constructive ways forward in the debate over vaccines with increased disability cultural competence. Med Humanit, 49, 9-16. doi: 10.1136/medhum-2021-012342 If you're interested in ordering CEs for listening to this episode, click here to go to the store page. You'll need to enter your name, BCBA #, and the two episode secret code words to complete the purchase. Email us at abainsidetrack@gmail.com for further assistance.

As our resolution for the new year, we decided to record 300 podcast episodes. And wouldn't you know it: We're almost there! Kick off 2025 by learning about the, surprisingly, never-before discussed on the show matching law! Then we blast off into a more recent development by reviewing research on Collaborative Problem Solving before settling down for a wintry Grab Bag jamboree. And speaking of jamborees, we release our 300th episode on the always relevant topic, vaccines not causing autism. Want to see ABA Inside Track celebrate the 300th episode milestone in person? Join us on Thursday, January 9th, 2025 from 5-7pm EST at Regis College for a full-length live recording, food, our typical brand of shenanigans, and a free CE. Click here to RSVP. Articles for January 2025 Matching Law Reed, D.D. & Kaplan, B.A. (2011). The matching law: A tutorial for practitioners. Behavior Analysis in Practice, 4, 15-24. doi: 10.1007/BF03391780 Alferink, L.A., Critchfield, T.S., Hitt, J.L., & Higgins, W.J. (2009). Generality of the matching law as a descriptor of shot selection in basketball. Journal of Applied Behavior Analysis, 42, 595-608. doi: 10.1901/jaba.2009.42-595 Morris, S.L. & Vollmer, T.R. (2022). The matching law provides a quantitative description of social time allocation in children with autism. Journal of Applied Behavior Analysis, 55, 934-957. doi: 10.1002/jaba.934   Auld Bag Syne (Winter 2025 Grab Bag) Graham, S., Keenan, M., & Dillenburger, K. (2024). All for one and one for all: The good inclusion game. Behavioral Interventions. doi: 10.1002/bin.2048 Migan-Gandonou Horr, J. & Campos, C. (2024). Effects of a technology‐based self‐management intervention on social media use in a college student. Behavior Analysis in Practice. doi: 10.1007/s40617-024-00977-3 Schmidt, J., Krantz, J., King, H., Vetter, J., & Maruska, C. (2024). Using a brief experimental analysis for writing speed intervention identification. Behavioral Interventions, 39. doi: 10.1002/bin.2019   Collaborative Problem Solving Greene, R.W., Ablon, J.S., & Goring, J.C. (2003). A transactional model of oppositional behavior: Underpinnings of the Collaborative Problem Solving approach. Journal of Psychosomatic Research, 55, 67-75. doi: 10.1016/S0022-3999(02)00585-8 Greene, R.W., Ablon. J.S., Goring, J.C., Raezer-Blakely, L., Markey, J., Monuteaux, M.C., Henin, A., Edwards, G., & Rabbit, S. (2004). Effectiveness of Collaborative Problem Solving in affectively dysregulated children with oppositional-defiant disorder: Initial findings. Journal of Consulting and Clinical Psychology, 72, 1157-1164. doi: 10.1037/0022-006X.72.6.1157 Pollastri, A.R., Wang, L., Eddy, C.J., & Ablon, J.S. (2023). An open trial of Collaborative Problem Solving in a naturalistic outpatient setting. Clinical Child Psychology and Psychiatry, 28, 512-524. doi: 10.1177/13591045221094387 Stoll, S.J., Hartman, J.D., Paxton, D., Wang, L., Ablon, J.S., Perry, B.D., & Pollastri, A.R. (2023). De-implemnting a point and level system in youth residential care without increased safety risk: A case study. Residential Treatment for Children and Youth. doi: 10.1080/0886571X.2023.2233408   Vaccines Do Not Cause Autism Ahearn, W.H. (2010). What every behavior analyst should know about the “MMR causes autism” hypothesis. Behavior Analysis in Practice, 3, 46-52. doi: 10.1007/BF03391757 Deer, B. (2011). How the case against the MMR vaccine was fixed. The BMJ, 342:c5347. doi: 10.1136/bmj.c5347 Taylor, L.E., Swerdfeger, A.L., & Eslick, G.D. (2014). Vaccines are not associated with autism: An evidence-based meta-analysis of case-control and cohort studies. Vaccine, 32, 3623-2629. doi: 10.1016/j.vaccine.2014.04.085 Alvik-Harju, C. (2024). Finding more constructive ways forward in the debate over vaccines with increased disability cultural competence. Med Humanit, 49, 9-16. doi: 10.1136/medhum-2021-012342