Podcasts about Georgetown University Medical Center

Why Your Stroke May Not Be Causing Your Brain Fatigue For a long time after my brain surgery, I assumed my body worked like this: the stroke happened in my head, so whatever went wrong afterward would also happen in my head. Fatigue, brain fog, slow thinking all of it filed under “neurological,” all of it explained by the injury I already knew about. That assumption turned out to be wrong, and the way I found out was almost accidental. About eighteen months after my brain surgery, I had thyroid surgery to remove a nodule so large it had pushed my windpipe and esophagus six centimeters out of place. I had no idea it was there. No lump I could see, no difficulty swallowing or breathing that I’d noticed. It was found only because I had a chest X-ray to rule out an infection, and a doctor spotted something that had nothing to do with why I’d walked in. What followed was a slow, confusing recovery from that second surgery, and a wave of fatigue I automatically blamed on my brain, because that was the injury I already understood. It took time to realize the fatigue might be coming from somewhere else entirely: my thyroid. Hormones and Stroke Recovery: The Connection Nobody Talks About I brought this experience to Dr. Robert Hedaya, a Clinical Professor of Psychiatry at Georgetown University Medical Center and a pioneer of functional medicine psychiatry, to understand what actually happened, and to ask a bigger question: how many other stroke survivors are dealing with fatigue, brain fog, or mood changes that they’ve written off as “just the stroke,” when the real driver is a hormonal system that’s quietly stopped working properly? Hormones and stroke recovery turn out to be far more entangled than most of us are told. As Dr. Hedaya put it plainly: the brain is a hormonal organ. Thyroid hormone, cortisol, testosterone, estrogen every one of them acts directly on brain tissue, and every one of them can be knocked off balance by the stress of a major medical event. Why “Normal” Thyroid Bloodwork Can Still Mean Something’s Wrong One of the most important things Dr. Hedaya explained is that a “normal” TSH result doesn’t rule out a thyroid problem, especially after a stroke. TSH is a signal sent from the pituitary gland, and if a stroke has affected the brain’s signaling pathways, the pituitary itself may not respond the way it should. A survivor can have genuinely low thyroid hormone while their TSH sits comfortably inside the standard reference range, because the system responsible for raising that number in response to a deficiency isn’t functioning correctly. He also raised a striking data point: population studies suggest the average TSH in a healthy population is closer to 1.4, yet most labs still use an upper reference limit of 4.5, a range wide enough, statistically, to miss a real problem. His advice for survivors going into a GP appointment: ask specifically for TSH, free T4, free T3, and reverse T3, not just the standard single-marker test, and come prepared with symptoms written down if a doctor pushes back. A Nodule That Grew in Silence The brain is a hormonal organ. It’s an immune organ. It’s a neurological organ… there’s not one hormonal axis when it’s abnormal that cannot cause neurological or psychiatric problems. -Dr. Robert Hedaya My own nodule is a case study in exactly this kind of silent progression. Dr. Hedaya explained that because it grew inward rather than outward, it never created the visible lump most people associate with a thyroid problem, and because it didn’t press on my vocal cords or laryngeal nerve, I never developed the hoarseness that might have flagged it sooner. My body adapted gradually, and the fatigue that eventually surfaced was easy to misattribute to the injury I already knew I had. Cortisol, Stress, and the Difference Between Pain and Suffering Beyond the thyroid, Dr. Hedaya walked through the role of cortisol, the body’s primary stress hormone, and why survivors often struggle to answer a deceptively simple question: “Are you stressed?” His distinction between pain and suffering is worth sitting with: pain is often unavoidable, but suffering is shaped by the story we tell ourselves about a situation, and a stroke can compromise the very brain systems that regulate that stress response in the first place. Testosterone, Estrogen, and the Brain’s Need for Hormones to Rewire The conversation closed on sex hormones, testosterone and estrogen, relevant to both men and women, and their role in neuroplasticity. Dr. Hedaya drew a direct comparison to adolescence: the teenage brain rewires itself while hormone levels are surging, and the same principle applies after a stroke. A brain trying to rebuild pathways needs adequate hormonal support to do that work. Without it, recovery can stall in ways that have nothing to do with effort or physiotherapy. What You Can Do About It If any of this sounds familiar fatigue that doesn’t track cleanly with other recovery milestones, or symptoms a doctor has waved off as “just stress,” Dr. Hedaya’s PNIE (psycho-neuro-immuno-endocrinology) questionnaire is a useful starting point. PNIE Questionnaire download: https://drive.google.com/file/d/1S7kC5uMFgBfS-gWcUOIHp0kOjGnrzZK5/view?usp=sharing If thyroid function specifically is what you’re navigating, the earlier conversation with Dr. Elena Zinkov, “Stroke Fatigue and Thyroid,” goes deeper into that piece (https://recoveryafterstroke.com/stroke-fatigue-and-thyroid/). And for more from Dr. Hedaya, the first conversation on photobiomodulation and stroke recovery is a good companion listen (https://recoveryafterstroke.com/photobiomodulation-stroke-recovery/). Getting your body back after a stroke is rarely just about the brain. My book, The Unexpected Way That A Stroke Became The Best Thing That Happened, goes further into the mindset shifts that came out of my own recovery (recoveryafterstroke.com/book). And if this podcast has helped you, you can support its continuation at patreon.com/recoveryafterstroke. This blog is for informational purposes only and does not constitute medical advice. Please consult your doctor before making any changes to your health or recovery plan. Hormones, Fatigue, and the Brain: Dr. Robert Hedaya Returns (Interview) A baseball-sized thyroid nodule hid in plain sight after Bill’s stroke. Dr. Hedaya explains the hormone testing every survivor should ask for. Support The Recovery After Stroke Podcast Bill’s Book: The Unexpected Way That a Stroke Became Thethe Best Thing That Happened Highlights: 01:45 Hormones and Stroke Recovery 02:11 Understanding Thyroid Function and Its Impact 17:07 Navigating Thyroid Health with Healthcare Providers 27:09 The Role of Stress and Cortisol 39:09 Nutrition’s Impact on Brain Recovery Transcript: Hormones and Stroke Recovery Bill Gasiamis (00:00) And they noticed a massive lump in my throat and my esophagus and my windpipe were pushed six centimeters. And they said to me, well, can you swallow? Can you breathe? Can you do it? And I was like, yeah, I’m all fine. There’s nothing wrong with my throat. that was the first sign that there was something wrong with my thyroid Bill Gasiamis (00:19) Welcome back to Recovery After Stroke. I’m Bill Garciamas, and today I’m joined again by Dr. Robert Hedeya, clinical professor of psychiatry at Georgetown University Medical Center and a pioneer of functional medicine psychiatry, whose highland approach to brain health first brought him onto the show for our conversation on episode 404, where we discussed, amongst other things, photobiomodulation, a type of transcript. cranial laser therapy helping some stroke survivors recover lost function. He’s back today for a conversation I wanted to have for a while, the hormonal side of stroke recovery. We’re going to talk about thyroid function, cortisol, and stress physiology, and sex hormones like testosterone and estrogen, and why every one of these systems can directly affect how well and how fast your brain recovers. I’ll also share my own story of a thyroid nodule that grew undetected, which was discovered after my brain surgery completely by accident. if this conversation resonates with you, my book, The Unexpected Way That a Stroke Became Thethe Best Thing That Happened goes deeper into the mindset shifts that shaped my own recovery. You can find it at recoveryafterstroke.com/book. And if you’d like to help keep this podcast going, you can support it financially at patreon.com/recoveryafterstroke. Bill Gasiamis (01:46) Robert Hedaya, welcome back to the podcast. Dr Hedaya (01:49) Thank you for having me, Bill. Understanding Thyroid Function and Its Impact Bill Gasiamis (01:51) thank you for being here. The last conversation we had was very well received. And it’s always difficult in a one hour interview to ask all the questions that we could possibly ask about the brain and stroke recovery and all the things that people go through. And… I’ve got a lot of other questions that are related to the brain and the link between other parts of the body and the brain, because we have this sense. Well, I did at least when I was first diagnosed that whatever happens in my head is kind of isolated, that it just impacts my head. But there seemed to be some other impacts and cascading effects. that were occurring, uh, that I didn’t know were linked to the brain injury, Dr Hedaya (02:45) Yeah. Bill Gasiamis (02:46) maybe indirectly, but they were perhaps. But one thing specifically that happened to me about, uh, 18 months after my brain surgery was I had thyroid surgery to remove a nodule on my thyroid. And when I was going through the recovery after that, surgery, I noticed that I had fatigue and I thought it was neurological fatigue related to my brain surgery. But it took a long time to develop an understanding that perhaps that batch of fatigue was related to my thyroid. And then that got me thinking all sorts of things. know, if the thyroid also causes the same neurological fatigue that brain injury causes, what people might be missing this in their healing from a brain injury, they might have a compromised thyroid and not know about it. So the first question is, what is a thyroid? What does it do? And why does it cause neurological fatigue? Dr Hedaya (03:54) Okay. So thyroid gland sits in the neck, right? There’s two lobes, there’s one on the right, one on the left, a little kind of island in the middle called the isthmus, and and it controls many functions, metabolism overall, energy overall, just broadly speaking. now it affects the immune system. It’s affects the nervous system. It affects the gastrointestinal system, it affects the muscles, it affects the heart, right? It affects the skin, it affects the nails, it affects the hair. You know, and I could go on and on and on. Okay? Bill Gasiamis (04:34) Wow. Dr Hedaya (04:35) Now the interesting thing about this is that this be a little technical, but the thyroid puts out a hormone called T4 or thyroxine, and this is a little molecule with four iodines in it on it, and that Gives you about 20% of the activity of your thyroid hormones in your body. But then that T4 goes all over the body to different tissues, and each tissue can has its own system to change that T4 into T3 by removing an iodine. T3 has 80% of the thyroid activity. So that means each tissue in the body can control how much thyroid it. It’s using and needs, right? And and has available to it. Okay. So that means the brain, the heart, the liver, the lungs, every tissue has its own enzyme that allows it to kind of modulate how much thyroid, right? Now, so why does that cause neurological fatigue? Well, thyroid in the brain affects neurotransmitters like adrenaline in the brain, which is called nor norepinephrine, noradrenaline. in order for that to work. The T3 has to be in the right amount for the receptors for the noradrenaline to be structurally correct so they can transmit the signal. It’s necessary for production of energy in all the brain cells. It helps the immune system in the brain. It carries molecules from here to there in the brain. it affects serotonin transmission in the brain, so mood regulation, anxiety, obsessiveness, depression. You know, those are just some of the functions of the brain, but it affects every cell in the bane in the brain. So you’re gonna, if your thyroid is off, most likely you’re gonna have some kind of brain problems, particularly, you know, when your thyroid is off, the tissues in your body that are most compromised or most stressed, that’s probably where it’s gonna show up, right? And in the case of stroke, that’s where it’ll show up. Bill Gasiamis (06:44) So it’s possible then, is it possible to overlook it? Is it very obvious that your thyroid is out of, well, is dysregulated or is not working properly? Dr Hedaya (06:56) Well, in general it’s easy to detect. And if you want, I’ll tell you how. So Bill Gasiamis (07:04) Yeah. Tell me how. Dr Hedaya (07:07) so there’s some blood tests that are simple and then s some symptoms. so for most people this holds. When your thyroid is low, you know, you’re gonna be cold easily, you’re gonna have dry skin, brittle nails, hair will fall out. Muscles will be weak, thinking will be slow, movement will be slow, getting up from a chair will be more difficult, going upstairs will be more difficult, your heart rate will slow down, you’ll be constipated. Those are the most common symptoms. If your thyroid is overactive, then you could be have palpitations, oily skin, acne, oily hair. Diarrhea, you know, kind of the opposite. The thing that’s a little confusing with the thyroid is sometimes overactive thyroid can show up and look like it’s underactive symptomatically, or vice versa. So you really need the labs. And the labs are TSH, which is thyroid stimulating hormone, and that’s tells you what the brain is doing. And then free T4. That’s the amount of T4 that’s kind of floating around free, not bound to protein, so it can actually do its job. The way I think of it is like, you know, a lot of the thyroid home is sitting on a bus. It’s not free, it’s bound to protein. Can’t do its job. But the stuff the thyroid this that’s out of the bus or not on a protein, that can do its job. That’s the free T four. And then the free T three, right, which carries eighty percent of thyroid activity. And then the last one is a reverse T3 because sometimes if your tissues in your body are making too much thyroid or getting too much thyroid, they’ll actually, instead of taking the iodine off the T4 molecule on the right side, they’ll take it off on the left side, or vice versa. So they make a fake T3 that doesn’t work. And this way they short circuited okay, you got all this T3. Well, let’s make it into a fake, fake T3 so it can’t do anything. So reverse T3 is also very important. And then you want to measure body temperature. Usually it’ll be low. And then, you know, a physical exam. Those are the ways to do it. If you wanted to go even deeper, you could do some genetic testing. There are genes that will tell you whether you’re converting the T4 to T3 in the brain. Adequately, or maybe you’re more likely to be slow in that regard. So you can have normal numbers in your blood, but your brain might be hypothyroid, right? And there are actually a lot Bill Gasiamis (10:05) Uh-huh. Dr Hedaya (10:05) of studies showing that hypermetabolic, like high doses of free T3, actually reverse treatment-resistant depression because it’s it’s thought that there’s a local in-brain. hypo-low thyroidism. You can have low thyroidism in your heart, in your muscles, but not in the other tissues, you know, because I told you every tissue can control how much it’s making. So if you have a genetic vulnerability, then you you might more be in general be more likely vulnerable to depression or to ADD or to anxiety, things like that. Bill Gasiamis (10:42) Wow. Are you blowing me away? I didn’t expect to hear any of the things that you just said. X. Um, some of the things that you described, the, uh, some of the symptoms that you described, had those intermittently in and out all the time, other than a thyroid nodule, which is what I had, which was obvious on a scan. Dr Hedaya (11:05) Yeah. Bill Gasiamis (11:06) What other things caused the thyroid to not function? correctly. So is there lifestyle factors that interfere with the thyroid gland and therefore, you know, then have the cascading effect and take off, take all those other things or some of those other things offline. Dr Hedaya (11:28) So there a number of causes, right? So first of all, let’s take someone who has had a stroke or chronic illness, right? So you’re under stress and that affects your stress hormones, your adrenal glands, cortisol, etc. Well, if your adrenals kind of poop out, then maybe your body says, Well, I can’t handle all this thyroid, even though the amount is normal, it’s like too much. I can’t handle it, so it’ll make less thyroids. Now you develop a hypothyroidism. You could develop it just because all the chemicals in the environment, the ha the hormone interrupting chemicals, there are hundreds of those. you could develop it ’cause of nutritional deficiencies like tyrosine is necessary to make thyroid hormone, copper, you know, things like that. I can’t tell you offhand which which nutritional factors, but people can look that up, what nutritional factors are important. To make thyroid hormone. and then infections like, for example, Lyme disease causes Hashimoto’s thyroiditis, which is an autoimmune where your immune system’s actually attacking your thyroid. COVID vaccination, like the Pfizer and the Moderna vaccine, if you are genetically vulnerable, can also cause your immune system to attack your thyroid. So there are many, many causes, plus there are inherited genetic vulnerabilities and it It’s not always low thyroid, sometimes it’s high thyroid, hyperthyroidism, like Graves’ disease, right? You can have antibodies Bill Gasiamis (13:01) Mm-hmm. Dr Hedaya (13:02) that are actually stimulating thyroid activity as well. Bill Gasiamis (13:06) Wow. The environmental toxins. we talking about all day, every day household use kind of environmental toxins? I imagine the external of the house, they’re kind of out of our control, right? We’ll talk about like, you know, like pollution or things that are associated to things that are caused that we don’t necessarily control, but internally inside the house or what we expose ourselves to that we can control. what would some of those environmental toxins Dr Hedaya (13:38) Well Bill Gasiamis (13:39) be? Dr Hedaya (13:40) so for example, you know, in your produce, you know, there are pesticides, or in the man made materials in your car or the man made materials in your home. Let’s say you bought a new home and you have, you know, some kind of synthetic floors or furniture with synthetic materials or materials that are natural that are treated with chemicals for various reasons. Those things all can be not everyone is, but many of them are called homes. hormone interruptors because they actually can change the way your hormones function. You know? So we’re the truth is we’re bathed in these chemicals. They’re everywhere. And very hard to escape them. The best thing you can do is kind of try to detox them using a healthy diet, a lot of crucifer vegetables and lots of vegetables, above ground vegetables that are grown in healthy soil. Without pesticides, organic preferably, right? and then there are supplements you can take, such as metagenics makes something called UltraClear Plus, which helps support the liver, and its detox functions. You know, some people are more vulnerable than others, but you know, these thyroid nodules you like you have, they’re very, very common now. Very common. And that’s you know. In large measure, I think these hormone interrupters that are interfering with how the the thyroid follicles in the thyroid gland are operating. Bill Gasiamis (15:13) Is it possible to have thyroid nodules and not know about it? I, I Dr Hedaya (15:18) Yeah. Bill Gasiamis (15:19) say that because I had nodules that were the size of a baseball, apparently in my throat that were growing inwards, that didn’t make a lump outside of my throat, which Dr Hedaya (15:33) Yeah. Bill Gasiamis (15:34) I was not aware of. And the way they found it was they did a chest X-ray after brain surgery because I wasn’t recovering well. to check my chest to see if there’s an infection. And they noticed a massive lump in my throat and my esophagus and my windpipe were pushed six centimeters. Dr Hedaya (15:52) Wow. Bill Gasiamis (15:53) I’m not sure what that is in inches. And they said to me, well, can you swallow? Can you breathe? Can you do it? And I was like, yeah, I’m all fine. There’s nothing wrong with my throat. But that was the first sign that there was something wrong with my thyroid before that. there was no sign of it. I ask that because either I’m totally oblivious or it is possible to have thyroid nodules and not know it. Dr Hedaya (16:23) Well, most people don’t know it. Now yours is so massive, but I think it’s kind of what you said is how it grew. If it grew towards your vocal cords or your laryngeal nerve or something, you would have had some pretty bad hoarseness or something like that. But it grew I guess backwards so it didn’t interfere that much. And I guess your s your body adapted gradually over time. You know, yes, it’s very possible for sure. Very common. Bill Gasiamis (16:49) And how would somebody interact with a general practitioner, for example, now to go through the process of understanding, A, their thyroid health and whether or not they have any nodules. Navigating Thyroid Health with Healthcare Providers Dr Hedaya (17:02) I mean in other words, given what we’ve talked about, how should they approach their doctor basically? Bill Gasiamis (17:07) Yeah. Dr Hedaya (17:08) I guess I would say go to AI, get a list of the symptoms of low thyroid or high thyroid or all of them, check them off. So then when you go to the doctor you have a list, check your temperature, check your pulse, although the doctor will should check that. And then you could say, look, I have these symptoms, or maybe you don’t have any. But if you do, you have these symptoms, and clearly thyroid hormone levels can affect the brain. And I’d like a TSH, a free T4, a free T3, and a reverse T3. That’s it. And if they Bill Gasiamis (17:45) Okay, perfect. Dr Hedaya (17:46) say, no, no, we don’t need to do that, you know, a lot of times what they do, they’ll just do a TSH. Or they won’t do the reverse T3. They don’t, unfortunately, look at the thyroid gland in a dynamic way. They say, the TSH is fine. If your thyroid was low, your TSH would go high. We don’t need to do the rest. But that’s not true. That’s not true at all. Because especially if you had a stroke, your pituitary function may be compromised. Your TSH may be fine or low and your low thyroid. As matter of fact, in the last interview, the case that I talked about, who referred me to you, she actually had a low TSH, but she had a very low, I think it was a free T4. Or free T3 or both, whatever it was, but she had too little thyroid hormone, and her pituitary couldn’t respond because of the stroke. Bill Gasiamis (18:37) understood. So that’s a great list of Dr Hedaya (18:37) So so be you have to be dogmatic and you say to the doctor, look Even put into even put into AI and say, look, if the doctor comes back to me and argues against these tests, what should I say? You gotta be prepared because the doctor will steamroll you. You know, that they only allow this, they only allow that, I’ll only do the free T4. Well, that doesn’t tell you how much has been converted to T3, free T3, and it doesn’t tell you, even if the free T3 is normal, that doesn’t mean you’re not overproducing thyroid and and dis you know, and neutralizing it with the reverse T three. So, you know I mean I I mean I think it’s s so important that a thorough look is is really important. If you have the symptoms, you know. Bill Gasiamis (19:22) I agree with you. That list of to-dos, I’m gonna put that on the show notes. People can go and get that list if they don’t wanna go into AI themselves or they haven’t got the time or whatever. They can just download it from there. And then they’ll be able to take that and begin a conversation with their general practitioner. What’s interesting is that I’m in Australia, you’re in the United States. My general practitioner is pushed back when a… when a patient will turn up and say, I have these tests? They’ll say, well, no, you don’t have any condition that is obvious that you need these tests. So it’s not covered. So you don’t need to do it. So my next suggestion to them is no problem. Order the tests and I’ll pay for them. Now it’s not ideal, but if you’re not going to do them for me and I need to know, cause it’s my health, I’m going to pay for them. So just tell me how much it is and I’ll find a way and I’ll make it happen and I’ll pay for it. So that’s another option. Dr Hedaya (20:17) Yeah. But if you go in with your symptom list, right, and you say, Well, that’s not true, because these are the symptoms, you know, that I have, here they are, right here. You can take a look, you know. And then the last thing I’ll say, this gets even more tricky, is the reference range, I’m sure in Australia, but certainly in the United States, the reference range basically is of the TSH, the pituitary home. Is 0.5 to 4.5, meaning you anywhere in that range and your TSH is normal. That is a bad reference range. And I know it to be a fact because I I I guess I won’t waste your time with it, but I did a study on a hundred people and with a very sensitive thyroid test called a TRH stimulation test. and I was able I hired a statistician to calculate this. And say, well, I don’t want to keep doing this test on everybody. What TSH predicts an abnormal TRH stimulation test? And he came back and said to me, Well, once the TSH is over 1.4, it starts to increase your odds of having an abnormal TRH stimulation. So I said, okay, so 1.4 TSH is my cutoff, right? That’s in my mind. I said, okay, that’s that’s my cutoff, that’s when I get suspicious. Later, several years later, a paper came out, a large, large study, called the NHANES Study, Nurses Health, and I’m not sure what it stands for. Thousands of people followed over many, many years, over decades, and they found the mean TSH in the US population is 1.4. So, right where I what right where my study found. So that means statistically, it is not. impossible to have the upper limit of the reference range being at four point five because statistically the upper limit is never more than two standard deviations. So even if your standard deviation is 1.4, which it can’t be, you you’re not going to reach 4.5, right? Unless you have a it’s called a bimodal distribution curve. If you have that, then you’d say, well, it it could be. But we don’t have that with thyroid. So that reference range is wrong. The upper limit of the reference range should be 2.5. And about half the endocrinologists in the United States believe that. And half say, no, no, no, don’t change it. So that’s another sticky point because, you know, easily people get a result and they’ll go to the doc and say, no, the reference range is 4.5. You’re normal. Then you could say, well, look, I have these symptoms, and they could do a literature search. What’s the normal reference point? What in in the N A N HANES N-H-A-N-E-S study? It’ll show you 1.4. and you could take be prepared to go to the doctor and say, Well, here’s a study that suggests that the reference range may be incorrect. and I have symptoms by the way. We don’t treat the lab, we treat the person. So could we give a trial? Just a trial, there’s no harm done, you know, trial. Let’s see let’s start at a very low dose. Let’s see how I feel. Maybe I’ll get better. I’ll come back in a month. Bill Gasiamis (23:45) Yeah, I love that. It’s really good advice, especially coming from someone who is a doctor who think is thinking on the same way as me, for example, the patient. Because that’s like a match made in heaven. And that’s so rare to be able to get that. Often, my challenge to my general practitioner was well, the reference range isn’t that average of a sick population, because it’s usually a sick population that comes to see you to get bloods. It’s It’s not the most healthiest people that come to see you to get bloods. And that’s kind of how I try to like start the conversation of convincing a general practitioner to do a test that they’re reluctant to do. And when I say they’re reluctant, I’m not in there every day. I’m not in there every week. And I’m not putting stress on the system to an extent where I’ve been over using the system. I’m not at all. in there once, twice a year, maybe, you so if I’m in once, twice a year, well, then, I’m not mucking around. Like I’ve come there to investigate something that I’m suspecting is wrong with me. It’s my body. I’m feeling something. had a bit of a look online. This is what I suspect. Don’t try and convince me out of my thinking or my instinct more better. Why don’t we just, work together to get to the bottom of it. If it is something it is, if it’s not, it’s not, and that’s okay. Not a big deal. I’m better to know. then not no, I think, you know, it’s better to be safe than sorry in my mind. Dr Hedaya (25:16) Yeah. I would I would only think only correction I would make is the reference ranges generally are made on normal populations. Now now the thing is who’s normal anymore? Number one. Number two, that’s a statistical norm that doesn’t tell you anything about your genetics. your vulnerabilities, it’s not an individualized statistic. I mean it’s it not an individualized thing. What’s your normal range? And are you out of your normal range? Nobody can answer that, right? Unless you had previous data before you were ill. And you say, well look, I’ve been running at a 1.1 for five years or 10 years and now I’m at 3.2. That’s a big change. Well, you know you’re stressed. Well yeah maybe but here are my symptoms. Always come back to your symptoms. Bill Gasiamis (26:11) Got it, got it. Dr Hedaya (26:12) No. Bill Gasiamis (26:13) You use the word stress just now and my general practitioner says, I might go in and some bloods might be out of whack or some things might be not feeling great. And he’ll say, are you stressed? And I’m like, well, I’m not stressed. like, I’m not stressed in any way that I can say is worse than normal. For example, I’m Dr Hedaya (26:35) Mm-hmm. Bill Gasiamis (26:36) just, you know, I’m attending to my clients at work. picking up the kids from school, I’m, you know, making sure the bills are paid. Like I’m just doing the normal things that I always Dr Hedaya (26:48) Right. Bill Gasiamis (26:48) do, which tend to be stressful. And somehow when we talk about stress, cortisol seems to come into the conversation. Dr Hedaya (26:57) Mm-hmm. The Role of Stress and Cortisol Bill Gasiamis (26:58) And I don’t know how to respond to a general practitioner who says to me, am I stressed? Because I’m not experiencing something extreme or dramatic. in the months before I came to see him. So can we have a conversation a little bit about stress, cortisol, what is stress, what is cortisol, are they linked? Tell me about that, give me your thoughts. Dr Hedaya (27:21) Okay. Okay, so this is a multi-layer system. Okay, it starts with your perception and your of a situation and the story you tell about you the story you tell yourself about the the situation and your need for control of a situation and as opposed to saying I’m in the flow of the universe and All right, this is you know, this is the way it is, and I’ll adapt to it. Not so easy by the way, but it’s a much healthier way because most things will not stress you. Now, pain, let’s say you stepped on a nail, you’re gonna have stress, okay? Totally stressful, etc. But there’s a a difference between pain and suffering. Most of our problem is suffering. Suffering is a result of thinking patterns. perspectives of yourself and the world and the future and blah blah blah. I could talk about that for a long time. And that is probably one of the most important places to intervene and to train yourself, etc. Now, once this thing is registered as stress, it goes through back to the hypothalamus and the pituitary where all those hormones are controlled, the hypothalamus and pituitary in the brain, now you’ve God forbid, you’ve had a stroke. Those things may be affected, therefore, those systems may not be working well. In that case, you may not be able to handle stresses that you used to handle. You may not you may not have those shock absorbers. So, how do you measure this? I think the way you measure it again are symptoms, and typically it would be low cortisol and low DHA, d DHEA, and low pregnenolone. And the symptoms would be a lot of fatigue, right? Maybe poor wound healing, muscle aches, body pains, getting sick more easily, cognitive slowing, depression, anxiety, extreme exhaustion, salt cravings, in unstable temperatures, you know, I would say yeah You know, th loss of appetite in severe cases, you know, dizziness on standing. Okay. So those are the low adrenal output things. Now how d how do you measure and again, you think you have a problem, go to an AI thing, make that list, check it off, whatever applies, and you know, work yourself up symptomatically and then ask well, okay, what what are the best tests here? What are the best test. Now the way I test it is I get morning I got a morning like eight to nine a.m fasting ACTH and cortisol. It’s gotta be in the morning around between eight and nine a.m. fasting. I also at the same time get a D, like David, H E A and a D H E A sulfate, and then I also get a pregnenolone. And if I think there’s any kind of sex hormone problem that I want to check, then I will check a free testosterone, FSH, LH, and The testosterone measures the free testosterone is very unreliable. So if it comes out low, you want to do it two more times to double check that. But the other measures are pretty reliable. And then you’ll you’ll know the other thing you can do is you could do something called a Dutch test, which is a urine test that’ll look at your cortisol through the day, or an adrenal saliva test. It’s ASI, alleval adrenal saliva index, the Dutch test. or the ASI, both good tests. and those will tell you what’s going on through the day. Like if you’re not sleeping, it could be because your cortisol high at night, you know. Wake up horrible or in pain. Could be because your cortisol is really low in the morning. Really low. You can’t even get out of bed, you know, can’t get going, right? So these are all all things that you can do to measure and then you can replace these hormones and That’s one thing to do. The other thing to do is to work on how you manage stress. There are millions of ways of doing that, right? From meditation to heart math to Bill Gasiamis (32:05) Mm-hmm. Dr Hedaya (32:06) yoga to you know, there’s just a lot a lot a lot of ways to Bill Gasiamis (32:10) Yeah, let’s go back for a moment and talk about testosterone because when I hear testosterone, I’m hearing you say to a male that I need to have testosterone in my body and at certain levels, et cetera. And sometimes it can fall out of whack and you need to get it tested. I had mine tested recently. It’s all good. But women also need testosterone. Tell me about that. Dr Hedaya (32:35) Yeah, so I was I was thinking of both male and female when I said it, Bill Gasiamis (32:38) Yeah. Dr Hedaya (32:39) because it’s it’s you know, women who are postmenopausal can have it’s much more common to have a low free testosterone loss of libido, you know. testosterone the studies which I’ve reviewed a few times, you know, there’s a debate does it affect the mind, the brain, you know. It seems to have an effect on well being, on vitality muscles, sex drive obviously, libido erectile function, brain cognitive function, some mood effects, etc. So I I think it’s important now i it it has to be managed in women as well as men. You know, in in women testosterone is a step on the way to estrogen as it is in men, right? And in the metabolism, right? So it it should certainly be assessed in everybody. Bill Gasiamis (33:39) Yeah. And estrogen, mentioned estrogen. Now, one of them in my mind, it seems to be more associated again to women, estrogen, especially. And, and then men also have estrogen, need estrogen. Dr Hedaya (33:55) Men also have estrogen. I haven’t studied it so I couldn’t tell you, but I imagine it’s doing something. it probably turns men into better leaders after they’re fifty, is my guess. Let Bill Gasiamis (34:08) more emotionally intelligent. Dr Hedaya (34:10) more emotionally intelligent, less testosterone, you know. You know, I I I Bill Gasiamis (34:15) You know what? That’s a good theory. We’ll run with that for now. I might relate to that, know, who knows. Dr Hedaya (34:22) Yeah. I I think Bill Gasiamis (34:24) Awesome, awesome, so… Dr Hedaya (34:24) Yeah, so w for for women on estrogen, it depends, you know, who are you assessing? Are you that’s a whole complex subject, you know. Is it a young woman who’s menstruating? Does she have premature ovarian failure, endometriosis, ovarian cysts, insulin resistance, they all kind of travel together, methylation problems, they travel together. is it someone who’s perimenopausal where she’s starting to lose progesterone and getting a lot of PMS? That’s pretty easy. You can replace the progesterone. Is it postmenopausal a woman who’s just kinda lost the estrogen, lost the progesterone? You know, if there’s a family history of cognitive decline or dementia or something like that, there’s great evidence that transdermal estrogen and some oral progesterone bio bioidentic, not synthetic, is great and reduces the risk for lots of disorders later in life for women. You know. So there’s a whole you know, there’s a whole way of working all that up, depending on who who you’re looking at. But very important. Now so the let me Bill Gasiamis (35:31) Yeah, I love it. Yeah. Dr Hedaya (35:34) say this. The important thing here, and this is maybe the most important thing. Someone’s had a stroke, they’re obviously tremendously stressed. You have to look at all the hormones. You can’t the brain is a hormonal organ. It’s an immune organ. It’s a neurological organ. I used to teach psycho, neuro, immuno, and the chronology at Georgetown for a number of years. Okay? And the brain and hormones, you can’t separate it. So if the brain is under stress, the hormonal axes are under stress, and there’s not one hormonal axis when it’s abnormal that cannot cause neurological or psychiatric problems. Okay? So you must, as part of the work of anyone who’s had stroke. You must look at the endocrine, the hormonal axis. You know, you must look at it. Why? Because if you’re trying to recover from a stroke and you don’t have adequate hormones, it’s gonna be much, much harder. Much, much harder. Right? But Bill Gasiamis (36:37) Peace. Dr Hedaya (36:38) if you have if you have the the hormones at good levels, okay, now the the brain has that. If it has its nutrients, it has that, you know, okay, now it can do something, you know. What happens, think about it this way. What happens in adolescence? The brain is being rewired, the body’s growing, brain is rew being rewired. Where are the hormones? The hormones are skyrocketing. They’re necessary for the rewiring. You had a stroke, you’re trying to rewire brain, you gotta have adequate hormones. Bill Gasiamis (37:10) I love it. This is the thing that people miss. You know, we talk about the gap in stroke recovery. Acute phase gets handled Dr Hedaya (37:19) That’s Bill Gasiamis (37:19) 99 % of the time really well. People get patched up and they get sent home in some kind of alive state, whether they are fully functional Dr Hedaya (37:27) Yeah. Bill Gasiamis (37:28) or working towards it or whether they are less functional and working towards being more functional, like some kind of stage Dr Hedaya (37:35) Mm-hmm. Bill Gasiamis (37:36) of you’re alive and you’re good enough to go home. And then there’s no information after that. So how do we assess address? How, what do we know? What do we not know that we need to know? And this is kind of what this conversation is, right? It’s like, okay, here’s Dr Hedaya (37:53) Yeah. Bill Gasiamis (37:53) a whole bunch of things we’ve just discussed. There might have been things that you heard for the first time. Don’t let that, get in the way of your curiosity and investigate the thing that pricked your ears up, whether it was a symptom that Dr. Hedaya mentioned and just do a little bit more work in understanding what that is, take that to your general practitioner and begin the conversation of taking responsibility for your recovery. And in my mind, like there’s gotta be like a foundational thing that people can do to intervene that doesn’t cost most of the time anything extra. And that helps encourage and nourish the brain in overcoming these challenges, but then has the a cascade effect of having the same positive outcome on all the other organs and hormones. And that to me is nutrition. So like, if you’re, if you would suggest to somebody how they might start thinking about their nutrition as opposed to what they might have been doing before stroke, how do you begin that conversation? And what are the two or three fundamental things that they need to consider? about nutrition. Nutrition’s Impact on Brain Recovery Dr Hedaya (39:11) Okay, so If it doesn’t grow that way, don’t eat it. I never saw a bread tree. I didn’t see an ice cream tree or a Twinkie tree. Okay. So if it doesn’t grow that way, don’t eat it. Balance your plate. Balance your plate. And actually our coach, Caroline Hade, is putting out an ebook. I don’t know, should be out at a week or two or three weeks. It’s like, I don’t know, four or five dollars or something. and that will tell you exactly how to balance your plate. and then I would say very important to have three meals and maybe, depending on your how insulin resistant you are, maybe additionally two snacks. and per day, but keep your calories you don’t want to be overweight, okay, because if you’re overweight, you know, that’s a That’s its own risk factor for brain problems, right? but you can’t lose weight in a day, you’re stressed, you’re hungry, you’re tired, you eat the carbs, you know, everybody struggles with that. But that that is one of the biggest enemies of eating eating eating these processed carbs that we all love is one of the biggest enemies of your health. One of the biggest enemies of your health for sure. Bill Gasiamis (40:35) Okay, there are some great resources that people can again look into how to eat to heal the brain. And we didn’t have to have a deep conversation about that. But I love Dr Hedaya (40:45) Mm-hmm. Bill Gasiamis (40:45) what you said about balancing the plate. And if it didn’t grow that way, don’t eat it. It’s such a simple thing. If it comes in a packet on a shelf in a supermarket with all fancy pictures Dr Hedaya (40:59) Yeah. Bill Gasiamis (41:00) and stickers and a list of ingredients, like it’s probably not nutritional. of food. It’s probably something that’s going to make inflammation worse. It’s probably something that’s going to give you the type of energy that is not helpful. It’s probably going to have a whole bunch of other things. And that’s kind of my approach to healing and recovering my brain. It’s one of the first things I did was just look at my nutrition, immediately stop smoking and drinking. mean, I know it should go without saying, but sometimes you have to have a stroke for it to actually sink in and make sense. and don’t have any alcohol at all. I’m talking about forever if you can, but I didn’t have alcohol Dr Hedaya (41:46) Yeah. Bill Gasiamis (41:47) for at least the first four or five years. And now in the next five years or so, maybe I had one glass per year, just because I was, in an event where it was, everyone was drinking and it was almost necessary to have sip or half a sip or act as if I was drinking. So with that, I think we’ll wrap up this conversation today. There’s been a lot for people to digest, go back and listen to it a second time. And a third time that we have some resources in the show notes. And Dr. Hedaya, thank you for joining me again. And I look forward to our conversation that’s coming up in a few weeks time where we’re going to talk about toxin load and neuroplasticity. Dr Hedaya (42:29) Beautiful. Thanks so much for the opportunity, Bill. I hope I hope people get something out of this and they pursue what they need to pursue. Bill Gasiamis (42:36) Well, that’s a wrap on this conversation with Dr. Robert Hedeya. If there’s one thing to take from today’s interview, it is this. The brain is a hormonal organ and recovery isn’t just about the brain healing in isolation. Thyroid, cortisol, testosterone, estrogen, all of it is connected, and all of it is worth checking if your recovery has plateaued in ways that don’t quite make sense. Dr. Hadea’s free PNIE questionnaire is linked in the show notes. Download it, work through it, and take it with you to your next GP visit. If you want to go deeper on the thyroid piece specifically, go back and listen to the earlier episode with Dr. Elena Zinkov on stroke fatigue and thyroid. And if you missed it, the first conversation with Dr. Hedeya on photobiomodulation is a great companion to this one. if this episode has helped you, share it with someone who needs to hear it. That’s genuinely the best way to help this show reach more survivors. My book, The Unexpected Way That a Stroke Became the Best Thing That Happened, is available at recoveryafterstroke.com/book. And if you’d like to support the show financially, you can do so at Patreon by going to patreon.com/recoveryafterstroke. Until next time, take care of yourself and don’t assume it’s just a stroke. The post Hormones, Fatigue, and the Brain: Dr. Robert Hedaya Returns appeared first on Recovery After Stroke.

Reflections from host Sarah Olivieri ... $20 Million in Grants, Suddenly Gone: How One Nonprofit Survived A year ago, a single nonprofit had $20 million in federal grants on the books. Three awards from three different agencies. By every conventional measure, the funding base looked strong. Then federal priorities shifted. All three grants were eliminated. The organization went from 30 staff to 18 in a matter of months, but they are still standing. That nonprofit is From Prison Cells to PhD, and its founder, Dr. Stanley Andrisse, is the guest on this week's episode of Inspired Nonprofit Leadership. The story has stayed with me, and this article is where I want to go deeper on the part of it that most fundraising conversations skip. The part most people focus on is the funding loss itself. That is the dramatic surface. The part that actually explains why this organization is still standing, and rebuilding faster than most would, sits one layer underneath. Their grant portfolio was huge, but every single dollar of it was aligned to their core mission. There was no program built to chase money that drifted from what they exist to do. When the grants disappeared, what was left was a smaller version of the same organization, not the wreckage of a stretched and confused one. That is the lesson I want to draw out here. Diversified funding gets the headlines in nonprofit strategy conversations. Mission alignment gets less airtime. The truth is, neither one works without the other. An organization with five revenue streams and a sprawl of mission-drifted programs is just as fragile as an organization with one revenue stream and a tight mission. The combination matters, and the combination is what makes a nonprofit shock-resistant. Mission Creep Is The Hidden Cost Of Grants Most leaders I work with know about mission creep in the abstract. They have heard the warning. Where it actually shows up is in the language of a grant application. A funder wants outcomes the organization does not currently produce. A funder wants a population the organization does not currently serve. A funder wants a program design the organization does not currently run. The grant is large. The deadline is short. The board is anxious. The cash flow is tight. The leader makes a small adjustment to fit the application. The grant lands. A program gets built around the requirements. Six months in, the staff is running a workstream that no one in the organization is particularly proud of, but the money is keeping the lights on, so it stays. Multiply that pattern by three or four grants over five years, and the organization no longer looks like itself. The mission statement on the website has not changed, but the actual portfolio of work has drifted significantly. From the inside, leaders rarely notice. They are too close to it. The drift only becomes visible when something forces them to subtract. This is the trap. Grants do not just bring in money. They bring in shape. Every restricted grant is a small set of constraints applied to the organization. A few of those constraints, aligned to the mission, sharpen the work. A lot of them, applied without discipline, distort the work into something else. What Mission Alignment Actually Protects When From Prison Cells to PhD lost $20 million in a single year, the organization did not face the second crisis that usually follows a funding crisis. The second crisis is the realization that half of what you have been doing was never really the work you wanted to do, and now you have to dismantle programs that staff and stakeholders are emotionally attached to in addition to surviving the revenue gap. Because every grant had been mission-aligned, the response was straightforward. Smaller staff. Same work. Same scholars. Same outcomes at a smaller scale. The organization could be honest about what it was paring back without having to defend choices made to chase prior funders. There were no orphaned programs to wind down. There was no donor narrative to untangle. The proportional scale-back was clean. This is what mission alignment actually protects. It protects the speed of your response in a crisis. It protects the morale of your team. It protects your credibility with the funders you still have, because the work that survives is recognizable as the work you have always done. And it protects your ability to rebuild, because the case for support stays consistent. You are not selling a new version of yourself to new donors. You are inviting them into the version that has always been there. Diversification Is The Other Half Of The Equation A mission-aligned organization that has built only one funding pipeline is still fragile. When that pipeline cuts off, the response is still hard. The work stays clear, but the resources to do it disappear. This is where the funding cake framework comes in. I use this language with clients all the time. Major donors are the base layer of the cake. They give unrestricted. They stay for life. They refer their friends. They are insulated from political swings because their decision is personal, not policy-driven. Individual donors at lower giving levels are the next layer. Corporate sponsorships, where they fit, are another layer. Planned giving sits with the major donor layer. Grants are the icing. Icing is wonderful in the right proportion. It is also the most exposed layer of the cake. It melts under the wrong heat. Organizations that treat grants as the foundation are running a cake made of icing, and the first political shift becomes an existential event. Organizations that treat grants as one accelerant among several can lose a major grant and stay upright. From Prison Cells to PhD did not have only grants. They had foundation relationships. They had city and state partnerships. They had philanthropic supporters who had given before and gave again. The grants were significant, but they were one layer in a stack. When that layer disappeared, the stack got shorter, not flat. Why The Two Pieces Have To Move Together This is the part I want every nonprofit leader reading this to take away. Mission alignment without diversified funding is admirable but exposed. Diversified funding without mission alignment is broad but distorted. The combination is what produces an organization that can take a hit and keep going. Picture the inverse of From Prison Cells to PhD's experience. Imagine an organization that took the same $20 million in grants, but each grant required a slight pivot, a new population, a new methodology, a new geography. When the grants disappear, that organization does not just lose revenue. It loses the programs the grants were funding, programs that were never quite the work the organization exists to do, programs that other funders will not back because they do not fit the brand of the organization either. The rebuild from that position takes years. The rebuild from From Prison Cells to PhD's position takes months, because the foundation underneath was always intact. Mentorship was another thread that came up in the conversation, and it deserves a mention here. Dr. Andrisse's own story turns on a mentor who saw a capacity in him that nothing in his environment was reinforcing. That same posture, applied at the program level, is part of what makes the organization's work effective. It is not separate from the funding story. The organizations that hold their mission tight enough to attract long-term funders tend to be the same organizations that hold their participants tight enough to produce real outcomes. Identity discipline at the leader level shows up as program discipline at the participant level and as funding discipline at the development level. It is the same muscle. What This Means For Your Next Grant Decision The practical implication is uncomfortable, because it asks leaders to leave money on the table sometimes. When a grant application asks you to describe work you do not actually do, the right answer is usually no. When a grant requires a population shift or a methodology shift that pulls you off your core, the right answer is usually no. When a grant requires you to invent a program to fit the funder's interests, the right answer is almost always no. The leaders who get this right tend to share a habit. Before applying for any significant grant, they ask one question. If this funder disappeared tomorrow, would this program still belong inside our organization? If the answer is yes, the grant is aligned. The work compounds. The grant lands and strengthens the organization. If the answer is no, the grant is a trap dressed up as a windfall. The work distorts. The grant lands and weakens the organization's center. This discipline is hard in the moment. The deadline is short. The cash flow is tight. The board wants the win. The discipline is also what produces the From Prison Cells to PhD outcome instead of the cautionary tale outcome. What Becomes Possible When mission is the filter and funding is the stack, the leader stops running the organization in reactive mode. There is room to say no to grants that distort the program. There is room to build the slower, deeper donor relationships that produce unrestricted gifts. There is room to develop staff into leadership rather than burning them out chasing the next application. There is room to take a $20 million loss and still be standing, smaller, but recognizable, and ready to rebuild on the same foundation that has always been there. The work is still hard. The mission is still complex. The world is still unpredictable. What changes is that the organization is no longer fragile. It can take a hit. It can take three hits. It can keep going. This isn't about doing less work. It's about doing work that compounds. Nonprofits can survive losses that would close other organizations. They can rebuild faster than seems possible. They can stay recognizable to themselves through hard seasons. Not by pushing harder, but by holding the mission steady and building the stack underneath it. About the Guest Dr. Stanley Andrisse is an endocrinologist, scientist and assistant professor at Howard University College of Medicine is researching type 2 diabetes and insulin resistance. Dr. Andrisse is a visiting faculty at Georgetown University Medical Center, held a visiting faculty position at Imperial College London, and held an adjunct professorship at Johns Hopkins Medicine after completing his postdoctoral training. Dr. Andrisse completed his PhD at Saint Louis University and his MBA and bachelor's degree at Lindenwood University, where he played three years of collegiate football. Dr. Andrisse's service commitments include: Executive Director and Founder of From Prison Cells to PhD, Vice President of the board for the Formerly Incarcerated College Graduates Network, board member on The Endocrine Society, past president of the Johns Hopkins Postdoctoral Association, founder of the Diversity Postdoctoral Alliance, member of several local and national committees, motivational speaker, and community activist. Connect with Stanley: Breaking Chains, Building Futures: Pathways to Redemption, Education, and Excellence — Amazon link Facebook: @Prof.Andrisse Instagram: @dr_andrisse LinkedIn: Dr. Stanley Andrisse X (Twitter): @Dr_Andrisse From Prison Cells to PhD (P2P) Website: www.fromprisoncellstophd.org Facebook: @fromprisoncellstophd Instagram: @prison2pro LinkedIn: From Prison Cells to PhD X (Twitter): @prison2pro TikTok: @prison2pro YouTube: From Prison Cells to PhD Be sure to subscribe to Inspired Nonprofit Leadership so that you don't miss a single episode, and while you're at it, won't you take a moment to write a short review and rate our show? It would be greatly appreciated! Let us know the topics or questions you would like to hear about in a future episode. You can do that and follow us on LinkedIn.

In many hospitals around the world, the neonatal unit is seen as the safest place for a newborn baby who needs anything more than basic care provided in the postpartum unit. Yet this well-intentioned reflex to protect a baby “just-in-case” can carry hidden costs. A new study led by Dr Indira Narayanan, neonatologist and researcher at Georgetown University Medical Center, suggests that a small but impactful number of babies admitted to neonatal units may not actually need intensive care at all. Instead, these admissions can increase pressure on already stretched units, especially in low-and middle-income countries, separate mothers from their babies, and unintentionally undermine breastfeeding efforts.

Havana Syndrome is not crickets, not mass hysteria, and not psychogenic illness — and Pentagon advisor Dr. James Giordano has the credentials and firsthand investigation to prove it. Days after 60 Minutes revealed the Pentagon secretly purchased and tested a directed energy weapon that reproduced the injuries, Georgetown neuroscientist Giordano joins The Good Trouble Show to deliver the most definitive expert account of Havana Syndrome to date. In 2018, Dr. Giordano briefed U.S. Special Operations Command and called these attacks "a beta test of a viable neuro weapon" — six years before the government's secret weapon purchase became public. He personally investigated 24-25 members of the original Havana cohort and confirms over 100 validated cases worldwide. In this interview, we cover directed energy and neuroweapons science, device miniaturization, the broader neuroweapons landscape, proliferation risks, the absence of international treaty protections, connections to anomalous phenomena research, and the human cost to service members who were injured and then told it was all in their heads. Dr. James Giordano is Professor of Neurology, Biochemistry, and Ethics at Georgetown University Medical Center, Senior Scientific Advisor to the Pentagon and DARPA, advisor to NATO and the World Health Organization, and heads the Center for Strategic Deterrence and Study of WMD at the National Defense University. He holds TS/SCI clearance.Investigative journalism on government accountability — subscribe for more.Become a supporter of this podcast: https://www.spreaker.com/podcast/the-good-trouble-show-ufo-uap-politics-interviews--5808897/support.Sponsorship Inquires:  sponsors@thegoodtroubleshow.comSubstack:  https://substack.com/@thegoodtroubleshowLinktree: https://linktr.ee/thegoodtroubleshowPatreon: https://www.patreon.com/TheGoodTroubleShowYouTube: https://www.youtube.com/@TheGoodTroubleShowTwitter: https://twitter.com/GoodTroubleShowInstagram: https://www.instagram.com/thegoodtroubleshow/TikTok: https://www.tiktok.com/@goodtroubleshowFacebook: https://www.facebook.com/The-Good-Trouble-Show-With-Matt-Ford-106009712211646Threads: @TheGoodTroubleShowBlueSky: @TheGoodTroubleShow

Send us a textDr. James Giordano, Ph.D. is the Director of the Center for Disruptive Technologies and Future Warfare in the Institute for National Strategic Studies at the National Defense University ( https://inss.ndu.edu/Centers/Center-for-Disruptive-Technology-and-Future-Warfare/ ). He is Professor Emeritus in the Departments of Neurology and Biochemistry, and Senior Scholar Emeritus of the Pellegrino Center for Clinical Bioethics of Georgetown University Medical Center, Washington, DC. Dr. Giordano has served as Senior Scientific Advisory Fellow of the Strategic Multilayer Assessment Branch of the Joint Staff, Pentagon; Senior Bioethicist of the Defense Medical Ethics Center; Distinguished Fellow in Science, Technology and Ethics of the Stockdale Center for Ethics at the United States Naval Academy; and as an appointed member of the Neuroethics, Legal and Social Advisory Panel of the Defense Advanced Research Project Agency (DARPA), and an appointed member of the Department of Health and Human Services' Secretary's Advisory Committee for Human Research Protections. Dr. Giordano is internationally recognized for his research on the use of neurocognitive sciences and technology in military and intelligence operations.A widely published author of over 350 peer-reviewed papers in the international scientific literature, and 25 governmental reports, Dr. Giordano's recent books include Brains and Bioethics; Neuroscience, Neuroculture and Neuroethics; and Neurotechnology in National Security and Defense: Technical Considerations, Neuroethical Concerns ( https://www.amazon.com/Neurotechnology-National-Security-Defense-Considerations/dp/1482228335 ).Dr. Giordano received a Ph.D. in biopsychology from the City University of New York, a Master of Arts in neuropsychology from Norwich University; a B.Sc. in physiological psychology from St. Peter's College; completed post-doctoral training in neuropathology and toxicology at the Johns Hopkins University Medical Center, and is currently completing a D.Phil. in political philosophy of science at the East Bavaria Technical University-Regensburg, Germany. Dr. Giordano is a former Fulbright Fellow; an elected Fellow of the Hastings Center for Ethics; the European Academy of Science and Arts; and the Royal Society of Medicine (UK); and frequently lectures in German and Italian.#JamesGiordano #CenterForDisruptiveTechnologiesAndFutureWarfare #InstituteForNationalStrategicStudies #NationalDefenseUniversity #Neurobiology #Nociception #Neuroethics #Biosecurity #Neurotechnology #Biotechnology #Biomanufacturing #ArtificialIntelligence #DirectedEnergyWeapons #AutonomousSystems #QuantumTechnologies #SuperSoldiers #Bioenhancement #MilitaryMedicalOperations #WarfighterPerformanceAugmentation #Neuroscience #Weaponization #Countermeasures #STEM #Innovation #Science #Technology #Research #ProgressPotentialAndPossibilities #IraPastor #Podcast #Podcaster #Podcasting #ViralPodcastSupport the show

What if the fears, traumas, and limiting beliefs stored in your body are the very things shaping your reality, and you could rewrite them to create the life you were meant to live? Tune in for an inspiring discussion with Cathleen Beerkens on her new book Your Creator Matrix: How to Use Optimal Wellness and Quantum Healing to Master Your Story and Create Your Reality.  Moments with Marianne airs in the Southern California area on KMET1490AM & 98.1 FM, an ABC Talk News Radio Affiliate!  https://www.kmet1490am.comCathleen Beerkens, a dedicated health professional, holds degrees from the University of Maryland and Georgetown University, with over 12 years of diverse experience at Georgetown University Medical Center. In Washington, DC, she contributed to various medical settings, including the emergency room, medical/surgical ward, and high-risk labor and delivery units. In 1996, Cathleen's journey led her to Amsterdam, where she delved into integrative medicine, earning certifications in practices such as Polarity Healing, Reflexology, and Reconnective Healing. Graduating as a certified Health Coach in 2017, she founded A Wellness Revolution in 2018. The organization globally trains Health and Wellness Coaches, emphasizing holistic coaching rooted in cellular well-being. Through her practice, Cathleen empowers individuals across professions, fostering positive change in the global landscape of health and wellness.   https://www.awellnessrevolution.comFor more show information visit: https://www.mariannepestana.com/

The Cognitive Crucible is a forum that presents different perspectives and emerging thought leadership related to the information environment. The opinions expressed by guests are their own, and do not necessarily reflect the views of or endorsement by the Information Professionals Association. During this episode, Dr. James Giordano discusses a broad range of topics related to national security from biopsychology to complexity to neurotechnology to enactivism. Recording Date: 25 Jun 2025 Research Question: James Giordano suggests an interested student or researcher examine: “How might the convergence of neurotech, big data, and AI lead to improved human and multinational relations, and in these ways, contribute to avoiding conflict and warfare?” Resources: Cognitive Crucible Podcast Episodes Mentioned #72 Noah Komnick on Cybernetics and the Age of Complexity James Giordano NDU Website Enactivism Architectonics Heilmeier Catechism N3: Next-Generation Nonsurgical Neurotechnology Bioethics and Brains, published by MIT Press, which I co-authored with my longtime colleague Dr John Shook Neuroscience, Neuroculture and Neuroethics, published by Springer, which I co-authored with John Shook and Dr Roland Benedikter Link to full show notes and resources Guest Bio:  Dr. James Giordano is the Director of the Center for Disruptive Technologies and Future Warfare of the Institute for National Strategic Studies at the National Defense University. He is Professor Emeritus in the Departments of Neurology and Biochemistry, and Senior Scholar Emeritus of the Pellegrino Center for Clinical Bioethics of Georgetown University Medical Center, Washington, DC. Dr. Giordano has served as Senior Scientific Advisory Fellow of the Strategic Multilayer Assessment Branch of the Joint Staff, Pentagon; Senior Bioethicist of the Defense Medical Ethics Center; Distinguished Fellow in Science, Technology and Ethics of the Stockdale Center for Ethics at the United States Naval Academy; and as an appointed member of the Neuroethics, Legal and Social Advisory Panel of the Defense Advanced Research Project Agency (DARPA), and an appointed member of the Department of Health and Human Services' Secretary's Advisory Committee for Human Research Protections.  Dr Giordano is internationally recognized for his research on the use – and ethical guidance and governance - of neurocognitive sciences and technology in military, intelligence and global security operations A widely published author of over 350 peer-reviewed papers in the international scientific literature, 25 governmental reports, 37 book chapters, and 10 books - which most recently include Bioethics and Brains; Neuroscience, Neuroculture and Neuroethics; and Neurotechnology in National Security and Defense: Technical Considerations, Neuroethical Concerns. Dr. Giordano is a former Fulbright Fellow; an elected Fellow of the Hastings Center for Ethics; the European Academy of Science and Arts; and the Royal Society of Medicine (UK); and frequently lectures in German and Italian. A former United States Naval officer, he was winged as a Naval Aerospace Physiologist, co-designated as a Research Physiologist and Psychologist, and served with US Navy and US Marine Corps. About: The Information Professionals Association (IPA) is a non-profit organization dedicated to exploring the role of information activities, such as influence and cognitive security, within the national security sector and helping to bridge the divide between operations and research. Its goal is to increase interdisciplinary collaboration between scholars and practitioners and policymakers with an interest in this domain. For more information, please contact us at communications@information-professionals.org. Or, connect directly with The Cognitive Crucible podcast host, John Bicknell, on LinkedIn. Disclosure: As an Amazon Associate, 1) IPA earns from qualifying purchases, 2) IPA gets commissions for purchases made through links in this post.

In this episode of Health Matters, we discuss what causes dizziness with Dr. Louise Klebanoff, a neurologist with NewYork-Presbyterian and Weill Cornell Medicine. Dr. Klebanoff explains the different types of dizziness, such as lightheadedness, vertigo, and gait instability. We also cover how to differentiate between these types, the potential causes, and  when to seek medical attention.___Dr. Louise Klebanoff, MD has been named the Chief of General Neurology and the Vice Chair of Operations for the Department of Neurology at Weill Cornell Medical College. She is also an Assistant Attending Neurologist at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.  Dr. Klebanoff received her medical degree from Georgetown University Medical Center, graduating first in her class, and went on to complete a residency in Neurology and a fellowship in Critical Care Neurology at NewYork-Presbyterian Hospital/Columbia University Medical Center.Prior to joining the Weill Cornell faculty, Dr. Klebanoff served as Attending Neurologist at Beth Israel Medical Center, where she also held leadership roles on various committees and served as the first female president of the Medical Board.Dr. Klebanoff is board certified in Psychiatry and Neurology. She is a member of the Alpha Omega Alpha honor society, the American Medical Association and the American Academy of Neurology.___Health Matters is your weekly dose of health and wellness information, from the leading experts. Join host Courtney Allison to get news you can use in your own life. New episodes drop each Wednesday.If you are looking for practical health tips and trustworthy information from world-class doctors and medical experts you will enjoy listening to Health Matters. Health Matters was created to share stories of science, care, and wellness that are happening every day at NewYork-Presbyterian, one of the nation's most comprehensive, integrated academic healthcare systems. In keeping with NewYork-Presbyterian's long legacy of medical breakthroughs and innovation, Health Matters features the latest news, insights, and health tips from our trusted experts; inspiring first-hand accounts from patients and caregivers; and updates on the latest research and innovations in patient care, all in collaboration with our renowned medical schools, Columbia and Weill Cornell Medicine. To learn more visit: https://healthmatters.nyp.org

In this #episode of the Longevity & Aging Series, Dr. Shubhankar Suman from the Department of Oncology at Georgetown University Medical Center joins host Dr. Evgeniy Galimov to discuss a #research paper he co-authored in Volume 17, Issue 1 of Aging (Aging-US), titled: “Senolytic agent ABT-263 mitigates low- and high-LET radiation-induced gastrointestinal cancer development in Apc1638N/+ mice.” DOI - https://doi.org/10.18632/aging.206183 Corresponding author - Shubhankar Suman - ss2286@georgetown.edu Author interview - https://www.youtube.com/watch?v=ClLO0ERwC0M Video short - https://www.youtube.com/watch?v=M_WEht4vy4w Sign up for free Altmetric alerts about this article - https://aging.altmetric.com/details/email_updates?id=10.18632%2Faging.206183 Subscribe for free publication alerts from Aging - https://www.aging-us.com/subscribe-to-toc-alerts Keywords - aging, senescence-associated secretory phenotype, senolytic agent, carcinogenesis, inflammation, β-catenin To learn more about Aging (Aging-US), please visit our website at https://www.Aging-US.com​​ and connect with us: Facebook - https://www.facebook.com/AgingUS/ X - https://twitter.com/AgingJrnl Instagram - https://www.instagram.com/agingjrnl/ YouTube - https://www.youtube.com/@AgingJournal LinkedIn - https://www.linkedin.com/company/aging/ Bluesky - https://bsky.app/profile/aging-us.bsky.social Pinterest - https://www.pinterest.com/AgingUS/ Spotify - https://open.spotify.com/show/1X4HQQgegjReaf6Mozn6Mc MEDIA@IMPACTJOURNALS.COM

Episode 10 highlights examples of how patient advocacy groups influenced pharmaceutical decisions at the US Food and Drug Administration (FDA). In a conversation with health policy researcher, author and activist, Sharon Batt PhD, we explore regulatory decisions on Relyvrio (AMX0035), Avastin (bevacizumab), and Addyi (flibanserin) within the context of our latest report “What Needs to Change at the FDA?Protecting and Advancing Public Health.”Pharmanipulation is produced by PharmedOut, a project at Georgetown University Medical Center that advances evidence-based prescribing. Additional Resources Full Report “What Needs to Change at the FDA? Protecting and Advancing Public Health”: https://georgetown.box.com/s/n87us836fpmdhtcvdaqopyobfwx7bymx  Webinar on “What Needs to Change at the FDA?”: https://www.youtube.com/watch?v=4g9br3wZW-k&t=11s  Article on “How some drug companies manipulate patient advocates” by Judith Garber: https://lowninstitute.org/how-some-drug-companies-manipulate-patient-advocates/  

Dean's Chat hosts, Drs. Jensen and Richey, welcome Dr. Douglas Pacaccio, director of the Northwest Illinois Foot and Ankle Surgical Fellowship program. Dr. Pacaccio graduated from the University of Illinois at Urbana/Champaign with a dual degree in biology and philosophy-focused on ethics.  In interview you will hear how this has helped shape his perspective and viewpoint.  He went on to complete his podiatric medical degree with Rosalyn Franklin University and did his 3-year surgical residency with the prestigious Inova Fairfax program.  He continued his education with a plastic surgery fellowship at Georgetown University Medical Center and then moved back to Illinois to start his practice with his wife who is also a podiatrist. Tune in as we discussed all things podiatric medicine and surgery, including how Fellowship impacted his own career and now what his thoughts are regarding fellowship training with special insights from a current fellowship director. Listen as we discuss academics and how to acquire life long learning skills.  Join us as we discuss complex hindfoot reconstructive surgery and how simple beginnings sparked his interest in the field along with the impact of watching the ingenuity and craftsmanship of his father. Join us as we dive into the importance of community and giving back. Dr. Pacaccio also has multiple patents for medical devices and shares his experiences and how curiosity and necessity began to spark innovation.  He also dives into important concepts including what brings joy, satisfaction and happiness into our lives.  Stay tuned for upcoming episodes where we dive deeper into this with a new session coined "Deep thoughts with Doug". https://www.orthoillinois.com/find-a-provider/douglas-pacaccio-dpm-facfas/ https://www.acfas.org/ https://bakodx.com/ https://bmef.org/ www.explorepodmed.org www.apma.org https://podiatrist2be.com/  

BUFFALO, NY—February 18, 2025 — A new #research paper was #published by Aging (Aging-US) on January 8, 2025, in Volume 17, Issue 1, titled “Senolytic agent ABT-263 mitigates low- and high-LET radiation-induced gastrointestinal cancer development in Apc1638N/+ mice.” Researchers Kamendra Kumar, Bo-Hyun Moon, Santosh Kumar, Jerry Angdisen, Bhaskar V.S. Kallakury, Albert J. Fornace Jr., and Shubhankar Suman from Georgetown University Medical Center explored whether a drug called ABT-263 could help reduce the risk of gastrointestinal (GI) cancer caused by radiation exposure. Their findings suggest that ABT-263, a senolytic agent, helps eliminate harmful aging cells in the gut, reducing inflammation and lowering cancer risk in mice. These results could lead to potential treatments for people exposed to radiation, including cancer patients and astronauts. Radiation exposure, whether from medical treatments, environmental sources, or space travel, can damage cells and increase the risk of GI cancer. One key factor in this process is cellular senescence, where damaged cells stop dividing but continue to release harmful molecules that promotes tumor growth. This study tested whether ABT-263, a drug designed to remove these aged cells, could lower cancer risk in a mouse model of GI cancer. In this study, researchers exposed mice to radiation and found that it increased the number of damaged cells in their intestines, leading to more tumors. However, when the mice were given ABT-263, the number of harmful cells decreased, and they developed fewer tumors. The drug also reduced inflammation and blocked signals that promote cancer growth. “Oral administration of ABT-263 in Apc1638N/+ mice resulted in a significant reduction in low-LET IR-induced intestinal tumor burden at 5 months post-exposure." These findings highlight the potential of senolytic drugs like ABT-263 as a preventive treatment for radiation-induced cancers. This approach could be especially beneficial for cancer patients undergoing radiation therapy, astronauts exposed to cosmic radiation, and individuals at risk from environmental sources such as radon gas. However, while ABT-263 showed promise, it also has known side effects, including reduced platelet counts, which can impact blood clotting. Future research will focus on optimizing senolytic treatments to ensure they are both safe and effective for human use. Scientists are also exploring alternative drugs and combination therapies that might offer the same benefits with fewer risks. This study provides strong evidence that removing senescent cells could help prevent radiation-related GI cancer. With further research, senolytic drugs may become an important tool in protecting at-risk populations from the long-term effects of radiation exposure. DOI - https://doi.org/10.18632/aging.206183 Corresponding author - Shubhankar Suman - ss2286@georgetown.edu Video short - https://www.youtube.com/watch?v=M_WEht4vy4w Subscribe for free publication alerts from Aging - https://www.aging-us.com/subscribe-to-toc-alerts About Aging-US The mission of the journal is to understand the mechanisms surrounding aging and age-related diseases, including cancer as the main cause of death in the modern aged population. The journal aims to promote 1) treatment of age-related diseases by slowing down aging, 2) validation of anti-aging drugs by treating age-related diseases, and 3) prevention of cancer by inhibiting aging. (Cancer and COVID-19 are age-related diseases.) Please visit our website at https://www.Aging-US.com​​ and connect with us: Facebook - https://www.facebook.com/AgingUS/ X - https://twitter.com/AgingJrnl Instagram - https://www.instagram.com/agingjrnl/ YouTube - https://www.youtube.com/@AgingJournal LinkedIn - https://www.linkedin.com/company/aging/ Pinterest - https://www.pinterest.com/AgingUS/ Spotify - https://open.spotify.com/show/1X4HQQgegjReaf6Mozn6Mc MEDIA@IMPACTJOURNALS.COM

Today on America in the Morning   Gaetz Report Released The House Ethics Committee released a long anticipated report into allegations of illegal sexual relations with an underage girl and drug use by former Trump Attorney General nominee and Republican Congressman Matt Gaetz. John Stolnis has more from Washington.    Mangione's Day In Court The man accused of fatally shooting the CEO of United Healthcare went before a judge in New York City. Correspondent Julie Walker reports as Luigi Mangione pleaded not guilty to state murder and other charges inside the courtroom, outside there were protests demanding he be released.     North Carolina Police Officer Killed A Greensboro, North Carolina police officer was killed after he responded to a 9-1-1 call about a man with a gun inside of a supermarket. Correspondent Lisa Dwyer reports.    Texas Sues NCAA Just 24 hours after President-elect Donald Trump told a crowd in Arizona that he will end what he called the “transgender lunacy,” Texas announced it is filing a lawsuit against the NCAA, as transgender athletes are about to face another challenge in court. Correspondent Gethin Coolbaugh reports.     Biden Commutes Death Sentences In his last month in office, President Joe Biden is commuting the sentences of most every prisoner on federal death row. Correspondent Donna Warder has the details.    Bill Clinton Hospitalized Bill Clinton has been hospitalized after developing a fever. The 78-year-old former president was in Washington, DC at the time, and was taken to Georgetown University Medical Center as a precaution for treatment and observation.      Busy Travel Day Today will be a busy travel day as a part of a tough travel week, with millions of Americans also facing weather issues including rain and snow in the Pacific Northwest and the Northeast, and some rain in the Midwest. Correspondent Julie Walker reports holiday travel did get off to a good start for some leaving early.    Trump On Panama & Greenland President-elect Donald Trump is doubling down on statements that he wants control of the Panama Canal returned to the United States, and that America should purchase Greenland from Denmark.     Migrant Arrested For NYC Subway Murder Critics are blasting New York City after surveillance video showed some people running away while others were standing around and watching after a woman was set on fire on a subway train. Pamela Furr reports fast action by police caught the primary suspect in the horrific killing, an illegal migrant from Guatemala who had been previously deported.    Dangerous California Surf A major storm is pounding California's central coast creating damaging surf conditions, and at least one person has died.  Correspondent Ben Thomas reports.    Arrest In Chemical Leak The head of a chemical company is facing charges in Michigan, related to the 2022 oil and chemical discharge into the Flint River.  Correspondent Haya Panjwani reports.    FAA Investigating Florida Drone Incident As Florida authorities are trying to determine why some drones fell from the sky in Orlando, Florida during a Christmas light show, the FAA is now getting involved after a young boy was hit by a falling drone and required life-saving surgery.  Correspondent Mike Hempen reports.     Nordstrom Sold A major department store chain is being sold and one of those buying Nordstrom is a Mexican retail group. Correspondent Rita Foley reports.     Tech News Quantum communications promises near instant transfer of massive amounts of data. But, until now, it was not able to traverse the existing Internet. Here's Chuck Palm with today's tech news.    Finally   This one most likely was not on your holiday gift list. Correspondent Norman Hall reports there's been an uptick in the sales of nuclear bomb shelters.    As we begin to close the door on Hollywood and music in 2024, Kevin Carr takes a look ahead for what we need to know about some of the top entertainment events in 2025. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Host: Charles Turck, PharmD, BCPS, BCCCP Guest: Joshua E. Reuss, MD The phase 2 ICARUS-Lung01 study evaluated not only the efficacy and safety of datopotomab deruxtecan (Dato-DXd) in patients with previously treated advanced non-small cell lung cancer (NSCLC), but also potential biomarkers associated with response and/or resistance. Here to discuss the findings with Dr. Charles Turck is Dr. Joshua Reuss, Assistant Professor in the Department of Medicine at Georgetown University Medical Center.

Welcome to another insightful episode of the NeuroNoodle Neurofeedback and Neuropsychology Podcast! This episode features tech legend Jay Gunkelman and special guest Dr. Robert Hedaya, a pioneer in Functional Medicine and laser therapy.

In this episode, Cassandra interviews Cathleen Beerkens about her new book, “Your Creator Matrix: How to Use Optimal Wellness and Quantum Healing to Master Your Story and Create Your Reality”. Cathleen Beerkens is an author, speaker and a dedicated health professional with a diverse background in nursing and a passion for holistic wellness and healing. She has recently published her first book, Your Creator Matrix. Holding a BS degree in Health Education from University of Maryland and a BSN from Georgetown University, Cathleen embarked on her nursing career at Georgetown University Medical Center in Washington, DC.  Driven by a desire to share her insights with the world, Cathleen founded A Wellness Revolution in 2018 (awellnessrevolution.com). This organization is dedicated to training and certifying Health and Wellness Coaches globally. Through A Wellness Revolution, Cathleen Beerkens continues to be a catalyst for positive change in the global landscape of health and wellness. Grab your copy of Your Creator Matrix here:https://amzn.to/3XKrVsk Follow and stay up to date with Cathleen here:https://www.instagram.com/awellnessrevolution?igsh=em1uamxqNWI1ejQ%3D&utm_source=qr https://www.awellnessrevolution.com/ https://www.youtube.com/channel/UCIrkiWzJZvMxwAh28MDZTmA Grab the DDYL 101 workshop for FREE at -https://www.divinelydesignyourlife.com/DDYL101 SIGN UP TO GET ACCESS TO THE *FREE* REALIGNMENT BUNDLE + CONSCIOUS LIFESTYLE DESIGN ASSESSMENT + BUNDLE  —https://cassandrabodzak.activehosted.com/f/33 Work with Cassandra One on One:https://cassandrabodzak.com/one-on-one-with-cassandra Grab the “Amplify your Magnetism” 40 day guided manifesting through meditation journey here:https://www.divinelydesignyourlife.com/offers/9W5F4G7C/checkout Ready to get accountable and have Cassandra's coaching towards writing that book or launching that course, business or website! This group is for you!Join Cassandra's Creative hours:https://cassandrabodzak.com/cassandras-creative-hours Grab my FREE Divinely Design Your Life Guided Meditation Bundle here: https://www.divinelydesignyourlife.com/meditation-bundle Join us in THE REALIGNMENT, the 8 week course will have you upgrading your life both physically and energetically in lightning speed. https://cassandrabodzak.com/the-realignment Join Divinely Design Your Life: The Process here: https://bit.ly/3m1cR2Y Grab your copy of “Manifesting Through Meditation” the book here: https://amzn.to/2TZkX49 Grab your copy of “The Spiritual Awakening Journal” here: https://amzn.to/3IJe8Jd Love audiobooks like me? Join audible: https://amzn.to/2W4RcO3 Say Hi to Cassandra on social media!http://facebook.com/cassandrabodzakhttp://twitter.com/cassandrabodzakhttp://instagram.com/cassandrabodzakhttp://youtube.com/cassandrabodzakTV

In this video, Dr. Catherine M. Broome, Professor of Medicine at Georgetown University Medical Center, answers questions asked by the audience during her CME/NCPD–approved activity with i3 Health, Putting the Freeze on Cold Agglutinin Disease (CAD). Dr. Broome shares insights into resources she recommends for patients with CAD, the role of thromboprophylaxis, treatment advances to expect within the next year, the most important things for primary care providers and non-hematologists to know about CAD, and more! Interested in completing this activity and earning FREE CME/NCPD credit? Click here: https://bit.ly/3RlJJ8X

Who gets to decide on what it means to have a disease? I posed this question a while back in reference to Alzheimer's disease. I'll save you from reading the article, but the main headline is that corporations are very much the “who” in who gets to define the nature of disease. They do this either through the invention of disease states or, more often, by redrawing the boundaries of what is considered a disease (think pre-diabetes). On today's podcast, we invite Adriane Fugh-Berman to discuss the influence of industry, whether it be pharma or device manufacturers, on healthcare. Adriane founded PharmedOut, a Georgetown University Medical Center project that “advances evidence-based prescribing and educates health care professionals and students about pharmaceutical and medical device marketing practices.” I've listened to a lot of Adriane's talks. It is clear to me that she is not anti-medicine or even anti-pharma but is very much against both the visible and hidden influences that pharma and device manufacturers use to sell their products.  This could be through overt marketing like advertisements or drug rep visits, or more covert measures like unrestricted grants to advocacy organizations, funding of CME, paying “key opinion leaders,” or the development of “disease awareness campaigns.” So take a listen and dont worry, while GeriPal podcasts offer CME, we never take money from industry. By: Eric Widera      

The World's #1 Personal Development Book Podcast!  Join the world's largest non-fiction Book community! https://www.instagram.com/bookthinkers/ Today's episode is sponsored by Ken Rusk, if you're ready to get UNSTUCK check out the links below: https://courses.kenrusk.com/ https://www.kenrusk.com/ In today's episode we have the pleasure to interview Cathleen Beerkens author of “Your Creator Matrix: How to Use Optimal Wellness and Quantum Healing to Master Your Story and Create Your Reality”  In this episode, you'll learn about:   - Her book - What good health actually looks like - How health is about the whole - mind, body, and spirit - What science has to do with spirituality and energy - Insights into quantum healing - How you can begin to create your reality and step into who you are really meant to be. To learn more about Cathleen and buy her book “Your Creator Matrix: How to Use Optimal Wellness and Quantum Healing to Master Your Story and Create Your Reality”  follow the links below: Website: https://www.awellnessrevolution.com/ Book: https://a.co/d/coAiIZz Instagram: https://www.instagram.com/awellnessrevolution/ YouTube: https://www.youtube.com/@AWellnessRevolution Facebook: https://www.facebook.com/AWellnessRevolution/ LinkedIn: https://www.linkedin.com/company/wellnessrevolution/ Cathleen, is a dedicated health professional, holds degrees from the University of Maryland and Georgetown University, with over 12 years of diverse experience at Georgetown University Medical Center. In Washington, DC, she contributed to various medical settings, including the emergency room, medical/surgical ward, and high-risk labor and delivery units. Fast forward and Cathleen's journey led her to Amsterdam, where she delved into integrative medicine, earning certifications in practices such as Polarity Healing, Reflexology, and Reconnective Healing. Graduating as a certified Health Coach in 2017, she founded A Wellness Revolution in 2018. The organization globally trains Health and Wellness Coaches, emphasizing holistic coaching rooted in cellular well-being.  Cathleen went from being involved in western medicine to finding a better approach to our health and I'm so glad she did! What we have done as a society isn't working and it's time to bring in the new health care system, one of wellness, not sickness.  We hope you enjoy this incredible conversation with Cathleen Beerkens! The purpose of this podcast is to connect you, the listener, with new books, new mentors, and new resources that will help you achieve more and live better. Each and every episode will feature one of the world's top authors so that you know each and every time you tune-in, there is something valuable to learn. If you have any recommendations for guests, please DM them to us on Instagram. (www.instagram.com/bookthinkers) If you enjoyed this show, please consider leaving a review. It takes less than 60-seconds of your time, and really makes a difference when I am trying to land new guests. For more BookThinkers content, check out our Instagram or our website. Thank you for your time!

Dr. Matthew Biel, Professor of Psychiatry and Pediatrics at Georgetown University Medical Center, worries about the impact of social media on young people; Carolyn Mullen, ASTHO Senior Vice President for Government Affairs and Public Relations, says the federal budget continues to be the focus of work on Capitol Hill; ASTHO has new policy statements on Adverse Childhood Experiences and Public Health Infrastructure; and harm reduction laws are mapped in a webpage developed by ASTHO's Public Health Legal Mapping Center. ASTHO Webpage: Policy Statements ASTHO Webpage: ASTHO's Public Health Legal Mapping Center  

Dr. Matthew Biel, Professor of Psychiatry and Pediatrics at Georgetown University Medical Center, tells us social media is not necessarily a good part of childhood; Lexa Giragosian, ASTHO Senior Analyst for the Maternal and Newborn Health Team, says one concern linked to social media use is eating disorders among young people; and Dr. Anne Zink, ASTHO Past President and Chief Medical Officer for the Alaska Department of Health's Division of Public Health, headlines a series of four events aimed at learning the basics of disease forecasting. New York Times News Article: Today's Teenagers – Anxious About Their Futures and Disillusioned by Politicians ASTHO Blog Article: Reducing the Impact of Eating Disorders on Adolescent Girls ASTHO Webinar: Disease Forecasting Learning Series ASTHO Webpage: Stay Informed

Episode 8 features an interview with Shahram Ahari MD, an emergency medicine physician and former drug rep, that explores the world of pharmaceutical samples. We chat about why samples are the most important marketing tactic drug companies have, how samples are used to manipulate prescribing choices, and discuss whether or not drug samples should be banned. Pharmanipulation is produced by PharmedOut, a project at Georgetown University Medical Center that advances evidence-based prescribing. Additional Resources PharmedOut fact sheet on drug samples: ⁠https://georgetown.app.box.com/s/y51hkdvu2dju9sv26fjcc976ivlvwtkj Summaries of key articles on the topic of drug samples: ⁠https://georgetown.app.box.com/s/3052cjlgv9thfw0qf3k9fkuyio978mbr PharmedOut's paper “Pharmaceutical marketing: the example of drug samples.” Link: https://joppp.biomedcentral.com/articles/10.1186/s40545-022-00479-z PharmedOut's paper “Following the Script: How Drug Reps Make Friends and Influence Doctors.” Link: https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0040150 PharmedOut's paper “Why lunch matters: Assessing physicians' perceptions about industry relationships.” Link: https://onlinelibrary.wiley.com/doi/abs/10.1002/chp.20081 Dr. Ahari's op-ed in The Washington Post “I was a drug rep. I know how pharma companies pushed opioids.” Link: https://www.washingtonpost.com/outlook/i-was-a-drug-rep-i-know-how-pharma-companies-pushed-opioids/2019/11/25/82b1da88-beb9-11e9-9b73-fd3c65ef8f9c_story.html

Artificial Intelligence enhances deterrence capabilities in various ways, contributing to the overall effectiveness of military strategies and national security. Deterrence aims to dissuade adversaries from taking certain actions by convincing them that the costs or risks outweigh the potential benefits. So, how does AI, particularly machine learning, serve as a force multiplier in the development and application of deterrence? Considering the role of AI in intelligence and military deterrence operations, how do algorithms enhance real-time human-machine interfacing and contribute to the overall deterrent effect against potential threats? And finally, what are some thoughts on the ethical considerations surrounding the use of AI in deterrence, especially in non-kinetic operations. Dr. James Giordano is Pellegrino Center Professor of Neurology and Biochemistry, Chief of the Neuroethics Studies Program, and Chair of the Sub-Program in Military Medical Ethics at Georgetown University Medical Center. He is a Senior Bioethicist of the Department of Defense Medical Ethics Center; Science Advisory Fellow of the Strategic Multilayer Assessment Branch, of the Joint Staff of the Pentagon; a Senior Fellow of the Simon Center for the Professional Military Ethic, United States Military Academy, West Point, and Distinguished Fellow at the Stockdale Center for Ethical Leadership. He was a designated Naval Aerospace Physiologist, and served with the US Navy and Marine Corps.

What does it really mean to “be healthy”? In this episode, join Dr. Kara Wada as she welcomes Dr. Kenneth Zweig, a specialist in sleep disorders, hypertension, and behavior change. They talked about the intricacies of primary care, the crucial role of sleep in overall health, practical tips for enhancing sleep quality, and the art of making lasting behavior changes. Plus, get insights into the unique aspects of concierge medicine. Listen to this latest episode for insights on how small changes in sleep and behavior can have a profound impact on your health and lifestyle! EPISODE IN A GLANCE-A Physician's Guide to Mastering Sleep & Behavior Change-Dr. Kenneth Zweig's Journey into Medicine-The Intricacies and Challenges of Primary Care-The Role of Sleep in Overall Health-Tips for Improving Sleep Quality-The Art of Behavior Change for Better Health-Concierge Medicine ABOUT KENNETH ZWEIG, MDKenneth Zweig, MD, is an experienced internist at Northern Virginia Family Practice Associates, specializing in personalized preventative care with a focus on sleep disorders, hypertension, and promoting behavioral changes for better health. With 18 years in the medical field, he values the patient-oriented approach of concierge internal medicine. Dr. Zweig emphasizes the importance of preventing medical issues by addressing poor behavioral habits and advocates for a holistic treatment approach that includes nutrition, exercise, and stress management.In addition to his clinical work, Dr. Zweig is an educator, serving as a clinical instructor at The George Washington University Hospital and an assistant professor at Georgetown University Medical Center. His past experiences include a 15-year tenure at General Medicine Internal Group, P.C. and involvement with the HealthConnect Accountable Care Organization. He has also volunteered in Honduras and received numerous accolades including Washingtonian's Top Doctor and the Patients' Choice Award. Dr. Zweig earned his doctorate from The Ohio State University College of Medicine. He lives in Arlington with his family and enjoys outdoor activities like hiking, biking, and skiing CONNECT WITH KENNETH ZWEIG, MDWebsite → https://nvafamilypractice.com/ LinkedIn → https://www.linkedin.com/in/louiskennethzweig/ Twitter → https://twitter.com/KenZweigMD ABOUT DR KARA WADAQuadruple board-certified pediatric and adult allergy immunology & lifestyle medicine physician, Sjogren's patient and life coach shares her recipe for success combining anti-inflammatory lifestyle, trusting therapeutic relationships, modern medicine & our minds to harness our body's ability to heal. CONNECT WITH DR WADAWebsite → https://www.drkarawada.com/ LinkedIn → https://www.linkedin.com/in/karawadamd/ Instagram → https://www.instagram.com/immuneconfident/ Facebook → https://www.facebook.com/KaraWadaMD Twitter → https://twitter.com/CrunchyAllergy TikTok → https://www.tiktok.com/@crunchyallergist SUBSCRIBE TO NEWSLETTER → https://www.drkarawada.com/newsletter Get Dr. Kara's weekly dose of a naturally-minded and scientifically-grounded approach to immune system health. JOIN THE BECOMING IMMUNE CONFIDENT JUMPSTART! If you are looking for support and realize that 2024 is 2024 the year that you gain a deep understanding of your body, learn to trust your ability to navigate the uncertainties that come along with living with chronic inflammation and build a lifestyle that supports and nourishes your immune system...APPLY HERE→ https://www.immuneconfident.com

​​This week's Wealthy Wellthy Podcast could actually save your life. I mean it.  Today's guests have a transformative approach to proactive healthcare. That's right, proactive healthcare. For too long, our healthcare industry has only responded to illness and disease after it's already present.  Well, Steven Marler and Dr. Anthony Sparks of Advanced Longevity are committed to changing that model in order to save your life, and they're both here to talk about this revolutionary new healthcare technology. Steve and Dr. Sparks, are not only experts in their fields but also passionate advocates for a transformative approach to healthcare. As you know, our healthcare system often gets caught in the trap of treating illness rather than preventing it. This episode sheds light on the critical yet often overlooked aspect of early disease detection and preventative health.  Steve shares the moving account of his mother's battle with late-stage cancer as a powerful reminder of the importance of early detection and the personal motivation that led him to champion comprehensive scans as a tool for saving lives. Dr. Anthony Sparks, with his time at Baylor College of Medicine and Georgetown University Medical Center, shares his invaluable perspective and experience throughout this conversation, highlighting how early detection of diseases like cancer - often when they are asymptomatic - can be life-saving for patients.  

Show SummaryOn this episode, we feature a conversation with Dr. Sumitra Muralidhar, Program Director for the Department of Veteran's Affairs Million Veteran Program. Since launching in 2011, 1 million Veterans have joined MVP. It's the largest research effort at VA to improve health care for Veterans and one of the largest research programs in the world studying genes and health.About Today's GuestDr. Sumitra Muralidhar is the Program Director for VA's Million Veteran Program (MVP) in the Office of Research and Development (ORD). She oversees the policy and infrastructure development for the collection and use of samples and genetic, clinical, lifestyle and military exposure data from one million Veterans. She served as ORD's liaison to the White House Precision Medicine Initiative under President Obama, and continues to represent ORD/MVP in the federal interagency group on precision medicine. She also serves as the designated federal officer for VA's Genomic Medicine Program Advisory Committee, which advises the VA Secretary on the development and implementation of research and clinical arms within the Veterans Health Administration. She previously served as Health and Science Advisor to the Senate Veterans Affairs Committee (SVAC), and Associate Professor at Georgetown University Medical Center. She received her Ph.D. in Molecular Biology from the University of Maryland.Links Mentioned In This EpisodeThe Million Veteran Program WebsitePsychArmor Resource of the WeekThis week's PsychArmor resource of the week is the PsychArmor course Demystifying Genomic Testing: Biomarker Tests for Better Prostate Cancer Outcomes. This course reviews some of the biomarker tests identified in this episode. This can improve the cancer diagnostic process as well as reduce unnecessary procedures, office visits, and costs. You can see find the course here:  https://learn.psycharmor.org/courses/Demystifying-Genomic-Testing This Episode Sponsored By: This episode is sponsored by PsychArmor. PsychArmor is the premier education and learning ecosystems specializing in military culture content PsychArmor offers an. Online e-learning laboratory that is free to individual learners as well as custom training options for organizations. Contact Us and Join Us on Social Media Email PsychArmorPsychArmor on TwitterPsychArmor on FacebookPsychArmor on YouTubePsychArmor on LinkedInPsychArmor on InstagramTheme MusicOur theme music Don't Kill the Messenger was written and performed by Navy Veteran Jerry Maniscalco, in cooperation with Operation Encore, a non profit committed to supporting singer/songwriter and musicians across the military and Veteran communities.Producer and Host Duane France is a retired Army Noncommissioned Officer, combat veteran, and clinical mental health counselor for service members, veterans, and their families.  You can find more about the work that he is doing at www.veteranmentalhealth.com  

Robin West, MD, Associate Professor of Orthopaedic Surgery at Georgetown University Medical Center, Professor of Medical Education at the University of Virginia School of Medicine, Inova Campus, Adjunct Associate Professor at Uniformed Services University of Health Sciences, and Head Team Physician for the Washington Nationals Baseball team shares the harrowing experience of her most difficult case, the differences in caring for football and baseball athletes, how her own experience as a patient has informed her professional practice, and more.

Join Christopher Habig in an enlightening conversation with Dr. Mark Dybul, CEO of Renovaro Biosciences and professor of medicine at Georgetown University Medical Center. The episode explores the challenges of healthcare innovation, advocating for a departure from bureaucratic hospital systems. Dr. Dybul shares Renovaro Biosciences' groundbreaking approach to cancer treatment, emphasizing immune system retraining and genetic modifications to minimize reliance on traditional chemotherapy. The discussion highlights the vision of democratizing access to innovative healthcare solutions, empowering providers in real-time decision-making, and fostering a culture of experimentation. As the episode concludes, Dr. Dybul offers invaluable advice for aspiring medical professionals: think big, push boundaries, and embrace technology to overcome challenges and drive innovation.More on Freedom Healthworks & FreedomDocSubscribe at https://healthcareamericana.com/episodes/More on Dr. Mark Dybul & Renovaro BiosciencesFollow Healthcare Americana:Instagram & LinkedIN

In this episode of The Root Cause Medicine Podcast, we discuss neuropsychiatric symptoms, brain health, brain inflammation, head trauma, and neurodegenerative conditions. They dive into: 1. Inflammation Root Causes 2. Traumatic Brain Injury and Psychological Processes 3. HYLANE Technology Dr. Robert Hedaya is a Clinical Professor of Psychiatry at Georgetown University Medical Center. He is a neuropsychiatrist that teaches functional medicine, psychiatry, brain health, brain inflammation, head trauma, and neurodegenerative conditions, and the founder of The Whole Psychiatry & Brain Recovery Center. Dr. Hedaya also wrote several books, including Understanding Biological Psychiatry, The Anti-depressant Survival Program, and Depression: Advancing the Treatment Paradigm. Order tests through Rupa Health, the BEST place to order functional medicine lab tests from 30+ labs - https://www.rupahealth.com/reference-guide

Today on Specifically for Seniors, we're going to do something just a bit different. We have three guests who are here to tell you three completely different stories about parts of their lives. You've met two of them on previous podcasts, but they didn't have the time to tell you the rest of their stories. The third is new to Specifically for Seniors, but it's the story of a part of American history that our generation cannot forget. So make yourself a cup of coffee, sit back, relax, and let these three men tell you about a part of each of their lives. Those of you who are regular listeners to specifically for seniors will recall Alistair Henry from our May, 2023 podcast. Alistair retired at 57, shed his possessions and went to live with the First Nations band in the Northwest Territory, then left Canada's North to volunteer, working with local NGOs. Those are nonprofit organizations in Bangladesh. He and his wife enjoyed budget pack packing for four months at a time in Central America and Southeast Asia in their sixties. In 2020, Alistair endured a double lung transplant. Alistair is back today to talk about the transplant and the work he is now doing as a Trillium Gift of Life advocate. On November 22nd, 1963, a 26 year old junior duty officer was on duty at Bethesda Naval Hospital when the casket containing the body of Jack Fitzgerald Kennedy arrived from Dallas. You met that naval officer on this podcast on May 3rd, 2023. Sorel Schwartz today is a professor emeritus of pharmacology at Georgetown University Medical Center, and Senior Pharmacology advisor at the FDA Sorel is with us today as we near the 60th anniversary of JFK's assassination. My third and final guest on today's podcast is Robert Norris. Robert's story is one that many of us who were draft aged during the Vietnam War era will have faced in one way or another. Robert is a Pacific Northwest, native Vietnam war, conscientious objector who served sometime in a military prison, an expat resident of Japan since 1983. He's the author of The Good Lord Willing, and The Creek Don't Rise. But, but let me let Robert tell you his story. We're talking to Robert from his home in Fukuoka, Fukuoka, Japan. Book Availability: The Good Lord willing and The Creek Don't Rise https://www.amazon.com/Good-Lord-Willing-Creek-Dont/dp/180100000X

Bilingual speakers effortlessly mix multiple languages into conversation – but something much more complex and fascinating is happening in their minds. Washington Post columnist Theresa Vargas and Sarah Phillips, a postdoctoral scholar in the neurology department at Georgetown University Medical Center, join host Krys Boyd to discuss bilingualism in our culture and the neurological pathways that allow language switching to flow so freely.

Episode 6 invites Ragen Chastain, activist and author, and Joel Lexchin MD of York University, to discuss myths about weight and health, the hype around Ozempic and Wegovy, and the unclear connection between weight loss and health.  Pharmanipulation is produced by PharmedOut, a project at Georgetown University Medical Center that advances evidence-based prescribing. To learn more about Ragen Chastain and her work, please visit her website: https://weightandhealthcare.substack.com/ Additional Resources Dances With Fat Monthly Workshop – September: Navigating Weight Stigma at the Doctor's Office date changed from September 27 to October 11 to avoid overlap with ASDAH's annual meeting. Link: https://danceswithfat.org/monthly-online-workshops/  Books “Fearing the Black Body: The Racial Origins of Fat Phobia” by Sabrina Strings. Link: https://nyupress.org/9781479886753/fearing-the-black-body/ “Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness” by Da'Shaun L. Harrison. Link: https://www.penguinrandomhouse.com/books/670607/belly-of-the-beast-by-dashaun-harrison/ Articles "Semaglutide: a new drug for the treatment of obesity" by Joel Lexchin and Barbara Mintzes. Drug Ther Bull. 2023 Oct 25:dtb-2023-000007. doi: 10.1136/dtb.2023.000007. Link: https://pubmed.ncbi.nlm.nih.gov/37879878/ “How the ‘It's Bigger Than Me' Campaign Is Harming Fat People for Profit" by Ragen Chastain. Link: https://themighty.com/topic/eating-disorders/its-bigger-than-me-campaign-harms-fat-people-for-profit/  “Weighing the Consequences of Weight-Loss Drugs” by Judy Butler and Dr. Adriane Fugh-Berman. Link: https://www.medpagetoday.com/opinion/second-opinions/104482 Igho J. Onakpoya, Carl J. Heneghan and Jeffrey K. Aronson. Post-marketing withdrawal of anti-obesity medicinal products because of adverse drug reactions: a systematic review. BMC Medicine 2016;14:191. Link: https://pubmed.ncbi.nlm.nih.gov/27894343/ Prescrire's "Semaglutide (Wegovy°) for excess body weight" Prescrire International 2023; 32 (245): 36-38. Link: https://english.prescrire.org/en/81/168/66102/0/NewsDetails.aspx Please note: the full article is available for subscribers only. PharmedOut is supported primarily by individual donations. To donate, please visit: https://sites.google/com/georgetown.edu/pharmedout/donate

Dr. Robert Hedaya has been practising functional medicine psychiatry for many years, and is a clinical professor of psychiatry at Georgetown University Medical Center. He is the author of Understanding Biological Psychiatry, The Antidepressant Survival Guide and Depression: Advancing the Treatment Paradigm, and the founder of the Whole Psychiatry and Brain Recovery Center, as well as a faculty member at The Institute for Functional Medicine (IFM). In this captivating interview for The MindHealth360 Show, Dr. Hedaya talks about how he uses Functional Medicine, focusing on nutrition, digestion, inflammation, toxicity, and hormone levels, and combines it with novel brain therapies which he bundles in his pioneering HYLANE protocol, for a truly personalised treatment for mental health and neurological disorders. HYLANE combines hyperbaric oxygen therapy (HBOT), qEEG guided transcranial laser therapy, and neural exercises to treat dysfunction in the brain. He has had great successes with treatment-resistant depression, anxiety, neurodegenerative and other brain disorders using this technology, sometimes even when not combined with functional medicine.  He also discusses how our brains can be deeply affected by socio-cultural, environmental factors and trauma, leading to dysregulation of the hypothalamic pituitary and adrenal (HPA) axis and epigenetic mutations which can affect vital functions such as methylation.

Rebecca McLaughlin is joined by Max Riesenhuber to have a conversation about the ethics and morality of artificial intelligence.Questions Covered in This Episode:What first interested you about neuroscience?Can you talk about recent advancement in AI and where we might go?Do we have a moral responsibility to artificial intelligence beings?What do you say to scientists who say that humans are just computers in a flesh case?What is moral truth?Do you think we need to be concerned about the ethical direction that AI's are taking us?What is the good side of artificial intelligence?How did you become a Christian?Guest Bio:Max Riesenhuber is a Professor in the Department of Neuroscience at Georgetown University Medical Center and Co-Director of the CNE. His research uses computational modeling, brain imaging and EEG to understand how the brain makes sense of the world, and how these insights can be translated to neuromorphic AI and augmented cognition applications. Max obtained his Master's degree in physics from the University of Frankfurt, Germany, and his PhD in computational neuroscience from MIT. He has received several awards, including Technology Review's “TR100”, one of the “100 innovators 35 or younger whose technologies are poised to make a dramatic impact on our world” and an NSF CAREER award.Resources Mentioned:“Klara and the Sun” by Kazuo Ishiguro“The Scandal of the Evangelical Mind” by Mark A. NollSponsors:To learn more about our sponsors please visit our website.Follow Us:Instagram | TwitterOur Sister Shows:Knowing Faith | The Family Discipleship Podcast | Starting Place | Tiny TheologiansConfronting Christianity is a podcast of Training the Church. For ad-free episodes and more content check out our Patreon.

A new editorial paper was published in Oncotarget's Volume 14 on August 30, 2023, entitled, “Subpopulations of AIB1 isoform-expressing breast cancer cells enable invasion and metastasis.” In their new editorial, researchers Amber J. Kiliti, Ghada M. Sharif, Anton Wellstein, and Anna T. Riegel from Georgetown University Medical Center discuss potential mechanisms of breast cancer invasion and metastasis. Genetic and epigenetic events drive individual tumor cells to proliferate and expand into a heterogeneous mixture of cells that evade immune surveillance, acquire the ability to invade the vasculature and spread as metastatic seeds to distant sites. Organ metastasis contributes to more than 90% of all cancer-related deaths. “The model of Darwinian evolution explains the stepwise selection of cancer cells capable of invasion and metastatic spread and an extensive body of work supports that cancer cell-autonomous features match the selected cancer cell ‘seed' with the appropriate ‘soil' of the target organ.” However, this concept was challenged in a recent paper in Cancer Research. Sharif et al. observed that a subclonal population of cells in a heterogeneous tumor can significantly alter the growth characteristics, invasiveness and metastasis of an entire tumor through cell-cell crosstalk. These functionally relevant cell subpopulations are difficult to detect through bulk analysis though their presence may influence disease outcome and efficacy of treatments. “In their paper, Sharif et al. detailed how expression of a splice isoform of the transcriptional coregulator and oncogene Amplified In Breast Cancer 1 (AIB1) in a small subpopulation of cells can lead to increased tumor growth and invasion of surrounding tissues by ductal carcinoma in situ (DCIS) cells.” DOI - https://doi.org/10.18632/oncotarget.28452 Correspondence to - Anna T. Riegel - ariege01@georgetown.edu Video short - https://www.youtube.com/watch?v=_yZnwzitBek Sign up for free Altmetric alerts about this article - https://oncotarget.altmetric.com/details/email_updates?id=10.18632%2Foncotarget.28452 Subscribe for free publication alerts from Oncotarget - https://www.oncotarget.com/subscribe/ Keywords - cancer, AIB1, AIB1Δ4, breast cancer, invasion, metastasis About Oncotarget Oncotarget (a primarily oncology-focused, peer-reviewed, open access journal) aims to maximize research impact through insightful peer-review; eliminate borders between specialties by linking different fields of oncology, cancer research and biomedical sciences; and foster application of basic and clinical science. To learn more about Oncotarget, please visit https://www.oncotarget.com and connect with us: SoundCloud - https://soundcloud.com/oncotarget Facebook - https://www.facebook.com/Oncotarget/ Twitter - https://twitter.com/oncotarget Instagram - https://www.instagram.com/oncotargetjrnl/ YouTube - https://www.youtube.com/@OncotargetJournal LinkedIn - https://www.linkedin.com/company/oncotarget Pinterest - https://www.pinterest.com/oncotarget/ Reddit - https://www.reddit.com/user/Oncotarget/ Media Contact MEDIA@IMPACTJOURNALS.COM 18009220957

This episode was originally released November 2021. Susan Hingle is a leader among leaders. She is an Internal Medicine specialist and a Professor of Medicine, who serves as Associate Dean for Human and Organizational Potential, and Director of Faculty Development at Southern Illinois University School of Medicine. She earned a bachelor's degree from Miami University and a medical degree from Rush University Medical College. She completed an Internal Medicine residency at Georgetown University Medical Center, where she served as Chief Resident of Internal Medicine. Dr. Hingle completed the Executive Leadership in Academic Medicine (ELAM) Program. She has been active nationally in numerous organizations, including the American College of Physicians, the American Medical Women's Association, the Alliance of Academic Internal Medicine, and the American Medical Association. She served as Chair of the ACP Board of Regents and Chair of Board of Governors and is President-elect for AMWA. Pearls of Wisdom from the episode: -Self-care is essential and we, as leaders, should lead by example by practicing it. -Wellness should be “THE Goal” NOT “A goal” in healthcare. -Organizations need to define what a healthy workforce looks like and make it a priority. -Let go of the drive for perfection! The goal should be to become the best version of ourselves. Just enough is good enough. -Understand the power of saying no. Recommended Reading: Just Enough- Laura Nash Untamed- Glennon Doyle The Hundred Years of Lenni and Margo- Marianne Cronin

You can also listen to this episode on Apple Podcasts or Spotify!Manish Agrawal MD and Paul Thambi MD are oncologists who have spent decades caring for patients with cancer. They realized early in their careers that chemotherapy could treat the cancer—but what about the emotional, psychological and spiritual impact of facing mortality? When they learned about the potential for medications like MDMA and psilocybin to help people gain access to parts of their minds they didn't know existed—and to address the human experience of suffering—they quit their day jobs as practicing cancer doctors to found Sunstone Therapies, the sole psychedelic-assisted therapy research and treatment center in the Washington, D.C. area.  The data are increasingly clear: these non-addictive substances hold the power to expand consciousness and improve quality of life.When guided by a trained therapist in the appropriate setting, even one experience with a psychedelic medication can help people unlock closed doors in their minds and to feel safe enough to explore its contents. They can be the catalyst for patients' ability re-route well-worn pathways of negative and maladaptive thoughts, feelings and behaviors.It turns out that science and spirituality aren't mutually exclusive.On this episode of Beyond the Prescription, Drs. McBride, Agrawal and Thambi discuss the inseparability of physical and mental health; the promise of psychedelic therapy to treat the psychological impact of cancer and other diseases such as PTSD, anxiety, and depression; and their shared excitement about the potential for these drugs to fundamentally expand the standard of care in medicine. Bios:Manish Agrawal, MDManish brings an extensive background and experience that spans medicine, engineering, philosophy, and ethics to his role as CEO of Sunstone Therapies. Driven by a deep interest in healing, Manish is particularly passionate about whole person healing and the transformative potential of psychedelic therapies. Manish previously held the position of Co-Director of Clinical Research at Maryland Oncology Hematology, where he dedicated 15 years to the care of cancer patients. He completed a fellowship at the National Cancer Institute, National Institutes of Health, and his residency at Georgetown University Medical Center.Paul Thambi, MDPaul brings deep experience in oncology care and clinical trial design to his role as Chief Medical Officer at Sunstone. He is a proponent of strong organizational culture and strives to create a compassionate, open and accepting workplace to advance whole person healing in medicine. As a medical oncologist, Paul developed important and meaningful relationships with patients, witnessessing their emotional and physical distress upon diagnosis and throughout treatment, leading him to explore psychedelic therapies to improve the emotional and mental health of patients fighting cancer. Paul completed his oncology fellowship at the National Cancer Institute and, prior to pursuing medicine, he began his professional career in engineering and consulting.Join Dr. McBride every Monday for a new episode of Beyond the Prescription.You can subscribe on Apple Podcasts, Spotify, or on her Substack at https://lucymcbride.substack.com/podcast. You can sign up for her free weekly newsletter at lucymcbride.substack.com/welcome.Please be sure to like, rate, and review the show!The transcript of the show is here![00:00:00] Dr. Lucy McBride: Hello, and welcome to my office. I'm Dr. Lucy McBride, and this is Beyond the Prescription, the show where I talk with my guests like I do my patients, pulling the curtain back on what it means to be healthy, health as more than the absence of disease. As a primary care doctor, I've realized that patients are more than their cholesterol and their weight. We are the integrated sum of complex parts. Our stories live in our bodies. I'm here to help people tell their story, and for you to imagine and potentially get healthier from the inside out. You can subscribe to my free weekly newsletter at lucymcbride.substack.com and to the show on Apple Podcasts, Spotify, or wherever you get your podcasts. So let's get into it and go Beyond The Brescription. [00:01:03] Buckle your seatbelt. Today we are going to talk about one of my favorite subjects, the re emerging field of psychedelic medicine. I truly believe it is going to change the landscape of modern mental health care in this country. I cannot wait to introduce you to my guests today, Dr. Manish Agarwal and Dr. Paul Thambi. They are oncologists who have spent decades caring for patients with cancer. They realized early in their careers that chemotherapy could treat the cancer, but what about the whole person? What about the emotional, psychological, and spiritual impact of facing a hard diagnosis and mortality? When they learned about the potential for psychedelic medicines like MDMA and psilocybin to address patients' whole health, to offer some acceptance and insight and access to the patient's interiority in ways that they had never seen before, Paul and Manish left their day jobs as practicing cancer doctors to found Sunstone Therapies. [00:02:13] This is where I am now sending some of my patients, not just to face cancer diagnoses, but also for anxiety, depression, and PTSD. Sunstone Therapies is the sole psychedelic assisted therapy research and treatment center in the Washington, D. C. area. The goal of Sunstone is to better treat the emotional and psychological impact of cancer and other disorders. Paul and Manish are contributing to the fundamental expansion of the standard of care in medicine and it is a wonderful thing to be part of and to watch. Paul and Manish, thank you so much for joining me today on the podcast.[00:02:53] Dr. Paul Thambi: It's a pleasure to be here. Thanks for having us.[00:02:55] Dr. Manish Agarwal: Yeah, it's great having you. Thank you. [00:02:57] LM:  The two of you together have backgrounds in medicine, engineering, philosophy, data science, and research, yet you landed in the field of psychedelics for a reason. Tell me why that is. What is so exciting about this field to you?[00:03:15] MA: Paul and I both have been practicing oncologists for almost 20 years, and over time we got really good at taking care of cancer patients, their physical symptoms, but their quality of life was not always directly proportional to how they physically felt. And over time it really starts eating away at you, that you're not able to take care of the emotional health of cancer patients.[00:03:35] When we saw this emerging field and started looking at the data, We visited and learned about it and then got training and explored to see is this real. And that's what sort of led us down this path is, for me personally I've always been into philosophy, that's why I have my masters in philosophy.[00:03:54] I've been interested in the human side of medicine not just the science side. Both have fascinated me and this really brought both of them together. The reason that Paul and I both went into medicine is to treat people and to make them feel better. And really, for the cancer patient, for any patient, you have to take care of everything, not just the physical symptoms.[00:04:14] PT: Everything that Manish said is echoed in my life and how I was drawn to this. And I think there were a few patients that really suffered emotionally that really hit home for me. And I carried that pain from what they went through with me. And when Manish showed me the data on psychedelic assistive therapy, it wasn't really the data, it was really more these YouTube videos where we saw how there were a couple of patients on the NYU trial and the Hopkins trial, and how they were before they went on that treatment and after. And there was a palpable change that you could feel through the video even, and it was just something that I wanted to be able to see if we can bring to our patients. [00:05:00] LM: Can you give me an example of a patient who has been served by this treatment, maybe a cancer patient? I'd love to hear an anecdote.[00:05:08] MA: There's a young patient with kids and a serious cancer, and had struggled with depression, didn't know anything about psychedelics, but really applied. And to see the change in his life, he's changed the relationship with his mother, who had a hard time with her son having cancer. And he was able to have a conversation with her afterwards, saying, I want my mom back.[00:05:29] And then he was bleeding, when he went home for something else, he got a cut. And his young boy sat up and said, “Dad, are you dying?” And he was able to sit and have a conversation with him. He said, I would never be able to do those things before. And he was able to really sense into that. And then the other group that's really, I've sort of been really blown away by is the military that we've been treating recently.[00:05:51] They have such complex things that they've seen, such complex trauma. And they've tried everything. I mean everything. For a military person to come and seek this care is not easy because the entire institution, it can affect their career if they talk about mental health. So they're desperate and to see the lives that are turned around, I literally wouldn't believe it if I didn't see it.[00:06:15] And it's been powerful to see them going from, thinking about suicide regularly, to really no meaning, to a sense of despair, to not where everything is great and perfect, but they're having a fundamental change, and they want to live, and they want to reconnect, and they're building their lives back together.[00:06:33] LM: I mean, that says everything that you need to know about why this is important. Acceptance, hope, peace, which isn't possible every day of the week, nor is it mutually exclusive with ongoing pain, as humans experience a myriad emotions on a day to day basis. But to think that there's something out there that could give people more agency and acceptance is pretty extraordinary given that we've had pretty poor tools to help people with emotional health and mental health. And so I guess my question to you is then, how do you see the psychedelics changing the way we think about mental health?[00:07:19] PT: One of the things that can help to do is just to shine a light on this is a part of our health that we need to focus on. There is now these tools that are being talked about that can be helpful, perhaps more helpful than the existing tools and that allows people to start talking about their emotional health more to their doctors, to their family.[00:07:44] And in terms of how these medicines can help, I think it's not just the medicine. I just want to talk a little bit more about that because the medicine does some things and would act on some of the same receptors that SSRIs act, but there's more to it than the medicine. You talked about it being an experience and it is that, and it's not always that it finds stories that are hidden, sometimes those stories are there and people feel them all the time, but they turn away from them. And what you need to do, what we're starting to learn with this is that you need to create an environment, a container as it's called in this space, that feels safe, that allows people to trust and be vulnerable in that space.[00:08:32] So that when they experience those fears, and some of those stories may be hidden, some of them may be ones that they've lived with their whole lives, but now they can look at those. They can be with that story that they've felt, and face it. Because they feel a sense of trust, and they're with therapists or people who care about them.[00:08:53] Who created a relationship with them that allow them to go deep into that story and find the pieces of that story that serve them and the, and the pieces of the story that don't and talk about that, integrate that into their lives, integrate that into their conversations with their families. It's that that does the healing more so than the medicine or as much as the medicine.[00:09:17] LM: It's such an important point because I see patients Who I will kind of raise this idea to—people who have complex PTSD or who are facing terminal diagnosis. And sometimes they'll say to me, well, I tried mushrooms in college and [it] didn't do much then. And I just had a bad experience. I remind them that that set and setting matters so much.[00:09:40] And I think it's such a good point that it's not just the medicine.It's the ability to feel vulnerable and safe, which is sort of this mystical aspect of the medications and then to face some things that you already did know you had and that weren't hidden. I think that's a great point.[00:09:57] MA: Yeah, I mean, I think it's actually pretty nuanced in all of that, because one thing I tell people is, I think psychedelics allow you to access psychic material like no other thing that I know of. But they're not a magic bullet. And if MDMA cured PTSD, I tell people that anyone that goes to a rave wouldn't have PTSD anymore.[00:10:22] But lots of people go to raves and still have PTSD. And so it must be more than the medicine. So it's not to take away from it, because I think you have access, but it is again, the context or, or how it's received. And so, it's like any medicine, the wrong dosage in the wrong context can be harmful or beneficial.[00:10:37] And what you talked about, I think, is really nuanced, and I think it's important. We actually call it sometimes therapy assisted by psychedelics. Because a relationship allows you to really trust, and to trust yourself, and to go deep. And if you have that sense of trust, you're able to access material that you may not otherwise be able to.[00:10:56] And a lot of times, sometimes injury or things occurred in a relationship and to have another wiring of your brain in a healthy relationship, to be witnessed when you were in pain or just to be held or to be supported is a different experience now than it might have been the time that it happened. And you're able to almost nurture that younger part of yourself.[00:11:18] And so that's, it's really, it is quite cutting edge and that's one of the things that fascinated us because it's not… people want medicine therapy. It's like, it's really this combination of the two and, and so you can emphasize one, emphasize the other, but without the two and done in concert and the right setting, it just is not as effective.[00:11:37] And so, you know, for us the therapists and the medicine are super important, but so is everything else. So the way the room is set up, the furniture, the music. The person that answers the phone, the way you're received, the way the follow up is. Because if you think about it, we all are sort of on alert, and you get a sense in your gut, can I trust this place? Can I trust this institution? Can I trust this store? We have relationships with people and institutions, and you start… some part of your psyche that's assessing for danger knows, how deep can I go? And so, you really have to build a place that tries to reassure even the unconscious part that it's okay to go deep here.[00:12:18] LM: I think it's such a good point. And because I was going to ask you how much… let's take psilocybin, for example, which is the active ingredient in mushrooms, how much of that feeling of safety and trust is the chemical itself, and how much is the therapist, the experience of, you know, calling the front desk, scheduling, seeing the lighting, seeing the room, because I have patients who are in therapy for 30 years, even, who trust their therapist, who feel safe, they have a comfortable experience, but they aren't actually making the kind of progress that you sometimes see in patients who have three experiences with psychedelics in the right setting.[00:13:08] MA: I don't think it's medicine that causes the trust. I think it's the environment. I think the medicine brings to the surface the issues that are there, and without the trust, you are not able to process them. And so, yeah, if they have a trusting relationship with their therapist, that's probably a really important piece, but then it's also deeper than that.[00:13:29] Can the therapist handle whatever material comes up? Are they able to be with that? Do they know how to navigate that? And so, if there's distress or anxiety or fear, what they don't necessarily need is reassurance or minimizing of it, and it's how to navigate those waters that's a different skill set than traditional therapy. I don't think the medicine in itself causes trust, it just amplifies what's there, but in a therapeutic relationship trust can be built, and trust is an intrinsic part of each one of us, but it's to rediscover that.[00:13:58] LM: Such a great point.[00:14:00] PT: I echo all of that. I think also, what the medicine does is when you feel that trust, the medicine is a catalyst for you to go into those crevices that you talked about within the story. It may be a story that you know about, but now there's going to be chapters of that story that were hidden to you. And if you feel the trust, it allows you to do that in a way that I think is hard to do on your own. So there is that catalyst that you get from the medicine around that.[00:14:30] LM: It's so gratifying to hear you talk about these sort of mystical and, and visible elements of the human experience because, again, I think that's what's missing in modern medicine, at least in the United States. We don't think about the 364 days a year you're not sitting with your doctor as health.[00:14:52] We don't think about the way we feel in our bodies, the way we think, our self perception, the way we approach stress or vulnerabilities as health. When actually there are direct physical impacts of chronic stress on our bodies. There's direct physical impact of what you described as a vigilance.[00:15:16] In fact, so many patients I see have been diagnosed with anxiety. And we'll use the word anxiety kind of casually, because it's so commonly used, people know the word, but, but actually when you dig deeper with a lot of these patients who have “anxiety” it's not necessarily that they worry excessively, or that they feel even anxious, they don't even often identify with that word, but that's the code in their charts: F41.9, but a more nuanced description of the way they feel, I think, is this vigilance, this sort of emotional, behavioral, and then sometimes medical reaction to feeling threatened that stems from an experience or set of experiences in their childhood. And we talk about adverse childhood experiences having physical and emotional mental health manifestations later in life.[00:16:06] But I see patients all the time who have been diagnosed with anxiety, but whose symptoms stem directly from some adverse childhood set of experiences or experience. And then they have hypertension, binge eating, cardiovascular disorder, cardiovascular disease, racing thoughts, sort of like a twitchiness physically and emotionally when they are faced with stress. And I think that those are the people, as far as I understand it, who have had PTSD who are being studied first and foremost with psychedelics. Is that right?[00:16:41] PT: Yeah, that's right. Right now, that's the indication that has shown the most benefit with MDMA.[00:16:45] MA: Yeah, and to piggyback on, I mean, you've made a couple of points, I guess, and we should probably just touch on them. I think just working backwards… the last point, I think that if people do have these feelings of anxiety or depression, and I think when, um, a disservice we've done is pathologize them, that somehow that's the problem.[00:17:05] And it actually is a sign of health because they're having a normal reaction to abnormal situations. And so, what trauma can sometimes be is that when you're very young you have a situation that was very difficult. But you responded normally, you would feel anxious or you'd feel depressed or sad. But then you didn't have support in that situation and so it got stuck.[00:17:27] And then, now you react when things arise, your body, your psyche has a visceral memory of that, of that lack of safety or that issue that occurred. And so, it's not that the person is a problem, it's not a pathology. They had a normal response to an abnormal situation, whether it was an abusive family member or neglect or abandonment, whatever it was.[00:17:50] It's just that, that situation isn't occurring now. And they need support to be able to work out of that. And what they do, what I've seen sometimes, is that actually becomes their superpower. So they get really sensitive. If you had power issues and somebody that powered over you wasn't, you get really sensitive to that.[00:18:07] And you know in your body when something might be happening even before your mind does. And so, it's turning that story to say it's not a problem as much as how you can move on with it. And then the only other comment I was going to make is on the first part you were saying around, medicine, not looking at these other aspects of our emotional health and I think it's a historical time, really. I think for much of history, the shamans were the physicians and there was a connection between the mind, body, and spirit. And then to great progress, we developed a great scientific understanding of the body and develop antibiotics and other things that help us live a lot longer.[00:18:47] And that's helped us, but then because your blood pressure is good and because your coronaries are clean and you don't have cancer, it doesn't mean you're happy. Now I think things are turning again, that the human is not just a biological entity, but it's also a spiritual, emotional, psychological… whatever you want to call it.[00:19:06] And until you have all of that together. You're just not going to feel fully human. And so before there was this science versus religion or science versus woo woo or whatever it is. But I think more and more you'll see really respected neurobiology labs that are starting to, to talk about that. And you're doing MRIs of monks of brains and you're seeing that meditation causes certain changes.[00:19:27] And then when we do MRIs of patients on psychedelics, going back to your point on vigilance, there is something called the default mode network. And that part of the brain is always looking for problems. It's the default mode. It's being vigilant. And that's the part that quiets down, other parts of the brain wake up, and they're able to start connecting.[00:19:49] And so science now is backing up what's happening. And so there's not so much this tension there, and people are wanting to both be physically and emotionally whole.[00:19:58] LM: It makes so much sense. I've heard Roland Griffiths talk about the experience that long term meditators can have as being the closest to the experience or benefits of psychedelic. Is that something you agree with?[00:20:18] PT: Yeah, I think that, that makes sense. I mean, I think deep meditation allows you to see or feel things that you're feeling with a little bit of removal from that. And that allows you to have a different perspective. So, there is a correlation that can be made.[00:20:36] LM: So, when people look at the New York Times and they see an article about psychedelic medicine, I think they automatically, in many cases, go to two thoughts. One, aren't these recreational drugs that are just for people in rock concerts in the 1960s? And two, that doesn't apply to me. This is for people who are really far gone. And so I'd love for you to speak to the sort of stigma around psychedelic medicine, where that comes from.[00:21:08] PT: Yeah, and Michael Pollan talks a lot about this in, in his book How to Change Your Mind and how there was social and maybe political pressure around creating stigma. So I think that's some of what happened and then also you get into the 1980s where, you know, this is your brain on drugs, those commercials that would come out that really heightened my sensitivity as a child growing up in the 80s around that.[00:21:34] And I think those are things that are hard to release. And now that we're starting to understand, and this is coming up again, psychedelics, realizing that these have been around for millennia. And they've been used by cultures as rites of passage for ways to solve the problems of a community. And I think now that those stories are coming back up and also the scientific data which provides people with a level of comfort, especially those people that have this fear of addiction and drugs and all of those things that I had when I was a kid, knowing that this is coming up in the medical institution. Along with the stories from the past are allowing for people to see this in a different way and to accept it more… I think one of the reasons that people feel safe doing this is that, especially like in the environments that we have at Sunstone, where it is in a sort of a medical environment, where our office, where we treat people, is on the campus of a hospital, and they can see the hospital out the window.[00:22:36] And we're clinicians that have treated patients before as doctors, and it's in a research setting. That allows them to overcome that stigma, to feel safe as they embark on this thing they were told never to do in the past.[00:22:51] LM: And so what do you make of this kind of... Emerging industry where people are taking the medicines off label with various healers and going on retreats in Costa Rica, because I worry, I don't know if you worry that if the set and setting are not appropriate, if the person who is supposed to be the guide isn't trained or perhaps worse, if the recipient of the therapeutic isn't aware of the potential risks and isn't guided in an appropriate way, then, then we might end up losing all the ground and getting these medications approved through the appropriate medical channels. Do you have that concern? [00:23:32] MA: For sure, to some degree I do. I mean, I think there are probably great practitioners around some of those settings, but there's just no way to filter through that. And what I worry about, and I get more worried about, is the longer we're doing this, because we're treating complex PTSD patients, they're complicated. And things that come up, if you're not trained and equipped to do that well, it actually... it causes more harm. In fact, I was speaking with a senior psychedelic therapist who's worked for MAPS in Colorado, and she does only things legally, but she does a lot of integration work, and it's integration work for people that did psychedelics underground.[00:24:17] And the biggest thing that she sees... As people got re-traumatized because they would have an experience and it was severe and the therapist wasn't able to be there. So then again, it felt like what I'm feeling is not okay, which is a feeling that they had the first time. And so she's having to rework through that.[00:24:35] So in that way there's legitimate concern. And the other thing that I worry about is, we've seen this, that you talk to people, they seem fine, or you have one assessment of their mental condition, but it gets more complex and even they're not aware of it fully. And so you have to be really prepared for that.[00:24:56] And the other point I was going to make is what you said, what you asked initially about the underground. But then you also said, people said, I'm not as sick, or how about that stigma? So I think there's a real stigma around mental health. There's a stigma around psychedelics and there's a stigma around mental health.[00:25:13] And so this is both. What it still surprises me time and time again is that people just under report their symptoms, but they still seek it out. So there's sort of this dance. They're like kind of… I'm really kind of okay because it's how they dealt with it. It's like we don't have an environment where you're able to be sad or anxious and there's not something wrong with you and so people play it down and… this is totally anecdotal, but I swear it's worse with men. We'll see, they'll come in, and they're like, I'm fine, I'm fine, and then you, well I drink a lot, and then, yeah, I guess I have feelings of sadness, and then you do the scale, and it's like, wow.[00:25:53] I think it's even harder for men to admit their emotional struggles and that's just a generality, but overall I think there's a collusion of denial around our emotional state and somehow you just have to be, present a certain way, and there's something wrong with you if you're struggling.[00:26:07] LM: I mean, I have a couple of thoughts about that. One is thank you for saying out loud that men are more walled off than women to a woman. No, I'm kidding. I think you're generalizing, but yes, let's just acknowledge that we are very self aware species, women, that is. Secondly, I think we all have a level of denial.[00:26:22] I think denial serves us sometimes, right. Denial is a way of partitioning off pain so that we can cope and function. But then when denial takes on a life of its own and the stuff that is in the denial closet is sort of seeping through the edges and like running out of the bottom of the closet and informing our health, that's when denial is no longer serving us. It's when it's actually in the driver's seat. So it strikes me that the experience, in an appropriate setting with a psychedelic, could help people pull that wall down or open that closet and, and take a look inside and maybe rethink how they approach that thing they didn't think they could approach.[00:27:08] And then secondly, yeah, mental health still has a bad rap when, as you both know, we all have mental health. It's not a feature you can kind of opt out of as like the human without the mental health. And as you said earlier as well, we tend to medicalize and pathologize mental health.[00:27:30] So in a way that's good because we are acknowledging that these have medical consequences, that an anxiety disorder is a medical condition, as opposed to just a personality flaw, which was what some people think of it as. But we also tend to label and sort and diagnose conditions that are just normal.[00:27:50] Like, of course, when someone has been raised by an alcoholic parent and they have been conditioned to sort of be a certain way, sort of invisible or good or not a problem, that is going to have an impact on their health such that when they get into a therapist's office or a doctor's office in their forties and their maybe that's not depression.[00:28:13] Maybe you had a response to an experience and sure the symptoms are that of depression, but it's actually something more complex, more nuanced. And so I'm not really asking you a question. I'm just making an observation that we're up against a lot as we market these medicines and therapeutics to people because of the stigma around mental health because of the stigma around drugs But I think if it's done well—which is why Sunstone and other research institutions exist—if it's done well, and we can actually help people understand that their interior lives their past their stories have relevance to their health. And that yes, having clean coronary arteries and nice blood pressure is great, but it's not sufficient for health, then it really, I do think is going to change the way we think about health.[00:29:04] It's already changed it for me. It's just that it's not legal yet in DC. And I haven't tried psychedelic medicine. I want to, it has changed the way I think about emotional health. I mean, I've been thinking about mental health and health in this way, my whole career, but I don't think modern medicine has given doctors really permission to do that.[00:29:20] And so I wonder what you think is in the pipeline. Are these things going to be FDA approved in the next five years, ten years? Are people going to be able to access these therapeutics? Are there going to be enough guides to appropriately shepherd people through the process? What are we looking at in the next year or five years.[00:29:41] MA: I just want to comment a little bit on what you said around the denial piece. I think that denial actually is quite healthy. And on where your neurological system was, when you experienced something, it might've been, it probably was overwhelming and the proper and healthy response would have been denial and to put it into a box.[00:30:00] It's just that now it's not necessary and it's not integrating back into your life. And so I'm very wary of pathologizing any of these things because they're usually healthy. It's just in the context now. And so I just make that one point and the other one around the mental health issue that, it's good that we're talking about it, but I think that we wouldn't want a life without emotions, right?[00:30:23] If you push down your anxiety and your fear, you also push down your joy and happiness and love, the things that we humans live for. And so they sort of go both hand in hand and you can't have both of those.[00:30:38] LM: Yeah, sort of like when we talk about alcohol when we're sort of self medicating, right? It blunts distress, but also blunts joy, libido, life. So you can't selectively numb. You also can't selectively be the human without an emotional life because that wouldn't be good. Then we'd all be like chat GPT or AI, right?[00:31:00] PT: Yeah, yeah, and it just, I'm just going to piggyback on that denial part of things too, because I think one of the things that's important to remember is that people have built up these ways of denial, of sort of pushing things away. Psychedelics, like we mentioned before, can be a catalyst to break through that denial.[00:31:17] That can be, you can lose your balance when that happens. So I just want to highlight again how important it is to have that integration and that container afterwards because you can't feel that way afterwards. You have to be with people that help you find that centeredness again. [00:31:35] And in terms of access and what's happening, we talked about how MDMA has been studied in PTSD for some time now. And there are two phase three trials. They're showing significantly positive results. And that might be the first medication that gets approved as a psychedelic for PTSD outside of esketamine, which has been approved for depression. And that might happen in the next year or two and we will hope for that.[00:32:01] And psilocybin is behind that in terms of how it's being used in various types of depression, and more and more information is coming out around that looks good, and perhaps if it continues to look good, that could be the next medication that gets approved. We'll see. So I think those are the things that are happening in terms of access and how we get this to people if they are approved, if they do show that they are effective, You're right, I don't think our healthcare system is built for this right now and there aren't enough therapists that are trained in this to treat everyone that has PTSD or even a half the people that have PTSD that might qualify for MDMA or for psilocybin in some sort of depression. And that's what we're thinking a lot about.[00:32:48] We have investigated how to do this in a group setting, with group preparation, taking the medicine as a group, and having integration as a group. We find it is not only a way that introduces efficiencies, but we also see therapeutic healing with that approach, too. To be able to be connected with another group of people that have something similar to what you have or what you're going through, whether that be cancer or PTSD or depression, and to develop this bond during the sessions that you have with each other around preparation and integration, we think that's probably going to be therapeutic, too.[00:33:29] That model also allows for more people to be trained on this. So, we're trying to think about how to do that from a group setting. We're trying to think about how digital tools can be used to improve or to give us efficiencies in this setting, but also remembering that there's compassion that's needed with this, so not to overuse digital processes. We're thinking about that as well. How do you do scheduling and other things? So, I think there's a number of problems to be solved around access, but they're solvable.[00:34:00] LM: And so if you're listening to this and you're thinking to yourself, wow, I've been in therapy for 10 years. I'm on Prozac, but I still feel anxious. I'm sure there's some parts of me I haven't really discovered. This sounds really interesting. Or if you're just listening and want to try psychedelics, where would you go?[00:34:18] Would you have to enroll in a clinical trial? Would you call Sunstone? Would you wait until MDMA is approved? What would you do if you were curious and wanted to participate in the research or the therapeutic elements here?[00:34:31] MA: I think the first thing you would do is look for a clinical trial. And so, there are many, many places now that are doing research throughout the country and internationally. And certainly at Sunstone, we have five studies open now, and we will have another three more open this year. We have them in depression and anxiety and PTSD and cancer and family members of cancer patients and so there's other places that have that. So I think that's sort of the most rigorous way to get that. And I do think that some medicines, as Paul said, will be approved next year. I think that, I cannot underemphasize the importance of the context and the safety. What you don't want is to do something and get worse and so you want to make sure that you have safety if you're not good on that road.[00:35:16] And I think we've talked a lot about the upsides of psychedelics and we're talking about that because so much of mental health right now, we don't have great treatments for, but we're still really in early days and we still have a lot to learn. Who's most going to benefit? Which people are completely contraindicated for?[00:35:36] How do you get people ready? And so I understand the hype because people are desperate. And at the same time, I want to be cautious in that I think we're still learning about how to use these powerful medicines.[00:35:50] LM: Yeah, I mean, I think one thing I am concerned about in particular, and I know this is out there in the public, is the potential risk for someone, particularly in their 20s who may be predisposed to schizophrenia. Is there a link between the use of psychedelic drugs and either the awakening or the schizophrenia or mental illness?[00:36:09] Plus, as you've already talked about, this idea of not having the right set and setting not having the appropriately trained guide or the feeling on the patient side of of safety and trust such that people get worse. So what are the absolute contraindications right now in your mind?[00:36:28] PT: Some of them are around people who have a tendency towards manic episodes. Like bipolar disorder with mania because that has been described where people had manic episodes after having a psychedelic experience, so I think that's one firm contraindication right now, at least in research trials. [00:36:49] The others are—there are some cardiac effects that people worry about with some of the psychedelic medicines, so if there's a history of abnormal heart rhythms or a potential tendency to have an abnormal heart rhythm, that's another contraindication. Some of them like MDMA have sympathomimetic effects, which means they can cause the heart rate to go up and the blood pressure to go up. So if someone doesn't have controlled high blood pressure, or if they have underlying heart disease, they may need to get evaluated with a stress test and things like that to show that things would be safe if those conditions happen.[00:37:27] LM: And what about, so many Americans are on SSRIs, so is there a contraindication? For people who are on SSRIs or who are on any other medications at all?[00:37:38] MA: In terms of the SSRIs, right now we taper people off of them, and it's less about safety as much as efficacy, that we think it might blunt the depth of the response of a psychedelic. Although there are ongoing studies that are bringing some of that into question, and so they probably do work maybe at a higher dose, and so it's not an absolute contraindication, it's certainly not a contraindication for safety, it's just a, you might limit its efficacy.[00:38:02] LM: Interesting.[00:38:03] MA: And some of the drugs that can prolong the QTC, there's some concern around that, and so we certainly do EKGs on all the patients.[00:38:11] LM: What is so great about the way you're describing the research is that you have a healthy level of respect for these medications. You have enthusiasm, but it is tempered with appropriate caution. So thank you guys for joining me. It's been so fun learning about Sunstone. I've been grateful to you guys for taking some of my patients into your clinical trials, and I can't wait to see what's next.[00:38:37] PT: Thanks for having us, Lucy.[00:38:39] MA: Yeah, it's just been great getting to know you.[00:39:03] LM: Thank you all for listening to Beyond the Prescription. Please don't forget to subscribe, like, download, and share the show on Apple Podcasts, Spotify, or wherever you catch your podcasts. be thrilled if you liked this episode to rate and review it. And if you have a comment or question, please drop us a line at info@lucymcbride.com. The views expressed on this show are entirely my own and do not constitute medical advice for individuals. That should be obtained from your personal physician. Get full access to Are You Okay? at lucymcbride.substack.com/subscribe

Plastic surgery is a profession that seems to be almost inextricably linked with certain ideas about physical beauty in popular culture. Yet, l have often wondered whether working in the field might not give plastic surgeons a more nuanced understanding of beauty than we tend to give them credit for.In this episode of This is Beauty Podcast, I talk to Plastic Surgeon and Researcher Dr. Michael Reilly, a double-board certified facial plastic and reconstructive surgeon at MedStar Georgetown University Hospital in Washington, DC, about the subject of beauty and the role it plays in his profession and his practices, both as a cosmetic and reconstructive surgeon. How does the concept of beauty inform his work and how has his work influenced, or been influenced by, his personal philosophy of beauty?While I have always had lots of questions on the subject, plastic surgery is a topic that I've always skirted on the show until now — not because it doesn't have a place here, but because I really wanted to avoid the kind of skin-deep only conversations that can erupt when people mention beauty and plastic surgery in the same breath. In Michael, I found not only an expert on the subject of cosmetic and reconstructive surgery, but someone who has clearly given the concept of beauty and its relationship to his work serious thought.In this conversation, we discuss Michael's work with both his cosmetic and reconstructive surgery patients and how beauty takes on different meanings depending upon the objectives of the procedure and more!Enjoy!When perfection matters Social media's influence on the field of plastic surgeryHow mental health and self-esteem influence patient outcomesDr. DeSilva on the Golden Ratio and the most world's most beautiful womenDefinitions of beauty Bell's Palsy and Facial Paralysis Who benefits most from plastic surgeryWhy men seek plastic surgeryStandards of physical beauty: men vs. womenAge as a factor in proceduresWhy people elect plastic surgeryMentioned in this episode:MedStar Georgetown University Hospital The Most Beautiful Women in the World - Dr. Julian DeSilvaBell's Palsy and Mental HealthPsychology Today Blog: Dissecting Plastic SurgerySocial Media Drives Interest in Plastic Surgery ProceduresPlastic Surgery Can Make You More LikeableAbout Today's Guest:Doctor Michael Reilly is a Professor of Otolaryngology--Head & Neck Surgery at Georgetown University Medical Center and a double-board certified facial plastic and reconstructive surgeon at MedStar Georgetown University Hospital in Washington, D.C. His areas of expertise include both facial cosmetic surgery, including the full spectrum of minimally invasive treatments, and facial reconstructive surgery, with particular interests in the areas of nerve paralysis and microvascular reconstructive and melanoma...

The Ethical and Religious Directives have been a popular topic of conversation in health care circles for the past year. But what if we stopped viewing them simply as a list of do's and dont's, but as a living document articulating the mission and identity of Catholic health care?Betsy Taylor, editor of Health Progress, and Fr. Myles Sheehan, director of the Edmund D. Pellegrino Center for Clinical Bioethics and the David Lauler chair of Catholic Health Care Ethics at Georgetown University Medical Center, join the show to discuss the ongoing conversation around the ERDs and how they can fortify the identity of Catholic health care. Fr. Sheehan also speaks directly to several specific parts of the ERDs, giving a comprehensive view of the directives and guiding principles beneath them.

Episode 5 invites Tony Scialli MD, an obstetrician-gynecologist and reproductive toxicologist, to talk about the overuse of gynecologic surgeries – namely hysterectomies and Cesarean sections. Pharmanipulation is produced by PharmedOut, a Georgetown University Medical Center rational prescribing project. For a transcript of this episode, please visit: https://georgetown.box.com/s/1bdbxvaezezlpu0qsm02q3101mmhsi3a To learn more about Dr. Tony Scialli, please visit his website: https://www.scialliconsulting.com/#about Additional Resources The Cultural Warping of Childbirth by Doris Haire. Link: https://www.abebooks.com/9789315600471/Cultural-Warping-Childbirth-Doris-Haire-9315600479/plp Our Bodies, Ourselves by Boston Women's Health Collective. Link: https://www.simonandschuster.com/books/Our-Bodies-Ourselves/Boston-Womens-Health-Book-Collective/9781439190661 Spiritual Midwifery by Ina May Gaskin. Link: https://www.abebooks.com/servlet/BookDetailsPL?bi=31385160493&ref_=ps_ggl_17730880232&cm_mmc=ggl-_-US_Shopp_Trade_10to20-_-product_id=COM9781570671043USED-_-keyword=&gclid=Cj0KCQjw1_SkBhDwARIsANbGpFs4ExX1P9YXQFUuTueJytlUy2VdelLMIBU7neywgGu14aYawh1w7hkaArxfEALw_wcB National Women's Health Network. Link: https://nwhn.org/ PharmedOut is supported primarily by individual donations. To donate, please visit: https://sites.google/com/georgetown.edu/pharmedout/donate

Episode 4 invites medical anthropologist Sylvia Önder PhD and cultural psychologist Yulia Chentsova Dutton PhD to discuss the differences among disease, sickness and illness and explore the concepts of invented diseases, folk illnesses, and the social value of certain diseases.  Pharmanipulation is produced by PharmedOut, a Georgetown University Medical Center rational prescribing project. For a transcript of this episode, please visit: https://georgetown.box.com/s/ufrrmreu5d26cbfvorbu863uz32qkih9 PharmedOut Conference: https://sites.google.com/georgetown.edu/pharmedout/resources/conferences/2023-conference Bonnie O'Connor. Healing Traditions: Alternative Medicine and the Health Professions. 1995. Link: https://www.jstor.org/stable/j.ctt3fhvd3 Irving Zola. Medicine as an institution of social control. 1976. Link: https://www.jstor.org/stable/43618673 Michel Foucault. The Birth of the Clinic: An Archaeology of Medical Perception. Link: https://www.penguinrandomhouse.com/books/55034/the-birth-of-the-clinic-by-michel-foucault/  PharmedOut is supported primarily by individual donations. To donate, please visit: https://sites.google/com/georgetown.edu/pharmedout/donate

Karen and Blake talk with Professor James Giordano from the departments of Neurology and Biochemistry at Georgetown University Medical Center about the phenomenon called Deja Vu. Learn more about your ad choices. Visit megaphone.fm/adchoices

In this episode, we talk to Dr. Yesmean Wahdan, Vice President for U.S. Medical Affairs in the Bayer Women's HealthCare division. In this episode, we discuss the prevalence, causes and treatments for heavy menstrual bleeding. This is a great opportunity to learn more about Bayer's new women's health strategy which emphasizes partnerships with startups, and which companies they're interested in working with.Remember to like, rate and subscribe and enjoy the episode!Guest bioDr. Yesmean Wahdan, MD is the Vice President for U.S. Medical Affairs in the Bayer Women's HealthCare division. She is the eldest of 6 children and was born and raised in the Northern Virginia area not far from the Nation's Capital – Washington, DC. She received her bachelor's degree in Cellular and Molecular Biology from Marymount University in Arlington, Virginia, and her Medical Degree from Georgetown University School of Medicine in Washington, DC. She completed her OB/GYN residency at a combined program at Georgetown University Medical Center and Washington Hospital Center in Washington, DC. She has also published several abstracts and articles in the field of Women's Health. In her time at Bayer, Dr. Wahdan has served as Medical Science Liaison, a Medical Director, and most recently as head of the U.S. Medical Affairs group for Women's HealthCare.  Dr. Wahdan is passionate about the care and health of women and is proud to work with an organization dedicated to advancing the health of women through science, research, and creating accessibility to options that impact the lives of women throughout their life journey. She believes that when women are healthy, informed, and can realize their full potential, their families, communities, and ultimately the world can have better tomorrows.Dr. Wahdan is based in the US Bayer Headquarters office in Whippany, New Jersey, and lives in Northern New Jersey with her family.FemTech Focus Podcast bioThe FemTech Focus Podcast is brought to you by FemHealth Insights, the leader in Women's Health market research and consulting. In this show, Dr. Brittany Barreto hosts meaningfully provocative conversations that bring FemTech experts - including doctors, scientists, inventors, and founders - on air to talk about the innovative technology, services, and products (collectively known as FemTech) that are improving women's health and wellness. Though many leaders in FemTech are women, this podcast is not specifically about female founders, nor is it geared toward a specifically female audience. The podcast gives our host, Dr. Brittany Barreto, and guests an engaging, friendly environment to learn about the past, present, and future of women's health and wellness.FemHealth Insights bioLed by a team of analysts and advisors who specialize in female health, FemHealth Insights is a female health-specific market research and analysis firm, offering businesses in diverse industries unparalleled access to the comprehensive data and insights needed to illuminate areas of untapped potential in the nuanced women's health market.Time Stamps[04:10] Dr. Wahdan's background[06:49] What is Bayer?[09:10] Why is Bayer deprioritizing women's health Research & Development?[12:45] What is Heavy Menstrual Bleeding?[15:14] Indicators of Heavy Menstrual Bleeding[16:06] Causes of Heavy Menstrual Bleeding[16:55] Prevalence of Heavy Menstrual Bleeding[19:27] Disproportion based on race, ethnicity, age and location[20:10] Are you born with Heavy Menstrual Bleeding or does it develop?[20:32] Treatment options[23:30] Hormonal contraceptive impact on bleeding[24:43] Non-hormonal options[25:34] Bayer's clinical trials for endometriosis treatments[28:03] What kind of partnership is Bayer looking for?[28:35] What's an area of Women's Health that still needs innovation?[30:42] What does the femtech industry as a whole need the most in order to be successful? ResourcesBayer's commitment to Women's Healthcare - Episode 141 Episode ContributorsDr. Yesmean WahdanLinkedIn: @Yesmean H. Wahdan, MD Dr. Brittany BarretoLinkedIn: @Brittany Barreto, Ph.D.Twitter: @DrBrittBInstagram: @drbrittanybarreto BayerWebsite: https://www.bayer.com/en/us/bayer-united-states-of-americaLinkedIn: @BayerTwitter: @BayerInstagram: @bayerofficial   FemTech Focus PodcastWebsite: https://femtechfocus.org/LinkedIn: https://www.linkedin.com/company/femtechfocusTwitter: @FemTech_FocusInstagram: @femtechfocus FemHealth InsightsWebsite: https://www.femhealthinsights.com/LinkedIn: @FemHealth Insights

Episode 3 of Pharmanipulation invites Gretchen LeFever Watson PhD and Robert Whitaker to question diagnoses of attention deficit hyperactivity disorder and to critique drug treatment of behaviors associated with ADHD. Pharmanipulation is produced by PharmedOut, a Georgetown University Medical Center rational prescribing project. For a transcript of this episode, please visit: https://georgetown.box.com/s/jjei0u9zhtezfqg2i5p83h9per8nzugc For a list of resources and studies mentioned in this episode, please visit: ⁠https://bit.ly/Ep3Resources To learn more about Dr. LeFever Watson, please visit her website: https://drgretchenwatson.com/ To learn more about Robert Whitaker, please visit his website: https://www.madinamerica.com/robert-whitaker-new/  PharmedOut is supported primarily by individual donations. To donate, please visit: https://sites.google/com/georgetown.edu/pharmedout/donate

In this episode of Causes or Cures, Dr. Eeks chats with Dr. James Giordano about narrowing in on the cause of Havana Syndrome, a mysterious illness targeting the intelligence community. Havana Syndrome was first identified in 2016, when diplomats and intel officers working in Havana, Cuba began experiencing a mysterious set of symptoms. Dr. Giordano was one of the experts tasked to investigate the cause of Havana Syndrome, and while other reports of Havana Syndrome have occurred in other locations, this podcast will focus on what happened in Havana in 2016. "Dr James Giordano is Pellegrino Center Professor in the Departments of Neurology and Biochemistry, and Chief of the Neuroethics Program at Georgetown University Medical Center, Washington DC. He is Senior Bioethicist of the Defense Medical Ethics Center, and Adjunct Professor of Psychiatry at the Uniformed Services University of Health Sciences/Walter Reed National Military Medical Center, Bethesda, MD, and is Distinguished Visiting Professor of Brain Science, Health Promotions, and Ethics at the Coburg University of Applied Sciences, Coburg, Germany. He is the author of over 350 peer-reviewed publications, 9 books, and 40 government reports on brain science, ethics, and biosecurity. Dr. Giordano was elected to the European Academy of Science and Arts; is an International Fellow of the Royal Society of Medicine (UK); was a Senior Fellow and Task Leader of the EU Human Brain Project; and was an appointed member of the US Department of Health and Human Services Secretary's Advisory Committee on Human Research Protections."You can contact Dr. Eeks at bloomingwellness.com.Follow Eeks on Instagram here.Or Facebook here.Or Twitter.Subcribe to her newsletter here.Support the show

This is our second installment of happiness week on the Plain English podcast. On Tuesday, I spoke with the directors of the Harvard Study of Adult Development about what makes a good life, based on their 80-year longitudinal study. Today's episode is about the phenomenon of rising teenage unhappiness. What's actually happening? Why is it happening? What theories make sense, and what theories don't? How can we fix this problem? Today's guest is Matthew Biel, the chief of child and adolescent psychiatry at Georgetown University Medical Center, and chief medical officer at Fort Health. Host: Derek Thompson Guest: Matthew Biel Producer: Devon Manze Learn more about your ad choices. Visit podcastchoices.com/adchoices

Episode 2 of Pharmanipulation invites Adewole S. Adamson MD, MPP, to discuss the relationship of sun exposure to melanoma, whether sunscreen actually prevents skin cancer, and the overdiagnosis of melanoma. Dr. Adamson is a board-certified dermatologist and an assistant professor in the department of Internal Medicine at Dell Medical School at the University of Texas at Austin where he studies skin cancer, evidence-based medicine, and health policy. He is also the Director of the Pigmented Lesion Clinic at the University of Texas at Austin, and he serves as an assistant editor at JAMA Dermatology. Pharmanipulation is produced by PharmedOut, a Georgetown University Medical Center rational prescribing project. For a transcript of this episode, please visit: https://georgetown.box.com/s/3bte8vynpulj33kv3qdtwdabamm2n9xx To learn more about Dr. Adamson, please visit his website: https://adeadamson.com/ Dr. Adamson's paper on Estimating Overdiagnosis of Melanoma Using Trends Among Black and White Patients in the U.S. is available here: https://jamanetwork.com/journals/jamadermatology/fullarticle/2789995 Dr. Adamson's paper on The Rapid Rise in Cutaneous Melanoma Diagnoses is available here: https://www.nejm.org/doi/10.1056/NEJMsb2019760?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed PharmedOut is supported primarily by individual donations. To make a donation please visit: https://sites.google/com/georgetown.edu/pharmedout/donate

Pharmanipulation is a new show created by PharmedOut, dedicated to the topics of evidence-based medicine and industry influence on medical information and public health. PharmedOut is a Georgetown University Medical Center rational prescribing project. Episode 1 covers pharmaceutical marketing tactics, industry influence on medical knowledge, and invented diseases. Join hosts Caroline Renko and Patricia Bencivenga as they interview Adriane Fugh-Berman MD, the Director of PharmedOut. Links PharmedOut website: https://www.pharmedout.org/ PharmedOut is supported primarily by individual donations. To make a donation please visit: https://sites.google.com/georgetown.edu/pharmedout/donate Pharma Marketing Hub (factsheets and summaries of important topics): https://sites.google.com/georgetown.edu/pharmedout/resources/pharma-marketing-hub?authuser=0 Patient Grooming Webinar: https://youtu.be/PD_tBqHDouY Transcript to this episode: https://georgetown.box.com/s/qsf6875gd5qgelemtx9urltgaxyl77lx

Study links nutrients in blood to better brain connectivity, cognition in older adults University of Illinois, December 20, 2022 A new study links higher levels of several key nutrients in the blood with more efficient brain connectivity and performance on cognitive tests in older adults. The study, reported in the journal NeuroImage, looked at 32 key nutrients in the Mediterranean diet, which previous research has shown is associated with better brain function in aging. It included 116 healthy adults 65-75 years of age. "We wanted to investigate whether diet and nutrition predict cognitive performance in healthy older adults," said University of Illinois postdoctoral researcher Christopher Zwilling, who led the study with U. of I. psychology professor Aron Barbey in the Beckman Institute for Advanced Science and Technology. The analysis linked specific patterns of a handful of nutrient biomarkers in the blood to better brain health and cognition. The nutrient patterns included omega-3 fatty acids, which are abundant in fish, walnuts and Brussels sprouts; omega-6 fatty acids, found in flaxseed, pumpkin seeds, pine nuts and pistachios; lycopene, a vivid red pigment in tomatoes, watermelon and a few other fruits and vegetables; alpha- and beta-carotenoids, which give sweet potatoes and carrots their characteristic orange color; and vitamins B and D. The researchers relied on some of the most rigorous methods available for examining nutrient intake and brain health, Barbey said. Rather than asking participants to answer food-intake surveys, which require the accurate recall of what and how much participants ate, the team looked for patterns of nutrient "biomarkers" in the blood. The team also used functional magnetic resonance imaging to carefully evaluate the efficiency with which various brain networks performed. The analysis found a robust link between higher levels of several nutrient biomarkers in the blood and enhanced performance on specific cognitive tests. These nutrients, which appeared to work synergistically, included omega-3 and omega-6 fatty acids, carotenoids, lycopene, riboflavin, folate, vitamin B12 and vitamin D. The analysis also revealed that a pattern of omega-3s, omega-6s and carotene was linked to better functional brain network efficiency. Different nutrient patterns appeared to moderate the efficiency in different brain networks. For example, higher levels of omega-3 fatty acids paralleled the positive relationship between a healthy frontoparietal network and general intelligence. The frontoparietal network supports the ability to focus attention and engage in goal-directed behavior. "Our study suggests that diet and nutrition moderate the association between network efficiency and cognitive performance," Barbey said. "This means that the strength of the association between functional brain network efficiency and cognitive performance is associated with the level of the nutrients." (NEXT) Sunlight offers surprise benefit -- it energizes infection fighting T cells Georgetown University Medical Center, December 20, 2022 Sunlight allows us to make vitamin D, credited with healthier living, but a surprise research finding could reveal another powerful benefit of getting some sun. Georgetown University Medical Center researchers have found that sunlight, through a mechanism separate than vitamin D production, energizes T cells that play a central role in human immunity. Their findings, published in Scientific Reports, suggest how the skin, the body's largest organ, stays alert to the many microbes that can nest there. "We all know sunlight provides vitamin D, which is suggested to have an impact on immunity, among other things. But what we found is a completely separate role of sunlight on immunity," says the study's senior investigator, Gerard Ahern, PhD, associate professor in the Georgetown's Department of Pharmacology and Physiology. "Some of the roles attributed to vitamin D on immunity may be due to this new mechanism." They specifically found that low levels of blue light, found in sun rays, makes T cells move faster -- marking the first reported human cell responding to sunlight by speeding its pace. "T cells, whether they are helper or killer, need to move to do their work, which is to get to the site of an infection and orchestrate a response," Ahern says. "This study shows that sunlight directly activates key immune cells by increasing their movement." Ahern also added that while production of vitamin D required UV light, which can promote skin cancer and melanoma, blue light from the sun, as well as from special lamps, is safer. And while the human and T cells they studied in the laboratory were not specifically skin T cells -- they were isolated from mouse cell culture and from human blood -- the skin has a large share of T cells in humans, he says, approximately twice the number circulating in the blood. What drove the motility response in T cells was synthesis of hydrogen peroxide, which then activated a signaling pathway that increases T cell movement. Hydrogen peroxide is a compound that white blood cells release when they sense an infection in order to kill bacteria and to "call" T cells and other immune cells to mount an immune response. "We found that sunlight makes hydrogen peroxide in T cells, which makes the cells move. And we know that an immune response also uses hydrogen peroxide to make T cells move to the damage," Ahern says. "This all fits together." (NEXT)  Capsaicin molecule inhibits growth of breast cancer cells Centre of Genomics, Ruhr-Universität Bochum (Germany), December 22, 2022  Capsaicin, an active ingredient of pungent substances such as chilli or pepper, inhibits the growth of breast cancer cells. This was reported by a team headed by the Bochum-based scent researcher Prof Dr Dr Dr habil Hanns Hatt and Dr Lea Weber, following experiments in cultivated tumour cells. The experiments were carried out with the SUM149PT cell culture, a model system for a particularly aggressive type of breast cancer, i.e. the triple-negative type. Chemotherapy is currently the only available treatment for this type of cancer. In the cultivated cells, the team detected a number of typical olfactory receptors. One receptor occurred very frequently; it is usually found in the fifth cranial nerve, i.e. the trigeminal nerve. It belongs to the so-called Transient Receptor Potential Channels and is named TRPV1. That receptor is activated by the spicy molecule capsaicin as well as by helional – a scent of fresh sea breeze. In collaboration with Dr Gabriele Bonatz from the Augusta clinics in Bochum (Brustzentrum), Hatt's team confirmed the existence of TRPV1 in tumour cells in nine different samples from patients suffering from breast cancer. The researchers activated the TRPV1 receptor in the cell culture with capsaicin or helional, by adding the substances to the culture for a period of several hours or days. As a result, the cancer cells divide more slowly. Moreover, the treatment caused tumour cells to die in larger numbers. The surviving cells were no longer able to move as quickly as heretofore; this implies that their ability to form metastases in the body was impeded. Earlier studies had demonstrated that the chemical arvanil – with a chemical make-up similar to that of the spicy molecule capsaicin – was effective against brain tumours in mice; it reduces tumour growth in the animals. Due to its side effects, however, this substance is not approved for humans. In addition to capsaicin and helional, the endovanilloids, produced naturally in the body, also activate the TRPV1 receptor. (NEXT)  Losing body fat could be facilitated by light evening exercise and fasting Baylor College of Medicine, December 20, 2022 Making muscles burn more fat and less glucose can increase exercise endurance, but could simultaneously cause diabetes, says a team of scientists from Baylor College of Medicine and other institutions. Mouse muscles use glucose (carbohydrate) as fuel when the animals are awake and active and switch to fat (lipid) when they are asleep. The team discovered that disrupting this natural cycle may lead to diabetes but, surprisingly, can also enhance exercise endurance. The switch is controlled by a molecule called histone deacetylase 3, or HDAC3. This finding opens the possibility of selecting the right time to exercise for losing body fat but also raises the concern of using HDAC inhibitors as doping drugs for endurance exercise. The study appears in Nature Medicine. Skeletal muscles, the voluntary muscles, are important in the control of blood glucose in the body. They consume most of the glucose, and if they develop insulin resistance and consequently are not able to use glucose, then diabetes likely will develop. To study the role of HDAC3 in mouse skeletal muscle, Sun and colleagues genetically engineered laboratory mice to deplete HDAC3 only in the skeletal muscles. Then they compared these knocked out mice with normal mice regarding how their muscles burn fuel. When normal mice eat, their blood sugar increases and insulin is released, which stimulates muscles to take in and use glucose as fuel. "When the knocked out mice ate, their blood sugar increased and insulin was released just fine, but their muscles refused to take in and use glucose," said Sun. "Lacking HDAC3 made the mice insulin resistant and more prone to develop diabetes." Yet, when the HDAC3-knocked out mice ran on a treadmill, they showed superior endurance, "which was intriguing because diabetes is usually associated with poor muscle performance," said Sun. "Glucose is the main fuel of muscle, so if a condition limits the use of glucose, the expectation is low performance in endurance exercises. That's the surprise." The researchers then studied what fueled the HDAC3-knocked out mice's stellar performance using metabolomics approaches and found that their muscles break down more amino acids. This changed the muscles' preference from glucose to lipids and allowed them to burn lipid very efficiently. This explains the high endurance, because the body carries a much larger energy reservoir in the form of lipid than carbohydrate. The team performed a number of functional genomics studies that established the link between HDAC3 and the circadian clock. "In normal mice, when the mouse is awake, the clock in the muscle anticipates a feeding cycle and uses HDAC3 to turn off many metabolic genes. This leads the muscles to use more carbohydrate," said Sun. "When the animal is about to go to sleep and anticipates a fasting cycle, the clock removes HDAC3. This leads the muscles to use more lipid." Although these studies were done in mice, the researchers speculate that human muscles most likely will follow the same cycle. The study opens the possibility of promoting body fat burning by increasing exercise activity during the periods in which muscles use lipid, which is at night for people. "Losing body fat would be easier by exercising lightly and fasting at night," said Sun. "It's not a bad idea to take a walk after dinner." (NEXT)  Employees who are open about religion are happier, study suggests Kansas State University, December 17, 2022 It may be beneficial for employers to not only encourage office Christmas parties but also celebrate holidays and festivals from a variety of religions, according to a Kansas State University researcher. Sooyeol Kim was involved in a collaborative study that found that employees who openly discuss their religious beliefs at work are often happier and have higher job satisfaction than those employees who do not. "For many people, religion is the core of their lives," Kim said. "Being able to express important aspects of one's life can influence work-related issues, such as job satisfaction, work performance or engagement. It can be beneficial for organizations to have a climate that is welcoming to every religion and culture." Kim said employers might even want to consider a religion-friendly policy or find ways to encourage religious expression. For example, organizations could have an office Christmas party, but also could celebrate and recognize other religious holidays and dates, such as Hanukkah, Ramadan or Buddhist holidays. For the cross-cultural study, the researchers surveyed nearly 600 working adults from a variety of industries -- including education and finance -- in the U.S. and South Korea. The surveyed employees were all Christian, but identified with a variety of denominations, including Presbyterian, Baptist and Methodist, among others. Results showed that employees who valued religion as a core part of their lives were more likely to disclose their religion in the workplace. Employees who felt pressure to assimilate in the workplace were less likely to disclose their religious identity, Kim said. But most significantly, the researchers found that the employees who disclosed their religion in the workplace had several positive outcomes, including higher job satisfaction and higher perceived well-being. "Disclosing your religion can be beneficial for employees and individual well-being," Kim said. "When you try to hide your identity, you have to pretend or you have to lie to others, which can be stressful and negatively impact how you build relationships with co-workers." Kim said the research on religion in the workplace plays a part into work-life balance. Research continues to show that individual characteristics -- such as family and religion -- can influence work-related issues. (NEXT) New Cannabis Capsule Is So Powerful It's Going To Completely Replace All Pain Killers University of Pennsylvania, December 19, 2022    In places where medical marijuana is legal, opioid abuse and addiction has fallen by 25%, but the government maintain they are stumped as to why Opioid abuse and addiction is a massive problem all over the US, hence why people are eager to find natural alternatives. The health benefits of cannabis are become more and more accepted in mainstream society, as more studies which support cannaboid use are published. This doesn't sit well with big pharma, who are desperate to hold on to the monopoly they control. In the U.S. states where medical marijuana is legal to use, deaths from opioid overdoses have decreased by almost 25 percent, according to a new data. The study was done by Bachhuber, of the Philadelphia Veterans Affairs Medical Center and the University of Pennsylvania, and his colleagues who used state-level death certificate data for all 50 states. According to JAMA Medicine, in states with a medical marijuana law, overdose deaths from opioids like morphine, oxycodone and heroin decreased by an average of 20 percent after just one year. After two years, they continued to decrease to 25 percent. In the mean time, opioid overdose deaths across the country skyrocketed. The cannabis capsules are made from the extract of cannabis flower. The active ingredients are processed without microbials and then packaged with a specific mix of 60 mg of THC (tetrahydrocannabinol) and 10 mg of CBD (cannabidiol). The combination together creates the perfect effect to relieve pain. The THC helps send happy feelings to the brain, while the CBD helps promote relaxation of the muscles. This helps reduce muscle spasms as well as inflammation.

In today's episode, Dr. Carrie Jones is joined by Dr. Robert Hedaya, a Neuropsychiatrist, Clinical Professor, and Author. They discuss neuropsychiatric symptoms, brain health, brain inflammation, head trauma, and neurodegenerative conditions. Dr. Robert Hedaya is a Clinical Professor of Psychiatry at Georgetown University Medical Center. He is a neuropsychiatrist that teaches functional medicine, psychiatry, brain health, brain inflammation, head trauma, and neurodegenerative conditions, and the founder of The Whole Psychiatry & Brain Recovery Center. Dr. Hedaya also wrote several books, including Understanding Biological Psychiatry, The Anti-depressant Survival Program, and Depression: Advancing the Treatment Paradigm.