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Can we do more than prescribe pills to address men's sexual health complaints? In this episode of the BackTable Urology Podcast, men's health expert Dr. Mohit Khera from Baylor College of Medicine joins guest host Dr. Amy Pearlman for a deep dive into testosterone management and the full spectrum of erectile dysfunction therapies. --- SYNPOSIS The conversation covers daily tadalafil use, lifestyle optimization, and the nuanced role of off-label medications. Dr. Khera also highlights emerging technologies like the Tech Ring and radiofrequency treatments, alongside practical insights into semen analysis and hormonal health markers. Throughout, he emphasizes a holistic, patient-centered approach to sexual health—blending medical therapy with meaningful lifestyle change. This is a must-listen for general urologists, men's health specialists, and trainees looking to expand their toolkit in this evolving field. --- TIMESTAMPS 00:00 - Introduction02:13 - Erectile Dysfunction and Testosterone08:05 - Young Men's Health and Early Detection10:20 - Semen Analysis for Overall Health12:50 - Daily Tadalafil and Its Benefits16:40 - Proactive Sexual Health Management21:28 - Female Sexual Health25:16 - Treating Delayed Ejaculation28:53 - Psychogenic Erectile Dysfunction31:16 - Technology in Sexual Health35:54 - Lifestyle Modifications for Better Sexual Health41:55 - Resources and Referrals for Patients44:30 - Final Thoughts
Can stress be managed before it becomes the silent killer of your potential? Bestselling author of You Can Win, Shiv Khera returns with Live While You're Alive, tackling stress with his signature clarity and punch. From the road to the boardroom, Khera shares practical insights on how to lead a life of purpose. Michelle Martin speaks with the internationally acclaimed speaker about handling pressure, personal resilience, choosing growth.—and how to take charge of the narrative. Hosted by Michelle Martin with Shiv Khera, Speaker and Internationally acclaimed author.See omnystudio.com/listener for privacy information.
In this episode, Dr. Kevin Chu and Dr. Justin Dubin engage with Dr. Mohit Khera to explore the concept of 'sex span'—the duration of life where individuals can engage in sexual activity. They discuss the interrelation between sex span, health span, and lifespan, emphasizing the importance of maintaining sexual health as a reflection of overall well-being. The conversation covers the implications of erectile dysfunction as a health indicator, the role of partners in sexual health, common myths surrounding aging and sexual activity, and practical steps to improve sexual function. The episode concludes with a focus on redefining sexual satisfaction and the importance of open communication in relationships.
Dr. Mohit Khera, renowned urologist, researcher, and expert in male and female sexual health, joins Dr. Rena Malik to discuss the global decline in testosterone, why symptoms matter more than blood test reference numbers, and the crucial role of free testosterone. They dive into types of testosterone replacement therapies—including injectables, gels, orals, and pellets—their risks, benefits, and considerations around fertility. The conversation also covers how semen analysis serves as a window into overall health, the influence of lifestyle changes (like weight loss, sleep, and stress management) on hormone levels, and the relationship between testosterone, cardiovascular health, depression, and prostate cancer. Dr. Khera and Dr. Malik explore regenerative therapies for erectile dysfunction, including hyperbaric oxygen, shockwave therapy, stem cells, PRP, and Botox, and discuss lesser-known issues such as post-finasteride syndrome and the status of sexual health in women. Become a Member to Receive Exclusive Content: renamalik.supercast.com Schedule an appointment with me: https://www.renamalikmd.com/appointments ▶️Chapters: 00:00:00 – Introduction 00:02:10 – The Testosterone Decline 00:06:07 – Free vs. Total Testosterone 00:11:32 – TRT Options 00:14:19 – Oral Testosterone & Fertility 00:17:26 – Protecting Fertility on TRT 00:20:38 – Recovery After TRT 00:29:10 – The Power of Estrogen 00:38:48 – Boosting Testosterone Naturally 00:42:31 – Stress & Operator Syndrome 00:50:12 – ED & Shockwave Therapy 00:55:13 – Regenerative Therapies 01:36:24 – Closing Thoughts Stay connected with Dr. Mohit Khera on social media for daily insights and updates. Don't miss out—follow him now and check out these links! INSTAGRAM - https://www.instagram.com/drmohitkhera/?hl=en X - https://x.com/drmohitkhera?lang=en WEBSITE - https://drmohitkhera.com/ Let's Connect!: WEBSITE: http://www.renamalikmd.com YOUTUBE: https://www.youtube.com/@RenaMalikMD INSTAGRAM: http://www.instagram.com/RenaMalikMD TWITTER: http://twitter.com/RenaMalikMD FACEBOOK: https://www.facebook.com/RenaMalikMD/ LINKEDIN: https://www.linkedin.com/in/renadmalik PINTEREST: https://www.pinterest.com/renamalikmd/ TIKTOK: https://www.tiktok.com/RenaMalikMD ------------------------------------------------------ DISCLAIMER: This podcast is purely educational and does not constitute medical advice. The content of this podcast is my personal opinion, and not that of my employer(s). Use of this information is at your own risk. Rena Malik, M.D. will not assume any liability for any direct or indirect losses or damages that may result from the use of information contained in this podcast including but not limited to economic loss, injury, illness or death. Learn more about your ad choices. Visit megaphone.fm/adchoices
In this conversation, Dr. Mohit Khera discusses the critical role of testosterone in men's health, its implications for various comorbid conditions, and the importance of lifestyle modifications. He emphasizes the need for regular testosterone level checks, especially for men over 40, and explores the interplay between testosterone and mental health. This episode also covers: - The definition of low testosterone - Underlying causes of low testosterone, including obesity and stress - How to optimize testosterone levels with a holistic approach that includes diet, exercise, sleep, and stress management - The critical relationship between health span, sexual health, and preventative care - The importance of early screening for conditions like erectile dysfunction, which can signal underlying cardiovascular issues - The interconnectedness of hormonal health, particularly the balance of testosterone, estrogen, and progesterone Show Notes:Check out the study referenced by Dr. Khera on the effect of testosterone supplementation on depression symptoms, the study on erectile dysfunction and cardiovascular disease, and explore the Sexual Men's Society of North America website. Learn more about Dr. Khera and follow him on Instagram @drmohitkhera! Get access to comprehensive patient reports, peer-reviewed and validated research, and expert clinical support by becoming a DUTCH Provider today.
Struggling with erectile dysfunction that just won't quit? When pills and other treatments fail, penile implant offers a life-changing solution. But how do they work, who are they for, and what are the risks?In this episode, we dive deep with renowned urologist Dr. Mohit Khera to uncover the truth about penile implant and how it can restore your sexual function. If you think you know all your options for ED, think again. This episode is packed with eye-opening insights that could revolutionize your sex life.Tune in now and take control of your sexual health!--------------About Mohit KheraDr. Mohit Khera is a world-renowned urologist, researcher, and educator specializing in men's health, sexual medicine, and hormone replacement therapy. A Professor in the Scott Department of Urology at Baylor College of Medicine, Dr. Khera holds the prestigious F. Brantley Scott Chair in Urology and serves as President of the Sexual Medicine Society of North America. With over 120 published articles, 250 international lectures, and groundbreaking clinical trials, Dr. Khera is a leader in advancing care for erectile dysfunction and other sexual health conditions. Known for his passion for education, he frequently shares his expertise on television, in academic settings, and through public outreach.--------------If you liked this episode, please SUBSCRIBE, like, leave a comment, and share so we can keep bringing you valuable content that gets results!--------------Follow Me On:InstagramTwitterFacebookTikTokYouTube--------------For all links and resources mentioned on the show and where to subscribe to the podcast, please visit https://sexualhealthformenpodcast.com/ultimate-guide-penile-implant-erectile-dysfunction-treatment--------------Ready to empower your health journey? Secure your FREE PDF copy of the “5 Natural Solutions to Overcome ED” today! Dive into knowledge that could transform your life. Click the link below to claim your copy
Are you curious about the latest breakthroughs in treating and preventing erectile dysfunction?In this groundbreaking episode, world-renowned urologist Dr. Mohit Khera spills the beans on the latest advancements in treating and preventing erectile dysfunction. From simple lifestyle tweaks to cutting-edge therapies, Dr. Khera reveals how to regain your confidence and reignite your passion. But that's not all—learn how ED can be a red flag for serious health issues and why taking action now could save your life.Tune in to this life-changing conversation and unlock the secrets to a happier, healthier you.--------------About Mohit KheraDr. Mohit Khera is a world-renowned urologist, researcher, and educator specializing in men's health, sexual medicine, and hormone replacement therapy. A Professor in the Scott Department of Urology at Baylor College of Medicine, Dr. Khera holds the prestigious F. Brantley Scott Chair in Urology and serves as President of the Sexual Medicine Society of North America. With over 120 published articles, 250 international lectures, and groundbreaking clinical trials, Dr. Khera is a leader in advancing care for erectile dysfunction and other sexual health conditions. Known for his passion for education, he frequently shares his expertise on television, in academic settings, and through public outreach.--------------If you liked this episode, please SUBSCRIBE, like, leave a comment, and share so we can keep bringing you valuable content that gets results!--------------Follow Me On:InstagramTwitterFacebookTikTokYouTube--------------For all links and resources mentioned on the show and where to subscribe to the podcast, please visit https://sexualhealthformenpodcast.com/erectile-dysfunction-treatment-prevention-dr-mohit-khera--------------Ready to empower your health journey? Secure your FREE PDF copy of the “5 Natural Solutions to Overcome ED” today! Dive into knowledge that could transform your life. Click the link below to claim your copy
Dive into the extraordinary life and teachings of Sant Baba Harnam Singh Ji Rampur Khera Wale, a legendary spiritual figure whose humility, devotion, and selfless service continue to inspire generations. This episode of the Gurmukh Series is based on the acclaimed biography “Se Kinehiya”, a life-changing book that captures Baba Ji's profound spiritual journey and timeless lessons.
What if the key to fixing your sexual health wasn't just about you, but your partner too? Discover why treating sexual dysfunction is a team effort—and how we've been getting it wrong.When it comes to sexual health, the focus is often one-sided. But the reality is that sexual dysfunction is rarely an individual issue—it's a couple's disease.I talk with Dr. Mohit Khera, renowned urologist and past president of SMSNA, to unpack the disparities in sexual health treatment for men and women and why it's time to rethink our approach.Dr. Khera shares personal insights from his career, revealing how focusing on one partner's libido or function can create unexpected challenges in a relationship. We explore the hidden world of male sexual dysfunction, from erectile dysfunction to Peyronie's disease, and uncover why women's sexual health still lags behind in research, funding, and treatment options.We also tackle the controversial topic of testosterone—its impact on men and women, the myths around its use, and why it's still inaccessible for women despite clear benefits. Dr. Khera offers actionable advice on lifestyle changes, sleep, and stress management that can dramatically improve sexual function for both partners.This isn't just about medicine—it's about partnership, communication, and the power of addressing sexual health as a team. Join us for a candid discussion that might change the way you think about intimacy, health, and what it means to truly support your partner.Highlights:Why sexual dysfunction is a “couple's disease” and how treating one partner impacts the other.The silent epidemic of Peyronie's disease and its profound emotional toll.The overlooked benefits of testosterone for women and why FDA-approved options remain elusive.How lifestyle changes like the Mediterranean diet, exercise, and sleep can reverse sexual dysfunction.The importance of destigmatizing sexual health concerns and advocating for the right care.If this episode resonated with you, don't keep it to yourself! Like, subscribe, and leave a comment to help us continue these essential conversations. Share this episode with someone who needs to hear it.Dr. Khera's Bio:Dr. Khera earned his undergraduate degree at Vanderbilt University. He subsequently earned his Masters Degree in Business Administration and his Masters Degree in Public Health from Boston University. He received his Medical Degree from The University of Texas Medical School at San Antonio and completed his Urology residency training in the Scott Department of Urology at Baylor College of Medicine. At Baylor, he completed a one-year general surgery internship and then went on to complete a five-year residency program in Urology. After completing his Urology residency, he went on to complete a one-year fellowship in Male Reproductive Medicine and Surgery at Baylor. Currently, he is a Professor in the Scott Department of Urology at Baylor College of Medicine, and he holds the F. Brantley Scott Chair in Urology. Dr. Khera specializes in male and female sexual dysfunction, Men's Health, and hormone replacement therapy. Dr. Khera also serves as the Director of the Laboratory for Andrology Research, the Medical Director of the Baylor Executive Health Program, and the Medical Director of the Scott Department of Urology. He also serves as President of the Sexual Medicine Society of North America.Dr. Khera has dedicated his clinical and research efforts to three main areas: Men's Health, sexual medicine, and hormone replacement therapy. Soon after completing my fellowship, he started the Laboratory for Andrology Research. His laboratory focuses on basic science research, and he has had the opportunity to train many residents and research fellows over the past 12 years. In addition to his basic science research, he has...
Join us as we welcome the incredible urologist and renown sexual medicine expert Dr. Mohit Khera, to discuss the various treatments for erectile dysfunction. Learn about how ED is treated, and how the various medications work. Listen now to the new episode for free on Spotify, Apple Podcasts and YouTube.
The Literature Lounge stands out as a unique podcast series devoted to authors whose books captivate readers and serve as catalysts for stimulating conversations. In partnership with Rupa Publications India, one of the leading publishing companies in India, we will host authors from diverse backgrounds to explore their literary works, delve into their creative journeys, and uncover the inspirations behind their achievements. So, let's dive into the world of books.Episode SummaryIn this episode of The Literature Lounge, we are joined by the dynamic Dr. Shamoly Khera to explore her latest book, Letters to Daughters of Tomorrow. Shamoly opens up about the book's powerful message of breaking free from stereotypes and societal conditioning, sharing how deeply the chapters resonate with her own life. She discusses the importance of women uplifting one another, the transformative effect of recognition in both her personal and professional spheres, and the empowering strength found in the ability to say "no." Tune in for an insightful conversation on embracing authenticity and empowerment.Chapters00:00 - Introduction01:48 - Book's Inspiration07:20 - Leadership Challenges for Women11:38 - Facing Gender Stereotypes14:24 - Breaking Societal Norms19:51 - Most Impactful Chapter24:40 - Women with Masculine Traits32:57 - Personal Achievements39:56 - Words to Younger Self42:00 - Mastering the Power of 'No'46:10 - Final ThoughtsConnect with UsMohua Chinappa: https://www.linkedin.com/in/mohua-chinappa/The Mohua Show: https://www.themohuashow.com/Connect with the GuestShamoly Khera: https://www.instagram.com/shamoly.khera/ Follow UsYouTube: https://www.youtube.com/@TheMohuaShowInstagram: https://www.instagram.com/themohuashow/LinkedIn: https://www.linkedin.com/company/themohuashow/Facebook: https://www.facebook.com/themohuashow/For any other queries EMAILhello@themohuashow.comBook Link Letters to Daughter of Tomorrow: Breaking Stereotypes to Unleash Her Potential:https://amzn.in/d/hs48Op2 DisclaimerThe views expressed by our guests are their own. We do not endorse and are not responsible for any views expressed by our guests on our podcast and its associated platforms.#TheMohuaShow #TheLiteratureLounge #Podcast #PodcastEpisode #Literature #Storytelling #PodcastInterview #Writers #WritersOfIndia #Authors #ShamolyKhera #BreakingStereotypes #SocietalNorms #WomenEmpowerment #Feminism #Empowerment #Patriarchy Thanks for Listening!
On this week's podcast, Dr Louise is joined by Dr Mohit Khera, a US-based leading urology specialist treating urinary tract disorders, male infertility, and male and female sexual dysfunction. They discuss the role of testosterone, the most biologically active hormone in the female body, why he believes testosterone is the best barometer of health of all hormones, and testosterone replacement. For more information about Dr Mohit, click here, and you can follow him on Instagram @ drmohitkhera. For more information on Newson Health, click here. Dr Louise Newson's first-ever live theatre tour, Hormones and Menopause – The Great Debate, takes place 27 September to 12 November. For more information and tickets, click here.
In Episode 1102, Dr. Mohit Khera, Mark Bell, Nsima Inyang, and Andrew Zaragoza talk about how erectile dysfunction may be an indicator of a much severe issue. They also discuss cures and remedies for erectile disfunction and what helps Dr. Khera's patients better than testosterone replacement therapy. Follow Dr. Mo on IG: https://www.instagram.com/drmohitkhera/ Official Power Project Website: https://powerproject.live Join The Power Project Discord: https://discord.gg/yYzthQX5qN Subscribe to the Power Project Clips Channel: https://youtube.com/channel/UC5Df31rlDXm0EJAcKsq1SUw Special perks for our listeners below!
In Episode 1102, Dr. Mohit Khera, Mark Bell, Nsima Inyang, and Andrew Zaragoza talk about how erectile dysfunction may be an indicator of a much severe issue. They also discuss cures and remedies for erectile disfunction and what helps Dr. Khera's patients better than testosterone replacement therapy. Follow Dr. Mo on IG: https://www.instagram.com/drmohitkhera/ Official Power Project Website: https://powerproject.live Join The Power Project Discord: https://discord.gg/yYzthQX5qN Subscribe to the Power Project Clips Channel: https://youtube.com/channel/UC5Df31rlDXm0EJAcKsq1SUw Special perks for our listeners below!
Hi guys! Welcome back :) Today, I sat down with Sunaina Khera, a world renowned designer, known for her slow fashion and highly in -demand bridal and bridesmaid fashion. She is known for her modern monotone lehengas, intricately designed and filled with glamor, glitz and elegance, offering a unique perspective and story to every collection she curates. Various Bollywood celebrities like Radhika Apte, Sonam Kapoor, Malaika Arora Khan, Tara Sutaria to name a few have been styled by the designer. Khera has gained recognition for her designs and has been featured in magazines such as Harper's Bazaar, Vogue, Cosmopolitan and Brides today. Sunaina is here today to talk about the beginnings of her label and how she was able to get to where she is today despite difficulties and challenges along the way. enjoy :)
Hi guys! Welcome back :) Today, I sat down with Sunaina Khera, a world renowned designer, known for her slow fashion and highly in -demand bridal and bridesmaid fashion. She is known for her modern monotone lehengas, intricately designed and filled with glamor, glitz and elegance, offering a unique perspective and story to every collection she curates. Various Bollywood celebrities like Radhika Apte, Sonam Kapoor, Malaika Arora Khan, Tara Sutaria to name a few have been styled by the designer. Khera has gained recognition for her designs and has been featured in magazines such as Harper's Bazaar, Vogue, Cosmopolitan and Brides today. Sunaina is here today to talk about her personal life from dating to marriage to her relationship with social media and success! enjoy :)
Dr. Khera earned his undergraduate degree at Vanderbilt University. He subsequently earned his Masters Degree in Business Administration and his Masters Degree in Public Health from Boston University. He received his Medical Degree from The University of Texas Medical School at San Antonio and completed his Urology residency training in the Scott Department of Urology at Baylor College of Medicine. At Baylor, he completed a one-year general surgery internship and then went on to complete a five-year residency program in Urology. After completing his Urology residency, he went on to complete a one-year fellowship in Male Reproductive Medicine and Surgery at Baylor. Currently he is a Professor in the Scott Department of Urology at Baylor College of Medicine and he holds the F. Brantley Scott Chair in Urology. Dr. Khera specializes in male and female sexual dysfunction, Men's Health and hormone replacement therapy. Dr. Khera also serves as the Director of the Laboratory for Andrology Research, the Medical Director of the Baylor Executive Health Program and the Medical Director of the Scott Department of Urology. He also serves as President-Elect of the Sexual Medicine Society of North America. Dr. Khera has dedicated his clinical and research efforts to three main areas: Men's Health, sexual medicine, and hormone replacement therapy. Soon after completing my fellowship he started the Laboratory for Andrology Research. His laboratory focuses on basic science research and he has had the opportunity to train many residents and research fellows over the past 12 years. In addition to his basic science research, he has initiated numerous FDA approved clinical trials. His basic science and clinic experiences have allowed him to thus far give over 250 lectures at scientific meetings throughout the world, publish over 120 articles in peer reviewed journals, complete 15 book chapters, and edit and write two books all in the field of sexual medicine and Men's Health. In 2007 he was awarded the American Urologic Association (AUA) Research Scholars Award to study the correlation between ED and BPH. In 2013 he was elected to serve a 4 year term on the American Urologic Society Examination Committee. Dr. Khera has also served on the AUA Peyronie's Disease and Erectile Dysfunction Guidelines Panel. For the past several years he has taught numerous course in testosterone therapy and sexual dysfunction nationally and throughout the world. Dr. Khera freely shares his time and knowledge with the general public. He has been voted several times as one of Houston's Best Doctors by Health and Sport Fitness Magazine and by Houstonia Magazine and is a frequent guest on such TV programs as Fox News' "Ask the Doctor." He also writes a blog on Men's Health for the Houston Chronicle Newspaper.
Imagine transforming your vacation rental business into a seamless, tech-driven hospitality powerhouse, captivating guests with personalized experiences that foster loyalty and ignite revenue growth. This vision is within reach, thanks to the pioneering strategies unveiled in this thought-provoking episode.Shiven Vinod Khera, the visionary co-founder and CEO of Linkbase Technologies, takes us on a journey through the cutting edge of vacation rental management. Brace yourself as he unveils the game-changing potential of AI and automation to revolutionize guest interactions, streamline operations, and unlock untapped revenue streams.One revelation that will leave you questioning the status quo? Guests typically allocate a staggering 70% of their vacation budget to activities and services beyond accommodation. Yet, this lucrative opportunity often goes untapped by property managers. Shiven deftly navigates this terrain, sharing strategic upselling techniques that allow you to effortlessly capture a share of this market, boosting your bottom line without compromising the guest experience.In this episode, you will be able to:Innovative ways to leverage AI for personalized guest communication and tailored upsell opportunitiesPractical tips for automating access, streamlining check-in, and enhancing operational efficiencyInsights into the power of data-driven guest experiences and nurturing direct repeat bookingsReal-world examples of successful upsell strategies, from early check-in to unique local experiencesA special limited-time offer from Linkbase to help you kickstart your journey towards elevated hospitalityAbout Shiven Vinod KheraShiven Vinod Khera, the co-founder and CEO of Link based Direct Booking Success, brings a blend of entrepreneurial acumen and a passion for innovation to the vacation rental management space. Originally from New Delhi, India, Shiven's journey into the world of vacation rentals was a serendipitous one, stemming from a university project focused on IoT platforms. His forward-thinking approach, with an emphasis on automation, AI messaging, and tailored guest experiences, has positioned him as a trailblazer in redefining hospitality practices. Shiven's unique background and unwavering commitment to leveraging technology for property management make him a compelling figure for those seeking to optimize revenue streams and elevate guest experiences in the vacation rental industry.Connect with Shiven & LinkBase:Instagram: https://www.instagram.com/_linkbase_/Website: https://linkbase.ca/Shiven's LinkedIn: https://www.linkedin.com/in/shiven-vinod-khera-a05149120/** EXCLUSIVE OFFER FOR DIRECT BOOKING SUCCESS PODCAST LISTENERS **LinkBase is waiving $600 boarding fee and offering 2 months of service for FREE! Don't miss out on valuable upsell opportunities. This offer is valid until August 15, 2024. Claim this special deal and boost your 5-star reviews, and increase revenue with LinkBase. The key moments in this episode are:00:00:41 Introduction to Direct Booking Success Podcast00:01:51 Shiven Vinod Khera's Journey and Recognition00:04:38 Entrepreneurial Beginnings and Business Journey00:06:40 Entry into the Vacation Rental Space00:12:09 The Importance of Upselling in Property Management00:12:55 Enhancing Guest Experience through Upsells00:14:35 Key Upsell Opportunities for...
Renowned expert Dr. Mo Khera sheds light on common sexual dysfunctions in both men and women, emphasizing the startling connection between erectile dysfunction and heart attacks.We delve into testosterone, exploring why low levels might not always warrant treatment and the importance of considering symptoms alongside testosterone levels for therapy decisions.The conversation extends to female sexual dysfunction, stressing the significance of addressing common symptoms and a woman's unique concerns.Dr. Khera speaks to the role of testosterone replacement therapy (TRT), providing in-depth insights and dispelling myths about increased risks of prostate cancer and heart disease.Join us in this eye-opening podcast where we tackle the often neglected topic of sexual health in relation to your overall wellbeing.
In this episode of TOP CMO, host Ben Kaplan sits down with Mandeep Khera, the Chief Marketing Officer of SecureAuth, to explore the shifting dynamics of the buyer's journey in the digital age. Mandeep discusses how today's buyers are increasingly well-informed and often make decisions long before they engage with sales teams. Learn how SecureAuth leverages this trend by tailoring marketing strategies that meet informed buyers where they are, emphasizing the importance of accurate and accessible information. Mandeep also sheds light on the evolving role of CMOs in shaping business strategy and the impact of AI and personalization on future marketing practices. Dive into a conversation that blends practical marketing insights with broader discussions on the importance of adaptability and innovation in a rapidly changing landscape.
Taboo to Truth: Unapologetic Conversations About Sexuality in Midlife
I'm honored to host Dr. Mohit Khera, a world-renowned expert on male sexual dysfunction. Dr. Khera brings his vast experience to the table, discussing the sensitive issue of sexual health with compassion and understanding. We take a deep dive into how modern medicine is transforming the way we approach and treat conditions such as erectile dysfunction, discussing both traditional and cutting-edge treatments that are giving new hope to many. The episode also explores the often-overlooked emotional and psychological dimensions of sexual dysfunction. Dr. Khera gives his expert advice on the importance of a supportive partnership and the benefits of a comprehensive treatment plan that includes both medical and lifestyle interventions. For anyone affected by or interested in male sexual health, this episode is an invaluable resource, offering hope, enlightenment, and practical guidance from one of the leading voices in the field. Dr. Mohit Khera Instagram ********************************************************** Have a burning question or topic suggestion? karen@taboototruth.com https://www.taboototruth.com/ https://www.instagram.com/taboototruth https://www.tiktok.com/@taboototruth Youtube @taboototruthpodcast *this podcast is not intended to give medical advice. Karen Bigman is not a medical professional. For any medical questions or issues, please visit your medical provider. --- Send in a voice message: https://podcasters.spotify.com/pod/show/taboototruth/message
The Honourable Kamal Khera was first elected as the Member of Parliament for Brampton West in 2015. She has previously served as Minister of Seniors, as Parliamentary Secretary to the Minister of International Development, as Parliamentary Secretary to the Minister of National Revenue, and as Parliamentary Secretary to the Minister of Health. Minister Khera is one of the youngest women ever elected to Parliament. A registered nurse, community volunteer, and political activist, she is passionate about improving the lives of those around her. Prior to entering politics, she worked as a registered nurse in the oncology unit at St. Joseph's Health Centre in Toronto, where she gained a deeper understanding of the issues that impact people's health and well-being every day. During the first wave of the COVID-19 pandemic, she went back to her roots as a registered nurse to volunteer at a hard-hit long-term care facility in her hometown of Brampton. Minister Khera continued to help on the front lines throughout the pandemic, including by administering vaccines in her community. Truly believing that diversity is our strength, Minister Khera is motivated to create a better present and future for all Canadians. Recently, Minister Khera was on our show talking about Black Excellence – A Heritage to Celebrate and a Future to Build. During our conversation, Minister Khera talked about: – Recognizing Black History Month and the Liberal Party's initiatives to help Black Canadians – What does their party need from Black Canadians – What are some of the common challenges she is hearing from Black Canadians You can follow Minister Khera via: Instagram Visit The Dr. Vibe Show™ at https://www.thedrvibeshow.com/ Please feel free to email us at dr.vibe@thedrvibeshow.com Subscribe to The Dr. Vibe Show™ YouTube channel here Please feel free to “Like” the “The Dr. Vibe Show” Facebook Fan Page here God bless, peace, be well and keep the faith, Dr. Vibe 2020 Podcast News Award Winner – Canadian Ethnic Media Association 2018 Innovation Award Winner – Canadian Ethnic Media Association The Dr. Vibe Show™ At “The Good Men Project” One of the first Brand Ambassador's – Cuisine Noir Magazine Dr. Vibe – Producer And Co-host of Black Men Talking On WJMS Radio Dr. Vibe on HuffPost Live – August 2, 2013 2013 Black Weblog Awards Finalist (Best Podcast) 2012 Black Weblog Awards Winner (Best International Blog) 2012 Black Weblog Awards Finalist (Best Podcast) 2011 Black Weblog Awards Finalist (Best International Blog and Best Podcast Series) Black Blog Of The Day – Black Bloggers Network – June 23, 2011 Twitter Twitter hashtag: #DrVibe The Dr. Vibe Show™ – iTunes The Dr. Vibe Show™ – Spotify Dr. Vibe Media – You Tube Google+ The Dr. Vibe Show™ – Stitcher Radio The Dr. Vibe Show™ – TuneIn Radio The Dr. Vibe Show™ – Google Podcasts The Dr. Vibe Show™ – iHeartRadio The Dr. Vibe Show™ at Anchor Linkedin – The Dr. Vibe Show™ Instagram The Dr. Vibe Show Facebook Fan Page
Raj Khera is an experienced practical SaaS founder who has used search engine optimization (SEO) to grow businesses very efficiently. Now he coaches entrepreneurs at MoreBusiness on how to use organic SEO as a core part of their marketing engine. In this expert interview, I ask Raj to explain the basics of SEO for SaaS founders, what tools and techniques are most useful, and how SaaS founders can make the most of SEO investments to drive revenue faster. SEO for Bootstrapped SaaS Topics Discussed on this Podcast How he used SEO to grow his previous software companies The basic concepts of search engine optimization (SEO) for SaaS founders Simple tactics for identifying search terms that would create qualified traffic His favorite tactic for gaining authority from Google for your organic website content Which search engine marketing tools are most useful to maximize your time and investment The simple ROI math that founders can use to measure their investment return with SEO Learn more at practicalfounders.com.
238. Testosterone: An Education Thanks to our sponsor Sprout Pharmaceuticals addyi.com/notbroken Go to Addyi.com and use code NOTBROKEN for a $10 telemedicine appointment. Thanks to our sponsor Uber Lube 10% off, Code NOTBROKEN uberlube.com Dr. Khera lives in Houston, TX practices at Baylor and has dedicated his clinical and research efforts to three main areas: Men's Health, sexual medicine, and hormone replacement therapy. His basic science and clinic experiences have allowed him to thus far give over 250 lectures at scientific meetings throughout the world, publish over 120 articles in peer-reviewed journals, complete 15 book chapters, and edit and write two books, all in the field of sexual medicine and Men's Health. Why is testosterone so interesting to Dr. Khera? Testosterone and prostate cancer – what do we know. Is a lowering Testosterone in men "natural"? and if it isn't, what causes low testosterone in men? What do the new weight loss drugs do to testosterone levels and male fertility? We discuss the different ways you can give testosterone to women: topical, pellets and compounded injectable doses of testosterone for women: 50mg/ml and start at 0.1 mg injected a week. The benefits of testosterone for women besides low libido. The role of chronic pain and testosterone and pain meds. The mechanism of how your testosterone goes up when you lose body fat. The four pillars of health for natural testosterone production – diet, exercise, sleep, stress reduction Erectile dysfunction is a harbinger for heart attack and heart disease. “There is not a better barometer of a man's overall health than his sexual health” – Dr. Khera The role of DHEA (a mild androgen made in the adrenals) in men and women. The link with Peyronies disease and Testosterone. And we discuss penile stretching devices. We discuss a 2013 Finkelstein article – they gave men testosterone and blocked its conversion to estrogen. So are we undertreating men by not addressing their estrogen? Dr. Khera was part of the NEJM study that came out this summer looking at T in men with low T and high risk CV risk. The Traverse trial. Conclusions: In men with hypogonadism and preexisting or a high risk of cardiovascular disease, testosterone-replacement therapy was non-inferior to placebo with respect to the incidence of major adverse cardiac events. Barriers to a testosterone prescription include that it is a regulated medication, a physician needs a DEA license to prescribe it – similar to a narcotic. Dr. Khera lends his opinion to safe prescribing of testosterone but thinks the DEA regulation is here to stay. He clarifies the number of men who suffer from hypogonadism and the number of men who are undergoing treatment for this condition? Testosterone levels are dropping because men are getting less healthy. Dr. Khera talks about measuring a baseline testosterone level in men as a marker of overall health and focus on lifestyle changes to naturally get this normal. 50% of men don't talk to their doctor about their erectile dysfunction, and 44% of those men don't talk to their partner about it. www.instagram.com/drmohitkhera Dr. Mohit and Dr. Morgentaler's testosterone course NEJM article discussed: Gonadal Steroids and Body Composition, Strength, and Sexual Function Traverse Trial https://drmohitkhera.com/ Did you get my “You Are Not Broken” Book Yet? https://amzn.to/3p18DfK Listen to my Tedx Talk: Why we need adult sex ed Join my NEW Adult Sex Ed Master Class: https://www.kellycaspersonmd.com/adult-sex-ed Join my membership to get these episodes ASAP when they are created and without advertisement and even listen live to the interviews and episodes. www.kellycaspersonmd.com/membership --- Send in a voice message: https://podcasters.spotify.com/pod/show/kj-casperson/message
Shiv Khera : Books, Latest Update - Amazon - https://www.amazon.in/Shiv-Khera/e/B0034PX71M?--------------Subscribe To Our Other YouTube Channels:-https://www.youtube.com/@rajshamaniclipshttps://www.youtube.com/@RajShamani.Shorts----------------- On our podcast, he shares what sets him apart, that his book sold 8 million+ copies and was translated into 21 languages. In today's episode, we talked about the early days of his career and his journey from being fired within 90 days of joining the company to being the best-selling author. He talks about the reality of the people who sell life insurance. He shares the reason why many young people are going through depression and how they can overcome it. We talked about how feeling rejected is linked with low self-worth and self-esteem. We also discussed how young people can deal with rejections and keep winning in life. Towards the end, we talked about what makes a good leader, how ministers can make India better, and how ministers have changed India in recent years. He also shared the reason why he decided to join politics and why he couldn't win.And if this conversation inspired you like it did to me, then don't forget to subscribe to our channel and join us on this journey of Figuring Out. We post interesting and insightful podcasts every Wednesday and Saturday. Follow Shiv Khera Here:YouTube: https://www.youtube.com/@shivkheraofficialTwitter: https://www.twitter.com/imshivkheraFacebook: https://www.facebook.com/shivkheraLinkedin: https://www.linkedin.com/in/shiv-khera-b7892549----------
In this episode of BackTable Urology, Dr. Jose Silva interviews Dr. Mohit Khera, professor of Urology at Baylor College of Medicine, about hypogonadism and testosterone replacement therapy. --- CHECK OUT OUR SPONSOR KYZATREX™ www.kyzatrex.com --- SHOW NOTES First, Dr. Khera explains how comorbid conditions, such as diabetes, metabolic syndrome, and obesity, can decrease testosterone levels as men age. We also discuss the importance of the four pillars of health - diet, exercise, sleep, and stress reduction - and the role of weight loss in increasing natural testosterone levels. Additionally, Dr. Kera outlines the lab results he orders to confirm hypogonadism, which includes testosterone, free testosterone, LH, FSH, prolactin, estradiol, DHT, TSH, IGF-1, and vitamins D and B12. Next, Dr. Khera discusses how to detect low free testosterone levels in patients with normal total testosterone levels and how to adjust treatment depending on the patient's sensitivity to testosterone. The doctors also discuss the role of testosterone in treating depression, the importance of managing estrogen levels, and avoiding overuse of aromatase inhibitors. Dr. Khera gives a brief history of testosterone replacement therapy (TRT), starting from the first oral testosterone formulation created in the 1930s to the new testosterone products developed in 2019. They also discuss the FDA's 2015 requirement for hypertensive testing, as well as the low risk of erythrocytosis associated with these new medications. Finally, Dr. Khera discusses the importance of checking testosterone levels frequently and the controversy surrounding the best time to do so. He explains the difference between using injectables, gels, and pellets, and the importance of checking the trough level instead of the mid-week level. He explains the need to check the liver enzymes when patients are using oral testosterone. He ends by sharing why it is important to consider the whole couple when treating patients with testosterone and not just one partner. --- RESOURCES Miner MM, Khera M, Bhattacharya RK, Blick G, Kushner H. Baseline data from the TRiUS registry: symptoms and comorbidities of testosterone deficiency. Postgrad Med. 2011 May;123(3):17-27. doi: 10.3810/pgm.2011.05.2280. PMID: 21566412. https://pubmed.ncbi.nlm.nih.gov/21566412/ KYZATREX™ by Marius Pharmaceuticals https://www.kyzatrex.com/
SummaryIn this episode of The Luke Coutinho Show, I had an opportunity to engage in a riveting dialogue with the acclaimed Urologist, Dr. Mohit Khera, an authoritative voice in the field of sexual health and medicine, and hormone replacement therapy. Tune in and enrich your understanding of:The pivotal role of testosterone on overall healthA natural path to enhancing testosterone through lifestyle changes.Impact of excessive masturbation and pornography on sexual health.The science behind libido, erectile dysfunction (ED), and premature ejaculation.Common misconceptions surrounding enlarged prostate (BPH).Clinical insights into Peyronie's Disease (curved penis) and painful sex.The significance of night-time erections in maintaining penile health.Integration of lifestyle changes and hormone replacement therapy (HRT) for enhanced sexual well-being.Scientific exploration of women's sexual concerns and therapeutic approaches.The indirect influence of a man's sexual function on his partner's libido.And more…
In this episode of The Luke Coutinho Show, I had the opportunity to have a profound dialogue with the acclaimed author, educator, business consultant, and inspirational speaker Shiv Khera. Discover his journey from coal mines to choices, and explore his valuable insights on: ▪️ Balancing confidence and humility▪️ Shaping life through timely action▪️ Choices versus compromises▪️ Cultivating habits for transformation▪️ Distinguishing self-discovery from ego▪️ Embracing the significance of each day▪️ And much more…
Megyn Kelly brings listeners and viewers a deep dive on men's sexual health, with Dr. Mohit Khera, a professor of urology and expert on the issue. They discuss how men don't focus on their sexual health in the same way women do, the causes of erectile dysfunction (ED), ways men can prevent EDs, the decline of testosterone levels and sperm count worldwide, the causes of male infertility, discuss whether there is a cure for erectile dysfunction, what stem cell therapy is, how “shockwave therapy" works, the differences between Viagra and Cialis, other more substantial treatments of ED, the connection between testosterone and libido, how antidepressants can affect libido, the different ways to take testosterone, the reality of Peyronie's disease that men suffer from silently, testicular cancer risk factors, what parents should think about for their young boys, the balance with porn, new drugs that help increase women's libido, and more.Khera: https://www.drmohitkhera.comFollow The Megyn Kelly Show on all social platforms: YouTube: https://www.youtube.com/MegynKellyTwitter: http://Twitter.com/MegynKellyShowInstagram: http://Instagram.com/MegynKellyShowFacebook: http://Facebook.com/MegynKellyShow Find out more information at: https://www.devilmaycaremedia.com/megynkellyshow
This week we are joined by Dr Jagjit Singh Khera, founder of Lions Judo and one of the event organisers of the Craig Fallon Cup. We recorded this episode just a couple of days after this years Craig Fallon Cup. The event was set up in memory of Craig and we talk through the event and what they want it do as Craigs legacy, as well as the amazing support it received from the British Judo community. If you are struggling with your mental health please reach out to someone, and organisations like The Samaritans or Mind.https://www.samaritans.org/https://www.mind.org.uk/
View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter Mohit Khera is a world-renowned urologist with expertise in sexual medicine and testosterone therapy. In this episode, Mohit provides a comprehensive overview of male sexual health. He begins with an in-depth exploration of erectile dysfunction, shedding light on its prevalence across different age groups, diagnostic methods, and its intriguing connection to cardiovascular disease. He then ventures into Peyronie's disease, penile fractures, penile enlargement treatments, prolonged erections, premature ejaculation, and anorgasmia. Shifting gears, Mohit delves into the intricate workings of testosterone, DHT, and estrogen, emphasizing their physiological significance and interplay. He explains blood tests for diagnosing low testosterone, the correlation between symptoms and blood levels in cases of low testosterone, and the pros and cons of different methodologies for increasing testosterone. He concludes with a thought-provoking conversation about the role of testosterone in patients with prostate cancer and addresses concerns surrounding DHT, finasteride, and post-finasteride syndrome. We discuss: Mohit's career path and interest in sexual medicine and infertility [3:00]; The anatomy of the male genitalia [5:45]; The prevalence of sexual dysfunction, its impact on quality of life, and the importance of seeking help [7:15]; Erectile dysfunction (ED): definition, diagnosis, pathophysiology, and more [11:00]; The history of medications to treat ED and the mechanisms of how they work [15:30]; Relationship between aging and erectile dysfunction and Mohit's approach to treating patients and prescribing medications [20:00]; The impact of lifestyle on sexual health and the association between ED and cardiovascular disease [29:30]; Causes and treatments for Peyronie's Disease, penile fracture, and more [37:30]; The value of ultrasound for ED diagnosis and management strategies [47:45]; Various treatment options for ED: injections, penile prosthesis, and more [50:15]; Priapism (prolonged erection): what is happening and when to seek treatment [57:15]; Shockwave therapy as a treatment for ED [1:02:45]; Stem cell therapy for ED [1:08:15]; Platelet-rich plasma (PRP) injections as a treatment for ED [1:12:00]; Premature ejaculation (PE): prevalence, pathophysiology, and treatment [1:14:45]; Anorgasmia: causes and treatment [1:22:00]; The interplay of sex hormones, the impact of aging, symptoms of low testosterone, and considerations for testosterone replacement therapy (TRT) [1:26:45]; Methods for increasing endogenous testosterone [1:38:45]; Testosterone replacement therapy: various forms of exogenous testosterone, weighing risk vs. reward, and more [1:52:30]; The physiology and purpose of testosterone and DHT, why some men feel fine even with “low” testosterone, personalized approaches to treating low testosterone, and more [2:02:30]; Post-finasteride syndrome [2:09:00]; The role of testosterone in prostate cancer and addressing the notion that TRT could increase risk [2:16:15]; The effects of testosterone as an adjunct to therapy for estrogen-sensitive breast cancer in women [2:27:15]; Resources for those looking for healthcare providers [2:28:45]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube
Low testosterone in men is becoming a bigger problem with each passing decade. But what is the most significant cause of hypogonadism (the technical term for low testosterone)? It isn't diet. It's not environmental toxins or concussions, though they can affect a guy's levels. It isn't even drinking Bud Light. As you might surmise from the article's title, the most significant cause of low testosterone is circadian syndrome, a condition related to a disrupted circadian rhythm and sleep debt. A new study shows how much of a problem this is for American men. In this article, I'll discuss some of the key findings and what we can do about them. What is the prevalence of low testosterone? The most current research shows that 20-50% of U.S. males have testosterone deficiency.Kwong JCC, Krakowsky Y, Grober E. Testosterone deficiency: a review and comparison of current guidelines. J Sex Med. (2019) 16:812–20. doi: 10.1016/j.jsxm.2019.03.262 The cutoff for clinically diagnosed testosterone deficiency is a blood level 300 ng/dl, which is where the data comes from, suggesting that up to half of American men have low testosterone. In comparison, optimal testosterone levels are between 800-1200 ng/dl. The problem is likely worse than that, as American men are less likely to get a checkup with their doctor than women, and even if they do, their doctors rarely check testosterone levels. What happens to men with low testosterone? Low testosterone leads to physical, mental, and sexual problems, including: Physical Changes: increased body fat, decreased muscle mass and strength, fragile bones, hot flashes, fatigue, and increased cholesterol levels.Mulligan, T., Frick, M. F., Zuraw, Q. C., Stemhagen, A., & McWhirter, C. (2006). Prevalence of hypogonadism in males aged at least 45 years: the HIM study. International Journal of Clinical Practice, 60(7), 762-769. Mental and Emotional Changes: changes in mood and mental capacity, including feelings of depression, irritability, trouble concentrating, and impaired memory.Shores, M. M., Sloan, K. L., Matsumoto, A. M., Moceri, V. M., Felker, B., & Kivlahan, D. R. (2012). Increased incidence of diagnosed depressive illness in hypogonadal older men. Archives of General Psychiatry, 61(2), 162-167. Sexual Dysfunction: reduced sexual desire, fewer spontaneous erections, and infertility.Khera, M. (2016). Male hormones and men's quality of life. Current Opinion in Urology, 26(2), 152-157. In many cases, as men develop any of these health problems, the health problems themselves lead to a greater decline in testosterone, which worsens the problems, which further tanks testosterone. You must break the downward cycle, and sleep is likely the most important place to start. What is Circadian Syndrome (CircS)? According to the study authors, CircS is primarily diagnosed based on hypertension, dyslipidemia, central obesity, diabetes, short sleep duration, and depression. Each of those symptoms is mainly governed by circadian rhythms, which are major regulators in almost every aspect of human health and metabolism. Association between the prevalence rates of circadian syndrome and testosterone deficiency in US males: data from NHANES (2011–2016) The Circadian Syndrome is diagnosed when a person has at least 4 of the following: Central obesity: waist circumference ≥102 cm (40 inches); High triglycerides (TG): TG ≥150 mg/dl or using TG-lowering drugs Low high-density lipoprotein cholesterol: high-density lipoprotein cholesterol
Have you ever met a circus performer? If you're anything like me odds are that you haven't. In this episode, Khera, a former circus performer, explains the behind-the-scenes of the circus. She talks about the unique lifestyle of circus performers, the amount of training that goes into it, and the dangers that come with the profession. She also shares the story about the time when her team almost died in a training accident. Enjoy! VISIT OUR WEBSITE ► https://almostfalse.net
On today's episode of the Dr. Geo podcast, we have a special guest, Dr. Mohit Khera, a renowned urologist and professor in the Scott Department of Urology at Baylor College of Medicine. He holds the F. Brantley Scott Chair in Urology and has extensive experience treating male and female sexual dysfunction, men's health, and hormone replacement therapy.This captivating episode reveals the intricate relationship between testosterone and the prostate. Throughout the episode, we explore the nature of testosterone, its receptors, and its effects on the body. We also address controversies surrounding testosterone and its relationship to the prostate, including the development of prostate cancer. Join us as we gain insights from Dr. Khera's wealth of knowledge on this fascinating topic._________________Thank you to our sponsors.This episode is brought to you by ExoDx™ Prostate Test for prostate tissue. The ExoDx™ Prostate Test is a simple, non-DRE, urine-based, liquid biopsy test indicated for men 50 years of age and older with a prostate-specific antigen (PSA) 2-10ng/mL, or PSA in the “gray zone” who may be considering a biopsy. The ExoDx Prostate test provides a risk score that determines a patient's potential risk of clinically significant prostate cancer (Gleason Score ≥7). The test is included in the National Comprehensive Cancer Network (NCCN) guidelines and has been clinically validated at the cut-point of 15.6 with a 91% sensitivity and 92% negative predictive value, meaning there is less than a 9% chance of having aggressive prostate cancer below the validated cut-point of 15.6. Ask your urologist about the ExoDx Prostate Test.This episode is also brought to you by AG1 (Athletic Greens). AG1 contain 75 high-quality vitamins, minerals, whole-food sourced ingredients, probiotics, and adaptogens to help you start your day right. This special blend of ingredients supports your gut health, your nervous system, your immune system, your energy, recovery, focus, and aging. All the things. Enjoy AG1 (Athletic Greens).----------------Thanks for listening to this week's episode. Subscribe to The Dr. Geo YouTube Channel to get more content like this and learn how you can live better with age.You can also listen to this episode and future episodes of the Dr. Geo Podcast by clicking HERE.----------------Follow Dr. Geo on social media. Facebook, Instagram Click here to become a member of Dr. Geo's Health Community.Improve your urological health with Dr. Geo's formulated supplement lines: XY Wellness for Prostate cancer lifestyle and nutrition: Mr. Happy Nutraceutical Supplements for prostate health and male optimal living.You can also check out Dr. Geo's online dispensary for other supplement recommendations Dr. Geo's Supplement Store____________________________________DISCLAIMER: This audio is educational and does not constitute medical advice. This...
This week, please join authors Marc Sabatine and Prakriti Gaba, as well as Associate Editor Amit Khera, as they discuss the article "Association Between Achieved Low-Density Lipoprotein Cholesterol Levels and Long-Term Cardiovascular and Safety Outcomes: An Analysis of FOURIER-OLE." Dr Greg Hundley: Welcome listeners, to this April 18th issue of Circulation on the Run and I am Dr. Greg Hundley, Associate Editor, Director of the Pauley Heart Center at VCU Health in Richmond, Virginia. Dr Peder Myhre: And I'm Dr. Peder Myhre, Social Media Editor from Akershus University Hospital and University of Oslo. Dr Greg Hundley: Peder, today's feature discussion, very interesting. We're going to evaluate the association between what's achieved with LDL cholesterol lowering, and then also long-term cardiovascular and safety outcomes. But before we get to that, how about we grab a cup of coffee and discuss some of the other articles in the issue? Would you like to go first? Dr Peder Myhre: Yes, Greg. I would love to. And the first paper is from the World of Preclinical Science and it comes to us from corresponding author, Jan Magnus Aronsen from University of Oslo in Norway. And perhaps, as you know, Greg, cardiomyocyte contraction and relaxation depend on the activity of the sarcoplasmic reticulum CA+2 ATPase 2, abbreviated SERCA2, and lowered levels or reduced activity of SERCA2, as seen in chronic heart failure, weakens contractile force and delays relaxation and no available therapy involves direct manipulation of the SERCA2 activity. And Greg, phosphodiesterase 3A is proposed to be present in the SERCA2 interactome limit SERCA2 activity and disruption of phosphodiesterase 3A from SERCA2 might thus be a strategy to develop SERCA2 activators. And in this study, the authors investigated and mapped SERCA2 and phosphodiesterase 3A and assessed this in experiments assessing the binding between these two in cardiomyocytes and in vesicles. Dr Greg Hundley: Wow Peder, sounds very interesting. So what did they find and how about the clinical implications of the findings? Dr Peder Myhre: So Greg phosphodiesterase 3A bounded directly to SERCA2 in the cardiomyocyte. So that's the first finding. Second, they demonstrated that SERCA2 phosphodiesterase 3A disruption increased SERCA2 activity independently of the catalytic activity of phosphodiesterase 3A in both normal and failing cardiomyocytes. And third, SERCA2 activity by the optimized SERCA2 phosphodiesterase 3A disruptor peptide OPT F reduced mortality and improved contractility after aortic binding in mice. So the clinical implication is that direct targeting of phosphodiesterase 3A binding to SERCA2 could be a novel approach to increase SERCA2 activity and thus cardiac contractility in patients with heart failure. Dr Greg Hundley: Very nice Peder. What a great new finding in the world of preclinical science. Well my paper is going to delve into the world of clinical science and involves patients with stroke. So Peder in this study led by corresponding author, Dr. Dileep Yavagal from University of Miami Miller School of Medicine performed a survey in 75 countries through the Mission Thrombectomy 2020+ Global Network between November of 2020 and February of 2021 to determine the availability of mechanical thrombectomy for large vessel occlusion in patients with stroke. Now Peder, the primary endpoints were the current annual mechanical thrombectomy availability, the mechanical thrombectomy operator availability and the mechanical thrombectomy center availability. All of these availabilities were defined as the proportion of estimated large vessel occlusion for patients receiving mechanical thrombectomy in a given region annually. Dr Peder Myhre: Okay, Greg, so this is really an access question. So in essence, what is the availability of mechanical thrombectomy worldwide? So what did they find? Dr Greg Hundley: Right, great Peder. So what they found, the authors received 887 responses from 67 countries and low-income countries had 88% lower mechanical thrombectomy availability compared to high-income countries. The global mechanical thrombectomy operator availability was 16.5% of optimal, and the mechanical thrombectomy center availability was only 20.8% optimal. And with these results, the authors indicate that global cooperation and targeted region-specific public health interventions, including all stakeholders involved in stroke care delivery, are really needed to rapidly increase access to this brain-saving and disability-sparing treatment with mechanical thrombectomy really worldwide. Dr Peder Myhre: Oh wow. What a beautiful summary, Greg. Thank you so much. And we also have some other interesting papers in the mailbag today. We have an exchange of letters between Dr. Yang and Dr. O'Donoghue regarding the article “Long Term evolocumab in Patients with Established Atherosclerotic Cardiovascular Disease.” Dr Greg Hundley: Great Peder, and also Professor Perera has a Frontiers article entitled “Unloading the Left Ventricle in Venoarterial ECMO in Who, When and How?” and then finally there's a Research Letter from Professor Verma entitled “Prevalence of Diabetes and Cardiovascular Risk in the Middle East and Africa: The Primary results of the PACT-MEA Study.” Well Peder, how about we jump to that feature discussion? Dr Peder Myhre: Can't wait. Dr Greg Hundley: Welcome listeners to this feature discussion on April 18th and we have with us today Prakriti Gaba and Marc Sabatine from Brigham and Women's Hospital and our own associate editor, Dr. Amit Khera. Welcome everyone. Well Marc, we'll start with you. Can you describe for us some of the background information that really helps constitute the preparation of your study and what was the hypothesis that you wanted to address? Dr. Marc Sabatine: Yeah, thanks Greg and thanks for having us. So we've seen in a variety of epidemiologic cohorts the association between LDL cholesterol and the risk of adverse cardiovascular events like in Framingham Heart Study and UK Biobank. But in those cohorts, in these industrial societies, we don't have the benefit of lots of data in individuals with very low levels of LDL cholesterol and so we had the opportunity with the FOURIER study that was the randomized comparison of evolocumab PCSK9 inhibitor versus placebo to get patients down to extremely low levels of LDL cholesterol and evolocumab. We were able to get individuals down to about 30 mg/dL. And so in addition to all the studies we've done showing the comparison of evolocumab to placebo, we also then had the chance to use FOURIER, and as you'll hear from PK, FOURIER-OLE, the open-label extension, as a cohort to then examine patients' new baseline, if you will, their new achieved LDL cholesterol and then it's association not only with cardiovascular events but safety events. And so the hypothesis is that there would be a relationship with the lower the LDL cholesterol, the lower the risk of cardiovascular events and we wanted to explore how far down that went. And then the second one for safety would be that there wouldn't be any association between low levels of LDL cholesterol and a variety of safety outcomes that rightly or wrongly people have ascribed to low levels of LDL cholesterol. Dr Greg Hundley: Thanks so much, Marc. Well listeners, now we're going to turn to PK, the first author, on this very interesting paper and PK, Marc mentioned to us the FOURIER-OLE study. Maybe describe for us here your study design and then what specifically was your study population? Dr. Prakriti Gaba (PK): Yeah, definitely. Thanks so much for the introduction. So the study population included 27,564 patients with stable atherosclerotic cardiovascular disease and LDL cholesterol levels that were greater than or equal to 70 mg/dL or non-HDL cholesterol greater than or equal to a 100 mg/dL on statin therapy. The patients who then went on to the FOURIER-OLE or the open-label extension part of the trial consisted of about 6,635 patients. And so in this study we essentially evaluated the combination of those populations in 2 separate analyses. We then categorized patients according to 6 pre-specified bins based on their achieved LDL cholesterol levels at designated time points and those ranged from LDL levels of less than 20 mg/dL all the way up to 100 mg/dL. And then we looked at their baseline characteristics and evaluated the cardiovascular and safety outcomes that Dr. Sabatine mentioned earlier. Dr Greg Hundley: Very nice PK. Well we've got a great listening audience today and they're anxious to hear your study results, so can you share those with us please? Dr. Prakriti Gaba (PK): Definitely. So over the course of more than 77,000 patient years of follow-up, we found that there was a monotonic relationship between achieving lower LDL cholesterol levels down to very low levels of less than 20 mg/dL and a lower annualized risk of the primary efficacy endpoint, which was a composite of 5 individual endpoints. We also found that there was a similar relationship observed between lower LDL achieved, LDL cholesterol levels and a lower annualized risk of the secondary efficacy endpoint, and then when we looked at safety, there were actually no clear monotonic trends between lower achieved LDL levels and the risk of any of the 8 adverse events and these included things like serious adverse events, hemorrhagic stroke or muscle related events. Dr Greg Hundley: Very nice PK and I'm sure our listeners are wanting to know, did you find any discrepancy in your results based on either age or gender? Dr. Prakriti Gaba (PK): That's an excellent question, and we did look at age and gender throughout. I think across the board the results were pretty consistent, but additional subanalyses will further address this question. Dr Greg Hundley: Very good. Well listeners now we're going to turn to one of our associate editors, Dr. Amit Khera, who has helped move this article through the process of evaluation with the editorial team. Amit, you have many papers come across your desk, what attracted you to this paper and then how do we put this study's results really in the context of other studies that have sought to dramatically lower LDL cholesterol? Dr. Amit Khera: Well first thanks a lot Greg for allowing me to participate today. I want to congratulate Drs. Gaba and Sabatine on a fantastic paper and the minute I saw it, and you know can tell when you've done this for a while what's a great paper, and this one certainly is and we work closely with them to try to make it better and enhance the analyses and as a group, I think we achieved that. I was fortunate to write an accompanying editorial that you'll see. So I got to take a pretty deep dive in this paper and I want to just talk about sort of what's important here, why is this important, and I think as Dr. Gaba mentioned, there's two sides to this. There's the efficacy side where you talk about LDL lowering and getting to very low levels. Now mind you, they got to, what I call, ultra low levels, even explored for a down to a median of 7 mg/dL, so really, really low. And first I think what our listeners need to know when we look at guidelines, these numbers of 70 or 55, these are completely arbitrary and they're based on what was observed in clinical trials, what was achieved in high intensity versus moderate intensity statins in IMPROVE-IT. There's no biology behind that, and I think what this study does is reminds us there is no biology behind how low we need to go. This group previously published their shorter-term data approximately 2 years with this construct of lower is better and I think that's fine, but people worry, particularly on the safety side about extension, and we'll get to that in a minute, so where this fits is it gives us even more reassurance that lower is better, reminds us there's no biologic basis of that even down to very low levels. And so what does that mean? I think that comes back to guidelines. We have some discrepancy between European, ACC, Multisociety Guidelines that are around 55 and so from a guideline perspective, I think we'll see a little bit more enthusiasm about lower cut points or lower thresholds. And from a clinical standpoint, as a clinician it reminds me that when I see someone that's very high risk, there's no magic to achieving a number that if the risk is high, we need to be quite intensive and get their LDL down as low as possible and as safely as possible. I do want to also acknowledge, there's not, to your point about context, the IMPROVE-IT study also showed very low levels show additional efficacy and there's also a lot of other data, genetics and ecologic data supporting this. So this is... we look at Bayesian analysis that this is consistent that we're seeing across different platforms. I do want to talk about safety too, Greg. That's really important because honestly this is when it comes to patient level, the safety part of it. We as clinicians may have comfort with very low levels, but the safety is important. I also want to, just from a steady design, this is post-hoc, so those that achieve very low levels are different. You can see that in their table 1, but these investigators did lots of things. They did pretty extensive multi-variable analysis, they looked at time-dependent LDLs, they looked at it multiple different ways, but as mentioned, there really did not seem to be a safety signal. And this is where time matters. Safety in two years, interesting, but safety 5 to 8 years really offers us much more reassurance. So I think that's where this really comes in about that safety piece with the extended analysis. So again, I think from a guideline perspective, from a clinical perspective, there's so many implications from this paper and I really hope people take the time to take a deep dive and also put it in context, like you said, to the other literature where this is not standalone, but it's corroborating what we're seeing. Dr Greg Hundley: Very nice, amit. Marc, I want to come back to you, just two quick questions thinking about the preparation of your study. One, did you sample cognition? One thing we hear about frequently in dramatic lowering of LDL cholesterol are questions around cognition, particularly in the elderly? Dr. Marc Sabatine: Yeah, it's a great question Greg. So first of all, in the FOURIER study itself, there was an embedded study called EBBINGHAUS that Bob Giugliano from our group led that actually did formal neurocognitive testing in individuals using basically a iPad-like test. We also collected the usual neurocognitive adverse events as part of safety collecting. So 2 ways, the general asking about any adverse events and then the specific neurocognitive testing. We had previously reported out the results of EBBINGHAUS that there wasn't any relationship between evolocumab and the low LDL cholesterol and the risk of any neurocognitive AEs. We just were able to recently do this OLE analysis over time for the major adverse cardiovascular events and for the general safety events including cognition, so all that looked good. As PK indicated, we're now digging into the EBBINGHAUS formal neurocognitive testing, which was also extended out. So stay tuned for those results. Dr Greg Hundley: Very nice. And then eligibility, maybe just walk us through that really quickly. Patients that are going to be randomized to this form of therapy, were they already on high-dose statins? Who exactly did we randomize in this trial? Dr. Marc Sabatine: Yeah, so at the get-go, as PK indicated, these are patients with atherosclerotic cardiovascular disease, so they had a prior MI, prior stroke, symptomatic PAD. They were to be on an optimized lipid-lowering regimen, optimized statin therapy, so for close to 70%, that was a high-intensity statin. We had a small percentage on ezetimibe, but that's because we hadn't yet published the results of the IMPROVE-IT trial that Amit mentioned when we were enrolling in FOURIER, but it was a well-treated population on statin therapy. So these results would apply to your typical patient with ASCVD who's on a good statin regimen. Dr Greg Hundley: Very nice. Well, listeners now we're going to go back to both of our authors and investigators, as well as Dr. Khera. PK we'll start with you. What do you see as the next study to really be performed in this sphere of research? Dr. Prakriti Gaba (PK): I think that's an excellent question. I think with the data presented here now we know that the lower the LDL, the lower the risk of adverse cardiovascular events and that having a low LDL is safe in the long term. I think moving forward, as Dr. Khera mentioned, there needs to be a shift of these recommendations into the guidelines. So I think additional studies confirming these findings is what we need, but we do have the evidence available. Dr Greg Hundley: Very nice. And Marc? Dr. Marc Sabatine: Yeah, and I agree with PK of course. I think there's a couple things that we want to look at. We had looked in the parent FOURIER trial and found some groups who were higher risk, who seemed to have a bigger benefit early on, and those by and large were people who had a lot of athero. But as Amit indicated that the parent FOURIER trial was relatively short at about in two and a quarter years median follow up, and so now we have the benefit of an additional half decade of follow up in a subset of people and so now we're starting to look through and see the subgroups where we saw some differential benefit and this was a paper we published in circulation soon after we published the primary results of FOURIER. Now we have the ability to go through and look at those same subgroups and see what happens now with an additional 5 years. And so that'll be quite interesting, I think, to see how those groups play out now over time. I think as Amit indicated, time is critical. We know the benefit of lipid lowering really tends to grow with time. We saw that in FOURIER, we saw that in FOURIER-OLE and then as Amit indicated, I think for safety also it's now very reassuring, being able to go out to not two and a half years, but 5, 6, 7, 8 years of safety follow up. Dr Greg Hundley: Very nice. Well, listeners we're next going to turn to Dr. Khera. I'm going to put him on the spot a little bit. I don't know if many of you know he's a cardiologist with expertise in primary prevention. So here we've really focused today, I think, on a very unique set of results in secondary prevention. Amit, as you think about studies to be performed in the future, is there a role for really lowering LDL cholesterol as a primary prevention target? Dr. Amit Khera: The short answer is absolutely. I think, to be fair, you can't necessarily directly extrapolate these results 'cause it's a secondary prevention population, but I think if we step back for a second, is there any reason I think this wouldn't work in primary prevention, there's not, and I think there's tons of genetic data, tons of other long-term data that suggests that lower is better than primary prevention. I think the challenge, as you know, is just from primary prevention is it's just about the number that you need to treat and primary prevention is pretty profound in terms of to lower events. So this is where the trade-off comes. I think even in their study, we do have to appreciate while lower is better, when you have very low levels and you're going to even lower, let's say when you go from in secondary prevention from 50 to 40, as much as that sounds valuable, that delta's pretty small and then the absolute risk reduction is still going to be pretty small for those individuals and that's only magnified in primary prevention. So the short answer is I have no reason to believe that lower is better is not applicable in primary prevention, but I do know that the cost and what entails to get there, you don't get as much return on investment. I do want to say one last thing though. We're talking about lower is better, and I know these investigators know this well, but it's not only just how low but how long and I think that's where primary prevention about to go to clinic and I play the long game for primary prevention that we know we've magnified these benefits over the long term and even a little bit early in life can pay off long dividends. So that's how I look at it. Dr Greg Hundley: Very nice. Well, listeners we want to thank Dr. Prakriti Gaba, Dr. Marc Sabatine, both from Brigham and Women's Hospital and also our own associate editor, Dr. Amit Khera from University of Texas Southwestern Medical Center for bringing us this study involving patients with arteriosclerotic cardiovascular disease indicating that long-term achievement of lower LDL cholesterol levels down to values less than 20 mg/dL was associated with a lower risk of cardiovascular outcomes and not and not an increase in the risk of significant safety related events. Well, on behalf of Peder, Carolyn and myself, we want to wish you a great week and we will catch you next week on the run. Dr. Greg Hundley: This program is copyright of the American Heart Association 2023. The opinions expressed by speakers in this podcast are their own and not necessarily those of the editors or of the American Heart Association. For more, please visit ahajournals.org.
This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!In part 1 we talked about a request that has been submitted for the World Health Organization (WHO) to add diet drugs (specifically GLP1 agonists like Novo Nordisk's Saxenda and Wegovy) to their list of “essential medicines.” We discussed who was making this request and the justification that they were using. In part 2 we took a deeper dive into the research that they used to try to support this request, and in this final installment, we will look at the research around efficacy, harm, and cost-effectiveness.First I'll offer a summary for each issue and then I'll give a breakdowns of the research that they cite. Just a quick reminder that this request is asking the World Health Organization (WHO) to add these drugs to their list of “essential medications” globally.Before we get into the sections, I want to mention two overarching issues that are found throughout the entirety of this request and the studies that are used to support it.First, in general, a belief has been fomented (predominantly by those in the weight loss industry) that being higher-weight is so terrible then it's worth “throwing anything at the problem.” This leads to acceptance of poor, short-term, and/or incomplete data as “good enough” to foist recommendations onto higher-weight people, which means that part of weight stigma in healthcare is that higher-weight people are afforded less right to ethical, evidence-based medicine than thinner people.Second, is clinging to correlation (without any mechanism of causation) when it comes to weight, health, and health outcomes, including the abject failure to consider confounding variables. So throughout these studies “being higher-weight is associated with [health issue(s)]” stated uncritically in support of weight loss interventions. There is an utter failure to explore the idea that the reason for the outcome differences is not weight itself but, instead, exposure to weight stigma, weight cycling (which these medications actually perpetuate by their own admission,) and healthcare inequalities. Issues with research supporting effectiveness, harms, and benefitsStudy Duration:This is the main issue. While there was one study that went up to 106 weeks, the vast majority of the studies are between 14 and 56 weeks. We know that these drugs can have significant, even life-threatening side effects (earning them the FDA's strongest warning.) 14-56 weeks is not not nearly enough time to capture the danger of long-term effects, or to capture long-term trends around weight loss/weight regain.Study PopulationMany of the studies included have small samples. Many have study populations are overwhelmingly white, which is a huge issue when making a global recommendations.Small effect and overlapMany of the studies show only a bit of weight loss (often 15lbs or less) and often there was overlap in weight lost between the treatment group and the placebo group. Even using the “ob*sity” construct that this request is based on, for many people, this amount of weight loss wouldn't even change their “class” of “ob*sity.”Failure to capture adverse eventsMuch of the research they use to support their claims of safety didn't actually capture individual adverse events or serious adverse events. Often they only captured subjects who reported leaving treatment due to side effects.Issues with research supporting cost effectivenessThe cost-effectiveness analyses they cite are based on Quality Adjusted Life Years (QALYs). This is a measurement of the effectiveness of a medical intervention to lengthen and/or improve patients' lives.The calculation for this is [Years of Life * Utility Value = #QALY]So if a treatment gives someone 3 extra years of life with a Health-Related Quality of Life (HRQL) score of 0.7, then the treatment is said to generate 2.1 [3 x 0.7] QALYs.This is a complicated and problematic concept that deserves its own post sometime in the future, but looking just at this request I think it's important to note that they are working on two main unproven assumptions:1. That being higher weight causes lower health-related quality of life and/or shorter life span (rather than any lower HRQL being related to experiences that higher-weight people have including weight stigma, weight cycling, healthcare inequalities et al.) 2. That this treatment induces weight loss and/or health benefits that increase the life span and/or health-related quality of life of those who take it.I don't believe either of these assumptions are proven by the material cited in the request to the WHO. Specifically, it's very possible that it's not living in a higher-weight body, but rather the experiences that higher-weight people are more likely to have (weight stigma, weight cycling, healthcare inequalities) that impact their HRQL.Further, the short-term efficacy data available (and Novo Nordisk's own admission about high rates of regain) fall far short of proving any assumptions about these drugs ability to actually improve or extend life. Further, the failure of the literature to adequately capture negative side effects of the drugs, both short and long-term, means that this calculation cannot be properly made.Incremental Cost-Effectiveness Ratio (ICER)ICER is how QALYs are turned into a monetary value. It is calculated by dividing the difference in total costs by the difference in the chosen measure of health outcome or effect.[(Cost of intervention A -Cost of Intervention B) / (Effectiveness of Intervention A – Effectiveness of Intervention B)]The result is a ratio of extra cost per extra unit of health effect of a more vs less expensive treatment which can then be measured in QALYs.Again, this is worthy of its own post because there are all kinds of ethical issues around things like how we value life, how we define “healthy” and the ethics of determining whether or not prolonging someone's life is “cost effective.” I'm not going to do a deep dive into that today, but I do want to note that it is a serious issue in these kinds of calculations.In this specific case, even if one was to get past the ethical issues, an accurate calculation is impossible to make on both of the measures of the equation.Cost of these drugs varies wildly between countries and sometimes within countries because, for example, Novo Nordisk is a for-profit corporation whose goal is to create as much profit as possible. Per the WHO request letter, the monthly cost of liraglutide is $126 in Norway and $709 in the US. Semaglutide is $95 per 30 days in Turkey, but $804 per 30 days in US.When it comes to effectiveness of the treatment, again, there is virtually no long-term data. We do know that in Novo Nordisk's own studies, weight is regained rapidly and cardiometabolic benefits are lost when the drugs are discontinued and even when people stay on the drugs, weight loss levels off after about a year, at 68 weeks weight cycling begins, and at 104 weeks (when follow-up ended) weight was trending up. It's possible that these drugs are utterly ineffective over the long-term and/or that the prevalence of long-term side effects renders any treatment effects moot. We simply do not know.I do not think that this is a remotely appropriate basis from which to request that these drugs be declared globally essential by the WHO.Here are the citation breakdowns. These are not deep dives since there are enough issues with the research on a simple surface analysis.Breakdowns of evidence of comparative effectivenessEffects of liraglutide in the treatment of ob*sity: a randomised, double-blind, placebo-controlled study, Astrup et al.)This is a 20-week study funded by Novo Nordisk. It included 564 people on various doses of liraglutide and a placebo group who didn't get the drug and a group on orlistat. There were no more than 90-98 people in each group.The study explains “Participants on liraglutide lost significantly more weight than did those on placebo” by which they meant that those on the highest dose of liraglutide lose about 9.7lbs more than those on the placebo over the 20 weeks.III LEAD studiesThese are four studies that look at liraglutide in combination with other drugs for the treatment of Type 2 Diabetes that also included some information on weight changes. One was 52 weeks, the others were 26, the maximum amount of weight lost was only about 5lbs. The first [Liraglutide, a once-daily human GLP-1 analogue, added to a sulphonylurea over 26 weeks produces greater improvements in glycaemic and weight control compared with adding rosiglitazone or placebo in subjects with Type 2 diabetes (LEAD-1 SU), Marre et al] was a study that looked at the efficacy of adding liraglutide or rosiglitazone 4 to glimiperide in subjects with Type 2 Diabetes to test effects on blood sugar and body size.The study followed 1041 adults for 26 weeks. The study found that those on .6mg of liraglutide gained 0.7kg, those on 1.2mg gained 0.3kg, and those on 1.8mg of liraglutide lost 0.2kg, while those on placebo lost 0.1kg.The second [Efficacy and safety comparison of liraglutide, glimepiride, and placebo, all in combination with metformin, in type 2 diabetes: the LEAD (liraglutide effect and action in diabetes)-2 study. Diabetes Care, 2009. 32(1): p. 84-90. Nauck, M., et al.,]looked at the efficacy of adding liraglutide to metformin therapy for those with Type 2 Diabetes. They found that over the 26-week study those on liraglutide lost 1.8 ± 0.2, 2.6 ± 0.2, and 2.8 ± 0.2 kg for 0.6, 1.2, and 1.8 mg doses. Those on placebo lost 1.5 ± 0.3kg.The third [Liraglutide versus glimepiride monotherapy for type 2 diabetes (LEAD-3 Mono): a randomised, 52-week, phase III, double-blind, parallel-treatment trial. Lancet, 2009. 373(9662): p. 473-81. Garber, A., et al.,] This was a study of the comparative effectiveness of Liraglutide versus glimepiride for type 2 diabetes, with small weight loss as an ancillary finding. Those in the liraglutide group lost an average of 2kg.The final study [Efficacy and safety of the human glucagon-like peptide-1 analog liraglutide in combination with metformin and thiazolidinedione in patients with type 2 diabetes (LEAD-4 Met+TZD), Zinman et al.] was a 26-week study with 533 total subjects. The goal was to study the efficacy of liraglutide when added to metformin and rosiglitazone for people with type 2 diabetes. They found that those on liraglutide lost between 0.7 and 2.3kg (1.5lbs to 5.1lbs) in 26 weeks.Meta-Analyses and Systematic Review FindingsEfficacy of Liraglutide in Non-Diabetic Ob*se Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Barboza, J.J., et al., None of the included studies were more than 56 weeks and one was only 14 weeks. One had as many as 3731 subjects, but one had only 40. Some had body weight loss as a primary outcome, but some did not. Maximum doses ranged from 1.8 to 3.0mg. The mean body weight reduction was 3.35 kg (7.4lbs) but in one study there was no difference in weight loss. The maximum difference was 6.3kg (13.9lbs)They also refer to Iqbal et al which we discussed in part 2.Effects of glucagon-like peptide-1 receptor agonists on weight loss: systematic review and meta-analyses of randomised controlled trials. Vilsbøll, T., et al.The included studies are between 20 and 53 weeks long, and include some of the studies they already cited individually above. Of the 25 included studies only 3 had “ob*sity” as the main inclusion criteria, the rest were Type 2 Diabetes.The mean weight loss for those on the highest dose of the drug was between 0.2kg and 7.2kg. For those in the control group it was 2.9 kg, so there was actually overlap between the treatment and placebo groups.Summary of evidence of safety and harmsThey begin with the claim “The safety profile of GLP-1 receptor agonists is also well studied”To support this they cite: Efficacy and Safety of Liraglutide 3.0 mg in Patients with Overweight and Ob*se with or without Diabetes: A Systematic Review and Meta-Analysis, Konwar, M., et al.,This included 14 total studies, many of which the authors of the WHO request had cited individually and were included in other systematic reviews and meta-analyses above. The smallest study included 19 people, the largest included 2,487. The total number of subjects was 4,142.Their conclusion was “Liraglutide in 3.0 mg subcutaneous dose demonstrated significant weight reduction with a reasonable safety profile for patients with overweight or ob*sity regardless of diabetic status compared to placebo.”Their methodology says that they omitted studies from analysis due to “short duration.” They included studies that had a minimum of 12 weeks and a maximum of 56 weeks of follow-up.While they included 14 studies, only 11 of them actually included information about adverse events.In terms of adverse effects (AEs,) they found that the pooled estimate of nine studies in nondiabetic patients and two studies in diabetic patients revealed a significant proportion of patients experiencing the adverse events in liraglutide 3.0 mg group when compared with placebo., and the pooled estimate of the eleven studies showed that liraglutide 3.0 mg had higher risk of AEs compared to placebo.When it came to “serious adverse events” they found that there was a similar risk level between the drug and placebo groups, but remember that's for only 12 to 56 weeks, and Novo Nordisk is recommending that people take these drugs for the rest of their lives. A few months to a little over a year is not enough time to capture long-term serious adverse events.The efficacy and safety of liraglutide in the ob*se, non-diabetic individuals: a systematic review and meta-analysis. Zhang, P., et al.,This included five RCTs (which were included in various of the above systemic reviews and meta-analyses) ranging in follow-up from 14 to 56 weeks.The only adverse event information captured was the number of people who withdrew from treatment due to adverse events (which they found was similar between drug and placebo) and nausea (which was experienced more by people on the drug.)So, in addition to being short in duration, this was far from a comprehensive list of side effects. They made no attempt to capture serious adverse side effects and their short-term nature would have made this difficult anyway.Association of Pharmacological Treatments for Ob*sity With Weight Loss and Adverse Events: A Systematic Review and Meta-analysis. Khera, R., et al.This looked at weight loss and adverse events with a number of different weight loss drugs. Interestingly liraglutide did not show the highest amount of weight loss but was associated with the highest odds of adverse event–related treatment discontinuation. It should also be noted that high drop-out rates of 30-45% plagued all of the trials which the study authors admit means that “studies were considered to be at high risk of bias.“Given that those who drafted the WHO request are asking that these drugs be considered essential globally, it is disappointing that they included this study and didn't bother to mention this issue in their written request.This included 28 RCTs (most of which were included in other citations above) and only 3 that included liraglutide. They didn't capture individual adverse events, but only “Discontinuation of Therapy Due to Adverse Events.” They only evaluated a year of data so, again, while it is likely that these studies would have captured common adverse events had they bothered to try, there isn't long enough follow-up to have any information about serious (possibly life-threatening) long-term adverse events.Association of Glucagon-like Peptide 1 Analogs and Agonists Administered for Ob*sity with Weight Loss and Adverse Events: A Systematic Review and Network Meta-analysis. Vosoughi, K., et al.,This study included 64 RCTs with durations from 12 to 160 weeks, with a median of 26 weeks. As is common in these studies, the majority of the sample (74.9%) was white.Like those above, they only looked at treatment discontinuation from adverse events, they did not capture specific adverse events (common or serious.) Of the seven GLP-1 drugs they tested, liraglutide was tied with taspoglutide for the highest discontinuation of treatment due to adverse events.The study authors also note that “Risk of bias was high or unclear for random sequence generation (29.7%), allocation concealment (26.6%), and incomplete outcome data (26.6%).”Breakdowns for Comparative Cost-effectiveness StudiesFirst, the WHO request authors themselves admit that when it comes to cost-effectiveness, “the analyses have generally been performed only for high-income countries.” This is significant since they are asking the WHO to consider these drugs essential for the entire world.It's also important to understand that none of the data looks at a comparison of cost effectiveness for weight-neutral health interventions to these drugs. Without that information there is no way to calculate actual “cost effectiveness” since it's possible that weight-neutral health interventions would have greater benefits with less risk and dramatically lower cost. NICE's guidance: Liraglutide for managing overweight and ob*sity Technology appraisal guidance [TA664]Published: 09 December 2020.Do recall that NICE is involved in the current scandal with Novo Nordisk for influence peddling.These guidelines are created based on a submission of evidence by Novo Nordisk. The committee's understanding of “clinical need” was based on the testimony of a single “patient expert” who “explained that living with ob*sity is challenging and restrictive. There is stigma associated with being ob*se.”Once again we see a rush to blame body size for any “challenges” and “restrictions” of living in a higher-weight body, accompanied by the immediate decision that those bodies should be subjected to healthcare interventions that risk their lives and quality of life in order to be made (temporarily, by Novo and NICE's own admission) thinner. There did not seem to be a patient expert to discuss the weight-neutral options.It was not immediately apparent if the patient expert was provided/paid by Novo Nordisk, but they certainly forwarded their narrative that simply living in a higher-weight body is a disease requiring treatment.It should be noted that while the trial Novo Nordisk submitted covered a wider range of people, they specifically submitted for this recommendation only the subgroup of that population who were diagnosed with “ob*sity,” pre-diabetes, and a “high risk of cardiovascular disease based on risk factors such as hypertension and dyslipidaemia.”So, even if we accept this guidance as true, the WHO Essential Medicines request applies to a population much wider than this and so this fails to justify the cost-effectiveness for that population.This guidance is also based on the costs associated with obtaining the drugs through a “specialist weight management service” since an agreement is in place for Novo Nordisk to give a discount to these services.In calculating the ICER per QALY gained, the recommendations note that “Because of the uncertainties in the modelling assumptions, particularly what happens after stopping liraglutide and the calculation of long-term benefits, the committee agreed that an acceptable ICER would not be higher than £20,000 per QALY gained”Again, this recommendation is based on a trial submitted by Novo Nordisk that included 3,721 people and lasted for three years, but only 800 met the criteria for this cost-effectiveness recommendation. The trial failed to show a significant reduction in cardiovascular events. Novo's calculation of risk reduction was based on surrogate outcomes, which NICE points out “introduces uncertainty because causal inference requires direct evidence that liraglutide reduces cardiovascular events. This was not provided in the company submission because of lack of long-term evidence.”The NICE committee admits “relying on surrogates is uncertain but accepted that surrogate outcomes were the only available evidence to estimate cardiovascular benefits.”I just want to point out that another option would be to refuse to experiment on higher-weight people without appropriate evidence.These cost-effectiveness calculations are based on someone using the drug for two years, with no actual data on reduction in cardiovascular events, and with the admitted assumption that “any weight loss returned to the base weight 3 years after treatment discontinuation.” Said another way, this committee decided that it was cost effective to spend up to £20,000 per QALY for people to take a weight loss drug with significant side effects for two years, with no direct evidence of reduced cardiovascular events, and with the acknowledgment that people will be gaining all of their weight back when they stop taking it.Those who wrote the request for WHO to consider these drugs “essential” chose to characterize this as “At the chosen threshold of £20,000 per quality-adjusted life year (QALY) gained, the report concluded that liraglutide is cost-effective for the management of ob*sity.” I do not think that is an accurate characterization of the findings.The request cites “A report by the Canadian Agency for Drugs and Technologies in Health (CADTH) found that compared to standard care, the ICER for liraglutide was $196,876 per QALY gained”For the US, they cite a study that found that to achieve ICERs between $100,000 and $150,000 perQALY or evLY gained, the health-benefit price benchmark range for semaglutide was estimated as $7500 - $9800 per year, which would require a discount of 28-45% from the current US net price.They also cite “Cost-effectiveness analysis of semaglutide 2.4 mg for the treatment of adult patients with overweight and ob*sity in the United States, Kim et al.Let's take a look at their conflict of interest disclosure (emphasis mine)“Financial support for this research was provided by Novo Nordisk Inc. The study sponsor [that means Novo Nordisk] was involved in several aspects of the research, including the study design, the interpretation of data, the writing of the manuscript, and the decision to submit the manuscript for publication.Dr Kim and Ms Ramasamy are employees of Novo Nordisk Inc. Ms Kumar and Dr Burudpakdee were employees of Novo Nordisk Inc at the time this study was conducted. Dr Sullivan received research support from Novo Nordisk Inc for this study. Drs Wang, Song, Wu, Ms Xie, and Ms Sun are employees of Analysis Group, Inc, who received consultancy fees from Novo Nordisk Inc in connection with this study.”Given that, you probably won't be shocked to learn that this concluded that Novo Nordisk's drug, semaglutide, was cost-effective. The reason I bolded the text above is that this study is based on modeling – they are taking what is, by their own admission, a “new drug” and making predictions for 30 years. Everything was simulated based on trial data (you know, those trials that we've been discussing that often have horrendous methodology…) and “other relevant literature.” The construction of the modeling and the interpretation of the results was directed by the company who stands to benefit financially from the findings, and carried out by that company's employees and consultants. Also, and I'll just quote again here since I don't think I can improve on their text “Cost-effectiveness was examined with a willingness-to-pay (WTP) threshold of $150,000 per QALY gained” I do not think that this WTP is based on a global assessment.In their (and by their I mean Novo Nordisk's) modeling they find that semaglutide was estimated to improve QALYs by 0.138 to 0.925 and incur higher costs by $3,254 to $25,086 over the 30-year time horizon vs comparators.And, again, this is without any kind of actual long-term data. I think that the best way to characterize this information is “back of the envelope calculations” at best.To sum up, I do not think that the research they cite comes anywhere close to proving that these drugs have levels of efficacy, safety, or cost-effectiveness that warrant their addition to the WHO list of essential medicines. I believe that if the WHO grants this request I think it will be an affront to medical science, it will cheapen the concept of “essential medicines,” and it will harm untold numbers of higher-weight people all over the world.Did you find this post helpful? You can subscribe for free to get future posts delivered direct to your inbox, or choose a paid subscription to support the newsletter and get special benefits! Click the Subscribe button below for details:Liked this piece? Share this piece:More research and resources:https://haeshealthsheets.com/resources/*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings' Fearing the Black Body – the Racial Origins of Fat Phobia and Da'Shaun Harrison's Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe
In this episode, Lisa Khera and I discuss why we should have personal mantras to set your intentions. So if you want to learn how to create a personal mantra, be open to new opportunities, and find ways to keep your body moving and your mind calm, Tune in now!
Gurmehar Kaur brings you the news from Delhi, Supreme Court, Assam, and Russia. Produced by P Madhu Kumar, edited by Umrav Singh. Hosted on Acast. See acast.com/privacy for more information.
It's time for your authentication journey! Mandeep Khera, the Chief Marketing Officer at SecureAuth, is our guide in this #SecurityByDesign episode of *Silo Busting.* And Sam Rehman, EPAM's Chief Information Security Officer and SVP, is of course on hand to pepper Khera with questions about the fascinating concept of passwordless. Khera begins with a little history—we move from plain text passwords to hashing to one-time passwords to multi-factor authentication, biometrics, and behavioral—and then concludes: “But guess what, passwords are still around and it doesn't make any sense.” The role of passwordless, Khera says, is to “clear all the friction for users and provide a lot more security.” It isn't, of course, that simple. “A lot of people are claiming [that they are using] passwordless, but it's not quite there yet,” says Khera. The reason—the real reason—we need to evolve to a real passwordless system, Khera says, is that roughly 80% of today's cyberattacks happen because of credentials. Together Khera and Rehman talk about identifying ourselves via our phones and physicality and the annoying friction created by passwords (“Let's just get rid of all the passwords. Let's get rid of all the friction. We just have everything we need”). The pair zero in on the idea that behavioral monitoring and analytics might provide an answer. “I kind of know what you like to talk about,” says Rehman. “If all the sudden you start talking to me about, you know, Amber Heard… I'd be like: Is this Mandeep?” It's a fantastic conversation about how our computing future might operate. To hear it, you need only intone the famed cinematic shibboleth *Klaatu barada nikto.* Just kidding. You need only click Play. Happy listening! Host: Alison Kotin Engineer: Kyp Pilalas Producer: Ken Gordon
On this special segment of The Full Ratchet, the following Investors are featured: Neha Khera Ravi Viswanathan Ali Hamed Each investor discusses a portfolio company that did not survive and why it was that they failed.
On this special segment of The Full Ratchet, the following Investors are featured: Neha Khera Brian O'Malley Samara Mejia Hernandez
On this special segment of The Full Ratchet, the following Investors are featured: Matt Cohen Julie Wroblewski Neha Khera Each investor describes the most unusual situation or pitch that they've encountered as an investor.
On this special segment of The Full Ratchet, the following Investors are featured: Tripp Jones Neha Khera Cameron Borumand Each investor highlights a situation where they decided not to invest, why they passed, and how it played out. The host of The Full Ratchet is Nick Moran, General Partner of New Stack Ventures, a venture capital firm committed to investing in founders outside of the Bay Area. Learn more about New Stack Ventures by visiting our Website. Also, follow us on LinkedIn and Twitter! Founders, are you frustrated by trying to find the ideal VC's for your stage, sector, and geography? Answer five questions with VC Rank and generate your customized list now.
Neha Khera of 2048 Ventures joins Nate to discuss Competing with a16z & Sequoia at Pre-Seed, the Evolution of Accelerators, and Deciphering Signal From Noise in Web 3. In this episode we cover: The Case for Underdog Founders and What Creates One Business Models that Lend Themselves to Becoming Platforms Pros and Cons of Accelerator vs Institutional Models of Investing Thoughts on the Current State of Cyber and Web 3 and Their Future Missed a recent episode? Go to The Full Ratchet blog and catch up! Also, follow us on LinkedIn and Twitter. The host of The Full Ratchet is Nick Moran, General Partner of New Stack Ventures, a venture capital firm committed to investing in founders outside of the Bay Area. Learn more about New Stack Ventures by visiting our Website. Also, follow us on LinkedIn and Twitter! Founders, are you frustrated by trying to find the ideal VC's for your stage, sector, and geography? Answer five questions with VC Rank and generate your customized list now.
Raj Khera is a past CEO and CMO of several SaaS businesses, growing them to successful multi-million dollar exits to public companies. He is now a Growth Advisor to B2B SaaS companies and Publisher of MoreBusiness.com where his personal goal is to provide training, templates and resources to help 250 entrepreneurs become millionaires within 5 years of starting their business. Raj is a prolific writer, bestselling author, and frequent guest on webinars and podcasts. He holds M.S. and B.S. degrees in electrical engineering from the University of Maryland, College Park. He also serves on the boards of several companies and nonprofits. He lives in suburban Washington, D.C. with his wife and two children. Raj's favorite activity is being a soccer dad followed closely by playing the drums. In this episode, Raj takes us through his story of how as a come-from-nothing immigrant to the United States he has built and sold multiple businesses, and the many lessons he's learned about having success not only in business, but as a father and husband along the way. You're going to love it! Connect with Raj: Website: www.morebusiness.com LinkedIN: https://www.linkedin.com/in/rajkhera/ Lions Guide Links: Join The Lions Guide Community: www.lionsguide.com Connect with Lions Guide: Facebook Page: www.facebook.com/lionsguide Instagram: www.instagram.com/lionsguide LinkedIn: www.linkedin.com/lionsguide
Raj Khera is a past CEO and CMO of several SaaS businesses, growing them to successful multi-million dollar exits to public companies. He is now a Growth Advisor to B2B SaaS companies and Publisher of MoreBusiness.com where his personal goal is to provide training, templates and resources to help 250 entrepreneurs become millionaires within 5 years of starting their business. Raj is a prolific writer, bestselling author, and frequent guest on webinars and podcasts. He holds M.S. and B.S. degrees in electrical engineering from the University of Maryland, College Park. He also serves on the boards of several companies and nonprofits. He lives in suburban Washington, D.C. with his wife and two children. Raj's favorite activity is being a soccer dad followed closely by playing the drums. In this episode, Raj takes us through his story of how as a come-from-nothing immigrant to the United States he has built and sold multiple businesses, and the many lessons he's learned about having success not only in business, but as a father and husband along the way. You're going to love it! Connect with Raj: Website: www.morebusiness.com LinkedIN: https://www.linkedin.com/in/rajkhera/ Lions Guide Links: Join The Lions Guide Community: www.lionsguide.com Connect with Lions Guide: Facebook Page: www.facebook.com/lionsguide Instagram: www.instagram.com/lionsguide LinkedIn: www.linkedin.com/lionsguide
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