Podcasts about crestor

Dr. Hoffman's vacation cruise highlightsWhich is better for me, NTFactor or Mitopure?My A1c went up since taking Crestor. Should I stop taking it?

What is your take on DMSO?I'm taking Zetia and Crestor and have familial hypercholesterolemia. Can I eat saturated fat?I think I have demodex mite infestation. My doctor says almost everyone has it and they don't cause issues. What say you?Why do I have to stop taking my supplements before hip replacement surgery? 

Do we need more fiber?; A discussion about Blue Zones; My BUN is high and my carbon dioxide is low. Do I have a kidney problem?; What do you think of spermidine for autophagy?; What about apigenin for anti-aging?; My doctor wants me to take Crestor but I'm concerned about side effects? What about Red Yeast Rice?

Eating Oreos lowers your LDL cholesterol? What's going on here. How did Oreo cookies beat Crestor in lowering LDL Cholesterol. Can you do this too? Should you do this? Nick Norwitz PhD and Harvard Medical student recently ran this experiment on himself. What does the data show? https://dralo.net/links

Gia is all fired up today! Possibly because she's binging Felicity and she has some concerns. Or maybe it's the Crestor. Regardless, she's full of energy (there's even some scatting). Keisha? Well, she's mostly (completely) consumed with worry that Leo will suffer if he's forced to do more scenes with that aggressively verbal, camera hog Violet. Don't let her get in your head, Leo! And both Gia and Keisha are wondering what's next for Esme. Don't let her get in your head, Esme! Plus, what is Carly going to do about this new guy who was only pretending to like her burgers?    #mauricebenard  #kellythiebaud #rogerhowarth #maurawest #delirious #tshirtgiveaway #barshampoo #daydrinkingwithsethmeyers #hillstreetblues #kinshriner #saveava #nicholaschavez #savediane #stonewallkitchen #hallandoates #superstore #freaksandgeeks #waitingonafriend #memyselfi #freefallin #alanarkin #whosgonnarideyourwildhorses #maneater #whippingpost #colonoscopy #takethenap #alleymills #billylibby #chickadee #fortgorgeous #robertgossett #daydrinkingwithsethandlizzo #marcuscoloma #useastaplegun #riptwitch #ripepiphany #ripsonyaeddy  #waywardchickadee #barshampoo #ripmiffy #lovedogs #justinebateman #brookeshields #neilgaiman #dnice #cq #deborahcox #malcolmjamalwarner #lume #ripjacklynzeman #jasonmomoa #adambelanoff #thecloser #majorcrimes #wings #murphybrown #thecosbyshow #pinkalicious #ripbillymiller #ripmatthewperry #riptylerchristopher #ripandrebraugher 

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Phil 4:8 "Finally, brethren, whatever things are true, whatever things are noble, whatever things are just, whatever things are pure, whatever things are lovely, whatever things are of good report, if there is any virtue and if there is anything praiseworthy—meditate on these things" During my self-help days, I often heard "You are what you think about all day long" or as it says in proverbs 23:7 "For as he thinks in his heart, so is he" What should we think about, or focus on, in this life? Our highest priority should be the unseen holy, set apart things, namely God and the things of God. The word for holy spirit or set apart in Hebrew is Kadosh Col 3:2 says "Set your mind on things above, not on things on the earth." Joshua 1:8 says "This Book of the Law shall not depart from your mouth, but you shall meditate in it day and night" Psalm 119:97 "Oh, how I love Your law! It is my meditation all the day" I used to think that when the Bible talked about meditating, or thinking, about His Word all day long, it didn't literally mean all day, but now I'm not so sure. I'm finding the more I focus on God the more I'm truly living. In the Torah it encourages us to think about His word throughout our day In Deut 6:6-9 says "And these words which I command you today shall be in your heart. 7 You shall teach them diligently to your children, and shall talk of them when you sit in your house, when you walk by the way, when you lie down, and when you rise up. 8 You shall bind them as a sign on your hand, and they shall be as frontlets between your eyes. 9 You shall write them on the doorposts of your house and on your gates." Number 15:39-41says "And you shall have the tassel, that you may look upon it and remember all the commandments of the Lord and do them, and that you may not follow the harlotry to which your own heart and your own eyes are inclined, 40 and that you may remember and do all My commandments, and be holy for your God. 41 I am the Lord your God, who brought you out of the land of Egypt, to be your God: I am the Lord your God.” Lesser in value than the set apart kadosh things that are unseen but still having great value are those things that are seen but also set apart. What we experience with our 5 senses. You could say our natural reality. Traditions in Judaism include saying prayers the moment you wake, when you walk to the bathroom, etc By doing so we are making our natural world set apart or kadosh, not totally of course, since we are in a fallen world. Gnosticism was a set of beliefs focused on knowledge and considered things natural to be avoided. I believe by coming to earth and taking on flesh, in addition to the important work of providing the necessary sinless sacrifice, Jesus also demonstrated the importance of us living in our natural reality. Also God wanted the tabernacle and then the temple to be made by human hands, and for us to it holy, even though they were types of the temple in the unseen realm. There a number of Songs with the theme “this is not my home” or "this world is not my home" which capture this idea. I've also heard of the hotel analogy.  Our life here is like staying in a hotel room but our true home will come after our death. That hotel room still has a purpose for us and is to be used and appreciated. If you want to go deeper on the concept of the unseen realm check out the book "The unseen realm" by Michael Heiser who died last last year. Also the Naked Truth podcast. So what are lesser thoughts or things we should avoid focusing on? Things of this world that do not honor God, that Satan has twisted and perverted. This can include things we might consider wholesome and good and G rated, but if focus on them too much, relying on them or making an idol of them, they become unholy and forbidden. There is another category of things to avoid, in my opinion even worse than the things of this world. Those are the unseen things that are not holy, set apart, that do not glorify God. This of course includes overtly evil practices like witchcraft, divination, going to a palm reader, playing with a ouige board, but it also includes things that most believers dont' think are a big deal but are also wicked and to avoided strongly. I'm talking about using your imagination to take you to a place that does not glorify God. This can include pornography as well as imagining images and activities that do not glorify God. Jesus raised the bar when it came to what is considered sin when he said that looking with lust and hating someone was the same as committing adultery and murdering someone. God cares about what we do but He seems to really care about what we think about or more specifically what is in our heart. 1 Samuel 16:7 says "For the Lord does not see as man sees; for man looks at the outward appearance, but the Lord looks at the heart.” If you have taken solace with your hands being clean but your mind being dirty, you are at risk of being hypocrites like the scribes and Pharisees who in Matt 23:27 Jesus said were "like whitewashed tombs which indeed appear beautiful outwardly, but inside are full of dead men's bones and all uncleanness." The line can blur between the seen and unseen both with things that are holy and things that are unholy. Just take this one verse as an example So put away all malice and all deceit and hypocrisy and envy and all slander. 1Pet.2.1ESV In that one sentence is a mixture of unholy things that are tangible actions as well as our thoughts. I used to freak out over this idea of controlling my thoughts, thinking I could not control them. I now know enough about God to know He would not ask me to do something I could not do, and in His love gives me the Holy Spirit to help me. 2 Cor 10:5 says "casting down arguments and every high thing that exalts itself against the knowledge of God, bringing every thought into captivity to the obedience of Christ," 1 Cor 10:13 says "No temptation has overtaken you except such as is common to man; but God is faithful, who will not allow you to be tempted beyond what you are able, but with the temptation will also make the way of escape, that you may be able to bear it" John 14:16 Jesus says "And I will pray the Father, and He will give you another Helper, that He may abide with you forever" Martin Luther said, “You cannot keep birds from flying over your head but you can keep them from building a nest in your hair.” I think of my thoughts as I do all of the commandments, they are ways for me to show my love for my heavenly Father, not a bunch of don't's I have to avoid out of fear. On the other side of obedience is a closer relationship with my Crestor and a life of joy and shalom. So to summarize, two things to focus on are both holy, one is unseen and perfectly holy, the other is seen and a type or foreshadow of holiness, or you could say a little slice of heaven. This is similar to the two commandments which is a summary of the law and prophets, to love God (unseen) and to love our neighbor as ourselves (seen). Note the second one has two parts to love our neighbor and ourselves. The two things to avoid, or to put more strongly to rebuke, hate and reject, are the unholy things, both seen and unseen. Another verse which captures this is Rom 12:2 "And do not be conformed to this world, but be transformed by the renewing of your mind, that you may prove what is that good and acceptable and perfect will of God." This is part of our human existence and Gods plan for us, at least as I'm beginning to understand and appreciate though will never fully comprehend since His ways are greater than my ways if you're looking for an application for your work, remember that you spend so much of your waking hours at your job, if you're going to focus on holy things all the day, you have to do so at work.  Your work is a great example of where the unseen and seen come together in a beautiful way.

Staffelfinale! Zum Ende der Staffel 4 - und vor einer kurzen Podcast-Pause - eine weitere Q&A-Folge, mit den folgenden Fragen: Welche Folge/Geschichte hat dich besonders beeindruckt? Hast du ein Team oder recherchierst du alleine? Wie kommst du emotional mit den Geschichten zurecht? Kannst du auch andere Crestor zum Thema Gedenkarbeit empfehlen (Verlinkungen zu den Accounts am Ende der Beschreibung) und: Kann man dich eigentlich buchen? Wir hören uns bald wieder - bis dahin schaut gerne bei Instagram und TikTok vorbei! *Zu meinen Account-Empfehlungen: @underthesilentbluesky | @jacob.arthur | @heeyleonie | @jewishfactsdaily

In today's episode of the IC-Disc podcast, I have a great guest today, Hayden Kelly from Chicago. He is with Chicago Atlantic and they have a really interesting cannabis fund for accredited investors. They've identified a market inefficiency because endowments, institutions, and non-profits are usually prohibited from investing in cannabis. Additionally, these cannabis companies are typically not bankable for traditional debt. So Chicago Atlantic has a really interesting debt model for accredited investors, with great collateral coverage and attractive loan-to-value ratios. Hayden is a really interesting guy, and even if you're not investing, he has a really interesting update on the state of the cannabis business, especially east of the Mississippi. In fact, Hayden shares some background on cannabis legalization history and why states east of the Mississippi are more financially attractive. I hope you enjoy the episode.   SHOW HIGHLIGHTS Chicago Atlantic leverages market inefficiencies in the cannabis industry to provide high-yield investment opportunities for accredited investors. Endowments, institutions, and nonprofits are typically prohibited from investing in cannabis, leaving a lucrative market for accredited investors. Chicago Atlantic's cannibus fund provides low-leverage loans to cannabis operators, offering attractive returns with high collateral coverage and loan-to-value ratios. Delayed draw term loans, low-leverage structures, amortization of loans, and floating rate loans are some benefits of investing in cannabis loans. Well-collateralized loans and the value of licenses as collateral add security to investments in the cannabis industry. There are two types of markets in cannabis: unlimited license models and limited license models, with the latter offering greater market control and higher valuations. The mispriced risk in the cannabis industry allows for higher investment returns, as operators prefer paying higher interest rates on debt rather than selling equity at depressed prices. Political uncertainties and regulatory hurdles in the cannabis industry contribute to the mispriced risk and present unique opportunities for investors. The black market for cannabis still exists due to high taxes and regulations in states like California, impacting legal operators and consumers. Chicago Atlantic's focus on high-collateral cannabis loans and low-leverage structures presents a unique opportunity for investors in the rapidly growing industry. LINKSShow Notes Be a Guest About IC-DISC Alliance About Chicago Atlantic GUEST Hayden KellyAbout Hayden TRANSCRIPT Dave Spray Hey, this is Dave. Welcome to another episode of the podcast. I had a great guest today, Hayden Kelly. He's with Chicago Atlantic and they have a really interesting Anibus fund for accredited investors. They've identified a market inefficiency because endowments institutions nonprofits are usually prohibited from investing in cannabis But additionally, these companies are not really bankable for traditional debt. So they have a really interesting debt model for accredited investors that has some really attractive returns with unbelievable collateral coverage and loan to value ratios. So Hayden is a really interesting guy And, even if you're not investing, he has a really interesting update on the state of the cannabis business, especially east of the Mississippi, as it relates to cannabis from a purely financial aspect. Hope you enjoy Well. Good morning, hayden. Welcome to the podcast. Hayden Kelly Thanks, david, appreciate you having me? Dave Spray Yeah, my pleasure. So what were you calling into? from today Are? Hayden Kelly you in Chicago. Despite the background, i'm actually in Miami, our offices are based out of Chicago. We have an office in Miami as well, but I made the move down to South Florida a little over eight months ago. Dave Spray OK, now are you so eight months ago? Sorry, are you a native of Chicago then, or how'd you end up in Chicago? Hayden Kelly Yeah, born and raised in Delaware. Actually, i spent two years in Chicago. I went to the University of Delaware, made the move to Chicago just in the beginning of 2020. I enjoyed the city. It's a great city. We just have a lot of clientele through South Florida and decided to make the move here for convenience. Whether that's a great place to be. Dave Spray OK, well, super. So let's talk about Chicago Atlantic real estate finance. So if I've got like a couple of single family homes that I want to rent out, are you getting the guys I call to get that financed? There's a little more to it than that. Hayden Kelly Yeah, no, absolutely, it's a little bit different. So we do operate as a REIT. Our public vehicle is a publicly traded mortgage. Right now, what I specialize in and where I work with is our private funds, which is very similar to the REIT the extent of the industries in which we invest in the collateral we we obtain as collateral towards loans. We make direct loans, and Chicago Atlantic as a whole is credit oriented. We're an investment platform that focuses on making loans to industries that for maybe some reason, banks won't lend to. Maybe it's one industry that we've really specialized in over the last four years is the US medical and recreational cannabis industry. So, ok, we started making loans in 2019. We have a public REIT on Nasdaq, we have a private credit fund, we have an equity fund and a variety of vehicles and our goals to get outsized returns to investors with very limited downside risk, and we're an industry where there's very limited competition. Dave Spray OK, i'd love to just dive into that cannabis industry. You know, kind of the last I looked at it, geez, four or five years ago, it seemed like because of the of us being a listed drug. Is it listed? What's the correct technical term? It is still a scheduled substance. Scheduled substance, yeah. So it created this hodgepodge thing where they couldn't use credit cards, they couldn't have a bank account, everything was in cash. Is that evolved in the business or is that still the case? Hayden Kelly So a few are still the case, still scheduled. You have an industry that is, for that reason, unbankable. So the big banks, the insurance companies, the endowments, the pensions, the institutions of the world that are typically the big check writers, the big investors in any traditional industry, are shut out from investing due to that lack of federal legalization, where the federal government has said you know, at states, you decide what you want to do. There's 22 states with recreational programs, meaning anyone over the age of 21 can consume cannabis and purchase it like alcohol, and then 38 with some sort of medical program where, if it's chronic pain, sleep apnea, etc. You can acquire cannabis with a note from a doctor and a prescription to be filled at a dispensary. Now your point on the card is completely right No credit card processing in dispensaries, and now what they do have is ATM obviously withdrawals, which is easy for cash transactions, but also you have debit card processing in a good chunk of dispensaries. What we've seen, though, is a big misconception on operators. Everyone thinks operators can't get bank accounts. They're paying us off through amortization payments for our loans and cash and trash bags account. The reality is there's probably anywhere from two to six state chartered banks. These are local banks that will take deposits, open up bank accounts for operators That's how we get comfortable potentially making loans And we require operators that bank accounts for at least a year and a half before we would consider a loan. So to that extent there are bank accounts in the space, but there definitely are a lot of regulatory hurdles at the operators' face. Dave Spray Okay. So I suppose I think it was Zig Ziglar that said every obstacle contains the seed of an equal or greater opportunity. So it kind of sounds like that's how you guys are looking at this. Instead of seeing all the obstacles right You can't use credit cards, can't get big institutional investing you're choosing to see the opportunity in it. it sounds like Absolutely, david. Hayden Kelly So I'll give you just a little bit of a background for us. It started a little over four years ago For one of our founders, tony Cappell. He worked at a traditional lending shop in Chicago called Stonegate And, being in Illinois, you had a super robust medical program. So when it flips recreational, all those patients were already consuming. You had a wholly new addressable market that was interested in cannabis. Maybe they were using it on the black market side and wanted to now try it from dispensaries etc. So when that state flipped recreational, you had what are now the billion dollar publicly traded companies like GTI, presco, barano, spinning out of the state And they were actually coming into the offices of the Stone Gates and the other credit shops of the world and saying listen, guys, the banks won't give us a loan. We'll give you whatever you need to get comfortable. You can take our real estate as collateral. We'll pledge you all of our assets. We'll even personally guarantee the loan. You can charge us 20%. We'll give you a little piece of the company, just give us debt. Because of that point in time there are equity valuations of skyrocketed. They didn't want to sell any more equity in their company, so what they wanted was debt. They were willing to pay an arm and a leg for it. But unfortunately, even Stonegate was a shop that said listen, we can't do it. We have leverage from a bank. We have a few institutional investors who are not comfortable with cannabis. We can't make these loans. And being the head of credit, which was where Tony sat, he said why not make these loans when you have very limited competition, an industry that is growing 20% year over year? You can charge whatever you want And it's way more secure than anything else we're doing. And that's pretty much how Chicago Land it came to be. He got together with two of his classmates at the University of Chicago. They did their executive MBAs together at Booze And it's solid to just really understand the industry travel state by state. And that's at that point is when we launched the fund. Dave Spray Oh, wow. That's really cool, and can you share approximate like size of the cannabis portfolio that you guys have or any kind of metrics? Hayden Kelly Yes, so between our public reach, our two private funds and LP call investments that would lead underwriter on and lead collateral agent on. we've deployed a little over 1.8 billion into cannabis, or the largest vendor in the space. Dave Spray Wow, and so help me understand, like, is that like a couple dozen clients, or is that tens of thousands, or is that something in the middle, you know kind of what's? could you maybe kind of walk me through just like a typical you know sort of deal structure, as much as you're able to, you know, without giving away your secret sauce. Hayden Kelly No, absolutely. Well, it's closer to the earlier part, which is that I've done about 60 loans. Okay, we have some very large loans, one to a company called Verano Holdings who is a billion dollar publicly traded operator. That's a $350 million line of credit. We have 30 million in our REIT, 30 million in our private fund. Verano is probably, in my opinion and you can look at it anywhere is probably one of the top five operators in the world today. Well, we will go in. We will do a loan anywhere from 10 to 30 million in size. We like to structure the loans as delayed drawl term loans, where we lend It's very accretive, so the operator is either building something or buying something. So we can structure the note to be delayed drawl term, which says we'll maybe give you the first tranche of 10 million upfront Once you get a permit to build your new cultivation or you're awarded the license, maybe we'll unlock the second member of that loan. So not putting all the cash up front is great from a downside protection standpoint. We like to lend anywhere less than two times and two and a half times senior debt to EBITDA. Dave Spray When in traditional businesses. Hayden Kelly You typically see people lending maybe at five, six, seven times senior debt to EBITDA. So very low leverage. The loans amortize. We prefer our operators to be amortizing monthly. So that is actually paying down the principal of the loan rather than just paying its interest. For the big balloon to a maturity, that loan principal amount is getting smaller and smaller every single month. And then one thing that we've done since early on, and we're very happy we did, was focus on floating rate loans. So where you've seen these increased rates and this inflation hedge and it affecting big credit shops, big publicly traded mortgage rates, it hasn't affected us, not in a negative way but in a positive way. Where our cost of capital right now is the best of expectations. We don't use leverage So we're not relying on a bank to ultimately lend to us. That rate would have gone up Where when we make a loan to a borrower, the rates based on crime. As capital becomes more expensive to borrow and crime rate goes up, our loan gets more expensive, making the return for investors higher. So we have a portfolio right now in one of our private funds that has 37 loans. The gross on levered yield on that vehicle is over 18%, which is phenomenal and it continues to rise. Dave Spray Yeah, and especially given the well collateralized nature of the loans. Hayden Kelly That's something we haven't even touched on yet, which is the most important part. A typical loan when there's real estate coverage, we're getting a mortgage or deed of trust. So the operators and where we're lending is primarily on the East Coast, where all agopolis exist. You have indoor warehouses, 15,000 square foot grow operations where the operator has various grow rooms and they're growing cannabis indoors. That's how they can control climate and ultimately grow in a state like New Jersey, pennsylvania, west Virginia, ohio, because you can't do it outside like you can in California and Oregon. We're getting all asset UCC one lean. So the company's assets, the receivables, cash on hands, security, interest on their inventory, equipment, lights, receivables, etc. But the real hammer, david, is we're actually getting what is called a stock pledge of the subsidiary that owns a license. One thing that I did not get the touch on it, which is super important, is there's two types of markets in cannabis. You have unlimited license models and you have limited license models, where some of the early adopters the California's, the Oregon's, the Washington's of the world said cannabis is great, let's issue as many licenses as we can, people love it, we're generating great tax revenue. But what happened was, over time, too much competition entered the state. When that competition entered the state, it created, at first phenomenal, a lot of cannabis coming online, a lot of people consuming it. But over the years you've seen a decline in wholesale cost. You've seen an increase in competition. You have operators that it's very difficult to be profitable and they're not making any money. What that's done at the state level is the states are now losing out on tax revenue because they're charging excise tax And the way to optimize your excise tax is to keep wholesale prices high. So the new states that have been adopting the Pennsylvanians, the Ohio's, the West Virginia's, the Florida's, the Illinois's of the world. They said we're going to issue limited amount of licenses, where maybe they issue 20, 30, 50 licenses. Doing so creates oligopolies. Doing so keeps wholesale prices high, limited competition, very easy to regulate. And with that not only do you have a market where cannabis is trading at 2,000 or even $2,800 a pound in some states, you also have now created this license that is very valuable. You can sell the license, you can transfer the license. Now what is the most important thing with our loans is when we focus on these east coast operators We're getting. That license is collateral. The Pennsylvania licenses are valued anywhere between 15 and 25 million dollars. You saw a license itself for over 90 million dollars. So it's a very attractive piece of collateral on our loans and with the licenses, the real estate, the leans, even personal guarantees. When we consider LTB's of the enterprise value of these companies, we typically say under 25% of an additional lending environment. Dave Spray Wow, that's, that's amazing. Can you kind of walk through like an example? I mean, this can just be What's the word I'm looking for an amalgamation of, like, yes, some different clients. You're sort of a Hypothetical scenario. Just kind of walk us through, maybe what it looks like like let's just pick a state and let's maybe, you know, maybe think of a particular deal you've done You can just talk about anonymously or something close. I know a lot of our listeners are, you know, financially oriented, so could we kind of just sort of walk through what a deal might look like. Hayden Kelly Yeah, absolutely, david, and I'll share what I would consider is one of our most reputable loans. It's a publicly traded company called Brano Holdings, and Brano is a 1.1 1.2 billion dollar Publicly traded operator. There's been quarters of the company doing over a hundred million dollars in EBITDA quarter. That is a 350 million dollar loan, meaning we're less than one time senior, that TV, that and that loan is at the cost of an all-in Just over 14 percent. Where seniors are cured on the deal, we're fully collateralized by real estate, all-acid lean stock pledge devices. No personal guarantees in that loan. It is a publicly traded company and no warrants in that deal. But that is just shows the The industry, the holes in the industry where there is very much so mispriced risk. If Verano was a Widget manufacturer or they were in the tire business Generating that type of revenue and having that type of dominance in the market, they would be at the cheapest cost of capital possible. But just given the lack of the institutional money in space, the banks not being willing to lend to the sin industry, which is cannabis, were able to charge a company of that magnitude north of 14 percent, which just speaks to This industry and how they're truly is mispriced risk. Ultimately, every single state to David, so they're all across the board. We've exposure through various states and many different markets just with that that one company. Dave Spray Okay, yeah, and they're happy to pay the 14 percent because their margins are substantially higher than that, obviously. Hayden Kelly Yeah, and there's a few other factors. There is a capital super creative to them. But what's more important to understand is you've had these cannabis equity markets. You have some operators that are performing very well whose equity valuations are still getting crushed. Now They're not going to inject equity and raise equity To dilute existing equity holders. They're not gonna, you know. I see, when they know their values are higher than they're being betrayed Today, which is ultimately why they're willing to pay for more expensive debt. Dave Spray Sure. So paying 14 percent for debt is still far cheaper than selling equity at a depressed price. Hayden Kelly Absolutely and it won't last forever, i can't tell. You will be able to generate 12% cash paying returns, a gross on every deal of over 18% forever. But I think we have a four to seven year window and the reason being is you have An issue right now with the Democratic Party as well, where originally the Democratic Party is ever in a league-class cannabis. It's great. We can generate significant tax revenue, we can implement social equity, we'll get back to the people that were harmed on the war, on drugs and incarcerated etc. And what happened as time kind of progressed is the Biden administration You know the runoff to the Senate ever thought it would happen and the cannabis equity market skyrocketed. If you look at a chart, i like to use MSOS. It's an ETF of the ticker to some of the largest publicly traded cannabis companies and You see this boom right following election and over the last few years It's just gone directly right back down, nearing all-time lows. And it's not because the companies can't perform. It's the loss of faith that there's gonna be any reform, any real meaningful impact and to get institutional investors involved. And it's because half the Democrats like it for tax revenue, half like it for tax revenue and one implements social equity. There's something going on in New York right now where, you know, potentially implementing 150 licenses for Dispensaries to ex-devicted felons. Now I think it's great if you want to, you know, get back to those who have been wrongfully incarcerated for something that is now legal. It makes sense. But what doesn't make sense is Having these operators now be the ones that are going to control the cannabis trade in the state, maybe individuals that don't have as much business experience or operating experience. So you see, issues like that the Republicans aren't too favorable of that. Some of the Democrats don't love it, which is why we've seen what is the safe banking act been shut down at the Senate level for a great time now. Dave Spray Oh, wow, okay, And so help us understand. like what a smaller deal looks like, like do you have any operators? or just like a single location. Was that too small? Hayden Kelly No, but location is everything. So we'll do individual deals. Anywhere from 10 to 30 million in size is our sweet spot. It might be an operator in a state like Pennsylvania or Ohio or Maryland where this limited license model exists. It might be a smaller operator, but the goal there and the thesis there is you're in a state like Pennsylvania where there's 25 cultivations, or in a state like Maryland where there's 50 cultivations and you're forced to be vertically integrated because if you have a cultivation you get three dispensaries. So having one of those licenses is super valuable Now, where the operator might not be printing as much cash as a Verano, a GTI or a Crestor or a big operator. They're in an industry where they don't need to do anything in an instant. Be attractive. They don't need to have the best brand, they don't need to have the best product, they just need to be able to operate. They need to be able to grow cannabis, open up their dispensary on time, have employees in the shop And, given the soledopathy that exists, they're very much able to be very profitable and have very attractive licenses, which is I break this flat as well. Dave Spray Okay, that makes sense. What makes me think of something here in Texas. There's a Texas ice cream company called Bluebell in about an hour northwest of Houston, in Brenham, texas, and supposedly if you go to the manufacturing facility they just have ice chest full of like single serving ice cream for the employees to just sample at will throughout the day. I'm guessing that some employees at cannabis operations think it's going to be a similar setup, but I'm guessing it's probably not like that, right? Is this the dream job for somebody who's a regular cannabis user? or they can just consume while they work? Is that, or is that just probably a myth? Hayden Kelly Yeah, no, it's definitely a myth. Now, a California, Washington, oregon grow operation or dispensary, that might be very, very all common, just given the lack of regulation, the very cheap wholesale prices, the oversupply, that is very much real Now in a state like Pennsylvania or Illinois and Ohio these states that keep looting to you can't do that in your rooms, you can't do that Your dispensary is, and then what you stand to lose is the ability to operate. So if you're consuming product in your cultivation, it's not a good idea. We don't advise on it. We haven't seen any of our operators doing it. But there's something to consider. Right, if you're working that close to the plant, you might have an affinity to the product. At Chicago Atlantic we don't have an affinity to the product, we just like the sufficient markets And it might happen. But from our perspective it's a big no-no and you stand to lose much more than you stand to gain by consuming product during the workday. Dave Spray Sure No, that makes sense. Hey, do you know one of the theories of one of the benefits of legalizing a cannabis was that, as I understand it, when you have a black market there's a huge premium that the consumers paying because of the risk of the whole supply chain being illegal. And part of the theory was that by legalizing it you could really dramatically reduce that premium to where the black market really wouldn't exist, because there would be kind of no economic aspect to it. Are you familiar with any of those dynamics, like in California, let's say? has the black market effectively been either eliminated or kind of made irrelevant? Hayden Kelly So it's interesting, ultimately the actually the opposite is happening in a state like California, where you have a very robust tax regime in a state like California where it's already hard to be profitable, no matter what business you're operating in. Now you're in a state that is overbuilt supply so dramatically that it is so hard to be profitable that some of these legal operators have adjusted and started doing black market activity shipping and product over state lines, maybe selling cannabis, you know, out of the shops And, david, there's actually kind of to an extent exist in New York too, because there's really no crackdown, there's no real push to let's incarcerate, let's shut down these black market operators that are selling out of trucks. You can go into a bodega, buy an e-cigarette, a sandwich, a soda and actually buy cannabis from someone behind the counter, and they might even put it on a credit card for you. So there's a lot of black market activity. In Houston it's not heavily regulated. Now in Pennsylvania, in Maryland, in Florida et cetera, you'll absolutely see that where. Why go to the black market dealer to purchase an eighth of smokable flour when it's going to cost maybe 30 to $40 from the black market dealer? That same eighth might be $35 or $50 in a dispensary. It's not dramatically more expensive. You get to know where it's grown. You get to see all the metrics of the cannabis how much THC, cbd, everything that's in the product. It's sealed, it's labeled, it's sold at a licensed dispensary. It's much safer. Now you even have a new adoption of people that maybe would never consider smoking cannabis if you're buying it in a bag from a black market dealer outside of a shopping center et cetera. Where, if you go into a dispensary, you see it's labeled, you see it's secure, you have the child-proofing packages, big brands, real customer service. You might have that housewife or that house husband that was once drinking a glass of wine or a beer before bed, now eating an edible or smoking a vape cartridge to relax. So it's definitely happening. Now in the more unlimited licensed states, the opposite's happening, because the operators can't be profitable, they're a little bit more desperate and they're turning towards a black market product. The states east of the Mississippi is where I typically go. They're really very much doing it right when it comes to issuing licenses and regulating licenses. Dave Spray Okay, and like is California, like one of those states where somebody can grow their own marijuana for personal consumption too. Hayden Kelly There's over 6,000 licensed grows in California, which is crazy. It's very easy to grow, It's very easy, obviously, to consume and then purchase and sell Where in some of the limited states it's very difficult to get a license. I mean an application process in a limited license state costs anywhere from $100,000 to $300,000 just to submit a good application and potentially be considered to be a worthy license. Dave Spray Wow. Well, we spent a fair amount of time in Colorado And my understanding of the Colorado law is it's actually legal, i think, maybe three plants per adult or something like that, where you can actually grow it completely unlicensed, unregulated, for personal use. Do you know if California or Oregon has that kind of stipulation too? Hayden Kelly I'm not exactly sure. I'm sure it does To the extent operator. both consumers want to grow their own cannabis, as long as they're not trying to open up a dispensary near positive. Dave Spray It's the same way in Oregon and California, because it would seem like that would also create another black market, because I'm guessing in California the tax rate on the cannabis is probably higher than just the standard sales tax rate. I'm guessing it's a pretty significant number. You know what that is. Hayden Kelly Absolutely. It's very high In California, one of the worst tax regimes. obviously in the US there's a premium associated with cannabis even in Illinois. Tax revenue generated from cannabis in Illinois just last year, for the first time ever, actually was larger than tax revenue generated from alcohol. It's not because there was more sales in alcohol, it was because the rate is higher. That just shows the magnitude of tax revenue from the product. States ultimately aren't legalizing it because they say you know what, david, this is better for you than buying Advil from Walgreen. This is better for you than getting prescription bill. It's ultimately to generate tax revenue where there are significant health benefits to cannabis. States are really being pushed and urged to legalize cannabis due to that tax revenue generation. Dave Spray Yeah Well, it would also seem like that would also further depress the price, the black market. Even if all you're doing is eliminating the tax, that creates a significant difference. Because I can just imagine somebody who's maybe been illegally growing their own cannabis for a long time. There's just a little small operation for them, a couple of their buddies, very low key. Now all of a sudden it's legal and they can have I don't know, it's either three or six plants, i think in Colorado You can grow them outside, i believe. Now all of a sudden they're like hey, just like in the past, i produce a little more than I need, so I can just sell it to my buddies. I'm actually selling it to them cheaper than I used to because I don't have to charge the incarceration risk premium. Now all of a sudden they're able to buy it from me for half the price that cost them to go to a dispensary. You only have one strain but they come over anytime they want. They can kind of see the operation. I would also think that would be another downward pressure phenomenon on pricing as well, although it may not be material and quantity. Hayden Kelly Yeah, that's. The latter is the most important part. Not only these plants aren't going to produce enough cannabis ultimately if you have three plants to supply many people with the product. But growing is not that easy. It's not like planting a tree where you can just put it in the backyard or somewhere or water it once in a while. It takes sophistication. It takes very significant nutrients, soil, water, lighting. The process is difficult where, if I was an advocate for cannabis and even just for some reason I couldn't buy from a dispensary, which would be the first place I would go. I'm much more likely to find a black market operator who would chip it to me from California, oregon or Washington because, a it's probably even cheaper than trying to grow it yourself and B the new sense of growing is it's not easy. It takes anywhere from six to 12 to 24 months to have a clone producing cannabis. That's smokable. It's not something that is ultimately too reputable or even it's not that easy to do. It takes someone that really understands it. There is definitely an existence. It's not going to have too much of an effect on wholesale pricing at the dispensary level. Dave Spray Okay, well, thanks for that industry background. Now you mentioned that in your $1.8 billion you have deployed that you haven't had access to the traditional equity markets, institutions and insurance companies. In that, because of this awkward age that we're in with cannabis, how are you all raising your funds? because it doesn't sound like you're borrowing money. It sounds like it's all equity investment from nontraditional sources. Is that correct? Hayden Kelly Correct. When I speak with anything here, it's in regards to our private funds. But our private funds are completely unlevered. We do not take on debt. We don't go to a bank and say let us borrow $50 million, $100 million, we'll mix it in the fund with LP equity. It'll actually sit on top of the LP equity, which means in a waterfall scenario or something goes wrong, the bank gets paid back before investors are considered. That's in the traditional investment world private credit. REIT et cetera. We are completely unlevered. It's no bank debt, it is all LP equity and traditional investors of ours are qualified purpose-served investors where you have to have $5 million or more in assets. Our typical minimum check is anywhere from $250,000 to $1 million. It's ultra-hine-worth individuals, It's family offices, It's private investors that want great opportunity for clients that offers quarterly income. Dave Spray How is the investment very liquid. What's the typical tie-up if an investor does choose to team up with you? Hayden Kelly guys. The investment has. A two-year lockup is the standard. Investors can get out at one year at a 10% discount if they need early liquidity. The standard two-year lockup has no discount associated with it. We make redemptions on a quarterly basis. But, if investors are interested in the fund, you come in immediately, diversified across 37 loans. 15 of those loans have some sort of equity kicker, which means about a third of the deals are actually able to get some sort of piece of the business if the company goes public or gets acquired, which is alluded to in the past significant markups. We've had years where equity kickers are worth an additional 200-300 basis points. We've had years where they've been worth nothing, but they're solely gravy and they can help bolster returns at the investor level. Dave Spray Okay, that explains how you lend the money at 14%. You pay your overhead, but your investors are capturing a greater than 14% return because of the equity kickers. Hayden Kelly To an extent that's correct. The only thing I'll say is that 14% that's to one of the best billion-dollar publicly traded companies, oh okay, the cost of capital is well over that. Dave Spray I've got you. Okay, That makes sense. So, accredited investor. if an accredited investor is listening to this and wants to learn more, where would you direct them to? Hayden Kelly There's two ways You can check out our website. You can read about the team I oversee, our investor relations team. We have about 500 line-item investors. If you have any interest in learning more talking about the cannabis industry, maybe you are pursuing debt for cannabis operation. If you're looking for income alternatives in these uncertain markets, I'm happy to talk to you about potential investment opportunities. Dave Spray Okay, should I just email you? That would be great. What's the email address? Hayden Kelly It is HKelly at ChicagoAtlanticcom. That is HTELY at ChicagoAtlanticcom. Dave Spray Okay, and then the website ChicagoAtlanticcom ChicagoAtlanticCreditcom Correct. Okay, chicagoatlanticcreditcom. Well, this has been really interesting. Is there anything that I didn't ask you, that you wish I had? Hayden Kelly No, i think we covered a good chunk of it. We covered a little bit of everything. You know what makes this different I think it's important because there are some other lenders in the space is both were largest by a pretty significant multiple but it's where we focus we said early on, we want to stick east of the Mississippi. We want to focus, for allogopolis exist. We've never done a direct loan in California, which speaks magnitude, because most people the first thing in the first state they think of when you hear cannabis is California. It's where started, it has this, you know, feeling to it. If you go to California, that's where cannabis is, etc. We really focus on these allogopolis and one thing that makes a significant be different, david, is we focus on direct originations. We directly originate our loans from ground up. We have eight direct originators that are in the field, looking for new deals, uncovering new opportunities, staying current with borrowers for introductions and up sizes, which gives us a competitive edge. But we're actually seeing a lot of these deals before anyone else has the opportunity to even talk to the operator. So that's us. I'm happy to chat with anyone more in depth. There's a lot we can go into and I look forward to it. Dave Spray Yes. So one last question. So is there any? you know, given the muddy waters during the federal and the states, if somebody has like Qualified retirement dollars They're looking to deploy, are there any prohibitions against that? I mean, if it's in a qualified retirement, you know, an IRA, roth IRA, or does it have to be, you know, outside that type of vehicle? Hayden Kelly No, great question. We included an offshore feeder on our Second fund, which is available to investors. That eliminates what is called UBTI and ECI, which are on favorable, favorable tax treatments for Qualified plans like a self-directed IRA. Now, if the individual is no longer employed with the firm that maybe they had a 401k with Like we heard is they can roll it into a self-directed IRA and invest. We take self-directed ira's, traditional ira, we take foundations etc. So you can use taxes and dollars. Very attractive from that perspective, given the high yield. Dave Spray Yeah, well, super Well, hey, this has really been. This has really been fun And I appreciate your kind of opening our eyes to an interesting Opportunity that sounds like it may not be around forever, because it was just kind of this unique, influenced of events that's created this opportunity. I heard this quote by Sam Zell. Do you know, sam, the famous Chicago? I think he invented the read. Basically, i think he did. I Heard him speak at a conference. In fact, it was that same conference in Miami where I first met one of your colleagues Earlier this year and Sam, i didn't hear this from him then. Sam spoke at that conference, but I heard him on a podcast and he said when somebody asked him what his occupation is, he said I'm a professional Opportunist, so this sounds like a great opportunity for a professional Opportunist absolutely. Hayden Kelly I think I need to send Sam an email and let him know what we're working on. A Chicago Atlantic, that sounds great. Dave Spray Well, hey, thanks again for your time. Really appreciate it. Have a great day. Thank you, david. Hayden Kelly Bye. Dave Spray There we have it another great episode. Thanks for listening in. If you want to continue the conversation, go to ic disc show dot com. That's ic D is C showcom and we have additional information on the podcast, archived episodes as well as a button to be a guest. So if you'd like to be a guest, go select that and fill out the information And we'd love to have you on the show. So that's it. We'll be back next time with another episode of the ic disc show. Special Guest: Hayden Kelly.

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Unscripted Pharmacist Podcast - The Negative Side of Statins 4/7/2023 To find out more about what Kyle and Chris talk about check out these links and people, Lipitor settlement information https://www.classaction.com/lipitor/settlement/ Crestor site for side effects https://www.crestor.com/cholesterol-medicine/side-effects.html#isisec Slides and a few links: go to YouTube and watch anything from dr david diamond, dr Nadir Ali, dr Zoe Harcombe, Nina Teicholz, Gary Taubes, dr. Robert Lustig, Dr Ben Bikman, Dr Aseem Malhotra, Dr Maryanne Demasi, Dr Jason Fung, Join Kyle Rootsaert, Pharmacist & Board Certified Diabetes Manager (BC-ADM), as he talks about how your body maintains it insulin levels and the effects of a ketogenic lifestyle on overall health in this episode of The Unscripted Pharmacist. His co-host is Chris Stevenson, and Oncology Nurse with many years of experience in the medical field. #health #wellness #diabetes #eatingwell #diabetescare #healthcare #keto #ketodiet #exercise #healthyeating #bewell #agingwell #caloriesincaloriesout #whycalories #calories #carbs #protien #carbohydrates #carbsvsprotien #insulinlevels #insulin #keto #ketodiet

Drugs known as statins are the first-choice treatment for high cholesterol but millions of people who can't or won't take those pills because of side effects may have another option. In a major study, a different kind of cholesterol-lowering drug named Nexletol reduced the risk of heart attacks and some other cardiovascular problems in people who can't tolerate statins, researchers reported. Doctors already prescribe the drug, known chemically as bempedoic acid, to be used together with a statin to help certain high-risk patients further lower their cholesterol. The new study tested Nexletol without the statin combination -- and offers the first evidence that it also reduces the risk of cholesterol-caused health problems. Statins remain “the cornerstone of cholesterol-lowering therapies,” stressed Dr. Steven Nissen of the Cleveland Clinic, who led the study. But people who can't take those proven pills “are very needy patients, they're extremely difficult to treat,” he said. This option “will have a huge impact on public health.” Too much so-called LDL or “bad” cholesterol can clog arteries and lead to heart attacks and strokes. Statin pills like Lipitor and Crestor – or their cheap generic equivalents – are the mainstay for lowering LDL cholesterol and preventing heart disease or treating those who already have it. They work by blocking some of the liver's cholesterol production. But some people suffer serious muscle pain from statins. While it's not clear exactly how often that occurs, by some estimates 10% of people who'd otherwise qualify for the pills can't or won't take them. They have limited options, including pricey cholesterol-lowering shots and another kind of pill sold as Zetia. Nexletol also blocks cholesterol production in the liver but in a different way than statins and without that muscle side effect.  This article was provided by The Associated Press.

Well, this episode is suddenly incredibly relevant again just with all the stuff going on with co-pay maximizers. If you're gonna understand maximizers, though, you really have to start here. In a nutshell, this whole thing is a battle royale between co-pay cards and patient assistance programs offered by pharma companies versus co-pay accumulators and co-pay maximizers deployed by health plans and PBMs (pharmacy benefit managers). I just want to start by getting everyone grounded on a few really key points. #1: Drug abandonment is a thing. Patient goes into the pharmacy to pick up their Rx and the out of pocket is too expensive, so they leave without their drug. This can happen on the first fill, like, “Oh, wow, I guess I don't really need that new drug my doctor just told me I should pick up.” Or it can happen downstream, like in January when, all of a sudden, a deductible kicks in. But in all cases, we have a patient getting sticker shock on the out of pocket for a med and then going without the drug … or pill splitting or rationing or doing other things to save money. #2: How PBMs shake rebates out of pharma manufacturers is to use what I just said (that whole abandonment possibility) as a leverage point. Pharma goes into a PBM that controls access for drugs for, I don't know, 100 million lives. The PBM says, “Hey, you, Pharma! If you want to be on our formulary, you gotta kick out this much in rebates.” Pharma says, “No, that is too much rebate. I cannot pay it.” PBM says, “Well, then … OK, you're not on formulary or you are poorly positioned on formulary. And let me translate what that means. Now the out of pocket for your drug will be so expensive that patients are gonna walk out of the pharmacy without your drug because I, the PBM, have control over patient out of pocket and I will make it very expensive.” From a pharma's standpoint, all those patients that aren't picking up the drug … that means a loss of market share. And that market share can translate into a lot of lost revenue for the pharma company. And thus begins the whole war of the co-pays/out of pockets. So now, let's fast-forward through the past, say, 10-plus years. It'll be like one of those movie montages with the action sped up so fast you don't need words to see what's going on … except this is an audio podcast, so I guess you do need words. Alright, so this is what happens next: Pharma starts raising its prices combined with there's more super expensive specialty pharmacy drugs. Reaction by the PBMs to this was to try to get more aggressive with Pharma demanding increasingly high rebates and other concessions, keeping in mind the prize and leverage point that the PBMs offered Pharma to secure those PBM rebates was lower co-pays or out of pockets for patients. Again, it's a well-known fact that the higher the patient out of pocket, the lower the market share of the drug because the higher the patient cost, the more patients abandon at the pharmacy counter. It's the old supply and demand curve at work. At a certain point here in all of this, the pharma companies start to get really pissed about their dwindling net prices as rebates start going up and up and their market share kind of doesn't because the PBMs are keeping the money and maybe not passing it along to plan sponsors or patients. It's a zero-sum game fight over the money, and Pharma feels like the PBMs are getting more than their share. And they're pretty smart, these pharma manufacturers. So, Pharma comes up with a Houdini move to escape PBMs holding Pharma hostage for rebates by using their control over how much patients pay or don't pay at the pharmacy counter. Fasten your seatbelts and let the games begin. Pharma decided to hand out co-pay discount cards. Then Pharma doesn't have to pay PBM rebates to get lower patient out-of-pocket costs. They can finesse lower patient out-of-pocket costs all by themselves. Take that, PBMs! Except now, the PBMs see this—and they raise. Enter co-pay accumulators and also co-pay maximizers. For this part of the extravaganza of game theory at its finest, I'm gonna let Dea Belazi, PharmD, MPH, my guest in this episode, explain further. However, one more thing to point out before we begin. In the olden days, this whole war of who has leverage over who transpired in the context of small molecule drugs in competitive markets a lot of times. So, like Lipitor versus Crestor and the brands all cost, like, $100 a month and, maybe, there was a generic equivalent. If the health plan made it too expensive for a patient to get one of those drugs, they usually made another one in the same class attractive financially. So, the patient had (theoretically, at least) options; and the stakes were also a lot lower. The dollar volumes that we're talking about here were a lot lower. Now this same war is being fought on the specialty side of the house, where drugs cost thousands or tens of thousands a month and the patient may have but one option. So, if it's made to be financially toxic for a patient to get that one drug, the patient has to choose between their family's health and dipping into their 401k in order to afford their out-of-pocket costs. Or going bankrupt. Or dying. And when I say “or dying,” that is not hyperbole. There are studies that clearly show the mortality rates for patients who have trouble affording their meds are worse. In these cases, Pharma can be, sort of authentically, a hero who steps in and helps patients who are functionally uninsured because they can't afford the co-pays and deductibles that their plan sponsors have put in place to actually use the insurance that they are paying handsome premiums to have. Pharma can step in and help via these co-pay discount cards or coinsurance programs or through patient assistance programs helping those with lower incomes. So, there's no question in the short term that when a patient desperately needs a drug and their insurance is insufficient, a pharma manufacturer can be a knight in shining armor financially. But only if this were so simple, like this is some kind of spaghetti western with the good guys and the bad guys. Now let's think about this co-pay/out-of-pocket assistance offered by Pharma with a longer timeframe or a more systemic timeframe in mind. How is it that Pharma can have prices that are as high as we all know they are? Right?! It's because enough patients don't abandon the med at the pharmacy counter or, these days, in the infusion clinic. So, the lower Pharma can drive the patient out of pocket for a really expensive drug, the more they have a certain amount of impunity to raise the drug prices. This is a lot of the argument against price caps on out of pockets just in general, by the way. They matter for patients. They save lives. But they also have the consequence of kind of getting rid of what is often seen as a big control point checking pharma prices from zinging even higher than they already are. Bottom line, we have a catch-22 on our hands—and the patient is stuck in the middle. If you're a patient and you need your miracle drug (and a lot of patients call these drugs their miracle drugs), Pharma is your hero … at least right now. However, Pharma is also now able to raise their prices even more next year; and now you really need their out-of-pocket support because the price of the drug is so high your employer/taxpayers can't afford the rising drug spend and even more cost gets shifted onto patients. It becomes like Stockholm syndrome. But again, no white hats and black hats here. This whole thing is one of those incomprehensible art house films with lots of plot twists and in every other scene, you start to feel for the character you just hated 10 minutes ago … because while Pharma is getting busy raising prices, you have PBMs and nothing-for-nothing plan sponsors also up to their own machinations. Like, hey, here's one that's quite a marvel: PBM double-dipping. If the PBM can get Pharma to pay the patient deductible and then also get the patient to pay the patient deductible … Hmmm … By the way, that was a backdoor introduction to accumulators. And then later on, maximizers showed up on the scene. I just want to say that with maximizers, not all are created equal. I can certainly see their value for patients when they are deployed by companies and plan sponsors as part of their benefit designs with an explicit goal of helping members and the plan itself (nothing for nothing) afford expensive drugs it's clear that the patients need. But … I have to say, and I'm not well versed enough yet in how this maximizer business has evolved to comment on whether some of what is going on is still a net positive for some members and patients. Some of these PBMs have opened up entirely separate maximizer companies, which, for sure, they are upcharging employer plan sponsors to use. And the whole point of these separate entities is to get as much cash out of Pharma as possible while they, I don't know, may or may not pass that cash on as savings to patients and members. I need to do a show on this coming up. There's a new bill in the House, by the way. It's called the HELP Copays Act, which I don't think is just aimed at accumulators. If you didn't understand what I just said, you will after you listen to this episode. With that, here's Dea Belazi. Dea is president and CEO over at AscellaHealth. He is a pharmacist by training who has worked for Pharma, and then he worked at a health plan, spending a lot of time in the PBM space. In other words, he's seen this tangled web from pretty much every angle. We kick right into the conversation talking about accumulators.   You can learn more at ascellahealth.com.   Dea Belazi, PharmD, MPH, has led the development and management of AscellaHealth's global specialty pharmacy benefit and healthcare services for nearly a decade. As a visionary and architect of change, leading the AscellaHealth shift from pharmacy benefit management to specialty pharmacy solutions, he has played a key role in the company, achieving a staggering four-year growth of more than 1556%. Previously, he served as a senior executive and played a key role in the growth and expansion of PerformRx, a PBM owned by Keystone First Health Plan. Additionally, Dea held a leadership position at FutureScripts, an Independence Blue Cross company that was sold to Catamaran. A respected industry professional and thought leader, Dea is often invited as a reviewer for multiple medical journals and holds a seat on the board of directors for numerous healthcare-related companies. Based on his impressive career and growing reputation, he was chosen to serve on FierceHealthcare's Editorial Advisory Council. Dea was most recently recognized as an Ernst & Young Entrepreneur of the Year 2022 Greater Philadelphia Award Finalist; he is also a 2022 Philadelphia Titan and a 2021 Philadelphia Business Journal Most Admired CEO honoree. Dea holds a PharmD from the University of Rhode Island. He completed his dissertation at Brown University, earned a Master of Public Health from Johns Hopkins University, and served as a post-doc health outcomes research Fellow at Thomas Jefferson University.   11:06 “The concept of co-pay accumulators wasn't just a … PBM thought, but it also came from their customers, whether it was health plans or employer groups.” 15:50 “[This is] literally a math problem based on, ‘Do I spend it now? Do I spend it later?'” 17:20 What reason do employers and payers have for doing this? 21:13 “This is another mechanism for payers to push down additional cost to both the patient and now the pharma company.” 22:24 EP241 with Vinay Patel. 22:59 “I don't think accumulators are really forcing Pharma to be more competitive.” 25:06 How co-pay maximizers are different from co-pay accumulators. 28:09 Who doesn't like co-pay accumulators and maximizers? 30:01 How patient advocacy groups are a different model. 32:10 What is the biggest challenge facing employers right now?   You can learn more at ascellahealth.com.   Dea Belazi of @AscellaHealth discusses #copayaccumulators and #copaymaximizers on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #copay   Recent past interviews: Click a guest's name for their latest RHV episode! Brennan Bilberry, Dr Vikas Saini and Judith Garber, David Muhlestein, Nikhil Krishnan (Encore! EP355), Emily Kagan Trenchard, Dr Scott Conard, Gloria Sachdev and Chris Skisak, Mike Thompson, Dr Rishi Wadhera (Encore! EP326), Ge Bai (Encore! EP356)

Agnes Fritz ist Geschäftsführerin bei Viva con agua Arts und des jährlich stattfindenden Musik- und Kunstfestivals der Millerntor Gallery in Hamburg, St. Pauli. Sie ist zweifache Mutter und Aktivistin. Eine Frau, die laut und leise sein kann, viel zu sagen hat und in deren Leben humanitäre Hilfe eine große Rolle spielt. In dieser Folge sprechen wir über: - Agnes Arbeit als Aktivistin und Crestor, - das Leben als Mutter und Geschäftsführerin, - die Dinge, die sie antreiben und für die sie aufsteht, - Nachhaltigkeit und die Bedeutung von Konsum, - die Bedeutung von Freundschaft und Beziehungen in ihrem Leben, - die gesellschaftliche Kraft von Musik & Kunst, - die Millerntor Gallery und die Arbeit mit ihrem Team, - Auszeiten im Kalender, - Rituale, die den Alltag leichter machen, - ein privilegiertes Leben, - die Frauenquote im Event- und Veranstaltungsbereich, - welche Bedeutung Wasser und humanitäre Hilfe in ihrem Leben haben, - Demos & das Leben in einer Kommune - und welche Strukturen wir für beide Geschlechter brauchen, um gut arbeiten zu können. Über Agnes Fritz: https://www.instagram.com/agnes.fritz/?hl=de Viva Con Agua https://www.vivaconagua.org/ Millerntor Gallery: https://www.millerntorgallery.org/ Agnes Buchtipp: Against White Feminism von Rafia Zakaria Über uns: Das Magazin: www.personalitymag.com Folge uns auf Instagram unter: https://www.instagram.com/personalitymag/ Melde dich für unser monatlichen Newsletter an: http://eepurl.com/hcgREz Hinterlasse uns einen Kommentar und eine Bewertung auf iTunes und abonniere uns bei Spotify

A study looking at people with genetic variants that mimic the effect of statins and PCSK9 inhibitors showed significantly worse cognition and brain area among those with the statin variants. This suggests that statins may negatively impact the brain (PMID 35953131).This suggests that important benefits to cerebrovascular disease may be counterbalanced by other negative effects on the brain by statins through other mechanisms.An important caveat to the study is that while these statin-mimicking variants are expressed everywhere in the body in people who have inherited them, different statins have a different degree of selectivity for the liver versus other tissues (such as the brain).Statins that are selective for the liver are called hydrophilic, while those that are nonspecific and inhibit HMGCR in all tissues (including the brain) are called lipophilic.This is because lipophilic statins freely travel across cell membranes, while hydrophilic statins need to be transported into liver cells using transporters (OATP1B1, OATP1B3, OATP2B1, BCRP, and MRP2) expressed only in the liver (PMID: 29051147).Interestingly, another recent study found that statin users with mild cognitive impairment using lipophilic statins had an increased risk of converting to dementia compared to non-users and users of hydrophilic statins (https://jnm.snmjournals.org/content/62/supplement_1/102).This same study found using FDG PET a decline in metabolism in several regions of the brain important for cognition in those using lipophilic statins but not non-users or users of hydrophilic statins.While no strong, gold standard evidence implicates lipophilic statins as harmful for brain health, given the wide availability of similarly priced alternatives, these findings might suggest that hydrophilic statins should be preferred to lipophilic ones whenever possible. The hydrophilic statins are pravastatin (Pravachol) and rosuvastatin (Crestor), while the lipophilic statins are fluvastatin (Lescol), lovastatin (Mevacor, Altoprev), simvastatin (Zocor), atorvastatin (Lipitor), and pitavastatin (Livalo).===Like, comment, subscribe.For more, find me at:PODCAST The Kevin Bass ShowYOUTUBE https://www.youtube.com/user/kbassphiladelphiaSUBREDDIT www.reddit.com/r/kevinbassWEBSITE http://thedietwars.comTWITTER https://twitter.com/kevinnbass/https://twitter.com/healthmisinfo/INSTAGRAM https://instagram.com/kevinnbass/TIKTOK https://tiktok.com/@kevinnbassAnd above all, please donate to support what I do:PATREON https://patreon.com/kevinnbass/DONATE https://thedietwars.com/support-me/

Are your arteries on fire? Are there hidden (or obvious) correctable risk factors that are fueling the fire? In most cases specialized blood testing, along with a careful evaluation by a knowledgeable healthcare provider, can uncover multiple addressable areas that can reduce your risk of ongoing artery damage. On this week's The Heart of Innovation, hosts Kym McNicholas and Dr. John Phillips are joined by Dr. Michael Dansinger, Medical Director at heart-health company Boston Heart Diagnostics, that does specialized blood testing to help doctors and patients manage and prevent vascular diseases including peripheral artery disease. Boston Heart also provides ultra-personalized nutrition and lifestyle prescriptions for patients based on their blood test results and other factors specific to each patient. Blood tests must be ordered by healthcare providers and are partially covered by medical insurance in most cases. They discuss a variety of different advanced blood tests for cardiovascular health and what they mean. Why is it important to perform advanced bloodwork? It's for: Uncovering obvious and hidden risk factors for ongoing cardiovascular damage Designing an optimal eating strategy based on an individual's specific blood test results, medical issues, and food preferences Identifying appropriate treatments including lifestyle recommendations, medications and/or supplements Measuring improvements resulting from treatments including lifestyle habits, medications, and/or supplements There are seven different categories of specialized cardiovascular blood tests offered through Boston Heart Diagnostics: Particles that cause artery damage Cholesterol source Cholesterol elimination Fatty acid balance Diabetes risk Inflammation Genetics During this show, we focused mainly on particles that cause artery damage, cholesterol source, cholesterol elimination, inflammation, and diabetes risk. More specifically: Particles that cause artery damage LDL cholesterol: The concentration of cholesterol in LDL particles. Levels around 60-70 mg/dL are optimal for artery health, especially in people with known cardiovascular disease or peripheral vascular disease. It usually requires statin medications to get that low. Levels of 70-100 mg/dL are reasonably good for people without known vascular disease. ApoB: This measures the concentration of LDL particles rather than the concentration of cholesterol contained in LDL particles. ApoB levels predict cardiovascular risk slightly better than LDL cholesterol. LDL-P: This is an alternative way to measure the concentration of LDL particles. Small-dense LDL cholesterol: Most of the damage caused by the smallest and densest LDL particles. Boston Heart measures the amount and percentage of cholesterol specifically in small-dense LDL particles. Publishes studies show this test is a superior predictor of cardiovascular disease, and you want the levels to be as low as possible. Along with appropriate medications and/or supplements, lifestyle changes such as weight loss, eating less refined sugars and starch, and daily exercise can reduce small-dense LDL cholesterol. Lipoprotein (a): This is an artery-damaging particle that is too high in about 20% of men and women. High levels can run in families since it is genetically determined. Cholesterol Source Testing Cholesterol production: The liver makes cholesterol. In some people the liver makes too much cholesterol leading to high levels of LDL particles, including small-dense LDL particles. This may happen for genetic reasons, or because there is a lot of fat accumulated in the liver, or for other reasons. There are blood tests that identify whether high cholesterol levels are due to overproduction. Weight loss can reduce fatty liver and cholesterol overproduction. Statin drugs (for example Crestor or Lipitor) reduce cholesterol production from by the liver. Repeat testing of cholesterol production levels can demonstrate the effectiveness of treatments. Cholesterol absorption: The intestines absorb cholesterol. In some people (about 25-30%) the main source of high LDL cholesterol levels is from over-absorption rather than over-production of cholesterol. These people are more sensitive than others to dietary cholesterol, and they do not respond as well to statin drugs. They respond well to medications (like ezetimibe) and supplements (like fiber and plant sterols/stanols) that block cholesterol absorption by the intestines. In this way, knowing the source of high LDL cholesterol can guide treatment decisions by doctors and patients. Cholesterol Elimination HDL cholesterol: Most people call this “good cholesterol” but it is actually a way to measure the level of HDL particles. HDL particles help remove excess cholesterol from the body. Higher levels of HDL cholesterol indicate lower risk of heart and vascular diseases. Exercise raises HDL cholesterol; smoking lowers HDL cholesterol. Large HDL particles: You want your HDL particles to be large. The large HDL particles are the ones that remove cholesterol most effectively. Unfortunately unhealthy refined sugars and starches, abdominal obesity, and insulin resistance prevent the HDL particles from becoming large and mature. Think of apples on a tree that never become large and ripe because the tree is not getting what it needs. People with cardiovascular disease often lack the large HDL particles, which can be measured most effectively with the “HDL Map” test by Boston Heart. Studies show the HDL map test is very effective at measuring improvements caused by favorable lifestyle changes. Diabetes Risk Studies show that among people age 65 and older in the U.S., about 25% have diabetes, plus another 50% have prediabetes! We are all at risk for diabetes in our lifetime, and there are blood tests for measuring that risk. Healthy lifestyle choices and certain medications can delay the progression from prediabetes to full type 2 diabetes, or potentially improve type 2 diabetes to the point of remission. Hemoglobin A1c: this simple blood test is in common use, and can be used to measure the risk or extent of prediabetes or diabetes. It provides a 2 to 3 month average blood sugar reading by showing how “sugar coated” your blood is. Insulin testing: This simple blood test is done after an overnight fast. Insulin is a hormone made by the pancreas to move sugar (glucose) from the blood into tissues to be used for energy. Some people have abnormally high or low insulin levels in the blood, which an be used to provide measures of diabetes risk. Improvements in insulin levels can be used to measure improvements in diabetes risk. At Boston Heart we offer a test called the “Beta Cell Function and Risk Index” which uses fasting insulin and glucose levels to monitor diabetes risk and recommend treatments based on the specific results. Prediabetes assessment testing: This test offered by Boston Heart gives doctors and patients a measure of how rapidly a patient is moving from prediabetes toward prediabetes toward type 2 diabetes. The test uses a combination of multiple blood tests and clinical factors that have been shown to predict (with an accuracy of 92%) the 10-year risk of diabetes in patients with prediabetes. Inflammation When we talk about “fire” in the arteries that is another way saying “inflammation” in the arteries. We can use special blood tests to measure different aspects of inflammation. C-reactive protein (CRP): This is the most common test for inflammation. Increased blood levels means there is inflammation somewhere in the body, from any cause. If there is no sign of infection, injury, or illness that could cause inflammation, then an increased blood level is often a measure of the intensity of ongoing artery damage from any cause. MPO: This is also known as “myeloperoxidase”. It is a general measure of active white blood cells and inflammation. In someone with known coronary artery disease, high levels of MPO can signal “hot plaque” that is at risk to cause a heart attack. LpPLA2: This is also known as the “PLAC test”. It is a measure of inflammation caused by cholesterol plaque inside the artery walls. It is more specific to artery health than C-reactive protein or MPO.

Statin drugs, Brain Loss, Cholesterol. "It's a Bit of a Breakfast Club today" . . . discussion about the ominous link between statin use and brain loss. Question: How discriminating are statins like Lipitor or Crestor? 25% of total-cholesterol is found in the brain. Cholesterol lowering drugs do not have the ability to self-adjust their influence traveling through the body's circulatory system. 

It's "In the News..." the only LIVE diabetes newscast! Top stories this week: Medtronic expands its insulin pump recall, Afrezza inhaled insulin pediatric studies to begin, new report says adults w/T1D are a "Forgotten population," new research into type 2 diabetes and statins and more! Join us each Wednesday at 4:30pm EDT live at https://www.facebook.com/diabetesconnections   Check out Stacey's book: The World's Worst Diabetes Mom! Join the Diabetes Connections Facebook Group! Sign up for our newsletter here ----- Use this link to get one free download and one free month of Audible, available to Diabetes Connections listeners! ----- Get the App and listen to Diabetes Connections wherever you go! Click here for iPhone      Click here for Android Episode transcript below: Hello and welcome to Diabetes Connections In the News! I'm Stacey Simms and these are the top diabetes stories and headlines of the past seven days. As always, I'm going to link up my sources in the Facebook comments – where we are live – and in the show notes at d-c dot com when this airs as a podcast.. so you can read more if you want, on your own schedule. XX In the News is brought to you by Real Good Foods! Find their Entrée Bowls and all of their great products in your local grocery store, Target or Costco. XX Our top story this week.. Medtronic has expanded a recall of its MiniMed 600 series insulin pumps to include nearly half a million devices. This is an FDA Class One recall – the most serious type – because the pumps may deliver incorrect insulin doses. The recall was first announced in 2019 for just two models. Medtronic now says it will replace any MiniMed 600 series insulin pump that has a clear retainer ring with one that has the updated black retainer ring at no charge. That's even if there is no damaged and regardless of the warranty status of the pump. There's more to this – including directions on how to check if your pump may be affected and who to call. I'll put all of that here in the FB comments and in the show notes. https://www.usnews.com/news/health-news/articles/2021-10-05/medtronic-expands-recall-to-include-more-than-463-000-insulin-pumps XX Enrollment is under way for the first pediatric trials for Afrezza inhalable insulin. This will involve children ages 4 to 17 living with type 1 or type 2 diabetes. It's called the INHALE-1 phase three trial. They're going to look at changes in A1C after 26 weeks.. and then changes in fasting glucose after another 26 weeks. If you're interested, we've got the link for more info to this study and to learn about enrollment. Afrezza was approved for adults back in 2014. https://clinicaltrials.gov/ct2/show/NCT04974528. https://investors.mannkindcorp.com/news-releases/news-release-details/mannkind-announces-first-patient-enrolled-inhale-1-study XX Last week we told you about the Glucagon emergency kit recall from Lilly. Reuters is reporting that the kits were made in a factory previously cited for quality-control violations, including several involving the glucagon product. Lilly had received a report of a patient who experienced seizures even after being injected with the drug, a sign that glucagon was not potent enough to work. The company said the product failure might be related to its manufacturing process, without elaborating. A spokesperson declined to say whether Lilly has received other reports of adverse events related to the Glucagon kits. Separately, Lilly is facing a federal criminal investigation into alleged manufacturing irregularities involving another of its U.S. factories in New Jersey. Reuters is following both stories and of course, we will too. https://www.reuters.com/business/healthcare-pharmaceuticals/exclusive-eli-lillys-recalled-emergency-diabetes-drug-came-plant-cited-by-fda-2021-10-04/ XX Big new report on adults with type 1.. called a forgotten population in this write up. The consensus statement covers diagnosis, goals and targets, schedule of care, self-management education and lifestyle, glucose monitoring, insulin therapy, hypoglycemia, psychosocial care and much more. This is a joint statement from the American Diabetes Association and the European Association for the Study of Diabetes Their last consensus report on type 2 diabetes has been "highly influential," these researchers say.. so they recognize the need to develop a comparable report specifically addressing type 1 diabetes in adults. https://www.medscape.com/viewarticle/960158 XX Adults with Type 2 diabetes on statin therapy may see worsening diabetes symptoms. Important caution: the researchers are quick to say that association does not prove causation, no patient should just stop taking their statins based on this study. These are cholesterol lowering medications with brand names like Lipitor and Crestor.. Statin users had a 37% higher risk for diabetes progression, including extremely high blood sugar levels and elevated rates of disease complications. Nearly half of adults with Type 2 diabetes also have high cholesterol and many of them stop taking statins due to this kind of thing. But that may increase the risk for heart attack or stroke. So definitely talk to your doctor before making any changes. https://www.upi.com/Health_News/2021/10/04/statins-diabetes-progression-risk-study/7261633358483/ XX More to come, But first, I want to tell you about one of our great sponsors who helps make Diabetes Connections possible. Real Good Foods. Where the mission is Be Real Good They make nutritious foods— grain free, high in protein, never added sugar and from real ingredients—the new Entrée bowls are great. They have a chicken burrito, a cauliflower mash and braised beef bowl.. the lemon chicken I've told you about and more! They keep adding to the menu line! You can buy online or find a store near you with their locator right on the website. I'll put a link in the FB comments and as always at d-c dot com. Back to the news… -- DreaMed Diabetes gets FDA approval to expand their platform to people with type 1 and type 2 diabetes. Called Advisor Pro, it's the first decision support system that has been cleared to assist healthcare providers in the management of diabetes patients who use insulin as well as CGMs and meters. We spoke to these folks on the podcast last year. They say Advisor Pro aims to solve the massive worldwide shortage of endocrinologists by empowering primary care clinicians, to be able to provide expert level endocrinological care to diabetes patients. The company's founder says the next step is to develop and extend the technology to cover all injectable or oral medications for diabetes. https://www.businesswire.com/news/home/20211006005640/en/ https://diabetes-connections.com/we-treat-the-data-lifting-the-burden-of-diabetes-with-dreamed/ -- Really interesting look at who's adopting newer diabetes technology. This is from an article over at Dia Tribe where they feature a research study showing that roughly 55% of people with diabetes had positive, open attitudes toward technology. However, another 20% had negative attitudes and did not trust technology, while the remaining 25% either did not want additional data, did not want to wear a device on their body or had a very high level of diabetes distress related to using devices. When they focused on people with type 2.. it turns out the uptake of technology was actually lowest among people aged 18 to 25. This group also had the highest levels of diabetes distress and the highest A1C levels, and many reported that they did not like having a device on their body as their main reason for refusing the devices. Others reported the frequency of alerts and alarms, feeling physically uncomfortable, and cost as reasons for rejecting devices. These researchers say providers need to find ways to avoid making patients feel guilty about their choice of technology as well as watching out for negative judgements for those who use devices but don't achieve near perfect glucose control. https://diatribe.org/new-tech-and-psychological-toll-diabetes-management Please join me wherever you get podcasts for our next episode - The episode out right now is all about the film Pay or Die an upcoming documentary about insulin access and affordability. – That's In the News for this week.. if you like it, please share it! Thanks for joining me! See you back here soon.

Rosuvastatin is an antilipemic agent that works through the inhibition of the rate limiting enzyme in cholesterol synthesis (HMG CoA reductase). It is used in the management of dyslipidemia as well as having benefits in cardiovascular event prevention. The typical dosing range when treating dyslipidemia is between 5-40 mg PO qd. The max dose is 40 mg/day. Dose adjustments are made every 2-4 weeks after initiating between 10-20 mg PO qd. Some concerns are to avoid red yeast rice due to the similarity to the medication lovastatin, avoid use during pregnancy and breastfeeding, and dose at the lower end of the therapeutic range in Asian American patients due to higher levels being present which could lead to an increased risk for toxicity. The most common side effects are headache, abdominal pain, nausea, joint pain, and weakness. Go to DrugCardsDaily.com for episode show notes which consist of the drug summary, quiz, and link to the drug card for FREE! Please SUBSCRIBE, FOLLOW, and RATE on Spotify, Apple Podcasts, or wherever your favorite place to listen to podcasts are. The main goal is to go over the Top 200 Drugs with the occasional drug of interest. Also, if you'd like to say hello, suggest a drug, or leave some feedback I'd really appreciate hearing from you! Leave a voice message at anchor.fm/drugcardsdaily or find me on twitter @drugcardsdaily --- Send in a voice message: https://anchor.fm/drugcardsdaily/message

Jeff joins Jennifer and David on a bridge to discuss Chicago Improv in the 90's, restarting the Players Workshop, and how he almost tackled Stephen Colbert. Jeff Rogers is Wall Street Journal & USA Today Best-Selling Author, award-winning Television Host, Professional MC and sought after public speaker with 25+ years of experience engaging audiences. Jeff can be seen on dozens of national television commercials for Crestor, BP, McDonald's, Miller Lite, Hanes,& Ford, as well as roles on Empire, Chicago PD, Chicago Fire, and Proven Innocent. He is the host of the cable TV's Jeff's Homemade Game Show. He is also the host of three different award-winning web series. Growing up as one of eleven kids from an Irish-catholic family in Chicago, Jeff grew up with a built-in audience and went on to become one of youngest performers to be hired at the renowned Second City Theater(John Belushi was the youngest). Jeff performed with Steve Carell from The Office, Stephen Colbert from The Late Show with Stephen Colbert, Saturday Night Live and 30 Rock star Tina Fey and Parks and Rec star Amy Poehler, and too many more to mention. Jeff is the owner of The Players Workshop, the oldest improvisation school in the country, home to alumni like Bill Murray, Bonnie Hunt, Harold Ramis, and Matt Walsh. Jeff continues the tradition of teaching improvisation to anyone interested in learning the art for stage or for life. www.playersworkshoponline.com www.jeffrogersunlimited.com  www.instagram.com/playersworkshopchi   www.bridgeimprovtheater.com

Description: Viagra, Crestor, Eliquis, and many other brand-name medications come to mind when the discussion turns to expensive drugs. These drugs are pocket change in comparison to Zolgensma, a new(ish) gene therapy for Spinal Muscular Atrophy that costs as much as a private island. Tune in as our hosts discuss this incredible drug and some of the ramifications of its incredible price tag. This is NOT your physician's podcast. Hosts Shane Garrettson and Cal Vandergrift dive into the pharmacy world with fun, interesting, and downright weird topics! Tune in for NEW episodes, available on Spotify, Apple, Anchor, and more! Check out our Facebook, Twitter, and Instagram pages at Let's Pharmonize to view videos and images relevant to every episode! If you have any questions, comments, or even corrections, e-mail us at pharmonization@gmail.com. PLEASE READ: Shane and Cal are NOT medical professionals. DO NOT USE the information presented in this podcast to aid in your own personal health or medicinal benefit. This is a light-hearted podcast that should not be taken with the same seriousness as your own personal health, A special thanks to Kelly Kerr for creating the music used in the intro and outro. Additional music by FesliyanStudios See omnystudio.com/listener for privacy information. Learn more about your ad choices. Visit megaphone.fm/adchoices

Description: Viagra, Crestor, Eliquis, and many other brand-name medications come to mind when the discussion turns to expensive drugs. These drugs are pocket change in comparison to Zolgensma, a new(ish) gene therapy for Spinal Muscular Atrophy that costs as much as a private island. Tune in as our hosts discuss this incredible drug and some of the ramifications of its incredible price tag. This is NOT your physician's podcast. Hosts Shane Garrettson and Cal Vandergrift dive into the pharmacy world with fun, interesting, and downright weird topics! Tune in for NEW episodes, available on Spotify, Apple, Anchor, and more! Check out our Facebook, Twitter, and Instagram pages at Let's Pharmonize to view videos and images relevant to every episode! If you have any questions, comments, or even corrections, e-mail us at pharmonization@gmail.com. PLEASE READ: Shane and Cal are NOT medical professionals. DO NOT USE the information presented in this podcast to aid in your own personal health or medicinal benefit. This is a light-hearted podcast that should not be taken with the same seriousness as your own personal health, A special thanks to Kelly Kerr for creating the music used in the intro and outro. Additional music by FesliyanStudios See omnystudio.com/listener for privacy information.

Viagra, Crestor, Eliquis, and many other brand-name medications come to mind when the discussion turns to expensive drugs. These drugs are pocket change in comparison to Zolgensma, a new(ish) gene therapy for Spinal Muscular Atrophy that costs as much as a private island. Tune in as our hosts discuss this incredible drug and some of the ramifications of its incredible price tag. This is NOT your physician's podcast. Hosts Shane Garrettson and Cal Vandergrift dive into the pharmacy world with fun, interesting, and downright weird topics! Tune in for NEW episodes, available on Spotify, Apple, Anchor, and more! Check out our Facebook, Twitter, and Instagram pages at Let's Pharmonize to view videos and images relevant to every episode! If you have any questions, comments, or even corrections, e-mail us at pharmonization@gmail.com. PLEASE READ: Shane and Cal are NOT medical professionals. DO NOT USE the information presented in this podcast to aid in your own personal health or medicinal benefit. This is a light-hearted podcast that should not be taken with the same seriousness as your own personal health, A special thanks to Kelly Kerr for creating the music used in the intro and outro. Additional music by FesliyanStudios --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app Support this podcast: https://anchor.fm/calvin-vandergrift8/support

Episode Title: How To Create A Super Bowl Ad In this episode, we talk to Tim Calkins(College Professor & Consultant) as we discuss this year's Super Bowl Ads, his book, and so much more. Be sure to check out TimCalkins.com Purchase his book How To Wash A Chicken: Mastering The Business Presentation **More On Tim** Tim is a marketing professor, author, speaker and consultant. His newest book is a guide to creating and delivering powerful business presentations. It is titled How to Wash a Chicken: Master the Business Presentation. You can read more about the new book here. Tim is Clinical Professor of Marketing at Northwestern University's Kellogg School of Management. He teaches courses including Marketing Strategy and Biomedical Marketing in the full-time, part-time and international executive MBA programs. He is also co-academic director of the Kellogg on Branding executive education program. He has received numerous awards for teaching excellence. In 2018, he received the Top Professor Award from Germany's Kellogg-WHU Executive MBA Program. He won the Lawrence G. Lavengood Outstanding Professor of the Year Award, the top teaching award at Kellogg, in 2006 and 2013, making him one of just four people in the award's more than forty year history to have won it twice. He also received the Sidney J. Levy Teaching Award, two Kellogg Faculty Impact Awards, and the Kellogg Executive MBA Program's Top Professor Award four times. Poets & Quants included him on its list “Favorite MBA Professors of 2016.” In addition to How to Wash a Chicken, Tim is the author of Defending Your Brand: How Smart Companies Use Defensive Strategy to Deal with Competitive Attacks (Palgrave Macmillan, 2012). Expert Marketer Magazine named Defending Your Brand the 2013 Marketing Book of the Year. He also wrote Breakthrough Marketing Plans (Palgrave Macmillan, 2008 and 2012). He is co-editor of Kellogg on Branding (John Wiley & Sons, 2005) and Kellogg on Branding in a Hyper-Connected World (John Wiley & Sons, 2019). Tim manages Building Strong Brands, a blog on brand strategy. Inc.com, the Web arm of Inc. Magazine, included the blog on its list of “Six Blogs That Can Teach You More Than an MBA.” He has published more than a dozen Kellogg case studies including Crestor, MedImmune: FluMist Introduction and Genzyme: the Synvisc-One Investment Decision. He has authored more than two dozen articles on marketing topics. Tim is an expert on Super Bowl advertising. He created the Kellogg Super Bowl Advertising Review in 2005 and has led the event ever since. Over the past ten years, the program has generated more than five billion media impressions. He has served as a judge for the Word of Mouth Marketing Association's WOMMY Awards, the Native Creatives Awards and the EthicMark Awards. In addition to teaching at Kellogg, Tim works with major corporations around the world on strategy and branding issues. His recent clients include Eli Lilly, Hearst and AbbVie. He is managing director of Class 5 Consulting, a marketing strategy firm. Tim is frequently cited by the media. He has been quoted in publications including Business Week, The Financial Times, The Wall Street Journal and The New York Times. He has appeared on all of the major television networks. He serves on the board of the Alliance Française de Chicago and completed two terms on the board of the Lycée Français, Chicago's French-International School. Tim began his career at the consulting firm Booz Allen and Hamilton, where he worked on strategy projects. He joined the marketing team at Kraft Foods in 1991. During his almost 11 years at Kraft, he led brands including Miracle Whip, Taco Bell, Parkay and DiGiorno. He was responsible for the launch of more than two dozen new products. He received his BA from Yale and his MBA from Harvard. Tim lives in Chicago with his wife and three children, and no chickens. Written by: Dominic Lawson  Executive Producers: Dominic Lawson and Kenda Lawson Music Credits: **Show Theme**  Behind Closed Doors - Otis McDonald  **Break Theme** Cielo - Huma-Huma  WWW.FUNKYMEDIA.AGENCY

Livalo (pitavastatin) is a newcomer to the statin market. It brings many advantages with improvements in LDL, HDL, muscle damage side effects, and even glucose/HgA1c values.  So why have I not given it? My treatment priority is inflammation, the immediate cause of heart attack and stroke. With statins, my priority has not been LDL and DM treatment. Livalo has no known impact yet on inflammation.For more information, contact us at 859-721-1414 or myhealth@prevmedheartrisk.com. Also, check out the following resources: PrevMed's blogPrevMed's websitePrevMed's YouTube channelPrevMed's Facebook page

In this episode, we talk to Tim Calkins (College Professor & Consultant) as we discuss this year's Super Bowl Ads, his book, and so much more. Be sure to check out TimCalkins.com Tim is a marketing professor, author, speaker and consultant. His newest book is a guide to creating and delivering powerful business presentations. It is titled How to Wash a Chicken: Master the Business Presentation. You can read more about the new book here. Tim is Clinical Professor of Marketing at Northwestern University’s Kellogg School of Management. He teaches courses including Marketing Strategy and Biomedical Marketing in the full-time, part-time and international executive MBA programs. He is also co-academic director of the Kellogg on Branding executive education program. He has received numerous awards for teaching excellence. In 2018, he received the Top Professor Award from Germany’s Kellogg-WHU Executive MBA Program. He won the Lawrence G. Lavengood Outstanding Professor of the Year Award, the top teaching award at Kellogg, in 2006 and 2013, making him one of just four people in the award’s more than forty year history to have won it twice. He also received the Sidney J. Levy Teaching Award, two Kellogg Faculty Impact Awards, and the Kellogg Executive MBA Program’s Top Professor Award four times. Poets & Quants included him on its list “Favorite MBA Professors of 2016.” In addition to How to Wash a Chicken, Tim is the author of Defending Your Brand: How Smart Companies Use Defensive Strategy to Deal with Competitive Attacks (Palgrave Macmillan, 2012). Expert Marketer Magazine named Defending Your Brand the 2013 Marketing Book of the Year. He also wrote Breakthrough Marketing Plans (Palgrave Macmillan, 2008 and 2012). He is co-editor of Kellogg on Branding (John Wiley & Sons, 2005) and Kellogg on Branding in a Hyper-Connected World (John Wiley & Sons, 2019). Tim manages Building Strong Brands, a blog on brand strategy. Inc.com, the Web arm of Inc. Magazine, included the blog on its list of “Six Blogs That Can Teach You More Than an MBA.” He has published more than a dozen Kellogg case studies including Crestor, MedImmune: FluMist Introduction and Genzyme: the Synvisc-One Investment Decision. He has authored more than two dozen articles on marketing topics. Tim is an expert on Super Bowl advertising. He created the Kellogg Super Bowl Advertising Review in 2005 and has led the event ever since. Over the past ten years, the program has generated more than five billion media impressions. He has served as a judge for the Word of Mouth Marketing Association’s WOMMY Awards, the Native Creatives Awards and the EthicMark Awards. In addition to teaching at Kellogg, Tim works with major corporations around the world on strategy and branding issues. His recent clients include Eli Lilly, Hearst and AbbVie. He is managing director of Class 5 Consulting, a marketing strategy firm. Tim is frequently cited by the media. He has been quoted in publications including Business Week, The Financial Times, The Wall Street Journal and The New York Times. He has appeared on all of the major television networks. He serves on the board of the Alliance Française de Chicago and completed two terms on the board of the Lycée Français, Chicago’s French-International School. Tim began his career at the consulting firm Booz Allen and Hamilton, where he worked on strategy projects. He joined the marketing team at Kraft Foods in 1991. During his almost 11 years at Kraft, he led brands including Miracle Whip, Taco Bell, Parkay and DiGiorno. He was responsible for the launch of more than two dozen new products. He received his BA from Yale and his MBA from Harvard. Tim lives in Chicago with his wife and three children, and no chickens. Hectic is an all-in-one business management software built specifically for freelancers who arejust getting started or looking to take their freelance business to the next level. Sign up at gethecticapp.com/thestartuplife

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog/ Three recent studies have shown a new light on treatments for diabetes. This group of research discoveries teaches us how to improve the severity of diabetes through several changes in diet and medication choices. One study discovered that a simple food addition to your diet can lower the risk of complicating illnesses and death from diabetes. The second study reveals the fact that statins increase the risk of getting Type II Diabetes just by taking a particular cholesterol lowering medication.  The third study found that select diabetic medications are effective at preventing heart disease in diabetics.  Join us to learn what you can do to help you, or someone you love, avoid diabetes and the complications from diabetes. Diabetes is a disease that is rapidly becoming the most common and dangerous disease of aging Americans.  The increase in obesity, the switch from whole food to junk food and fast-food and lack of active lifestyles, has contributed to the development of Adult-Onset Diabetes in almost half of all Americans.  Now that our society is flooded with citizens who have high blood sugars that cause heart disease, stroke, infections and increase the risk of cancer, what are we to do?  The first medical study recommends a simple diet change to those MEN (and possibly women) who already have diabetes, to prevent Adult-Onset Diabetes.  A study done at Stratton Veterans Affairs (VA) Medical Center in Albany, NY revealed that just one cup of blueberries daily, fresh, frozen or freeze-dried, significantly decreased triglycerides in the men tested who followed this recommendation.  It is widely known that elevated triglycerides increase the risk of cardiovascular disease in diabetic men, and one cup of blueberries daily lowered triglycerides and the risk of cardiovascular disease.  I believe that this diet recommendation can work for women as well, but they only tested men. The previous research gave Diabetics a simple way to lower their risk of getting heart disease by eating one readily available food!   Our next study reveals how doctors can prevent their patients from developing diabetes in the first place, beyond the strategies of achieving ideal weight, exercise, and eating a low carbohydrate diet?  A study done recently revealed the fact that taking statins for high cholesterol increased the risk for elevated blood sugars, HBA1C and triglycerides in patients who weren't diabetic and could cause Type II Diabetes!  As with most meds, all statins are not the same. The cholesterol medication, Crestor ®, is the least likely to have this side effect, however it is better to take an alternate drug that lowers cholesterol called Zetia® if it is strong enough to lower these blood fats enough. Zetia® is not a statin, and It doesn't cause any of the side effects that statins do, including raising your blood sugar, because it works in a completely different way than statins. If you have gotten diabetes since starting your statin then ask your doctor to switch your medication to Crestor®, Zetia®, or try normalizing your sex hormones and triglycerides through diet or by taking diabetic medications like Metformin®., which will lower your LDL cholesterol as well, without a statin! At BioBalance Health® we are able to get patients off statins all the time by replacing testosterone with pellets, lowering body fat, treating patient's AODM with Metformin, and normalizing thyroid hormones.  This is Dr. Maupin's secret weapon for treating patients with a high risk for vascular disease, who have high LDL cholesterol and or Triglycerides…Testosterone pellet therapy! Last but not least is a study from the June 2020 Endocrine News that gives us hope for a new classification of diabetic drug that lowers cardiac risk and all vascular causes of morbidity!  This class of drug is called SGLT2 Inhibitors, specifically Invocana® and Farxiga®.  These two drugs lower glucose by increasing sugar in the urine to get it out of your system.  This is how it works to treat the intended disease of Adult-onset Diabetes, but recently it has been found to prevent a common outcome of diabetes, cardiovascular disease!  Specifically, it lowered the rate of heart failure by 35% in diabetics.   Dr. Maupin has always started AODM patients on Metformin® for the past 18 years to lower blood sugar, sensitize diabetics to insulin which helps them lose weight and lower their blood sugar, and to make the other diabetic drugs they are taking, more effective.  It is inexpensive, generic, very effective, and has few side effects if a patient follows a low carbohydrate diet. The Endocrine Society guidelines, that rule the actions of Endocrinologists, changed this year: Pre-diabetes and early noncomplicated diabetes first with Metformin®. Patients with established AODM and atherosclerotic heart disease and kidney disease should be placed on SGLT2 Inhibitor like Invokana®, or the drugs like Victoza®, a GLP-1 receptor agonist. The experts in treating Adult-Onset Diabetes, Endocrinologists, are considering the use of Metformin ® for diabetic and non-diabetic patients alike, who have kidney disease, and heart disease without diabetes to improve these diseases as well.  If you have these complications to diabetes, or have these diseases but do not have AODM, ask your doctor about these new uses for this old drug. The most important part of this message is for individuals to prevent diabetes if at all possible, with lifestyle changes low carbohydrate diet and daily exercise, however some people get diabetes anyway because of their genetic makeup.  You can easily have a cup of blueberries every day to prevent heart disease if you do have diabetes, and then change your statin to Crestor® or Zetia®, and yes to the appropriate diabetic medications plus Metformin® to save you from having a heart attack, heart failure or stroke.   All of these recommendations for medications should be discussed with your doctor, who knows you best.  If they have not read these new studies or find that this research is not going to help you then always follow the advice of your diabetes doctor.

Rosuvastatin (Crestor) has a half-life of 17 hours. That means it takes 17 hours for half of the medication to be excreted/neutralized/metabolized. So that allows us to give Crestor every other day, or even 3 times per week. Very low doses of rosuvastatin have a positive impact on inflammation. We routinely give 5 or even 2.5 mg. If the inflammatory markers are low, and there are no unusual cholesterol problems, we can even go to 3 times per week dosage.  Brad Bale and Amy Doneen have even reported decreases in inflammation from having some intolerant patients "lick" the tablet 3 times/week. Yes, lower doses are good. And they mean lower side effects.For more information, contact us at 859-721-1414 or myhealth@prevmedheartrisk.com. Also, check out the following resources: PrevMed's statin articlePrevMed's websitePrevMed's YouTube channelPrevMed's Facebook page

Which statins are best for cardiovascular Inflammation? And how do statins actually impact cardiovascular inflammation? I know Lipitor (atorvastatin) works, but not as well as Livalo (pitavastatin), Crestor (rosuvastatin), pravastatin, or simvastatin. However, Livalo is prohibitively expensive, while Crestor has lost its patent for years now so it's not expensive.For more information, contact us at 859-721-1414 or myhealth@prevmedheartrisk.com. Also, check out the following resources: PrevMed's statin articlePrevMed's cardiovascular inflammation articlePrevMed's websitePrevMed's YouTube channelPrevMed's Facebook page

Let’s cut to the chase here for our conversation about co-pay cards offered by pharma companies versus co-pay accumulators and co-pay maximizers deployed by health plans. This whole war of the co-pays started back in the day when PBMs (pharmacy benefit managers) began to shake down Pharma for higher discounts. The prize that PBMs offered Pharma was lower co-pays for patients. It’s a well-known fact that the higher the patient out of pocket, the lower the market share of the drug—the old supply-and-demand curve at work. So, the PBMs and health plans kind of had an ace up their sleeve because they control how much the patient pays out of pocket. And so, they use that ace to pull in higher discounts from Pharma. “You’ll make it up in volume,” they told Pharma. “We’ll make sure you get lots of patients by putting your drug on a lower formulary tier and giving patients who take your drug the lowest possible co-pays.” At a certain point, pharma companies started to get mad about their dwindling net prices. And they’re pretty smart. So, Pharma came up with a workaround to PBMs holding them hostage for lower net prices. Pharma decided to hand out co-pay discount cards. Then, they don’t have to pay the PBM. They can finesse lower patient co-pays all by themselves. Except now, the PBM sees this and they raise. Enter co-pay accumulators and co-pay maximizers. For this part of the extravaganza of game theory at its finest, I’ll let Dea Belazi, PharmD, MPH, explain. Dea is the president and CEO over at AscellaHealth. He’s a pharmacist by training who has worked for Pharma, then at a health plan, then spent lots of time in the PBM space. Now he’s working to create a different kind of pharmacy benefit at AscellaHealth. He has seen this tangled web from pretty much every angle. One thing to point out here before we begin: In the olden days, this whole war of who has leverage over who transpired in the context of small molecule drugs in competitive markets. So, like, Lipitor versus Crestor versus simvastatin—and they all cost, like, $100 a month. If the health plan made it untenable to get one of those drugs, they usually made another one in the same class financially attractive. So, the patient had options, and the stakes were a lot lower. Now this same war is being fought on the specialty side of the house, where drugs cost thousands or tens of thousands of dollars a month and the patient may have but one option. So, if it’s made financially toxic for a patient to get that one drug, then the patient has to choose between their family’s health and dipping into their 401(k). In these cases, Pharma can be, sort of authentically (and the “sort of” is an important qualifier), a hero who steps in and helps patients who are basically functionally uninsured because they can’t afford the co-pays and deductibles to actually use the insurance they’re paying handsome premiums to have. Pharma can step in and help via co-pay discount cards or through patient assistance programs to help those with lower incomes. But let me point out an obvious but rarely-mentioned-in-the-same-sentence connection. If the patient cost share is really high, there are at a minimum two parties responsible for that: the insurance company, who set the patient cost share and may have created functionally uninsured members in the process, and the pharma company, who may have set the price of the drug untenably high, maybe way over what the value of the product was. Neither is an innocent bystander, and the patient, sadly, is caught in the middle of this war. You can learn more at ascellahealth.com.   Dea Belazi, PharmD, MPH, has more than 20 years of experience in the health care industry, mostly developing and managing pharmacy benefit management companies. He is currently the president and CEO of AscellaHealth, a national specialty pharmacy benefit manager (SPBM™) serving commercial, Medicare, and Medicaid segments. He was part of the development of PerformRx, a PBM owned by Keystone First Health Plan, as well as another, FutureScripts, an Independence Blue Cross company that was sold to Catamaran a few years ago. Dea holds a PharmD from the University of Rhode Island and completed his dissertational work at Brown University. He later completed a Master of Public Health from Johns Hopkins University and a post-doc health outcomes research fellowship at Thomas Jefferson University. He is a reviewer for multiple medical journals and sits on multiple boards. 05:03 “The concept of co-pay accumulators wasn’t just a … PBM thought, but it also came from their customers, whether it was health plans or employer groups.” 10:00 “[This is] literally a math problem based on, ‘Do I spend it now? Do I spend it later?’” 11:31 What reason do employers and payers have for doing this? 15:26 “This is another mechanism for payers to push down additional cost to both the patient and now the pharma company.” 19:57 EP241 with Vinay Patel. 20:33 “I don’t think accumulators are really forcing Pharma to be more competitive.” 22:49 How co-pay maximizers are different from co-pay accumulators. 25:57 Who doesn’t like co-pay accumulators and maximizers? 28:03 How patient advocacy groups are a different model. 30:14 What is the biggest challenge facing employers right now? You can learn more at ascellahealth.com.   Check out our newest #healthcarepodcast with Dea Belazi of @AscellaHealth as he discusses #copayaccumulators and #copaymaximizers. #healthcare #podcast #digitalhealth #healthtech #copay “The concept of co-pay accumulators wasn’t just a … PBM thought, but it also came from their customers, whether it was health plans or employer groups.” Dea Belazi of @AscellaHealth discusses #copayaccumulators and #copaymaximizers. #healthcare #podcast #digitalhealth #healthtech #copay #healthcarepodcast “[This is] literally a math problem based on, ‘Do I spend it now? Do I spend it later?’” Dea Belazi of @AscellaHealth discusses #copayaccumulators and #copaymaximizers. #healthcare #podcast #digitalhealth #healthtech #copay #healthcarepodcast “This is another mechanism for payers to push down additional cost to both the patient and now the pharma company.” Dea Belazi of @AscellaHealth discusses #copayaccumulators and #copaymaximizers. #healthcare #podcast #digitalhealth #healthtech #copay #healthcarepodcast “I don’t think accumulators are really forcing Pharma to be more competitive.” Dea Belazi of @AscellaHealth discusses #copayaccumulators and #copaymaximizers. #healthcare #podcast #digitalhealth #healthtech #copay #healthcarepodcast What reason do employers and payers have for doing this? Dea Belazi of @AscellaHealth discusses #copayaccumulators and #copaymaximizers. #healthcare #podcast #digitalhealth #healthtech #copay #healthcarepodcast What is the biggest challenge facing employers right now? Dea Belazi of @AscellaHealth discusses #copayaccumulators and #copaymaximizers. #healthcare #podcast #digitalhealth #healthtech #copay #healthcarepodcast

Statins, prescribed to lower cholesterol levels, are not without a major downside. As always, this is not medical advice, and I urge you to have a conversation with your doctor if you have been prescribed statins; popular names include Lipitor, Crestor, Zocor, Pravachol amongst others. Common side effects of these drugs include: muscle pain and fatigue, increase in type II diabetes, liver & kidney damage, memory loss and confusion and more. If you are taking a statin it is recommended that you supplement with 100-300 mg CoQ10. https://drsarahbrewer.com/statins-and-co-enzyme-q10 Here is a good place to start your research: https://bit.ly/MayoStatins but you can simple type "statin side effects" into google and choose where you would like to learn your information from. It's always a good idea to do your own research and advocate for yourself.  Your doctor should be open to have a discussion with you about your wellness and your health concerns.

Today I am talking with Dr. Joel Kahn. Joel Kahn, MD, FACC of Detroit, Michigan, is a practicing cardiologist, and a Clinical Professor of Medicine at Wayne State University School of Medicine.  He graduated Summa Cum Laude from the University of Michigan Medical School. Known as "America’s Healthy Heart Doc", Dr. Kahn has triple board certification in Internal Medicine, Cardiovascular Medicine and Interventional Cardiology. Dr. Kahn has authored scores of publications in his field including articles, book chapters and monographs. He writes health articles and has five books in publication including Your Whole Heart Solution, Dead Execs Don’t Get Bonuses and The Plant Based Solution. His 6th book, Lipoprotein(a): The Heart’s Silent Killer, is about to be published. He has regular appearances on Dr. Phil, The Doctors Show, Dr. Oz, Larry King Now, Joe Rogan Experience, and with Bassem Yousef.www.drjoelkahn.com This series features conversations I conducted with individuals who have dedicated their work and lives to Vegan research, businesses, art, and society. This podcast series is hosted by Patricia Kathleen and Wilde Agency Media. TRANSCRIPTION*Please note, this is an automated transcription please excuse any typos or errors[00:00:00] In this episode, I had the fortunate opportunity to speak with America's healthy heart doc, Dr. Joel Kahn. Dr. Kahn is a practicing cardiologist and a clinical professor of medicine at Wayne State University School of Medicine. Key points addressed were Dr. Kahn's books, titled The Plant Based Solution, published in 2018, and his most recent book, Leipold Protein Little, a published in March of 2020. We also conducted a Q&A with Dr. Khan regarding some of the most common inquiries. Our audience had regarding cardiovascular health and Vegan diets. Stay tuned for my informative talk with Dr. Joel Kahn. [00:00:45] My name is Patricia Kathleen, and this series features interviews and conversations I conduct with experts from food and fashion to tech and agriculture, from medicine and science to health and humanitarian arenas. The dialog captured here is part of our ongoing effort to host transparent and honest rhetoric. For those of you who, like myself, find great value in hearing the expertize and opinions of individuals who have dedicated their work and lives to their ideals. If you're enjoying these podcasts, be sure to check out our subsequent series that dove deep into specific areas such as founders and entrepreneurs. Fasting and roundtable topics. They can be found on our Web site. Patricia Kathleen, dot com, where you can also join our newsletter. You can also subscribe to all of our series on iTunes, Spotify, Stitcher, Pod Bean and YouTube. Thanks for listening. Now let's start the conversation. [00:01:42] Hi, everyone, and welcome back. I'm your host, Patricia. [00:01:45] And today, I'm delighted to be sitting down with Dr. Joel Kahn. He is a practicing cardiologist and a clinical professor of medicine at Wayne State University School of Medicine. You can find out more about all of his endeavors on his Web site. W w w. Dr. Joel Kahn, K. H and dot com. Welcome, Joel. [00:02:05] Thank you very much. Excited to be here. [00:02:08] I am excited to have you on as well. We were talking prior to recording and you're involved in an insane amount of endeavors. But today I'm going to kind of forecast for everyone listening. We're going to unpack a couple of Dr. Kahn's works and then get into some general questions that our audience has reached out and kind of wanted to know on the medical forefront. Before I get to all of that, for everyone listening, I will offer a brief bio on Dr. Khan, as well as a roadmap for today's podcast. Let me start with the roadmap. We'll look at unpacking a couple of books, as I mentioned. One being the plant based solution published in 2020. And then we'll look at another book, Libro Protein A and kind of is the latest launch. And then I'll get into the general questions that a lot of you have reached out regarding some of the covered 19 pandemic inquiries and future scientific research being done as it relates to the Vegan diet and heart health prior to getting into all of that. Let me quickly do a bio on Dr. Kahn. Joel Kahn, M.D., F.A. of Detroit, Michigan, is a practicing cardiologist. Any clinical professor of medicine at Wayne State University School of Medicine. He graduated summa cum laude from the University of Michigan Medical School known as America's Healthy Heart Doc. Dr. Kahn has triple board certification in internal medicine, cardiovascular medicine and interventional cardiology. He was the first physician in the world to certify and metabolic cardiology within a four m m m I and the University of South Florida. He founded the Kahn Center for Cardiac Longevity and Bingham Farms, Michigan. Dr. Kahn has authored scores of publications in his field, including articles, book chapters and monographs. He writes healthy health articles and has five books in publication, including Your Whole Heart Solution Dead Exacts Don't Give Bonuses and the Plant Based Solution. His sixth book, Lipoprotein A., was just released, I believe, in March of this year. The Heart Silent Killer. He has regular appearances on Dr. Phil the Doctor Show, Dr. Oz, Larry King, now Joe Rogan experience and with Bassem Youssef. He has been awarded a Health Hero Award from Detroit Crain's Business. He owns GreenSpace and Go, a health restaurant in suburban Detroit, and he serves as medical director of the largest plant based support group in the USA. W w w dot p and s g dot org. Dr Con again can be found at w. W. W. Dr Joel Corn. Dot com. So I'd like to launch straight into your book and the inquiries that we have within that, namely the plant based solution that was published in 2020. We grabbed a quote from online. That's no disease that can be treated. Oh I'm sorry. It's the dedication that you did in this book that I found to be so pertinent after reading it. And it's no disease that can be treated by diet, should be treated with any other means by an old philosopher in the 12th century. I can't remember. Moloney's how do you pronounce that? [00:05:17] My Munadi My Money is a Spanish Moroccan born rabbi. Physician and I lived in Egypt most of his life. Quite a remarkable history in and of itself. [00:05:30] Yeah. And I like the quote. It reminds me a lot of like let food be thy medicine. People getting into some of the Aristotle and things. The book is described as a passionate, compelling and scientific argument for plant based nutrition. [00:05:45] You get into. For everyone who's listening and hasn't read it or would like to get a brief overview on it. It explores weight loss, how most people get it wrong when it comes to calcium protein, carbs. It's a relationship between lay people's knowledge and the heart health. And then you kind of unpack these different areas. The links between Vegan diet and your sex drive, gut health, brain chemistry, why plants might hold the key to better aging, eating out, stocking your pantry. And the whole thing is kind of wrapped up with this 21 day meal plan and advice for, as I call them, action items or this implant implementation into one's life. And my first question for you is in in your previous book, Dead Exists, Don't Get Bonuses, you focus on the coronary heart disease and you talk about a lot of the statistics and the science behind it. And this one seems to be like an application guide as you and. Talking about earlier. And I'm wondering what the impetus for the change in that was, what what the kind of inspiration behind writing this was. [00:06:50] You know, I spent decades practicing as a cardiologist. And that book called that exact I don't get bonuses and even my previous book, first book called Your Whole Heart Solution at a Real Cardiology Focus. It's my training. It's my practice. It's my primary avocation. But I had not written a book that went deep into plant based nutrition, that went deep into the science and went beyond her disease because the plant based solution goes well beyond our disease to speak about some other entities you talk about. And I wanted to do it. I just needed a resource to give to my patients. And people were asking in a way that didn't require, you know, a month to read, wasn't thick enough to know if your table were shaking. It was the heavy book you'd pick to balance it out. So I wanted it to have content and medical support, of course, but to be an easy read for people. And as you say, to be practical. So it ends with recipes. It ends with pantry, stocking solutions or the very challenging what do you do when you go over family or go to restaurants? Well, you know, very, very grounded in the science literature. I was always amazed. You know, there are a growing number of plant based cardiologists and there should be a growing number of plant based nephrologists and pulmonologists and gynecologists and all the others. I don't like dividing the body into organs. It all works together in one symphony when it's working well. But there really wasn't a book by a cardiologist. And with all respect, Esselstyn trained as a surgeon and Dr. Ornish trained as an internist and others. It just wasn't a bug out there with the experience I had over decades of treating heart attacks and congestive heart failure. And now I'm being part of hospital faculty. So I put that all together. And thank you for your kind words about it. I think it's a practical book. [00:08:47] Absolutely it is. I'm wondering how you chose. How did you curated? [00:08:50] Was it combined from patients that you had over the years or was it from areas that you found to be most integral for the person picking up an informational moment about diet and cardio health? [00:09:03] It was clearly based on, you know, by the time I wrote that book, it came out. I think you mentioned 20, 20, but actually came out in twenty eighteen, to be fair. No problem. I wrote most of it in late twenty seventeen. I mean I've been plant based since nineteen seventy seven. I started cardiology practice in nineteen ninety. So literally by the time I wrote that book I had twenty seven years of experience recommending to heart patients, high blood pressure patients, weight challenged patients, cholesterol patients, diabetic patients, auto immune patients. That there was science to suggest I would add multiple sclerosis patients. There was science to suggest shifting their diet to a complete or nearly complete whole food plant based diet would be of some potential therapeutic benefit. I had so many wonderful results and stunning results and people that avoided surgery and people that hit their goal, reduced their medication. Ever get on a medication, avoid surgery? So it certainly was based on that. This is the real deal. There's nothing theoretical about the science base and the practical application of whole food plant diets. The frustrated group is the small group that are trying hard and don't reach that goal. They're not getting enough blood pressure meds and they're not getting off cholesterol medicine. And that's what I try and help them with in my clinic in suburban Detroit is what are we missing? You know what's missing in their physiology, their chemistry, their genetics, their toxicology or their diet itself? [00:10:29] But majority people respond dramatically well and really just need a little push. A book like mine, watch a couple of videos, have a couple simple recipes. And, you know, you don't need to hold their hand for 30 years. They'll get it because they're gonna feel better in two, three, four weeks. The majority of the time. [00:10:49] Yeah. And ideally, there wouldn't be a lot of handholding, particularly between your clinic. What I like about the book is it talks a lot about prevention and not just treatment of heart disease. I feel like, you know, and when one goes into a cardiologist, there's already an issue. You know, you have a specialty that a lot of people don't talk about prevention. It's more about treatment once there becomes a problem. And so I like the idea of a book coming from the concept of prevention. [00:11:17] Do you feel like we are moving towards that as a society, into a prevention based model, or are we still based in a treatment moment when it comes to cardio health or crawling or crawling if if a average person walked into or maybe you say if a person walked into an average cardiologist office and said, I feel great, I just want you to check me. They probably would be told we don't do that here. Yeah, it's that in every case, in a large practice, there might be one cardiologist in twenty five that has that preventive interest. You know, you'd end up getting a stress test you probably don't need and some routine bloodwork. It's what I do know every day of the week in my clinic and people don't need to have a problem. In fact, I had a wonderful follow up phone call today with a woman who we went through the process of checking her advanced labs. She already was on a excellent diet of plants. And all we did was celebrate the fact you're healthy, you're healthy or healthy. You'll see in 10 years. I mean, that is a wonderful thing. And it ends the relationship and it ends anxiety. Allow these people have a family history like she did of a father with a heart attack at a young age and able to share such good news. But very often it's not such good news. There is heart disease, there is inflammation, there is metabolic abnormalities, vitamin abnormalities, and there's just lots to do. And food is the basis and food fix is most of it. But if you're low in vitamin D, if you're missing, I have to. I mean, I got to be very specific with some of the testing we do. I know nutrition science. Just you know, the reason I wrote the book in part, nutrition science is tough and that's why we see this war of Quito Paleo, you know, Mediterranean diet. There's a Mediterranean diet aren't as aggressive as the pro paleo pro Iquito. Prokhanov for the vegans are weak ninnies and meat eaters are strong and incredible. It's just amazing how contentious it is. It's also difficult to do good nutrition science. It's hard to get a thousand people to eat in different patterns for 20 years and really make measurements. So you've got to do the best with what you have from basic science, from epidemiology, from the few randomized studies like Dr. Ornish. Just you got to take a jam, put it all together and try and be very honest with the data. I mean, once in a while, an article comes out that low fat dairy may be decent for your blood pressure. Well, I'm not going to recommend my patients start drinking milk if they're not. But after recognizer is some data out there. So you got to be fair and authentic. [00:13:52] Yeah. And you mentioned in a previous interview, I think it was a podcast or something we dug up on YouTube. But you talked about and it was kind of a divisive rhetoric, you know. [00:14:02] I think was it more aggrandize than when I watched it at a Google talks between yourself and some experts with them? The names are escaping me, but with Anderson from what? [00:14:13] The Health and Dave Asprey from Bulletproof Coffee. Yeah, well, reporters in California. [00:14:20] Yeah. You talked a lot about in the clip I saw the divisiveness is concerning for someone who's trying to get, you know, good health out of good health information and things like that. [00:14:30] Because you stated in this clip your concern was that if if you hear one camp saying one thing, one camp saying directly opposite the, you know, the client or the public walks away and does nothing and they're walking and they walk and they walk into McDonald's in one days because they say the experts can't figure this out. [00:14:48] I'll just eat what I want to eat and doesn't seem to really matter. So it does really confuse the public. I just give an example. 60 years, a science suggests the more saturated fat, rich foods you eat butter, cheese, pepperoni, bacon, the more likely to develop heart disease and a lot of other things. Diabetes, cancer, dementia. Decades of science. The last 10 years that got very muddied by some very poor science that got big headlines like Time magazine butter's back cover in 2014. But about four or five weeks ago, the most prestigious science group independent of funding did a review paper. Saturated fat causes heart disease. When you cut back butter and cheese and pepperoni and croissance and pizza, you will reduce your cholesterol. You reduce your risk of having a heart attack or stroke. This is the most respected group. So I wrote a couple blogs. I did a interview. All that stuff came on the last week. It did nothing to bring any real unity, even though the science is pretty well unified. If you're entrenched, meat, cheese, butter, eggs, pro science are good for you. You know, you ignore the science. You find some flaw in it even when there really isn't much of a flaw. So it's unfortunate that food wars exist. But it really what I always come back to when I lecture and I'll be quiet. And if you look at the Harvard School of Public Health, they have a food plate from 2011. Fruits, vegetables, whole grains, healthy protein. If you look at Canada's food plate, 2019, same beautiful food plate. We look at peace. Cierra physician, Kabbani, responsible medicine, all plant food. There actually is tremendous unanimity around the world by reasonable people that your diet should be brightly colored, whole fruits, vegetables, whole grains, legumes. I don't add in small amounts of extra meat. Some of these food plates give you the option of adding in small amounts of eggs and meat. I think diets are better when they don't include that. But we're really talking about truly a very tiny debate with tremendous unanimity. But, you know, if you've got a platform and a, you know, a YouTube channel, Alhurra, a blog, you can create a mountain of what is really a molehill of differences. [00:17:09] Yeah. And I like the celebration of unifying factors. You talk a lot about how a lot of these people, you know, everyone is in unison that white flour, sugar, processed foods, these things should not be in one's diet. And beginning from that standpoint, I think is good. And yes, the the visual representations that have come out since 2016 and the advice they're all very similar to looking can turn the old food paradigm where it needs to be, which isn't just on its head. [00:17:37] I think just to complete rubbish. I want to look at the book like a protein A and I told you before we started, I hadn't thought it had launched yet. I was corrected. You said it's been out since March. I think I've been in a little bit. There it is. I think I've been in a little bit of a cave. But what I did see, what I did do is find research from you yourself online, making up a recipe of overnight oats. I'm always amazed. I fancy myself as a very adventurous Vegan cook. And I've been doing a search for 10 years. And it's always amazing to me how there's just this the overnight oats I haven't ever made. And it's so ironic. But I think that it's it points to the utility of books like this. And I'm hoping you can speak because I haven't read it a little bit about the impetus for writing it and what it contains, aside from recipes. [00:18:27] But as I say, started out writing kind of cardiology books for the public, wrote a couple books directly on the Vegan topic. This actually brings the two together. It's a very interesting story I'll blurt out in about two minutes. But it turns out about 60 years ago, a kind of cholesterol. This we get a little science, see that you can inherit from mom and dad was identified in the blood and it is called it's a terrible name. If you're were in the marketing field, Lifebook Protein Live Olay. Anybody can see the cover, the book. The word liberal isn't there. It's lowercase A.. But that's how it's pronounced scientifically. Lipoprotein Little A, you could ask your family doctor, your internist, your gynecologist next routine physical. Can you add a light poke protein little a blood level to my standard blood. It's a form of cholesterol you inherit from your mom and dad. And if you inherit it and if it's high, it can clog up your arteries. It can lead to heart attack, stroke, erectile dysfunction aneurysms and even destroy one of the heart valves in the heart. And it does it very slowly and very progressively because since you inherit it, it's in your blood. From the time of conception forward, the dramatic statement is 25 to 30 percent of people inherit it. So that means 90 million Americans, one point eight billion people worldwide and hardly a doctor in the United States checks the little box to measure it. It's been researched. There's hundreds and hundreds of very high quality research articles and it has been mentioned. If you have a family history, if mom had a stroke at age 48, if dad had bypass surgery at age 52, maybe your doctor should order this. But that's rarely done, even though that's been in the mainstream. But just recently, there's a growing incentive. Maybe everybody should just ask, is it twenty or thirty dollar blood tests? It's not like a fancy genetic test. It's just a blood test. And find out early in life. Did you inherit it or not? It's kind of that's why it's a silent heart killer, because it's silent in part because we don't test for it. And also, by its nature, it's slowly, slowly, slowly can damage vessels. And this tradition also you can get your routine cholesterol. Your cholesterol is one hundred and eighty and your HDL, your LDL. It won't show up on that. And it could be that your lipoproteins is still very high, the standard treatment of cholesterol. Exercise. Change your diet. Take your lipid tour. Take your Crestor or do very little to lower it. If you inherit a high level, I have a whole practice full of people with very high blood levels, and many of them have had a bypass, heart attack, a stroke and other problems, heart valve surgery. The vitamin niacin can lower it, but there's at least some science at a Whole Foods plant. Diet can also lower it. And even if it doesn't lower it much, it'll probably lower the blood pressure to lower the blood sugar, to lower the more commonly checked LDL cholesterol at a lower inflammation. So, you know, that's why the book is Half Science and half beautiful recipes, including the overnight out recipe that I did a little YouTube video on. [00:21:41] I mean, I brought in one of my favorite plant based recipe writers, Beverly Lynn Bennett. I've worked with her before. So it's kind of like the plant based solution, their science. And then there's some practical steps. There's all this gorgeous food and the food and the recipes were specifically selected to be very likely to help control cholesterol, blood pressure, inflammation, blood sugar. They're delicious, but they emphasize things like oats, oats, lower cholesterol by the soluble fiber and the glue cans and a lot of chia hemp flax seeds, which can lower cholesterol and blood pressure. So there it's kind of a heart healthy, delicious diet book with some fascinating science and probably somebody listening right now. Undoubtedly, somebody watching this has a high lipoprotein egg because it's come it's the most common genetic heart risk that exists. But we never talk about it. I'm trying to break that there. But, you know, somebody is going to benefit just by thinking, God, my whole family's riddled with heart disease and they keep telling me we don't know why. No, nobody smoke and nobody has insulin required diabetes. I'm telling you. Check your libro protein, literally. [00:22:53] It reminds me when you're saying this. [00:22:55] We've spoken to a few autoimmune experts about veganism, you know, the vegan diet and the auto immune triggers and things of that nature. And I know from the sound of it, it's going to build regardless, except for, you know, these these things that you can do with diet and maybe niacin. [00:23:13] But he isn't similar. It's not a trigger. It's not a switch that's getting switched on like the autoimmune. Right. It's just destined to build more than genetic. [00:23:22] We know what chromosome we know and which genes are involved. And the trigger is conception. Right. Unlike the idea that there might be a gut issue that triggers lupus or a toxicity from Roundup that might trigger an auto immune disease, a gut damage. So nothing triggers us. It just sits there circulating in the blood, knocking into arteries, knocking in the Arpels, causing a reaction that, again, slowly, slowly, slowly. But by the time you're forty five, you might be sitting on a little ticking time bomb you didn't know about without scaring anybody. But it is possible. Yeah. You talk about the big famous just so people can relate. A lot of people used to watch The Biggest Loser show and there was Jillian Michaels looking repped and there was Bob Harper looking. Well, three years ago, Bob Harper at age 51, had a massive heart attack and almost died. And he announced a couple months later when he had recovered from a very long illness, that he found out he had inherited a very high level of late pope protein, little ache, and he was under treatment now and very optimistic for the future. But what if he found out 10 years before we can argue? What could he have done about it? There is a drug in development that will be the answer to the problem. But in the meantime, get your diet right exercise. Get your weight right. Know your numbers. I mean, take super good care yourself. [00:24:47] Yeah. You talk a lot about kind of affecting. I think it's important, especially for scientists as well. Particularly when you get into book writing and things like that to consider all groups and industries within, you know, the people they are talking about, which are all masses of people in your society. And to that end, I was curious, you know, you talk a lot about fast food. And in even in something I watched you talked about, you know, just as the sad irony of having a Wendy's or McDonald's in their hospital green room before the rat reception. Yeah, but I'm wondering to that end to kind of speaking to everybody, all socioeconomic classes and things of that nature in the book, Libo Lipoprotein Little A.. When you went to form your recipes, did you consider like the nationwide availability of the products of the ingredients that you were putting in those recipes, income, status or other like necessary moments to think about when you were trying to make. Accessible to everybody, but also have the same or the necessary ingredients to help the condition. [00:25:53] You know, in general, a well constructed whole food plan diet is an inexpensive and widely accessible diet. You just got to get back to basics. A lot of the recipes have brown rice. The recipes have Ghinwa. The recipes have beans and peas and lentils. The lagoon family, which if you know, you go to a bulk store and you buy big bags of dried rice and dried beans, you know, you need access to produce. Could be frozen big bags. The book doesn't stress organic because that becomes a price point. Many people get it. It's a nice add on when it's available and when you can afford it. But nonetheless, any well constructed whole food plan diet, even if it's not organic, is going to beat out from a total health standpoint. Almost any plant based plant, animal based meal, whether it's organic or not. So I think it is sensitive to all that. And there are other great resources. I wrote a book two ago with coauthor Ellen Jaffe Jones. She has a great paperback called Vegan on Four Dollars a Day that I would recommend anybody who's really trying. And it was written probably seven, eight years ago. So maybe it's Vegan and six dollars a day now. But there are so many tips in a book like that that you could adapt a few. But it takes a little preparation and, you know, a little bit of courage to dove into these recipes if you're coming from a place that has never really cooked. You've just got to have a chopping board and some good nice. [00:27:25] You mentioned on one of the episodes I saw that an average C.T. scan tips to obtain artery health reports and calcium scan ESAN. [00:27:35] Seventy five to one hundred dollars in most major hospitals. And this is a piece of information. I had no idea. I think you get thousands. I don't have a great idea about how much medical tests cost since the bills. Always astronomical from anything I hear about. And I'm wondering if you have a basic elevator pitch style pieces of advice like that within the cardiac health industry that you give people who kind of run into you and are looking for like your top type five pieces of advice. You talk about men being between the ages of 45 and 50, getting there for a C.T. scan if they haven't had one. And things like that. You have other little pieces of information that you like to give off to people as quickly as possible when you run into them. [00:28:12] Yeah. You know, I have a few little things that roll off my tongue over and over. And one of them is, you know, we can talk about recipes and food, but it takes technology added to great lifestyle to really cement the security that you and I are going to have a sudden medical adverse event or particularly cardiovascular heart adverse event. And, you know, talking about getting a blood test for Lipoprotein Little A is actually a very technical topic. I could go on and on and refine that about the genetics of it, but we don't need to simply just check a box and get it. Similarly, you know what I bring up all the time with patients. Just think about it. You know, somebody recommended you to get a mammogram at age 45. If you're a woman, somebody recommended you get a call and ask could be at age 50 at an annual physical. Did anybody want to check your heart in all that? And even if you say, I know my father had a stent at age 59, did anybody recommend anything? So that's where the entree is to talk about that. There actually has been a test, quick CAT scan, no dye, no needle, no pain, no claustrophobia. It used to be a thousand dollars 20 years ago, but in the hospitals in suburban Detroit and usually around the country, it's one hundred dollar range and you just pay out of pocket and you immediately know I'm weathering life well with clean cut, flexible arteries that are degraded by calcium deposits, which make your arteries hard, hardening of the arteries, or there's a problem. Something's going on. I'm walking around with heart disease. I didn't know about it. You need to find that preventive doctor in your community and work with him or her and get a handle on it and get your diet. You know, the plant based solution done of approved diet. So test, I guess, comes out of my mouth. Prevent, not stent. Lot of people are getting invasive procedures. Stents bypass. All the data, including just in the last six weeks is for the majority of people. This is hardcore science data at the best centers in the world can be approached with medication, diet, fitness and avoid stents. A bypass or prevent that stent is a nice little one. You know, you mention, you know, I just like the word reversal. So many people come to me. They've had heart disease, diabetes, high blood pressure, high cholesterol, erectile dysfunction, gut issues. And just to open Pandora's box, that it may be related to their lifestyle and it may be possible to reverse some or all of it is to most patients an idea that's never been brought up with them before. You know, I had no idea there's a chance I might be able to reduce my blood pressure, blood sugar, blood. Heart medication, if you worked very hard at it, you're going to have to work very hard at it. But gives people a lot of hope and a lot of actually empowerment to know that they know it's not all about the prescription pad the doctor has. It's a lot about the pantry, the grocery store, the fridge aerator, the freezer, the treadmill, the sidewalk, the pillow. You've got to sleep at night. The whole lifestyle that I educate patients. [00:31:17] Yeah. And speaking to lifestyles, I've been on YouTube. And it seems like some of the videos since the Cauvin 19 pandemic has really set in and the stay at home quarantine has been advised. [00:31:29] You have a lot of little I like your videos, the very brief, very succinct, and I'm very diversified. You have a lot of things, combination of exercise and stacking, a combination of exercises, movements, connection to the earth, conquer thing. You talk about melatonin and the recent research being done in treatment, or at least alongside the Kovik 19, the microbiome of an Apple nutrition of sprouts and the sprouting book with a colleague of yours that came out nitric oxide. Are there any other things that you're kind of looking at right now? Vitamins, exercise, et cetera, that you do like that that are kind of at the forefront of what you're what you're looking at with health as diversified as they might be? [00:32:11] Yeah. You know, so just since you brought up the word covered, 19, you know, nobody can authentically say we actually know how to prevent it or treat it. We're struggling to find that pathway. There's a lot of people talking about that. There isn't prominent professor of what's called pulmonary critical care medicine in Norfolk, Virginia, who suggested it might be reasonable to add in some vitamin D, some vitamins, C, some zinc. These are supplements. You can do it in your food. Of course, you know, zinc is a quite rich in soy like hemp and tofu template of melatonin at night is one of his recommendations. And there is finally an antioxidant called quercetin, which is finding garlic and apples and onions and cherries. But there are people that are taking a course. It's an supplement based on reasonable recommendations. Do we know? Has it been studied? We don't. These are very safe, very inexpensive supplements. Pennies a day. Good night's sleep. Maintaining proper body weight, excess body weight has been a risk factor for not doing well if you do contact Koven 19. You might be in a state of constant inflammation. Here you got a virus that triggers massive inflammation. If you started a high point, that's going to be a little easier to reach a critical inflammatory status. And of course, wash your hands and physical distance as appropriate and wear your mask as appropriate for sure. Those are all interesting. There is actually just to mention there's a theory. Again, remember, 25 to 30 percent of people have lipoprotein little they elevated in their blood. One of the bad actions of this special cholesterol inherited Mollica is it can cause blood, the clot. And one of the tragic circumstances in a lot of cases, sick people with Cauvin, 19 in the ICU is all of sudden there's clotting everywhere. There's clotting in the heart, there's clotting in the lungs, there's clotting. It's a theory that lipoprotein the delay may be partly to explain why some people just explode with this terrible issue and others don't. So not now, but maybe the God forbid, the next pandemic will have more people that are where they have lipoprotein little a inherited problem. I'll have a better therapy for MRSA or anything else. I'm working. I'm always working on something. I'm deep, deep right now into the endocannabinoid system. You know, the fact that we have a chemicals in receptors in our body, that when you access cannabis or hemp or know CBD, why does that activate reactions and about. I'm just reading a lot about it. Oh, it is. These are phyto cannabinoids, plant based chemicals that are hacking into our own internal system. Most people don't know we make a series of chemicals in our body that are the authentic cannabis like chemicals, and it just happens to be many plants. But cannabis is the most famous plant. You don't have to smoke it. It could be a hemp oil capsule or A-S, but many plants have a response in the body, just like our own internal system. Some people there may be the future diagnosis. Maybe you have a hypo cannabinoid system. You better add in some cannabinoids like hemp oil. It's a fascinating pathway right now being looked at in anxiety, poor sleep. Some metabolic issues, some pain issues. So I'm pretty deep into learning as much as possible on that. [00:35:50] Excellent. I look forward to your findings. And I reached out to some of our audience members and colleagues when I knew I was going to be speaking with a cardiologist today. And I asked them about any questions that they had late or not. I told them I wasn't going to quote any of them. And I have a few I'd like to run by you. One is and kind of a general inquiry that how would one know without pain or some kind of a cardiac arrest moment if there was an issue with their heart. [00:36:22] Yeah. So I don't wait for the cardiac arrest. Very bad way to find out. You have heart disease because recovery from that is very low. Again, just succinctly. Get a few extra blood tests, get blood tests. Go see your doctor. Get your blood pressure check. Get the routine stuff. Maybe ask for the lipoprotein little lei and maybe a test of inflammation. The C reactive protein. [00:36:46] But I'm going to reach over. And just so a visual is always better. This is a practice for sure. But again, if people aren't familiar, there's a great documentary you can find on Netflix called The Widowmaker movie, and I'm not in it. It's about seven, eight years old. But this is a picture of a CAT scan of the heart. That's the bones on the outside. The lungs are black, the heart and the metal. And there's a yellow arrow. If you want to know if you're walking around with silent blocked arteries that you're not aware of, you get is called a coronary artery calcium scan. And you need a prescription generally from your doctor. And you spend, as I say, seventy five. One hundred dollars. If you're being charged more than that. Just call the next hospital. And if you want to learn more about it. The Widowmaker movie, Boom, you'll have all the data you need. And that is now recommended by the American Heart Association and others. This is not a unique viewpoint that I have. Yeah. [00:37:44] OK. And how so? Olive oil, coconut oil and other plant based oils have been something that a lot of people that we've reached out to feel like they've had misinformation about. [00:37:55] And how do you feel about these particular oils when added as condiments or sources to a vegan diet? [00:38:03] So very hot topic when I know a lot about. And I'll give you again a quick answer. You've got to go back to science. Number one, people have been using olive oil for thousands of years. That's not true of coconut oil. It's a basic component of the Mediterranean diet, which we learned in the 1950s resulted in a much lower rate of diabetes, cancer, dementia and heart disease than junky Western foods. So you could ingest in Crete and the island of Crete off of Greece. They drank olive oil like a liter a week. It constituted 40 percent of their calories of their diet. And they had very low rates of these diseases. But it wasn't butter and it wasn't lard and it wasn't ghee. And there's no coconut trees in Crete. It wasn't coconut. There is also very strong data from the Harvard School of Public Health that if you're using butter or if you're using lard and you switch over to extra virgin olive oil, you will def. And actually, it's also true of other plant oils. You will definitely drop your risk statistically of developing heart disease. So olive oil has gotten a very bad rap in some portions of the Vegan world because if you're the very small slice of the pie. It is terrible heart disease. And when somebody comes to me and says, I'm supposed to have bypass surgery next week, what do I do? I'm going to definitely advise them. Whole food, plant based, no added oil diet, because that's consistent with the studies by Dr. Esselstyn, Dr. Ornish, Mr. Nathan Pritikin and such. But that's a very small slice. If you're sitting at home and you're healthy. Maybe if add your calcium score down and it's great and you want to drizzle some extra virgin olive oil on your Froogle a salad. God bless you. Enjoy it. It's a delicious way. [00:39:47] And it may actually help you absorb fat soluble vitamins like vitamin D, invite him and even vitamin A out of your foods a little better. So I'm not as rigid that nobody can have oil. Coconut oil has a unique position. It's very high in saturated fat where olive oil, avocado oil and canola oil are very low in saturated fat. And there's just no data that coconut oil actually supports healthy heart lifestyle. It's not part of the Mediterranean diet. Some people mentioned that it just doesn't exist. It's a it's a tropical plant. It's not a Mediterranean basin plant. And there is concern that oil raises cholesterol. The official word to the American Heart and American College of Cardiology Associations is we're concerned avoid eliminated from your diet. Put it on your skin if you want, but don't eat it. There was this trend by Dave Astbury. Here's a cup of coffee. Here's a couple tablespoons of coconut oil. Your brain will be fired up for super function, but some people's cholesterol go insane with that approach. Two hundred to five hundred in three weeks. So if you're going to do it, do it with an experimental mind to at least check your blood work. But I don't use coconut oil. I do use extra virgin olive oil. But I know my arteries are wickedly clean. Thank you. [00:41:09] Absolutely. Well, and to that end, yeah, I did. And once I heard it was going to produce all sorts of brain clarity, I myself down just a straight tablespoon, never felt any clarity. There's that personally. [00:41:21] Try getting a lot of it. You will find clarity in your colon because it causes a very rapid diarrhea. You do. [00:41:28] I did not do enough. That would have stopped me as well. I'm wondering. We've had a lot of feedback from people who've spoken to either advisors, health advisors, to people that said they spoke with doctors, just general M.D. and that said that they shouldn't fast because their calorie intake as vegans is both a little bit more fickle and different from that. They're carnivorous or milk eating counterparts. And Dan, a lot of vegans that are watching the show and listen to it have a relationship with fasting. You yourself have talked about what the doctor, Longo and Autophagy, those things, you know, kind of have been heated conversations even in the Vegan community with cellular repair and things like that. How do you personally stand about vegans fasting from, oh, mad one meal a day, too intermittent or longer? Fast. [00:42:26] On average, a well constructed plan diet has fewer calories in a day than a general American or meat based diet. It's, you know. The food is nutrition dense, but not very calorie dense. If you're eating big salads and beans and peas and grains, you will change up a little bit of use, too much extra virgin olive oil because of the density of calories. And you can bring it up. So we are some people talk about we are like leaning towards fasting naturally day after day after day, because even if it's two or three hundred calories a day, less than our compatriots are eating meat day after day after day, that is less of a metabolic stress on the body. But there is a magic to going a period of time and it may take three or four or even five days of reduced or no calories. I don't do no calorie fasting. I don't do water fasting. I could I'm healthy enough to some people are not healthy enough. Too frail to diabetic to nutritionally imbalanced for heart failure. Some people should. So Dr. Longo created this five day, 800 calorie day plant meal based program called the Fasting Mimicking Diet. That's a trademark name or prolon. That's a trademark. And I'm a big, big advocate because there's some magical responses when you deprive the body of glucose and protein for five days. And this program is a very low glucose, very low protein, high fat, high complex carbohydrate program. With all the food provided, you can you can inhibit some pathways that cause damage and aging. You can activate some pathways that cause rejuvenation, regeneration. You can stimulate stem cells. It's all very high level science. And you will see in 2020 that this particular program, fasting, mimicking diet, combined with cancer, chemotherapy, combined with other programs, is revolutionary, revolutionary, revolutionizing the way we're using nutrition as an adjunct to treating serious disease. But it's a perfectly great choice for somebody just wants to enhance their health. So, you know, there has not been a study. You've got a perfect plant based diet. Will adding on fasting give you some even further health advantage? But there are some people, as I mentioned, they're struggling, they're eating all food based diet, but their weight still isn't at target. Their blood pressure still isn't at Target. Doing fasting with that whole food plant based diet may be the key to turn on metabolism the way they want and get the results they want. Interesting. [00:44:59] Yeah. And finally, we had just a general inquiry as to what your personal thoughts were. And there's been a lot of people a little bit more shocked than not regarding how little their personal doctors or cardiologists and specifically know about nutrition. And I'm wondering if you can speak to your own personal testament as to whether or not you feel like the majority of your colleagues are educated in the science of nutrition and particularly latter day nutrition. [00:45:30] You know, the answer is generally no. There are some that are just completely resistant to the topic and you're not going to get them away from their steak and potato diet. There are some of the younger ones that just can't help but notice the game changers movie they heard about or Tennessee Titans football team or Serena Williams. I mean, it's just too much in the public culture. So they're aware and they may have done some readings from research. There's a growing number of plant based doctors and plant based cardiologists that as many as there should be. But it's growing. But it is frustrating. And again, when you walk into a hospital and there's a Wendy's or you walk in the doctor's dining room and there's fried chicken on a regular basis, you know that there's mixed messages and inconsistent education, that the board exams to become a doctor rarely have any nutrition questions. So that means the curriculum is not going to have much nutrition because one of the goals are going to training is to pass the darn test. And why spend too much time on a topic that's not been tested for? So there's a movement to get more nutrition questions on these board exams, forcing the curriculum to be more nutrition based. I think everybody listening should buy a copy of the plant based solution and gift it to their doctor and we can start a revolution. You know that it's going to take things like that. I mean, I've had the pleasure of giving grand rounds at cardiology departments on nutrition as recently as last week by Xoom and other ways. And it's frankly now 10 percent of the audience has any clue what I'm talking about. And the rest of them are just blown away that there's data about this. But are they blown away and they're going to make changes or are they blown away and they're on to the next topic? I'm only hopeful that it's altering some of their opinion about spend four minutes of your 20 minutes talking to people about nutrition or just tell them to watch forks overnight. I mean, that's what I did for years. I had 15 minutes. One minute was prescription pad. Please watch this movie. I usually actually had at that time DVD they could take home. Now it's just online. So one little statement to a patient can change your life forever. [00:47:41] Is there any index to find or locate cardiologists who are open to or entertaining Vegan or vegetarian diets? [00:47:50] A cardiologist, not exclusively. There is a website article on it called Plant Based Doctors Dot Org. And if you type in your zip code and twenty five mile radius, you know, it might be a therapist, it might be a nurse practitioner and it might be a general internist or cardiologist. But at least from the meetings I go to, there's a few dozen cardiologists, maybe, maybe there's one hundred, but that's out of thousands in the United States. [00:48:18] That's terrifying. Well, I want to say thank you so much, Dr. Khan. We're out of time. I do appreciate you indulging me in our questions and unpacking your books. I really appreciate everything and all of your candor today. [00:48:32] Well, I always appreciate the opportunity. I'm very passionate about talking about what we talked about as one, two, three, four, five people that are listening and maybe 10 times. And many are going to you'll find out something. And even if it's just that blood test lipoprotein little. Hey, but, you know, if you're eating plant based, you are making a quality decision. Don't give up. And if you're having a struggle with it, reach out to somebody in your community or, you know, my clinic does cancels. Let me help you figure out why I click in for you. [00:49:00] Wonderful. Thank you for everyone listening. We've been speaking with Dr. Joel Klein. You can discover more about him, all of his research on W WW, Dr. Jill Concow. You can also purchase all of the books mentioned here on Amazon until we speak again next time. [00:49:17] Remember to eat clean, eat responsibly, stay in love with the world and always bet on yourself. Slainte.  

Cardiovascular meds. Cholesterol lowering agents. Hyperlipidemia, Atorvastatin (Lipitor), Fluvastatin (Lescol), Lovastatin,  Pitavastatin (Livalo), Pravastatin (Pravachol), Rosuvastatin calcium (Crestor), Simvastatin (Zocor) Free quiz & full course at https://Simplenursing.com/nursing-school  Pharmacology Master Class - 100 videos not on YouTube - Try it for Free!    Pharmacology Master Class - Try it for Free: https://Simplenursing.com/nursing-school  100 videos not on YouTube    FREE Access to new app + 1,000 videos not on youtube!  https://Simplenursing.com/nursing-school   NCLEX FREE TRIAL:  https://simplenursing.com/NCLEX   STAY IN TOUCH

Toni D'Antonio | Actor - Producer - Writerhttps://www.tonidantonio.comhttps://www.shakethetreeproductions.comToni grew up in Rhode Island with her proud Italian American heritage playing a part in many facets of her life. Maintaining strong family ties, this only child has been cultivating her imagination since age 7 entertaining her family recording a fictional talk show voicingALL seven characters. Thus, her acting career is comprised of 20+ years of credits in theater, studio and independent films, television, commercials, industrials and voiceovers. This SAG/AFTRA actress has been seen commercially as the face of iShares and the US Army and has been heard as the voice of Fidelity, Crestor, Humira, Walmart, Cumberland Farms and Publix Market, to name a few. Theatrical credits include TV shows Law & Order SVU, The Blacklist, The Mysteries of Laura, Taxi Brooklyn, Blue Bloods, The Following andNurse Jackie and the feature films Nasty Baby with Kristen Wiig, Alto with Diana DeGarmo and Annabella Sciorra, Where God Left His Shoes with John Leguizamo, Riding In Cars With Boys with Drew Barrymore and Faraway Eyes with Christina Ricci, and more.Married to a restaurateur over 30 years, she is the true definition of a hyphenate and has been a creative presence in many aspects of the entertainment industry. A passion for all things creative and a career in front of and behind the camera that spans over 20 years,Toni has worked as a Producer, Writer, Director, Script Supervisor, 1st AD, 2nd AD, HMU, Production Supervisor, Production Coordinator, Casting Director, Location Scout, Script Supervisor and Production Consultant as well as an Actor. The company’s first full-length feature film, Alto, was shown at over a dozen festivals and garnered such awards as Audience Award Winner (Visionfest Domani Film Society Film Festival 2015) and Jury Award Best Women’s Feature (North Carolina Gay and Lesbian Film Festival 2015) among others. Upcoming productions include 2 features to be directed by Mark Lester (a Lou Martini, Jr. (Sopranos) feature called Honor which she will also star and the feature A Brooklyn Christmas, 7 scripted television pilots (Sober, Staff, Good Fellows, Mooch, Justin Case, and Breakhouse and Staff), 4 unscripted series (Family Lot, The B & B Diaries, Whacked!...Where Are They Now? and Justice Delayed) and 5 cooking shows. She works with all team members of Shake The Tree ... the writers on all scripts being developed, directors and editors among others to ensure the highest quality results for the success of all project. Toni continues to strive to give back by volunteering. She was a first responder after Hurricane Sandy in the Breezy Point communities; she worked tirelessly in conjunction with The Roxbury Volunteer Fire Dept. to help the community in its recovery efforts. She is a corporate sponsor of the My Destiny Foundation, Inc. helping raise awareness for early detection of breast cancer. She is also a supporter of the Limitless Child International, Semillas de Amour, the Alzheimer’s Foundation and Broadway Dreams. A proud member of NY Women in Film and Television, she has an immense respect for the collaborative process that drives her to continue discovering, learning and educating through artistic expression.

This week on Episode 219 on the Inner Monologue Podcast is Crestor and Teacher of IGNITE Wellness Collective,Stephanie Bard. IGNITE wellness collective exists to inspire and empower those seeking to elevate their true essence of being. Our collection consists of opulent gemstones and fine metals in handcrafted jewelry, daily movement and yoga classes, as well as yoga teacher trainings. To learn more about Stephanie got to... www.ignitewellnesscollective.com Entelechy Visions www.entelechyvisions.com Theme Music provided by Cloudkicker.   To learn more go to www.cloudkickermusic.com Other Musical Contributions Fourth Dimension The Perfect Form by Fourth Dimension https://itunes.apple.com/us/album/the-perfect-form/1279434288 Synphaera Records www.synphaera.com Subscribe to Inner Monologue today on iTunes, Spotify, Stitcher or I Heart Radio!

David Brownstein, M.D. is a Board-Certified family physician and one of the foremost practitioners and speakers of holistic medicine. Dr. Brownstein has practiced holistic medicine for 25 years, has 16 books out, many of them best-sellers. In this dynamic and personal dialogue between two colleagues and dear friends,  you will learn: What are the most accurate ways to assess cholesterol. What are ideal cholesterol levels. Why do cardiologists recommend statins when the statistical science is so poor. Statins include atorvastatin (Lipitor), fluvastatin (Lescol XL), lovastatin (Altoprev), pitavastatin (Livalo), pravastatin (Pravachol), rosuvastatin (Crestor, Ezallor) and simvastatin (Zocor, FloLipid). Learn the most common side effects and the underlying mechanisms. Statins increase calcium score numbers: what this is and why you should care. Relative versus accurate statistical significance. The role of thyroid and hormones in heart health. Thyroid resistance, what it is, what labs look like and how you treat it . How Dr. Brownstein trains medical students to learn this information. And more! Links: https://www.drbrownstein.com/ https://www.drbrownstein.com/blog/ https://www.drbrownstein.com/store/ References: The Statin Disaster Brownstein David How statistical deception created the appearance that statins are safe and effective in primary and secondary prevention of cardiovascular disease. Expert Review of Clinical Pharmacology, 2015; 8 (2): 201 DOI: 10.1586/17512433.2015.1012494

Statins are one of the most dispensed medications in the World to help lowering bad cholesterol in the system. However, this group of medication also attracts a lot of good and bad attention from the media. In this episode, Nhan and Ishaan will be discussing about this interesting class of medication and debunk some myths.If you like this episode, be sure to subscribe and leave us a review on iTunes!!https://podcasts.apple.com/au/podcast/breaking-the-capsule/id1479407995Follow us on Facebook and Instagram:https://www.facebook.com/Breaking-the-Capsule-110257606996674/https://www.instagram.com/breakthecap/?hl=enEmail us at breakingthecapsule@gmail.com with any question

https://www.youtube.com/watch?v=AgUJQtQUrEs IDEA Pharma: A Conversation with Dr. Menelas Pangalos of AstraZeneca Mike Rea:                          Just a quick note this is Menelas Pangalos, can I have your official title? Dr. Menelas Pangalos:       I am EVP of Innovative Medicines and early development. I’m at Biotech Unit and also Global Business Development. Mike Rea:                          Okay, we’ll get on to innovative medicines. This is obviously one of the series of Idea collider interviews with people with actually very interesting thoughts on innovations. Dr. Menelas Pangalos:       Hopefully. Hopefully interesting. Mike Rea:                          Definitely interesting and hopefully very useful for the viewers. So, actually let’s starts with our first question, what does AstraZeneca means by innovative medicine? Dr. Menelas Pangalos:       Yes that's probably the most difficult question because innovation is different things to many people, & I’m sure - I remember when first joined the company & was walking around the site’s; looking at project’s & people were telling me about their innovative programs & they actually - you know, if you think about this as a competitive sport, I think our view of innovation when I first joined was personal best versus world records, And when I think of innovation, I think of world records. You know, you’re cutting edge, the cold face of innovation in terms of whatever area you’re in, whether it’s a technology or whether it’s a therapy area. Disease understanding is actually - you’re making the discoveries rather than following discoveries. Mike Rea:                          So, that was an almost an internally referenced versus external referenced. Dr. Menelas Pangalos:       Yeah, so exactly they were very inwardly as an organization we were incredibly inwardly focused & we were getting better internally but when your benchmark is very low, you’re getting better on a very low benchmark actually it’s isn’t getting you anywhere near where you need to be. So, one of the big shifts in our culture which I think is helpful in our innovation is being much more outwardly focused. Seeing what’s happening as a consequence, understanding where we should be pushing ourselves to be even better & who we should be working with to enable us to build on whatever it is that we choose to do. Mike Rea:                          That’s interesting & the innovative medicines group is focused on forward looking pipeline -? Dr. Menelas Pangalos:       Yeah, So I run everything from the first target ideation all the way to proof of concept. So, we have to hand over to our latest [inaudible 02:28] organization programs that are ready for phrase III. So, everything from - you know the basic disease understanding – to therefore give you the new targets so you identify & optimizing those programs to generate molecules that are ultimately suitable for phrase III investment. So, there’s therapy area-based research, then we also have our technology platform group to support the therapy areas  Mike Rea:                          And you’re essentially then combining ways of doing that with choices that you’ve made along the way of which areas to focus on itself. Dr. Menelas Pangalos:       Choices all the way & one of the things - the big shifts that we made, which actually we made when Pascal joined the company at the end of 2012 is really focus down on the areas where we thought we could be globally competitive or we could be setting world records not personal bests, & so, we really focused organization down on to sort of oncology, cardiovascular, metabolic & renal disease. Which there’s a lot of overlap & than respiratory disease & there’s couple of areas that we not dabbled in but we have small – relatively small investments, less than 5% of our budget goes on there in neuroscience & infections where we tend to pawn all those program with other companies where that’s their core area of competence & where they want to be leading from an innovation perspective. Mike Rea:                          ok, that’s interesting. So, it’s more like the British Olympic teams approach the winning gold medals. where we can win gold and…  Dr. Menelas Pangalos:       Go deep & yes, it’s been very interesting because, as we’ve gone deep and as we’ve got more & more focused in those areas. You see that actually you’re starting to build a depth of knowledge & a depth of pipeline that really does make you quite competitive in that space, & the quality of the partnership – you can create the quality of the people who you recruit – the quality of the decision making it all gets better because the commercial organizations also lined up the same way. For me it was like the organization was never all - but I always thought of us as iron filings all going in different directions. When we focus organization on those three core areas, everyone’s thoughts then point in the same direction & they understood, well good looking [inaudible 04:44]  Mike Rea:                          Yeah, & it’s been interesting. you mentioned when Pascal took over but it seems to be in a purposeful shift at AstraZeneca, because for a long time it wasn’t my favorite company. But this certainly - your publications & the kind of pursuit of a kind of directed improvement Has been clear from the outside. Do you have the room to do that? Dr. Menelas Pangalos:       Yeah, look I mean - I was hired by the CEO before Pascal joined, a guy called David Brennan who was a super smart guy, very commercially driven. They’ve built a great company with an amazing brand Seroquel, Nexium, Crestor. And what’s interesting is most of those were me too or me better drugs, but nevertheless, very successful in their time & what David realized when he hired me was that the R&D organization wasn’t where it needed to be & they had to try & re-invent themselves & I was the one of the first recruits to try & help with that reinvention.  Mike Rea:                          What was the first thing that you had to do under that new regime? Dr. Menelas Pangalos:       Yeah, it was a challenging [blank] - activity wasn’t particularly high so one of the things that I tried to really get the organization bought into reasons why we need to change, to learn from what we’ve done before. So, we looked at all of the projects that were run from 2005 - 2010. We were spending about 5 million dollars a year on R&D. And really trying to look at what differentiated a successful project from a non-successful project. obviously, we had a lot more unsuccessful projects. Mike Rea:                          What was your definition of successful? Dr. Menelas Pangalos:       Launch.   your medicine launching or moving into late stage of development at least. But actually, launching is the most important one & looking at what data – what information we have & how programs actually progressed from candidate nomination all the way through to phase III. And what we saw was – actually when we did the analysis, if you measured us by the number of things that we were doing, the numbers of candidates that we’re putting into the clinic or the number of R&D's that we were filing. We were one of the most productive companies in the industry. Secondly only to Pfizer after it had acquired Wyeth. But if you measured us by the number of launches that we had – we were the second least productive company in industry. So clearly there was a disconnect. Our science was getting rewarded, but there were no medicines coming out at the other end & that’s what we had to fix it.                                          The take-way message from all of this work was quality over quantity. It’s the quality of what you work on not the quantity of what you do. And then as we dug further there were five things or we call a five R framework that we thought, based on the data that we analyzed would improve your probability of running a successful program and they’re pretty obvious I have to say, pretty intuitive & yet actually quite difficult I think to execute on consistently.                                          So, the first of the five R's is around the right target. How well do you understand the biology of the target that you work on? how well do you understand the disease pathophysiology? How it connects – relates to path whether you’re trying to modulate? What genetic validation do you have either in pre-clinical animal models or in human genetics & how do your scientists consequently try to prove or importantly disapprove Your hypothesis. are they asking those killer questions to try and invalidate, not just validate there’s something for hypothesis? Mike Rea:                          Yeah. So how important is that almost adversarial nature? Dr. Menelas Pangalos:       It’s really important actually rewarding your scientists for disapproving things as much as approving things & making good decisions – good kills is actually something that we’re very passionate about and very proud about & we celebrate as well.  As I’ll say in a moment the reason why we’re failing now the most is actually because of lack of efficacy in phase II, which means we still don’t understand the targets and the pathways well enough. But we’re getting better, so that’s perhaps the most important of all of the 5 R's. Mike Rea:                          Okay. I think we talked about this a little bit before that we’ve reframed this role and we're calling it failure; we call the process of early phase – development asymmetric learning. Can you learn faster & better than the other guys? Dr. Menelas Pangalos:       Exactly. Mike Rea:                          And if you call it learning it’s not trying to failing anymore. Dr. Menelas Pangalos:       It’s exactly right & making sure that you fail, you haven’t spent too much money & you don’t just keep on - cause what we were very good at what we saw as we had – our science was very creative. Finding ways of getting to the next hurdle & just for the sake of getting the next hurdle, cause that’s where we're being measured on. So right target, second one right issue. When you have a molecule whether it’s a monoclonal antibody or small molecule or the drug modality, demonstrate first of all in the preclinical models that you can engage the target & understand what your PK / PD relationships are. So, understand you’ve got to inhibit a kinase in a tumor? Do you have to inhibit that kinase for 24 hours? Do you have to inhibit it at 50%, 80%, 100%? Really understand what the relationship is in order to generate the efficacy you are after & then even more importantly you have to have a way of measuring that in the clinic. If you can’t demonstrate target engagement in a clinic, we have a big problem, because then if you fail you have no idea if it’s your molecule is cramp or lousy - excuse my French - or if your hypothesis is wrong. So, a good failure is for me is ones who I know have demonstrated target engagement but the molecule didn't work so biology is wrong. Right. And we hardly had any ways of demonstrating proof medicines – so a number of phase II that we were running. where the molecules failed and you asked the question – I remember these first six months in project meeting, so it didn't work – did we engage the target? Did the receptor antagonist get into the brain? If it’s a schizophrenia program and quizzical blank stares from everybody saying - we have no idea.  Mike Rea:                          Oh, so you weren't learning well.  Dr. Menelas Pangalos:       So, you weren't learning anything, not well, you weren't learning anything actually because you had no idea why you are failing, so that doesn't happen anymore. The third one is right safety, so again because our scientists were being rewarded for number of candidates, they were remarkably good - working how to lower the doses to the minimum amount, where they now – because they're not measuring target engagement, engaging the target but they still get the candidate through. And what we saw was that when you had early safety signals, they invariably came back to bite you somewhere during early development or even worse later stage development. So, waiting out your safety signals early, making sure you are working on the right series, on the right scaffolds, that you understand both your target-based toxicity and your molecule-based toxicity, really, really important. So, we spent a lot of time developing our safety models. Fourth of the five R's right patient. To find the patient population in which your medicine is most likely to work. Because if It doesn't work in that patient population, it's not going to work on a broader patient population, and we were again very good at going into broad patient populations. What we saw actually was that as the programme moved through the clinic, the commercial organization got into full steam ahead and wanted to go into broader bigger. Of course AstraZeneca was very much a primary cadre of an organization and so what we saw actually in the data was that the scientists were becoming less confident about their projects and the commercial folks were becoming more confident because the big yourselves the number is getting bigger, but you know a 100% of nothing is not a very big number. So that was the other pieces - to find the patient population and do that experiment first and develop it there and then other things will happen. This is not different, advanced for example we have been doing for quite some time, and then finally the last of the 5R’s is right commercial. By right commercial, I don’t mean is it going to be a billion dollar pick yourselves - what I mean is why would anyone want to take or prescribe the medicine and why would anyone want to reimburse it. So, understanding what your comparators need to be, understanding what the standard of care will be in the time frame that you are going to be launching. It’s a very difficult thing to do, often 10 - 15 years ahead but really challenging the teams to think about where that puck will be when the programmes moves through the clinic or when it launches to make sure they are being ruthless about the comparisons they do. This now goes back to the conversation around being outward looking versus inward looking. And then it was interesting, when we submitted the paper for review, one of the comments that came back from one of the reviewer's was - well if you do all of this you need to add a 6th R which is the right culture. Because what you are actually doing is changing the culture of the company and so you need to talk about how it back ships and he was actually, he or she was actually right because as we start to implement  the 5 R's to every governance meeting we have, through  every project review that we do, what you start to see is is the culturing shifting from one where science is being rewarded for just numbers of candidates, to they are being rewarded for proof of mechanism, for proof of concept, for launches, for diagnostic strategies and for publishing great research papers and it has shifted the culture from one that's being very inwardly focused, personal best to one that's outwardly focused, more collaborative and hopefully setting a few world records. Mike Rea:                          Which is interesting. So, we, did you use incentive structure as a lever or was that a kind of after effect of getting people to focus in the right place? Dr. Menelas Pangalos:       So the incentives changed and our global incentives in the company actually changed when Pascal joined where we didn't just have R&D incentives, we had incentives around R&D - which were phase 3 investment decisions, launches, phase II starts, and there's assessing of commercial goals which are around the growth drivers of the company which you can land everybody up in oncology, cardiovascular, metabolic, respiratory etc. and then  some financial goals and we were thrust to meet our objectives, we have to get all of these things - not just the R and D ones. So, the whole organizations actually got very well lined up. But for us the things that we rewarded scientists on were:- the quality of the work they were doing, so these good kills, or good moving forward in a CD package, coming forward you know a lot less candidates coming forward every year than we ever had, we were no longer the most prolific, but the quality was much higher and the teams had to be able to cover every aspect of the programme including what the developing plan looks like going forward to proof of concept. And then the successes, their rewards came and they demonstrated proof of mechanism, demonstrated proof of concept, when they get the phase III investment decision because I don't get to decide what goes into phase III, someone else has to put that through and so that you can’t game the system in that way. Mike Rea:                          Yes. Interesting. We have always quoted the Brazil Germany World Cup final, cause as you look at the goals, clearly very big divide, but actually Brazil won the game on all of the surrogate metrics. They shot some goals, shot some targets, possession Brazil won.   Dr. Menelas Pangalos:       But the goals count. Launching drugs count. So, the launching drugs counts and of course the challenges is, when you are in a research team launching a drug somewhere away. We were lucky that we had a few drugs that moved quite fast through the whole process. So, people got a sense that we could actually do this and then the other piece that was a very important measure actually for us is actually just the quality of the publications coming out of the organization. And if you look at where we were, I had an organization of about 5000 people when I joined and we were publishing about 200 papers and one nature or science paper. Today we are half that size, we are about 2500 people, we are publishing between 40 - 50 nature science sell papers a year. So even those, and of course when I first joined it was impossible, you couldn’t do drug discovery and good science, now it’s part of our DNA. Mike Rea:                          It’s all the same thing. Dr. Menelas Pangalos:       Yeah and people don't even question that, and of course what happens as a consequence of doing it is, people want to come and work with you, whether it is an academic collaborator, whether it is Biotech or whether it’s someone who actually wants to be a part of AstraZeneca.  Mike Rea:                          Of course  Dr. Menelas Pangalos:       So it’s made a huge shift to us and of course our move down to Cambridge is all part of that shift, it’s part of being close to an academic hotbed where there is amazing science because we have become much more open than we ever were, which for me again it’s part of my DNA in terms of being collaborative. Being collaborative in Cambridge is really, really easy because there is so many people you can collaborate with. And of course we have Oxford, London in our doorstep and the rest of the UK and the rest of the world, we have tried to join UK and Sweden together to try and create a European hub and the partnerships we have now which when we have many and some quite unusual, we actually have AstraZeneca scientists work in the same lab as an academic scientist, shared goals and they are working on basic research as well as drug discovery programs. It’s made us much, much more porous than we have ever been. Mike Rea:                          The thing I mentioned to you before was, we have been doing the pharmaceutical innovation index for 9 years now. And if you look where AstraZeneca started to where Astra Zeneca came number 1 this year. It’s been a rapid turnaround. I think because all the things that you recognize and our index measures, did you launch and did you launch successfully? Did you get reimbursement?  So clearly you have gone from that period when you were doing a lot of internal R&D anywhere to suddenly getting somewhere. Dr. Menelas Pangalos:       And it’s been - the wins are important. Celebrating the wins when you get them is actually one of the things that galvanized the organization. But you know, I think that are the three key things, being really focused on high quality science, being really collaborative and open, and then executing flawlessly when it comes to moving through the pipeline and launching. Mike Rea:                          When you said, you came up with the five R’s. Was that a process to come up with or were those the five things that mattered the most or did you go in with -? Dr. Menelas Pangalos:       No actually look, you know Pfizer had published their three pillars,  these things are very intuitive and most interesting is people ask me about - because these are you know, they're bleeding obvious, you’d think everybody would do it, people ask me - why do you publish this, because it’s like a trade secret. They're not! Everybody should be doing this and I think many companies do, but Actually many companies don’t and when I ask people that join us from other companies about what's different about the way that we do it versus others, it’s that we really do practice this. I don't let well not I; we don't let programs come forward if the odds don't look good, and if they do come forward with a gap, let’s say we’re not sure about right safety, we have a question mark about whether we’re going to have the right dose versus safety liability. It’s the first question we ask in the clinic. So, do you really understand the proof of mechanism, the PKPD and workout the margins, so it really focuses the attention is you understand where your liabilities are in a program to go there first and workout whether you can flip a red to an amber or green –  Mike Rea:                          So, it’s okay to go at risk as long as you –  Dr. Menelas Pangalos:       As long as you know what the risk is and you're very clear about what the killer experiment is. Mike Rea:                          Hoping it’s not there. Dr. Menelas Pangalos:       Yeah and then of course the first few years projects will come and you say no once, you say no twice, you take teams through it and teams change their behavior. Mike Rea:                          Oh, you do mean it? Dr. Menelas Pangalos:       Yeah, yeah. Doesn’t make a difference. It’s kind of important, right. There's got to be some tease to it. Mike Rea:                          So, is there a definition of innovation at AstraZeneca? Because one of the things we always find is that everyone has a different approach to what it is and what it means. Dr. Menelas Pangalos:       As I said earlier, it means so many things to different groups. So, for my precision medicine group, innovation would be developing the first plug-based DNA test for EGFO - it’s very different to my oncology therapy, it should be looking to identify a new target or pathway and get the first molecules or the first crystal structure that target with the molecule. So I think innovation really is different things to different groups, I think as I said earlier the most important thing is that whatever we choose to do and whichever areas we’re focusing, whether its Crispr or whether its Protacs or whether it’s a new – some other drug modanity or something around new safety models that improve our prediction, that we are aware of what's out there, so we’re not re-inventing the wheel. We’re working with the very best people and we’re pushing the boundaries of science so that when hopefully we’ve cracked something, when we publish it, people aren't saying ‘so what’. I’d really like us to be viewed as driving science forwards and not just helping ourselves but actually helping the fields that we work in also get better at what they do, and that culture piece is really important because it’s one of the things that I think can make us a little bit different. When we moved to Cambridge, our new building in Cambridge is right in the Addenbrookes campus, the Addenbrookes hospital, its next to the Papworth hospital and then on the other side we’re opposite the laboratory for microbiology, the MRC microbiology. More Nobel laureates than any other institution in the world and an incredibly, if you want high powered science that's one of the places to go in the world and I was talking to John Savalo at the time, he was the CEO of the MR center, ‘wouldn’t it be great, given that we’re going to be in Cambridge to see if we can start working with the MRC, with the LMB’ and so we put a small pot of money together that we co funded and I went and saw Hugh Pelham who was the director at the time and I said, let’s try and do something and of course his natural first inclination was well you know, we’re all very, very smart and you're from industry and we don't want you to suck our brains dry and us get nothing back. Which I think is – I think pharma has moved on a long way over the past few years but I think still in some circles the [inaudible 23:55] of what we do and how we work – and so we worked really, really hard to build a strong relationship with the LMB and to actually make it a very easy way to get – we created this pot of money that basically PI’s from AZ and the LMB, to come and apply for, and they can get a post doc and it’s a two pager and it would be very, very quick and easy and not bureaucratic and Hugh and myself would review this and we’d say yes or no. Based on the quality of the science. Mike Rea:                          Together? Dr. Menelas Pangalos:       Together, we did it together. And it was – of course the first round was not particularly well subscribed but today we work with more than half the PI’s in the LMB, collaboratively, and they get back as much as – because they can see that we can do things, we can create molecules for them, we have certain capabilities and technologies that they don't have access to, but more importantly there's actually a lot of overlap in terms of our common interest. And so, when you put us both together, we actually get more powerful because we’re obviously quite plad in our thinking, they're quite basic in their thinking, we put it together and actually magic happens, and we've got some amazing stuff that's going on working with them.  Mike Rea:                          Which is an interesting – I think your comfort with ‘open’ is an interesting differentiator for you in that way that you described this long-term approach, proof of concept if you like of going in. Have you found it easy to have your scientists behave the right way in the collaboration? Dr. Menelas Pangalos:       It’s been an evolution right, because initially we were incredibly closed. We didn't want to share anything. Everything was proprietary and you just do it in baby chunks and you chip away, you chip away and eventually people get comfortable and there's many examples, of course we had to do it – because if you think of where we were and having to try and change the culture quickly, one of the best ways of changing the culture is actually bringing external scientists in that can show you what world records they'd make. So for example, we did another collaboration with the MRC, we made lots of our molecules, clinical molecules available to MRC scientists to try and find new indications for which then spurred the - NCATs was happening as well, and we’re one of the companies that has the most molecules, both clinical and preclinical in those types of things, you know when we set up the bio park in [inaudible 26:17], park, we had this huge site that was half empty and I used to wander through the corridors going from one group to the other and there would be those empty laboratories, they used to call it tumbleweed labs where you could hear the winds rushing through and it was a demoralizer and from the era when everyone was investing in bricks and infrastructure, bricks and mortar and infrastructure, because they thought they could just industrialize R&D and find out the very hard way that you couldn't, so then the organization shrank and we had these huge buildings. And so, what we did was we said – lets collapse our footprint on the building and let’s bring biotech’s in. So that was actually our first bio park and in contrast to other bio park cities, let’s not have the biotech’s that come in partitioned and walled off. Let’s have them using our cafeteria, our coffee shops, our shared spaces, let’s have them potentially using our equipment if they want to, so they have to buy capital, and we can really try and share our infrastructure, make ourselves good partners, help give them advice when they need it, if they need some regulatory advice some clinical advice, without asking for anything in return, it does start to encourage biotech’s to come in, it makes us again start to forge relationships with other companies and probably most importantly it starts to fill the space up and make you feel vibrant and energetic and full. Mike Rea:                          Which is an interestingly human approach – there's this great book called Obliquity which talks about getting what you want but approaching it in an oblique way and you're described a lot of internal and external signals about your readiness to embrace the future instead of the past. How important is that -? Dr. Menelas Pangalos:       And treat people like grown-ups, the other thing is treating people like grown-ups, because again when we first set this up they were like – what do you mean they're going to be wandering around – everyone signs a CDA, if they don't follow what they should be doing they’ll get kicked off the side, so I think if we go in with the assumption that everybody is going to behave themselves and actually follow the appropriate principles, then actually you're pretty safe. You don’t have to have barriers and passes and everything else, and actually we’ve done it in Boston, in Wharton and actually created – we had a half empty building in Boston which is now packed and actually has a waiting list for biotech’s to come in and in Gothenburg as well. Now in Cambridge it’s a little bit different because we’re already in the middle of the biotech cluster so it’s a little bit less important, but for those sites it’s a little bit more isolated and not right in the midst in Kendall square or not in England for example, in Sweden. It makes quite a big difference having this sort of vibrant environment.  Mike Rea:                          Kendall Square has almost become a hiring hub rather than an innovation spreading hub, because people aren’t necessarily collaborating there, just hiring the folks from –  Dr. Menelas Pangalos:       Well the nice thing about this – what I find about us being in Cambridge is you know–  you go to a coffee shop or you drop your kids off into school, and you bump into someone, happens to be a hematologist who has just come over, is working and you can start to talk about things that we couldn’t talk about when we were in Cheshire, because the environment is just different. So, it’s actually amazing, how many collaborations and relationships have been initiated through these informal connections. So one of the things that I've been trying to do over the years is try and generate as many opportunities for our scientists to have informal connections, whether it’s with people in the bio houses where the collaborators were, you're just making it easier for the serendipitous to happen and then again innovation can happen. Mike Rea:                          Yeah planning for serendipity. Absolutely. So, one of the things that's been apparent from the outside is the way that you've approached innovation as an active process and five hours is a very good illustration of that. Do you measure it year on year?  Dr. Menelas Pangalos:       So, we measure lots of things. I have got a great portfolio management group. I measure it but don’t necessarily incentivize on it. So, I think we measure how many proof of mechanisms we have done, we measure our proof of concepts, so obviously we get rewarded for things like phase III investment decisions and launches. We measure how many publications are coming out, from which groups. But I try not to get to, we tend to do - first full three-year holding averages, so no one is ever pressured into doing something in one year and getting a number. And actually, the focus really is on the quality of what people are doing, and how innovative is it, how inventive is it. Is it going to lead to hopefully to break through in the therapy area in terms of capability? Mike Rea:                          So, you have got trendlines rather than timelines. Dr. Menelas Pangalos:       Yeah so, we are quite careful about that because I just think it drives the wrong behavior if you are not careful. Mike Rea:                          Right, People start gaming whatever they are given as a target. Dr. Menelas Pangalos:       Sounds so brilliant doing that. You know you give whatever target you give them they are good at hitting them. Again, the CD one, it’s amazing what behave - in 2005 - 2010 period, because there were [inaudible 31:30] the number of backups we had in the pipeline. Backup number 1,2,3,4,5,6,7, then of course all the backups had exactly the same probability as the lead molecule. So, we don’t do backups anymore. Mike Rea:                          Right, I remember sitting in Sweden once, listening to the team saying that it doesn’t matter if this one doesn’t work because you have got a backup - how does that not matter? Just because you are in a job for another couple of years, but -  Dr. Menelas Pangalos:       Exactly right. Now unless it’s a really, really important program they know they are going to get one shot so they've got the time, they have got to work out the quality of the molecules versus taking a bit more time to get rid of a few more of the work. So, it’s a real balancing acta and for some plans we will have backups, but they are unusual. Less than 5% of our pipeline now has backups.   Mike Rea:                          Interesting times, and what’s been the biggest learning for you as a director of all of this activity over the period? Dr. Menelas Pangalos:       You know I've worked in different companies now, there's not a lot I would have done differently. I have seen Wyeth go through - before it was acquired by Pfizer, go through relatively similar transformations of what [inaudible 32:45] said of R&D, time was much more focused on a number of things. But he had a leadership team that was very passionate about science. And so, we were all very much focused on the quality of the science. I think the biggest piece is celebrating the wins, but also celebrating the good failures and then exemplifying them - constantly exemplifying the individuals, teams, projects. You know we were lucky that we had to grow in [inaudible 33:15] in particular, which came from our teams in Orderly Park actually which went from – you know we put the resources behind it and there was a new generation when I arrived and we moved it in the CD and then it went from CD to launch and in about three years, now that was a brilliant thing to have coming along because it was an example of what you can do.  And of course having a quick win, that also made the organization feel better about itself, Limpasa which was written off, we resurrected and brought back to line, even though we’ve never really stopped working on it and the Imed, when Pascal joined me asking me why is this not in phase III, suddenly pumped everyone's chest up and then everything we’ve been doing at Astra has been about rebuilding and then [inaudible 34:04] really well your artistic molecule. So, there's lot of really cool stuff in every area that we’re working in, of course that makes it easier to walk on and keep going.  Mike Rea:                          So, with what you described sounds like the early stage of an exponential growth rather than just seeing the results -  Dr. Menelas Pangalos:       I hope so. So, the other piece I love about our company is I think we are a humble company, starting with Pascal and his leadership team all the way through our leaders and our scientist. You know once we got better, I think - I have said this to you previously, we are still failing 80% of the time. Right so we have got lots of room for improvement and very few companies that have been able to continuously in 5 years cycles continue to be at the top end of the productivity chart. So, we have had a good 5 years. That is one set of 5 years so for me the huge chance is making sure we continue to do this. So, the pipeline continues to fuel new launches and new medicines, that No one in the organization gets complaced in any way- shape or form. They remain humble collaborative, open and porous to ideas whether they are from inside or outside. Mike Rea:                          Which has been an interesting characterization of the change I think and having that humility seems – adds more to AstraZeneca, in my external perception to where it is today. So, what drives you personally in this space? Dr. Menelas Pangalos:       I have always been - it’s difficult now not to think of myself as a leader, but I always used to get really upset when people called me a line manager or a leader versus scientist. I'm a scientist first and foremost. I get excited about seeing people’s data. Not the bullet points from the power points, the actual data. The graphs the –  Mike Rea:                          And a scientist in your approach to the day job as well, I guess. Dr. Menelas Pangalos:       There's a keenness, so I still have a couple of students and I don't spend anywhere near enough time with them but I’ve tried to keep my academic links, but more importantly it’s just to encouraging science, constantly encouraging science, constantly speaking to our scientists. Going and seeing their projects, seeing them present their posters, seeing and encouraging the next generation of science and scientist just to come through. To me that's the first driver is just the quality of the science and being an organization that you can say and be really proud is doing good science. Second one is about being collaborative. I’ve always been quite collaborative by nature and I get irritated actually by people that hoard data or think that they can't share things and so –  Mike Rea:                          Yeah, I’ve noticed cause you're active on twitter too that that's – how do you feel about that as a collaborative exchange. Dr. Menelas Pangalos:       It’s good so we’ve got this new thing called Workplace which is a spinoff from Facebook and its actually working really well, where you can start to post – so someone will post a bit of scientific data and then you can ask questions and you can generate – Twitter is a great place for – I see it more for news and getting people’s opinions on things that are coming out., particularly if they're from outside of AZ. But this being open to ideas wherever they come from and being porous and you can talk about being collaborative and then you can be collaborative and I really want it to be collaborative. So, I am probably being too open rather than less open. If I ever have to choose if it works for us, I think the risks are relatively small and the upside is huge. And then – there is two things, and then the other piece that I'm incredibly passionate about which – actually Katherine in the room here, was an example is developing our talent. So really I’ve seen it happen all through my career actually as I’ve grown through the industry, but surrounding yourself with people that are smarter than you are, but also pulling people up more rapidly, and I kind of think about my career journey and I’ve been lucky to have some managers that were quite – leaders that were prepared to take risks on me and sort of propelled me up the line, probably more quickly than I was ever expecting, not probably, a lot more than I was ever expecting, but some people getting there – you're sure about that? And I kind of have this same conversation with my leaders and their leaders about take risks on people. If you haven't got people in places that are a little bit uncomfortable and really pushing themselves and finding out they can really swim versus sign, you'll never accelerate people’s careers. So that's something that we spend quite a little time, with my team and their team. So, I spend a little time doing talent development and really trying to pull out the bright sparks faster than they would otherwise have moved Mike Rea:                          That's interesting. I’m going to ask Katherine; do we have two more minutes? I'm going do the 2-minute timeline. Okay so, within a spurt of a 2-minute rule, so what – you clearly read a lot, what books do you go back to as your core – which books do you recommend? Dr. Menelas Pangalos:       So, the one that's probably closest to my heart from a heartstring’s perspective is probably Roy Vagelos’s autobiography around Science, Medicine and Merck. Mike Rea:                          That was a great period. Dr. Menelas Pangalos:       And for me he was – apart from [inaudible 40:04] obviously a Greek heritage like I am, I’ve never had a scientist in my family, so reading his – I just read his book and it was just amazing what he did and Merck for me, as you know I was doing my PhD, that was the prototypical, what a great R&D organization looks like and I actually did a PhD that was sponsored by them and Roy was like a hero. He was one of the first science led CEO’s and he took a company and really to me he epitomized the science at organizations and so – that's probably one of my favorite discovery books that I read in kind of a – I’ve never actually met him, but I would love to meet him and I just think he did an amazing job and actually it so happened when Merck lost that science focus – they got it back now and I think it made a huge difference, that for me has been one of my guiding lights. All through my career. And then when I was at Wyeth actually I met Bill George for the first time and we’ve met him – I’ve been at AstraZeneca a few times, he’s written a book called Discover your True North and that's about what are your guiding principles, what are your true norths and sticking to them, well actually not sticking to them, knowing what they are so you can stick to them and that has been something that again I have used, when I first joined the company I wrote down my list of four or five things that were the most important things for me, but I never should have talked about over the past few minutes and sticking to those principles and not ever letting them go, because they're what define you, and have been really important. Mike Rea:                          Fantastic. And what are your ambitions for the next five years? Dr. Menelas Pangalos:       To do this. I think we have the best jobs in the world honestly. Scientists in the organization, we’re able to turn science into medicine and really see the impact of what we do and for me, I’ve completed part one of my journey at AstraZeneca, we now need to show that we can do it again, and that we can hopefully improve even further. It was something that we can continue through, I want to just keep doing that, I love doing what I'm doing. Mike Rea:                          Fantastic, and one thing that you wished that I’d ask you that I haven't asked you. That's the last question. Dr. Menelas Pangalos:       How do you relax? As I'm sure you know, you know from speaking to – these are pretty intense jobs, and so my family probably are the thing that brings me down to earth and you're talking about your kid being a guitarist, my kids they're young, they're nine and ten, my wife’s a scientist but they're all very good at when I come home to making me silly daddy and just bringing me completely down to earth and I find that the most relaxing thing out there, being with my family. Mike Rea:                          Excellent, well thank you so much and I know there's a thousand questions I could have continued to ask you. Hopefully we’ll get to do it again. Thanks.  Dr. Menelas Pangalos:       Thank you very much. 

Dr. Morrow’s Show Notes on Statins Before talking about statins, we should talk about high cholesterol. What qualifies as high cholesterol? Has changed a lot over the years. Now, it is LDL > 130 or HDL < 40 if you have no family history of heart disease. It is an LDL > about 75 if […] The post To Your Health With Dr. Jim Morrow: Episode 3, The Truth About Statins appeared first on Business RadioX ®.

PaleoJay's Smoothie Cafe #104 Your Doctor can NOT save you from a bad Lifestyle!! One of the biggest scams there is in this world is that conventional medicine, which is the kind of treatment you can get from an American clinic or hospital can make you WELL! Nothing is further from the truth…a medical doctor of today just means that that person is a member of the biggest, most powerful labor union in history- the American Medical Association. This is a labor union par excellence- it guarantees incredibly high wages for the practitioners in “the Brotherhood” as Malcolm Kendrick calls it, as long as those doctors tow the line, don’t rock the boat, and follow “approved” treatments ONLY- things like chemotherapy, radiation, and surgery only for cancer treatment- nothing else can even be considered, or the doctor doing so can be thrown out of the union- in other words -lose their high priced and time consuming right to practice medicine! Your doctor is actually forbidden to recommend common sense lifestyle and diet changes to actually cure your condition, and is instead forced to recommend expensive pharmaceutical drugs (all of which have side effects, often worse than the disease!), and surgeries only. None of these options do any thing at all to address your disease or condition- they only mask the symptoms so you might feel a little better. You will go home with your expensive prescriptions for drugs that make BILLIONS of dollars for the pharmaceutical companies annually, and billions of dollars for the medical clinic that prescribed them- all without curing your condition in the slightest. You see, the pharmaceutical companies fund most of the research, and bankroll the medical colleges where the future M.D’s train. They have a mutually beneficial relationship- the doctors recommend their products; in fact insist the patient use these products, and then everyone makes lots and lots of money… except YOU. You are left sick, with endless pills and/or painful and damaging surgeries to endure, and are now a drug addict! Even though your drugs are LEGAL, they are still usually endlessly necessary and actually addicting once you start, and hugely expensive- and, even though your medical insurance (if you have it) will mask the true costs since you only need a co-pay, rest assured that the ultimate cost is there, it is huge, and you are paying it through your other many taxes that are set to continue rising forever! And let’s talk side effects: All drugs have side effects! This is often glossed over, but if you ever pay attention to the MANY drug commercials on the television all day long, listen to the potential side effects of the most popular ones, the ones they recite rapidly while showing attractive, loving couples dancing, walking on pristine beaches, and playing with laughing children and romping dogs: Here are the side effects of the Statin drugs, which are among the MOST prescribed drugs on earth! Liver function, muscle wasting and pain, possible heart attack risk, increased side effects with any other drug you might be taking, depression and irritability, headaches, joint pain, and abdominal pain, tingling, numbness and burning, sleep problems, sexual function problems, dizziness and a sense of detachment. Additionally, people have mentioned experiencing swelling, shortness of breath, vision changes, changes in temperature regulation, weight change, hunger, breast enlargement, blood sugar changes, dry skin, rashes, blood pressure changes, nausea, upset stomach, bleeding, and ringing in ears or other noises. In addition, Statin drugs, which include Crestor, lipitor, and several other brand names tend to deplete CO q10, which is a vital substance manufactured by your body to produce cell growth and maintenance in every cell in your body- as you grow older, the supply lessens, and it can cause your heart to malfunction, and cause brain and cognition problems as well! And all of those are

What You Need To Know About the Problems with Statin Drugs Statin is prescribed to people who have high cholesterols. The aim of this drug is to lower cholesterol and reduce the chances of experiencing heart related issues such as a heart attack. The statin drug blocks the substances that support the liver in making cholesterol. This makes the liver emit it through the blood. This drug is very effective, but it has very severe side effects. This makes it seem like the riskiness of taking the drug outweighs the benefits of statin drugs. Examples of statins include simvastatin (Zocor), rosuvastatin (Crestor), pravastatin (Pravachol), pitavastatin (Livalo), lovastatin (Altoprev), fluvastatin (Lescol), and atorvastatin (Lipitor). This read will outline some of the problems or side effects you are likely to experience when you ingest Statin. Side Effects of Statins If you start experiencing side effects of statin, ask your medical practitioner for advice on what to do. Do not just rush into pausing your medication. Muscle damage and pain- This is a very common complaint. The pain might resemble that of weakness, fatigue, or soreness in the muscles. It could be severe enough to affect how you go about your errands and work obligations or mild. It is possible but rare that statins can cause muscle pain and damage that is life threatening. This type of muscle damage is known as rhabdomyolysis. It is severe because it affects the kidney, liver, and muscles. It could even cause death. This can happen when you ingest high doses of statins or you take it with a combination of other drugs. Liver damage- Statins affect the enzyme levels that cause liver inflammation. If the enzyme levels are very high, seek medical attention immediately you start experiencing the following symptoms yellow eye or skin,  dark-colored urine, upper abdominal pain, loss of appetite, unusual weakness or fatigue. Neurological issues- Some people experience confusion and develop memory loss when they take some statins. The good thing is that this side effect reverses once the person discontinues their medication. This means that it is not permanent damage. Take note that this side effect is very rare. Even though it does affect the neurological functions of some people, it would be beneficial to note that it also helps people who suffer from dementia. Thus, the effects are different. Just because your friend is experiencing memory loss, it does not mean that you will. Make sure you consult your doctor before you stop taking your medication. The doctor might prescribe other statins that do not have that effect on your neurological functions.

Welcome back to our weekend Cabral HouseCall shows! This is where we answer our community's wellness, weight loss, and anti-aging questions to help people get back on track!  Check out today's questions: Ruben: Hello Dr. Cabral, First of all THANK YOU for putting in the time to put out the podcast on a regular basis. I wasn't sure what address to reach out with my question, so I figured I would start with this one. The question is actually for my wife. She had a annual exam yesterday and the Cholesterol test came back high. The doctor prescribed her a low dose Statin. My wife has been really sad since then because she really watches what she eats and is active. here is a brief overview: Height: 5'8 Weight: 134 lbs Age: 38 - Does not eat beef/pork - Eats chicken ( once a week) - eats fish ( once a week) - drinks a green drink 98% of the time, daily ( spinach, banana, apple, ginger, tumeric, spirulina, water) - when she doesn't pull her back ( she has few back issues), she works out about 4 times a week. - workouts consist: 10 minutes cardio fast pace, 20-30 minutes strength and conditioning. - Prior to the blood test she hasn't really worked out for about 2 weeks here are the numbers ( fasted test) Chol: 280 Trigly: 173 HDL: 51 Chol/HDL rate: 5.49 LDL: 194 Non HDL Chol : 229 Rest of the numbers look good. She has a history of high cholesterol even though she doesn't eat bad at all 2012 : Chol 169 | Tri 62 | HDL 40 | Ratio: 4.23 | LDL 117 2015: Chol 246 | Tri 139 | HDL 46 | Ratio: 5.35 | LDL 172 2017: Chol 226 | Tri 186 | HDL 47 | Ratio: 4.81 | LDL 142 2018: Chol 280 | Tri 173 | HDL 51 | Ratio: 5.49 | LDL 194 She does not want to start taking a statin but she really feels defeated, so I am reaching out to see if there are any other tests that she could do to make sure there aren't other things that are actually causing the high cholesterol. Also, if she can do any of your protocols or any of the daily support products. Any info that could give us some hope or something to try in the near future would be really really appreciated! Kind Regards, Ruben Breanna: Hi Dr. Cabral. Thank you so much for providing us with such amazing content, and inspiring many to live happier, healthier and happier lifestyles. I listen to your podcast daily and have providing me with the knowledge I've always wanted to know growing up. I have a little story for you. For as long as I can remember I would be in excruciating pain 24/7, especially in the morning. I was diagnosed with lactose intolerance as a baby, but it wasn't until I was 11 years old that the doctors diagnosed me with Celiac Disease... then depression, then anxiety, then acid reflux, then anemia... my symptoms never went away, my intestines never fully recuperated and I was taking 5 different pills daily at 12 years old, despite eliminating gluten. I stopped taking all medication a year ago because I was fed up and I am now 18. Through your podcast I now realize why all these extra symptoms occurred and how they were going against me.. the health system failed me. My intestines still aren't fully recuperated but this isn't part of my question. I just believe my health background may play a part in my current situation. I was always super active growing up as I was a competitive dancer. A year ago I decided to start going to the gym and got approached by a coach who offered her services to help prepare me for a bodybuilding competition. I did my first competition in april and won 2nd place. That diet wasn't bad and didn't have to do too much cardio as I was only 17 and she didn't want anything bad to happen. 3 months later I started prepping for my second show, at 18 years old. My "diet" lasted 12 weeks. She started me off at 1800 calories, lowered weekly and by the end I struggled to loose weight. For the last 4 weeks I was doing 2 hours of cardio + 1 hour weight training, and my diet composed of 5 chicken breasts and 2 tbsp ground flaxseed (+ 1/4 cup oats ONCE a week on leg day, and cut out those carbs 2 weeks out). How did I survive? Barely. I realize that this is extremely unhealthy, but I was too far in to give up. I had 0 days off the gym in 4 months. Also, I was extremely constipated. There was a period where I went 4 weeks only pooping 3 times and had to use diuretics each time to force myself to go!!! I started taking probiotics as another coach had told me this helped her use the bathroom, and it did for a while. My body toxicity was so high. She also advised me to use "estro control" to help get rid of that toxicity and loose my last pounds on my legs. I won first place by the way :). But here is my question.. what exactly did I do to my body? And what could I do differently next time? From listening to your podcasts, (especially your low carb diet ones), I realize I lowered my metabolism dramatically, lowered my thyroid, increased cortisol, burned a lot of muscle and increases levels of disease from purely eating chicken. To put in perspective, I'm 18, 5ft, mesomorph body type, was 95 pounds before going to the gym, gained a lot of muscle and started my diet at 112 lbs but cut down to 98 lbs for my competition. To reverse diet, she advised me to eat 200g carbs, 100g protein and 45g fat, and 0 cardio.I had very minimal "cheats", meaning I only eat whole clean foods such as sweet potato, rice, berries, gluten free oats, veggies, protein powder, eggs, chicken, extra lean ground turkey, rarely red meat, nuts, peanut butter and coconut oil (literally all I eat). Following this diet I am 5 weeks post show and 120 lbs!!! I went from being 10% body fat to having the most fat on my body I've ever had. So what do I do now? Do I just follow this new diet and wait for my metabolism to reset? I know that lowering my calories and doing cardio is only going to hurt me more in the long run (metabolism, thyroid, cortisol)... so I'm just confused and extremely unhappy. On top of that, I haven't gotten my period in months (and no I'm not pregnant). I now go to the gym 5 times a week to weight train and I take multivitamins, omega 3, potassium, digestive enzymes and probiotic5, but no more estro control... should I still be taking these supplements? I have recently started implementing your morning routine (water, yoga, smoothie) and definitely feeling better, but not looking better. Can you help me? I'm sooooo lost. And I know you are the best of the best, and the only person I would trust answering this properly, as you always look at all perspectives. Amanda: Hi Dr. Cabral, I have been listening to your show for over a year and absolutely love it. I receive more knowledge from you to help my clients than most other sources. My question is about a current private client I am working with. She is about 65, has had 2 heart attacks in the last 8 years (the last one about 2 years ago) and she is on about 12 different medicines (metformin, wellbutrin, Spironolactone, Zetia, *Metoprolol ER, *Crestor, *Aspirin, Cymbalta, Levothyroxine, Plavix, Avapro) progesterona along with 2 topical hormones estrogen and testosterone. My question is, what would be your order of operations for this client. She is open and ready to change her diet and lifestyle and ideally, one day she would love to not be taking any medications or the least amount possible. I've got her on your daily support shake and doing berry smoothies daily. We are working on increasing her stomach acid and next I would like to help her get rid of heavy metals (is there something you recommend for this that won't interfere with her medications?) She is on so many medications and I can see that they are crossing to cause many of her symptoms, I also want to be sure to take things really slow and respect her doctor decisions (although she has tried to come off medications many times and they almost always resist her requests). Any advice would be great, thanks for all that you do   Judy: Hi Dr. Cabral! I just finished your podcast (713) on body types and Inhave a follow up question. I am currently on week 2 of your detox and I have suffered for over a decade with adrenal fatigue and hypothyroidism. Therefore, I have metabolism issues that I didn’t always have at a young age. When determining my body type, should I consider my current state or when I aas a kid with no health issues? Judy: Hi Dr. Cabral, In your podcasts, you mentioned the importance of a cheat meal once a week for grehlin and leptin levels. I have a hard time resisting cravings once I cheat. I am on week 2 of your detox and no linger crave all the bad foods. I worry I will go downhill again once I allow myself the bad foods. What do you recommend I do to prevent a relapse? Are the better cheat foods to stick with that still address grehlin and leptin and avoid a relapse? What about portion sizes for cheat meals?   Thank you for tuning into today's Cabral HouseCall and be sure to check back tomorrow where we answer more of our community’s questions! - - - Show Notes & Resources: http://StephenCabral.com/771 - - - Get Your Question Answered: http://StephenCabral.com/askcabral  

On This Edition of The Zoomer Week in Review:It's the 50th Anniversary of the Kennedy Assassination. Libby is joined by Rush DeNooyer, producer of the documentary "Cold Case JFK", which uses modern forensics to determine that there was just one shooter.Plus, American authorities changed the guidelines for prescribing cholesterol- busting drugs called statins. Now instead of focusing on lowering bad cholesterol, and monitoring those levels regularly, doctors are being told to put more patients on medications like Crestor and Lipitor. How do you know if you should be taking these drugs? Cardiologist Dr. Beth Abramson is here with her advice.

How to Find a New Prescription Drug Plan Welcome Medicare Nation! Many clients have been contacting me the last several weeks to tell me their Medicare plan has dropped one or several of their prescription drugs from the plan’s formulary. MAPD plans and Stand Alone Prescription Drug Plans (PDP) may change their formularies during the calendar year. Two examples of when they can do this, is if a prescription drug is found to be unsafe by the FDA. If a prescription drug may cause serious injury or death, they will remove the drug from the market. All Medicare plans would be forced to remove that drug from their formulary. Another reason a drug may be removed or added is when a generic of the brand drug comes out. This year Crestor, a brand drug for high cholesterol, became generic. With generic drugs available, the cost of the drug to the Medicare plan goes down. The plan adds the generic to their formulary and either keeps Crestor in addition to the generic, or removes Crestor from the formulary and keeps the generic versions. If you are on a Medicare Advantage Prescription Drug Plan (MAPD), you are locked in the plan, until the open enrollment period which begins on October 15th this year, or you have a special enrollment period. You can go to www.Medicare.gov to look up special election periods, or you can listen to episode #36 published on April 15, 2016. Stand Alone Prescription Drug Plans and MAPD plans, which have prescription drugs included, will be announcing their 2017 plans and formularies by October 1, 2016. Several Medicare Advantage Plans or Stand Alone Prescription Drug Plans may be available in your area. How do you compare plans to find the right one for you or your loved one? Use the official Medicare Website Plan Finder’s database. Go to www.Medicare.gov You’ll see a Dark Blue Bar under Medicare.gov Hover your cursor over the tab that reads “Drug Coverage.” Click on the last item in the column labeled “Find Health & Drug Plans.” Add your zip code & click on “Find Plans.” Check the box that pertains to you. Original Medicare? Health Plan (MAPD)? Check the box that pertains to you in regards to assistance. Do you receive extra help? I Don’t Know? Click “Continue.” Now enter your drugs. All of them. When you enter a brand drug, a box will come up asking you if you’d prefer to check the “generic.” If you take the brand, keep the brand drug. If you use the generic – choose the generic. If you don’t know…..choose the generic for now. You can ask your pharmacist or doctor later. Select “My Drug List is Complete.” You’ll see on the right side a grayish box that has a Prescription ID# Copy that number and the Password Date. You will be able to come back and edit the drug list in the future, without having to add all the previous drugs again. What a timesaver! Now select a pharmacy you use. Then select “Continue to plan results” On this page, you’ll see a summary of your search. Select the box that pertains to your plan.    Either Prescription Drug Plan with Original Medicare or    Health Plan with Prescription Drug Plan (MAPD).       All the drug plans in your geographical area available to you will be displayed.       Now you can look at each plan to determine which plans have all your prescription drugs and which ones do not.       You can enroll directly from the Medicare.gov portal, call Medicare directly or call your insurance agent or better yet – your Medicare Advisor.       You have several options.       With your Prescription ID# and the Password Date,  you will be able to come back at a later date and edit your list.       Start getting your list together, so it will be easier for you to check out 2017 plans!  Here's the link to read the guidelines your Primary Doctor uses in prescribing you scheduled drugs. www.cdc.gov/drugoverdose/prescribing/guideline Do you have questions or feedback? I’d love to hear it! I may answer one of your questions on the air! email me: support@themedicarenation.com        Go to the Contact page and send me an email or “click” on the “Speak” button and talk to me! No other equipment is needed! Thank you for listening! If you enjoyed this podcast, please subscribe and leave a 5 star rating and review in iTunes! (Click here)     Find out more information about Medicare on Diane Daniel’s website! www.CallSamm.com    

How to Find a New Prescription Drug Plan Welcome Medicare Nation! Many clients have been contacting me the last several weeks to tell me their Medicare plan has dropped one or several of their prescription drugs from the plan’s formulary. MAPD plans and Stand Alone Prescription Drug Plans (PDP) may change their formularies during the calendar year. Two examples of when they can do this, is if a prescription drug is found to be unsafe by the FDA. If a prescription drug may cause serious injury or death, they will remove the drug from the market. All Medicare plans would be forced to remove that drug from their formulary. Another reason a drug may be removed or added is when a generic of the brand drug comes out. This year Crestor, a brand drug for high cholesterol, became generic. With generic drugs available, the cost of the drug to the Medicare plan goes down. The plan adds the generic to their formulary and either keeps Crestor in addition to the generic, or removes Crestor from the formulary and keeps the generic versions. If you are on a Medicare Advantage Prescription Drug Plan (MAPD), you are locked in the plan, until the open enrollment period which begins on October 15th this year, or you have a special enrollment period. You can go to www.Medicare.gov to look up special election periods, or you can listen to episode #36 published on April 15, 2016. Stand Alone Prescription Drug Plans and MAPD plans, which have prescription drugs included, will be announcing their 2017 plans and formularies by October 1, 2016. Several Medicare Advantage Plans or Stand Alone Prescription Drug Plans may be available in your area. How do you compare plans to find the right one for you or your loved one? Use the official Medicare Website Plan Finder’s database. Go to www.Medicare.gov You’ll see a Dark Blue Bar under Medicare.gov Hover your cursor over the tab that reads “Drug Coverage.” Click on the last item in the column labeled “Find Health & Drug Plans.” Add your zip code & click on “Find Plans.” Check the box that pertains to you.                                                 Original Medicare?                                                                           Health Plan (MAPD)? Check the box that pertains to you in regards to assistance.                     Do you receive extra help?                                                                      I Don’t Know? Click “Continue.” Now enter your drugs. All of them. When you enter a brand drug, a box will come up asking you if you’d prefer to check the “generic.” If you take the brand, keep the brand drug. If you use the generic – choose the generic. If you don’t know…..choose the generic for now. You can ask your pharmacist or doctor later. Select “My Drug List is Complete.” You’ll see on the right side a grayish box that has a Prescription ID#   Copy that number and the Password Date. You will be able to come back and edit the drug list in the future, without having to add all the previous drugs again. What a timesaver! Now select a pharmacy you use. Then select “Continue to plan results” On this page, you’ll see a summary of your search. Select the box that pertains to your plan.                                           Either Prescription Drug Plan with Original Medicare or                         Health Plan with Prescription Drug Plan (MAPD). All the drug plans in your geographical area available to you will be displayed. Now you can look at each plan to determine which plans have all your prescription drugs and which ones do not. You can enroll directly from the Medicare.gov portal, call Medicare directly or call your insurance agent or better yet – your Medicare Advisor.       You have several options. With your Prescription ID# and the Password Date,  you will be able to come back at a later date and edit your list.  Start getting your list together, so it will be easier for you to check out 2017 plans!   Do you have questions or feedback? I’d love to hear it! I may answer one of your questions on the air! email me: support@themedicarenation.com        Go to the Contact page and send me an email or “click” on the “Speak” button and talk to me! No other equipment is needed! Thank you for listening! If you enjoyed this podcast, please subscribe and leave a 5 star rating and review in iTunes! (Click here)     Find out more information about Medicare on Diane Daniel’s website! www.CallSamm.com  

You'll see more top-selling drugs go generic in 2016. But don't expect drastic price drops initially...the first generic usually has 180-day exclusivity before other generics come out. Prepare patients for these switches. Explain these are best-guess release dates...they can change due to legal maneuverings, etc. OxyContin (oxycodone ER)...available now. But advise patients generics are only out for the 10, 20, 40, and 80 mg tabs so far. Gleevec (imatinib)...February. This could be a game changer for certain leukemias...since the brand costs about $10,000/month. Crestor (rosuvastatin)...May. This is big...it's the only high-intensity statin besides atorvastatin. Consider rosuvastatin if interactions or muscle problems are an issue with atorvastatin. Nuvigil (armodafinil)...June. Explain armodafinil may last longer than modafinil...but there's no proof it's better or safer. Suggest either option for shift workers if nondrug treatments (sleep hygiene, etc) and caffeine aren't enough. Benicar (olmesartan)...October. It will join a handful of other generic ARBs. Pick one based on payer preference. ProAir HFA (albuterol)...December. Explain this generic will NOT be equivalent to Ventolin HFA, Proventil HFA, or ProAir RespiClick. Encourage prescribers to write "albuterol HFA" to give you flexibility. Zetia (ezetimibe)...December or early 2017. Suggest saving ezetimibe as an add-on for high-risk patients who can't tolerate a high-intensity statin. For patients on Vytorin, consider suggesting generic ezetimibe plus a generic statin instead...at least until Vytorin goes generic. Also look for Basaglar in late 2016. It's a new BRAND of insulin glargine that will be similar to Lantus...NOT a generic or biosimilar.

I continue to be horrified by guidelines issued by the American Heart Association and American College of Cardiology, which speak of giving statin drugs to healthy people. Meanwhile, draft recommendations from the US Preventive Task Force have issued new directives claiming that healthy people should be taking statin drugs as a “preventative against possible future illness.” Their main plan is to see one third of all adults in the United States are put on statin drugs—44% of all men and 22% of all women—even if none of these people have ever had a previous heart attack or stroke. Statins are the most widely prescribed drugs on the market. One in four Americans over 45 are already on statins, despite more than 900 studies reporting dangerous side effects from these drugs. These range from heightened risks of cancer and diabetes to sexual problems, neuropathy, and liver dysfunction, as well as immune system suppression, and even a higher risk of cataracts. In Britain too, statins are the most commonly prescribed drugs, costing the NMS £450 million a year. Now 40% of adults (175 million people) are being advised to take the drug. If the new directives are put into practice by the UK medical establishment—as they are likely to be—the numbers of men and women being prescribed statins could well become legion. What are statins anyway? Statins are a group of drugs prescribed to lower cholesterol levels by inhibiting the enzyme HMG-CoA reductase, which plays a central role in the production of cholesterol in the liver. Statins have many different names, such as Lipitor, Lescol, Mevacor, Altocor, and Zocor. These drugs are prescribed on the assumption that they will lower the risks of cardiovascular events and strokes. The new directives assert that, if given to healthy people, they could help protect the population from heart attacks and strokes at some time in the future. Happily, a growing number of cardiologists are strongly opposed to the new directives. What’s the problem with statins? Plenty: They deplete your body of CoQ10, which is essential for every cell in your body, and ubiquinol. Both CoQ10 and ubiquinol keep the so-called bad cholesterol from doing harm to your body. However, very few mainstream doctors are ever aware of these dangers. One exception is cardiologist Steven Sinatra, founder of the New England Heart Center. Sinatra recommends that anyone taking statins should take between 100 and 200 mg of CoQ10 or ubiquinol each day as protection. Statins lower Vitamin K2 in the body. This puts you at risk of deficiency of this vitamin, which contributes to chronic diseases, such as osteoporosis, cancer, and brain disease. Long-term statin use—10 years or so—has been shown to increase your risk of diabetes, neurogenerative diseases, musculoskeletal problems, and even cataracts. Dr. Eric Topol, highly respected cardiologist and Professor of Genomics at Scripps Research Institute in California, wrote an excellent article for The New York Times Opinion Page in which he warns: “We’re overdosing on cholesterol-lowering statins.” Topol is especially concerned about the sharp increase in the prevalence of Type 2 Diabetes that is occurring in people using them. He writes: “Statins have been available since the 1980s but their risk of inducing diabetes did not surface for nearly 20 years. When all the data available from multiple studies was pooled in 2010 for more than 91,000 patients randomly assigned to be treated with a statin or a sugar pill (placebo), the risk of developing diabetes with any statin was one in every 255 patients treated. But this figure is misleading since it includes weaker statins like Pravachol and Mevacor—which were introduced earlier and do not carry any clear-cut risk. It is only with the more potent statins—Zocor (now known as simvastatin), Lipitor (atorvastatin), and Crestor (rosuvastatin)—particularly at higher doses—that the risk of diabetes shows up. The cause and effect was unequivocal because the multiple large trials of the more potent statins had a consistent excess of diabetes.” Meanwhile, a recent study by Jean A. McDougall and her colleagues in the Journal of Cancer Epidemiology, Biomarkers & Prevention reveals that long-term use of statins increases the risk of both lobular and ductal breast cancer in women between 55 and 74. I am no doctor, but what I have learned during my more than forty years of writing and broadcasting on health is this: When a body is restored to healthy functioning naturally, the need for medication is either dramatically reduced or, more often than not, eliminated altogether. Statins, like most pharmaceuticals, only mask symptoms—they do not heal. Only nature can heal from within. My advice to anyone thinking of accepting the new directives is this: Before you agree to take statins, research the implications of doing so. Learn as much as you can about statin drugs. There are excellent natural alternatives, such as inexpensive dietary changes. So, if your doctor wants to prescribe statins for you, you can be sure you have done your homework. Then you’ll know yourself if these drugs are appropriate for you. Chances are they are not. Here are a few recommendations for where to start your research: U-T San Diego “Doctors assail new guidelines for statins: 18 November, 2013 Cancer Epidemiology, Biomarkers & Prevention; Published Online First July 5, 2013; doi: 10.1158/1055-9965.EPI-13-0414 http://www.greenmedinfo.com/toxic-ingredient/statin-drugs. This is an excellent compilation of dangers from statin drugs, with links to abstracts. www.ncbi.nlm.nih.gov/pubmed/24052188 Association of statin use with cataracts: a propensity score-matched analysis. This is a good source of information on the use of statins for the elderly. A. Sultan and N. Hynes, "The Ugly Side of Statins. Systemic Appraisal of the Contemporary Un-Known Unknowns," Open Journal of Endocrine and Metabolic Diseases, Vol. 3 No. 3, 2013, pp. 179-185. doi: 10.4236/ojemd.2013.33025.

I continue to be horrified by guidelines issued by the American Heart Association and American College of Cardiology, which speak of giving statin drugs to healthy people. Meanwhile, draft recommendations from the US Preventive Task Force have issued new directives claiming that healthy people should be taking statin drugs as a “preventative against possible future illness.” Their main plan is to see one third of all adults in the United States are put on statin drugs—44% of all men and 22% of all women—even if none of these people have ever had a previous heart attack or stroke. Statins are the most widely prescribed drugs on the market. One in four Americans over 45 are already on statins, despite more than 900 studies reporting dangerous side effects from these drugs. These range from heightened risks of cancer and diabetes to sexual problems, neuropathy, and liver dysfunction, as well as immune system suppression, and even a higher risk of cataracts. In Britain too, statins are the most commonly prescribed drugs, costing the NMS £450 million a year. Now 40% of adults (175 million people) are being advised to take the drug. If the new directives are put into practice by the UK medical establishment—as they are likely to be—the numbers of men and women being prescribed statins could well become legion. What are statins anyway? Statins are a group of drugs prescribed to lower cholesterol levels by inhibiting the enzyme HMG-CoA reductase, which plays a central role in the production of cholesterol in the liver. Statins have many different names, such as Lipitor, Lescol, Mevacor, Altocor, and Zocor. These drugs are prescribed on the assumption that they will lower the risks of cardiovascular events and strokes. The new directives assert that, if given to healthy people, they could help protect the population from heart attacks and strokes at some time in the future. Happily, a growing number of cardiologists are strongly opposed to the new directives. What’s the problem with statins? Plenty: They deplete your body of CoQ10, which is essential for every cell in your body, and ubiquinol. Both CoQ10 and ubiquinol keep the so-called bad cholesterol from doing harm to your body. However, very few mainstream doctors are ever aware of these dangers. One exception is cardiologist Steven Sinatra, founder of the New England Heart Center. Sinatra recommends that anyone taking statins should take between 100 and 200 mg of CoQ10 or ubiquinol each day as protection. Statins lower Vitamin K2 in the body. This puts you at risk of deficiency of this vitamin, which contributes to chronic diseases, such as osteoporosis, cancer, and brain disease. Long-term statin use—10 years or so—has been shown to increase your risk of diabetes, neurogenerative diseases, musculoskeletal problems, and even cataracts. Dr. Eric Topol, highly respected cardiologist and Professor of Genomics at Scripps Research Institute in California, wrote an excellent article for The New York Times Opinion Page in which he warns: “We’re overdosing on cholesterol-lowering statins.” Topol is especially concerned about the sharp increase in the prevalence of Type 2 Diabetes that is occurring in people using them. He writes: “Statins have been available since the 1980s but their risk of inducing diabetes did not surface for nearly 20 years. When all the data available from multiple studies was pooled in 2010 for more than 91,000 patients randomly assigned to be treated with a statin or a sugar pill (placebo), the risk of developing diabetes with any statin was one in every 255 patients treated. But this figure is misleading since it includes weaker statins like Pravachol and Mevacor—which were introduced earlier and do not carry any clear-cut risk. It is only with the more potent statins—Zocor (now known as simvastatin), Lipitor (atorvastatin), and Crestor (rosuvastatin)—particularly at higher doses—that the risk of diabetes shows up. The cause and effect was unequivocal because the multiple large trials of the more potent statins had a consistent excess of diabetes.” Meanwhile, a recent study by Jean A. McDougall and her colleagues in the Journal of Cancer Epidemiology, Biomarkers & Prevention reveals that long-term use of statins increases the risk of both lobular and ductal breast cancer in women between 55 and 74. I am no doctor, but what I have learned during my more than forty years of writing and broadcasting on health is this: When a body is restored to healthy functioning naturally, the need for medication is either dramatically reduced or, more often than not, eliminated altogether. Statins, like most pharmaceuticals, only mask symptoms—they do not heal. Only nature can heal from within. My advice to anyone thinking of accepting the new directives is this: Before you agree to take statins, research the implications of doing so. Learn as much as you can about statin drugs. There are excellent natural alternatives, such as inexpensive dietary changes. So, if your doctor wants to prescribe statins for you, you can be sure you have done your homework. Then you’ll know yourself if these drugs are appropriate for you. Chances are they are not. Here are a few recommendations for where to start your research: U-T San Diego “Doctors assail new guidelines for statins: 18 November, 2013 Cancer Epidemiology, Biomarkers & Prevention; Published Online First July 5, 2013; doi: 10.1158/1055-9965.EPI-13-0414 http://www.greenmedinfo.com/toxic-ingredient/statin-drugs. This is an excellent compilation of dangers from statin drugs, with links to abstracts. www.ncbi.nlm.nih.gov/pubmed/24052188 Association of statin use with cataracts: a propensity score-matched analysis. This is a good source of information on the use of statins for the elderly. A. Sultan and N. Hynes, "The Ugly Side of Statins. Systemic Appraisal of the Contemporary Un-Known Unknowns," Open Journal of Endocrine and Metabolic Diseases, Vol. 3 No. 3, 2013, pp. 179-185. doi: 10.4236/ojemd.2013.33025.

If you are taking a cholesterol-lowering statin drug such as Lipitor, Zocor, Crestor or Pravachol and want to add to the body what is being robbed that the heart must have, then we have important news to share with you today. WE HAVE ALL BEEN LED TO believe that cholesterol is bad and that lowering it is good. Because of extensive pharmaceutical marketing to both doctors and patients, so we think that using statin drugs is proven to work to lower the risk of heart attacks and death. But on what scientific evidence is this based, what does that evidence really show? Roger Williams a theologian; once said something that is very applicable to how we commonly view the benefits of statins. “There are liars, damn liars, and statisticians.” Tune in this Wednesday evening September 10, at 7:PM to hear the rest of the story.

Have you noticed that when a person starts taking medications, more medications are prescribed to treat the side effects caused by the original medications. Many of these side effects are caused by Medications That Cause Nutritional Deficiencies that these drugs create. In the end, these medications can really add up.   Many prescription drugs on the market cause nutrient deficiencies. For example, a common medication like the statins (Pravachol, Lipitor and Crestor), which are used to treat high cholesterol, reduces CoQ10 in the body. CoQ10 is the most abundant antioxidant in the body. It is very important for muscle function. A symptom of CoQ10 deficiency is muscle aches, like thigh or trunk pain. Patients cannot feel the depletion of CoQ10 in the heart muscle, however. Absolute CoQ10 depletion can cause heart failure and death.   Another example would be diuretics that patients are prescribed for hypertension. These medications get rid of water as well as the minerals Magnesium and Zinc. When men are deficient in Magnesium and Zinc, they are unable to make Testosterone.   So, when you look at the complex biochemical cascade, many cofactors are necessary for these pathways to run properly in the body. When one or many or lacking, the results can cause a decrease in the hormones produced. See how a simple deficiency in Magnesium or Zinc caused by diuretics can cause another problem such as low Testosterone. The male then experiences the side effects of low Testosterone, which are plentiful.   If a medication causes low Magnesium, this mineral has 300-400 functions in the body. Low Magnesium can lead to an enormous amount of problems in the body. Physicians who specialize in Functional and Regenerative Medicine or Anti-Aging can test for Magnesium and there are high-quality Magnesium supplements available if you are deficient. You can look at Triton Nutrition and read the article on Magnesium to find the best form of chelated Magnesium supplement for maximum absorption and look at their online store to view their product Mag Powersorb. Low Magnesium leads to poor blood sugar control, poor bowel function (constipation), poor blood pressure control, muscle cramps and spasms, and insomnia or poor sleep. One deficiency leads to a multitude of problems.   Proton Pump Inhibitors such as Prilosec, Nexium, and Prevacid are prescribed to reduce the amount of acid in the stomach. Without a certain amount of acid in the stomach, we don't absorb certain minerals like Calcium. So, it is common to see a person who started taking Proton Pump Inhibitors (PPI) end up with Calcium depletion and weak bones. Actually, Functional Medicine Physicians believe that the treatment with acid is what is needed instead so that the lower esophagael sphincter will tighten and close off after it is signaled by a proper amount of acid in the stomach.   Your micronutrient levels can be tested. It is necessary before you start bio-identical hormone replacement therapy to supplement any deficiencies before you start on your therapy for you to receive optimal results. Also, hormone replacement therapy can cause nutrient deficiencies so you must monitor your micronutrients so they can be replaced sufficiently. The most common deficiencies that require repletion are Folic Acid, Magnesium, and Vitamin B12 after you start your therapy. These are all necessary cofactors.   For more information, Dr. Pamela Wartian Smith, a physician with American Academy of Anti-Aging, wrote an excellent book called Vitamins, Minerals, Herbs and More. There you will find specific protocols on how to overcome specific nutrient depletions. Natural database has a chart on common medications that cause nutrient depletions.   A prescription drug depletion chart complements of Maryland Medical Center can be downloaded as well.   by Robert Seik, PharmD

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