Podcasts about jama internal medicine

Senkt vegane Ernährung den Testosteronspiegel – oder ist das nur ein Fitness-Mythos? In dieser Folge sprechen wir über Testosteron, Soja, Cholesterin, Muskelaufbau, Krafttraining, Energiedefizite, Blutwerte und den wachsenden Trend rund um TRT. Wissenschaftlich eingeordnet, praxisnah erklärt und mit Blick darauf, was für vegane Sportlerinnen und Sportler wirklich relevant ist. ------------------------------------------------------------------------ Dominiks Buch zur pflanzenbasierten Sporternährung im UTB-Verlag: https://www.utb.de/doi/book/10.36198/9783838560328 Dominiks Gesundheitscommunity: www.gsundes-hannover.de Dominiks Online-Knie-Kurs: https://gsundes-hannover.de/knieschmerzen/ Dominiks Online-Rücken-Kurs: https://copecart.com/products/34bd5abb/checkout Marcs veganes Online-Fitness-Coaching: https://vegainer-academy.com/ Marcs Online-Kurs: https://www.copecart.com/products/a50f88f2/checkout ------------------------------------------------------------------------ Dieser Podcast wird unterstützt von der Firma Watson Nutrition. Die Firma bietet als einzige umfassend laborgeprüfte Nahrungsergänzungsmittel für eine optimierte Nährstoffversorgung. Zum Angebot zählen Multi-Supplemente, Mono-Supplemente, Sportsupplemente wie Kreatin oder auch Proteinriegel, Shakes und essenzielle Aminosäuren Mit dem Code veganperformance erhältst du 5 % Rabatt auf deine Bestellung.  Zur Firmenwebseite: Watson Nutrition ------------------------------------------------------------------------ Quellen: Wissenschaftliche Studien, Reviews und Leitlinien Allen, N. E., Appleby, P. N., Davey, G. K., & Key, T. J. (2000). Hormones and diet: Low insulin-like growth factor-I but normal bioavailable androgens in vegan men. British Journal of Cancer, 83(1), 95–97. Baillargeon, J., Kuo, Y. F., Westra, J. R., Urban, R. J., & Goodwin, J. S. (2018). Testosterone prescribing in the United States, 2002–2016. JAMA, 320(2), 200–202. Bhasin, S., Storer, T. W., Berman, N., Callegari, C., Clevenger, B., Phillips, J., Bunnell, T. J., Tricker, R., Shirazi, A., & Casaburi, R. (1996). The effects of supraphysiologic doses of testosterone on muscle size and strength in normal men. The New England Journal of Medicine, 335(1), 1–7. Bhasin, S., Brito, J. P., Cunningham, G. R., Hayes, F. J., Hodis, H. N., Matsumoto, A. M., Snyder, P. J., Swerdloff, R. S., Wu, F. C., & Yialamas, M. A. (2018). Testosterone therapy in men with hypogonadism: An Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 103(5), 1715–1744. Christou, M. A., Christou, P. A., Markozannes, G., Tsatsoulis, A., Mastorakos, G., & Tigas, S. (2017). Effects of anabolic androgenic steroids on the reproductive system of athletes and recreational users: A systematic review and meta-analysis. Sports Medicine, 47(9), 1869–1883. Cinar, V., Polat, Y., Baltaci, A. K., & Mogulkoc, R. (2011). Effects of magnesium supplementation on testosterone levels of athletes and sedentary subjects at rest and after exhaustion. Biological Trace Element Research, 140(1), 18–23. Corona, G., Rastrelli, G., Monami, M., Saad, F., Luconi, M., Lucchese, M., Facchiano, E., Sforza, A., Forti, G., Mannucci, E., & Maggi, M. (2013). Body weight loss reverts obesity-associated hypogonadotropic hypogonadism: A systematic review and meta-analysis. European Journal of Endocrinology, 168(6), 829–843. Demay, M. B., Pittas, A. G., Bikle, D. D., Diab, D. L., Kiely, M. E., Lazaretti-Castro, M., Lips, P., Mitchell, D. M., Murad, M. H., Powers, S., Rao, S. D., Scragg, R., Tayek, J. A., Valent, A. M., Walsh, J. M. E., & McCartney, C. R. (2024). Vitamin D for the prevention of disease: An Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 109(8), 1907–1947. Dubin, J. M., Jesse, E., Fantus, R. J., Bennett, N. E., Brannigan, R. E., Thirumavalavan, N., & Halpern, J. A. (2022). Guideline-discordant care among direct-to-consumer testosterone therapy platforms. JAMA Internal Medicine, 182(12), 1321–1323. European Association of Urology. (2026). Male hypogonadism. In EAU guidelines on sexual and reproductive health. Guisado-Cuadrado, I., Recacha-Ponce, P., Peinado, A. B., & Romero-Parra, N. (2026). Biochemical responses to experimentally induced short-term low energy availability in athletes: A systematic review. Scandinavian Journal of Medicine & Science in Sports, 36(3), Article e70249. Key, T. J. A., Roe, L., Thorogood, M., Moore, J. W., Clark, G. M. G., & Wang, D. Y. (1990). Testosterone, sex hormone-binding globulin, calculated free testosterone, and oestradiol in male vegans and omnivores. British Journal of Nutrition, 64(1), 111–119. Leproult, R., & Van Cauter, E. (2011). Effect of 1 week of sleep restriction on testosterone levels in young healthy men. JAMA, 305(21), 2173–2174. Lincoff, A. M., Bhasin, S., Flevaris, P., Mitchell, L. M., Basaria, S., Boden, W. E., Cunningham, G. R., Granger, C. B., Khera, M., Thompson, I. M., Wang, Q., Wolski, K., Davey, D., Kalahasti, V., Khan, N., Miller, M. G., Snabes, M. C., Chan, A., Dubcenco, E., Li, X., et al. (2023). Cardiovascular safety of testosterone-replacement therapy. The New England Journal of Medicine, 389(2), 107–117. Messina, M. (2010). Soybean isoflavone exposure does not have feminizing effects on men: A critical examination of the clinical evidence. Fertility and Sterility, 93(7), 2095–2104. Morden, N. E., Woloshin, S., Brooks, C. G., & Schwartz, L. M. (2019). Trends in testosterone prescribing for age-related hypogonadism in men with and without heart disease. JAMA Internal Medicine, 179(3), 446–448. Morton, R. W., Sato, K., Gallaugher, M. P. B., Oikawa, S. Y., McNicholas, P. D., Fujita, S., & Phillips, S. M. (2018). Muscle androgen receptor content but not systemic hormones is associated with resistance training-induced skeletal muscle hypertrophy in healthy, young men. Frontiers in Physiology, 9, Article 1373. Mountjoy, M., Ackerman, K. E., Bailey, D. M., Burke, L. M., Constantini, N., Hackney, A. C., Heikura, I. A., Melin, A., Pensgaard, A. M., Stellingwerff, T., Sundgot-Borgen, J. K., Torstveit, M. K., Jacobsen, A. U., Verhagen, E., Budgett, R., Engebretsen, L., & Erdener, U. (2023). 2023 International Olympic Committee's consensus statement on Relative Energy Deficiency in Sport. British Journal of Sports Medicine, 57(17), 1073–1097. Mulhall, J. P., Trost, L. W., Brannigan, R. E., Kurtz, E. G., Redmon, J. B., Chiles, K. A., Lightner, D. J., Miner, M. M., Murad, M. H., Nelson, C. J., Platz, E. A., Ramanathan, L. V., & Lewis, R. W. (2018). Evaluation and management of testosterone deficiency: AUA guideline. The Journal of Urology, 200(2), 423–432. Prasad, A. S., Mantzoros, C. S., Beck, F. W. J., Hess, J. W., & Brewer, G. J. (1996). Zinc status and serum testosterone levels of healthy adults. Nutrition, 12(5), 344–348. Rao, P. K., Boulet, S. L., Mehta, A., Hotaling, J., Eisenberg, M. L., Honig, S. C., Warner, L., Kissin, D. M., Nangia, A. K., & Ross, L. S. (2017). Trends in testosterone replacement therapy use from 2003 to 2013 among reproductive-age men in the United States. The Journal of Urology, 197(4), 1121–1126. Reed, K. E., Camargo, J., Hamilton-Reeves, J., Kurzer, M., & Messina, M. (2021). Neither soy nor isoflavone intake affects male reproductive hormones: An expanded and updated meta-analysis of clinical studies. Reproductive Toxicology, 100, 60–67. Sagoe, D., Molde, H., Andreassen, C. S., Torsheim, T., & Pallesen, S. (2014). The global epidemiology of anabolic-androgenic steroid use: A meta-analysis and meta-regression analysis. Annals of Epidemiology, 24(5), 383–398. Travison, T. G., Araujo, A. B., O'Donnell, A. B., Kupelian, V., & McKinlay, J. B. (2007). A population-level decline in serum testosterone levels in American men. The Journal of Clinical Endocrinology & Metabolism, 92(1), 196–202. Travison, T. G., Vesper, H. W., Orwoll, E., Wu, F., Kaufman, J. M., Wang, Y., Lapauw, B., Fiers, T., Matsumoto, A. M., & Bhasin, S. (2017). Harmonized reference ranges for circulating testosterone levels in men of four cohort studies in the United States and Europe. The Journal of Clinical Endocrinology & Metabolism, 102(4), 1161–1173. Wankhede, S., Langade, D., Joshi, K., Sinha, S. R., & Bhattacharyya, S. (2015). Examining the effect of Withania somnifera supplementation on muscle strength and recovery: A randomized controlled trial. Journal of the International Society of Sports Nutrition, 12, Article 43. West, D. W. D., & Phillips, S. M. (2012). Associations of exercise-induced hormone profiles and gains in strength and hypertrophy in a large cohort after weight training. European Journal of Applied Physiology, 112(7), 2693–2702. Whittaker, J., & Wu, K. (2021). Low-fat diets and testosterone in men: Systematic review and meta-analysis of intervention studies. The Journal of Steroid Biochemistry and Molecular Biology, 210, Article 105878. Positionspapiere, Behörden und Informationsquellen Deutsche Gesellschaft für Ernährung. (2024). DGE veröffentlicht neues Positionspapier zu veganer Ernährung. Deutsche Gesellschaft für Ernährung. National Institutes of Health, Office of Dietary Supplements. (n.d.). Vitamin B12: Fact sheet for health professionals. Abgerufen am 21. Mai 2026. National Institutes of Health, Office of Dietary Supplements. (n.d.). Vitamin D: Fact sheet for health professionals. Abgerufen am 21. Mai 2026. U.S. Food and Drug Administration. (2025, 28. Februar). FDA issues class-wide labeling changes for testosterone products. U.S. Food and Drug Administration. World Anti-Doping Agency. (2026). The 2026 prohibited list. World Anti-Doping Agency. ‘They've invented a spurious pseudo-disease': Why are so many men being told they have low testosterone? (2026, 10. Mai). The Guardian.  

Hosted by Michael Tetreault | Editor-in-Chief, Concierge Medicine Today Episode Overview In one of the most comprehensive episodes in DocPreneur Leadership Podcast history, host Michael Tetreault takes an honest, evidence-based, and encouraging look at the cash-pay and subscription-based primary care landscape — who it serves, how it works, where it's heading, and what every physician and advanced practice clinician needs to understand before making a career-defining decision. This episode doesn't take sides. It takes a clear-eyed look at the full picture — including the parts that don't always make it into the conference keynote. What's Covered in This Episode The Foundation Not all subscription-based primary care models are the same. Two models operating in this space share surface-level similarities but are structurally distinct businesses with different economic logic, different patient populations, and different long-term trajectories. Understanding which one you're considering — and why — changes everything about how you plan. A Lesson From Healthcare History Before committing to any practice model, it helps to understand what happened to the movements that came before it. This episode traces three instructive parallels: the micropractice and ideal medical practice movement of the early 2000s; the decades-long fight for healthcare price transparency and what happened when physicians finally got it; and the rise and reality check of retail health — what scaled, what didn't, and why. The common thread in every model that has achieved durable scale in American healthcare is the same: structural fit with the economic environment, not ideological purity. Two Pathways, One Brand Name The episode walks through both economic models in the cash-pay primary care space — the purist, cash-only, no-insurance model and the employer-integrated model — explaining how each works, who each serves, and what the financial picture actually looks like for physicians considering either path. The revenue math is done out loud. The sustainability data from peer-reviewed research is cited. The patient demographic fit for each model is examined honestly and specifically. Who Each Model Serves — and Where Other Models Fit Better A detailed breakdown of the patient populations each model genuinely serves well — and an honest, evidence-based look at the patient populations where other models may be a better structural fit. Including Medicare-eligible patients, patients with complex chronic disease, lower-income households, and employees of small and mid-sized businesses. The Overlooked Opportunity — NPs, PAs, and Advanced Practice Clinicians One of the most significant and underexplored opportunities in subscription-based healthcare delivery today is the direct-care model as a pathway for nurse practitioners, physician assistants, and other advanced practice clinicians. The evidence on NP and PA-led primary care outcomes is strong and peer-reviewed. The physician shortage projections make the need urgent. And the organizational infrastructure for advanced practice clinician-led direct-care practices is largely unbuilt — which means the opportunity belongs to whoever moves first. The Organizational Landscape An honest look at what the multiplicity of organizations, coalitions, and alliances in the cash-pay primary care space tells us — and what research on professional association dynamics says about the long-term implications of organizational fragmentation for legislative effectiveness and individual practice planning. One Brand, Two Directions Drawing on four documented historical parallels from the history of American medicine — the AMA and managed care, osteopathic medicine's identity divide, family medicine's emergence as a separate specialty, and the micropractice movement — the episode makes the case that two communities with genuinely different economic interests and regulatory priorities currently sharing a brand name may, consistent with historical precedent, find their own distinct professional homes over time. This is presented as pattern recognition grounded in verified historical evidence — and as practical planning context for physicians building practices today. The Tax and Structuring Update A clear, practical summary of the 2025 "One Big Beautiful Bill" Act changes — effective January 2026 — and what they mean for HSA eligibility of cash-pay membership fees. What qualifies, what doesn't, and why legal counsel is essential before making any representations to patients about tax-advantaged payment options. Eight Questions Before You Commit A practical pre-decision checklist — eight specific questions every physician or advanced practice clinician should be able to answer clearly before committing to any cash-pay practice pathway. Key Takeaways Cash-pay primary care and concierge medicine are not the same model, do not serve the same patient populations, and should not be evaluated as interchangeable alternatives. The purist cash-pay model has grown from approximately 100 practices in 2009 to over 2,100 by 2023 — real and meaningful growth. The financial sustainability data, however, reflects consistent challenges that peer-reviewed research has documented specifically in lower-income markets and solo practice settings. The employer-integrated pathway has stronger structural sustainability — multiple revenue streams, embedded benefit relationships, and documented employer cost reductions of 12 to 20 percent over three to five years. A December 2025 Johns Hopkins study found concierge and cash-pay primary care practices combined grew 83.1 percent between 2018 and 2023. The employer-integrated model is the primary driver of that growth trajectory. Concierge medicine — particularly the PCM model — is not retreating. The global concierge medicine market is projected to surpass $34 billion by 2032 and is growing at a compound annual rate that outpaces most healthcare market segments. The National Academy of Medicine's 2021 Future of Nursing report, AAMC physician shortage projections, and peer-reviewed NP/PA outcomes research collectively point to advanced practice clinician-led direct-care models as one of the most significant underexplored opportunities in subscription-based healthcare delivery. Pattern recognition from healthcare history — price transparency, retail health, the micropractice movement — consistently shows that the distance between a compelling healthcare idea and durable scaled impact is longer and more complicated than early advocacy suggests. Models that have achieved durable scale in American primary care share one characteristic: structural fit with the economic environment, not independence from it. Sources and Citations All claims in this episode are supported by published, verifiable sources. Full citations below. Micropractice and Practice Model History Moore, G. (2002). "Accountability and Improvement in Physician Practice." Family Medicine. Moore, G. & Showstack, J. (2003). "Primary Care Medicine in Crisis." Health Affairs. healthaffairs.org AAFP TransforMED Initiative. (2006). aafp.org Nutting, P.A. et al. (2010). "Initial Lessons From the First National Demonstration Project on Practice Transformation to a Patient-Centered Medical Home." Annals of Family Medicine. Rittenhouse, D.R. et al. (2009). "Primary Care and Accountable Care." New England Journal of Medicine. Rittenhouse, D.R. & Shortell, S.M. (2009). "The Patient-Centered Medical Home." JAMA. Price Transparency Research Pathak, Y. & Muhlestein, D. (2024). "Public Awareness and Use of Price Transparency: Report From a National Survey." West Health Institute / Gallup. pmc.ncbi.nlm.nih.gov Parente, S.T. (2023). "Estimating the Impact of New Health Price Transparency Policies." Inquiry.pmc.ncbi.nlm.nih.gov ScienceDirect. (2025). "Outcomes of Price Transparency Policies for Healthcare Services in the United States: A Systematic Review." sciencedirect.com Retail Health Fein, A.J. (2017). "Retail Clinic Check Up: CVS Retrenches, Walgreens Outsources, Kroger Expands." Drug Channels. drugchannels.net CNBC. (2024). "Why Walmart, Walgreens, CVS Retail Health Clinic Experiment Is Struggling." cnbc.com Healthcare Finance News. (2023). "Retail Clinics Seeing Utilization Soar, Popularity Grow." healthcarefinancenews.com MedCity News. (2023). "Retail Clinics Are Gaining Momentum." medcitynews.com Cash-Pay and Subscription Primary Care Market Data MedCity News. (March 2026). "DPC Is Scaling — The Financing Architecture Isn't Ready." medcitynews.com Johns Hopkins. (December 2025). Study on concierge and cash-pay practice growth 2018–2023. As cited in MedCity News, March 2026. Liaw, W. et al. (2024). "Direct Primary Care: Financial Analysis and Potential to Reshape the U.S. Healthcare Landscape." Journal of General Internal Medicine. springer.com Lujan, D.Y. (2025). "Why Direct Primary Care Models Fail." KevinMD. kevinmd.com Doan, L. et al. (2019). "Physician Perspectives on Direct Primary Care." Family Medicine. Eskew, P.M. & Klink, K. (2015). "Direct Primary Care: Practice Distribution and Cost Across the Nation." Health Affairs. healthaffairs.org Tseng, P. et al. (2018). "Administrative Costs Associated With Physician Billing and Insurance-Related Activities." JAMA Internal Medicine. Medscape Physician Compensation Report. (2023). medscape.com Employer-Integrated Model Spann, S.J. et al. (2020). "Employer-Sponsored Direct Primary Care." Journal of Occupational and Environmental Medicine. National Alliance of Healthcare Purchaser Coalitions. (2021). purchaseralliance.org Kaiser Family Foundation. (2023). Employer Health Benefits Annual Survey. kff.org National Business Group on Health. (2022). businessgrouphealth.org Employers Health Coalition. (2022). employershealthcoalition.org Patient Demographics and Population Health Anderson, G.F. (2010). "Chronic Conditions: Making the Case for Ongoing Care." Johns Hopkins Bloomberg School of Public Health. Tikkanen, R. & Abrams, M.K. (2020). "U.S. Health Care from a Global Perspective." Commonwealth Fund.commonwealthfund.org Collins, S.R. et al. (2022). "Paying for It: How Health Insurance and Healthcare Costs Are Shaping the Lives of American Adults." Commonwealth Fund. commonwealthfund.org Bureau of Labor Statistics. (2023). "Contingent and Alternative Employment Arrangements." bls.gov Petterson, S. et al. (2012). "Unequal Distribution of the U.S. Primary Care Workforce." Annals of Family Medicine. Advanced Practice Clinicians and Nursing Laurant, M. et al. (2019). "Revision of Professional Roles and Quality Improvement in Primary Care." New England Journal of Medicine. Naylor, M.D. & Kurtzman, E.T. (2010). "The Role of Nurse Practitioners in Reinventing Primary Care." Health Affairs. healthaffairs.org National Academy of Medicine. (2021). "The Future of Nursing 2020–2030." nationalacademies.org AAMC. (2021). "The Complexities of Physician Supply and Demand: Projections from 2019–2034." aamc.org Legal, Tax, and Compliance Eischen, J. (2025). Legal Commentary on Cash Practice Structuring. eischenlawoffice.com DLA Piper. (2025). "Paying for Direct Primary Care Arrangements With HSAs." dlapiper.com IRS Notice 26-05. irs.gov CMS. "Opt-Out Affidavits and Private Contracts." cms.gov Organizational and Professional Identity Research Hoff, T.J. (2010). Practice Under Pressure: Primary Care Physicians and Their Medicine in the Twenty-First Century. Rutgers University Press. Scott, W.R. (2008). Institutions and Organizations: Ideas and Interests. SAGE Publications. Freidson, E. (2001). Professionalism: The Third Logic. University of Chicago Press. Wolinsky, H. & Brune, T. (1994). The Serpent on the Staff: The Unhealthy Politics of the American Medical Association. Putnam. Gevitz, N. (2004). The DOs: Osteopathic Medicine in America. Johns Hopkins University Press. Stephens, G.G. (1989). "Family Medicine as Counterculture." Journal of Family Practice. Colwill, J.M. (1992). "Where Have All the Primary Care Applicants Gone?" New England Journal of Medicine. Meltzer, D.O. & Chung, J.W. (2014). "The Population-Based Physician Workforce." Health Affairs.healthaffairs.org Bodenheimer, T. & Pham, H.H. (2010). "Primary Care: Current Problems and Proposed Solutions." Health Affairs. healthaffairs.org Grumbach, K. & Grundy, P. (2010). "Outcomes of Implementing Patient Centered Medical Home Interventions." JAMA. Concierge Medicine Market Data Grand View Research. (2022). Concierge Medicine Market Size & Growth Report. grandviewresearch.com Precedence Research. (2023). U.S. Concierge Medicine Market Size and Forecast. globenewswire.com MDVIP. (2020). Personalized Primary Care Reduces ER Visits, Hospitalizations, and Outpatient Expenditures.mdvip.com AAPP / Software Advice. (2023). "Concierge Medicine Salary and Definition." softwareadvice.com Disclaimer The DocPreneur Leadership Podcast is produced by Concierge Medicine Today, LLC, an independent healthcare leadership publication. This episode and its accompanying summary are intended for educational and informational purposes only. Nothing in this episode or summary constitutes medical, legal, financial, or accounting advice. The information presented reflects publicly available research, published data, and editorial observation, and is not intended to replace the guidance of qualified medical, legal, financial, or business professionals. All factual claims are supported by named, verifiable third-party sources, which are cited in full above. Concierge Medicine Today makes no guarantee regarding the completeness or currency of external sources cited and encourages listeners to verify information independently. References to specific organizations, publications, legal decisions, or market data are provided for educational context only. Mention of any organization, publication, or individual does not constitute endorsement, and no commercial relationship exists between Concierge Medicine Today and any source cited in this episode unless otherwise disclosed. Physicians, nurse practitioners, physician assistants, and other clinicians considering any practice model change are strongly encouraged to seek qualified legal counsel with specific experience in healthcare compliance, tax structuring, and the applicable regulatory environment in their state before making any practice or business decisions. © 2007–2026 Concierge Medicine Today, LLC. All rights reserved. Reproduction or distribution of this content without written permission is prohibited.

Interview with Shalender Bhasin, MBBS, author of Testosterone Treatment in Prostate Cancer Survivors With Hypogonadism: A Randomized Clinical Trial, and Peter C. Albertsen, MD, author of Collaborating to Improve Quality of Life Among Prostate Cancer Survivors. Hosted by Eve Rittenberg, MD. Related Content: Testosterone Treatment in Prostate Cancer Survivors With Hypogonadism Collaborating to Improve Quality of Life Among Prostate Cancer Survivors

Interview with Vineet Ahuja, DM, author of Fecal Microbiota Transplant and Multidrug-Resistant Organism Decolonization in Gastrointestinal Disease: A Randomized Trial and Michael H. Woodworth, MD, MSc, author of Fecal Microbiota Transplant for Multidrug Resistance—No Benefit Without Disruption? Hosted by Ilana Richman, MD, MHS. Related Content: Fecal Microbiota Transplant and Multidrug-Resistant Organism Decolonization in Gastrointestinal Disease Fecal Microbiota Transplant for Multidrug Resistance—No Benefit Without Disruption?

Send us Fan MailDescription: An immersive reading of Sommelier by by Suraj Bala with reflection on reflection, death, resurrection, candles and em dashes. Work:Poem: https://jamanetwork.com/journals/jamaoncology/article-abstract/2839156Bala S. Sommelier. JAMA Oncol. 2025;11(11):1399. doi:10.1001/jamaoncol.2025.2896References: Meditation for the Primary and Secondary Prevention of Cardiovascular Disease. Rees K, Takeda A, Court R, et al. The Cochrane Database of Systematic Reviews. 2024;2:CD013358. doi:10.1002/14651858.CD013358.pub2.Meditation Programs for Psychological Stress and Well-Being: A Systematic Review and Meta-Analysis. Goyal M, Singh S, Sibinga EM, et al. JAMA Internal Medicine. 2014;174(3):357-68. doi:10.1001/jamainternmed.2013.13018.Inner Engineering Practices and Advanced 4-Day Isha Yoga Retreat Are Associated With Cannabimimetic Effects With Increased Endocannabinoids and Short-Term and Sustained Improvement in Mental Health: A Prospective Observational Study of Meditators. Sadhasivam S, Alankar S, Maturi R, et al. Evidence-Based Complementary and Alternative Medicine : eCAM. 2020;2020:8438272. doi:10.1155/2020/8438272.Systematic Review for the Medical Applications of Meditation in Randomized Controlled Trials. Kim DY, Hong SH, Jang SH, et al. International Journal of Environmental Research and Public Health. 2022;19(3):1244. doi:10.3390/ijerph19031244.

In this episode, Vanessa breaks down the fasting mimicking diet (FMD) — including the exact calories, macros, and protein intake used in the research — and compares it to higher-protein fat loss approaches like protein-sparing modified fasting (PSMF) days.

New research was published in JAMA Internal Medicine revealing how physical therapy costs vary substantially based on state/location in the U.S. and insurance status. So, how does Connecticut fare? We asked Dr. Josh Skydel, co-author of this study and part of the Yale School of Medicine, for more.For more on the study: https://news.yale.edu/2026/03/05/cost-physical-therapy-varies-widely-state-state

Interview with Rohan Khazanchi, MD, MPH, author of Wait Time Modifications for Black Transplant Candidates Affected by Race-Based Kidney Function Estimation and L. Ebony Boulware, MD, MPH, author of Important Lessons Learned From Eliminating Race-Based Medicine in Kidney Care—Praxis and Policy Matter. Hosted by Eve Rittenberg, MD. Related Content: Wait Time Modifications for Black Transplant Candidates Affected by Race-Based Kidney Function Estimation Important Lessons Learned From Eliminating Race-Based Medicine in Kidney Care—Praxis and Policy Matter

Send a textWellness is a word we hear all the time—but what does it actually mean when life is complicated, busy, and sometimes overwhelming? In this milestone 200th episode, I explore the idea that living well isn't about perfection or rigid routines, but about the small choices we make every day that quietly shape our health, our relationships, and the direction of our lives. I invite you to reflect on the emotions you're choosing from, the responsibilities you're carrying, and the possibility that wellness might be closer than you think. If you've ever wondered how to care for yourself while managing a full and demanding life, this conversation might open a new perspective on what it truly means to live well.Quotes of the Week“Well-being is realized by small steps, but is truly no small thing.” — Zeno “The part can never be well unless the whole is well.” — Plato CitationsCohen, S., Janicki-Deverts, D., & Miller, G. E. (2012). Psychological stress and disease. JAMA.Lee, I. M., et al. (2019). Association of Step Volume and Intensity With All-Cause Mortality in Older Women. JAMA Internal Medicine.Waldinger, R., & Schulz, M. Harvard Study of Adult Development. Harvard Medical School.National Institutes of Health – Your Healthiest Self: Wellness Toolkits. Let's go, let's get it done. Get more information at: http://projectweightloss.org

Welcome to Ozempic Weightloss Unlocked, where we dive into the latest news on Ozempic, from medical breakthroughs to lifestyle impacts.Johns Hopkins Bloomberg School of Public Health researchers analyzed 64 clinical trials with tens of thousands of patients on GLP-1 drugs like semaglutide, the key ingredient in Ozempic. They found these drugs work similarly across ages, races, ethnicities, starting weights, and blood sugar levels. Women saw about 11 percent average weight loss from their starting weight, while men averaged 7 percent, a meaningful difference possibly linked to estrogen interactions. Senior author Hemal Mehta says this builds confidence for doctors and patients in diverse groups. The study appeared in JAMA Internal Medicine on March 2.In exciting pill news, ScienceAlert reports a phase 3 trial where Eli Lillys orforglipron outperformed oral semaglutide. Among 1,698 people with type 2 diabetes, orforglipron delivered 6 to 8 percent weight loss and better blood sugar control versus 4 to 5 percent on semaglutide tablets. It does not need an empty stomach, boosting convenience, though more dropped out due to stomach issues. Published in The Lancet, this positions orforglipron as a strong oral contender, with heart health trials underway.J.P. Morgan Global Research forecasts the GLP-1 market hitting 200 billion dollars by 2030, with 25 million Americans on these treatments, up from 10 million in 2025. Oral versions approved late 2025 are driving growth by skipping injections. Medicare and Medicaid expansions, like the BALANCE program capping out-of-pocket at 50 dollars monthly, plus falling prices and generics abroad, mean broader access. This could reshape food spending, cutting grocery bills as calorie intake drops.Patient satisfaction with semaglutide remains high, Rheumatology Advisor notes, fueled by strong weight loss outweighing gut side effects.These updates show Ozempic and kin transforming health, but talk to your doctor for personal fit.Thanks for tuning in, listeners. Subscribe for more insights. This has been a quiet please production, for more check out quiet please dot ai. Some great Deals https://amzn.to/49SJ3QsFor more check out http://www.quietplease.aiThis content was created in partnership and with the help of Artificial Intelligence AI

What does it mean if you have a rotator cuff tear on your MRI? Listen to our latest podcast as we break down the latest JAMA Internal Medicine article, "Incidental Rotator Cuff Abnormalities on Magnetic Resonance Imaging."

Is fasting really the best way to lose fat — or is there a smarter, more strategic approach? In this masterclass episode, Vanessa introduces a powerful new concept: Protein Fasting — a structured approach using PSMF (Protein-Sparing Modified Fast) days to optimize fat loss, suppress appetite naturally, protect muscle, and potentially tap into fasting-like cellular signaling.

In this episode, Annika Theodoulou speaks to Professor Jonathan Bricker, a Professor of Public Health at the Fred Hutchinson Cancer Research Center and Affiliate Professor of Psychiatry at the University of Washington in Seattle, Washington, US. The interview covers Jonathan's research article covering intersectionality in cigarette smoking cessation using a latent class analysis to predict 12-month cessation in a randomized controlled trial.Intersectionality and why it is important to explore in smoking cessation [01:19]Six factors that are well-known predictors of smoking [03:20]The aim of a latent class analysis [04:55]The key findings of the study [07:09]The differences found between smartphone apps used in the trial [11:02]The implications of the findings for policy and practice [14:49]About Annika Theodoulou: Annika is a researcher at the Nuffield Department of Primary Care Health Sciences at the University of Oxford. Her work focuses on health behaviours, including smoking cessation and weight management, with an emphasis on evidence synthesis. Annika's doctoral research, funded by the Society for the Study of Addiction (SSA) and The Rotary Foundation, examined socioeconomic inequalities in smoking cessation behaviours and outcomes using quantitative and qualitative methods. She is an Associate Editor of Nicotine & Tobacco Research. Annika holds a Bachelor of Health Sciences and a Master of Clinical Science from the University of Adelaide.About Jonathan Bricker: Jonathan is an expert in the field of health behavior change interventions. He is a Full Professor of Public Health at the Fred Hutchinson Cancer Research Center and Affiliate Professor of Psychiatry at the University of Washington in Seattle, Washington. Dr. Bricker is founder and leader of the Health and Behavioral Innovations in Technology (“HABIT”) Research Group. The HABIT research group focuses on developing and testing innovative theory-based behavioral interventions for tobacco cessation and weight loss, especially those delivered in widely disseminable technology platforms. He and his team have developed a novel health behavior change intervention model based on the principles of Acceptance and Commitment Therapy (“ACT”). The principal investigator of over $35 million US dollars in research grants, he has been leading ten NIH R01 randomized trial grants, as well as led or collaborated on multiple other Federal and private research grants. His current grants focus on testing a machine learning natural language processing chatbot for quitting smoking, several smartphone applications for tobacco cessation in the general population, among cancer patients, American Indians & Alaska Natives, Hispanics, and adolescents, and a weight loss telephone coaching program based on ACT. His “iCanQuit” smartphone app based on ACT was proven more effective than a leading National Cancer Institute smartphone app based on the US Clinical Practice Guidelines in a large, randomized trial published in JAMA Internal Medicine. iCanQuit is now publicly available. He has published over 150 peer-reviewed research articles on addictions, behavioral interventions, and technologies. Currently, he serves as a Senior Editor of the journal Addiction. Original article: Intersectionality in cigarette smoking cessation: A latent class analysis to predict 12-month cessation in a randomized controlled trial https://doi.org/10.1111/add.70185Digital Object Identifier (DOI)The opinions expressed in this podcast reflect the views of the host and interviewees and do not necessarily represent the opinions or official positions of the SSA or Addiction journal.The SSA does not endorse or guarantee the accuracy of the information in external sources or links and accepts no responsibility or liability for any consequences arising from the use of such information. Hosted on Acast. See acast.com/privacy for more information.

Interview with Thomas Ibounig, MD, author of Incidental Rotator Cuff Abnormalities on Magnetic Resonance Imaging and Brian T. Feeley, MD, author of Magnetic Resonance Imaging Abnormalities and Incidental Age-Related Changes. Hosted by Eve Rittenberg, MD. Related Content: Incidental Rotator Cuff Abnormalities on Magnetic Resonance Imaging Magnetic Resonance Imaging Abnormalities and Incidental Age-Related Changes

A nurse in Pennsylvania had been on her feet for twelve hours. She was supposed to go home, but the unit was short-staffed, so she stayed. During that overtime, a patient was diagnosed with cancer and needed two chemotherapy doses. She administered the first, placed the second in a drawer, and headed home. She forgot about the second dose. It wasn't discovered until the next day. The patient was fine; they got the treatment in time. But think about what happened. This wasn't a careless nurse. This was a dedicated professional who stayed late to help her team. Her skills didn't fail. Her knowledge didn't fail. Her energy failed, and her judgment went with it. That's the trap. We assume our thinking stays constant, that the brain in hour fourteen is the same brain that showed up in hour one. It's not. Last episode, we tackled deciding under uncertainty. But fatigue does something different. Uncertainty makes you hesitate. Fatigue makes you stop caring. Why Your Brain Makes Worse Decisions by Evening You've probably heard the popular saying: "Making too many decisions wears you out, so by evening your judgment is shot." That idea dominated psychology for twenty years. Researchers believed decision-making drained from a limited mental reserve, like a battery running down. Then, independent labs tried to reproduce those results at scale, and the effect vanished. One study, 23 labs, over 2,000 people, found nothing. A second, 36 labs, 3,500 people, same result. The experience is real, though. People do make worse decisions after a long day of mental effort. What was wrong was the explanation. Your brain doesn't drain like a battery. After sustained effort, it shifts priorities. It starts favoring speed and ease over accuracy. Not because it can't think carefully, but because it decides careful thinking isn't worth the effort. Decision fatigue isn't your brain shutting down. It's your brain quietly lowering its standards without telling you. Decision Fatigue in the Real World That science isn't abstract. It plays out every day. Researchers at Brigham and Women's Hospital tracked over 21,000 patient visits. Doctors prescribed unnecessary antibiotics more frequently as the day went on. Not because afternoon patients were sicker. Because saying "here's a prescription" is easier than explaining why you don't need one. Five percent more patients received antibiotics they didn't need, purely because of timing. The same pattern shows up everywhere. Surgeons make more conservative calls later in the day. Hand hygiene compliance drops across a twelve-hour shift. Financial analysts grow less accurate with each additional stock prediction they make in a single day. The drift always goes in the same direction: toward whatever requires the least effort. That drift explains something we've been exploring across this series. When you're exhausted, someone else's conclusion isn't just tempting, it's a relief. The algorithm's recommendation saves you from having to evaluate. The expert's opinion saves you from forming your own. That's mindjacking, finding the open door. Fatigue doesn't just degrade your thinking. It makes you grateful to hand it over. Your Four Warning Signals Knowing the science is useful. But what matters more is catching fatigue in yourself before it costs you. Here are four signals that your judgment is compromised. Signal 1: The Default Drift. Someone proposes a plan that sounds... fine. Not great, not terrible. Two hours ago, you'd have pushed back, asked harder questions. Now you just nod. You're not agreeing because you're convinced. You're agreeing because disagreeing takes energy you no longer have. Signal 2: The Irritability Spike. A colleague asks a reasonable question, and it feels like an interruption. When your emotional response is out of proportion to the situation, it's not the situation. Your reserves are low. Signal 3: The Shortcut Reflex. A decision that should take twenty minutes takes thirty seconds. You skip the analysis, go with your gut. There's a version of this that sounds like confidence. "I trust my instincts." But late in the day, that phrase is often code for "I'm too tired to think this through." Signal 4: The Surrender. You stop forming conclusions and start borrowing them. Someone says, "I think we should go with Option B" and you feel a wave of relief. Not because Option B is right, but because you no longer have to figure it out. That relief is the signal. When outsourcing, your judgment feels like a gift instead of a loss, you're running on empty. If two or more of these show up at the same time, stop. Your judgment isn't reliable right now. Don't trust it with anything that matters. Four Moves to Protect Your Judgment Those signals tell you something's wrong. Here's what to do about it. Move 1: Postpone it. Move the decision to a high-energy window. For most people, that's morning. Think of those hours like premium real estate. Stop filling them with trivial meetings. Move 2: Shrink it. Instead of "Should we pursue this entire strategy?" ask "What's the one thing I need to decide tonight?" Tired minds handle focused questions better than open-ended ones. Move 3: Add a checkpoint. Make the call, but build in a mandatory review: "Here's my decision. We revisit on Thursday morning." Not indecisiveness. A safety net. Move 4: Pre-commit. Before you're ever exhausted, set rules for your future tired self. "I don't approve expenditures over $10,000 after 6 PM." "I don't respond to emotionally charged emails the same day." "I don't make personnel decisions on Fridays." This is the most powerful move because you're making the decision when you're strong so you don't have to make it when you're weak. Pre-commitment also means structuring the order of your decisions. Researchers studying car buyers found that customers who faced the most complex choices first were significantly more likely to accept defaults on everything that followed. The decisions wore them down. The fix was simple: put simple choices first. Front-load your high-stakes choices the same way. Design your day so that by the time your energy fades, the remaining decisions matter least. Recovery as a Decision-Making Strategy Everything I've just described helps you manage fatigue in the moment. But there's a deeper question: what are you doing to actually replenish? We treat fatigue like it's inevitable. It's not. It's a sign you're spending more than you're recovering. The fix isn't another productivity hack. It's genuine rest. Real time away. Disconnected. Off. I learned this the hard way. Early in my career, I was a workaholic, just like my father. It took years to see the connection between rest and judgment. When I became a CEO, I made recovery a priority. We offer unlimited PTO, but offering it isn't enough. I take it visibly, because if the person at the top doesn't step away, nobody believes they're allowed to. A team that never replenishes is permanently operating in a degraded state. That's slow-motion failure. The triage framework buys you time. Recovery is what actually refills the tank. Your Pre-Commitment Challenge Every framework in this series assumes you'll use it when it counts. But mental fatigue is the silent killer of good frameworks. You can know everything about logical reasoning and second-order effects, and still make a terrible call at 10 PM because your mind decided careful thinking wasn't worth the effort. That's why this isn't just another episode. This is the one that determines whether everything else actually works in your real life. So, before this episode ends, pick one pre-commitment. One rule your strong self creates for your tired self. "I don't approve budgets after 7 PM." "I don't reply to conflict emails the same day." Whatever yours is, write it where you'll see it when you're exhausted. Then tell one person. Not for accountability theater. Because saying it out loud makes it real in a way that thinking it never does. Remember that nurse? She had the knowledge, skills, and dedication to stay late for her team. What she lacked was a system to protect her judgment when her energy failed. Your worst decisions don't happen because you're not smart enough. They happen because you're too tired to use the intelligence you already have. That nurse had all night to realize what she'd missed. But what if she hadn't? What if someone had needed that decision in the next five minutes? That's a different kind of danger. Not fatigue alone, but fatigue with a ticking clock. "We need an answer by the end of the day." "This offer expires at midnight." "The board meets tomorrow." Sometimes those deadlines are real. Sometimes they're manufactured to make you decide before you can think. How do you tell the difference? That's next time. Subscribe so you don't miss it. Before You Go If you haven't written down your pre-commitment yet, do it now. Sticky note, phone, back of your hand — I don't care where. Then tell someone. If mindjacking is a new concept for you, I've got a full episode that breaks down how to spot when your thinking has been hijacked, whether by outside forces or by yourself. Link's below. For those who want to support the work and the team behind these episodes, you can become a paid subscriber on Substack.  One question for the comments: What's your pre-commitment? Drop it below. Make it public. Make it real. The best decision you make today might be the one you don't let your exhausted self make tonight. Sources: Berxi/NCSBN case studies: Pennsylvania nurse fatigue incident (chemotherapy administration error) https://www.berxi.com/resources/articles/medication-errors-in-nursing/ Linder, J.A., et al. (2014). Time of Day and the Decision to Prescribe Antibiotics. JAMA Internal Medicine, 174(12), 2029-2031. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1910546 Hagger, M.S., et al. (2016). A Multilab Preregistered Replication of the Ego-Depletion Effect. Perspectives on Psychological Science, 11(4), 546-573. https://journals.sagepub.com/doi/10.1177/1745691616652873 Vohs, K.D., et al. (2021). A Multisite Preregistered Paradigmatic Test of the Ego-Depletion Effect. Psychological Science, 32(10), 1566-1581. https://journals.sagepub.com/doi/10.1177/0956797621989733 Levav, J., et al. (2010). Order in Product Customization Decisions: Evidence from Field Experiments. Journal of Political Economy, 118(2), 274-299. https://www.journals.uchicago.edu/doi/10.1086/652463 Dai, H., et al. (2015). The Impact of Time at Work and Time Off From Work on Rule Compliance: The Case of Hand Hygiene in Health Care. Journal of Applied Psychology, 100(3), 846-862. https://pubmed.ncbi.nlm.nih.gov/25365728/

A JAMA Network Open consensus guide standardizes adult UTI triage for telehealth and in-person care. Nonpregnant women with classic cystitis symptoms and no resistance risks may receive empiric antibiotics without testing; men and higher-risk women require urinalysis with culture before treatment. Urine color or odor alone does not justify testing, and urgent evaluation is advised for suspected complicated infection or sepsis. A Danish registry study in JAMA Internal Medicine found SGLT2 inhibitors offer greater kidney protection than GLP-1 receptor agonists in type 2 diabetes. Long-term ASPREE follow-up in JAMA Oncology showed low-dose aspirin did not lower cancer incidence and increased cancer-related mortality in older adults.

Interview with Katherine Majzoub Morgan, MD, MPP, author of Primary Care Clinicians Available for New Patient Visits, and Ishani Ganguli, MD, MPH, author of A Different Lens on the Primary Care Workforce Shortage—Who Is Accepting New Patients? Hosted by Eve Rittenberg, MD. Related Content: Primary Care Clinicians Available for New Patient Visits A Different Lens on the Primary Care Workforce Shortage—Who Is Accepting New Patients? Changes in Physician Work Hours and Implications for Workforce Capacity and Work-Life Balance, 2001-2021

Warum ist es so wichtig, Esoterik und Spiritualität zu unterscheiden? In dieser Folge erklärt Anna Schaub, warum viele auf dem geheimen Weg der Esoterik steckenbleiben und wie du stattdessen den bewussten, klaren Weg der Spiritualität gehst. Mit konkreten Beispielen erfährst du, wie du mystische Denkfallen erkennst, deine Glaubenssätze überprüfst und innere Klarheit findest. Für echte Selbsterkenntnis statt Selbsttäuschung.Impulse für dichWarum es wichtig ist Esoterik und Spiritualität zu unterscheiden.Wie du erkennst, ob dein Glaube dich weiterbringt oder dich blockiert.Warum Achtsamkeit bedeutet nicht alles zu glauben was man denkt UND fühlt. Wie du Spiritualität für deine persönliche Weiterentwicklung nutzen kannst.Warum echte Spiritualität nichts mit Magie, sondern mit Bewusstsein zu tun hat.

Police Addicted to Drugs And His Amazing Recovery, Special Episode. Police Officer Attacked, Multiple Surgeries, Forced Retirement, Addiction, and an Inspiring Recovery. This special episode is streaming for free on the Law Enforcement Talk Radio Show and Podcast website, on Apple Podcasts, Spotify, YouTube, and most every major Podcast platform Brock Bevell never imagined that a single violent moment would change the entire trajectory of his life. A retired Mesa, Arizona police officer, Brock dedicated his career to public service, until a targeted act of violence ended his time on the job and set him on a painful, unexpected journey through addiction and recovery. Look for The Law Enforcement Talk Radio Show and Podcast on social media like their Facebook , Instagram , LinkedIn , Medium and other social media platforms. “She threw the truck into reverse and hit me,” Brock recalls. “In an instant, everything changed.” Supporting articles about this and much more from Law Enforcement Talk Radio Show and Podcast in platforms like Medium , Blogspot and Linkedin . A Career Cut Short by Violence While serving with the Mesa Police Department, Brock was seriously injured during a violent incident involving a vehicle. The attack caused devastating, career-ending injuries and required multiple surgeries. What followed was a long and grueling rehabilitation process, one familiar to many injured officers across the country. Police Addicted to Drugs And His Amazing Recovery, Special Episode. Available for free on their website and streaming on Apple Podcasts, Spotify, Youtube and other podcast platforms. To manage the intense pain, Brock was prescribed opioid pain medication. Like countless patients recovering from serious injuries, he trusted the prescriptions meant to help him heal. Instead, they quietly became the beginning of a much deeper struggle. From Recovery to Addiction During months of surgeries and physical therapy, Brock developed a severe dependence on opioid painkillers. What started as medically prescribed relief slowly evolved into addiction. “I didn't recognize myself anymore,” Brock says. “My world became smaller and darker. I was surviving, not living.” Brock openly shares how addiction affected every part of his life, his relationships, his identity, and his sense of purpose after forced retirement from policing. His story reflects a reality many first responders face but few openly discuss. Police Addicted to Drugs And His Amazing Recovery, Special Episode. The Law Enforcement Talk Radio Show and Podcast episode is available for free on their website , Apple Podcasts , Spotify and most major podcast platforms. The Science Behind the Crisis Research underscores just how common Brock's experience is. A major study published in JAMA Internal Medicine by researchers at the Stanford University School of Medicine found that patients undergoing 11 common surgeries faced an increased risk of becoming chronic opioid users. Lead author Eric Sun, MD, PhD, explained: “For a lot of surgeries, there is a higher chance of getting hooked on painkillers.” The study defined chronic opioid use as filling 10 or more prescriptions or receiving more than a 120-day supply within a year after surgery. Patients undergoing knee surgery faced the highest risk, nearly five times that of nonsurgical patients, followed by gallbladder surgery. Importantly, the study did not suggest avoiding surgery, but emphasized the need for careful monitoring and alternative pain management strategies. Police Addicted to Drugs And His Amazing Recovery, Special Episode. The interview can be found on The Law Enforcement Talk Radio Show and Podcast website, on Apple podcasts, Spotify, Youtube and on LinkedIn, Facebook, Instagram, and across most podcast platforms where listeners will find authentic law enforcement stories. Trauma, Policing, and Substance Use Law enforcement officers face unique occupational hazards, including repeated exposure to trauma. Studies show that substance use disorders, including alcohol and drug dependence, occur at higher rates among officers, particularly those experiencing psychological distress. In nationally representative data, more than half of men with lifetime PTSD also had a history of alcohol abuse or dependence. For police officers, these risks are compounded by work stress, injuries, and the cultural stigma surrounding mental health and asking for help. “We wear the uniform, but we're human,” Brock says. “And sometimes the damage doesn't show until it's almost too late.” The full podcast episode is streaming now on their website, on Apple Podcasts, Spotify, Youtube and across Facebook, Instagram, and LinkedIn. Hitting Bottom and Choosing Recovery Brock's turning point came when he realized addiction had taken everything it could from him. With professional help, support, and unwavering determination, he entered recovery and committed to sobriety. “Recovery didn't give me my old life back,” he says. “It gave me a new one, one with purpose.” Police Addicted to Drugs And His Amazing Recovery, Special Episode. Today, Brock uses his experience to help others struggling with addiction, trauma, and life after law enforcement. His message is clear: recovery is possible, even after profound loss. Healing Beyond the Badge In the aftermath of violence and trauma, communities often look to police officers as symbols of strength. Yet officers themselves must also heal. Proactive wellness programs, mental health resources, and open conversations about addiction are critical, not just for officers, but for the communities they serve. You can find the show on Facebook, Instagram, Pinterest, X (formerly Twitter), and LinkedIn, as well as read companion articles and updates on Medium, Blogspot, YouTube, and even IMDB. Mesa, located just east of Phoenix, is known for its deep history, from the ancient Hohokam culture to the modern city Brock once patrolled. It is also where his story originated, one of resilience, accountability, and hope. Listen to Brock's Story Brock Bevell's journey is featured in this Special Episode of the Law Enforcement Talk Radio Show and Podcast available for free on their website, also on Platforms like Apple Podcasts, Spotify, YouTube and most major podcast platforms. His story is also being shared across their Facebook, Instagram, LinkedIn, and other Social Media and News outlets. Listen to Brock's inspiring account of what happened, how prescribed opioids led to addiction, and how recovery helped him rebuild his life, and helps others do the same. Police Addicted to Drugs And His Amazing Recovery, Special Episode. Because sometimes, the most powerful stories of policing aren't about arrests or badges, but about survival, healing, and redemption. You can help contribute money to make the Gunrunner Movie . The film that Hollywood won't touch. It is about a now Retired Police Officer that was shot 6 times while investigating Gunrunning. He died 3 times during Medical treatment and was resuscitated. You can join the fight by giving a monetary “gift” to help ensure the making of his film at agunrunnerfilm.com . Background song Hurricane is used with permission from the band Dark Horse Flyer. You can contact John J. “Jay” Wiley by email at Jay@letradio.com , or learn more about him on their website . Stay connected with updates and future episodes by following the show on Facebook, Instagram, LinkedIn, their website and other Social Media Platforms. Find a wide variety of great podcasts online at The Podcast Zone Facebook Page , look for the one with the bright green logo. Be sure to check out our website . Be sure to follow us on X , Instagram , Facebook, Pinterest, Linkedin and other social media platforms for the latest episodes and news. Listeners can tune in on the Law Enforcement Talk Radio Show website, on Apple Podcasts, Spotify, YouTube, and most every major Podcast platform and follow updates on Facebook, Instagram, and other major News outlets. You can find the show on Facebook, Instagram, Pinterest, X (formerly Twitter), and LinkedIn, as well as read companion articles and updates on Medium, Blogspot, YouTube, and even IMDB. Police Addicted to Drugs And His Amazing Recovery, Special Episode. Attributions Stanford Medical IACP NIH Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Interview with Robert Goulden, MBBS author of Magnesium Supplementation and Tachyarrhythmias:A Nonrandomized Clinical Trial and Jason H. Wasfy, MD, MPhil author of Evidence for Clinical Treatment Decisions Without Randomized Data. Hosted by Ilana Richman, MD MHS. Related Content: Magnesium Supplementation and Tachyarrhythmias Evidence for Clinical Treatment Decisions Without Randomized Data

A new JAMA Internal Medicine study reveals that Trump's NIH funding cuts have abruptly halted nearly 400 clinical trials, leaving more than 74,000 patients — especially those in underserved communities — without essential care and research options. Subscribe to our newsletter to stay informed with the latest news from a leading Black-owned & controlled media company: https://aurn.com/newsletter Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

A new JAMA Internal Medicine study reveals that Trump's NIH funding cuts have abruptly halted nearly 400 clinical trials, leaving more than 74,000 patients — especially those in underserved communities — without essential care and research options. Subscribe to our newsletter to stay informed with the latest news from a leading Black-owned & controlled media company: https://aurn.com/newsletter Learn more about your ad choices. Visit megaphone.fm/adchoices

Interview with Giselle Corbie, MD, MSc, Associate Editor of JAMA Internal Medicine, and Lynda H. Powell, PhD, author of Lifestyle Intervention for Sustained Remission of Metabolic Syndrome: A Randomized Clinical Trial. Hosted by Eve Rittenberg, MD. Related Content: Lifestyle Intervention for Sustained Remission of Metabolic Syndrome

Interview with Giselle Corbie, MD, MSc, Associate Editor of JAMA Internal Medicine, and Lynda H. Powell, PhD, author of Lifestyle Intervention for Sustained Remission of Metabolic Syndrome: A Randomized Clinical Trial. Hosted by Eve Rittenberg, MD. Related Content: Lifestyle Intervention for Sustained Remission of Metabolic Syndrome

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers goals of care conversations.Our guest for this episode is Dr. Tavis Apramian, a clinician-investigator in the Department of Family & Community Medicine (DFCM) at the University of Toronto and scientist in the Office of Education Scholarship. He works as a palliative care physician at St. Michael's Hospital and at Kensington Hospice. His largely qualitative program of research is focused on advance care planning; workplace-based learning and assessment; palliative care in family medicine; medical assistance in dying; and inequity in end-of-life care. His primary focus is on telling rich stories of learner and patient experiences to spark conversation about socioculturally complex educational and clinical problems in serious illness.The learning objectives for this episode are as follows:Describe a palliative approach to care and its relevance across different contextsDemonstrate a structured and compassionate approach to goals of care conversationsApply effective communication strategies to build therapeutic alliance, navigate difficult conversations, and involve multiple actors in the palliative contextRecognize and manage challenges in goals of care conversationsGuest: Dr. Tavis ApramianHosts: Dr. Daamoon Ghahari (PGY2) and Dr. Angad Singh (PGY2)Audio editing: Dr. Angad Singh (PGY2)Timestamps:(1:07) - Journey to palliative care(5:07) - What is palliative care(14:47) - Understanding patient values(33:47) - Structuring goals of care conversations(44:16) - Communication strategies(57:05) - Navigating family meetings(77:25) - Reflections on MAiD for sole mental illnessResources:Roth, H. (2024). Hearing the unspoken. Canadian Family Physician, 70(10), 642-642. https://pmc.ncbi.nlm.nih.gov/articles/PMC11477260/pdf/0700642.pdfReferences:Bernacki, R. E., & Block, S. D. (2014). Communication about serious illness care goals: a review and synthesis of best practices. JAMA internal medicine, 174(12), 1994-2003.Gross, J., & Koffman, J. (2024). Examining how goals of care communication are conducted between doctors and patients with severe acute illness in hospital settings: A realist systematic review. PLoS One, 19(3), e0299933.Scheunemann, L. P., Ernecoff, N. C., Buddadhumaruk, P., Carson, S. S., Hough, C. L., Curtis, J. R., ... & White, D. B. (2019). Clinician-family communication about patients' values and preferences in intensive care units. JAMA internal medicine, 179(5), 676-684.You, J. J., Downar, J., Fowler, R. A., Lamontagne, F., Ma, I. W., Jayaraman, D., ... & Canadian Researchers at the End of Life Network (CARENET). (2015). Barriers to goals of care discussions with seriously ill hospitalized patients and their families: a multicenter survey of clinicians. JAMA Internal Medicine, 175(4), 549-556.For more PsychEd, follow us on Instagram (⁠@psyched.podcast⁠),  Facebook (⁠PsychEd Podcast⁠), X (⁠@psychedpodcast⁠), and Bluesky (⁠@psychedpodcast.bsky.social‬⁠). You can email us at ⁠psychedpodcast@gmail.com⁠ and visit our website at⁠ ⁠⁠psychedpodcast.org⁠.

Interview with Sammy Saab, MD, MPH, author of Targeting MASLD and MASH in the US Hispanic/Latino Population: A Review. Hosted by Eve Rittenberg, MD. Related Content: Targeting MASLD and MASH in the US Hispanic/Latino Population

A large meta-analysis in The Lancet found clopidogrel superior to aspirin for long-term secondary prevention in coronary artery disease, reducing major cardiovascular events by 14% without added bleeding risk. The REBOOT trial in NEJM showed no benefit of beta-blockers in post-MI patients with preserved ejection fraction, and even potential harm in women on high doses, prompting reevaluation of routine use. Finally, a phase 2 trial in JAMA Internal Medicine showed daily azelastine nasal spray reduced COVID-19 incidence by 67% and shortened illness duration, though larger studies are needed to confirm its prophylactic role.

Interview with Robert Bals, MD, PhD, author of Azelastine Nasal Spray for Prevention of SARS-CoV-2 Infections: A Phase 2 Randomized Clinical Trial, and Dan H. Barouch, MD, PhD, author of A Novel Approach for Preventing Respiratory Virus Infections. Hosted by Eve Rittenberg, MD. Related Content: Azelastine Nasal Spray for Prevention of SARS-CoV-2 Infections A Novel Approach for Preventing Respiratory Virus Infections

Send us a textOrganic food often sounds like a smarter, healthier choice—but is it really worth the extra cost? In this episode, we dig into the scientific evidence behind organic foods, pesticide risks, and whether you're buying better health or just paying for a better-sounding label.We begin by breaking down the steep price differences between organic and conventional food. According to the USDA, Americans spend roughly $1 trillion annually on food at home, averaging over $3,100 per person. Organic options can increase grocery bills by 50% or more, as LendingTree reports in this price comparison analysis. My own market trip found Fuji apples nearly double in price, and wild-caught salmon more than twice as expensive.But do organics deliver better health outcomes? Most organic foods contain lower pesticide residues, which 85% of Americans cite as a concern. Yet research shows these lower levels don't clearly translate to better health. Rodent studies show harm at extremely high pesticide doses, far above what's found in conventional produce. Human risk data mostly comes from farm workers, not everyday consumers.A 2023 meta-analysis of 50 studies found that organic diets reduced blood pesticide levels and increased plant-derived phenolics, but showed inconsistent results for antioxidants. Cancer data is also mixed. One observational study found no clear differences across 15 cancer types. Another study of 68,000 participants linked organic food with perhaps a  0.6% lower risk of cancer incidence (JAMA Internal Medicine). However, organic eaters also are more likely health oriented (perhaps exercise more, sleep better), so lifestyle may explain the difference—not the food alone.I ran the numbers: avoiding one case of cancer might require 150 people to eat organic, costing about $300,000 in additional food expenses to avoid 1 cancer. And since organic prices may lead families to buy less produce overall, there's a tradeoff. We know from a meta-analysis that increasing fruit and vegetable intake (organic or not) is linked to a 13% reduction in mortality and a 35% drop in cancer risk. That's a far more impactful move.If you're looking for a middle ground, consider using the Environmental Working Group's Dirty Dozen and Clean 15 lists. While not a neutral source, their rankings can help prioritize which foods might be worth buying organic. Washing produce also helps reduce, but not eliminate, pesticide residues.Takeaways:Organic foods have lower pesticide levels but no clear, consistent health advantage.The biggest health gain comes from eating more fruits and vegetables—regardless of whether they're organic.If organic costs limit your produce intake, stick with conventional and focus on volume, variety, and other wellness investments like better sleep or exercise.As always, I'd love to hear what you think. Does this shift how you shop? Let me know—and share this episode with someone navigating the same choice.

Interview with Alison J. Huang, MD, MAS, and Stephanie Faubion, MD, MBA, authors of Nonhormonal Treatment of Menopausal Vasomotor Symptoms. Hosted by Eve Rittenberg, MD. Related Content: Nonhormonal Treatment of Menopausal Vasomotor Symptoms

JAMA Internal Medicine fellows Jerard Z. Kneifati-Hayek, MD, MS, Ilana B. Richman, MD, MHS, and Nathan Stall, MD, PhD, discuss their experiences learning how to work as members of the editorial team at a leading, widely read, high-impact internal medicine journal. They explore key elements including how the fellowship enhanced their teamwork, writing, critical appraisal, and research skills. Hosted by Ilana B. Richman, MD, MHS. Related Content: Introducing the Expanded JAMA Internal Medicine Editorial Fellowship

JAMA Internal Medicine fellows Jerard Z. Kneifati-Hayek, MD, MS, Ilana B. Richman, MD, MHS, and Nathan Stall, MD, PhD, discuss their experiences learning how to work as members of the editorial team at a leading, widely read, high-impact internal medicine journal. They explore key elements including how the fellowship enhanced their teamwork, writing, critical appraisal, and research skills. Hosted by Ilana B. Richman, MD, MHS. Related Content: Introducing the Expanded JAMA Internal Medicine Editorial Fellowship

Interview with Connor Prosty, MD, author of Prophylactic Antibiotics for Upper Gastrointestinal Bleeding in Patients With Cirrhosis: A Systematic Review and Bayesian Meta-Analysis, and Catherine Mezzacappa, MD, MPH, author of Antibiotic Prophylaxis in Variceal Hemorrhage—Time to Stop? Hosted by Ilana Richman, MD. Related Content: Prophylactic Antibiotics for Upper Gastrointestinal Bleeding in Patients With Cirrhosis Antibiotic Prophylaxis in Variceal Hemorrhage—Time to Stop?

How would you encourage sustainable behaviour?  You might assume logical messages work best.  Stuff like “the average three-hour flight creates ~250–400 kg of CO₂”.  But today's guest on Nudge has tested logical messages.  And they don't work.  Today on Nudge, Toby Park from the Behavioural Insights Team explains how renaming a meat-free dish doubled its sales. Why targeting home-movers made Americans 400% more likely to cycle. How social norms can increase sales by 20%. And the reframing led the majority of Brits to choose energy-efficient fridges.  ---  Watch the bonus episode: https://nudge.kit.com/27720ca0ad Connect with Toby on LinkedIn: https://www.linkedin.com/in/toby-park-67773279/  Read Toby's Net Zero Report: https://shorturl.at/Wy8RP How to Build a Net Zero Society: https://shorturl.at/0PcRk Sign up for my newsletter: https://www.nudgepodcast.com/mailing-list  Connect on LinkedIn: https://www.linkedin.com/in/phill-agnew-22213187/  Watch Nudge on YouTube: https://www.youtube.com/@nudgepodcast/  --- Sources:  Das, G., Spence, M. T., & Agarwal, J. (2021). Social selling cues: The dynamics of posting numbers viewed and bought on customers' purchase intentions. International Journal of Research in Marketing, 38(4), 994–1016. Kirkman, E. (2019). Free riding or discounted riding? How the framing of a bike share offer impacts redemption. Journal of Behavioral Public Administration, 2(2), 1–10. Park, T., Whincup, E., Parker, F., & Bhura, A. (2024). Net Zero communications, marketing and public engagement: Why we need it, and what we can learn from past case studies [Report]. Behavioural Insights Team. Shotton, R. (2018). The Choice Factory: 25 behavioural biases that influence what we buy. Harriman House. Sparkman, G., & Walton, G. M. (2017). Dynamic norms promote sustainable behavior, even if it is counternormative. Psychological Science, 28(11), 1663–1674. Turnwald, B. P., Boles, D. Z., & Crum, A. J. (2017). Association Between Indulgent Descriptions and Vegetable Consumption: Twisted Carrots and Dynamite Beets. JAMA Internal Medicine, 177(8), 1216–1218. Vennard, D., Park, T., & Attwood, S. (2019). Encouraging Sustainable Food Consumption By Using More-Appetizing Language.

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

Contributor: Alec Coston, MD Educational Pearls: For patients presenting to the emergency room with hypertension, clinicians should determine if it is isolated and uncomplicated, or involves comorbidities with more complex underlying pathophysiology.  For uncomplicated and isolated hypertension, first-line treatment is thiazide diuretics.  How do thiazide diuretics work to treat hypertension? Thiazide diuretics work by blocking sodium and chloride resorption in the kidneys.  “Where sodium goes, water follows,” thus promoting diuresis and lowering blood pressure. Examples of thiazide diuretics and their benefits? Hydrochlorothiazide (HCTZ): First-line medication in uncomplicated and chronic hypertensive states. Cheaper and fewer significant adverse effects compared to chlorthalidone. HCTZ can be associated with decreased risk of stroke and myocardial infarction. However, for more complicated hypertension, especially in the setting of heart failure, Angiotensin Converting Enzyme (ACE) Inhibitors should be considered.  How do ACE Inhibitors manage blood pressure? The body's kidneys drive the Renin-Angiotensin-Aldosterone-System (RAAS) to regulate blood pressure. It is easiest to understand RAAS as being pro-hypertensive as a response to decreased renal perfusion. As renal perfusion decreases, renin is released and activates angiotensin I, which is converted by ACE to Angiotensin II, which causes release of aldosterone. ACE Inhibitors prevent the conversion of Angiotensin I to Angiotensin II, thus decreasing the kidneys' production of Angiotensin II and Aldosterone levels. Why, in the context of heart failure, are ACE Inhibitors preferred? In heart failure, especially left-sided or left-ventricular heart failure, a vicious cycle can develop wherein the left ventricle fails to perfuse the kidneys due to over-dilation. The kidneys are hypoperfused and activate RAAS to try to retain volume and increase peripheral vasoconstriction, promoting renal perfusion. The increase in blood pressure puts further strain on the heart, thereby further decreasing cardiac output. The cycle develops, and extremely elevated blood pressures can develop. ACE Inhibitors can directly block this cycle, hence their preference in heart failure. Big takeaway? In uncomplicated hypertensive patients, consider thiazide diuretics. When comorbidities, especially heart failure, are introduced, then consider ACE Inhibitors. References Carey RM, Moran AE, Whelton PK. Treatment of Hypertension: A Review. JAMA. 2022;328(18):1849-1861. doi:10.1001/jama.2022.19590 Fan M, Zhang J, Lee CL, Zhang J, Feng L. Structure and thiazide inhibition mechanism of the human Na-Cl cotransporter. Nature. 2023;614(7949):788-793. doi:10.1038/s41586-023-05718-0 Hripcsak G, Suchard MA, Shea S, et al. Comparison of Cardiovascular and Safety Outcomes of Chlorthalidone vs Hydrochlorothiazide to Treat Hypertension. JAMA Internal Medicine. 2020;180(4):542-551. doi:10.1001/jamainternmed.2019.7454 Yu D, Li JX, Cheng Y, et al. Comparative efficacy of different antihypertensive drug classes for stroke prevention: A network meta-analysis of randomized controlled trials. PLoS One. 2025;20(2):e0313309. doi:10.1371/journal.pone.0313309 Summarized by Dan Orbidan, OMS2 | Edited by Dan Orbidan & Jorge Chalit, OMS4 Donate: https://emergencymedicalminute.org/donate/  

Interview with Adrian D. Haimovich, MD, PhD, author of National Trends in Prolonged Emergency Department Length of Stay Among Older Adults: 2017-2024 and Maura Kennedy, MD, MPH author of Addressing the Hospital Boarding Crisis in the US—Time to Act: Addressing the Hospital Boarding Crisis in the US. Hosted by Eve Rittenberg, MD. Related Content: Addressing the Hospital Boarding Crisis in the US—Time to Act Prolonged Emergency Department Stays for Older US Adults

Today's episode focuses on a recent article in JAMA Internal Medicine regarding maternal mental health in the United States. I'll explain and summarize the study and results, and discuss the most appropriate next steps. Since I'm presenting the information in summary form, please read the article for yourself by clicking the link in the Resources section for this episode.  Show Highlights: The findings of this study are sobering and validating. Scope and value of research findings like this to “fill the gap” in maternal mental health The details of the study subjects: 198,000+ US mothers from 2016-2023 who self-reported their physical and mental health The key findings: The percentage of mothers reporting a rating of “excellent” mental health dropped dramatically during the time frame, the percentage reporting “fair” or “poor” mental health increased, and the trend of declining maternal mental health crosses through all socio-economic groups. The key factors contributing to maternal mental health conditions  Results of the study show that we need more investment into the underlying causes of mental health decline, especially for lower socio-economic status moms. Moms are suffering under the weight of silence, stigma, shame, and societal expectations. Studies like this one are vital to break down barriers to care and support. Learning to identify your needs, choose rest when needed, and prioritize self-compassion What we can do to help: offer screenings at multiple points, effect policy change, and find positive ways to support the entire family system. Resources: Read the JAMA article, “Trends and Disparities in Maternal Self-Reported Mental and Physical Health.” Click here. Call the National Maternal Mental Health Hotline at 1-833-TLC-MAMA or visit cdph.ca.gov Please find resources in English and Spanish at Postpartum Support International, or by phone/text at 1-800-944-4773. There are many free resources available, including online support groups, peer mentors, a specialist provider directory, and perinatal mental health training for therapists, physicians, nurses, doulas, and anyone who wants to become more supportive in offering services.  You can also follow PSI on social media: Instagram, Facebook, and most other platforms Visit www.postpartum.net/professionals/certificate-trainings/ for information on the grief course.   Visit my website, www.wellmindperinatal.com, for more information, resources, and courses you can take today! If you are a California resident looking for a therapist in perinatal mental health, email me about openings for private pay clients! Learn more about your ad choices. Visit podcastchoices.com/adchoices

In this episode of Quality Talks With Peggy O'Kane, NCQA President Peggy O'Kane sits down with Dr. Rita Redberg, a cardiology pioneer and fierce advocate for evidence-based care. Dr. Redberg, who famously served as Editor-in-Chief of JAMA Internal Medicine for 14 years, shares her "Less is More" philosophy — a perspective that challenges the view that "more" care is always better.Join Peggy and Rita as they explore:The Problem with "More": Why a health care culture focused on technology and volume over patient needs leads to runaway costs and poor results.The Stent Story: How a widely adopted procedure in cardiology gained traction without initial evidence of patient benefit, and the uphill battle to integrate rigorous clinical trials.Mary Caldwell's Odyssey: A cautionary tale illustrating the dangerous cascade of unnecessary testing and interventions, based on a desire for reassurance rather than clinical need.Re-evaluating Statins: Rita's unconventional view on the use of statins in asymptomatic people. She advocates lifestyle changes over medication when the evidence of benefit is thin.Rebuilding Trust: How the fee-for-service payment model erodes the patient-doctor relationship and how regulatory reforms can shift incentives towards patient wellbeing.Rita reminds us that health care quality isn't about more tests or interventions. It's about thoughtful, patient-centered decisions and a commitment to "first, do no harm." This episode is a must-listen for anyone curious about improving health outcomes and reducing waste in health care.Key Quote:Most statins are prescribed for people that have not already had a heart attack or have established coronary disease. In that higher risk group, there is some benefit to taking statins. It's not huge but there is some benefit.But most people I see, and most people taking statins, are not in that category. They're healthy people that want to prevent a heart attack and want to live longer. They definitely are not going to feel better. Rita Redberg, MDTime Stamps:(02:09) Misconceptions in Medicine(10:01) Mary Caldwell: A Cautionary Tale(13:35) Choosing Wisely Campaign: A Step Towards Better Care(16:32) Debating the Use of Statins(21:31) Trust, Incentives and the High Cost of US Care(27:05) Technology, Teams and Trust Links:JAMA Internal Medicine “Less is More”Choosing WiselyConnect with Rita

CT scans are quick, painless, non-invasive tests that can identify everything from brain tumors to injuries from an accident. But a new study published in the journal JAMA Internal Medicine shows a link between the radiation exposure from the imaging tool and cancer. Ali Rogin spoke with Dr. Rebecca Smith-Bindman, the study's lead author, to learn more. PBS News is supported by - https://www.pbs.org/newshour/about/funders

CT scans are quick, painless, non-invasive tests that can identify everything from brain tumors to injuries from an accident. But a new study published in the journal JAMA Internal Medicine shows a link between the radiation exposure from the imaging tool and cancer. Ali Rogin spoke with Dr. Rebecca Smith-Bindman, the study's lead author, to learn more. PBS News is supported by - https://www.pbs.org/newshour/about/funders

In this episode, Dr. Zanotti discusses the science of hope. He's joined by Dr. Stephen Trzeciak, a physician-scientist, the Edward D. Viner Endowed Chief of Medicine at Cooper University Health Care, and Professor and Chair of Medicine at Cooper Medical School of Rowan University in Camden, New Jersey. Dr. Trzeciak is a practicing intensivist and a clinical researcher with more than 100 publications in the scientific literature. In addition, he is co-author of two excellent books: Wonder Drug: 7 Scientifically Proven Ways That Serving Others Is the Best Medicine for Yourself (2022) and Compassionomics: The Revolutionary Scientific Evidence that Caring Makes a Difference (2019). Additional resources: Recovery Expectations and Long-term Prognosis of Patients with Coronary Heart Disease Barefoot JC, et al. JAMA Internal Medicine 2011: https://pubmed.ncbi.nlm.nih.gov/21357800/ Optimism and Rehospitalization After Coronary Artery Bypass Graft Surgery. Scheler MF, et al. JAMA Int Med 1999: https://pubmed.ncbi.nlm.nih.gov/10219928/ The median is not the message. By Jay Gould: https://journalofethics.ama-assn.org/sites/joedb/files/2018-05/mnar1-1301.pdf Books mentioned in this episode: Man's Search for Meaning. By Viktor E. Frankl: https://bit.ly/3SqsNyt Wonder Drug: 7 Scientifically Proven Ways That Serving Others Is the Best Medicine for Yourself. By Stephen Trzeciak and Anthony Mazzarelli: https://bit.ly/4kiyA5q Compassionomics: The Revolutionary Scientific Evidence that Caring Makes a Difference. By Stephen Trzeciak and Anthony Mazzarelli: https://bit.ly/43ul5IE

Interview with Tricia M. Leahey, PhD, author of Patient-Delivered Continuous Care for Weight Loss Maintenance: A Randomized Clinical Trial, and Kathryn M. Ross, PhD, MPH, author of Mentor and Peer Support for Long-Term Weight Loss Maintenance: You've Got a Friend in Me. Hosted by Eve Rittenberg, MD. Related Content: Patient-Delivered Continuous Care for Weight Loss Maintenance Mentor and Peer Support for Long-Term Weight Loss Maintenance

Our main focus today was on nudging critical care clinicians to consider a more palliative approach to care.  Our guests are all trained in critical care: Kate Courtright, Scott Halpern, and Jaspal Singh.  Kate and Scott have additional training in palliative medicine.  To start. we review: What is a nudge? Also called behavioral interventions, heuristics, and cognitive biases. Prior podcasts on the ethics of nudging, and a different trial conducted by Kate and Scott in which the default for hospitalized seriously ill patients was to receive a palliative care consult. What is sludge?  I'd never heard the term, perhaps outside of Eric's pejorative reference to my coffee after adding copious creamers, flavoring, and sweeteners.  Sludge is apparently when you create barriers or extra work for someone.  For example, putting the healthy food at the back of the grocery store is sludge; making an applicant for health insurance climb the flight of stairs to the office - weeding out those less fit - is also sludge.  Prior-auth forms? Sludge. Examples of nudges, some based in health care, others in coffee.  This specific study, published in JAMA Internal Medicine, was conducted in 17 ICUs in North Carolina. Many were community hospitals.  Participants were critically ill and intubated.  Clinicians were randomized to 4 groups: Usual care Prognosis nudge - EHR prompt asking, do you think your patient will be alive in 6 months? This is called a focusing effect Comfort care nudge - EHR prompt asking if they'd offered comfort-focused care. This is called accountable justification - an appeal to standards of care for critically ill patients endorsed by multiple professional societies. Both the prognosis and comfort care nudge. A few key points of discussion: Is an EHR prompt a nudge or sludge?   The intervention was a negative study for the primary outcome, hospital length of stay.  Why?  The prognosis nudge did nothing.  What to make of that? Would you think an EHR nudge to consider prognosis might move the needle, at least on some outcomes? The nudge toward offering comfort care led to more hospice and early comfort-care orders.  Is this due to chance alone, given the multiplicity of secondary outcomes examined?  Or is it a tantalizing finding that suggests a remarkably low cost EHR based nudge might, on a population level, lead to critical care clinicians offering comfort care and hospice more frequently?  Imagine!    -Alex Smith  

Lisa S. Rotenstein, MD, MBA, MSc, Seth Berkowitz, MD, MPH, and Elizabeth Dzeng, MD, PHD, MPH, each sit down one on one with JAMA Internal Medicine Associate Editor Ishani Ganguli, MD, MPH, to discuss the work they are presenting at the 2025 Society of General Internal Medicine Annual Meeting. Related Content: Incomplete Team Staffing, Burnout, and Work Intentions Among US Physicians JAMA Internal Medicine at the 2025 Society of General Internal Medicine Annual Meeting

A pragmatic trial evaluates the effectiveness of a treatment or intervention in “real-world” clinical practice.  Outcomes are typically assessed from available records.  Eligibility in pragmatic trials are often broad, and don't have the exclusions of efficacy studies, which examine treatment effects under highly controlled conditions in highly select populations. Today we are delighted to welcome Jennifer Wolff, Sydney Dy, and Danny Scerpella, who conducted a pragmatic trial of advance care planning (ACP) in primary care practices; and Jasmine Santoyo-Olsson, who wrote an accompanying commentary in JAMA Internal Medicine. We spend the last portion of the podcast discussing the surprising finding of the study.  In the primary care practices that received the advance care planning intervention, rates of advance care planning were higher (about double). Shockingly, rates of potentially burdensome intervention (intubation, CPR, etc) were also higher in the advance care planning intervention group.  What?!?  Not a typo. We spend some time unpacking and contextualizing the potential reasons for this surprising finding, including: Disconnect between relatively low rates of new advance directives (12% in intervention arm vs 7% control) and higher rates of potentially burdensome treatment among decedents (29% in intervention arm vs 21% control).  Only 5% of intervention patients received the facilitator led component of the intervention (there were other components, facilitator-led was the most engaged component). Was there really a causal connection between the intervention, new advance directives, and higher rates of potentially burdensome interventions? Potential that care received, though potentially burdensome, was in fact aligned with goals, and might represent goal concordant care. Potential that documenting advance directives without a robust conversation about prognosis might have led to these findings.  My goals will differ if I think I probably have 2 years to live vs 10 years. Comparison to a trial Yael Shenker discussed in our podcast on AAHPM/HPNA plenary abstracts (also used the Respecting Choices intervention, outcome differed). Implications for the larger discussion over the value of advance care planning, and additional research into advance care planning.  As I say on the podcast, I'm sure Sean Morrison would be delighted to point to these findings as evidence that advance care planning doesn't work, and in fact may be harmful. And I got to sing in Spanish for the second time. I hope my pronunciation is better than my Urdu, or French! -Alex Smith  

Last week, we heard a former U.S. ambassador describe Russia's escalating conflict with the U.S. Today, we revisit a 2019 episode about an overlooked front in the Cold War — a “farms race” that, decades later, still influences what Americans eat. SOURCES:Anne Effland, former Senior Economist for the Office of Chief Economist in the U.S.D.A.Shane Hamilton, historian at the University of York.Peter Timmer, economist and former professor at Harvard University.Audra Wolfe, writer, editor, and historian. RESOURCES:Freedom's Laboratory: The Cold War Struggle for the Soul of Science, by Audra Wolfe (2018).Supermarket USA: Food and Power in The Cold War Farms Race, by Shane Hamilton (2018).“Association of Higher Consumption of Foods Derived From Subsidized Commodities With Adverse Cardiometabolic Risk Among US Adults,” by Karen R. Siegel, Kai McKeever Bullard, K. M. Narayan, et al. (JAMA Internal Medicine, 2016).The Rise and Fall of American Growth: The U.S. Standard of Living Since the Civil War, by Robert J. Gordon (2016).“How the Mechanical Tomato Harvester Prompted the Food Movement,” by Ildi Carlisle-Cummins (UC Davis Department of Plant Sciences Newsletter, 2015). EXTRAS:"Is the U.S. Sleeping on Threats from Russia and China?" by Freakonomics Radio (2024).

Think back to the last time you went to the doctor's office. Chances are, at the start of the visit, they took your temperature, pulse, and blood pressure—your “vitals.”But how did they take your blood pressure? The medical literature that describes safe blood pressure ranges is all based on readings taken with the patient sitting with feet flat on the floor, legs uncrossed, back supported, and the testing arm supported by a desk at mid-heart level. But if the blood pressure is measured with the person in a different position—say, perched on the edge of an exam table, legs dangling, and an arm hanging at the side—the readings given by a blood pressure monitor can be distorted. In a recent study published in the journal JAMA Internal Medicine, researchers found that arm position could account for as much as a 7mmHg difference in pressure readings. That difference could be enough to incorrectly classify some people as hypertensive.Dr. Tammy Brady, medical director of the Pediatric Hypertension Program at Johns Hopkins University, joins Ira to talk about the art of blood pressure measurement, how to better track your own blood pressure, how to find blood pressure monitors that have been properly validated, and the importance of advocating for yourself in medical settings.Transcript for this segment will be available after the show airs on sciencefriday.com. Subscribe to this podcast. Plus, to stay updated on all things science, sign up for Science Friday's newsletters.