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Episode 138 When One Plus One Equals Three: A Conversation with National Aphasia Synergy               In this episode you will discover: 1.  People with aphasia hold the map. At NAS, people with aphasia don't just have a seat at the table — they built the table. Real peer leadership changes everything about how an organization thinks and acts. 2.  Recovery is about more than speech. The isolation and psychological distress that follow aphasia are just as real as the communication challenges — and just as deserving of attention and support. 3.  Peer-befriending is life participation in action. When people with aphasia support one another through shared experience, that's not a supplement to good care — it is good care. 4.  Sinergia: one plus one equals three. When survivors and professionals work as true equals, something greater emerges than either could create alone. June is National Aphasia Awareness Month, and around here, that means it's time for one of my favorite podcast traditions. For the past few years running, we've spent this month in conversation with people who know aphasia from the inside — those living it every day. Today is no exception, and this one is a conversation I've genuinely been looking forward to.   Welcome to the Aphasia Access Conversations Podcast. I'm Katie Strong from Central Michigan University, where I lead the Strong Story Lab, and I'm a member of the Aphasia Access Podcast Working Group. Aphasia Access is dedicated to transforming services and environments so people with aphasia can participate more fully in life — and today's guests are living proof of exactly what that looks like.         Today I'm speaking with two leaders from National Aphasia Synergy — known as NAS — a peer-led nonprofit founded in 2021 by people with aphasia, for people with aphasia. NAS was built on the belief that those living with aphasia are best positioned to support others on the same journey. Through peer-befriending, technology empowerment, and community building, NAS works to end the isolation that so often follows a stroke — connecting people across the country through a shared sense of what they call Sinergia: the idea that when survivors and professionals work as true equals, one plus one equals three.   Today's conversation feels especially meaningful to me. I've had the privilege of seeing Trish and Amy in action at conferences like Aphasia Access and ASHA — learning from their presentations and watching their advocacy make ripples far beyond those conference walls. As someone who researches friendship and aphasia, I've followed the peer befriending movement closely — it began in the UK, and when I heard that NAS was bringing it to the United States, led by a peer organization, I thought: this is what life participation actually looks like.   Before we get into the conversation, let me tell you a bit more about our guests.   Trish Hambridge is the President and Founder of National Aphasia Synergy. Trish has lived with aphasia since her stroke in 2008, and that experience is the foundation of everything she has built. A former project manager for AppleCare, Trish has become not only a powerful advocate but a published researcher — partnering with research teams to influence the questions being asked and the evidence being built in our field. Her co-authored work spans game-based rehabilitation design, posttraumatic growth in aphasia, and the measurement of motivation and psychological needs in aphasia rehabilitation — all published in leading journals including the American Journal of Speech-Language Pathology. She has spoken at conferences including the Aphasia Access Leadership Summit, Aphasia Access Chautauqua and ASHA, serves on the Disability Advisory Committee in Dunedin, Florida, and is a member of Voices of Hope for Aphasia. Her vision brought NAS to life, and her leadership — in the clinic, in the research literature, and in the community — continues to shape it.   Amy Walters is the Vice President of National Aphasia Synergy. Amy has lived with aphasia since her stroke in 2018 — a stroke that, in a striking twist of fate, occurred while she was attending a neurosurgical conference. A Harvard graduate with a Master of Public Health from Johns Hopkins, Amy spent 30 years as a senior leader in the medical device industry before her stroke, and she has channeled that same expertise and drive into aphasia advocacy. She has presented at neurosurgical conferences to raise awareness, participates in aphasia groups across the country, and brings a remarkable combination of professional knowledge and lived experience to everything NAS does.   So — let's get into the conversation.   Katie Strong: Trish and Amy, welcome. I'm so excited to have you both here today and learn about what's going on in National Aphasia Synergy.   Trish Hambridge: Thank you for the chance to meet.   Amy Walters: We are so pleased to be here with the Aphasia Access Community. Katie Strong: Well, we're delighted that you are sharing your time and expertise with us. I wanted to get started by asking about National Aphasia Synergy. How was it created? Just wondering if you could share the origin story of the organization and how that concept of synergy or working together defines your mission. Trish Hambridge: Long time ago, I had a stroke, major stroke. But I was the same person then as I am now. I remember sitting on the hospital patio in San Jose and Karen, my good friend from college and speech therapist was there, and she was teaching everyone about aphasia. My friends and family were so patient. I remember my Dad talking to me and say, "You are stubborn." and I said, "Thank you!" Because that choice – being subborn - changed everything and gave me the chance to get my identity back. Katie Strong: So, Trish, just to verify, you're saying your stubbornness got you where you are right now. Trish Hambridge: Yes, but yes! Katie Strong: Love it. Trish Hambridge: Sorry to say, I have issues! But going back to the beginning, I had only had five words. Even my 'yes' and 'no' were flipped. Traditional homework is not my cup of tea. Shhh! Quiet, I'm lazy! I needed a better strategy, and I found it with P2Go. It's so much more than an app. It is the tool that gave me my voice back. Katie Strong: I love that, so if I'm understanding correctly, traditional homework is not for you, and that you really needed something that was technology based, which goes back to your expertise in your life, career to be able to really help you communicate, and it was the P2Go. Trish Hambridge: Yeah, yeah, is small, is so, is easy, my opinion. Katie Strong: Well, that's what we're here for today, is your opinion. Trish Hambridge: In 2016, a move to Dunedin, Florida changed everything. I joined Voices of Hope and finally found my community. Then the pandemic hit. But it couldn't stop our connection. We moved to Zoom. I want to be honest, though: some of my friends didn't make it through that storm. Their pain is part of this journey. We build this community in their honor. Katie Strong: Oh, that's really touching, you know. It is. It's hard, so many friends don't stay in our lives for many reasons, but aphasia can really be a challenge for friends sticking around. Trish Hambridge: Yeah, and the technology is not my cup of tea. Katie Strong: Wonderful, wonderful. Thank you for sharing that. Trish Hambridge: In 2021, I stepped up. I moved from a 'Lead Pathfinder' to the Founder of National Aphasia Synergy. I reached out to Debbie Yones, the big cheese of Voices of Hope. She and the Board Director gave me wise advice to help me grow. I didn't do it alone. My sister and my sister-in-law helped me think through the logistics. They helped me build the support for the nonprofit. Because of them, my vision became a reality. Katie Strong: So, your consultation with those important people to your life really helped National Aphasia Synergy become a reality. Trish Hambridge: Yeah. Finally, I asked Amy to join the mission. She became part of the organization. Now, we are moving forward together. Katie Strong: Thanks, Trish. I love that. Amy Walters: Thanks, Trish. Nine years ago, I had my stroke at the neurosurgical conference. Ironic, right? Yeah, the conference was in Colorado Springs. I was in a medically induced coma for 10 days and diagnosed with Global Aphasia. Then I was airlifted to the Shepherd Center in Atlanta, Georgia, where I had a craniotomy and cranioplasty. On the flight I remembered thinking, "Am I in a simulator? What's happening to me?"   Katie Strong: Wow! That sounds surreal! Amy Walters: My career was in clinical affairs for a medical neurosurgical device company, so I am professionally and personally familiar with neuroplasticity. I know how crucial neuroplasticity is to our physical, mental, and emotional recovery. National Aphasia Synergy was born from a deep need for collaborative survivor-led company. Katie Strong: The advocacy you're doing is really amazing, and I'm so excited for our listeners to be able to hear more about it. Amy Walters: Thank you. When we look at the aphasia community today, we see massive gaps. Most organizations are built for us, but they aren't led by us. The 'medical way' focuses only on the speech deficit, but it leaves a gaping hole in mental health, identity, and social connection. The research is heartbreaking: 40% to 60% of stroke survivors with aphasia experience chronic depression, and in early recovery, a staggering 93% experience high levels of psychological distress. This isn't just about the survivor—46% of our family members also face depression. Our mission is to bridge those gaps. We aren't just here to 'fix' speech; we are here to empower the whole person. We call it Sinergia—the Greek word for Synergy. It means we don't work in silos. We don't have 'experts' on one side and 'patients' on the other. We have a partnership where 1 plus 1 equals 3.   Katie Strong: I love it!   Amy Walters: We are moving away from the isolated patient model and toward a Sinergia where survivors and professionals work as equals to reclaim our lives. We are here to educate and empower our peers to use technology to reclaim their voices. But more importantly, we are here to promote peer-befriending. We reach out to those who are new to this path or struggling to find their way, because no one should walk this road alone. Katie Strong: I know, Amy, I just am so excited. I've been watching this peer befriending happen over in the UK, or reading about it, and hearing about it, and I was just so delighted when I heard that National Aphasia Synergy was taking this up and helping us to, to have a really solid connection. I think one of the things that breaks my heart the most is when I meet someone who has aphasia, who's been living with aphasia for a really long time, and they've never met anyone else who had aphasia. Amy Walters: Heartbreaking. Katie Strong: It really is. It really is. Amy Walters: Our goal is to develop a national community that encourages optimism. We believe a positive outlook isn't just a 'nice feeling'—it is a strategy for recovery. Katie Strong: Heck, yes! Amy Walters: At NAS, we don't just look for what's lost; we build on the strengths that remain. There were gaps in the Aphasia Community. Trish Hambridge: Speech Therapists and care partners are vital to recovery. They have good intentions, but the 'medical way' is often the wrong way. Katie Strong: Yeah, yeah, it's not quite the right way. Trish Hambridge: Many researchers only survey the Speech Therapists and the partners. But what about me? What about us? What am I, chopped liver? Think about the last time someone completely iced us out. It hurts, right? It honestly chips away at our sense of self, leaving us clueless as to where we actually fit in. Katie Strong: Yeah, so Trish, just to recap this for the listeners, you're saying when somebody ices you out, you're asking the listeners to reflect on how that really feels, Trish Hambridge: Yeah, I email [a researcher], and have offered [to be a part of their team] but they are like "Oh no, but sorry." Katie Strong: I hear, I hear you. Yeah and I think what you're bringing up - and you and Amy are bringing up such a great point that as the aphasia research community has not always included people with aphasia. Or they're only including people with mild aphasia versus more severe types of aphasia, so I love that you're calling this out and shining light on it. It's, it's time. Trish Hambridge Here's what the research tells us. Therapists and partners see the journey from the outside. But those of us living it? We know the honest truth. Katie Strong: Yeah, yeah, so as the clinicians, the therapists, and the care partners see that journey from the outside, and you all are living it for sure. Trish Hambridge: It is the 'Chicken and the Egg' problem: Does the partner change first? Or does the people with aphasia change? The answer is: The Environment. We must change the environment to find true recovery. We need to move from being 'patients' to being Lead Pathfinders. Katie Strong: Yes, so I love it. You're, you're flipping the script there and reclaiming your identity, or renegotiating it from that patient role to being a lead pathfinder. I love that terminology. Thank you. Thank you. One of you said this earlier that organizations are for people with aphasia, but National Aphasia Synergy is led by people with aphasia. Why is this distinction critical for the community to understand, and how does it change the way an organization is run? Amy Walters: Right, Katie. In the past, organizations were built for us, like a charity. But National Aphasia Synergy is different. We are led by people with aphasia. We are moving from 'being helped' to leading. This is more than an organization. It is a revolution of identity. At National Aphasia Synergy, we are flipping the script on leadership. Our Board makes decisions with one clear priority: putting voices with aphasia at the forefront. That means leaders like Trish, Bruce, and me are the ones making the big calls. We collaborate with wonderful professionals, like Kait, our SLP, Helen, our Financial and Secretarial support and Will Evans, our Volunteer Consultant. They are essential to our success. They ensure our communication is accessible and our business stays strong. I always think of our board meetings being like a United Nations meeting with "international representatives" (i.e., China, France, Japan, etc.) each of us is coming to the table with a different lived experience, different aphasia types, etc. We work together to "translate" and work through our differing communication styles. But make no mistake: The people with aphasia are the primary drivers of the vision. The professionals provide the tools, but we hold the maps.   Katie Strong: Such a great analogy. I love it and it also sounds like your work is fun too.   Amy Walters: Driving you crazy, but you mean you mean you mean, yeah. Hold the phone!   Katie Strong: Oh, that's great. I love it. Well, what does National Aphasia Synergy offer that others should know about? Trish Hambridge: Look at what we have built together: First, our Peer Befriending Program. A team of four SLPs and four people with aphasia worked as equals to create our training. Today, we have 15 volunteer Allies trained and ready to support the community. Katie Strong: I love it. So, 15 people with aphasia, volunteer Allies, have been trained as peer befrienders to go out and connect with other people who newly have aphasia. Trish Hambridge: Right, but anything like… Katie Strong: Or rather, anybody who has aphasia that they're wanting to connect with. Trish Hambridge: Come! Come! But we meet on Zoom.    Katie Strong: On Zoom, right? Yeah, absolutely. This is all virtual, which is amazing, you know, because you get a good reach, a really, a really great reach. What else is going on? Amy Walters: Second, our Aphasia & Mental Health Video. We have four excellent SLPs sharing the research, stats, resources and the power of neuroplasticity. And we also surveyed 10 people with aphasia to capture the honest truth of our emotional journeys and provide 10 essential tips for recovery. Trish Hambridge: I always start with a roadmap. But originally, we were filming something completely different. But three weeks before the shoot, I went to Debbie and asked: 'What do you think?' She said, 'There are enough basic videos out there... why doesn't NAS focus on Mental Health?' Katie Strong: Yeah, okay. So, you were doing all this planning, and then three weeks before the shoot, you went and talked to Debbie and said, "What do you think?" And she said, "There's already enough videos out there on basic aphasia, but not on mental health. I love it! Trish Hambridge: Yeah and so I agree!!! We agreed right away. We made a right turn...  And changed the plan on the fly! I ran a preview for my friends at Voices of Hope. They loved it, but they asked the killer question: 'Where is the actual resource? Where do we go for help?' Katie Strong: Trish, you are speaking to my heart here, and I know I'm one of those "outsider perspectives" as a clinician. But we just don't have great resources for mental health. It's really challenging. So, I love that your friends at Voices of Hope called you out on that. What happened after that? Amy Walters: That was the lightbulb moment, right? Trish Hambridge: Yeah, a video wasn't enough—we needed a map. So, we built the Aphasia and Mental Health Resources paper. The researchers and I had some serious back-and-forth debate, but that's how you get a solid plan. We ended up with something really cool: real tools for real people. Katie Strong: Love, love it! Trish Hambridge: Third, our Adaptive Growth Culture paper. This provides a brand-new map for recovery that the whole world can use to look past the 'broken parts.' Katie Strong: Yeah, Trish, I've heard you speak on this. That talk you gave it, ASHA. I'm going to say listeners, particularly clinicians, you should check this out, because we need to get our clients with aphasia, our lead pathfinders with aphasia to be able to  think in this sort of way, so yeah, Trish Hambridge: But like I have like the speech therapist and the caregiver, and people with aphasia -  it like, look right -- is the good plan. Katie Strong: Love it, fantastic, Amy Walters: Kait and I shared five powerful aphasia stories on video to show our diversity, our strength, our inhumanity, frankly. All of this lives on our National Synergy website. These aren't just projects, they are the proof that when people with aphasia lead, we create world that actually works for us. Katie Strong: Oh, this is fantastic. And we'll have links to your website in the show notes, but you can certainly Google National Aphasia Synergy, and the website pops right up. I've been exploring it for a little bit, but I was looking at it again this morning, and there's just such great, great stuff on there. So please go and check it out. Well, I'm curious, Amy and Trish, what's on the horizon for National Aphasia Synergy, and how can our listeners, whether they're Aphasia Access members or people living with aphasia get involved or support your work. Amy Walters: We are so proud of what we have built, but we are just getting started. This is our Call to Action. Trish Hambridge: We want the world to get excited about Mental Health!  Katie Strong: And I think get excited about your Adaptive Growth Culture too. Trish Hambridge: Yeah! We recently presented a poster at the Chautauqua virtual conference, and the feedback from Aphasia Access members was powerful. The keynote speaker, Dr. Nina Simmons-Mackie, spoke about moving from 'managing a condition' to 'owning a life.' That is exactly what we do! We focus on the strengths, the emotions, and the identity that the old medical model ignores. Katie Strong: Yeah, so okay. So, Trish, you, you were, I think you presented you National Aphasia Synergy presented a poster at the Chautauqua, the Aphasia Access Chautauqua recently. Trish Hambridge: First time presenting a poster! Katie Strong: I love it, I love it. Yep, and the feedback that you got from the Chautauqua attendees was spectacular, right? And that's when, and, and, and Dr. Simmons-Mackie or Nina Simmons Mackey took that idea and we wove it into her keynote at the end, right, and talked about how it's important for us to support people and people with aphasia and care partners move from managing a condition to owning a life. I mean, that that's powerful stuff. I love it! Trish Hambridge: I'm so honored. Katie Strong: Well, you are out there making an impact. Amy Walters: Thank you. We are building something historic, and we want you to be part of it. Here is how you can join the revolution: Trish Hambridge: To the speech therapists and researchers, Help us build our evidence base. We want the test that adapted growth culture map to prove how it improves mental health and builds confidence. Don't just watch from the sidelines—come test this with us! Soon, I'm taking the Adaptive Growth Culture to the global stage. I'll be at the International Aphasia  Rehabilitation Conference in Athens. Katie Strong: You'll be at the International Aphasia Rehabilitation Conference, or IARC, in… Trish Hambridge: Athens!! I am presenting our Adaptive Growth Culture Poster to the top minds in the field. Katie Strong: Fantastic. Trish Hambridge: We have built the roadmap. Now, the researchers will provide the data-driven proof. It is time to see the Adaptive Growth Culture in action. We are moving from lived experience to clinical evidence. Katie Strong: I love it, moving from lived experience to clinical evidence. Amy Walters: That's right, that's right, Trish. If you run a community group, a local program, or a support network, we want to connect with you. Help us build this referral network so that no one is left behind in isolation. We aren't just looking for 'places to go' to pass the time. We are looking for places where we can belong and grow. We are looking for communities that see our potential, not just our deficits. To my peers with Aphasia: Your voice is our power. Share your story or send us a shout-out with your favorite tips and tricks. We also need Buddies for our Peer Befriending program. Help us show the world that we are truly 'owning our lives.' To the Volunteers: We are looking for passionate people to join our Board of Directors. We specifically need one more person with aphasia, as well as SLPs, care partners, and friends. The only requirement? You must believe in the Adaptive Growth Culture. Whether you have the tools or you hold the map, there is a seat at the table for you. Visit us and let's grow together! Katie Strong: Amazing. I hope that our listeners will take you up on the offers that you just laid out there, and that they'll also go out there and share with others that they need to hook everybody up with National Aphasia Synergy. It's a great organization. I enjoyed learning about it more today. And Amy and Trish, I so appreciate you both being here with us and sharing your stories and the amazing work that's going on in National Aphasia Synergy. Trish Hambridge: Thank you. Aphasia Access is fantastic! Katie Strong: I'm glad that you're enjoying Aphasia Access, too. It's a great network, and it's great that we're having lots of communities continue to grow and blossom to support people living successfully with aphasia.   Amy Walters: Hear, Hear! Katie Strong: Thanks. You too. Amy Walters: Thank you. Katie Strong: Have fun in Greece. Trish Hambridge: Yay! Amy Walters: Jealous! Katie Strong: Me too, me too. Amy Walters: Bye, bye. Trish Hambridge: See you. Bye.   On behalf of Aphasia Access, thank you for listening. For references and resources mentioned in today's show, please see our show notes, available on our website at www.aphasiaaccess.org. There you can also become a member of our organization, browse our growing library of materials, and find out about the Aphasia Access Academy. If you have an idea for a future podcast episode, email us at info@aphasiaaccess.org. For Aphasia Access Conversations, here at Central Michigan University in the Strong Story Lab, I'm Katie Strong.     Resources   Below is a list of links to the National Aphasia Synergy (NAS) resources and other organizations as discussed:  NAS Website:  https://nationalaphasiasynergy.org NAS email:  info@nationalaphasiasynergy.org   NAS Facebook page:  https://www.facebook.com/WeRSynergy (to keep up with what's going on at NAS and for inspirational, adaptive growth mindset content) NAS YouTube Channel: https://www.youtube.com/@nationalaphasiasynergy1410 (to watch our Aphasia Stories series, learn about resources, and tune into our quarterly video newsletter, "The Synergy Turf" to hear real people with aphasia) NAS Adaptive Growth Culture paper: https://drive.google.com/file/d/1VIq0juI4FTPKqF0Cev8qZAI5I5po5ouO/view?usp=share_link NAS "You Have Options!" Paper:  https://drive.google.com/file/d/1PBgvb1mDrjnFASaK_dpGL2gnZND_CjaU/view?usp=share_link NAS Aphasia & Mental Health video: https://www.youtube.com/watch?v=GThkxrKbQTI NAS Aphasia & Mental Health Resource paper:  https://drive.google.com/file/d/1pXbFLtZJ8KZ9Pxpg3HVZHBEd_D7BnsED/view?usp=share_link NAS Aphasia Stories video series: https://youtube.com/playlist?list=PLk1GJP6QGrPDOapMhQlmAUBHfVb5-Mnfi&si=BIuoNmeu-TM-ab65NAS  Peer Befriending: To get involved with NAS Peer Befriending, contact  info@nationalaphasiasynergy.org o Flyer:  https://drive.google.com/file/d/1dCETc1pZck59mw6OgaEjZGnXWOcdSlCh/view?usp=sharing o Video:  https://youtu.be/0RNvCeh0BKM   Referenced resources and organizations: Proloquo2Go AAC App mentioned (what Trish uses):  https://www.assistiveware.com/products/proloquo2go Voices of Hope for Aphasia: https://www.vohaphasia.org/    

Dr Angeliki Lysimachou, Head of Science and Policy at Pesticide Action Network (PAN) Europe, examines systemic failures in EU pesticide risk assessment that prioritise industry data over independent science. With a background in environmental toxicology, she scrutinises how regulatory loopholes—such as selective dismissal of genotoxicity, neurotoxicity, microbiome disruption, and low-dose carcinogenicity studies—enable the continued authorisation of hazardous substances like glyphosate despite IARC's probable carcinogen classification and alarming findings from the Ramazzini Institute's full-life-cycle trials showing increased leukaemia and tumours at supposedly safe exposure levels. Lysimachou highlights how corporate influence, ghostwriting, revelations from the Monsanto Papers, and statistical manoeuvering by conflicted experts undermine the precautionary principle embedded in EU law, resulting in “glyphosate deserts,” biodiversity collapse, and persistent PFAS metabolites like TFA contaminating groundwater for decades. Her analysis reveals a deeper structural bias where economic dependencies on pesticide fees, political pressures from member states, and industry lobbying trump public health protections, as evidenced by repeated 5- and 10-year renewals amid abstentions and U-turns like Germany's. By mounting court challenges and pushing for agroecological transitions under the Farm to Fork strategy, she exposes how the current framework shields profitable broad-spectrum herbicides while externalising long-term costs of soil degradation, farmer health burdens (e.g. elevated lymphoma risks), and irreversible environmental damage onto society. Lysimachou's critique underscores the tension between regulatory rhetoric and implementation, calling for genuine accountability and faster phase-outs of forever chemicals. Get full access to Savage Minds at www.savageminds.co/subscribe

A Clare-based Irish Ambulance Representative Council representative says the prospect of ambulance workers carrying out a 72-hour work stoppage should be a "concern for everybody". Trade unions representing National Ambulance Service staff have confirmed that next week's planned 48-hour strike won't be going ahead following yesterday's Labour Court talks. Members are seeking the implementation of a 2020 report's recommendations around updating salary scales to reflect changes in responsibilities and workload. Unions have confirmed plans remain in place for a 72-hour work stoppage on May 26th, and Midwest IARC representative, Clooney Quin native Orla Considine, says this isn't taken lightly.

What if two of the most ordinary things in your life, your cell phone and your tap water, were interacting inside your body in ways no one has ever fully explained before? In this eye-opening solo episode, Darin breaks down emerging research showing that wireless radiation and industrial toxins like chromium-6 may work together inside the body, creating a level of cellular stress and DNA damage far greater than either exposure alone. This isn't about fear, it's about awareness. Because for the first time, we're starting to understand that modern life isn't about isolated exposures… it's about combined effects happening simultaneously. From the shocking reality of contaminated water supplies to the invisible EMF environment we live in daily, Darin connects the dots between science, lifestyle, and practical action. Most importantly, he gives you a clear roadmap for reducing your exposure and strengthening your body's natural defenses, so you can live powerfully within the modern world, without being silently impacted by it.     What You'll Learn Why modern health risks are not isolated—but compounded through multiple exposures The surprising connection between cell phone radiation and chromium-6 What new research reveals about synergistic DNA damage inside cells Why current safety standards may not reflect real-world conditions How widespread chromium-6 contamination is in modern water systems The concept of "toxic load" and how it builds over time Why your body can repair damage—but only up to a certain threshold The importance of reducing exposure instead of chasing perfection How EMFs impact cellular stress responses and long-term health Practical strategies to reduce your exposure starting today     Chapters 00:00:00 – Welcome to SuperLife and the mission of building a healthier world 00:00:33 – Sponsor: the truth about NAD+ supplements and quality verification 00:02:17 – Setting intention: breathwork and grounding into the episode 00:03:08 – Introducing today's topic: cell phones, tap water, and hidden health risks 00:03:54 – New research reveals unexpected interactions inside the body 00:04:35 – How wireless radiation and chromium-6 combine inside cells 00:05:17 – Inside the Bioelectromagnetics Lab and what researchers tested 00:06:01 – Key finding: isolated exposure vs combined exposure 00:06:50 – Why "1 + 1" doesn't equal 2 in biological systems 00:07:43 – DNA fragmentation and what it means for long-term health 00:08:21 – Why current safety standards may be incomplete 00:09:01 – What chromium-6 actually is and why it matters 00:09:56 – The Erin Brockovich connection and why this is bigger than one case 00:10:09 – 200 million Americans exposed through drinking water 00:10:57 – How chromium-6 enters water systems 00:11:30 – The lack of federal regulation and what that means 00:12:00 – Why this isn't about panic: it's about awareness 00:12:37 – Chronic low-level exposure vs acute exposure 00:13:00 – Your body's repair systems—and when they get overwhelmed 00:13:11 – Sponsor: non-toxic cookware and reducing toxic exposure 00:15:01 – Introducing your "Digital Hygiene Protocol" 00:15:40 – Step 1: Creating an EMF-free sleep environment 00:16:30 – Why sleep is critical for DNA repair 00:16:58 – Step 2: Distance as your greatest protection 00:17:30 – Why proximity to your phone matters more than you think 00:18:03 – Eliminating Bluetooth exposure and switching to wired options 00:18:36 – Hardwiring your home and reducing Wi-Fi exposure 00:19:05 – Why earbuds and constant proximity increase risk 00:19:30 – Step 3: Filtering your water to remove chromium-6 00:20:00 – Reverse osmosis and why it matters 00:20:22 – Supporting your body's defense systems through nutrition 00:20:45 – Antioxidants, minerals, and detox support 00:21:10 – Adaptogens and strengthening resilience 00:21:30 – Final perspective: technology isn't the enemy—misuse is 00:22:00 – The concept of the "multi-stressor environment" 00:22:20 – Empowerment over fear: what you can control today 00:22:36 – Closing thoughts and invitation to share the message     Thank You to Our Sponsors: Our Place – Non-toxic cookware that keeps harmful chemicals out of your food. Get 10% off at fromourplace.com with code DARIN. Tru Niagen – Boost NAD+ levels for cellular health and longevity. Get 20% off with code DARIN20 at truniagen.com.     Find More From Darin: Website: darinolien.com Instagram: @darinolien Book: Fatal Conveniences     Key Takeaway "We don't live in a world of single exposures anymore—we live in a world of combinations. It's not just what you're exposed to, it's how those exposures interact inside your body over time. The good news is, you don't need to eliminate everything—you just need to reduce the load. And every small, intentional choice you make moves your biology back toward balance."     Bibliography/Sources Primary Scientific Study Zhu, Y., Zhu, L., Lan, Y., Sun, C., & Chen, G. (2026). Exposure to hexavalent chromium and 1800 MHz electromagnetic radiation can synergistically induce intracellular DNA damage in mouse embryonic fibroblasts. Biochemical and Biophysical Research Communications, 804, Article 153360. https://doi.org/10.1016/j.bbrc.2026.153360 Environmental & Regulatory Resources California State Water Resources Control Board. (2024). Chromium-6 drinking water maximum contaminant level. California Environmental Protection Agency. https://www.waterboards.ca.gov/drinking_water/certlic/drinkingwater/Chromium6.html  Environmental Working Group. (n.d.). Chromium-6 report. https://www.ewg.org/areas-focus/toxic-chemicals/chromium-6  Environmental Working Group. (n.d.). EWG's tap water database. https://www.ewg.org/tapwater International Agency for Research on Cancer. (n.d.). IARC monographs on the evaluation of carcinogenic risks to humans: Non-ionizing radiation, Part 2: Radiofrequency electromagnetic fields (Group 2B). World Health Organization. https://publications.iarc.who.int/Book-And-Report-Series/Iarc-Monographs-On-The-Identification-Of-Carcinogenic-Hazards-To-Humans/Non-ionizing-Radiation-Part-2-Radiofrequency-Electromagnetic-Fields-2013

Birra, vino, fumo, prosciutto, mortadella sono cancerogeni. La carne rossa invece è probabilmente cancerogena mentre l'aspartame è possibilmente cancerogeno. Ma cosa vuol dire? Qual è la differenza tra queste denominazioni? In questo video vedremo cosa significa cancerogeno, come vengono classificate le sostanze dall'IARC nei vari gruppi (gruppo 1, gruppo 2A, gruppo 2B, gruppo 3) e quali sono le 14 raccomandazioni per prevenire i tumori secondo il Codice Europeo Contro il Cancro. Prendi parte alla nostra Membership per supportare il nostro progetto Missione Cultura e diventare mecenate di Geopop: https://geopop.it/ngCbN00:00 Cosa significa “cancerogeno”? 01:01 Chi stabilisce se una sostanza è cancerogena 02:10 La storia dell'IARC 04:20 Le classificazioni IARC: i 4 gruppi 06:20 Gruppo 1: fumo, alcol, carni trasformate 07:26 Gruppo 2A: probabilmente cancerogeni 08:25 Gruppo 2B: possibilmente cancerogeni 09:58 Gruppo 3: non classificabili 11:08 Le 14 raccomandazioni del Codice Europeo contro il Cancro Learn more about your ad choices. Visit megaphone.fm/adchoices

Renue Healthcare https://Renue.Healthcare/ToddYour journey to a better life starts at Renue Healthcare. Visit https://Renue.Healthcare/Todd Bulwark Capital https://KnowYourRiskPodcast.comBe confident in your portfolio with Bulwark! Schedule your free Know Your Risk Portfolio review. Go to KnowYourRiskPodcast.com today. Bonefrog https://BonefrogCoffee.com/ToddGet the new limited release, The Sisterhood, created to honor the extraordinary women behind the heroes. Use code TODD at checkout to receive 10% off your first purchase and 15% on subscriptions.LISTEN and SUBSCRIBE at:The Todd Herman Show - Podcast - Apple PodcastsThe Todd Herman Show | Podcast on SpotifyWATCH and SUBSCRIBE at: Todd Herman - The Todd Herman Show - YouTubeIs Instagram Designed to Be Evil? // Glyphosate is Safe Says Monsanto - Faith and Fitness // Is This Woman Why President Trump Is Failing as a Christian?Episode Links:Meta's Internal Research Shows Its Platforms Are Addictive and Harmful, Still It Targets TeensThis is crazy… In 2000, there was a study done famously called the “Williams Study” — which 99.9% of all studies Cite regarding the “Safety” of Glyphosate . Just last month, that study was retracted because it was found that Monsanto executives wrote it… wowCourtney Swan in Senate testimony… "Glyphosate is classified as a carcinogen by the IARC. It's in breast milk, placentas, organs, rain & drinking water." This toxin is everywhere—driving chronic illness—yet unlabeled on food. End poison subsidies! - Courtney Swan, MS | Integrative Nutritionist"I'm not gonna lay hands on people till you're obedient" - At her recent 2026 Unleashed Conference, a petulant Paula White made a grotesque and manipulative pitch for the pocketbook, saying she needs people to give $100,000, then gets upset when she sees only three envelopes.

O balanço desta semana destaca o início da vacinação de 1,2 milhão de profissionais contra a dengue no Brasil e o alerta global da IARC sobre como infecções preveníveis, como HPV e hepatites, continuam associadas a parcela relevante dos cânceres. O episódio recapitula a resolução histórica da OMS sobre hemofilia , o combate do FDA a versões não aprovadas de medicamentos GLP-1 e os novos fluxos de urgência para o manejo do AVC na gestação. Acompanhe a síntese dos fatos que exigem maior preparo técnico e resiliência na prática médica no seu podcast diário de atualização, com curadoria médica e produzido por IA.Afya News. Informação médica confiável e atualizada no seu tempo.Fontes do episódio aqui:⁠https://portal.afya.com.br/podcasts/afya-news/14-02-2026

Esta edição apresenta as lideranças da lista TIME100 Health 2026 e os avanços em inteligência artificial e terapias que estão moldando o futuro da medicina. O boletim detalha o alerta da IARC sobre como a vacinação e o tratamento de infecções preveníveis, como HPV e Hepatite, são estratégicos para a redução global do risco de câncer. Destacamos também o uso de realidade virtual pela OPAS para o treinamento imersivo de profissionais em resposta a vírus respiratórios. Acompanhe as tendências que impactam a sua prática assistencial no seu podcast diário de atualização, com curadoria médica e produzido por IA.Afya News. Informação médica confiável e atualizada no seu tempo.Acesse o link das fontes aqui:https://portal.afya.com.br/podcasts/afya-news/13-02-2026

Hii leo jaridani tunaangazia juhudi za kutokomeza sarati, mashambilizi dhidi ya misafara ya chakula katika kaunti ya Baliet, jimbo la Upper Nile, nchini Sudan Kusini na tunamulika miaka kumi na nne baada ya wakimbizi wa kwanza wa Syria kuvuka mpaka kuingia Jordan.Mabadiliko ya mfumo wa maisha na mazingira yanaweza kuzuia ugonjwa wa saratani kwa wagonjwa wanne katika kila wagonjwa kumi, limesema shirika la Umoja wa Mataifa la afya duniani, (WHO) na shirika lake tangu la Utafiti kuhusu saratani, IARC.Shirika la Umoja wa Mataifa la Mpango wa Chakula Duniani (WFP) leo Februari 4, 2026 limetangaza kusitisha shughuli zake zote katika kaunti ya Baliet, jimbo la Upper Nile, nchini Sudan Kusini kufuatia mfululizo wa mashambulizi dhidi ya msafara wake wa majini mwishoni mwa wiki iliyopita. Anold Kayanda na taarifa zaidi.Miaka kumi na nne baada ya wakimbizi wa kwanza wa Syria kuvuka mpaka kuingia Jordan kusaka usalama, kambi ya wakimbizi ya Zaatari bado ni makazi ya maelfu ya watu wanaosubiri suluhu ya kudumu. Wiki hii, Kamishna Mkuu wa Umoja wa Mataifa wa Wakimbizi, Barham Salih, ametembelea kambi hiyo na kukutana na familia ambazo zimeishi ukimbizini kwa zaidi ya muongo mmoja wengi wao wakiwa bado na matumaini ya kurejea nyumbani, lakini tu pale ambapo itakuwa salama.Mwenyeji wako ni Anold Kayanda, karibu!

Mabadiliko ya mfumo wa maisha na mazingira yanaweza kuzuia ugonjwa wa saratani kwa wagonjwa wanne katika kila wagonjwa kumi, limesema shirika la Umoja wa Mataifa la afya duniani, (WHO) na shirika lake tangu la Utafiti kuhusu saratani, IARC kama anavyoripoti Rashid Malekela.

Proporção de notificações da doença poderia ser evitada através da redução de fatores de risco conhecidos em todo o mundo; dados de 185 países e 36 tipos de câncer fazem parte de nova análise global da OMS e da Iarc.

Send us a textThe 20th edition of the Arctic Report Card was released on December 16th, 2025 with an impressive compilation of scientific reports on the Arctic. Today's conversation is with editor and long-time contributor, Rick Thoman, who is an award winning climate specialist at IARC's Alaska Center for Climate Assessment and Preparedness(ACCAP). Rick has attempted retirement more than once, but his passion for all things Arctic and climate fuel numerous newsletters and also news rooms as he is truly an expert on this topic. His positive impacts are felt amongst Arctic peoples and also for being a wonderful liaison between the scientific community and Arctic policy makers. The Arctic Report Card is an annual report supported by NOAA (National Oceanic and Atmospheric Administration) with Pan-Arctic perspective and an independent editorial team. The efforts of scientists and climate specialists to create this robust scientific peer reviewed report is in Ricks words, "Herculean"!  The amount of work contributed to this scientific document is extremely important in documenting climate change in the Arctic, which is warming at an alarming rate. Rick discusses highlights that include surface air temperatures and impacts on intensity of storms, including Typhoon Halong, as well as terrestrial snow cover, Greenland Ice Sheet, sea ice, glaciers, marine algae, tundra greenness...all in relatable terminology from complex and hard earned scientific data.  The Report Card is intended for a wide audience, including scientists, teachers, students, decision-makers and the general public interested in the Arctic environment and science. It is encouraged that the Report Card to be utilized and studied, as the scientific community has created it to be an easily read report for the general population to better understand the complexities of the warming Arctic.Here is the link to the 2025 Arctic Report Card:https://arctic.noaa.gov/report-card/report-card-2025/This year held a photo contest for the cover of the Arctic Report Card:https://globalocean.noaa.gov/2025-arctic-report-card-photo-video-contest/Here is the full PFD on the 2025 Arctic Report Card. https://arctic.noaa.gov/wp-content/uploads/2025/12/ArcticReportCard_full_report2025.pdfBe sure to visit this year's Arctic Report Card 2025 for all of the in-depth scientific review of the things that have caught attention of this year's events. Here is the executive summary of the 2025 Arctic Report Card:https://arctic.noaa.gov/report-card/report-card-2025/executive-summary-2025/Thank you for listening the the Alaska Climate and Aviation Podcast!Katie Writerjournalist/pilot/photographerktphotowork@gmail.com907/863-7669PS. If you enjoy the Alaska Climate and Aviation Podcast, become a subscriber. Thanks for tuning in! Click here if you'd like to support the show: https://www.buzzsprout.com/951223/supporters/newphoto credit: Joana Kristin Steffens~finalist for Arctic Report Card Photo ContestSupport the showYou can visit my website for links to other episodes and see aerial photography of South Central Alaska at:https://www.katiewritergallery.com

Send us a textToday's episode includes an interview with climate specialist, Rick Thoman. Rick discusses the conditions that lead to an atmospheric river, La Nina winter predictions and also the importance of weather forecasts and radio coverage for Alaskans. Rick Thoman, a climate specialist at IARC's Alaska Center for Climate Assessment and Policy (ACCAP).  Rick is a contributor and editor of the Arctic Report Card and was also awarded NOAA Distinguished Career Award for Professional Achievement in 2020. Rick was honored after a 30 plus year career with the National Weather Service for continued efforts to improve climate services in Alaska and for outstanding outreach efforts working with the Alaska Native community. We are happy that he has not yet retired, as his wealth of information is an invaluable resource for communities all around Alaska. Thank you, Rick!Rick Thoman has a very informative newsletter on Substack called: Alaska and Arctic Climate Newsletter. You can see illustrations, graphs and be informed of all things Alaska weather.Talkeetna River at Alaska Railroad Bridge NOAA link:  https://water.noaa.gov/gauges/TKTA2Thank you for tuning into the Alaska Climate & Aviation Podcast!Also, I'm happy to announce my scenic flight seeing business, Visionary Adventures, LLC.  "Cub Rides with Katie" offers scenic flights in a Piper Super Cub Airplane here in South Central Alaska.  Message me if you wish to book a flight. Katie Writerktphotowork@gmail.com907/873-7669Support the showYou can visit my website for links to other episodes and see aerial photography of South Central Alaska at:https://www.katiewritergallery.com

Quick PSA! Red Meat Does NOT Cause Cancer! Hard Facts About the WHO IARC Cancer Classifications on Meat and Cancer.   If you liked this and want to learn more go to my new website www.DrAnthonyChaffee.com   ✅Join my PATREON for early releases, bonus content, and weekly Zoom meetings! https://www.patreon.com/AnthonyChaffeeMD ✅Sign up for our 30-day carnivore challenge and group here! https://www.howtocarnivore.com/ ✅Stockman Steaks, Australia Discount link for home delivered frozen grass-fed and grass finished pasture raised meat locally sourced here in Australia! Use discount code "CHAFFEE" for free gift with qualifying orders! http://www.stockmansteaks.com.au/chaffee ✅ 60-minute consultation with Dr Chaffee https://calendly.com/anthonychaffeemd/60-minute-consultation   Sponsors and Affiliates: ✅ Brand Ambassador for Stone and Spear tallow and soaps referral link https://www.stoneandspeartallow.com/?ref=gx0gql8b Discount Code "CHAFFEE" for 10% off ✅ Carnivore t-shirts from the Plant Free MD  www.plantfreetees.com ✅THE CARNIVORE BAR: Discount Code "Anthony" for 10% off all orders!   https://the-carnivore-bar.myshopify.com/?sca_ref=1743809.v3IrTuyDIi ✅Schwank Grill (Natural Gas or Propane) https://glnk.io/503n/anthonychaffeemd $150 OFF with Discount Code: ANTHONYMD ✅X3 bar system with discount code "DRCHAFFEE" https://www.kqzyfj.com/click-100676052-13511487 ✅Shop Amazon https://www.amazon.com/shop/anthonychaffeemd?ref=ac_inf_hm_vp   And please like and subscribe to my podcast here and Apple/Google podcasts, as well as my YouTube Channel to get updates on all new content, and please consider giving a 5-star rating as it really helps!   This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast or materials linked from this podcast is at the user's own risk. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their health care professionals for any such conditions.

Are cancer rates going up or down? It seems like depending on where you look, you'll find different answers to the question. What's going on here — have some writers just got it completely wrong? Is it something to do with different types of cancer? Are we being confused by some kind of weird statistical artefact? All of the above? In this episode of The Studies Show, we do our very best to find out.The Studies Show is brought to you by Works in Progress magazine, the ultimate place online to read about new and underrated scientific and technological ideas that could make the world a better place. You can find a huge range of essays online, for free, at www.worksinprogress.co.Show notes* BBC Future article on early-onset cancer rates* BMJ Oncology article on global cancer incidence increasing by 79%* And its online supplementary information* July 2025 Economist article on how the world is winning the war on cancer* Saloni Dattani's 2025 article on the decline in global cancer rates* The GLOBOCAN data update from the IARC, 2002 and 2008* Our World in Data's graph on global cancer incidence over time* Their graph on smoking rates and lung cancer deaths* Their graph on stomach cancer death rates* New RCT on vaping and smoking cessation* A 90% drop in cervical cancer rates in England* The hepatitis B vaccine and a massive drop in liver cancer incidence in China* On H. pylorii, ulcers, and cancer* 2000 JAMA article questioning the utility of the 5-year survival rate statistic* 2014 PLOS ONE article that's more positive about the statistic* Tom's BuzzFeed News article on oncology* RCT of herceptin on breast cancer survival* Study on rates of colorectal cancer * And the same, in relation to BMICreditsThe Studies Show is produced by Julian Mayers at Yada Yada Productions. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.thestudiesshowpod.com/subscribe

In this episode, I sit down with Dr. David Klurfeld—longtime USDA scientist and one of the few insiders to publicly challenge the WHO's classification of red meat as a carcinogen. We go deep into the flawed evidence behind the infamous 2015 IARC report, why nutritional epidemiology often fails to prove causality, and how a small group of researchers helped shape global policy with low-quality science. If you've ever felt confused about meat, saturated fat, or dietary guidelines, this conversation will help you think critically about what “counts” as evidence—and who gets to decide. We cover:Dr. Klurfeld's personal journey and lessons from a career in public healthWhy the 2015 IARC red meat classification was based on weak and inconsistent evidenceHow observational studies and “allegiance bias” mislead nutrition scienceThe politics of dietary guidelines and the role of the USDA and WHOWhat the media got wrong—and why red meat remains a nutrient-dense foodWhether you're a clinician, dietitian, or simply trying to make better nutrition decisions, this episode is a powerful reminder that bias, groupthink and weak data can distort science and mislead the public. We need to be discerning about the nutrition and health advice we follow. Who is Dr. David Klurfeld?Dr. David Klurfeld is a nutritional scientist and former National Program Leader for Human Nutrition at the USDA's Agricultural Research Service. He also served as Professor and Chair of Nutrition and Food Science at Wayne State University and Associate Editor of The American Journal of Clinical Nutrition. He has authored more than 200 scientific publications and was one of 22 experts invited to the 2015 IARC working group on red meat and cancer. He is a longtime advocate for scientific integrity in public health policy.This episode is brought to you by: LMNT- Free Sample Pack with any purchase, visit https://DrinkLMNT.com/DRLYONTimeline - Get 20% off your order of Mitopure - https://timeline.com/LYONMUDWTR - Use code DRLYON to get up to 43% off your starter kit - https://mudwtr.com/DRLYONNeeded - Use code DRLYON for 20% off your first order - https://thisisneeded.com Find Dr. David Klurfeld at: Indiana University Bloomington - https://publichealth.indiana.edu/about/directory/David-Klurfeld-dmklurfe.html Google Scholar - https://scholar.google.ca/citations?user=Ym5Og20AAAAJ&hl=en LinkedIn - https://www.linkedin.com/in/david-klurfeld-812845209/ Find me at:Instagram:@drgabriellelyon TikTok: @drgabriellelyonFacebook: facebook.com/doctorgabriellelyonYouTube:

The IARC Perspective on the Effects of Policies on Reducing Alcohol Consumption New England Journal of Medicine In 2020, alcohol use was responsible for over 740,000 new cancer cases worldwide. In response, The International Agency for Research on Cancer (IARC) released a two-part handbook assessing the effectiveness of public policy measures in reducing alcohol-related cancer risk. The report found that reducing or stopping alcohol consumption lowers the risk of certain cancers and that several policy interventions, such as increasing alcohol taxes; setting minimum pricing; restricting sales by time, place, and age; implementing total sales bans; and enacting strong marketing restrictions, effectively reduce alcohol consumption. Government-run alcohol monopolies and coordinated national strategies were also associated with decreased use. However, bans on alcohol discounts produced inconsistent results. These findings align with the WHO's Global Alcohol Action Plan and SAFER initiative, highlighting the importance of targeted, enforceable strategies to reduce alcohol-related harm globally.    Read this issue of the ASAM Weekly Subscribe to the ASAM Weekly Visit ASAM

Send us a textToday's conversation is with climate specialist, Rick Thoman. Topics discussed include climate impacts on caribou herds of the Arctic, The Arctic Report Card 2024, Arctic ERMA, CAPRI, and the challenges Arctic communities face as marine traffic increases in the Arctic.  Rick Thoman, a climate specialist at IARC's Alaska Center for Climate Assessment and Policy (ACCAP).  Rick is a contributor and editor of the Arctic Report Card and was also awarded NOAA Distinguished Career Award for Professional Achievement in 2020. Rick was honored after a 30 plus year career with the National Weather Service for continued efforts to improve climate services in Alaska and for outstanding outreach efforts working with the Alaska Native community.The Arctic Report Card is an annual report led by the National Oceanic and Atmospheric Administration(NOAA). The efforts of scientists and climate specialists to create this robust scientific report every year is impressive.  The amount of work contributed to this scientific document is extremely important in documenting climate change in the Arctic, which is warming at an alarming rate. The Report Card is intended for a wide audience, including scientists, teachers, students, decision-makers and the general public interested in the Arctic environment and science. It is encouraged that the Report Card to be utilized and studied, as the scientific community has created it to be an easily read report for the general population to better understand the complexities of the warming Arctic.Here are the links to the 2023 Arctic Report Card and NOAA website:https://arctic.noaa.gov/report-card/report-card-2023/The Arctic Report Card 2024 will be published on December 10th, 2024.https://www.arctic.noaa.govThanks for tuning into the Alaska Climate and Aviation Podcast!Katie WriterJournalist/Pilot/Photographerktphotowork@gmail.comSupport the showYou can visit my website for links to other episodes and see aerial photography of South Central Alaska at:https://www.katiewritergallery.com

If you've spent any time on TikTok or Instagram, there is no doubt you've heard about the “dangers of glyphosate”. This message has only increased since the introduction of MAHA and RFK Jr. A group of people who continuously spread misleading and false claims about nutrition, food science, vaccines, COVID-19, climate change, pharmaceutical industry, gun violence, and more. The MAHA group is convinced that glyphosate in our food is one of the leading causes of poor health outcomes in America. Meanwhile, there is a large body of research, including both human and animal subjects, showing no evidence of this risk. This group also forgets to address and acknowledge the social determinants of health and how oppressive systems impact a person's overall health, but that's for another post. Let's talk about the facts. Sources: Williams, G. M.; Kroes, R.; Munro, I. C. Safety evaluation and risk assessment of the herbicide Roundup and its active ingredient, glyphosate, for humans. Regul. Toxicol. Pharmacol. 2000, 31, 117-165. Stout, L.; Ruecker, F. Chronic study of glyphosate administered in feed to albino rats. Unpublished Report no. MSL-10495 R.D. 1014, 1990, submitted to U.S. Environmental Protection Agency by Monsanto Agricultural Company. Reregistration Eligibility Decision (RED) Glyphosate; EPA-738-F-93-011; U. S. Environmental Protection Agency, Office of Prevention, Pesticides, and Toxic Substances, Office of Pesticide Programs, U.S. Government Printing Office: Washington, DC, 1993. Atkinson, C.; Strutt, A.V.; Henderson, W.; Finch, J.; Hudson, P. Glyphosate: 104 week combined chronic feeding/oncogenicity study in rats with 52 week interim kill (results after 104 weeks). Unpublished report No. 7867, IRI project no. 438623, 1993, submitted to World Health Organization by Cheminova A/S, Lemvig, Denmark, prepared by Inveresk Research International, Tranent, Scotland. Pesticide Residues in Food - 2004: Toxicological evaluations; International Programme on Chemical Safety, World Health Organization: Geneva, Switzerland, 2004. Roberts, T. R. Metabolic Pathways of Agrochemicals-Part 1: Herbicides and Plant Growth Regulators; The Royal Society of Chemistry: Cambridge, UK, 1998; pp 396-399. Davoren M.J., Schiestl R.H. Glyphosate-based herbicides and cancer risk: A post-IARC decision review of potential mechanisms, policy and avenues of research. Carcinogenesis. 2018;39:1207–1215. Williams G.M., Kroes R., Munro I.C. Safety Evaluation and Risk Assessment of the Herbicide Roundup and Its Active Ingredient, Glyphosate, for Humans. Regul. Toxicol. Pharmacol. 2000;31:117–165. Benbrook C.M. Trends in glyphosate herbicide use in the United States and globally. Environ. Sci. Eur. 2016;28:1–15. Bai S.H., Ogbourne S.M. Glyphosate: Environmental contamination, toxicity and potential risks to human health via food contamination. Environ. Sci. Pollut. Res. 2016;23:18988–19001.

The most enthralling conversation I've ever had with anyone on cancer. It's with Charlie Swanton who is a senior group leader at the Francis Crick Institute, the Royal Society Napier Professor in Cancer and medical oncologist at University College London, co-director of Cancer Research UK.Video snippet from our conversation. Full videos of all Ground Truths podcasts can be seen on YouTube here. The audios are also available on Apple and Spotify.Transcript with audio links and many external linksEric Topol (00:07):Well, hello, this is Eric Topol with Ground Truths, and I am really fortunate today to connect us with Charlie Swanton, who is if not the most prolific researcher in the space of oncology and medicine, and he's right up there. Charlie is a physician scientist who is an oncologist at Francis Crick and he heads up the lung cancer area there. So Charlie, welcome.Charles Swanton (00:40):Thank you, Eric. Nice to meet you.Learning from a FailureEric Topol (00:43):Well, it really is a treat because I've been reading your papers and they're diverse. They're not just on cancer. Could be connecting things like air pollution, it could be Covid, it could be AI, all sorts of things. And it's really quite extraordinary. So I thought I'd start out with a really interesting short paper you wrote towards the end of last year to give a sense about you. It was called Turning a failing PhD around. And that's good because it's kind of historical anchoring. Before we get into some of your latest contributions, maybe can you tell us about that story about what you went through with your PhD?Charles Swanton (01:26):Yeah, well thank you, Eric. I got into research quite early. I did what you in the US would call the MD PhD program. So in my twenties I started a PhD in a molecular biology lab at what was then called the Imperial Cancer Research Fund, which was the sort of the mecca for DNA tumor viruses, if you like. It was really the place to go if you wanted to study how DNA tumor viruses worked, and many of the components of the cell cycle were discovered there in the 80s and 90s. Of course, Paul Nurse was the director of the institute at the time who discovered cdc2, the archetypal regulator of the cell cycle that led to his Nobel Prize. So it was a very exciting place to work, but my PhD wasn't going terribly well. And sort of 18, 19 months into my PhD, I was summoned for my midterm reports and it was not materializing rapidly enough.(02:25):And I sat down with my graduate student supervisors who were very kind, very generous, but basically said, Charlie, this isn't going well, is it? You've got two choices. You can either go back to medical school or change PhD projects. What do you want to do? And I said, well, I can't go back to medical school because I'm now two years behind. So instead I think what I'll do is I'll change PhD projects. And they asked me what I'd like to do. And back then we didn't know how p21, the CDK inhibitor bound to cyclin D, and I said, that's what I want to understand how these proteins interact biochemically. And they said, how are you going to do that? And I said, I'm not too sure, but maybe we'll try yeast two-hybrid screen and a mutagenesis screen. And that didn't work either. And in the end, something remarkable happened.(03:14):My PhD boss, Nic Jones, who's a great guy, still is, retired though now, but a phenomenal scientist. He put me in touch with a colleague who actually works next door to me now at the Francis Crick Institute called Neil McDonald, a structural biologist. And they had just solved, well, the community had just solved the structure. Pavletich just solved the structure of cyclin A CDK2. And so, Neil could show me this beautiful image of the crystal structure in 3D of cyclin A, and we could mirror cyclin D onto it and find the surface residue. So I spent the whole of my summer holiday mutating every surface exposed acid on cyclin D to an alanine until I found one that failed to interact with p21, but could still bind the CDK. And that little breakthrough, very little breakthrough led to this discovery that I had where the viral cyclins encoded by Kaposi sarcoma herpes virus, very similar to cyclin D, except in this one region that I had found interactive with a CDK inhibitor protein p21.(04:17):And so, I asked my boss, what do you think about the possibility this cyclin could have evolved from cyclin D but now mutated its surface residues in a specific area so that it can't be inhibited by any of the control proteins in the mammalian cell cycle? He said, it's a great idea, Charlie, give it a shot. And it worked. And then six months later, we got a Nature paper. And that for me was like, I cannot tell you how exciting, not the Nature paper so much as the discovery that you were the first person in the world to ever see this beautiful aspect of evolutionary biology at play and how this cyclin had adapted to just drive the cell cycle without being inhibited. For me, just, I mean, it was like a dream come true, and I never experienced anything like it before, and I guess it's sizes the equivalent to me of a class A drug. You get such a buzz out of it and over the years you sort of long for that to happen again. And occasionally it does, and it's just a wonderful profession.Eric Topol (05:20):Well, I thought that it was such a great story because here you were about to fail. I mean literally fail, and you really were able to turn it around and it should give hope to everybody working in science out there that they could just be right around the corner from a significant discovery.Charles Swanton (05:36):I think what doesn't break you makes you stronger. You just got to plow on if you love it enough, you'll find a way forward eventually, I hope.Tracing the Evolution of Cancer (TRACERx)Eric Topol (05:44):Yeah, no question about that. Now, some of your recent contributions, I mean, it's just amazing to me. I just try to keep up with the literature just keeping up with you.Charles Swanton (05:58):Eric, it's sweet of you. The first thing to say is it's not just me. This is a big community of lung cancer researchers we have thanks to Cancer Research UK funded around TRACERx and the lung cancer center. Every one of my papers has three corresponding authors, multiple co-first authors that all contribute in this multidisciplinary team to the sort of series of small incremental discoveries. And it's absolutely not just me. I've got an amazing team of scientists who I work with and learn from, so it's sweet to give me the credit.Eric Topol (06:30):I think what you're saying is really important. It is a team, but I think what I see through it all is that you're an inspiration to the team. You pull people together from all over the world on these projects and it's pretty extraordinary, so that's what I would say.Charles Swanton (06:49):The lung community, Eric, the lung cancer community is just unbelievably conducive to collaboration and advancing understanding of the disease together. It's just such a privilege to be working in this field. I know that sounds terribly corny, but it is true. I don't think I recall a single email to anybody where I've asked if we can collaborate where they've said, no, everybody wants to help. Everybody wants to work together on this challenge. It's just such an amazing field to be working in.Eric Topol (07:19):Yeah. Well I was going to ask you about that. And of course you could have restricted your efforts or focused on different cancers. What made you land in lung cancer? Not that that's only part of what you're working on, but that being the main thing, what drew you to that area?Charles Swanton (07:39):So I think the answer to your question is back in 2008 when I was looking for a niche, back then it was lung cancer was just on the brink of becoming an exciting place to work, but back then nobody wanted to work in that field. So there was a chair position in thoracic oncology and precision medicine open at University College London Hospital that had been open, as I understand it for two years. And I don't think anybody had applied. So I applied and because I was the only one, I got it and the rest is history.(08:16):And of course that was right at the time when the IPASS draft from Tony Mok was published and was just a bit after when the poster child of EGFR TKIs and EGFR mutant lung cancer had finally proven that if you segregate that population of patients with EGFR activating mutation, they do incredibly well on an EGFR inhibitor. And that was sort of the solid tumor poster child along with Herceptin of precision medicine, I think. And you saw the data at ASCO this week of Lorlatinib in re-arranged lung cancer. Patients are living way beyond five years now, and people are actually talking about this disease being more like CML. I mean, it's extraordinary the progress that's been made in the last two decades in my short career.Eric Topol (09:02):Actually, I do want to have you put that in perspective because it's really important what you just mentioned. I was going to ask you about this ASCO study with the AKT subgroup. So the cancer landscape of the lung has changed so much from what used to be a disease of cigarette smoking to now one of, I guess adenocarcinoma, non-small cell carcinoma, not related to cigarettes. We're going to talk about air pollution in a minute. This group that had, as you say, 60 month, five year plus survival versus what the standard therapy was a year plus is so extraordinary. But is that just a small subgroup within small cell lung cancer?Charles Swanton (09:48):Yes, it is, unfortunately. It's just a small subgroup. In our practice, probably less than 1% of all presentations often in never smokers, often in female, never smokers. So it is still in the UK at least a minority subset of adenocarcinomas, but it's still, as you rightly say, a minority of patients that we can make a big difference to with a drug that's pretty well tolerated, crosses the blood-brain barrier and prevents central nervous system relapse and progression. It really is an extraordinary breakthrough, I think. But that said, we're also seeing advances in smoking associated lung cancer with a high mutational burden with checkpoint inhibitor therapy, particularly in the neoadjuvant setting now prior to surgery. That's really, really impressive indeed. And adjuvant checkpoint inhibitor therapies as well as in the metastatic setting are absolutely improving survival times and outcomes now in a way that we couldn't have dreamt of 15 years ago. We've got much more than just platinum-based chemo is basically the bottom line now.Revving Up ImmunotherapyEric Topol (10:56):Right, right. Well that actually gets a natural question about immunotherapy also is one of the moving parts actually just amazing to me how that's really, it's almost like we're just scratching the surface of immunotherapy now with checkpoint inhibitors because the more we get the immune system revved up, the more we're seeing results, whether it's with vaccines or CAR-T, I mean it seems like we're just at the early stages of getting the immune system where it needs to be to tackle the cancer. What's your thought about that?Charles Swanton (11:32):I think you're absolutely right. We are, we're at the beginning of a very long journey thanks to Jim Allison and Honjo. We've got CTLA4 and PD-1/PDL-1 axis to target that's made a dramatic difference across multiple solid tumor types including melanoma and lung cancer. But undoubtedly, there are other targets we've seen LAG-3 and melanoma and then we're seeing new ways, as you rightly put it to mobilize the immune system to target cancers. And that can be done through vaccine based approaches where you stimulate the immune system against the patient's specific mutations in their cancer or adoptive T-cell therapies where you take the T-cells out of the tumor, you prime them against the mutations found in the tumor, you expand them and then give them back to the patient. And colleagues in the US, Steve Rosenberg and John Haanen in the Netherlands have done a remarkable job there in the context of melanoma, we're not a million miles away from European approvals and academic initiated manufacturing of T-cells for patients in national health systems like in the Netherlands.(12:50):John Haanen's work is remarkable in that regard. And then there are really spectacular ways of altering T-cells to be able to either migrate to the tumor or to target specific tumor antigens. You mentioned CAR-T cell therapies in the context of acute leukemia, really extraordinary developments there. And myeloma and diffuse large B-cell lymphoma as well as even in solid tumors are showing efficacy. And I really am very excited about the future of what we call biological therapies, be it vaccines, an antibody drug conjugates and T-cell therapies. I think cancer is a constantly adapting evolutionary force to be reckoned with what better system to combat it than our evolving immune system. It strikes me as being a future solution to many of these refractory cancers we still find difficult to treat.Eric Topol (13:48):Yeah, your point is an interesting parallel how the SARS-CoV-2 virus is constantly mutating and becoming more evasive as is the tumor in a person and the fact that we can try to amp up the immune system with these various means that you just were reviewing. You mentioned the other category that's very hot right now, which is the antibody drug conjugates. Could you explain a bit about how they work and why you think this is an important part of the future for cancer?Antibody-Drug ConjugatesCharles Swanton (14:26):That's a great question. So one of the challenges with chemotherapy, as you know, is the normal tissue toxicity. So for instance, neutropenia, hair loss, bowel dysfunction, diarrhea, epithelial damage, essentially as you know, cytotoxics affect rapidly dividing tissues, so bone marrow, epithelial tissues. And because until relatively recently we had no way of targeting chemotherapy patients experienced side effects associated with them. So over the last decade or so, pioneers in this field have brought together this idea of biological therapies linked with chemotherapy through a biological linker. And so one poster chart of that would be the drug T-DXd, which is essentially Herceptin linked to a chemotherapy drug. And this is just the most extraordinary drug that obviously binds the HER2 receptor, but brings the chemotherapy and proximity of the tumor. The idea being the more drug you can get into the tumor and the less you're releasing into normal tissue, the more on tumor cytotoxicity you'll have and the less off tumor on target normal tissue side effects you'll have. And to a large extent, that's being shown to be the case. That doesn't mean they're completely toxicity free, they're not. And one of the side effects associated with these drugs is pneumonitis.(16:03):But that said, the efficacy is simply extraordinary. And for example, we're having to rewrite the rule books if you like, I think. I mean I'm not a breast cancer physician, I used to be a long time ago, but back in the past in the early 2000s, there was HER2 positive breast cancer and that's it. Now they're talking about HER2 low, HER2 ultra-low, all of which seem to in their own way be sensitive to T-DXd, albeit to a lower extent than HER2 positive disease. But the point is that there doesn't seem to be HER2 completely zero tumor group in breast cancer. And even the HER2-0 seem to benefit from T-DXd to an extent. And the question is why? And I think what people are thinking now is it's a combination of very low cell service expression of HER2 that's undetectable by conventional methods like immunohistochemistry, but also something exquisitely specific about the way in which HER2 is mobilized on the membrane and taken back into the cell. That seems to be specific to the breast cancer cell but not normal tissue. So in other words, the antibody drug conjugate binds the tumor cell, it's thought the whole receptor's internalized into the endosome, and that's where the toxicity then happens. And it's something to do with the endosomal trafficking with the low level expression and internalization of the receptor. That may well be the reason why these HER2 low tumors are so sensitive to this beautiful technology.Eric Topol (17:38):Now I mean it is an amazing technology in all these years where we just were basically indiscriminately trying to kill cells and hoping that the cancer would succumb. And now you're finding whether you want to call it a carry or vector or Trojan horse, whatever you want to call it, but do you see that analogy of the HER2 receptor that's going to be seen across the board in other cancers?Charles Swanton (18:02):That's the big question, Eric. I think, and have we just lucked out with T-DXd, will we find other T-DXd like ADCs targeting other proteins? I mean there are a lot of ADCs being developed against a lot of different cell surface proteins, and I think the jury's still out. I'm confident we will, but we have to bear in mind that biology is a fickle friend and there may be something here related to the internalization of the receptor in breast cancer that makes this disease so exquisitely sensitive. So I think we just don't know yet. I'm reasonably confident that we will find other targets that are as profoundly sensitive as HER2 positive breast cancer, but time will tell.Cancer, A Systemic DiseaseEric Topol (18:49):Right. Now along these lines, well the recent paper that you had in Cell, called embracing cancer complexity, which we've talking about a bit, in fact it's kind of those two words go together awfully well, but hallmarks of systemic disease, this was a masterful review, as you say with the team that you led. But can you tell us about what's your main perspective about this systemic disease? I mean obviously there's been the cancer is like cardiovascular and cancers like this or that, but here you really brought it together with systemic illness. What can you say about that?Charles Swanton (19:42):Well, thanks for the question first of all, Eric. So a lot of this comes from some of my medical experience of treating cancer and thinking to myself over the years, molecular biology has had a major footprint on advances in treating the disease undoubtedly. But there are still aspects of medicine where molecular biology has had very little impact, and often that is in areas of suffering in patients with advanced disease and cancer related to things like cancer cachexia, thrombophilia. What is the reason why patients die blood clots? What is the reason patients die of cancer at all? Even a simple question like that, we don't always know the answer to, on death certificates, we write metastatic disease as a cause of cancer death, but we have patients who die with often limited disease burden and no obvious proximal cause of death sometimes. And that's very perplexing, and we need to understand that process better.(20:41):And we need to understand aspects like cancer pain, for example, circadian rhythms affect biological sensitivity of cancer cells to drugs and what have you. Thinking about cancer rather than just sort of a single group of chaotically proliferating cells to a vision of cancer interacting both locally within a microenvironment but more distantly across organs and how organs communicate with the cancer through neuronal networks, for example, I think is going to be the next big challenge by setting the field over the next decade or two. And I think then thinking about more broadly what I mean by embracing complexity, I think some of that relates to the limitations of the model systems we use, trying to understand inter-organ crosstalk, some of the things you cover in your beautiful Twitter reviews. (←Ground Truths link) I remember recently you highlighted four publications that looked at central nervous system, immune cell crosstalk or central nervous system microbiome crosstalk. It's this sort of long range interaction between organs, between the central nervous system and the immune system and the cancer that I'm hugely interested in because I really think there are vital clues there that will unlock new targets that will enable us to control cancers more effectively if we just understood these complex networks better and had more sophisticated animal model systems to be able to interpret these interactions.Eric Topol (22:11):No, it's so important what you're bringing out, the mysteries that still we have to deal with cancer, why patients have all these issues or dying without really knowing what's happened no less, as you say, these new connects that are being discovered at a remarkable pace, as you mentioned, that ground truths. And also, for example, when I spoke with Michelle Monje, she's amazing on the cancer, where hijacking the brain cells and just pretty extraordinary things. Now that gets me to another line of work of yours. I mean there are many, but the issue of evolution of the tumor, and if you could put that in context, a hot area that's helping us elucidate these mechanisms is known as spatial omics or spatial biology. This whole idea of being able to get the spatial temporal progression through single cell sequencing and single cell nuclei, all the single cell omics. So if you could kind of take us through what have we learned with this technique and spatial omics that now has changed or illuminated our understanding of how cancer evolves?Charles Swanton (23:37):Yeah, great question. Well, I mean I think it helps us sort of rewind a bit and think about evolution in general. Genetic selection brought about by diverse environments and environmental pressures that force evolution, genetic evolution, and speciation down certain evolutionary roots. And I think one can think about cancers in a similar way. They start from a single cell and we can trace the evolutionary paths of cancers by single cell analysis as well as bulk sequencing of spatially separated tumor regions to be able to reconstruct their subclones. And that's taught us to some extent, what are the early events in tumor evolution? What are the biological mechanisms driving branched evolution? How does genome instability begin in tumors? And we found through TRACERx work, whole genome doubling is a major route through to driving chromosome instability along with mutagenic enzymes like APOBEC that drive both mutations and chromosomal instability.(24:44):And then that leads to a sort of adaptive radiation in a sense, not dissimilar to I guess the Cambrian explosion of evolutionary opportunity upon which natural selection can act. And that's when you start to see the hallmarks of immune evasion like loss of HLA, the immune recognition molecules that bind the neoantigens or even loss of the neoantigens altogether or mutation of beta 2 microglobulin that allow the tumor cells to now evolve below the radar, so to speak. But you allude to the sort of spatial technologies that allow us to start to interpret the microenvironments as well. And that then tells us what the evolutionary pressures are upon the tumor. And we're learning from those spatial technologies that these environments are incredibly diverse, actually interestingly seem to be converging on one important aspect I'd like to talk to you a little bit more about, which is the myeloid axis, which is these neutrophils, macrophages, et cetera, that seem to be associated with poor outcome and that will perhaps talk about pollution in a minute.(25:51):But I think they're creating a sort of chronic inflammatory response that allows these early nascent tumor cells to start to initiate into frankly tumor invasive cells and start to grow. And so, what we're seeing from these spatial technologies in lung cancer is that T-cells, predatory T-cells, force tumors to lose their HLA molecules and what have you to evade the immune system. But for reasons we don't understand, high neutrophil infiltration seems to be associated with poor outcome, poor metastasis free survival. And actually, those same neutrophils we've recently found actually even tracked to the metastasis sites of metastasis. So it's almost like this sort of symbiosis between the myeloid cells and the tumor cells in their biology and growth and progression of the tumor cells.Eric Topol (26:46):Yeah, I mean this white cell story, this seems to be getting legs and is relatively new, was this cracked because of the ability to do this type of work to in the past everything was, oh, it's cancer's heterogeneous and now we're getting pinpoint definition of what's going on.Charles Swanton (27:04):I think it's certainly contributed, but it's like everything in science, Eric, when you look back, there's evidence in the literature for pretty much everything we've ever discovered. You just need to put the pieces together. And I mean one example would be the neutrophil lymphocyte ratio in the blood as a hallmark of outcome in cancers and to checkpoint inhibitor blockade, maybe this begins to explain it, high neutrophils, immune suppressive environment, high neutrophils, high macrophages, high immune suppression, less benefit from checkpoint inhibitor therapy, whereas you want lymphocyte. So I think there are biomedical medical insights that help inform the biology we do in the lab that have been known for decades or more. And certainly the myeloid M2 axis in macrophages and what have you was known about way before these spatial technologies really came to fruition, I think.The Impact of Air PollutionEric Topol (28:01):Yeah. Well you touched on this about air pollution and that's another dimension of the work that you and your team have done. As you well know, there was a recent global burden of disease paper in the Lancet, which has now said that air pollution with particulate matter 2.5 less is the leading cause of the burden of disease in the world now.Charles Swanton (28:32):What did you think of that, Eric?Eric Topol (28:34):I mean, I was blown away. Totally blown away. And this is an era you've really worked on. So can you put it in perspective?Charles Swanton (28:42):Yeah. So we got into this because patients of mine, and many of my colleagues would ask the same question, I've never smoked doctor, I'm healthy. I'm in my mid 50s though they're often female and I've got lung cancer. Why is that doctor? I've had a good diet, I exercise, et cetera. And we didn't really have a very good answer for that, and I don't want to pretend for a minute we solved the whole problem. I think hopefully we've contributed to a little bit of understanding of why this may happen. But that aside, we knew that there were risk factors associated with lung cancer that included air pollution, radon exposure, of course, germline genetics, we mustn't forget very important germline variation. And I think there is evidence that all of them are associated with lung cancer risk in different ways. But we wanted to look at air pollution, particularly because there was an awful lot of evidence, several meta-analysis of over half a million individuals showing very convincingly with highly significant results that increasing PM 2.5 micron particulate levels were associated with increased risk of lung cancer.(29:59):To put that into perspective, where you are on the west coast of the US, it's relatively unpolluted. You would be talking about maybe five micrograms per meter cubed of PM2.5 in a place like San Diego or Western California, assuming there aren't any forest fires of course. And we estimate that that would translate to about, we think it's about one extra case of never smoking lung cancer per hundred thousand of the population per year per one microgram per meter cube rise in the pollution levels. So if you go to Beijing for example, on a bad day, the air pollution levels could be upwards of a hundred micrograms per meter cubed because there are so many coal fired power stations in China partly. And there I think the risk is considerably higher. And that's certainly what we've seen in the meta-analyses in our limited and relatively crude epidemiological analyses to be the case.(30:59):So I think the association was pretty certain, we were very confident from people's prior publications  this was important. But of course, association is not causation. So we took a number of animal models and showed that you could promote lung cancer formation in four different oncogene driven lung cancer models. And then the question is how, does air pollution stimulate mutations, which is what I initially thought it would do or something else. It turns out we don't see a significant increase in exogenous like C to A carcinogenic mutations. So that made us put our thinking caps on. And I said to you earlier, often all these discoveries have been made before. Well, Berenblum in 1947, first postulated that actually tumors are initiated through a two-step process, which we now know involves a sort of pre initiated cell with a mutation in that in itself is not sufficient to cause cancer.(31:58):But on top of that you need an inflammatory stimulus. So the question was then, well, okay, is inflammation working here? And we found that there was an interleukin-1 beta axis. And what happens is that the macrophages come into the lung on pollution exposure, engulf phagocytose the air pollutants, and we think what's happening is the air pollutants are puncturing membranes in the lung. That's what we think is happening. And interleukin-1 beta preformed IL-1 beta is being released into the extracellular matrix and then stimulating pre-initiated cells stem cells like the AT2 cells with an activating EGFR mutation to form a tumor. But the EGFR mutation alone is not sufficient to form tumors. It's only when you have the interleukin-1 beta and the activated mutation that a tumor can start.(32:49):And we found that if we sequence normal lung tissue in a healthy adult 60-year-old adult, we will find about half of biopsies will have an activating KRAS mutation in normal tissue, and about 15% will have an activating mutation in EGFR in histologically normal tissue with nerve and of cancer. In fact, my friend and colleague who's a co-author on the paper, James DeGregori, who you should speak to in Colorado, fascinating evolutionary cancer biologists estimates that in a healthy 60-year-old, there are a hundred billion cells in your body that harbor an oncogenic mutation. So that tells you that at the cellular level, cancer is an incredibly rare event and almost never happens. I mean, our lifetime risk of cancer is perhaps one in two. You covered that beautiful pancreas paper recently where they estimated that there may be 80 to 100 KRAS mutations in a normal adult pancreas, and yet our lifetime risk of pancreas cancer is one in 70. So this tells you that oncogenic mutations are rarely sufficient to drive cancer, so something else must be happening. And in the context of air pollution associated lung cancer, we think that's inflammation driven by these white cells, these myeloid cells, the macrophages.Cancer BiomarkersEric Topol (34:06):No, it makes a lot of sense. And this, you mentioned the pancreas paper and also what's going in the lung, and it seems like we have this burden of all you need is a tipping point and air pollution seems to qualify, and you seem to be really in the process of icing the mechanism. And like I would've thought it was just mutagenic and it's not so simple, right? But that gets me to this is such an important aspect of cancer, the fact that we harbor these kind of preconditions. And would you think that cancer takes decades to actually manifest most cancers, or do we really have an opportunity here to be able to track whether it's through blood or other biomarkers? Another area you've worked on a lot whereby let's say you could define people at risk for polygenic risk scores or various cancers or genome sequencing for predisposition genes, whatever, and you could monitor in the future over the course of those high-risk people, whether they were starting to manifest microscopic malignancy. Do you have any thoughts about how long it takes for the average person to actually manifest a typical cancer?Charles Swanton (35:28):That's a cracking question, and the answer is we've got some clues in various cancers. Peter Campbell would be a good person to speak to. He estimates that some of the earliest steps in renal cancer can occur in adolescence. We've had patients who gave up smoking 30 or so years ago where we can still see the clonal smoking mutations in the trunk of the tumor's evolutionary tree. So the initial footprints of the cancer are made 30 years before the cancer presents. That driver mutation itself may also be a KRAS mutation in a smoking cigarette context, G12C mutation. And those mutations can precede the diagnosis of the disease by decades. So the earliest steps in cancer evolution can occur, we think can precede diagnoses by a long time. So to your point, your question which is, is there an opportunity to intervene? I'm hugely optimistic about this actually, this idea of molecular cancer prevention.An Anti-Inflammatory Drug Reduces Fatal Cancer and Lung Cancer(36:41):How can we use data coming out of various studies in the pancreas, mesothelioma, lung, et cetera to understand the inflammatory responses? I don't think we can do very much about the mutations. The mutations unfortunately are a natural consequence of aging. You and I just sitting here talking for an hour will have accumulated multiple mutations in our bodies over that period, I'm afraid and there's no escaping it. And right now there's not much we can do to eradicate those mutant clones. So if we take that as almost an intractable problem, measuring them is hard enough, eradicating them is even harder. And then we go back to Berenblum in 1947 who said, you need an inflammatory stimulus. Well, could we do something about the inflammation and dampen down the inflammation? And of course, this is why we got so excited about IL-1 beta because of the CANTOS trial, which you may remember in 2017 from Ridker and colleagues showed that anti IL-1 beta used as a mechanism of preventing cardiovascular events was associated with a really impressive dose dependent reduction in new lung cancer primaries.(37:49):Really a beautiful example of cancer prevention in action. And that data weren't just a coincidence. The FDA mandated Novartis to collect the solid tumor data and the P-values are 0.001. I mean it's very highly significant dose dependent reduction in lung cancer incidents associated with anti IL-1 beta. So I think that's really the first clue in my mind that something can be done about this problem. And actually they had five years of follow-up, Eric. So that's something about that intervening period where you can treat and then over time see a reduction in new lung cancers forming. So I definitely think there's a window of opportunity here.Eric Topol (38:31):Well, what you're bringing up is fascinating here because this trial, which was a cardiology trial to try to reduce heart attacks, finds a reduction in cancer, and it's been lost. It's been buried. I mean, no one's using this therapy to prevent cancer between ratcheting up the immune system or decreasing inflammation. We have opportunities that we're not even attempting. Are there any trials that are trying to do this sort of thing?Charles Swanton (39:02):So this is the fundamental problem. Nobody wants to invest in prevention because essentially you are dealing with well individuals. It's like the vaccine challenge all over again. And the problem is you never know who you are benefiting. There's no economic model for it. So pharma just won't touch prevention with a barge pole right now. And that's the problem. There's no economic model for it. And yet the community, all my academic colleagues are crying out saying, this has got to be possible. This has got to be possible. So CRUK are putting together a group of like-minded individuals to see if we can do something here and we're gradually making progress, but it is tough.Eric Topol (39:43):And it's interesting that you bring that up because for GRAIL, one of the multicenter cancer early detection companies, they raised billions of dollars. And in fact, their largest trial is ongoing in the UK, but they haven't really focused on high-risk people. They just took anybody over age 50 or that sort of thing. But that's the only foray to try to reboot how we or make an early microscopic diagnosis of cancer and track people differently. And there's an opportunity there. You've written quite a bit on you and colleagues of the blood markers being able to find a cancer where well before, in fact, I was going to ask you about that is, do you think there's people that are not just having all these mutations every minute, every hour, but that are starting to have the early seeds of cancer, but because their immune system then subsequently kicks in that they basically kind of quash it for that period of time?Charles Swanton (40:47):Yeah, I do think that, I mean, the very fact that we see these sort of footprints in the tumor genome of immune evasion tells you that the immune system's having a very profound predatory effect on evolving tumors. So I do think it's very likely that there are tumors occurring that are suppressed by the immune system. There is a clear signature, a signal of negative selection in tumors where clones have been purified during their evolution by the immune system. So I think there's pretty strong evidence for that now. Obviously, it's very difficult to prove something existed when it doesn't now exist, but there absolutely is evidence for that. I think it raises the interesting question of immune system recognizes mutations and our bodies are replete with mutations as we were just discussing. Why is it that we're not just a sort of epithelial lining of autoimmunity with T-cells and immune cells everywhere? And I think what the clever thing about the immune system is it's evolved to target antigens only when they get above a certain burden. Otherwise, I think our epithelial lining, our skin, our guts, all of our tissues will be just full of T-cells eating away our normal clones.(42:09):These have to get to a certain size for antigen to be presented at a certain level for the immune system to recognize it. And it's only then that you get the immune predation occurring.Forever Chemicals and Microplastics Eric Topol (42:20):Yeah, well, I mean this is opportunities galore here. I also wanted to extend the air pollution story a bit. Obviously, we talked about particulate matter and there's ozone and nitric NO2, and there's all sorts of other air pollutants, but then there's also in the air and water these forever chemicals PFAS for abbreviation, and they seem to be incriminated like air pollution. Can you comment about that?Charles Swanton (42:55):Well, I can comment only insofar as to say I'm worried about the situation. Indeed, I'm worried about microplastics actually, and you actually cover that story as well in the New England Journal, the association of microplastics with plaque rupture and atheroma. And indeed, just as in parenthesis, I wanted to just quickly say we currently think the same mechanisms that are driving lung cancer are probably responsible for atheroma and possibly even neurodegenerative disease. And essentially it all comes down to the macrophages and the microglia becoming clogged up with these pollutants or environmental particulars and releasing chronic inflammatory mediators that ultimately lead to disease. And IL-1 beta being one of those in atheroma and probably IL-6 and TNF in neurodegenerative disease and what have you. But I think this issue that you rightly bring up of what is in our environment and how does it cause pathology is really something that epidemiologists have spent a lot of time focusing on.(43:56):But actually in terms of trying to move from association to causation, we've been, I would argue a little bit slow biologically in trying to understand these issues. And I think that is a concern. I mean, to give you an example, Allan Balmain, who works at UCSF quite close to you, published a paper in 2020 showing that 17 out of 20 environmental carcinogens IARC carcinogens class one carcinogens cause tumors in rodent models without driving mutations. So if you take that to a logical conclusion, in my mind, what worries me is that many of the sort of carcinogen assays are based on driving mutagenesis genome instability. But if many carcinogen aren't driving DNA mutagenesis but are still driving cancer, how are they doing it? And do we actually have the right assays to interpret safety of new chemical matter that's being introduced into our environment, these long-lived particles that we're breathing in plastics, pollutants, you name it, until we have the right biological assays, deeming something to be safe I think is tricky.Eric Topol (45:11):Absolutely. And I share your concerns on the nanoplastic microplastic story, as you well know, not only have they been seen in arteries that are inflamed and in blood clots and in various tissues, have they been seen so far or even looked for within tumor tissue?Charles Swanton (45:33):Good question. I'm not sure they have. I need to check. What I can tell you is we've been doing some experiments in the lab with fluorescent microplastics, 2.5 micron microplastics given inhaled microplastics. We find them in every mouse organ a week after. And these pollutants even get through into the brain through the olfactory bulb we think.Charles Swanton (45:57):Permeate every tissue, Eric.Eric Topol (45:59):Yeah, no, this is scary because here we are, we have these potentially ingenious ways to prevent cancer in the future, but we're chasing our tails by not doing anything to deal with our environment.Charles Swanton (46:11):I think that's right. I totally agree. Yeah.Eric Topol (46:15):So I mean, I can talk to you for the rest of the day, but I do want to end up with a topic that we have mutual interest in, which is AI. And also along with that, when you mentioned about aging, I'd like to get your views on these two, how do you see AI fitting into the future of cancer? And then the more general topic is, can we actually at some point modulate the biologic aging process with or without help with from AI? So those are two very dense questions, but maybe you can take us through them.Charles Swanton (46:57):How long have we got?Eric Topol (46:59):Just however long you have.A.I. and CancerCharles Swanton (47:02):AI and cancer. Well, AI and medicine actually in general, whether it's biomedical research or medical care, has just infinite potential. And I'm very, very excited about it. I think what excites me about AI is it's almost the infinite possibilities to work across scale. Some of the challenges we raised in the Cell review that you mentioned, tackling, embracing complexity are perfectly suited for an AI problem. Nonlinear data working, for instance in our fields with CT imaging, MRI imaging, clinical outcome data, blood parameters, genomics, transcriptomes and proteomes and trying to relate this all into something that's understandable that relates to risk of disease or potential identification of a new drug target, for example. There are numerous publications that you and others have covered that allude to the incredible possibilities there that are leading to, for instance, the new identification of drug targets. I mean, Eli Van Allen's published some beautiful work here and in the context of prostate cancer with MDM4 and FGF receptor molecules being intimately related to disease biology.(48:18):But then it's not just that, not just drug target identification, it's also going all the way through to the clinic through drug discovery. It's how you get these small molecules to interact with oncogenic proteins and to inhibit them. And there are some really spectacular developments going on in, for instance, time resolved cryo-electron microscopy, where in combination with modeling and quantum computing and what have you, you can start to find pockets emerging in mutant proteins, but not the wild type ones that are druggable. And then you can use sort of synthetic AI driven libraries to find small molecules that will be predicted to bind these transiently emerging pockets. So it's almost like AI is primed to help at every stage in scientific investigation from the bench all the way through to the bedside. And there are examples all the way through there in the literature that you and others have covered in the last few years. So I could not be more excited about that.Eric Topol (49:29):I couldn't agree with you more. And I think when we get to multimodal AI at the individual level across all their risks for conditions in their future, I hope someday will fulfill that fantasy of primary prevention. And that is getting me to this point that I touched on because I do think they interact to some degree AI and then will we ever be able to have an impact on aging? Most people conflate this because what we've been talking about throughout the hour has been age-related diseases, that is cancer, for example, and cardiovascular and neurodegenerative, which is different than changing aging per se, body wide aging. Do you think we'll ever changed body wide aging?Charles Swanton (50:18):Wow, what a question. Well, if you'd asked me 10 years ago, 15 years ago, do you think we'll ever cure melanoma in my lifetime, I'd have said definitely not. And now look where we are. Half of patients with melanoma, advanced melanoma, even with brain metastasis curd with combination checkpoint therapy. So I never say never in biology anymore. It always comes back to bite you and prove you wrong. So I think it's perfectly possible.Charles Swanton (50:49):We have ways to slow down the aging process. I guess the question is what will be the consequences of that?Eric Topol (50:55):That's what I was going to ask you, because all these things like epigenetic reprogramming and senolytic drugs, and they seem to at least pose some risk for cancer.Charles Swanton (51:09):That's the problem. This is an evolutionary phenomenon. It's a sort of biological response to the onslaught of these malignant cells that are potentially occurring every day in our normal tissue. And so, by tackling one problem, do we create another? And I think that's going to be the big challenge over the next 50 years.Eric Topol (51:31):Yeah, and I think your point about the multi-decade challenge, because if you can promote healthy aging without any risk of cancer, that would be great. But if the tradeoff is close, it's not going to be very favorable. That seems to be the main liability of modulation aging through many of the, there's many shots on goal here, of course, as you well know. But they do seem to pose that risk in general.Charles Swanton (51:58):I think that's right. I think the other thing is, I still find, I don't know if you agree with me, but it is an immense conundrum. What is the underlying molecular basis for somatic aging, for aging of normal tissues? And it may be multifactorial, it may not be just one answer to that question. And different tissues may age in different ways. I don't know. It's a fascinating area of biology, but I think it really needs to be studied more because as you say, it underpins all of these diseases we've been talking about today, cardiovascular, neurodegeneration, cancer, you name it. We absolutely have to understand this. And actually, the more I work in cancer, the more I feel like actually what I'm working on is aging.(52:48):And this is something that James DeGregori and I have discussed a lot. There's an observation that in medicine around patients with alpha-1 antitrypsin deficiency who are at higher risk of lung cancer, but they're also at high risk of COPD, and we know the associations of chronic obstructive pulmonary disease with lung cancer risk. And one of the theories that James had, and I think this is a beautiful idea, actually, is as our tissues age, and COPD is a reflection of aging, to some extent gone wrong. And as our tissues age, they become less good at controlling the expansion of these premalignant clones, harboring, harboring oncogenic mutations in normal tissue. And as those premalignant clones expand, the substrate for evolution also expands. So there's more likely to be a second and third hit genetically. So it may be by disrupting the extracellular matrices through inflammation that triggers COPD through alpha-1 antitrypsin deficiency or smoking, et cetera, you are less effectively controlling these emergent clones that just expand with age, which I think is a fascinating idea actually.Eric Topol (54:01):It really is. Well, I want to tell you, Charlie, this has been the most fascinating, exhilarating discussion I've ever had on cancer. I mean, really, I am indebted to you because not just all the work you've done, but your ability to really express it, articulate it in a way that hopefully everyone can understand who's listening or reading the transcript. So we'll keep following what you're doing because you're doing a lot of stuff. I can't thank you enough for joining me today, and you've given me lots of things to think about. I hope the people that are listening or reading feel the same way. I mean, this has been so mind bending in many respects. We're indebted to you.Charles Swanton (54:49):Well, we all love reading your Twitter feeds. Keep them coming. It helps us keep a broader view of medicine and biological research, not just cancer, which is why I love it so much.******************************************The Ground Truths newsletters and podcasts are all free, open-access, without ads.Please share this post/podcast with your friends and network if you found it informativeVoluntary paid subscriptions all go to support Scripps Research. Many thanks for that—they greatly helped fund our summer internship programs for 2023 and 2024.Thanks to my producer Jessica Nguyen and Sinjun Balabanoff tor audio and video support at Scripps Research.Note: you can select preferences to receive emails about newsletters, podcasts, or all I don't want to bother you with an email for content that you're not interested in. Get full access to Ground Truths at erictopol.substack.com/subscribe

We're releasing episodes from our mini failure library while we're on production hiatus. This week's Mini Failure is about PFOA/C8 Contamination (Dupont Scandal). PFOA has been poisoning living creatures in the Ohio river basin for decades. One brave lawyer took on a huge corporation in this real life David and Goliath story. Original Air Date: December 12, 2022 Episode Sources https://en.wikipedia.org/wiki/DuPont https://www.business-humanrights.org/en/latest-news/dupont-lawsuits-re-pfoa-pollution-in-usa/ https://peri.umass.edu/toxic-100-air-polluters-index-current https://www.alleghenyfront.org/ohio-river-communities-are-still-coping-with-teflons-toxic-legacy/ https://en.wikipedia.org/wiki/Category:IARC_Group_2B_carcinogens https://www.cancer.org/healthy/cancer-causes/chemicals/teflon-and-perfluorooctanoic-acid-pfoa.html#:~:text=IARC%20has%20classified%20PFOA%20as,cause%20cancer%20in%20lab%20animals. Podcast - https://www.alleghenyfront.org/category/fullepisodes/ Ways to get in touch with us Email - thefailurologypodcast@gmail.com Website - www.failurology.ca

The Top News, publications and trials in Oncology for the week of March 28- April 4, 2024SENOMAC out in NEJM on Breast CancerACS & IARC 2022 Cancer Statisticsand more

Pulling weeds around the yard isn't most people's idea of a good time. Busting out a spray bottle of herbicide might be the easy way out, but what's the price we pay for that? Casey and Sara discuss the use of herbicides in agriculture and urban areas, including the recent news surrounding the use of dicamba.    Resources for this episode: Protecting Pollinators from Herbicides: Rethinking Weed Management at Home Benefits and risks of the use of herbicide-resistant crops - Kathrine Hauge Madsen & Jens Carl Streibig How to use herbicides to safely control weeds on farms | OSU Extension Service Different pesticides dominate in different land-use areas Video: Herbicides: A Double-Edged Sword? What We Know about Herbicide Impacts on Pollinators History of Weed Control in the United States and Canada Herbicide Use in the Era of Farm to Fork: Strengths, Weaknesses, and Future Implications - PMC New Study: Agricultural Pesticides Cause Widespread Harm to Soil Health, Threaten Biodiversity Glyphosate-based herbicides and cancer risk: a post-IARC decision review of potential mechanisms, policy and avenues of research - PMC Weed Management in Lawns Guidelines--UC IPMBee Precaution Pesticide Ratings

In this “Spotlight on…” episode, host Gautam Bhattacharyya welcomes arbitrator and SVAMC AI Task Force chair Benjamin Malek (FCIARB) to discuss what led him to a career in international arbitration. The pair discuss the challenges and opportunities presented by new technologies like AI, and how to maintain and improve the effectiveness of arbitration in an ever-changing legal landscape.----more---- Transcript: Intro: Hello and welcome to Arbitral Insights, a podcast series brought to you by our International Arbitration practice lawyers here at Reed Smith. I'm Peter Rosher, global head of Reed Smith's International Arbitration Practice. I hope you enjoy the industry commentary, insights and anecdotes we share with you in the course of this series, wherever in the world you are. If you have any questions about any of the topics discussed, please do contact our speakers. With that, let's get started. Gautam: Hello everyone and welcome back to our Arbitral Insights podcast series, and thank you for joining us. I am delighted to have with us as our guest today,  Ben Malek. Uh Hello, Ben. Ben: Hi Gautam, thank you for having me. Gautam: It's great to have you with us. Now, I'm gonna introduce Ben, but I'm gonna preface this by saying I love to see new arbitrator talent emerge and I'm unashamed about that. I love to see it. And Ben epitomizes this new number of arbitrators that I just love to see. Ben has got a very interesting background. Uh he's based in New York, but he – I'm gonna share some interesting stuff about him with you all. He's obviously a practitioner of arbitration. He's also an arbitrator and he has great experience of being in private practice and also working for institutions who deal with arbitration. And we'll come to that in the course of our discussion. He also speaks an incredible number of languages, which would, which certainly is something worth noting. So, so obviously, not only apart from English, but he also speaks fluent German, Romanian, Spanish and French, and he can also turn his hand very ably to Italian, Hebrew, Mandarin and Korean. And I'm just in awe of that, Ben. But so obviously, you can see we're talking uh to, to someone who's truly international. We'll talk a little bit about what you do Ben in the course of this podcast but for our listeners, Ben is with T.H.E Chambers in New York. And as I said, prior to his current role, he has worked in private practice at some major law firms and also with arbitral institutions. So, on that note, a huge welcome again to you, Ben and I'm much looking forward to our discussion. So let me ask you the first thing a little bit about your background because you, you do have a very interesting background just based purely on your geographic origins, your languages and how the world has just seen so much of you. But could you just tell us a little bit about your background and how you found the law and arbitration or conversely how law and arbitration found you. Ben: Thank you so much Gautam for inviting me such an honor to be on your podcast. I always look forward to the new episodes you have so it's uh it's truly a pleasure. Thank you. So I grew up in Germany. I was born and raised in Germany to Romanian parents and my maternal grandparents wanted to talk German to us because that's what first generation immigrants do. However, they spoke a very broken German because they're German just wasn't that good. So my mother had the idea of them talking to me in Romanian, which was their maternal language. And this way, I would have two languages once I hit kindergarten, which is exactly what happened. I talked Romanian at home until I started kindergarten, which is where I learned German. So that was the beginning of my duality, I guess. Later on my parents decided that an international school would be best for my brother and I, I have a twin brother by the way. So we went to an international school where languages was really emphasized. I was taught everything in English. English was my maternal language, German was my first foreign language. And that's when I started to really learn my other languages. French became my second foreign language, Spanish became my third foreign language. So by the time I graduated high school I was fluent in five languages. So that was uh extremely helpful at that time, and, uh, that's when I knew that I needed to do something with languages. Unfortunately, and just to give a little more background, I decided to pursue dentistry. I'm not sure if you knew that Gautam.  Gautam: No, I didn't know this. You're a man of many, many hidden talents. Ben, I had no idea. I I know now. Ben: So I went to dental school and because, because I grew up in, in Germany to Romanian parents, I always wanted to, to understand my origins and see where I'm from. So I went and studied uh dentistry in Romania. So while in Romania, I graduated dentistry, I came back to Germany and actually started practicing dentistry. At which point I realized that that might really not be the best career. And I'll explain why. I loved the attention to detail. I loved the artistry of it. But the one thing that I really couldn't deal with was talking to the walls. And what do we, what do I mean by that? When patients sit in the chair before you and you talk and their mouth is open, they cannot respond. And I never realized how much that would impact me psychologically. I felt like I was in isolation, I was talking to them and I talked to them in so many languages, but nothing was coming back. So at that point, I realized with my first year of practice that even though I like what I do, I don't think I could do that for the rest of my life. So I decided to go back and study law. And during my last year of law school, I got a job at BDO in Romania. And because of my languages, I was on-boarded on an arbitration which was held in English with a German party and a French party. And because they had somebody that spoke German and French, they decided to save some costs and have me translate. So that was my introduction to arbitration. And I thought it was wonderful. It was absolutely delightful, especially in a country where the judicial system is sometimes questionable in the sense that you may win for your clients, but you win such a small insignificant amount that you can't really consider it to be a win. I realized that arbitration is a true fairness out there and it is accessible. So it was that moment during that arbitration that I realized and decided to pursue a master's in arbitration, which I ultimately did. I went to the University of Miami where I pursued my LLM. I had the privilege to study under Jan Paulsson, Marike Paulsson, Carolyn Lamm, Jonathan Hamilton. And I really did have the privilege to study under Martin Hunter who has passed away just a few years ago. So it was, it was an amazing masters and that really gave me the basis to start my career in arbitration. Gautam: Well, now that's an incredible journey and a truly uh a diverse background, a truly a diverse professional background you've had and you know, thank you for sharing those great thoughts. Now figures while you're in international arbitration, because you truly are international Ben, in the truest sense of the word. Now you've mentioned some amazing teachers that you had in the law who are truly not just first class, they're world class in terms of names. But um I'm most interested to hear from our guests as to who they would say have been their biggest mentors and inspirations in their career. So if you were to look at your legal career, and it's not often that I do a podcast with someone who's a qualified dentist as well as a qualified lawyer. But there's always a first for these things. But in your career as a lawyer, I wonder if you could share with us some of those names who have been your great mentors and inspirations. Ben: Absolutely. I think all of us owe our entry especially in arbitration to someone as the saying goes, we we need somebody to open the door, we gotta walk through it ourselves, but somebody is always there to open the door. For me I really had, John Fellas was an amazing mentor. I got to know John during my masters and we've kept in touch ever since. What struck me about John was his humbleness and his absolutely striking kindness. I mean, I was a mere student who just got my feet wet and he always made the time, always respected my time, always trying to see how and where he can help me or brainstorm what to do or where to do. It was a true mentorship. And I value that, especially after so many years, I, I wouldn't be here without him. One more mentor that I can think of is Crenguța Leaua. She's um with LDDP in Romania. Over the years, we've got to know each other. She's just such an amazing practitioner who has truly shown me what there is to do and has helped me or help me guide my way into arbitration. So uh without those two, I wouldn't be where I am. But I would also say I really, I consider that every, every person I worked for in the past, every boss I had potentially got me into where I am. So that being said when I worked at the American Arbitration Association or the ICDR to be more, more precise, Tom Ventrone was an amazing mentor. I mean, I learned so much from that and it was interesting because I only got to know him once I was at the ICDR. I did, I quite frankly and uh I don't know if I should say this out loud, but I've never heard of him before. Um However, when I was there, I realized that I don't think the ICDR would be where it is without Tom Ventrone and his team. So that was absolutely outstanding. Gautam: Thank you very much. And you know, some really great names there, Ben that you've given, who've been your real guiding lights in your career so far and you, you're very fortunate to have had all of those people. Now, you've alluded to it in your answer that you just gave and I mentioned it in the introduction that you've worked at major law firms and you've worked for arbitral institutions. I wonder if you could share with us a few things that you've learned by having had the benefit of working on both sides of the fence, so to speak. Ben: I would say at first when I started off at institutions and in all disclosure, I didn't start my career at the American Arbitration Association, I actually started at CPR Institute in New York. I filled in this case manager after which shortly after I got the opportunity at the ICDR. The one thing I learned was really what an impact an institution can make and what a driving force it is in arbitration. Of course, I've learned and I've been part of adhoc arbitrations and that's when you really start to appreciate institutions and what they can do. So I really do value institutions for what they are. I believe the work is truly in vain. And during my time at the ICDR, I mean, it was high volume, in the sense that we administered many cases. And when COVID hit, it felt like those cases doubled even though they didn't. It was just that the traffic of email because nobody had any, any place to be. There was no traveling, there were no dinners, there were no vacations. Everybody was on their email all the time. But it was uh truly valuable. You learn how to manage your time, you learn how to manage other people's time and you learn how to truly value time and deadlines and how to set them fairly. During my time at the American Arbitration Association, I was truly privileged to be part of what they call IARC which on the international part is the International Administrative Review Committee. Where different challenges are being discussed and decided upon. So having been part of that and having seen many cases come in and out and the decisions thereof have really helped me to make better decisions as counsel. Once I, I left the institution. Gautam: I think that amazing kaleidoscope of experience that you had in private practice and with institutions brings us nicely to the next question I wanted to ask you. And this and again, I'll preface it with, again saying how much I love to see new arbitrator talent coming through. I love to see it because we need new talent, fresh blood coming in and you are certainly one of that group. And so I was mentioning that you are with T.H.E Chambers in New York. And I'd love you to tell us a little bit about the work of T.H.E Chambers where you are an arbitrator and including, first of all, if you wouldn't mind what T.H.E stands for a Ben. Ben: Thank you, Gautam. Absolutely. So, as a young arbitrator, I think it's interesting to see that there are not many out there and if they are, it is always combined with some sort of additional workload, whether that is tribunal secretary or they still work as an associate somewhere else or consultant. It, it it is self explanatory why that happens. Uh But I am privileged, I believe to be part of a small group of young arbitrators. And I, I think it's, it's highly important to understand that even young arbitrators do have a specific know-how that we would not have had 20-25 years ago whenever I'm approached or I'm asked about my expertise, I do unfortunately get the answer oftentimes that people didn't realize that a young practitioner could have so much experience or could have the pertinent know-how. And I think that's where arbitration really expanded and advanced in the last decade or two. We have master degrees at, at so many universities throughout the world. We have so many courses and we have so many practitioners willing to talk and mentor people that it is truly possible at a younger age to become an arbitrator. Gautam: I completely agree and if I'm not mistaken, the, you know, the, T.H.E Chambers stands for Tribunals, Hearings and Enforcement, is that correct Ben? Ben: That is correct. Absolutely. Yes, thank you. So, when I started off sitting as an arbitrator, I was approached and, and I happily work with Arbitra International out of London as a transitional member as they call it. And when thinking about it, I had two options. I could either say this is Benjamin Malek arbitration or I could start something bigger. And that was my goal. So when starting T.H.E Chambers, which as you said, stands for Tribal Hearings and Enforcements, the big challenge was what I call it. And despite the fact that T.H.E, it, it looks very nice together as ‘the', um it does stand for tribunal hearings and enforcements. And that is because I believe that those are the core points that any practitioner will always look for. Uh you need to have a tribunal for an arbitration, you need to have a hearing, any sort of hearing un unless it's a paper arbitration. Um And then the, either the arbitrator or the parties waive the hearing and you gotta make sure that any award is enforceable. So from my council of work that I started off with at the beginning of T.H.E Chambers, that was my expertise, the enforcement part of it. Uh that was also one of the most important aspects that I dealt with while at the ICDR when a case comes in that was the first question. How does the case look and will the award be enforceable? So that is one thing that I definitely learned at the institutions and that I carried with me to always look at the arbitration from the end rather than from the beginning, which is the enforcement stage. T.H.E Chambers -  that's what it stands for. Currently it is set up to on board more younger arbitrators worldwide because of COVID and then changes in COVID, we haven't gotten there yet but I hope we'll get there very soon. Gautam: I've got no doubt you will. And you know, and as the saying goes, if anyone's good enough, they're old enough. And there's no doubt that you and the team bring a lot of great energy and insight into arbitration and it's certainly not something that should be homogenous. So it's fantastic to know that you can bring all your talents to bear. I want to turn next to another aspect of what you do because I know that you are a member of the Silicon Valley Arbitration and Mediation Center and particularly its Artificial Intelligence task force. Now, one of the things that all of us will be very well aware of is that artificial intelligence, AI, is an incredibly happening concept. It's developing and it'll develop more and more and it has its role and will have its role in arbitration. I know that you've been part of the team that's been looking at guidelines for the use of artificial intelligence in international arbitration. And I wonder if you could just share some of your thoughts as to what the potential usage of artificial intelligence might be in international arbitration and some of the risks and issues that we should be aware of. Ben: Yes, thank you. So I have been a part of the Silicon Valley Arbitration Mediation Center for quite some time and um when the New York case versus Avianca came out where the claimants council used chatGPT to come up with cases and, and I use that word deliberately, ‘come up' with cases to use against Avianca. It turned out that all of those were in fact made up by chatGPT as uh what we would call hallucinations. The judge dismissed the case and uh actually sanctioned the attorneys. To that point, I realized that it is only a matter of time until this issue flows into arbitration, especially arbitration. We work in so many jurisdictions with so many different parties. And specifically, since COVID, most arbitrations have been online, some have stayed online, some still have a hearing component in person, but most of it is online. And the big question was, do we need guidelines for the use of artificial intelligence in arbitration? So I had discussed that with the leadership at the Silicon Valley Arbitration Mediation Center and they gave me carte blanche to see what we can come up with so I was privileged to have a team of experts help me draft the guidelines for the use of  AI in arbitration. My team was composed of Elizabeth Chan in Hong Kong, Orlando Cabrera in Mexico, Sofia Klot in New York, Dmitri Evseev in London, Marta Garcia Bel, which now is in New York, Soham Panchamiya and Duncan Pickard in New York. I was truly blessed, I would say to have these colleagues. It became a true adventure that we all went on when we started discovering what AI could potentially do and what could potentially be prevented. So we took around nine months to draft guidelines. We had no timeline, but we did come up with what I would say good guidelines or a good basis of guidelines in October, we have put it out for the public to comment on. Uh the commenting period is still open until December and institutions can comment until February. And the goal is not to come up with guidelines that people can use, but to get a full consensus of the arbitration community on how they would like to use these guidelines and what they believe is relevant. If something is not relevant, then there's no reason for us to have it in there. So that was the whole idea behind it. The other aspect we were looking at was when it came to cybersecurity, each institution came up with their own guidelines and quite frankly, they use different words, but they're saying the same thing. And we are hoping to avoid having several guidelines on AI and to comprise it all into one. I think it's gonna be a very difficult task. I'm not sure we will succeed, but we are giving all institutions the opportunity to give their input or it submits their commentary to the guidelines so that every practitioner could look into the commentary for the respective institution when the case goes to arbitration. We were looking at several aspects regarding the use of artificial intelligence in arbitration. Two main aspects are disclosure and confidentiality. With regards to disclosure, we actually have an open option for the community to vote on. And that is whether a two prong test should be used to decide whether a party or the arbitrator should disclose the use of artificial intelligence or whether it should always be up to the parties to decide or to as the tribunal for opposing party to disclose the use of artificial intelligence. We weren't sure internally, we debated heavily and we came to the conclusion to leave that question up for the public to decide on. Um it did come back or as of now, the results are interesting, which is that in Europe, there is a more libertarian approach. Whereas uh the US and some common law jurisdictions voted for a two prong test, which I believe to be quite interesting, uh quite frankly. Um if this continues to be open ended, we might leave it up to the parties to decide which option they would ever put in. But ultimately, the goal is to draw awareness of the use of AI to let parties and arbitrators as well as council understand that artificial intelligence is not open ended. That if it's used outside a closed circuit information can be leaked or can be disclosed one way or another and to just draw attention to the fact that A I can only be used to disclose information, but also to create other sorts of the information that would otherwise not be there. Whether that is good or bad will be up to the parties to decide, but it is important to understand what AI can do and what the consequences are. Gautam: I agree with you and it's something that's gonna develop and develop. There's no doubt about that and we've not seen the last of it. I mean, it's gonna be happening for sure. And we just have to see what does transpire, but look, thank you for your great work on everything you're doing. You're not just, you know, doing arbitrations, you're doing thought leadership, you're driving all of these things and it's really great. And uh I'm just, you know, and I look forward to talking to you more about these things as these things progress. Now with these podcasts, we, we always end our podcast with a little bit of lighthearted conversation because I think our listeners will have got a really good handle on your incredible talent in the course of this podcast, your thoughtfulness and your experience. What I want them to also get a feel of is some of the more fun side of things. Now, I know Ben that you are a very proud daddy to a couple of daughters, one of whom is really a newborn. And uh, and I've, and I'm just so ecstatic for you and Rebeca on your two daughters. But let me ask you this when you do have some spare time from not being a, a very busy daddy as well as a very busy arbitrator. What sort of music do you particularly enjoy listening to? Have you got any favorite bands or groups or singers or even a favorite album that you love to play? Ben: Regarding music that's an interesting topic. Before I went on my dentistry career I actually worked in music management. Gautam: you are so multitalented. It's unbelievable. Go on. Sorry. I just could not resist saying that. Ben: Yeah. No, thank you. It's uh I, I just like life. I like life. Life is important. It's what drives us. I will say this and, and you know, thank you for the question. But we all live to work, but we also work to primarily live. And I think it's really important to, to, to know that I always believe that one of the most important things in life is to live and to know how to live. So, uh I did get into music management very early in my life. We were host to several big names, but to answer your question, my favorite music, as I always said is good music. I especially nowadays where the charts are filled with explicit lyrics. I actually like to go back to the Beatles. The Beatles are one of the foundations I believe of modern music. Now, given the fact that a new song was actually just released with the help of AI, I think that it's, it's worth to go back and, um, and really understand the changes that as Sir Paul McCartney, um and his colleagues have made. Yeah, I would definitely call The Beatles my favorite music. Gautam: Oh, fantastic. Well, it's, you know, that's a great choice. And, uh, you know, again, as a first, I've never done a podcast with someone who worked in music management, then who, who became a dentist and then became a lawyer and who can speak about 10 languages. So this is a complete first for me. So let me just ask you one last question in this podcast. So, you know, you are a very international person and we ascertain that just from speaking to you in the course of this podcast and you've no doubt traveled very widely because you've worked around the world in many places. Is there one place apart from where you grew up, okay, so excluding that, is there one place in the world - and excluding New York where you live - ok, Is there one place that you just love traveling to? Ben: Oh. That's a difficult question. I would have to say, I've always enjoyed traveling to London. My brother is actually a physicist and he did his PhD in Cambridge. I thought those were the most fun trips I've ever had. To fly to London Cambridge is, is amazing. Uh Whoever hasn't been uh it is really missing out. London is just stunning. I mean, the amount of history and just the culture and the multiculture you have. It's, it's just, it's great. Um I guess uh deep down I am a European so London is always there. Paris is absolutely yeah, romantic. I mean, I am married with two kids so Paris is always, it is always a good idea. Gautam: Yes. Ben: Yeah. The only thing I would add is I love, I would love to see more of the world. I do want to travel and see places. I I've never been, I haven't been to Australia yet, but in general, I would love to go see, I hope to go to Hong Kong maybe during ICA, maybe not, but just to see Hong Kong and see uh see more than I have seen yet. Gautam: Fantastic. Well, look, Ben. Thank you. It's been an absolute delight to speak to you in this podcast. Thank you for being such a superb guest and for sharing all of your stories and your background, your thoughts. And uh I look forward to seeing you very soon. You know, I hope you'll because we're recording this podcast on a Friday. So I hope that you will have a great weekend and I look forward to seeing you in person soon. Thank you. Ben: Thank you so much Gautam, Likewise. And if I may just end on one note, I do wanna thank my wife. I don't think I would be the person I am without her. And she inspires me to be a better person every day. Gautam: You know that I, I think that's so fitting Ben. And I'm gonna say this in response, I'm going to say two quick things in response to that. One, you're absolutely correct because I have the great honor and privilege of knowing Rebeca. And I know that she's a wonderful, wonderful lady and you are indeed very lucky to have her. And I also will say the second thing I will say is that many years ago, a judge got sworn in as a Supreme court judge here and one of the former Supreme court judges who was giving a speech when he became a judge said that behind every successful man, there's a surprised woman and Rebeca shouldn't be surprised at how successful you've been. But you know, you are very fortunate to have her. So thank you for mentioning her. Ben: Thank you. And thank you for having me, Gautam. It was an absolute pleasure looking forward to meeting you in person. Gautam: Looking forward to that. Outro: Arbitral Insights is a Reed Smith production. Our producer is Ali McCardell. For more information about Reed Smith's Global International Arbitration practice, email arbitralinsights@reedsmith.com. To learn about the Reed Smith Arbitration Pricing Calculator, a first of its kind mobile app that forecasts the cost of arbitration around the world, search arbitration pricing calculator on reedsmith.com or download for free through the Apple and Google Play app stores. You can find our podcast on Spotify, Apple, Google Play, Stitcher, reedsmith.com and our social media accounts at Reed Smith LLP on LinkedIn, Facebook and Twitter. Disclaimer: This podcast is provided for educational purposes. It does not constitute legal advice and is not intended to establish an attorney client relationship nor is it intended to suggest or establish standards of care applicable to particular lawyers in any given situation. Prior results do not guarantee a similar outcome, any views, opinions or comments made by any external guest speaker are not to be attributed to Reed Smith LLP or its individual lawyers. All rights reserved. Transcript is auto-generated.

The Arctic Report Card is an annual report led by the National Oceanic and Atmospheric Administration(NOAA). The efforts of scientists and climate specialists to create this robust scientific report every year is impressive.  The amount of work contributed to this scientific document is extremely important in documenting climate change in the Arctic, which is warming at an alarming rate. Today's episode is a conversation with Rick Thoman, a climate specialist at IARC's Alaska Center for Climate Assessment and Policy (ACCAP).  Rick is a contributor and editor of the Arctic Report Card and was also awarded NOAA Distinguished Career Award for Professional Achievement in 2020. Rick was honored after a 30 plus year career with the National Weather Service for continued efforts to improve climate services in Alaska and for outstanding outreach efforts working with the Alaska Native community.Rick discusses the greening tundra, the melting sea ice and the adaptability of the indigenous people and how helpful their generational observations are on the changing landscape of the North.The Report Card is intended for a wide audience, including scientists, teachers, students, decision-makers and the general public interested in the Arctic environment and science. It is encouraged that the Report Card to be utilized and studied, as the scientific community has created it to be an easily read report for the general population to better understand the complexities of the warming Arctic.Here are the links to the 2023 Arctic Report Card and NOAA website:https://arctic.noaa.gov/report-card/https://www.arctic.noaa.govYou can visit my website for links to other episodes and see aerial photography of South Central Alaska at:https://www.katiewritergallery.comThanks for tuning in to Alaska Climate & Aviation Podcast!Katie WriterJournalist/Pilot/Photographerktphotowork@gmail.comSupport the show

Check out Citrine: My favorite, one-stop-shop for all things low-tox skincare and beauty. Save 10% by using code: ashleytaylorwellness (all brands except TheraBody, Vintner's Daughter, and Kypris) Click here:  https://citrinenaturalskin.com/?sscid=71k7_56uy45:00 - IARC classifies shift work as a group 2A carcinogen6:00 - CDC blog - https://blogs.cdc.gov/niosh-science-blog/2021/04/27/nightshift-cancer/8:30 - Ashley's top sleep tips10:30 - Smart bulbs are terrible for our mitochondria10:45 - SaunaSpace photon light Code: ASHLEY will save you money12:00 - Castor oil packs Code: Ashleytaylorwellness https://www.shopqueenofthethrones.com/?platform=grin&link_id=1533705&token=7LWCG2nUcQOCWMhwU9UvTPrarooYPY1p&contact_id=acb055d1-6b9b-4268-a8c6-8e88eb2048fc&attribution_window=3012:45 - Caffeine13:30 - Ra Optics “Popp” https://raoptics.com/ashleytaylorwellness Code: Ashleytaylorwellness15:00 - CGMs https://www.nutrisense.io/?rfsn=6778584.5479636&utm_source=affiliate&utm_medium=referral&utm_campaign=Ashleytaylorwellness&utm_term=6778584.547963617:30 - My favorite non-toxic and comfortable mattress Essentia REM5 https://myessentia.com/collections/memory-foam-mattresses?sscid=c1k7_4es4g22:00 - Oura ring https://ouraring.com/?utm_source=4544&utm_medium=affiliate&cppid=4544&cpclid=1dde3087e0a5479890331d306eea7a2b&utm_campaign=oura&utm_content=&utm_term=Ashley+Taylor+Wellness+LLC22:46 - Oura post - https://www.instagram.com/p/Cy_TYRrRmV1/?hl=en&img_index=324:30 - Therasage bamboo weighted blanket blocks emf Code: ashleytaylorwellness20 saves you 20% until Dec 25th! therasage.com26:12 - Mitozen - Sandman - https://www.mitozen.club/?ref=Lx15YMHzqBnYBd MITOZEN Club (PMA) $10 one-time fee. Save with code ASHLEYTAYLORWELLNESS29:00 - Navage sinus irrigation29:37 - Importance of morning sun30:49 - Epsom salts 2-4 cups before bed 32:20 - Sleep supplements:*Tranquinol by Premier Research Labs (on Fullscript) https://us.fullscript.com/welcome/ashleytaylorwellness/store-start?signup_source=shareable_protocol&source=shareable_protocol&source_record=VHJlYXRtZW50UGxhblRlbXBsYXRlLTEzOTU2Mg%3D%3D*Sandman by Mitozen (see 26:12 for the link^)*Magnesium breakthrough from Bioptimizers *Kava*5-HTP*L-theanine*GABAFollow me on Instagram here:https://www.instagram.com/ashleytaylorwellness/https://www.instagram.com/highmaintenancehippiepodcast/Apply for 1:1 Coaching: https://secure.gethealthie.com/appointments/embed_appt?dietitian_id=1270471&require_offering=true&offering_id=133465&hide_package_images=false

Ron Gang, 4X1MK, had his early amateur radio beginnings in Canada, and later immigrated, as part of a group, to Israel in the 1970s, where his amateur radio license, skills, and equipment were highly appreciated and valued.  Always an active amateur radio operator, 4X1MK is willing to try every operating mode. Ron is also a musician and painter who shares his amateur radio story and his perspectives of the amateur radio service in Israel, past and present.

Tell us what you thought of this episode - send us a text!In this episode, Sujani sits down with public health physician Dr. Arunah Chandran. They discuss Arunah's clinical work and how she became interested in the field of public health, her work at the Ministry of Health of Malaysia and experience moving to France to work with the IARC, and share job application tips for those interested in working with international organizations. You'll LearnThe clinical encounters that led Arunah to becoming involved in the field of public health What additional training Arunah went through to become a public health physicianArunah's research and work in noncommunicable diseases and women's health with the Ministry of Health in MalaysiaFinding different job opportunities within the same company or systemAdvice on how to figure out if you should seek an additional degree or notArunah's work with the IARC and her experience moving to a different country for workTips on applying for jobs with international organizations and the benefits of keeping a log of values and responsibilities you have had at every positionToday's GuestPublic health medicine specialist, with experience in clinical medicine, health systems, NCD policies, public health operations, and clinical research. Led national policy response for cardiovascular diseases, diabetes, and cancers in Malaysia. Currently, focused on implementation and evaluation of affordable and equitable integrated multi-cancer early detection package to improve cancer outcomes in resource-constrained settings. Initially trained as a physician, I have a double Masters in Public Health and Medical Aesthetics/Anti-aging as well as a doctorate in Public Health (Epidemiology).ResourcesConnect with Arunah on LinkedIn Learn more about the International Agency for Research on Cancer Listen to the previous episode on the Public Health Resume and CVSupport the showJoin The Public Health Career Club: A global membership community where public health professionals connect, learn, and support each other in building meaningful and impactful careers. Go from feeling confused, alone and overwhelmed, to feeling confident and in control of your life and career!

In this episode, Sujani sits down with public health physician Dr. Arunah Chandran. They discuss Arunah's clinical work and how she became interested in the field of public health, her work at the Ministry of Health of Malaysia and experience moving to France to work with the IARC, and share job application tips for those interested in working with international organizations. You'll LearnThe clinical encounters that led Arunah to becoming involved in the field of public health What additional training Arunah went through to become a public health physicianArunah's research and work in noncommunicable diseases and women's health with the Ministry of Health in MalaysiaFinding different job opportunities within the same company or systemAdvice on how to figure out if you should seek an additional degree or notArunah's work with the IARC and her experience moving to a different country for workTips on applying for jobs with international organizations and the benefits of keeping a log of values and responsibilities you have had at every positionToday's GuestPublic health medicine specialist, with experience in clinical medicine, health systems, NCD policies, public health operations, and clinical research. Led national policy response for cardiovascular diseases, diabetes, and cancers in Malaysia. Currently, focused on implementation and evaluation of affordable and equitable integrated multi-cancer early detection package to improve cancer outcomes in resource-constrained settings. Initially trained as a physician, I have a double Masters in Public Health and Medical Aesthetics/Anti-aging as well as a doctorate in Public Health (Epidemiology).ResourcesConnect with Arunah on LinkedIn Learn more about the International Agency for Research on Cancer Listen to the previous episode on the Public Health Resume and CVSupport the showJoin The Public Health Career Club: the #1 hangout spot and community dedicated to building and growing your dream public health career.

Nuclear power seems like exactly what we want: a reliable, low-carbon source of huge amounts of energy. So why does it produce less of our electricity per capita now than it did decades ago?A major reason: nuclear power suffers from very bad PR. In this episode of The Studies Show, Tom and Stuart discuss the ever-present safety fears surrounding nuclear power, the problems of nuclear waste, and the reasons that nuclear power is so drastically expensive. How many people died in the Chernobyl and Fukushima disasters, anyway? Could new reactor designs fix some of nuclear power's problems? And is nuclear power so irredeemably unpopular that we should just give it up and move on to renewables?The Studies Show is sponsored by the i, the UK's smartest daily newspaper. You can get a half-price deal on digital subscriptions to the whole paper, including full access to Stuart's columns and his subscriber-only science newsletter, by following this special podcast link.The Studies Show is also sponsored by Works in Progress, an online magazine about science, technology, and human progress. The newest issue of Works in Progress is out now, with essays on topics like the discovery of the malaria vaccine and the surprising economics of copper.Show Notes* Fumio Kishida eats a Fukushima flounder; John Selwyn Gummer eats a British beef burger (with his daughter)* Graph showing the plateau in nuclear power generation* Hannah Ritchie on the safest sources of energy; review comparing health effects of different sources of electricity generation* Jack Devanney on plutonium in Works in Progress; and on why the “Linear No-Threshold” model is “nonsense”* Jason Crawford summary & review of Devanney's book Why Nuclear Power Has Been a Flop* Article on the wildly-varying cancer and death numbers suggested for Chernobyl* UNSCEAR report; IAEA estimate of deaths; Alternative TORCH estimate; IARC estimate of cancers up to 2065* IAEA analysis of Fukushima water and comparison to normal levels of radiation* Report on deaths from the evacuation after the Tōhoku earthquake/tsunami* Tom's article in the i on Fukushima and nuclear power's PR problem* Article on spent fuels and waste from nuclear reactors* Summary of “breeder” and “burner” reactors* Hannah Ritchie on mining for low-carbon energy vs. mining for fossil fuels* Article on the pollution produced from lignite mines* Sceptical view of new nuclear plant technologies* Graph of solar panel prices dropping over timeCreditsThe Studies Show is produced by Julian Mayers at Yada Yada Productions. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.thestudiesshowpod.com/subscribe

Join Dr. Debrah Harding, an expert in integrative oncology, as we explore often-ignored cancer risk factors. We'll discuss environmental culprits like heavy metals and chemicals, along with lifestyle choices related to diet and estrogen balance. These elements significantly influence cancer risk and outcomes. Additionally, we'll stress the value of thorough medical forms in spotting these risks and elevating patient care. We'll also address radiation dangers, highlighting a case study. This leads to a broader conversation on electromagnetic effects, risks of phones being held close, and potential harm from earbuds. Take note: The International Agency for Research on Cancer classifies certain radio waves as "2B carcinogens." Next, we evaluate the role of naturopathic oncology care in enhancing cancer treatments. We'll clarify misconceptions, spotlighting the significance of the FABNO title. As we conclude, Dr. Harding offers strategies for minimizing pill use and countering supplement fatigue for cancer patients. This episode delivers crucial information for both practitioners and patients.EPISODE CHAPTERS:(0:00:01) - Modifiable Risk Factors for Cancer(0:08:17) - Radiation Exposure and Its Health Impact(0:13:05) - Electromagnetic Hypersensitivity and Its Symptoms(0:24:59) - Naturopathic Medicine in Oncology Care(0:35:11) - Naturopathic Care in Cancer Treatment(0:39:21) - FABNO Certification and Integrative Oncology CareLinks:American Institute for Cancer ResearchNational Association of Environmental MedicineJoin Over 18,000 Leading Medical Professionals and Become a Vibrant Wellness Provider Today!

On The Studies Show, we're all about trying to get it right. But sometimes we get it wrong. Every so often, we'll do a feedback/corrections/clarifications episode where we go back and try to correct any errors in the last few episodes, and reply to your more general feedback. This is the first one of those, covering Episodes 1-8. Our thanks go to everyone who pointed out our mistakes. Please keep the feedback coming!Show notes* Retatrutide phase 2 trial; semaglutide vs. tirzepatide cost-effectiveness study* The IARC's useful, detailed report on (e.g.) whether being a firefighter is a cancer risk; the FDA disagrees with the IARC on whether aspartame should be labelled as a “possible” cause of cancer* The newest published trial of psilocybin for depression* Stuart's more recent article on ultra-processed foods, with discussion of mechanisms; Chris Snowdon's two part review of Chris van Tulleken's book; interview with Herman Pontzer on his book BurnCreditsThe Studies Show is produced by Julian Mayers at Yada Yada Productions. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.thestudiesshowpod.com/subscribe

Have you seen the headlines? Social media and the internet at large are abuzz with the controversy surrounding the well-known artificial sweetener aspartame.  The recent classification of aspartame as a possible human carcinogen (category 2B) by the International Agency for Research on Cancer (IARC) has sparked a new wave of discussions, concerns, and media sensationalism. In this episode, Alan Aragon helps unravel the complexities and provide a more balanced perspective on this hot topic. Alan is no stranger to the podcast, but in case you're not familiar with him, he's a nutrition researcher and educator who's been at the forefront of the evidence-based fitness movement for over a decade now and has helped countless fitness enthusiasts, professional athletes, and top coaches, and even influenced my own work. Alan has a knack for translating science into practical application, which you can see for yourself if you check out his research review, which was the first of its kind in 2008. In this podcast, you're going to learn about . . . The latest news and opinions on aspartame and its classification by the IARC The negative connotations associated with artificial sweeteners and why people often overlook their benefits Animal testing on artificial sweeteners and whether the findings can be applied to humans Practical considerations for the consumption of artificial sweeteners, their place in a balanced lifestyle, and how much is safe to consume And more . . . This episode offers valuable insights for anyone interested in artificial sweeteners, diet, and overall health, cutting through the confusion and fear to provide an evidence-based viewpoint. So, click play to listen and learn about aspartame and its effects on health. Timestamps: 0:00 - Please leave a review of the show wherever you listen to podcasts and make sure to subscribe! 06:36 - What is the latest news with aspartame? 13:30 - Do you have an opinion on what is going on with aspartame and the IARC? 18:28 - Do you think the negative findings of aspartame and artificial sweeteners has put a bad connotation on them? and prevents people from looking into the benefits of artificial sweeteners? 27:41 - My award-winning fitness books for men and women: https://legionathletics.com/products/books/ 29:41 - If animal testing shows an increase in cancer risk can that really be applied to humans? 57:16 - Where can people find you and your work? Mentioned on the Show: My award-winning fitness books for men and women: https://legionathletics.com/products/books/ Alan Aragon's Research Review: https://alanaragon.com/aarr/ Alan Aragon's Website: https://alanaragon.com/ Alan Aragon's Instagram: https://www.instagram.com/thealanaragon/

De acordo com a Organização Mundial da Saúde (OMS) e a Agência Internacional de Pesquisa sobre o Câncer (IARC), estima-se que, globalmente, cerca de 1,8 milhão de novos casos de câncer colorretal sejam diagnosticados a cada ano1, sendo esse o terceiro tipo de câncer mais comum. Em mais um episódio do podcast, #BoraFalarDeCâncer, especialista e paciente falam sobre a importância do diagnóstico precoce e também do acolhimento, tanto do profissional da saúde quanto das famílias. O câncer colorretal é tema do 4º episódio da série de podcasts #Borafalardecâncer, que discute a jornada do paciente. Esta série é patrocinada pela Pfizer e esse episódio foi apresentado pela jornalista Barbara Guerra. Ouça! Convidados: Dr. Fabricio Ruzon (CRM: 166905-SP) e Farley Lopes. Referências:  World Health Organization; Disponível em: 1Colorectal cancer – IARC (who.int); acessado em: 24/07/2023 National Cancer Institute; Disponível em: Colorectal Cancer — Cancer Stat Facts acessado em: 24/07/2023 Inca; disponível em:  Câncer de intestino — Instituto Nacional de Câncer - INCA (www.gov.br)/ ; acessado em: 24/07/2023 Ministério da Saúde – Disponível em: https://www.inca.gov.br/sites/ufu.sti.inca.local/files/media/document/estimativa-2020-incidencia-de-cancer-no-brasil.pdf  - acessado em 04/08/2023 Ann Oncol. 2023;34(1):10-32.A. Cervantes, R. Adam, S. Roselló, et al, on behalf of the ESMO Guidelines Committee - acessado em 04/08/2023 PP-UNP-BRA-2605See omnystudio.com/listener for privacy information.

Have we soured on artificial sweeteners??Recently the World Health Organization (WHO) and the International Agency for Research on Cancer (IARC) released statements about artificial sweeteners and potential risks to our health. The IARC went as far as to list aspartame as “possibly carcinogenic to humans”So, what's all the hubbub about? Are artificial sweeteners actually bad for us? Does data exist to support a link between artificial sweeteners and cancer? Metabolic disease? Any other health concerns?Do we have to stop drinking "sugar-free" beverages? Should we panic??NO!Listen to Your Doctor Friends! Let us help you understand the relevant data, and provide some context. We're your friends. Its what we're here for :)Major points-of-interest (i.e. SWEET SPOTS) in this episode include:Where do artificial sweeteners come from? Are they all "chemicals"?What does the WHO's statement on non-nutritive sweeteners mean? What's the context? What are the data origins which spurred this recommendation?Is there evidence that links artificial sweeteners to cancer? What kind of evidence?How does the IARC classify carcinogenicity of substances? What are examples of substances that are "Group 1- Carcinogenic to Humans" vs "Group 2A and 2B- Probably and Possibly Carcinogenic to Humans, respectively"?What is JECFA? How do they classify substances and determine "safe levels" to consume on a daily basis?What are stevia and monk fruit extract? Are they "better" for us since they're "natural"?What is lycasin and why are the reviews of "Sugarfree Haribo Gummi Bears" so hilarious??For more episodes, limited edition merch, or to become a Friend of Your Doctor Friends (and more), follow this link!Also, CHECK OUT AMAZING HEALTH PODCASTS on The Health Podcast Network(For real, this network is AMAZING and has fantastic, evidence-based, honest health information, and we are so happy to partner with them!) Find us at:Website: yourdoctorfriendspodcast.com Email: yourdoctorfriendspodcast@gmail.com Call the DOCLINE on 312-380-5005 and leave us a message. We will listen and maybe even respond/play it on the show! (Disclaimer: we will not answer specific medical questions or offer medical advice. Consult your healthcare professional with any and all personal health questions.) Connect with us:@your_doctor_friends (IG)@JeremyAllandMD (IG, FB, Twitter)@JuliaBrueneMD (IG)@HealthPodNet (IG)

El café puede clasificarse de varias formas. Aquí te presento una clasificación basada en tres aspectos principales: la especie de la planta de café, el método de preparación y el tipo de tostado.1. Especies de la planta de café:Las dos especies más comunes de café son Arabica y Robusta.Arabica: Se considera de mayor calidad y tiene un sabor suave y ligeramente dulce. Representa alrededor del 60% del café producido en todo el mundo.Robusta: Tiene un sabor más fuerte, a menudo descrito como amargo. Contiene más cafeína que el café Arabica.2. Método de preparación:Espresso: Un método de preparación en el que el agua caliente se fuerza a través de café molido finamente a alta presión.Café filtrado o goteado: Este es el método más común en muchos hogares, en el que el agua caliente se vierte sobre café molido y se deja pasar a través de un filtro.Café prensado francés o de émbolo: En este método, el café molido se remoja en agua caliente, luego se presiona con un émbolo para separar el café del grano molido.Café de olla: Un método tradicional mexicano en el que el café se hierve junto con canela y a veces piloncillo (un tipo de azúcar sin refinar).Café turco o griego: Un método en el que el café finamente molido se hierve en una olla pequeña llamada ibrik o cezve.3. Tipo de tostado:Tostado claro: Los granos de café se tuestan solo hasta que alcanzan la "primera grieta". Tienen un sabor más ácido y pueden tener matices de sabor que reflejan su origen.Tostado medio: Los granos se tuestan un poco más, pero no hasta el punto de la "segunda grieta". Tienen un equilibrio de acidez y cuerpo.Tostado oscuro: Los granos se tuestan hasta la "segunda grieta" o más allá. Tienen un sabor fuerte, a menudo con notas de cacao o tostadas, y muy poca acidez.Cada una de estas categorías tiene una gran cantidad de variación, y hay muchas más formas de clasificar y describir el café. Por ejemplo, también se puede clasificar el café por su origen geográfico (como el café colombiano, etíope, etc.), por el método de procesamiento del grano (lavado, natural, honey), y muchos otros factores.¿El café tiene acrilamida y es peligroso?La acrilamida es una sustancia química que puede formarse en algunos alimentos durante procesos de cocción a alta temperatura, como freír, asar y hornear. También puede formarse durante el proceso de tostado del café. La Agencia Internacional de Investigación sobre el Cáncer (IARC) ha clasificado la acrilamida como un "probable carcinógeno humano".Sin embargo, es importante tener en cuenta que el nivel de exposición a la acrilamida a través del café es generalmente bajo en comparación con otros factores de riesgo para el cáncer, como el tabaquismo y el consumo excesivo de alcohol. Además, el café ha sido estudiado por sus potenciales beneficios para la salud, incluyendo una posible reducción en el riesgo de ciertos tipos de cáncer.La mejor guía es la moderación. Si estás preocupado por la acrilamida en el café, puedes hablar con tu médico o un dietista registrado para obtener más información personalizada.

To start the episode, Ali and Asif discuss the controversy surrounding country singer Miranda Lambert chastising concertgoers for taking selfies (0:48). Then, after a brief digression on Dana Carvey's Joe Biden impression, Asif asks Ali about the surprise hit TV show ‘Jury Duty' (10:32). They discuss the background of the show and how it is a combination of ‘The Office' and ‘The Joe Schmo Show'. They then discuss how the show did not make much of a splash when it first debuted, but then gained buzz via TikTok. Ali and Asif then discuss the show's reception and  their thoughts on the show. They then discuss the Emmy nominations the show has received, including James Marsden for best supporting actor…for playing himself. Then the guys RE-discuss artificial sweeteners because of a new press-release issued by the WHO on the possible carcinogenic effects of aspartame (37:45). Asif explains how it was a joint press release, highlighting findings about   aspartame are released today by the International Agency for Research on Cancer (IARC) and the World Health Organization (WHO) and the Food and Agriculture Organization (FAO) Joint Expert Committee on Food Additives (JECFA). Overall, Asif explains how the IARC found “limited evidence” for carcinogenicity in humans aand classified aspartame as possibly carcinogenic to humans. He then explains that JECFA reaffirmed the acceptable daily intake of 40 mg/kg body weight (ie an adult weighing 70kg would need to consume more than 9–14 cans per day to exceed the acceptable daily intake). Asif clarifies how  the agencies' statements are "complementary" in that the two groups work differently, and have a different aim: while IARC flags a potential hazard based on even limited evidence, JECFA assesses the real-life risk.   A reminder that the pod will be taking a month off in August. Look for new episodes coming your way on Sept 8, 2023!   The opinions expressed are those of the hosts, and do not reflect those of any other organizations. This podcast and website represents the opinions of the hosts. The content here should not be taken as medical advice. The content here is for entertainment and informational purposes only, and because each person is so unique, please consult your healthcare professional for any medical questions.    Music courtesy of Wataboi and 8er41 from Pixabay   Contact us at doctorvcomedian@gmail.com   Follow us on Social media: Twitter: @doctorvcomedian Instagram: doctorvcomedian   Show notes: Miranda Lambert has a point: https://www.avclub.com/miranda-lambert-scolds-fans-at-show-backlash-1850651000 How Jury Duty Orchestrated the Trial of a Lifetime: https://www.vulture.com/article/jury-duty-interview.html How 'Jury Duty' completely faked a trial in real courtroom with a narcissistic James Marsden: https://www.usatoday.com/story/entertainment/tv/2023/04/08/jury-duty-feevee-series-fakes-civil-trial-james-marsden/11610571002/ Their Show Flew Under the Radar. TikTok Blew It Up: https://www.nytimes.com/2023/06/08/arts/television/jury-duty-freevee.html How Jury Duty became the surprise comedy breakout of the year: https://www.theguardian.com/tv-and-radio/2023/jul/17/show-jury-duty-amazon-freevee-tiktok What is aspartame and what do the new WHO rulings mean? https://www.reuters.com/business/healthcare-pharmaceuticals/what-is-aspartame-what-do-new-who-rulings-cancer-consumption-mean-2023-07-13/ Opinion: What the WHO aspartame findings mean for your diet: https://www.cnn.com/2023/07/21/opinions/aspartame-sweetener-diet-world-health-organization-branca/index.html Does Aspartame Cause Cancer or Is It Safe to Consume? The Latest Evidence About the Artificial Sweetener: https://time.com/6294701/aspartame-cancer-sweetener-studies/ Ninety-sixth meeting - Joint FAO/WHO Expert Committee on Food Additives (JECFA): https://www.who.int/publications/m/item/ninety-sixth-meeting-joint-fao-who-expert-committee-on-food-additives-(jecfa) IARC Monographs Hazard Classification: https://www.iarc.who.int/wp-content/uploads/2023/06/IARC_MONO_classification_2023_updated.png Carcinogenicity of aspartame, methyleugenol, and isoeugenol: https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(23)00341-8/fulltext Summary of findings of the evaluation of aspartame at the International Agency for Research on Cancer (IARC) Monographs Programme's 134th Meeting, and the Joint FAO/WHO Expert Committee on Food Additives (JECFA) 96th meeting: https://www.who.int/publications/m/item/summary-of-findings-of-the-evaluation-of-aspartame-at-the-international-agency-for-research-on-cancer-(iarc)-monographs-programme-s-134th-meeting--and-the-joint-fao-who-expert-committee-on-food-additives-(jecfa)-96th-meeting

The artificial sweetener aspartame that's widely used in fizzy drinks has just been classified as “possibly” cancer-causing by UN scientists - but there's no cause for alarm.That's the key message from the International Agency for Research on Cancer (IARC), whose assessment of aspartame was carried out on behalf of the World Health Organization (WHO), by an expert panel of nutritional epidemiology and nutritional toxicology scientists.With more details on what these findings mean for all of us, UN News's Daniel Johnson spoke to IARC's Mary Schubauer-Berigan, who's head of the agency's Monographs Programme.

I'm sure you've seen this circulating: the aspartame drama. With the media jumping on the World Health Organization's IARC reclassification of aspartame as "possibly carcinogenic", it's easy to get lost in the chaos. In this episode we're going to go over all things aspartame and discuss why all this media fear mongering does not deserve your mental or emotional energy. If the aspartame drama has been stressing you out, check out this week's diet-culture-debunk of the "spooky" sweetener that's been around since the 60s. Follow Mallory on Instagram by clicking HERE. Apply to Live Unrestricted by clicking HERE. Get on the Waitlist for the Live Unrestricted Practitioner Program by clicking HERE. Do The Free 3 Day Challenge by clicking HERE. Submit Podcast Requests by clicking HERE. Mentioned - Public Summary

The Food and Drug Administration is breaking from the WHO and IARC over the subject of aspartame, which the latter says is “possibly carcinogenic to humans.” While officials and media run PR-cover for one of the most beloved children of the food industry, the issue is obscured with cancer concerns instead of what aspartame is know to do to the body: behavioral and cognitive changes, learning disabilities, seizures, migraines, mood swings, depression, and insomnia. Perhaps this is why the president, who loves his ice cream, one of the main vessels for the neurotoxic sweetener, is so obviously out of his mind. However, the FDA says aspartame safe so long as you consume the recommended amount, an erroneous notion that poison can be healthy, and something that has no consideration for the universal and heavy dosage people get of the substance on a daily basis. Their justification is that it has been studied and is legal in other countries. But it's not just aspartame. Sucralose, in a recent Journal of Toxicology and Environmental Health, Part B, study was fond to cause cellular and DNA damage like food colorings, along with leaky gut syndrome, and thus allergies and inflammation. A recent government study also found that the thousands of PFAS, or forever chemicals, in water without a doubt cause fertility damage, liver damage, hormonal suppression, obesity, and thyroid disease. So if Sucralose can cause DNA damage like food coloring then why is the alternative media not encouraging a boycott of products that contain the sweetener, or colorings, like they are other products? If conspiracy-minded media are so concerned with fluoride calcifying the pineal gland then why are they not concerned with aspartame severing consciouses from the brain and body through neurological damage? Another study from the Journal of Nutrition, and reported on by the American Council on Science and Health, is furthermore promoting the NOVA-4 classification of food, i.e., ultra-processed food-like items, as being at 91% consumption “far healthier than the typical American diet,” although the SAD Diet, or Standard American Diet, is almost exclusively comprised of UPFs. We have finally reached the point of idiocracy. It seems that ASPARTAME BRAIN is responsible.This show is part of the Spreaker Prime Network, if you are interested in advertising on this podcast, contact us at https://www.spreaker.com/show/5328407/advertisement

“Aspartam kommer på WHO's kræftliste.” Det var én af de mange overskrifter, man kunne læse, da det for to uger siden blev afsløret, at Verdenssundhedsorganisationen ville klassificere sødemidlet som ‘muligvis kræftfremkaldende'. Nu er WHO udkommet med deres begrundelse – men siger samtidig, at det ikke er skadeligt at indtage. Og det har – forståeligt nok – skabt både frygt og forvirring. I denne episode gennemgår vi WHO pressemeddelselse samt de forskellige instanser, IARC og JECFA, der er involveret i asapartam-udmeldingen og hvad der egentlig er op og ned på kategoriseringen af aspartam. Vi besvarer ud fra det spørgsmålet: Er der grund til bekymring for aspartam skulle være skadeligt at indtage? Hvis du vil støtte podcasten, så finder du vores sponsor Zetland lige her. Du får to måneders lytbar, reklamefri, dommedagsfri kvalitetsjournalistik for 50 kroner i alt. Det er under en tredjedel af normalprisen: zetland.dk/slutmedforbudt Ting, vi nævner i podcasten: Elsøes Instagram-opslag, der opsummerer hele sagen: https://www.instagram.com/p/CutgghKNoKh/  Pressemeddelelsen fra WHO, der både indeholder konklusionen fra IARC og JECFA: https://www.who.int/news/item/14-07-2023-aspartame-hazard-and-risk-assessment-results-released Artiklen i Lancet, der indeholder IARC's begrundelse for vurderingen af aspartam: https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(23)00341-8/fulltext JECFA's begrundelse for stadig at vurdere, at aspartam er sikkert at indtage: https://www.who.int/publications/m/item/ninety-sixth-meeting-joint-fao-who-expert-committee-on-food-additives-(jecfa) IARC's database over alt, de har har vurderet til dato: https://monographs.iarc.who.int/list-of-classifications/  EFSA's kritik af de italienske aspartam-forsøg, der – som de eneste – konkluderede, at aspartam var kræftfremkaldende i mus: https://www.efsa.europa.eu/en/news/efsa-assesses-new-aspartame-study-and-reconfirms-its-safety 

In a new report, the WHO has categorised the artificial sweetener aspartame as “possibly cancerous” to humans. But the groupings used by the IARC, which decides these categories, don't mean the same things we think they do. ThePrint #PureScience, Sandhya Ramesh explains. 

This week, Alice looks at media reports around the IARC classification of aspartame as carcinogenic and Mike asks 'why did the chicken cross the road?' Meanwhile, Marsh faces off against crypto scammers and Mike takes a holiday.Tickets for QED are available now. Get yours today!If you want to sign up to speak at SkeptiCamp, you can do that at sitp.online/skepticampTo support Emma running to QED for the Prison Reform Trust, you can do that justgiving.com/page/emmarunstoqed

Cada vez que você vê uma manchete dizendo que algo causa câncer, a IARC (agência Internacional para a pesquisa do câncer) costuma estar envolvida. Bacon, carne vermelha, batatas fritas… A mais recente notícia diz respeito ao aspartame. Mas qual o grau de certeza que temos sobre essas coisas? E qual a magnitude do risco? Hoje vamos conversar sobre a IARC. Para falar sobre esse assunto, temos hoje uma convidada ilustre, Dra. Vanessa Andrade. A Vanessa é pesquisadora e trabalha exatamente nessa área. Estamos no Instagram: Dr. Souto - Sari Fontana  Área de membros do blog Ciência Low-Carb: Clique Aqui! Para ser avisado sobre cada novo episódio e receber os links das matérias mencionadas e as referências bibliográficas por e-mail, cadastre-se gratuitamente em https://drsouto.com.br/podcast Para aprender sobre rótulos e como fazer melhores escolhas, acesse https://sarifontana.substack.com/ e cadastre seu e-mail. Você passa a receber conteúdo gratuito, e se quiser apoiar este trabalho, receber conteúdo exclusivo e enviar rótulos para a Sari analisar, faça upgrade para os planos pagos. Conheça também o Podcurso Low-Carb da Teoria à Prática em https://drsouto.com.br/podcurso/

Dr. Chadi Nabhan one of the lead doctors who testified during the Monsanto Roundup trials, and proved that glyphosate containing Roundup Ready weed killer does in fact cause non-Hodgkin's lymphoma, joins the show to talk about the trials and this alarming chemical. Dr. Nabhan gives us a first hand account of what it was like to testify in the trial, and some of the surprising things that happened during his time in court. He also goes over what non-Hodgkin's lymphoma is, and the many other health issues Roundup may be contributing to. We also go over the political aspects of Roundup and glyphosate, what the EPA is actually doing about it, and the future of this dangerous chemical. So many important topics covered on this pervasive and sometimes lethal chemical, so make sure to tune in!  On today's podcast, you will learn: How Dr. Nabhan got involved in the Monsanto trials. Fascinating stories about the courtroom and how the trials unfolded. Is glyphosate causing other severe health issues? How Monsanto used employees to ghostwrite medical articles to counter the true findings by IARC. What is non-Hodgkin's lymphoma and the type Mr. Johnson had in the major Dewayne Johnson v. Monsanto Company trials. The fascinating story that lead Dr. Nabhan to write his incredible book Toxic Exposure. What do to if you believe you've had dangerous exposures to glyphosate. The politics of involved around Monsanto and the future of glyphosate.   Dr. Chadi Nabhan's Bio: Chadi Nabhan, MD, MBA, is an award-winning hematologist and a medical oncologist who previously hosted an award-winning podcast, Outspoken Oncology, which has now been rebranded to Healthcare Unfiltered – an honest, raw, timely podcast tackling any and all topics in healthcare. No edits and no filters; that is “Healthcare Unfiltered.”  Combining his background in clinical care, cancer research, precision medicine, genomics, clinical trials, real-world data, controversies in medicine, and health care advocacy, Dr. Nabhan brings a unique and powerful perspective to current medical events. It's the weekly podcast that you don't want to miss. You can learn more about Dr. Nabhan and his work at www.chadinabhan.com Make sure to pick up his incredible book Toxic Exposure! https://chadinabhan.com/mybooks/   ✨SUBSCRIBE✨ http://bit.ly/38pyo1U  

Welcome to the Aphasia Access Aphasia Conversations Podcast. I'm Ellen Bernstein-Ellis, Program Specialist and Director Emeritus for the Aphasia Treatment Program at Cal State East Bay and a member of the Aphasia Access Podcast Working Group. AA strives to provide members with information, inspiration, and ideas that support their aphasia care through a variety of educational materials and resources. I'm today's host for an episode that will feature Davetrina Seles Gadson. We'll discuss her work involving how brain lesion characteristics may intersect with aphasia recovery, race, and psychosocial factors, as well as issues involving health-related quality of life assessments. Dr. Davetrina Seles Gadson is the first Black-American to graduate with a Ph.D. in Communication Sciences and Disorders from the University of Georgia. She is a neuroscientist and certified speech-language pathologist with expertise in adult neurological rehabilitation and patient-centered outcomes. She currently is Research Faculty, in the Department of Rehabilitation Medicine, at Georgetown University. Dr. Gadson's research focuses on the influence of health disparities in minority stroke survivors with aphasia and the effect of such disparities on brain functioning, aphasia severity, and health-related quality of life. Most rewardingly Dr. Gadson is the co-host of “Brain Friends”, a podcast for neuro nerds and stroke survivors to talk about aphasia advocacy, language recovery, and community. Listener Take-aways In today's episode you will: Learn how health disparities may influence aphasia outcomes and why more research is needed   Discover why "Brain Friends" is another podcast you'll want to add to your playlist.   Gain practical tips on how to build confidence in intercultural interactions with your clients   Hear how health-related quality of life (HRQL) measures can help  inform your clinical practice   We'd like to recognize Kasey Trebilcock & Amanda Zalucki, students in the Strong Story Lab at CMU, for their assistance with this transcript. Show notes edited for conciseness Ellen Bernstein-Ellis (EBE) EBE: I am so excited to have a fellow podcaster here today. Thank you for being here. And I just listened to the January Brain Friend's episode. It was great. So I hope our listeners will check it out too. I want to also give a shout out to your consumer stakeholder and co-podcaster, Angie Cauthorn, because she was a featured guest on episode 70, in June of 2021, as we recognized Aphasia Awareness Month, and you just spoke with her about aphasia types and aphasia conferences, and you gave a big shout out to CAC and you gave clinical aphasiology conference and you also gave a big shout out to the Aphasia Access Leadership Summit. So really important conferences, I think that stimulate a lot of discussion and values around patient centered care. And your Brain Friends podcast just has a great backstory. So why don't we just share about how that all started? Where's the backstory to that, Davetrina? DAVETRINA SELES GADSON: Thank you so much for having me. This is such an exciting opportunity. So, Brain Friends started with myself and Angie. We were on the National Aphasia Association's Black Aphasia group call and I just loved her energy. She reached out to me after we finished that group call, and we just started talking. Our conversations were so informative, and it just lit this passion and excitement in me. I said, “Hey, can I record some of these, and maybe we do like a podcast?”, and she was totally down for it. It's just been such an innovative and fun way to disseminate science and engage many stakeholders. EBE: I want to thank Darlene Williamson, who's president of the National Aphasia Association for sending me a little more information. You told me about this group, and so I wanted to find out more. She provided this description by Michael Obel-Omia and his wife Carolyn, and I hope I said his name correctly, who provide leadership to this group. And they said that in this group, the Black American Aphasia Conversation group, “provides a place for Black people with aphasia to share their stories, provide support, meditation, and brainstorm ways to advocate and consider policies. We will discuss the unique challenges and gifts we share due to our experiences with disability and race.” I found out that you can reach out to the National Aphasia Association (NAA) for more information and to get on the email list for a meeting notifications. And in fact, I put the registration link in our show notes today. So, sounds like that group has been a meaningful discussion forum for you, too. SELES GADSON: It's been so fun. I share how for me, I've been in the field practicing for a little over 16 years now, and this was my first time being in a room with so many people that look like me. And for many of the survivors on the call, I was one of their first Black SLPs that they had ever met. Just even having that connection, and being able to speak to some of the challenges, and some of the things culturally that we both share has been my outlet, biweekly. EBE: I'm going to make sure we have that link in our show notes. Also, the link to your podcast because I encourage people to listen to Brain Friends, I've really enjoyed it.  When you and I were planning for this episode today, you talked about how being part of the National Aphasia Association's Black American Aphasia Group really helped to energize you and the research you were doing, and what a nice integration of life that was. I will want to tell our listeners about one more wonderful thing, and that's the interview you were part of on the ASHA Voices podcast as well as the related article in the ASHA leader, where I learned more about your journey to doing this research. So, as you provided clinical services for a Black client as an outpatient clinician, and this is pre- doctoral research, you recognized that there was a significant gap in the literature around working with African Americans with aphasia. You saw the need to understand the impact of aphasia on identity and motivation in order to best help this particular client. And those are both really important concepts within the Life-Participation Approach to Aphasia (LPAA) framework as well. So, then you shared that you got some important advice from an important mentor. Do you want to share what happened next? SELES GADSON: Definitely. So, one thing that's also unique about that time is that at that point in my career, I had worked in many of the clinical settings. I had done acute care, inpatient rehabilitation, skilled nursing facility, and even worked as a travel SLP traveling throughout the United States. And so, once I had got to that outpatient setting, it was different from any of the other settings because these individuals were home. And often times, they wanted to get back to work. I remember feeling a little discouraged because I wasn't finding research on a lot of functional treatment approaches or functional therapy. In addition, I wasn't finding research on black stroke survivors with aphasia. And so, I mentioned to one of my mentors at the time, Dr. Paul Rao. I said, “what's going on in the field? And I'm not seeing this, and I have this client, and I don't really know what to do.” And he said to me, “Stop complaining kiddo, and go back and get your PhD.” Admittedly, when he said it, it was kind of like, “okay fine, I'll go do it.” I don't think I realized all what it would take. That's what really made me pursue the degree was this notion that I could help facilitate some of that change and bring some of the research that I needed to see. EBE: That is so important. And that story really made me reflect on another story that has really impacted me from a dear colleague, because you experienced in your doctoral work some concerns about doing research on Black Americans because your interest was seen, as it said in I think the ASHA Voices interview or in the Leader, as “personally motivated.” Your story mirrors one that a colleague and dear friend, Nidhi Mahindra, told me as well. During her doctoral research, she was told that while pursuing multicultural interests were worthy, that she may face barriers to getting funding to pursue that line of work. That might be problematic, right? She had to struggle with that. Despite that daunting message, she persisted, and then was funded by ASHA on a grant studying barriers influencing minority clients' access to speech pathology and audiology. Nidhi reminded me how our life experiences can often inform our work in important and valuable ways. Davetrina, you've channeled your experiences into these explicit observations and data that you shared with your doctoral committee. That was a really important part of moving forward.  Do you want to share some of the points  gathered for that doctoral committee to help support why this research is so important? SELES GADSON: First, I want to thank Nidhi. Hopefully I'm pronouncing her name right, for her perseverance, because it was some of her work that helped me in my dissertation. Being able to cite her just really shows the importance that everybody plays in breaking barriers and pursuing the things that really speak to them. And one of the things that I'll clarify, it was two parts in pleading this case. The first part was that I changed the committee. I think that that was a supportive thing. And then, the second part was that when I prepared all of the research on why I needed to do this work. Some of the research looked at what we knew already with stroke recovery in minoritized groups, which was that Black African Americans were twice as likely to have a recurrent stroke than any other ethnic group and what we were seeing in the aphasia literature for Black Americans, which was the narrative of Black Americans having longer hospital stays, more hospital costs, but poor functional outcomes. And so, it was these two key pieces that I had really gathered. When I went back to the new committee to share and plead my case on why I really wanted to do this research, they had that initial onset of knowing that this research definitely needs to be done. I think that that's what helped it go through. EBE: Wow. I think those are really important reasons. That whole concept of allowing our life experiences to inform our work and to value that. As we start to talk about your research, and I'm really excited to get to share this amazing work you're doing, I thought it might be helpful to define some of the terms that are integral to this research Some of the definitions are a little tough to wrap your arms around because they're not consistent in the literature or are still waiting to develop. Let's start by discussing what you want the listeners to know about the definition for health-related quality of life, or, as we'll call it, HRQL. SELES GADSON: HRQL is operationally defined that it's multi-dimensional. The way I define it a lot in my work is the perception of the individual's ability to lead a fulfilling life in the presence of a chronic disease or disability such as aphasia, but really their perception in five domains. The five domains that I look at in my work are physical, mental, emotional, social communication, and then role, the individual's ability to get back into the activities that they used to be able to do. EBE: Okay, that's really helpful. I think we should also discuss or define patient-reported outcomes or PROs. Sometimes they are also referred to as PROM's, patient-reported outcome measurements. How do they relate to HRQLs? SELES GADSON: Patient-reported outcomes is a health outcome directly reported by the patient without interpretation. Patient-reported outcomes often look at the status of the health condition. The biggest thing about patient-reported outcomes is that it's without the interpretation of the practitioner. So, whatever the patient says is what we're going to take as gold. EBE: Why is it particularly important then to look at HRQOL for Black stroke survivors? SELES GADSON: That's such a great question. And so I want to break it down in two parts. I think the first part is that given the lack of normative data for Black stroke survivors, when we're only looking at clinician-reported outcomes, that's where we get to this bias and the normative bias. I know that there's research out where there are some outcomes to where we're already seeing this five-point difference. And for some research, that five-point difference is considered clinically meaningful. I think that if we're not using these patient-reported reported outcomes, then we put ourselves in a position to contribute to the disparities that we're seeing in standardized assessments. So that's the first answer. The second reason is that we know that nonclinical factors such as physician-race concordance drive up to 80% of what we're seeing in poor functional outcomes in minoritized groups. If we're not asking the person, then we're not able to really understand the things that they want to do, and we're already coming in with this majority type attitude which could influence one's participation in therapy. The last thing that I think is most important, whether you're Black, white, purple, whatever, is that we have these insurance demands that sometimes may not allow us to get to all the things that we may see from an impairment base. By using the patient-reported outcomes, we are helping structure therapy in ways that matter most to the patient. EBE: Well, that reminds me of this amazing quote that I was hoping I could work in today. I circled it in big yellow pen when I first read through your research. You said that it's really important because, due to the lower HRQL that we find in individuals with aphasia, it's “imperative that the development of a treatment plan incorporates what the patient prioritizes. And it's imperative that clinicians have a way to measure these subjective attributes to make a meaningful impact on care.” That's what we want to do. SELES GADSON: So important, because I think what we have to realize is that part of our role as the practitioners providing this skilled intervention, is really helping the individual get back to what they want to do. And I think that if we're not asking them what they want to do, then we're not really able to structure therapy in matters that mean the most to them, but also help them to start to recognize that as part of this identity with aphasia, that there's this new normal for them. Sometimes, individuals are going to rate themselves based off of what they used to be able to do. But if they know that one of their goals was to be able to talk on the phone, or to play bridge with their friends, and we worked on that in therapy, they're now able to look and see, before I scored my telephone confidence at a 50. Now I feel like I'm at a 90, and so sometimes that own self-recognition can support motivation, and can even support therapy, once insurance dollars run out. EBE: I really appreciated doing this deeper dive into PROs as I read through some of your research. And one of the resources I came across was a really interesting table that talked about six categories of PROs. And I'll put a link in the show notes to a 2015 book by Cella, Hahn, Jensen and colleagues called “Patient-Reported Outcomes and Performance Measurement.” (They list six different kinds of PROs in a helpful table.) But the main category that your work is utilizing is actually these HRQL measures. You've been stating why it's so important. HRQL PROs help to frame diagnostics and treatment because you're trying to prioritize what the patient wants and needs-- what they're expressing. SELES GADSON: Right, exactly. I think that one of the things that it's really important for practitioners to understand, is that these things are mandated by what we see in our scope of practice. When I say mandated, I mean we are called to reduce the cost of care by designing and implementing treatment that focuses on helping the individual. If we're not asking the individual what they want to get back to, then I think that we're putting ourself at a position that makes it more challenging to serve in that way. EBE: One of the things we like to do on this podcast is to provide resources that will help clinicians think differently or do something differently tomorrow as they meet face-to-face with their clients. And one of the things I thought we'd put in our show notes is a link to the PROMIS website, because that was something you've used in your research. Do you want to explain a little bit about that website? SELES GADSON: One of the things that I like about the PROMIS website is that it has a list of health outcomes available to use for a range of individuals-- for pediatrics, for adults. I like that it's free, most of them, and I think that it's a good place to start. Some of the outcomes on that website are also even appropriate for in acute care, meaning that they may not take a long time to administer. And so, I think that that's a good place to start. EBE: Well, thank you. And I want to move right into this wonderful paper where you are co-author with Wesley, van der Stelt, Lacey, DeMarco, Snider, & Turkeltaub, that looked at how brain lesion location interacts with HRQL. Can you share a couple key takeaways from that paper?  I hope you'll highlight the one related to depression and HRQL. We're having a lot of research right now around the emotional impact of aphasia and how that will impact recovery outcomes as well. So, tell us a little bit more about that work. SELES GADSON: We looked at the domains of health-related quality of life associated with specific deficits and lesion locations in chronic aphasia. We examined the relationship between HRQL using the Stroke and Aphasia Quality of Life Scale by Hilari and her colleagues, as well as a depression scale, and different impairment-based measures---our battery that we used here. What we found was that language production and depression predicted communication HRQL, meaning that those individuals that reported lower communication HRQL also had a significant depression associated with it. We did lesion symptom mapping in this study. Basically, what we were looking at is to see if HRQL mapped on to discrete areas of the brain. We found that individuals that reported lower psychosocial HRQL had inferior frontal and anterior insula lesions; where individuals who reported lower physical HRQL had lesions in the basal ganglia. This confirmed for us that even though HRQL is this subjective perception, we were seeing it map on to these very specific areas in the brain that also predicted some of the impairment measures that we know of. EBE: That can get us to start thinking about if we have patients with these types of lesions, maybe to be more on the alert for depression. I think that's one point you made. But you also mentioned another important takeaway in the study about the impact of depression on HRQL related to the training of SLPs. This all ties together. What are your thoughts there? SELES GADSON: I think that when we are recognizing that individuals with aphasia are experiencing a new normal, and I think that the research has been very clear on understanding that depression does relate to and contribute to one's communication. I think that there is an opportunity for speech-language pathologists to have more counseling classes. And again, make sure that we're tapping into what the patient wants to do in order to hopefully help mitigate some of those feelings of depression. EBE: I really endorse building those counseling skills in our graduate programs for our students, so they go out feeling more confident and more skilled and knowing that that is going to be an ongoing journey as a speech-language pathologist to build that skill set. SELES GADSON: And shameless plug, I think our episode six of Brain Friends is a mental health episode. I have one of my good girlfriend colleagues there who is a counseling psychologist. She shares with us helping skills for the practitioner, and we share on that episode10 skills that you can do as a clinician to support the person with aphasia. EBE: Thank you for sharing that. That's really important. And again, the link to Brain Friends will be in our show notes. Let's take a moment and talk about how you connect this finding about depression to the role of social communication, because you said it was those scores that were down in your measure. SELES GADSON: With that particular study or overall? EBE: However you'd like to discuss it. I'm opening that door to you. SELES GADSON: One of the things that we were seeing is that individuals were reporting the depression within this Communication HRQL domain. So even though we didn't dive into it too deep in this study, it was more of the correlation and recognizing that individuals that were reporting this higher level of depression, also have this higher level, or this lower report of communication HRQL, making those links specifically. I do have something that I'm working on right now, that will completely answer that question a little bit more solidly. I don't want to speak too much on this, so stay tuned. EBE: Absolutely staying tuned, there's no question. You also had another article that I found intriguing-- An article with your coauthors, Wallace, Young, Vail, and Finn, a 2021 article that examined the relationship between HRQL, perceived social support, and social network size in Black Americans with aphasia. And that paper highlights that there's been little research exploring HRQL in Black Americans. Of the five factors that comprise HRQL, why did you decide to focus on social functioning? And specifically social support and social network in this study? SELES GADSON: Well, that really came from the literature. One of the things that the literature said is that we knew that social HRQL contributed in some way, but we weren't sure what way. And we weren't sure what pieces of social functioning contributed. My apologies to the researcher who said it, but it set me up perfect for my dissertation work to say, “this is why I'm looking at social functioning in these two specific pieces,” because we didn't know. Was it social participation? Was it social network? Was it social support? That was one of the reasons why I wanted to pull out those two specific pieces. The other thing that was really important about this work was that it was the first study that really looked at what HRQL looked like in Black stroke survivors. We didn't know any of that. And so for me, it was really important to compare Black stroke survivors to normal aging Black individuals because I feel that for us to really get baseline understanding of what some of these factors are and how individuals respond in recovery, we have to compare them to their norm, or to other members in their community that look like them before comparing between Black and white or any other ethnic groups. This study is where we found that in terms of HRQL, the main difference between stroke survivors with and without aphasia and in our normal aging individuals, was that communication was the impairment. And then, with the social network and social support, we weren't seeing a difference between this homogenous group of Black people in those areas. EBE: That takes me to my next question, your research noted that the Black survivors with and without aphasia, have smaller social networks compared to white stroke survivors. That's the data that we have based on that social network data. Even though you weren't trying to compare in this study, per se, you still made sense of that finding-- trying to make sure that we don't make assumptions, and instead look at different factors that could be at play. How did you make sense of that finding, the smaller network? SELES GADSON: It was two things that allowed us to make sense of that finding. One was recognizing that in both groups, the stroke survivors with aphasia and our normal aging individuals, that because they were age matched, it could have been a factor of age--meaning that the individuals receiving the support quality and then their network, everyone was kind of in the same age group, and so, it was more of a factor of time of life versus actual culture. But then a lot of that came through in some of the anecdotal reports, and things that we even circled on the scale that we used--we use the Lubben Social Network Scale. With some of those questions, one might be how many people do you feel comfortable sharing personal details with? And often times, we got this report of “just my husband”, or “only God”. And so, we were seeing that some of this really related to the traditional and cultural values in Black Americans, where you're not going to share a lot of stuff with a lot of people. You have your set group, your small network. And that's okay. That doesn't mean that you're isolated.  EBE: I think another point you make, and maybe even thinking back to the ASHA Voices Podcast, why it's particularly important to target social communication. That is yet another life participation core concept. Do you want to speak to that for a moment? SELES GADSON: I think the thing that we have to realize with social communication is that individuals, especially within the black community, they are social, they want to talk, they want to get back to doing and interacting with their community. And so, one of the things that that looks like is maybe being able to participate again in Bible study or being able to stand up and read a scripture. And the only way that you know that, is by asking them that on a patient-reported outcome. I think that that's where that social communication piece is coming in. One of the things that I'm seeing with the Black aphasia group is that moment, that hour, where everyone is together, it's amazing. It's them using social communication. You spoke about how I said that that energized my research, and that was why--because I was on this call, and they were speaking about these things, that sometimes I feel like I have to explain to the powers that be why social communication or the LPAA approach is important. But here I was talking with all of these survivors, and they were telling me, I want to be able to communicate, I want to be able to do these things. It just really confirmed for me that this type of research, we were on the right path. EBE: Right. And this is my chance for a “shameless plug” because of my life work, and that is just the power of groups. The power of groups is amazing. SELES GADSON: You know, your life work and... EBE: Well, we don't want to go there, this episode is about you. SELES GADSON: Okay. I'm telling you; I'll get into just how influential your work has been, even when I was working as a practitioner and doing group therapy, it was your work and your research that I was going to. EBE: Well, I had the honor of getting to work with Dr. Roberta Elman, and starting the Aphasia Center of California and doing that initial research, that has been such a gift to me, so, but thank you, back to your work now. That's a great transition, because I'm going to bring us to your 2022 study, looking at how aphasia severity is modulated by race and lesion size in chronic survivors. That was an amazing study. I'm going to read another quote here from that study. And that is, “understanding the origin of disparities in aphasia outcomes is critical to any efforts to promote health equity among stroke survivors with aphasia.” You said this work led you to an “Aha!” moment. And I'd love for you to share more about that moment, and about this study. SELES GADSON: Yes, this was one of my babies, I would say it was definitely a labor of love. And it's been well received. One of the things that led us to this study was that we were already aware of what the research was saying, in regards to the narrative of Black stroke survivors having these lower scores, they were having poor functional outcomes, longer hospital stays. I really wanted to understand what components neurologically, were playing into that. The research has shown that Black Americans often may have a larger stroke due to a myriad of factors-- delayed hospital arrival, not being able to receive TPA. But I wanted to know what factors neurologically were contributing to what we were seeing, not only in this baseline difference that we were seeing, but what was the bigger picture essentially. What we found was that when we looked at race and lesion size, when we did an interaction of race and lesion size, that Black and white survivors with small lesions performed similarly. But larger strokes resulted in more severe aphasia for Black people, than white people. And that was something that we didn't quite understand, because if you think about it, the larger the lesion, the poorer your aphasia should be. But in this case, the larger the lesion, the white stroke survivors were performing better and so we offered two reasons for that. One was the potential assessment bias-- that maybe with the larger stroke, there was this code-switching element that the Black stroke survivors just weren't able to do. And we were seeing that in the larger strokes, and it wasn't being picked up in the smaller strokes. Then the other was the disparity that I had mentioned earlier, which is that access to rehabilitation. It might have been more evident-- we were seeing some of those disparities in the larger strokes. We know that individuals that come from higher earning SES groups have greater access to rehabilitation services like speech and language. That was our other reason, that we were wondering if that's why we were seeing that outcome. EBE: This reminds me some of the research that Dr. Charles Ellis has been doing. I attended his keynote speech at the IARC conference in 2022 that talked about understanding what is happening upstream, because it's going to impact what's happening downstream. In terms of health disparities, it's going to have an impact. I think your research supports that. We need to learn more about it and do the research you're doing. As you reflect on your findings across these amazing studies, this research that you've been doing, can you offer to our listeners some tips on how to have more confidence with intercultural contact? SELES GADSON: That's a great question. I think the first thing that that you have to do is put yourself in places where you are connecting with people that don't look like you. EBE: I agree. And that can be hard and challenging to do. SELES GADSON: It can be, but one of the things that I say is that it goes back to some of the things that Dr. Ellis has talked about, which is being intentional. That might mean going to a different side of the neighborhood to support a Black owned business, and being within that space, to feel how it feels to be around different cultures. The other thing that I think is really important, and it comes out of literature that looks at reducing racial bias in health care, which is to avoid stereotype suppression. So oftentimes, people may be thinking something and they don't want to share it, or they try to suppress it. And the reason why that's negative is because stereotype is a cognitive organization strategy that we use. And where it becomes negative is that if you're having these stereotype ideas, or you're just not sure, if you're not able to express them within a space that you feel comfortable with, then you suppress them. And then it kind of comes out in therapy. And so, I think that those are two huge things. And then the last thing that I would say is that it's really important to build partnerships. And so, building partnerships, either with local churches, within the university area, or just seeing how you can serve in order to help create some of that confidence. But you have to put yourself out there and not wait until therapy day. EBE: Wow, thank you for those tips. And one of them reminded me of something, a tip that a local educator suggested that, even if you don't feel like you're in an environment where your everyday social context might put you with people who look different from you, that you can still listen to other voices by listening to podcasts, sign up for podcasts, sign up for Twitter feeds of people with different voices, so you can start being present to that conversation. So that was something that I have found useful and really good advice as well. SELES GADSON: So true. The other thing that I did, even someone who identifies as a Black American when I was doing my dissertation work, and previously before some other things in my career, I noticed that perspective taking was a huge piece--putting myself or imagining myself in the individual's shoes. And so, for me, that meant that I went to Black museums and exposed myself to different cultural experiences. I wasn't going into some of these spaces, whether it was collecting data or even working with individuals from other earning communities, with some type of privilege. So even in that sense, I wanted to make sure that I checked my privilege as well by doing that perspective taking. EBE: Thank you,. And this discussion could keep going, but I know our time is getting tight here. This whole effort that you put in your research of looking at HRQL measures reminds me of some of the work that I've really admired by Hilari and you had a wonderful story you could share about her, your interaction and your use of her work. Would you like to share that quickly? SELES GADSON: Oh, she's so awesome. I was sharing how when I first was diving into this literature, her work was one of the pieces that I found, the Stroke and Aphasia Quality of Life Scale. I reached out to her and she shared this scale. And a couple of years later, I attended the International Aphasia Rehabilitation Conference in London. And she sat down with me. I asked her if she had any time, if we could just talk, and she was so welcoming. We sat down, and she might not even remember this, but even in that moment of us being able to talk about these things that we were both so passionate about, she just really spoke to me and encouraged me. And it's so funny, because now as I publish and do different things, my mom always says, “you gonna be just like Dr. Hilari.” EBE: Let's just do a shout out for mentorship, for people who take the time, and feel committed and passionate. Again, we're using that word again today, passionate, to support the new voices that are coming into the field. So that's the gift of mentorship. And in this whole discussion, you and I also talked about how important it is to be inclusive, and we talked about how HRQL measures sometimes are harder to use with people with severe aphasia and how they can get excluded from research. It's hard enough to get people with aphasia into the research, right? There's work by Shiggins and her colleagues looking at how often people with aphasia are excluded. But you made a good point about ways that we can include people with more severe aphasia. Do you want to mention that? SELES GADSON: I think one of the things that we have at our fingertips, and we know just from our training, is to use different visual cues to support those individuals that might have more severe aphasia. One of the things that we highlighted in the 2020 paper looking at the psychometric properties of quality of these patient reported outcomes, was that there are certain assessments that are perfect for individuals with severe aphasia, assessments like the Assessment for Living with Aphasia (ALA), because it has the pictures available and it has simple language. Just recognizing that even by using some of these compensation tools, whether it's pictures or modifying the language, we can still get the individual's perspective of what they want in therapy just by using some of these modifications. EBE: This reminds me, I can put one more link and resource into the show notes, because the Center for Research Excellence in Aphasia offers this wonderful speaker series. And there was just an excellent recent session by Dr. Shiggins on including people with aphasia in research. So, I'll put that link in. I want everybody to listen to that presentation. And finally, as our closing question for today, Davetrina, if you had to pick only one thing we need to achieve urgently as a community of providers, of professionals, what would that one thing be? SELES GADSON: I think we have to start using patient-reported outcomes. I think that if you were doing a clinician-reported outcome to assess the impairment, paired with that has to be some level of patient-reported outcome that will give you insight into what the patient wants to do. It's no longer optional. I think that we have to make it a paired thing with our clinician-reported outcome, is getting the perspective of the patient. EBE: I so agree with you, thank you. Thank you for this wonderful interview today. I really, really appreciate it. SELES GADSON: Thank you. EBE: And I want to thank our listeners for listening today. For references and resources mentioned in today's show, please see our show notes. They're available on our website, www.aphasiaaccess.org. And there, you can also become a member of this organization. Browse our growing library of materials and find out about the Aphasia Access Academy. If you have an idea for a future podcast episode, email us at info@aphasiaaccess.org. For Aphasia Access Conversations, I'm Ellen Bernstein Ellis and thank you again for your ongoing support of aphasia access. References and Resources Brain Friends Podcast: https://www.aphasia.org/stories/brain-friends-a-podcast-for-people-with-aphasia/ https://www.facebook.com/groups/1563389920801117 https://open.spotify.com/show/5xgkrhUhEIzJgxpRXzNpBH   Centers for Disease Control and Prevention (CDC) HRQL website: https://www.cdc.gov/hrqol/concept.htm     National Aphasia Association  Black American Conversation group registration: The Black American Aphasia Conversation Group meets through Zoom every other Monday at 4:00pm EST (1:00pm PST) . If you are interested in joining this group, please complete the form https://docs.google.com/forms/d/e/1FAIpQLSfJN9VWjrujhebT8Z48bqDZePOHYotipFC34S8T0X8_o8rG-g/viewform Patient Reported Outcome Measurement System (PROMIS) https://www.promishealth.org/57461-2/   Cella, D., Hahn, E. A., Jensen, S. E., Butt, Z., Nowinski, C. J., Rothrock, N., & Lohr, K. N. (2015). Patient-reported outcomes in performance measurement. . Research Triangle Park (NC): RTI Press; 2015 Sep. Publication No.: RTI-BK-0014-1509ISBN-13: 978-1-934831-14-4  https://www.ncbi.nlm.nih.gov/books/NBK424378/   Gadson, D. S., Wallace, G., Young, H. N., Vail, C., & Finn, P. (2022). The relationship between health-related quality of life, perceived social support, and social network size in African Americans with aphasia: a cross-sectional study. Topics in Stroke Rehabilitation, 29(3), 230-239.   Gadson, D. S. (2020). Health-related quality of life, social support, and social networks in African-American stroke survivors with and without aphasia. Journal of Stroke and Cerebrovascular Diseases, 29(5), 104728.   Gadson, D. S. (2020). Health-related quality of life, social support, and social networks in African-American stroke survivors with and without aphasia. Journal of Stroke and Cerebrovascular Diseases, 29(5), 104728.   Gadson, D. S., Wesley, D. B., van der Stelt, C. M., Lacey, E., DeMarco, A. T., Snider, S. F., & Turkeltaub, P. E. (2022). Aphasia severity is modulated by race and lesion size in chronic survivors: A retrospective study. Journal of Communication Disorders, 100, 106270   Gray, J. D. (2022). Transcript: ASHA Voices: Confronting Health Care Disparities. Leader Live. https://leader.pubs.asha.org/do/10.1044/2021-0902-transcript-disparities-panel-2022   Law, B. M. (2021). SLP Pioneers Research on Aphasia Rehab for African Americans. Leader Live https://leader.pubs.asha.org/do/10.1044/leader.FTR4.26092021.58   Lubben, J., Gironda, M., & Lee, A. (2002). Refinements to the Lubben social network scale: The LSNS-R. The Behavioral Measurement Letter, 7(2), 2-11.   Shiggins, C., Ryan, B., O'Halloran, R., Power, E., Bernhardt, J., Lindley, R. I., ... & Rose, M. L. (2022). Towards the consistent inclusion of people with aphasia in stroke research irrespective of discipline. Archives of Physical Medicine and Rehabilitation, 103(11), 2256-2263.   Shiggins, C.  (2023) The road less travelled: Charting a path towards the consistent inclusion of people with aphasia in stroke research.  Aphasia CRE Seminar Series  #36 (Video) https://www.youtube.com/watch?v=sqVfn4XMHho

The Arctic Report Card is an annual report led by the National Oceanic and Atmospheric Administration(NOAA). The efforts of scientists and climate specialists to create this robust scientific report every year is impressive.  The amount of work contributed to this scientific document is extremely important in documenting climate change in the Arctic, which is warming at an alarming rate. Today's episode is a conversation with Rick Thoman, a climate specialist at IARC's Alaska Center for Climate Assessment and Policy (ACCAP).  Rick is a contributor and editor of the Arctic Report Card and was also awarded NOAA Distinguished Career Award for Professional Achievement in 2020. Rick was honored after a 30 plus year career with the National Weather Service for continued efforts to improve climate services in Alaska and for outstanding outreach efforts working with the Alaska Native community.The Report Card is intended for a wide audience, including scientists, teachers, students, decision-makers and the general public interested in the Arctic environment and science. It is encouraged that the Report Card to be utilized and studied, as the scientific community has created it to be an easily read report for the general population to better understand the complexities of the warming Arctic.Here are the links to the 2022 Arctic Report Card and NOAA website:https://arctic.noaa.gov/Report-Card/Report-Card-2022https://www.arctic.noaa.govYou can visit my website for links to other episodes and see aerial photography of South Central Alaska at:https://www.katiewritergallery.comThanks for tuning in to All Cooped Up Alaska!Katie WriterJournalist/Pilot/Photographerktphotowork@gmail.com

In today's episode Jeffrey dives into the absolute corruption of science and scientists when Monsanto first released Roundup for widespread use.  In the early studies submitted by Monsanto in 1985 the EPA clearly saw in an IARC report that rodents exposed to low doses of Roundup were developing some tumors and developing more tumors with higher doses.  The EPA and IARC wanted to label it as a possible carcinogen.  This was not the end for Monsanto; over the course of many decades Monsanto engaged in an entire marketing campaign to discredit these studies.  Included in their plan was: "Orchestrate Outcry"   Industry outreach to media.social media Third-party experts blog, op/ed, tweet, link, repost, retweet, etc. Use front groups Have grower associations write to regulators Opinion leader write letter to daily newspaper on day of IARC ruling Ghost write or inspire supporting research papers And so much more, including paying off scientists and EPA executives like Jess Rowland. The Institute for Responsible Technology is working to protect you & the World from GMOs (and while we're at it, Roundup®...)  To find out exactly how we do this and to subscribe to our newsletter visit https://www.responsibletechnology.org/ Join us at Protect Nature Now to Safeguarding Biological Evolution from GMOs 2.0. The place to get critical up to date information, watch our short film and most importantly, learn easy ways for you to take action against this existential threat. Visit: https://protectnaturenow.com/ Watch the film: Secret Ingredients Watch "Don't Let the Gene Out of the Bottle" Get the book: "Seeds of Deception" IG @irtnogmos Facebook @responsibletechnology YouTube @TheInstituteforResponsibleTechinology Twitter @TheInstituteforResponsibleTechnology  

Featuring articles on pemafibrate to reduce cardiovascular risk, on lifting universal masking in schools, defibrillation strategies for refractory ventricular fibrillation, bepirovirsen in chronic hepatitis B infection, and the IARC perspective on oral cancer prevention; a review article on climate change and vectorborne diseases; a case report of a woman with decreased vision and headache; and Perspective articles on privacy and security, on protecting care for all, and on transgender health and science denialism.

How did the meat industry, government, and cancer organizations respond to the confirmation that processed meat, like bacon, ham, hot dogs, and lunch meat, causes cancer?