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In this episode of PEM Currents: The Pediatric Emergency Medicine Podcast, we take a structured, evidence-based approach to the acute treatment of migraine in children and adolescents. From confirming the diagnosis and screening for concerning features to optimizing outpatient therapy and executing a protocolized emergency department strategy, this episode walks through what works. We review the role of NSAIDs and triptans, clarify how IV fluids and ketorolac fit into care, and provide a stepwise framework for dopamine antagonists, valproate bridge therapy, DHE protocols, steroids, discharge planning, and admission decisions. Practical dosing, reassessment timing, and family-centered communication strategies are emphasized throughout. Learning Objectives Recognize the clinical features of pediatric migraine and distinguish it from secondary causes of headache. Implement a stepwise, evidence-based emergency department approach to acute pediatric migraine, including appropriate medication selection and timing of reassessment. Develop safe discharge and follow-up plans by defining treatment endpoints, minimizing medication overuse, and identifying patients who require referral or inpatient management. References 1. Oskoui M, Pringsheim T, Holler-Managan Y, et al. Practice Guideline Update Summary: Acute Treatment of Migraine in Children and Adolescents: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology. 2019;93(11):487-499. doi:10.1212/WNL.0000000000008095. 2. Patterson-Gentile C, Szperka CL. The Changing Landscape of Pediatric Migraine Therapy: A Review. JAMA Neurology. 2018;75(7):881-887. doi:10.1001/jamaneurol.2018.0046. 3. Bachur RG, Monuteaux MC, Neuman MI. A Comparison of Acute Treatment Regimens for Migraine in the Emergency Department. Pediatrics. 2015;135(2):232-238. doi:10.1542/peds.2014-2432. 4. Ashina M. Migraine. The New England Journal of Medicine. 2020;383(19):1866-1876. doi:10.1056/NEJMra1915327. 5. Richer L, Billinghurst L, Linsdell MA, et al. Drugs for the Acute Treatment of Migraine in Children and Adolescents. The Cochrane Database of Systematic Reviews. 2016;4:CD005220. doi:10.1002/14651858.CD005220.pub2. Transcript This transcript was generated using Descript automated transcription software and has been reviewed and edited for accuracy by the episode's author. Edits were limited to correcting names, titles, medical terminology, and transcription errors. The content reflects the original spoken audio and was not substantively altered. And today we're gonna talk about the acute treatment of migraine headache in children and adolescents. This is bread and butter for the PED, requires precise diagnosis and evidence-based treatment. We're gonna talk about making that diagnosis, red flags, outpatient and ED treatment, as well as some second-line agents, admission decisions, and a whole lot more. So migraine in children is defined by three criteria, and at least five attacks lasting two to 72 hours. So you gotta have at least two of the following: pulsating or throbbing quality, moderate to severe intensity, aggravation by routine activity, and a unilateral location. Although in children, it's often bilateral, plus at least one of nausea or vomiting and photophobia and/or phonophobia. In children headaches are frequently bilateral, bifrontal, bitemporal. The duration might be shorter than adults, especially in kids under second or third grade. And you may have to infer whether or not they have photophobia from their behavior. Like does the child close their eyes or wanna go into a dark room? In the emergency department, we're often diagnosing based on pattern recognition plus exclusion of dangerous secondary causes. Or even more often than that, the patient comes in and says, I've got a migraine. Before I move on to treatments, let's talk about some red flags where you might wanna pause and not just jump to migraine therapy. And the mnemonic SNOOP can be helpful here. And it stands for S for systemic symptoms such as fevers, myalgia, weight loss, or another S, secondary risk factors such as an immune deficiency, cancer, pregnancy, N for neurologic signs, papilledema, focal deficit, confusion, seizures. O onset sudden, or thunderclap. Migraines are often a little more gradual than that. The other O is older age, or technically younger age too, younger than five years or older than 50. Hopefully those patients are not coming into the pediatric emergency department. And then pattern changes, these new symptoms in a previously stable pattern. Don't ignore that. And precipitants, you know, is it worse with Valsalva, position change, or under significant exertion? If these signs are present, you'll probably wanna take a pause and just not throw migraine treatment at the patient. If they're stable, MRI is the preferred imaging modality, but a very sick patient, it'd be okay to get a head CT. If you've got a normal neurologic exam, there's no red flags. Again, you don't need routine imaging for migraine headaches. So let's talk about treatment. So hopefully patients have actually started to treat their headache before they arrive in the emergency department. If they haven't, it's a good idea to have some triage protocols in place. So ibuprofen, 7.5 to 10 milligrams per kilogram, 10 milligrams per kilogram is superior to placebo and it's superior to acetaminophen at two hours. So that's what we would use. Early treatment's critical. So ideally within the first hour of onset. So that's why triage protocols help. We'll give kids 10 mg per kg of ibuprofen and like 30 ounces of Gatorade. Blue is often the first Gatorade choice, though that's not an evidence-based statement. You can also use naproxen, but most of the studies are on ibuprofen. If NSAIDs fail, many adolescents and some older children will be prescribed triptans. The best evidence currently supports sumatriptan plus naproxen or zolmitriptan nasal spray. Rizatriptan is FDA approved down to age six. Adolescents respond to these agents better than younger children, and the route matters. The nasal formulations help when nausea is prominent. Families should be counseled to treat early, use weight-appropriate dosing, and avoid using acute medications more than 10 days per month. Often patients will have already taken an NSAID and a triptan before they get to the ED, and that's where we get into the treatment of refractory migraine. Now this is most of the patients that I will see, and before we push medications, let's briefly review ED treatment goals. You either want the patient headache free. Back to their baseline or mild descending pain. So a pain score of one to three. If you don't reach one of those endpoints and it's not agreed upon with the patient and their family, you've not completed treatments. You should do a reassessment within one hour after each intervention. And let's face it, if you're not reassessing within an hour and defining treatment goals, you're not practicing protocolized migraine care. So in the emergency department, many of you may be familiar with the migraine cocktail. So what is that? In general, it's a dopaminergic agent such as prochlorperazine or metoclopramide plus ketorolac, plus IV fluids. Let's take a look at all three of those components and see if you can guess which one is actually the one that can abort the migraine. So fluids are commonly given in pediatric migraine, but they alone do not treat it. They're helpful. Many patients have been throwing up or a bit dehydrated, but there are small randomized trials that show essentially no meaningful pain reduction in patients that get IV fluids alone. Well, what about ketorolac? Toradol, like that's the first thing you give to a kid with a kidney stone, right? It does help, but it's really adjunctive. So the main first-line agents for refractory or status migrainosus in the emergency department are the dopamine antagonists, and the first-line treatment for most patients is prochlorperazine or Compazine. The dose is 0.15 milligram per kilogram IV. The max is 10 milligrams. This is the backbone of ED migraine care. And why do they work? Well, migraines aren't just some random vascular headache. This is an inherited disorder with central pain pathways gone awry. Dopamine plays a large role in that pain, nausea, hypersensitivity, amplification of symptoms and more that, frankly, I won't get into this podcast because molecules hurt my head. The dopamine antagonists treat the headache, they reduce the nausea, and they just tamp down this process. Overall, the response rates approach 85%. Some studies have suggested that the response rate is about 77% at an hour and 90% at three hours. If you add the ketorolac and IV fluids, you get your response rate up to about 93 to 94%. These agents really do work well together. There have been randomized trials comparing IV prochlorperazine versus ketorolac. 85% of prochlorperazine patients achieved headache relief versus only 55% of ketorolac patients. So ketorolac helps, but really it's the prochlorperazine. Metoclopramide, or Reglan, is used in a lot of centers as well. There are some smaller studies in children and adolescents that show that prochlorperazine is more effective, but if kids have an adverse reaction, more on that in a moment, or they prefer metoclopramide because they've responded to it in the past, it's okay to go with it as well. Right. So what does it actually look like when you give the migraine cocktail to a patient? I think it's important to explain to patients and families what to expect, and if this is a teenager, I'm talking to them directly. I mean, they're getting the medication first and foremost. I tell them that the most effective way to treat their headache is with an IV. This often causes lots of angst, even in older teenagers. The medication just does not get to the brain as effectively and fast enough if you take it by mouth. Many patients who get the dopaminergic agents, so prochlorperazine, will invariably feel jittery or anxious or like they gotta move or like they got ants in their pants. I tell them to expect this so they're not surprised and worried when it happens. I tell them that once they start feeling that way, it means the medicine is probably working. They need to hit the nurse button and we're gonna get them up and have them take a walk. This fixes it for the majority of patients just getting up and moving. In adult centers, even with the initial administration of the prochlorperazine or as sort of a reflexive response to any of those symptoms, they just give a slug of IV Benadryl. There's some studies in adolescents especially that this may decrease the effectiveness of the IV agents you're giving in the first place, and it may also increase return rates to the ED. So I will use IV diphenhydramine if getting up and moving around isn't working, or if the distress is significant, or if the patient clearly indicates they've needed it in the past. So if after the migraine cocktail, the patient has met their pain goals and the reassessment is favorable, they can go home to outpatient follow-up. How about if the headache got better, but not all the way? It's usually when the initial migraine cocktail didn't achieve the pain endpoints fully, like it helped partially. If the dopamine blockade didn't do anything, valproate is unlikely to rescue the case. And so valproate works on GABA and it stabilizes some of these pain processes, but the dopaminergic agent needs to have done something first for valproate to work. Per the most common protocol, you give an initial dose of IV valproate, then you discharge the patient home on Depakote ER. So oral valproic acid under 10 years old or under 50 kilograms, 250 milligrams PO twice a day for two weeks, or older than 10 or greater than 50 kilos, 500 milligrams twice a day for two weeks. This is the extended release and it's most helpful if you give the first oral dose in the emergency department. So that's why it's very important to build this protocol in advance. If you don't have IV valproate, then don't just give the patient oral valproate, and definitely don't prescribe an oral course for discharge. All right, well, what about DHE? Dihydroergotamine for refractory or status migrainosus? Generally, this is only given at pediatric centers where you have neurology coverage. It's contraindicated if you've had another dose of DHE within 14 days, or you've had any triptan of any sort within 24 hours, and you must obtain a pregnancy test in adolescent females before giving it. The dosing for less than 30 kilograms is 0.5 milligram. At least 30 kilograms is one milligram. You give 50% of the dose over three minutes, then the remaining 50% over 30 minutes. If this is gonna work, the patients are gonna start feeling wretched at first. They're gonna get very nauseous and they're gonna vomit. They're gonna have flushing, and you'll see transient hypertension. Most of that resolves within the hour in most centers. If you're committing to DHE, you're kind of bringing the patient into the hospital anyway, though some facilities will have DHE done in the emergency department with close outpatient follow-up. Either way, it's really best practice to involve child neurology if you're giving DHE. Alright, well what about steroids? They give those in grownups too, right? Steroids really only have a role for recurrence prevention in children. So for kids that have a history of returning within 72 hours for rebound headache, you can give dexamethasone 0.6 milligram per kilogram IV dose, the max of 10 milligrams. You do not discharge them home on a steroid prescription or a Medrol dose pack or something else, and this can cut the recurrence risk down a bit. There's other therapies out there like magnesium and ketamine. There's just not enough evidence there. And the purpose of this episode is to discuss the therapies that have good evidence behind them and should be part of protocols across the country. Some patients are unfortunately not responsive to emergency department therapy and need admission. The main inpatient therapy is the DHE protocol. If they're not DHE eligible, they haven't tolerated it well or it's unavailable, admission's unlikely to help them unless they just need some IV fluids to help them get back up on their feet. You should consult neurology if the headache goals are not met after maximizing ED therapy for advice. And we should definitely avoid opioids. They don't treat patients with migraines. They increase recurrence risk. They increase revisit rates. Again, the dopamine antagonist prochlorperazine, it's superior for sustained relief when families ask about them, and fortunately they're asking about opioids far less. We use medications that treat the migraine pain pathways and signaling. We don't just wanna mask the pain. All right, so that's all I've got on the acute management of migraine headaches, especially in the emergency department. Remember that migraine care in the ED should be protocolized and evidence-based. IV fluids are supportive. Prochlorperazine is the first line, or you can use metoclopramide as well. Ketorolac is an adjunctive therapy. Valproate is next line. If you've gotta escalate, and DHE is specialized therapy, you can start in the ED, but most of these patients are getting admitted. Dexamethasone or steroids in children can reduce recurrence risk, but they're not really part of the acute management. You should definitely define the endpoints and structurally and systematically reassess patients at an hour. The goal is to get them feeling better to a defined endpoint and to restore function. There is evidence-based pediatric emergency migraine care. You should understand that, plus how to explain why these agents are being given and some of the side effects to patients and families. I find that that approach increases your likelihood of buy-in and success. Alright, so that's it for this episode on the Acute Management of Migraine Headaches in Children and Adolescents. I hope you found it helpful and I can pretty much guarantee that you're gonna see a patient with a migraine on your next shift. If you've got any feedback or comments, send them my way. If you like this episode, leave a review on your favorite podcast site. It helps more people find the show. Or recommend it to a colleague. If there's other topics that you'd like to hear, send them my way for the Pediatric Emergency Medicine podcast. This has been Brad Sobolewski. See you next time.    

What if the reason you’re not healing isn’t that you need another diagnosis? 0:08 It’s that your cells aren’t receiving the right signals. Because the body doesn’t run on diagnosis, it runs on 0:16 communication. And peptides are one of the most powerful, most misunderstood 0:21 tools we have for cellular signaling, immune balance, tissue repair, gut 0:27 lining support, metabolic control, brain signaling, sleep cycles, and even sexual 0:35 wellness. Today, I’m going to do what most people won’t. Define peptides in 0:41 plain English for you. break them into categories by what they’re best at and 0:47 tell you which ones are FDA approved on the list and which ones are commonly 0:53 used off label or investigational with the evidence that actually says these 1:00 work. This is going to be a powerful episode and if you’ve ever felt like you’re hearing hype without clarity, 1:07 this one’s for you. So, as usual, grab your cup of coffee or tea and settle in 1:13 as we talk about peptides that can fit into your healing journey. We’re going 1:19 to have a short word from our sponsor. You know, we got to do that. That’s how we stay on the air here. So, we will be 1:26 right back after this. Did you know sweating can literally heal your cells? 1:32I nfrared saunas don’t just relax you. They detox your body, balance hormones, 1:37 and boost mitochondrial energy. I’m obsessed with my health tech sauna. And 1:42 right now, you can save $500 with my code at healthtechalth.com/drmuthqen25. 1:54 All right, here we go, guys. I am excited to dive into peptides with you. 2:00 So understanding peptides is foundational, right? And I’ve been 2:06 studying peptides now for about nine years. Um, and I find that they are 2:13 incredible. Um, so I want to break down for you what peptides actually are, what 2:19 they do, and some of the top peptides that are available today, and how they 2:25 can be utilized. Because I think it’s really important. And I think it’s it’s there’s a lot of confusion out there about what these things actually are and 2:32 are they safe? Are they not? When do we use them? What’s the science behind them? So, we’re going to dive in and 2:38 we’re going to talk about all things peptides. So, let’s get ready here. Here we go. So, peptides are short chains of 2:45 amino acids and they typically range anywhere from 2 to 50 amino acids and 2:51 they’re linked by peptide bonds. So think of them as the superglue that holds the amino acids together. They sit 2:58 between the amino acids and they are full proteins in terms of their size and 3:04 their complex structure. And what makes peptides particularly interesting in 3:10 medicine is their role as signaling molecules. They’re essentially the 3:15 body’s text messages carrying specific instructions to cells and tissues. And 3:21 unlike our proteins which often serve as structural roles or act as enzymes, 3:28 peptides typically function as hormones, neurotransmitters and growth factors and 3:33 they bind to specific receptors on the cell’s surfaces or within the cells and 3:39 they trigger this effect. It’s like a cascade effect of a biochemical reaction 3:45 that ultimately changes the cellular behavior. So basically, it’s changing 3:50 the way the body’s cell structure acts. And this is why peptides can be so 3:56 incredibly powerful and therapeutic when you introduce the right peptide signal. 4:02 Now, you could theoretically redirect cellular processes toward healing, 4:07 towards metabolism, immune balance, tissue repair. Any of those things can 4:14 be manipulated to do a certain thing once we add the peptide. The challenge 4:19 in peptide medicine though lies in distinguishing between those peptides that have been rigorously studied, 4:26 proven safe and effective and approved by regulatory bodies like the FDA versus 4:31 those that exist in what we call the gray zone of a promising clinical data. 4:36 But they really lack human validation so far. And this distinction is critical because the presence of a plausible 4:43 mechanism does not guarantee safety or efficacy in living humans. So, this is 4:50 really important and we’re going to dive in and look at some of the research on all of these different peptides that are 4:56 available and I’m excited to say there’s some amazing peptides being studied right now that unfortunately are not 5:01 available. But I can’t wait to see them hit the market for us because it is going to be a gamecher as far as health 5:09 and longevity. So there is a quality control issue and there is a hidden 5:14 variable in peptide medicine with this and it’s one of the most underappreciated aspects of peptide 5:21 therapy particularly for non-FDA approved peptides. It’s quality control. 5:26 When we discuss pharmaceutical medicines, we take for granted that the pill contains what the label says. Not 5:32 always true depending on where it comes from. You guys, if you’ve heard my episodes before talk about how many of our medications are made in China and 5:41 have been contaminated with other things, you will realize that that is not always true. So, just because it has 5:48 the FDA stamp of approval on the medication, it still does not necessarily mean it’s safe and we still 5:54 need to do our homework on it. So, sorry for digressing on you guys, but you know, when we get a medication, we we 6:00 think that what the amount says is what is there, doesn’t have contaminants, it’s manufactured with good 6:06 manufacturing practices. You’ll see that listed as GMP on the bottle, and it’s been stored properly, it’s been 6:12 maintained stable, and with research peptides and compounded formulations, 6:17 none of this can be assumed. So, I will share a story with you. There was a gentleman that was purchasing these 6:24 peptides online from a research facility and um did not know that they were 6:30 coming from China and he was ordering a particular growth hormone peptide and 6:35 after a little while he had he had done fine for the few first few bottles. After a little while he started having 6:42 some complications. He started getting really irritable and angry and ragy and 6:47 he didn’t quite know what was going on. And so he decided to go get some testing done. He had some blood testing done and 6:53 his testosterone level was over 5,000. So for those of you who know what testosterone level should be for a guy, 7:00 they really shouldn’t be any higher than about 1,00200 would be absolute max that we’d want to see. Now he was taking 7:06 testosterone but not to that degree. And prior to adding this peptide, his 7:12 testosterone was very stable. What they ended up finding out was the peptide that he was getting, whoever was 7:18 manufacturing it added testosterone to the peptide. They felt like if if it had growth hormone, that was great, but if 7:25 it had growth hormone and tes testosterone, all the better. And he didn’t know that. And this is the 7:31 problem that we can have with peptides if you don’t source them properly. if you’re not working with somebody that 7:37 knows how to source them and can prove that they are what they say they are. Um, I’m sure there’s a whole bunch of 7:42 studies out there too of people getting these peptides and paying hundreds of thousands of dollars for them over their 7:48 lifetime and finding out they were nothing more than just sterile water. So, you really do need to be careful 7:53 with your quality control. Now, this kind of leads us right into the next topic that we’re going to talk about and that’s the manufacturing question, 8:00 right? The FDA approved peptides are manufactured in facilities subject to 8:05 the FDA inspection rules following our GMP regulations and these facilities 8:11 must validate their manufacturing process, demonstrate consistency batch to batch, test for purity and potency. 8:18 They need to test for bacterial endotoxins and sterility and they need to maintain detailed records. So, when a 8:25 pharmaceutical company submits a drug application, the FDA inspects the manufacturing facility as part of the 8:32 approval process. If you’re getting peptides from a different country, none of that is happening. And there are some 8:38 ways for us to determine if that is what you’re getting. Typically, the rule of thumb is if your peptides are coming 8:44 with a different colored top, every one of them has a different colored top. Those are typically being sourced out of 8:49 China. I wouldn’t say that’s 100% but that’s kind of the rule of thumb that people follow. So compoundingies these 8:56 are thearmacies that make our bio identical hormones. They can make medications in any dose or strength or 9:02 route. There are thousands of them in every not that not in every state but 9:08 there are thousands of them around the country right now. So these compoundingies are registered as 503A 9:15 facilities. They do traditional compounding for individual prescriptions, right? Like they can make 9:20 thyroid, they can make LDN, they can make estrogen. You can also have a 503b 9:27 facility, which is an outsourcing facility. And these companies produce larger batches of products. They’re they 9:34 have some oversight, but they’re less stringent than for FDA approved 9:40 manufacturers. And state boards of pharmacy regulate a 503A pharmacy. And 9:45 the FDA can inspect the 503b facility, but doesn’t preapprove any of their 9:52 compounding products. So, they can inspect it, but they don’t approve them. So, research chemicals and these 9:58 suppliers operate essentially with no oversight. They explicitly market products for research use only, not for 10:06 human consumption to avoid FDA regulation. If they put that on their 10:12 product, they don’t have to comply to what the FDA is saying. And there is no required manufacturing strategies or 10:19 standards, no required testing, no required sterility assurance, and no enforcement mechanisms if products are 10:26 mislabeled or contaminated. So basically, they don’t have the liability, but that doesn’t mean that 10:31 all of them are badies or bad suppliers. It just means they don’t have to comply 10:37 to the FDA rules. Now, there are many of these companies that I’ve seen and I’ve talked to that do do a lot of this. They 10:44 do test their product for sterility. They do test their product to make sure it is what it says it is. They don’t 10:51 have to, but they do. So, if you’re going to decide to use a company that 10:56 has research only, not for human consumption, at least ask for their 11:02 proof of testing so that you know that the product you’re getting is what it says it is and that it’s clean. Because 11:08 this is where we run into the problem is in purity. So in purity peptide 11:13 synthesis can produce not just the targeted peptide but also related 11:19 peptides with deletions, substitutions, truncations or truncations of amino 11:25 acids. Sorry. And this high performance liquid we call it uh chromatography can 11:30 separate these related impurities and quality and quantify the actual target 11:35 of the peptide content. So a certificate of analysis is what you want to ask these companies for. This shows the HPLC 11:44 the testing mechanism with greater than 95% or ideally 98% purity which 11:51 indicates a higher quality product. So this certificate of analysis can be fabricated may not represent the 11:57 specific batch being sold. It happens. We need to know not everybody is honest. Not everybody, you know, does what they 12:03 say and it does what’s right. But at least you at least they’re giving you something and you have some security. 12:10 and then choose a company that was referred to by someone else that has done some homework as well. In in 12:16 commercial research, there’s independent testing and they research peptides and this has been really shocking 12:23 variability that they’ve seen. Some products contain 50% or less of the 12:29 claimed peptide and some contained primarily degradation of the product or manufacturing impurities and some 12:36 contained bacterial endotoxins at levels that could cause fever and systemic 12:42 inflammation if it was truly injected. And I would also worry with some of those problems, you know, depending on 12:48 what impurity or bacterial endotoxin was there. If you’re using a product to boost your immune system and your immune 12:54 system is already compromised, these bacterial endotoxins can actually make you sicker instead of what you want it 13:02 to do, which is making you better. So, sterility is always an issue with anything that is manufactured, 13:08 especially things that we’re doing as an injection. Peptides are intended for injection. They must be sterile. They 13:16 must be kept safe. And pharmaceutical manufacturers conduct this sterility testing on every batch. 13:22 Compoundingarmacies should conduct sterility testing particularly for high-risisk compounded 13:28 sterile preparations and research chemical suppliers may or may not conduct any testing. So injecting 13:35 non-sterile material can cause local infections, abscesses at the injection 13:41 site and or if the bacteria enters the bloodstream could potentially be 13:46 life-threatening and you could have sepsis. Now, excuse me. We saw this 13:52 happen in a compounding pharmacy uh gosh, it’s probably been 10 years ago 13:57 now, I think. um they unfortunately had a strep uh contamination in their 14:03 product and they weren’t testing it. It was a large compounding pharmacy out of Florida and they were making products 14:08 that were being injected into the joints and um these people got very very sick 14:14 and some of them died and um some of them got very very injured by this uh 14:21 complication that happened. So it’s not like this doesn’t happen. It does, but it doesn’t happen often. And that’s what 14:28 we have to know about. And so, when we’re talking with you guys about storage and stability, it’s really 14:34 important to make sure you maintain your peptides well. So, many peptides are unstable at room temperature. They 14:41 require refrigeration or freezing. We tell everyone to make sure you’re refrigerating your peptides. That way, 14:48 there’s no question about it. when it stays cold um it prevents or slows down 14:54 the process of uh bacteria growing in it. So some of these peptides actually 14:59 degrade very rapidly in the solution and they must be reconstituted immediately before use and reconstitution of the 15:07 peptides really has limited stability often just days to weeks not months. So 15:13 improper storage, temperature, um changes during shipping or prolonged 15:19 storage of a reconstituted product can lead to degradation into inactivity or 15:25 potentially even a harmful breakdown of the product itself. So if you have a product that’s been sitting in your 15:30 refrigerator for a month or two months or 3 months or 6 months, just throw it away. It’s not going to be any good. 15:37 you’re not going to actually get the peptide and the uh potency that you’re looking for anyway out of it and the 15:44 potential of you introducing an endotoxin, a bacterial endotoxin is quite high at that point. So you just 15:50 really don’t want to take the risk, excuse me. So what practitioners, what 15:56 should we do and what should patients do? Well, for any peptide therapy, we 16:03 want to source our verification. know where the peptide product comes from. Is 16:08 it an FDA approved product? Is it a 503b compounding? A research chemical 16:14 supplier? Is there a certificate of analysis? Request and review this COA. 16:20 And you want it to show purity greater than 95% but ideally greater than 98%. 16:27 You want that identity be identity to be confirmed by mass spectromedy. Uh 16:33 sterility testing should be done. Bacterial endotoxin testing should be done. Batch number matching of the 16:39 product that you received should be done. Proper storage. You want to know that this has been refrigerated or 16:46 frozen as directed once it’s been mixed. Look at the expiration dates for reconstituting your peptides. Track that 16:53 reconstitution date and discarded accordingly like we just talked about. Monitor for your adverse effects. Even 17:01 with the perfect quality control, monitoring for adverse effects is essential with questionable quality and 17:08 vigilance is really critical here. I know it’s frustrating for a lot of patients when they have to get several 17:15 bottles and they only last a week or two. right here, you guys. This is why 17:21 they only last a short period of time because once they’re mixed, they start 17:26 to degrade and they won’t be good and you won’t get the benefit from it. So, 17:31 it’s really important with these research peptides specifically, practitioners should recognize that all 17:38 recommending products without quality assurance violates the fundamental medical principle of first do no harm. 17:45 If a patient is determined to use research peptides despite counseling, providing guidance on quality 17:52 verification, requesting those COAs, using pharmaceutical grade sources when available, proper testing, this all 17:59 reduces harm, but doesn’t constitute necessarily that recommendation. Now, 18:06 that being said, today it’s very difficult to find peptides by the compoundingies because of what the FDA 18:13 has done. So most of the peptides that are available to us have been labeled 18:18 not for human consumption, not because they’re not good products, but because 18:25 of what the FDA did. And this is how these companies have been able to 18:31 continue to provide peptides to the medical community. And if you know you 18:36 have a good company, then you’re, you know, you’re still taking the risk, right? But at the end of the day, the 18:42 reason they’re doing that is to protect themselves from the FDA, from liability. Um, so just kind of know that there is 18:50 some talk in the community with um Bobby Kennedy that this is going to change and 18:55 they are going to bring peptides back to the compounding pharmacies. Now, we don’t know which ones they’re going to 19:01 bring back. Uh, will it be all of them? Will it just be some of them? What’s going to happen here? Um, is it going to 19:07 go to the pharmaceutical companies like our GLP1s did? We don’t know what that’s going to look like quite yet. Um, but it 19:14 is coming and that is positive news. So, let’s talk now about FDA approved 19:21 peptide medications. So, this is the metabolic revolution, right? GLP1 19:28 and our dual increeting agonists. This is an exciting time. GLP-1s are amazing. 19:35 Um, a lot of people are skeptical, a lot of people love them, a lot of people hate them. Whichever side of the fence 19:42 that you’re on, I understand. But I want to talk about the science of it today 19:48 and what it actually means for people. So, the story of GLP1 glucagon like 19:54 peptide one represents one of the most significant advances in metabolic 19:59 medicine in the past several decades. GLP-1 is an accretin hormone. It’s 20:05 gutder derived peptide that potentiates insulin secretion in response to food 20:11 intake. And the body naturally produces GLP-1 in the intestinal L cells, but it 20:17 rapidly degraded by the enzyme DPP4 giving it a halflife of only about 2 20:24 minutes. So this rapid breakdown made in therapeutically impractical until 20:31 research was developed and modified the analoges that resist the enzyme degradation. So for those people who 20:39 never feel full when they’re eating, never feel satisfied when they’re done, this is because their body is either not 20:46 producing enough GLP1 or it’s not getting the signal right. And this is a 20:51 leptin issue. This is an insulin issue. It’s a GLP-1 issue. It’s a complicated 20:56 issue. This is not anything that the person is doing wrong. It’s what is happening to their body. And so GLP1s 21:03 have really revolutionized this. So one particular GLP-1 that we have is 21:09 semiglutide. And this GLP-1 agonist is what changed everything in the world of 21:16 metabolic medicine. Semiglutide is marketed as ompic for type 2 diabetes 21:23 and it’s marketed as WGOI for chronic weight management. It is a modified 21:29 GLP-1 analog with 95 or sorry 94% amino acid sequence uh homology to human 21:37 GLP-1. So it means that it’s it’s just like our own GLP-1 that we make. This 21:42 modification includes specific amino acid substitutions and the addition of C18 21:50 a fatty acid chain which allows the peptide to bind to albumin. Now this 21:56 albumin binding dramatically extends the half-life to approximately one week 22:01 enabling one weekly dosing which is a major advantage over the earlier GLP-1 22:07 agonists that require daily or twice daily injections. The mechanism by which 22:13 semiglutide works is multiaceted. At the pancreatin level, it binds to GLP-1 22:20 receptors on the pancreatic beta cells enhancing glucose depending sorry 22:27 enhancing glucose dependent insulin secretion. This glucose dependency is 22:33 crucial. It means the peptide only stimulates insulin release when blood glucose is elevated. This dramatically 22:41 reduces the hypoglycemic risk compared to insulin or even uh sulfuras. 22:47 Simultaneously semiglutide suppresses glucagon secretion from pancreatic alpha 22:53 cells further improving glycemic control. This is really amazing because 23:00 over the years when we’ve used insulin, which is also a peptide by the way, you 23:05 had to dose it just right because if you didn’t, you would produce so much insulin that it would crash the blood 23:12 sugar and then somebody would have too low of a blood sugar. They’d be hypoglycemic and they’d have to eat more 23:18 sugar and then they’d have to modify the insulin again and the person would be going up and down, up and down, up and 23:24 down all day long. And that created a lot of problems for people and so this 23:30 helps to stabilize that so it is not such an intense change. Now in the GI 23:36 tract semiglutide delays the gastric emptying particularly pronounced during 23:41 the initial weeks of therapy. This slowing of the gastric emptying contributes to the sensation of being 23:48 full and early satiety that patients often describe. However, this effect 23:54 tends to attend to weight over time as the body adapts through the appetite 24:00 suppressing effects generally persist through central mechanisms. So, when we 24:05 talk about what is actually happening, we’re slowing that digestive process down. That’s why people aren’t so 24:11 hungry. It’s why they’re not eating so much. This is why people can develop constipation with these products because 24:17 it’s slowing the body’s digestive tract down. Now some people will call this 24:22 gastroparesis. Um gastroparesis is actually different. 24:28 It is when we lose control over what’s happening in the in the colon like the 24:34 nerves and things like that just stop working. I have never seen that with the GLP1s that we prescribe in micro doing. 24:42 um it’s been documented. It can happen, but again it a lot of it is dosing and a 24:48 lot of it is staying on top of your client and what’s happening and what’s going on and what you’re doing and making sure that they do have good 24:54 motility still. So a lot of these things can be mitigated if you have problems 24:59 with them. Now one of the most profound effects of semiglutide occur in the 25:05 central nervous system. GLP-1 receptors are widely distributed in the brain 25:10 particularly in the hypothalamus and the brain stem area where we are involved in 25:15 appetite regulation. So when when wilding and colleagues published their 25:20 landmark step one trial in the New England Journal of Medicine in 2021, 25:25 they demonstrated that participants receiving 2.4 4 milligrams of semiglutide weekly achieved an average 25:32 weight loss of 14.9% of their body weight over 68 weeks. Now, I want you 25:39 guys to really understand this. We’re talking roughly 15% body weight loss 25:45 over a year, longer than a year. 52 weeks is a year, right? This is 68 25:50 weeks. So, it took longer for them to lose. We’re not talking about giving 25:55 somebody a dose to lose 15% of their body mass in a month or two. That that 26:01 is not healthy for any of us. That is not what we’re talking about doing here. Now, they compared this to placebo and 26:08 the placebo was only 2.4%. So, that is a significant difference. 26:14 And even beyond the numbers, patients reported something very qualitatively different, a reduction in what’s now 26:21 called food noise. Everybody knows what food noise is. We’ve talked about this long before GLP1. It’s that craving. 26:28 It’s that part of your brain that just keeps thinking about I want to eat something. You know, that was actually 26:34 reduced and they didn’t expect to see that happen. Now, this refers to the constant mental preoccupation with food, 26:42 the intrusive thoughts about eating, the difficulty in feeling satisfied. Semi-glutide appears to appears to 26:49 modulate reward pathways in the misolyic system reducing hedonic eating and food 26:57 cravings. Now there are also great cardiovascular effects of semiglutide 27:02 that extend beyond weight loss. Uh the sustained six and select trials 27:07 demonstrated significant reductions in major adverse cardiovascular events uh 27:14 mace in high-risisk populations. The select trial published in 2023 showed 27:20 that semiglutide reduced cardiovascular death, non-fatal myioardial inffection 27:25 and non-fatal stroke by 20% in adults with overweight or obesity and 27:31 established cardiovascular disease but without diabetes. So this suggests that 27:37 mechanisms beyond glucose control and weight loss possibly including 27:42 anti-inflammatory effects, improvements in endothelial function and favorable 27:47 changes to lipid profiles. Now I will tell you the clients that I work with that are on GLP1, 27:53 they will tell you that their inflammation has been significantly reduced. We are also seeing really 28:00 amazing results in lipid profiles. um part of its weight loss, but there is a 28:06 component to this that is lowering the triglyceride levels because it’s related to sugar and how the body’s processing 28:11 it. And we’re seeing better profiles, less need for statins as a result of 28:17 that. If if you want to listen to my episode on statins, I have one on that. Uh they are not my favorite medication. 28:24 I think it’s overprescribed and overused um and not really affecting or 28:29 addressing the problem. So these things can really be helpful. There’s also some 28:34 uh ramblings going on with GLP-1s saying that they may be able to help with 28:40 addiction in the future because of where they’re finding it affecting the brain and how it affects the food noise and 28:47 the cravings that we have for food and the addiction for food. Could it potentially help with other addictions 28:53 down the road? We’ll have to wait and see on that one. So semiglutide’s FDA prescribing information also includes a 29:00 box uh boxed warning about thyroid sea cell tumors. So in rodent studies 29:06 semiglutide caused dose dependent and treatment duration dependent sea cell 29:12 tumors at clinically relevant exposures. So while it’s unknown whether or not 29:17 semiglutide causes uh thyroid cancer tumors in humans and the rodent thyroid biology 29:26 differs significantly from humans, the drug is contraindicated in patients with a personal or family history of 29:33 medillary thyroid carcinoma or in patients with multiple endocrine neopl neoplasia syndrome type two. it is 29:42 uh contraindicated for safety effects with that. Um I have seen endocrinologists okay GLP1s to be used 29:50 in patients who’ve had other forms of thyroid cancer just not the meillary 29:55 thyroid cancer. So there is possibility there. Now the most common side effects 30:00 are gastrointestinal. It’s nausea affects about 20 to 44% of patients 30:06 depending on the formulation with diarrhea, vomiting, constipation, abdominal pain, and also frequently 30:13 reported in clinical trials. I see this in my clinic, too, especially dose dependent. Um, and it happens early on 30:20 when you’re first starting the medication, but seems to settle out over time. The one that I would add to this 30:26 that I don’t think they have on here is an increase in acid reflux. We also see that quite often uh especially in people 30:33 who suffer with acid reflux to begin with. Now these effects are typically most 30:40 pronounced during the escalation and they like I said often improve over time 30:45 but more serious but less common adverse effects include acute pancreatitis. 30:51 The medication needs to be discontinued immediately if this is confirmed. You can see some diabetic retinopathy 30:57 complications in patients with pre-existing retinopathy and acute kidney injury. Um, this usually happens 31:05 secondarily to dehydration from the GI effects. There are some gallbladder disease um that can occur and people who 31:13 have a sensitive gallbladder will describe uh discomfort with that. I’ve 31:18 even seen some people who’ve had their gallbladder out on GLP1s at the higher doses complain of similar pain that they 31:25 used to have when their gallbladder was in. So, really important to just kind of monitor these symptoms and work closely 31:32 with somebody that understands them and can be on top of them quite quickly if this happens. Excuse me. From an 31:39 integrative medicine perspective, semiglutide really represents a powerful tool, but it’s not a standalone 31:46 solution. Remember, the medication addresses one aspect of the metabolic dysfunction, the signaling systems 31:53 controlling appetite and glucose homeostasis, but it doesn’t address the root cause that led to the metabolic 32:00 disease in the first place. Patients who rely solely on the medication without addressing the ultrarocessed food 32:07 consumption, the ccadian disruptions, the chronic stress, the sleep apnea, or 32:12 underlying hormonal imbalances often experience weight regain when the medication is discontinued. 32:20 The drug is also not a substitute for addressing the emotional and psychological drivers of eating 32:26 behavior, including the unresolved trauma that may manifest as emotional eating. I think this is really important 32:33 because we don’t address the trauma issue enough with clients and we need to 32:38 be looking at that. There is a huge trauma effect out there these days that is I don’t want to say leading to or 32:45 causing but it is definitely contributing to chronic illness and it’s not being talked about enough. So we 32:52 really need to be talking about this and addressing this trauma aspect. Now the next GLP that one that I want to talk 32:59 about is trespathide. This is a dual agonist. It takes center stage. It is my 33:05 favorite GLP one. Trisepatide is marketed as Mangjaro for type 2 diabetes 33:11 and Zepbound for chronic weight management and it represents the next 33:16 evolution in increantbased therapy. This is a dual agonist a 39 amino acid 33:23 synthetic peptide structurally based on the human glucose dependent insulin tropic peptide so GIP sequence but 33:31 modified to activate both the GIP receptors and the GLP1 receptors. So the 33:37 addition of the GI GIP agonism to the GLP1 agonism appears to create this 33:46 synergistic effect that goes beyond simply adding the two mechanisms together. So the GIP like GLP-1 is an 33:55 increant hormone secreted by what is called the K cells in response to nutrient intake. It enhances glucose 34:02 dependent insulin secretion but it also effects on atapost tissue metabolism 34:09 potentially improving the insulin sensitivity in fat cells and influencing 34:14 how the body stores and metabolizes fat. So some research suggests that GIP may 34:20 also have effects on energy expenditure though this remains an area of 34:26 investigation. So basically what we’re saying is this drug may actually help 34:32 people who are insulin resistant or insulin sensitive, not just somebody who 34:38 has problems with glucose control. So, this is super exciting because it opens 34:43 up the door for all of these people for decades that we’ve been trying to manage with insulin resistance and trying to 34:50 prevent diabetes and honestly most of the time have been unsuccessful 34:56 unless you can keep your diet at 50 grams of carbs or less a day, which is extremely difficult. Um, and take some 35:04 supplements that may or may not work and or take some metformin that may or may not help. this drug actually really 35:11opens that up and helps in that capacity. So there was a clinical trial 35:17 called the surmount clinical trial which demonstrated that trespathide produces 35:22 even more substantial weight loss than semiglutide. In the surerount one trial published by uh J tree I might have said 35:31 that wrong. I apologize if I slaughtered your name and colleagues in the New York England Journal of Medicine in 2022. 35:38 Participants receiving the highest dose of trespide, which is 15 milligrams, achieved an average weight loss of 20.9% 35:47 of their body weight over 72 weeks, compared to 3.1% with placebo. This 35:54 level of weight loss approaches what’s typically only seen in beriatric surgery. So, this is amazing because if 36:02 this medication works and we don’t have to do beriatric surgery, stomach stapling basically, um, oh my gosh, it’s 36:11 amazing. There are so many complications and risks that go with stomach stapling and the different procedures that they 36:17 do these days. People don’t absorb their nutrients properly. They have to do liquid nutrients. It’s very complicated. 36:24 It’s very challenging. Many of these people gain their weight back. Um, and 36:30 this procedure is not fun to go through. So, if we could change that and change 36:35 the lives of people who’ve really been struggling, it is amazing. And I will tell you that I have seen this work. I 36:42 have seen people lose 100 150 pounds on these medications over a year or two 36:50 period of time. It is definitely slower than beriatric surgery on some standpoints, but that is okay. You don’t 36:56 want that rapid weight loss. It’s not good for you. It’s not healthy for you. It doesn’t look well. You know, we want 37:03 to do this safely and effectively in the best way that we can possibly do that for you. Now, the adverse effect profile 37:10 is similar to semiglutide. It’s dominated by gastrointestinal effects. 37:15 Nausea, diarrhea, decreased appetite, vomiting, constipation. These were all commonly reported in the surmount 37:22 trials. And like semiglutide, tricepide carries a blackbox warning regarding the 37:27 thyroid sea cell tumors based on the rodent data and it shares the same contra indications in patients with a 37:34 family history of thyroid cancer and men too. So the mechanism behind why 37:40 tepatide often produces more substantial weight loss than GLP-1. The agonism 37:45 alone remains under investigation, but it may relate to the complimentary effects on the different aspects of 37:51 energy homeostasis or to GIP’s effects on atapost tissue and potentially on 37:58 central central nervous system pathways that GLP1 alone doesn’t fully address. 38:03 Now patients often report even more profound reductions in food noise with tricepide compared to GLP1 and uh sorry 38:12 GLP1 the agonists through this is anecdotal and hasn’t been regularly 38:17 quantified in quality studies. So I’ve done both uh personally and in my 38:22 practice. I really like trespide better than semiglutide. For me I had too many side effects with semiglutide. uh I had 38:30 less side effects with trespathide. I also plateaued on semiglutide which I 38:35 didn’t really care for. And with Tresepide, I haven’t plateaued and I’ve been able 38:42 to lose about 25 pounds in um a year and a half and I’ve been able to maintain 38:49 that. Um and I continued to use it because I do have a strong family history of cardiovascular disease. And 38:56 if this could help me so that I don’t follow my family lineage with cardiovascular disease, I am all for 39:03 trying to do that. I’ve watched too many of my family members suffer from this. I’ve lost my dad at a very young age. I 39:09 lost my grandfather at a young age to it. All of their brothers to this. And I don’t want to be that same person. So 39:16 that is why I chose to do that. And I think it’s really important for us to take a look at that and understand that. 39:24 Now, I know this has been a really long podcast and I don’t typically do podcasts this long. I have a whole host 39:31 of information on additional peptides. So, I’m going to break this up for you 39:36 guys and I’m going to do another episode and we’re going to pick up where we left off here with these peptides so that we 39:43 can actually start to dive into different peptides as well. So, check 39:48 out my next podcast show when we’re going to dive into the peptides that 39:54 talk about sexual wellness, immune function, and all the other cool things 39:59 that we can do with peptides. So until then, remember to like, share, and 40:04 subscribe. It really helps us get out to other people and share our information, 40:10 and join us for our next episode as we continue the talk about peptides. 40:15 Welcome to Let’s Talk Wellness Now, where we bring expert insights directly to you. Please note that the views and 40:21 information shared by our guests are their own and do not necessarily reflect those of Let’s Talk Wellness Now, its 40:28 management, or our partners. Each affiliate, sponsor, and partner is an 40:34 independent entity with its own perspectives. Today’s content is provided forformational and educational 40:40 purposes only and should not be considered specific advice, whether financial, medical, or legal. While we 40:48 strive to present accurate and useful information, we cannot guarantee its completeness or relevance to your unique 40:56 circumstances. We encourage you to consult with a qualified professional to address your 41:01 individual needs. Your use of information from this broadcast is entirely at your own risk. By continuing 41:08 to listen, you agree to indemnify and hold Let’s Talk Wellness Now and its 41:14 associates harmless from any claims or damages arising from the use of this 41:20 content. We may update this disclaimer at any time and changes will take effect 41:26 immediately upon posting or broadcast. Thank you for tuning in. We hope you 41:31 find this episode both insightful and thought-provoking. Listener discretion 41:36 is advised.The post Episode 256 – How Peptides Work, Benefits, and FDA-Approved vs Off-Label Use Explained first appeared on Let's Talk Wellness Now.

Dr. Christie Langenberg reviews the No. 5 article of 2024, titled “Once-Weekly Semaglutide in Persons with Obesity and Knee Osteoarthritis,” which was originally published in The New England Journal of Medicine in October 2024. Dr. Jeremy Schroeder serves as the series host. Dr. Langenberg is a member of the Top Articles Subcommittee, and this episode is part of an ongoing mini journal club series highlighting each of the Top Articles in Sports Medicine from 2024, as selected for the 2025 AMSSM Annual Meeting. Once-Weekly Semaglutide in Persons with Obesity and Knee Osteoarthritis: https://www.nejm.org/doi/full/10.1056/NEJMoa2403664

In our latest episode, we discuss the results of the PRIMA retinal implant in treating eyes with center involved geographic atrophy as presented in a recent New England Journal of Medicine article. 85% of eyes had meaningful improvement in vision at one year with Dr. Daniel Palanker, Professor of Ophthalmology and Electrical Engineering, Stanford University.

Welcome to Ozempic Weightloss Unlocked, where we dive into the latest on Ozempic from medical breakthroughs to real-life health impacts. Im here to unpack fresh news thats changing how we view this game-changer.A brand-new study from Rutgers University, published in the Journal of Medical Internet Research, reveals why so many stick with Ozempic despite side effects. Researchers analyzed sixty anonymous reviews on Drugs.com and found that sixty-two percent of users faced nausea, vomiting, or stomach issues, yet satisfaction soared when weight dropped. HealthDay News reports that sixty-seven percent experienced less appetite or fewer cravings for sugar and greasy foods, making the benefits outweigh the discomfort. Lead researcher Abanoub Armanious notes this cuts through social media hype to show everyday experiences: if youre losing weight, youre likely to keep going.Semaglutide, the key ingredient in Ozempic, mimics a hormone to control blood sugar, slow digestion, and curb hunger. Originally for type two diabetes, its now a weight loss powerhouse, with users seeing fifteen to twenty percent loss when paired with lifestyle tweaks, per UC Davis Health. But heres the catch: Physicians Committee research warns that stopping often leads to regaining two-thirds of the weight within a year, as the body rebounds with stronger cravings.Exciting advances are emerging. Georgia State Universitys Eric Krause found combining Ozempic-like drugs with anti-stress treatments boosts fat loss while sparing muscle and helps maintain results post-treatment. Plus, a daily oral semaglutide pill, approved this year, matches injections for thirteen to fifteen percent weight loss, according to Mount Sinai Health and the New England Journal of Medicine.Ozempic is transforming obesity care, but experts like those at UC Davis stress its best with diet, exercise, and doctor guidance to tackle root causes like stress or mental health hurdles. Note a recent retraction in the International Journal of Obesity on combo therapies, reminding us science evolves fast.Listeners, balance the wins with realities: results drive loyalty, but long-term success needs habits. Consult your doctor before starting.Thanks for tuning in, Ozempic Weightloss Unlocked listeners. Subscribe for more updates. This has been a quiet please production, for more check out quiet please dot ai. Some great Deals https://amzn.to/49SJ3QsFor more check out http://www.quietplease.aiThis content was created in partnership and with the help of Artificial Intelligence AI

Psychedelics are having a cultural moment. Research is promising. Stories of healing are everywhere. But here's the truth: these experiences aren't magic cures. And they aren't right for every nervous system at every time.   In this episode, Elisabeth Kristof and Jennifer Wallace slow the conversation down. Instead of asking, "Do psychedelics heal trauma?" They explore a more grounded question: What becomes possible when psychedelic or peak somatic experiences are approached through the lens of nervous system safety, preparation, and integration?   If you've been curious about psychedelics, already had experiences, or feel unsure whether they're right for you, this episode offers nuance, research, and deep nervous system perspective. Because post-traumatic growth isn't about becoming someone new. It's about becoming more available to the life that's already waiting for you.   Topic Covered Why psychedelics may reorganize meaning, not just reduce symptoms How trauma fragments narrative and how safety allows integration The science of psychological flexibility and why it predicts long-term outcomes What "somatic journeying" is and why it can feel disorienting The importance of preparation, titration, and facilitator trust Why intensity does not equal healing Psychedelics vs antidepressants in research on connectedness Default Mode Network (DMN), identity rigidity, and belief updating Why creativity often emerges when survival softens The risks of over-reliance and "chasing the medicine" Why discernment and self-trust matter more than hype   Chapters  00:00 – Psychedelics Aren't Magic Cures
 03:00 – Meaning-Making & Narrative Reorganization
 08:58 – Psychological Flexibility & Emotional Capacity
 17:00 – Preparation, Somatic Journeying & Integration
 23:29 – Connectedness & Relational Repair
 34:33 – Identity, Neuro Tags & the Default Mode Network
 41:03 – Creativity as a Byproduct of Safety
 48:14 – Discernment, Industry Hype & Self-Trust   Calls to Action: Neurosomatic Intelligence is now enrolling : https://neurosomaticintelligence.com/nsi-certification Sacred Synapse: an educational YouTube channel founded by Jennifer Wallace that explores nervous system regulation, applied neuroscience, consciousness, and psychedelic preparation and integration through Neurosomatic Intelligence.    Wayfinder Journal: Track nervous system patterns and support preparation and integration through Neurosomatic Intelligence.   FREE 1 Year Supply of Vitamin D + 5 Travel Packs from Athletic Greens when you use my exclusive offer: https://www.drinkag1.com/rewired  Learn to work with Boundaries at the level of the body and nervous system at https://www.boundaryrewire.com Get a two-week free trial of neurosomatic training at https://rewiretrial.com Sources:    Amada, N., et al. "The Transformative Potential of Psychedelic Experiences: A Qualitative Analysis of Meaning-Making and Narrative Reorganization." Journal of Consciousness Studies, vol. 27, no. 7–8, 2020, pp. 122–150.   Carhart-Harris, Robin L., et al. "Neural Correlates of the Psychedelic State as Determined by fMRI Studies with Psilocybin." Proceedings of the National Academy of Sciences, vol. 109, no. 6, 2012, pp. 2138–2143.   Carhart-Harris, Robin L., et al. "The Entropic Brain: A Theory of Conscious States Informed by Neuroimaging Research with Psychedelic Drugs." Frontiers in Human Neuroscience, vol. 8, 2014, article 20.   Carhart-Harris, Robin L., et al. "Psilocybin with Psychological Support for Treatment-Resistant Depression: Six-Month Follow-Up." Psychopharmacology, vol. 235, no. 2, 2018, pp. 399–408.   Davis, Alan K., Roland R. Griffiths, and Frederick S. Barrett. "Psychological Flexibility Mediates the Relations between Acute Psychedelic Effects and Subjective Decreases in Depression and Anxiety." Journal of Contextual Behavioral Science, vol. 15, 2020, pp. 39–45.   Davis, Alan K., et al. "Effects of Psilocybin-Assisted Therapy on Major Depressive Disorder: A Randomized Clinical Trial." JAMA Psychiatry, vol. 78, no. 5, 2021, pp. 481–489.   Erritzoe, David, et al. "Effects of Psilocybin Therapy versus Escitalopram on Depression and Emotional Connectedness in Major Depressive Disorder." The New England Journal of Medicine, vol. 384, 2021, pp. 1402–1411.   Griffiths, Roland R., et al. "Psilocybin Produces Substantial and Sustained Decreases in Depression and Anxiety in Patients with Life-Threatening Cancer: A Randomized Double-Blind Trial." Journal of Psychopharmacology, vol. 30, no. 12, 2016, pp. 1181–1197.   MacLean, Katherine A., Matthew W. Johnson, and Roland R. Griffiths. "Mystical Experiences Occasioned by the Hallucinogen Psilocybin Lead to Increases in the Personality Domain of Openness." Journal of Psychopharmacology, vol. 25, no. 11, 2011, pp. 1453–1461.   Watts, Rosalind, et al. "Patients' Accounts of Increased 'Connectedness' and 'Acceptance' after Psilocybin for Treatment-Resistant Depression." Journal of Humanistic Psychology, vol. 57, no. 5, 2017, pp. 520–564.   Weiss, B., et al. "Associations between Naturalistic Psychedelic Use, Psychological Insight, and Changes in Social Connectedness and Personality." Frontiers in Psychology, vol. 12, 2021, article 667987. Disclaimer: Trauma Rewired podcast is intended to educate and inform but does not constitute medical, psychological or other professional advice or services. Always consult a qualified medical professional about your specific circumstances before making any decisions based on what you hear. We share our experiences, explore trauma, physical reactions, mental health and disease. If you become distressed by our content, please stop listening and seek professional support when needed. Do not continue to listen if the conversations are having a negative impact on your health and well-being. If you or someone you know is struggling with their mental health, or in mental health crisis and you are in the United States you can 988 Suicide and Crisis Lifeline.   If someone's life is in danger, immediately call 911.   We do our best to stay current in research, but older episodes are always available. We don't warrant or guarantee that this podcast contains complete, accurate or up-to-date information. It's very important to talk to a medical professional about your individual needs, as we aren't responsible for any actions you take based on the information you hear in this podcast.   We invite guests onto the podcast. Please note that we don't verify the accuracy of their statements. Our organization does not endorse third-party content and the views of our guests do not necessarily represent the views of our organization. We talk about general neuro-science and nervous system health, but you are unique. These are conversations for a wide audience. They are general recommendations and you are always advised to seek personal care for your unique outputs, trauma and needs.   We are not doctors or licensed medical professionals. We are certified neuro-somatic practitioners and nervous system health/embodiment coaches. We are not your doctor or medical professional and do not know you and your unique nervous system. This podcast is not a replacement for working with a professional. The BrainBased.com site and RewireTrial.com is a membership site for general nervous system health, somatic processing and stress processing. It is not a substitute for medical care or the appropriate solution for anyone in a mental health crisis.   Any examples mentioned in this podcast are for illustration purposes only. If they are based on real events, names have been changed to protect the identities of those involved.   We've done our best to ensure our podcast respects the intellectual property rights of others, however if you have an issue with our content, please let us know by emailing us at traumarewired@gmail.com. All rights in our content are reserved.

Light smoking is not harmless.

CBS lawyers shut down Stephen Colbert's Senate interview — and suddenly it's “Trump censorship.” A Democrat Super PAC darkens Jasmine Crockett's skin in a primary ad. A DHS building is targeted in Idaho. And the New England Journal of Medicine quietly admits COVID vaccine blood clots were real. Tara connects the dots on media double standards, political hypocrisy, terror labeling, and the slow unraveling of the COVID narrative.

Ted Joyce is a Professor of Economics at Baruch College and the Graduate Center, the City University of New York and a Research Associate in the National Bureau of Economic Research's program in Health Economics. He has published extensively in the area economic demography and reproductive health policy.  His work on abortion policy has appeared in the Journal of Political Economy, New England Journal of Medicine, the Journal of the American Medical Association, the Journal of Human Resources and the Review of Economics and Statistics. His most recent work is on the evaluation of programs to improve the academic outcomes of low-income students in higher-education. Dr. Joyce is on the Editorial Board for the Journal of Policy Analysis and Management. Part 1 The discussion included the following topics: does tension exist between AI and online learning; whether AI transforms online learning into something more effective; role played by AI in measuring student performance; and determining certainty that the work produced by a student is by that individual.      

Intermittent fasting is the most Googled diet-related term on the planet, except everyone who does it will tell you it's not a diet. It's a protocol. An eating window. A lifestyle. An optimization hack. Definitely, absolutely, under no circumstances a diet. You just don't eat for sixteen hours. Totally different.In this episode, we trace IF from ancient religious fasting traditions through its secularization and commodification, afrom Martin Berkhan's Leangains forum and its tagline ("fuck breakfast") to Michael Mosley's BBC documentary, Hugh Jackman's Wolverine physique, and Jack Dorsey describing his weekend-long fasts as "hallucinating" like that's a selling point. We walk through how a Nobel Prize in yeast biology became a justification for skipping breakfast, why Jason Fung's The Obesity Code scored 31% on scientific accuracy and still became the IF bible, and how the fasting app market turned one simple rule into a multimillion-dollar industry.Then we get into what the science actually says. We break down the claimed mechanisms — metabolic switching, autophagy, insulin sensitivity — and look honestly at where the evidence lands. Spoiler: the mechanisms are real, but the confidence far outpaces the human data. The first direct measurement of autophagy in humans was published in 2025. Mouse metabolism runs seven times faster than ours. And the landmark Liu et al. trial in the New England Journal of Medicine found that time-restricted eating is no better than regular caloric restriction for weight loss. You're not metabolic switching. You're just eating less.We also dig into what IF means for active people (no performance benefit across any exercise type, real risk of under-fueling and RED-S, and a protein distribution problem that no eight-hour window can solve), what the AHA, ADA, NIA, and ISSN actually say about it, and the robust research linking IF to eating disorder behaviors across all genders — including a landmark study showing that fasting was a stronger predictor of binge eating disorder than any other form of dietary restraint. Fasting is listed in the DSM-5 as a compensatory behavior. Just because you give it a different vocabulary doesn't mean your body experiences it differently.Your body is smarter than any fasting app. Also, breakfast slaps..This Episode's Sponsors:rabbit — Code YDSFEB for 10% offOsmia — Code YDS20 for 20% offTailwind — Code YOURDIET20 for 20% offMicrocosm Coaching — Book a free consultationFull references, episode archive, and our advertising ethics policy at yourdietsuckspodcast.comHosted by: Zoë Rom & Kylee Van Horn, RDN

In part two of this series, Dr. Tesha Monteith and Dr. Andrew Hershey discuss appropriate treatment strategies to prevent migraines in children and adolescents. Show citation:  Hershey AD, Szperka CL, Barbanti P, et al. Fremanezumab in Children and Adolescents with Episodic Migraine. N Engl J Med. 2026;394(3):243-252. doi:10.1056/NEJMoa2504546  Show transcript:  Dr. Tesha Monteith: This is Tesha Monteith with the Neurology Minute. I'm back with Andrew Hershey, professor of Pediatrics and Director of the Division of Neurology at Cincinnati Children's and the Children's Headache Center. This is part two of our discussion on his paper published in the New England Journal of Medicine, fremanezumab in Children and Adolescents with Episodic Migraine. Andrew, now that we have fremanezumab approved for prevention of episodic migraine in children and adolescents, and we have a number of other devices and treatments for patients that can be used as part of FDA-approved treatment or even off-label, can you discuss an appropriate treatment paradigm to prevent migraine? Dr. Andrew Hershey: I think the first and foremost part of the paradigm is to identify the disease, so recognition that headaches are a component of the disease migraine, so you have headaches attacks due to migraine is an essential part. Many of the children, adolescents and their families are unaware that that is even what they're having, and clarifying the etiology actually goes a long way. One of my former mentors, Dr. Prensky, always said that 50% of kids get better from just seeing a child neurologist, and I think it's that clarification of the diagnosis. Second to that, you need to provide a very adequate acute treatment as well as what's probably even more essential than anything else is healthy lifestyle habits. So regular eating, drinking, sleeping, and exercise. And then finally, if the headache is causing severe disability or frequent headaches or interfering with the child's school, home or social life, the prevention medications may need to be added. And this is where the fremanezumab, or if you prefer devices, devices can be used for both the acute and preventive treatment. Dr. Tesha Monteith: Well, thank you for the summary, and congratulations again on your paper. Dr. Andrew Hershey: Thank you. Dr. Tesha Monteith: Do check out the full podcast for more details about the paper and treatment of migraine in children and adolescents. This is Tesha Monteith. Thank you for listening to the Neurology Minute.

A phase 3 trial in The New England Journal of Medicine found that the oral PCSK9 inhibitor enlicitide reduced LDL by 57% at 24 weeks in high-risk patients, with similar adverse events to placebo. An oral option may improve uptake and help more patients reach lipid targets. In The Lancet, SMART-CHOICE 3 showed clopidogrel monotherapy after DAPT post-PCI reduced death, MI, or stroke versus aspirin, without more bleeding. Finally, a large meta-analysis confirmed most reported statin side effects are not causally linked, reinforcing their strong benefit–risk profile.

Get My Brand Master list⁠: https://drchristiangonzalez.com/best-brands-form-2-2/ Get Liver Supplement Guide: https://drchristiangonzalez.com/liver-supplements-pdf-request-form/ → My one stop shop for quality supplements: https://theswellscore.com/pages/drg Episode Description Over 100 million Americans have some form of liver disease right now—and most don't know it. Your liver doesn't hurt when it's inflamed. No pain, no warning signs, not until it's too late. Meanwhile, the supplement industry is flooding the market with "liver support" formulas packed with proprietary blends, underdosed ingredients, and zero clinical evidence. Dr. Christian Gonzalez went through all the research to find the five best evidence-based liver supplements—proven in human trials to actually protect and repair your liver. In this episode, Dr. G reveals: • The omega-3 dosage shown to reduce liver fat on MRI imaging • Which vitamin E study in the New England Journal of Medicine showed reversal of liver damage • The supplement that activates your body's "master metabolic switch" for fat burning • Why milk thistle has been the gold standard for liver health for over 2,000 years He's ranking each supplement by strength of clinical evidence, giving you exact dosages, who should take them, who shouldn't, and his top brand picks. If you drink alcohol, take medications regularly, eat processed foods, or just live in the modern world—your liver needs support. This episode shows you how. Timestamps: 0:00 - Intro 1:47 - How to Know If Your Liver Is Inflamed 2:54 - The Turmeric Mistake Most People Make 5:34 - The Fatty Acid That Burns Liver Fat 7:43 - The Vitamin E Study That Changed Everything 9:29 - The Blood Sugar Supplement Going Viral 11:54 - Two Supplements Your Doctor Should Know About 13:21 - The 2,000-Year-Old Gold Standard Learn more about your ad choices. Visit megaphone.fm/adchoices

In part one of this two-part series, Dr. Tesha Monteith and Dr. Andrew Hershey summarize findings from the SPACE trial evaluating fremanezumab in adolescents and children with migraine. Show citation: Hershey AD, Szperka CL, Barbanti P, et al. Fremanezumab in Children and Adolescents with Episodic Migraine. N Engl J Med. 2026;394(3):243-252. doi:10.1056/NEJMoa2504546  Show transcript:  Dr. Tesha Monteith: Hi, this is Tesha Monteith with the Neurology Minute. I'm here with Andrew Hershey, Professor of Pediatrics and Director of the Division of Neurology at Cincinnati Children's and the Children's Headache Center. We're here talking about his new paper published in the New England Journal of Medicine, Fremanezumab in Children and Adolescents with Episodic Migraine. Andrew, thank you for being on our Neurology Minutes. Dr. Andrew Hershey: Thank you for inviting me. Dr. Tesha Monteith: Can you summarize the findings of the space trial investigating Fremanezumab for adolescents and children with migraine? Dr. Andrew Hershey: This is one of the four monoclonal antibodies against CGRP, or it's this receptor that had been proven effective for adults. And it's the first one, the formazepam, that's been able to report its effectiveness in children and adolescents with less than 15 headache days per month. This study looked at over 200 children adolescents that were in a double-blinded randomized placebo controlled study. And reached its primary, as well as its secondary endpoint of a reduction compared to placebo. And the number of attacks of migraine per month, as well as a greater than 50% reduction in the number of headache attacks per month, with minimal to no side effects, the most notable side effect being injection site erythema. Dr. Tesha Monteith: Great. Thank you so much for providing that update. Do check out the full podcast for more details about his paper and the treatment of migraine in children and adolescents. This is Tesha Monteith. Thank you for listening to the Neurology Minute.  

In episode 67 of Going anti-Viral, Dr Martin Hirsch joins host Dr Michael Saag to discuss his career in HIV medicine, mentorship, and his scientific legacy. Dr Hirsch is a Professor Emeritus at Harvard Medical School and was Director of the Harvard Collaborative AIDS Treatment Evaluation Unit from 1986 to 2003 and Director of the Harvard Multidisciplinary AIDS Research Training Grant. Dr Hirsch's research focused on finding drug combinations that delay the development of multidrug resistance and reduce viral replication in HIV-1 infection. Dr Hirsch served as an Editorial Board member for numerous prestigious medical journals over the past 3 decades, including AIDS, the New England Journal of Medicine, Clinical Infectious Diseases, and the Journal of Infectious Diseases, where he was Editor-in-Chief. Dr Hirsch discusses his extensive career, the evolution of antiviral therapies, and the importance of mentorship in science. He reflects on his early experiences, the emergence of HIV, and the collaborative efforts that led to advancements in treatment. Dr Hirsch emphasizes the need for individualized mentorship and shares insights on the future of HIV research and his optimism for the potential of HIV prophylactic treatments.0:00 – Introduction1:50 – Early career and mentorship5:07 – Transitioning to HIV research7:55 – The emergence of antiretroviral therapies11:06 – The AIDS epidemic and initial cases14:30 – Collaboration in HIV research17:42 – The AZT trial and its impact20:16 – Navigating the shift from CMV to HIV22:39 – Antiretroviral resistance and combination therapy26:39 – The role of mentorship in science30:56 – Future directions in HIV researchResources:Going-anti-Viral: Episode 6 - A Conversation With Dr Anthony Fauci __________________________________________________Produced by IAS-USA, Going anti–Viral is a podcast for clinicians involved in research and care in HIV, its complications, and other viral infections. This podcast is intended as a technical source of information for specialists in this field, but anyone listening will enjoy learning more about the state of modern medicine around viral infections. Going anti-Viral's host is Dr Michael Saag, a physician, prominent HIV researcher at the University of Alabama at Birmingham, and volunteer IAS–USA board member. In most episodes, Dr Saag interviews an expert in infectious diseases or emerging pandemics about their area of specialty and current developments in the field. Other episodes are drawn from the IAS–USA vast catalogue of panel discussions, Dialogues, and other audio from various meetings and conferences. Email podcast@iasusa.org to send feedback, show suggestions, or questions to be answered on a later episode.Follow Going anti-Viral on: Apple Podcasts YouTubeXFacebookInstagram...

Dr. Tesha Monteith talks with Dr. Andrew D. Hershey about the advancements in the treatment of pediatric migraines.  Read the related article in The New England Journal of Medicine.  Disclosures can be found at Neurology.org. 

Meniscus tears are common in the older population but is physical therapy a good treatment? Listen to our latest podcast as we discuss the findings of the recent NEJM article, "A Randomized Trial of Physical Therapy for Meniscal Tear and Knee Pain" with Dr. Carlin Senter.

In this video, Dr. Doug Lucas breaks down a recent New England Journal of Medicine study examining long-term use of the bisphosphonate zoledronate (Reclast) for fracture prevention. He explains how infrequent dosing over 10 years reduced vertebral fractures, but also highlights persistent suppression of bone turnover markers and plateauing bone density over time. Study Linkshttps://pubmed.ncbi.nlm.nih.gov/39813642/

Ozempic promete hacerte perder peso rápido.Pero casi nadie te explica qué le está pasando realmente a tu cuerpo mientras lo usas.Hoy te explico qué dice la ciencia de verdad sobre Ozempic, Wegovy y Mounjaro: cómo funcionan, qué efectos tienen realmente, qué riesgos existen, cuándo NO deberías usarlos y por qué perder peso rápido no siempre significa mejorar tu salud.En este vídeo aprenderás:• Qué es Ozempic y cómo actúa en tu cerebro y tu apetito• Cuánto peso se pierde realmente según los estudios• Efectos secundarios frecuentes: náuseas, vómitos, problemas digestivos• Riesgo de pérdida de masa muscular (y por qué eso empeora tu metabolismo)• Problemas de vesícula y pérdida rápida de peso• Advertencia sobre tumores tiroideos observados en animales• Cuándo NUNCA deberías usarlo• En qué casos médicos extremos podría tener sentido• Y la alternativa real: hábitos que funcionan sin depender de fármacosSi estás pensando en usar Ozempic para adelgazar, mira este vídeo antes de tomar una decisión.Si te gusta el contenido claro, basado en ciencia, suscríbete al canal y activa la campanita.Déjame en comentarios tu opinión: ¿usarías Ozempic o prefieres cambiar hábitos?

Welcome to Episode 53 of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants! News Reports Mission Local. (2025, December). Timeline of the fatal stabbing at a San Francisco hospital. https://missionlocal.org/2025/12/sf-hospital-killing-timeline/ YouTube. (n.d.). News report on stabbing at SFG [Video]. https://www.youtube.com/watch?v=JAGzwGwJcXI Segment 1: The Wet Read (1 min | YouTube Short) JournalFeed. (2020). Epinephrine 0.3 mg or 0.5 mg for anaphylaxis? https://journalfeed.org/article-a-day/2020/anaphylaxis-guidelines-2020/ JournalFeed. (2020). Anaphylaxis guidelines for 2020. https://journalfeed.org/article-a-day/2020/anaphylaxis-guidelines-2020/ Hayden, F. G., Sugaya, N., Hirotsu, N., Lee, N., de Jong, M. D., Hurt, A. C., … Baloxavir Marboxil Study Group. (2018). Baloxavir marboxil for uncomplicated influenza in adults and adolescents. New England Journal of Medicine, 379(10), 913–923. https://www.nejm.org/doi/full/10.1056/NEJMoa1716197 Wang, Y., Chen, L., & Zhang, Y. (2021). Clinical efficacy and safety of baloxavir marboxil in the treatment of influenza: A systematic review and meta-analysis of randomized controlled trials. Journal of Infection. https://www.sciencedirect.com/science/article/pii/S0163445321000512 Segment 2: Dry Scan (2–3 min | TikTok) JournalFeed. (2023). New PECARN C-spine rule. https://journalfeed.org/article-a-day/2023/new-pecarn-c-spine-rule/ JournalFeed. (2023). C-spine clearance in kids: What you need to know. https://journalfeed.org/article-a-day/2023/c-spine-clearance-kids/ JournalFeed. (2024). New, dangerous synthetic opioids hit the streets. https://journalfeed.org/article-a-day/2024/new-dangerous-synthetic-opioids/ JournalFeed. (2024). Synthetic opioids: The nitazene wave. https://journalfeed.org/article-a-day/2024/synthetic-opioids-nitazenes/ Segment 3: Oral Contrast (10 min | YouTube / Instagram) JournalFeed. (2023). Can we spot potentially violent patients at the door? https://journalfeed.org/article-a-day/2023/spot-violent-patients/ JournalFeed. (2023). What precedes and leads to workplace violence? https://journalfeed.org/article-a-day/2023/workplace-violence-healthcare/ JournalFeed. (2024). Healthcare violence is too high—3 ways to break the cycle. https://journalfeed.org/article-a-day/2024/healthcare-violence-cycle/ Our social media: TikTok: https://www.tiktok.com/@ccme_courses Instagram: https://www.instagram.com/ccme_courses Facebook: https://www.facebook.com/CenterForMedicalEducation LinkedIn: https://www.linkedin.com/in/rickbukata Our podcasts: The 2 View Podcast (Free): Subscribe on Apple Podcasts https://apple.co/3rhVNZw​ Subscribe on Google Podcasts: http://bit.ly/2MrAHcD​ Subscribe On Spotify: http://spoti.fi/3tDM4im Risk Management Monthly Podcast (Paid CME): https://www.ccme.org/riskmgmt ** The information in this video is not intended nor implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images, and information, contained in this video is for general information purposes only and does not replace a consultation with your own doctor/health professional. The information in this video is for informational purposes only and not for the purpose of providing legal advice. You should contact your attorney to obtain advice with respect to any particular issue or problem. Nothing here should be construed to form an attorney-client relationship. ** emergencymedicine #cme

🧭 REBEL Rundown 🗝️ Key Points 💉 Hydrocortisone Saves Lives:The 2023 Cape Cod Trial (NEJM) showed a clear mortality benefit and reduced need for intubation in severe CAP patients treated with hydrocortisone.📊 Guidelines Are Catching Up:The SCCM (2024) and ERS now recommend steroids for severe CAP, while ATS/IDSA updates are still pending.🔥 Redefining “Severe”:Patients requiring high FiO₂ (>50%), noninvasive or mechanical ventilation, or PSI >130 meet criteria for steroid therapy — even outside the ICU.🍬 Main Risk = Hyperglycemia:Elevated glucose was the most consistent adverse effect, but rates of GI bleed and secondary infection were not increased.🧭 Early, Targeted Use Matters:Start hydrocortisone within 24 hours of identifying severity — especially in patients with high CRP (>150) or strong inflammatory response. Click here for Direct Download of the Podcast. 📝 Introduction Corticosteroids have long sparked debate in the treatment of bacterial pneumonia — once viewed with skepticism, now increasingly supported by high-quality evidence. In this episode, Dr. Alex Chapa joins the REBEL Core Cast team to explore how the 2023 Cape Cod Trial (NEJM) reshaped practice and guideline recommendations for severe community-acquired pneumonia (CAP). 📖 Historical Context & Long-Standing Skepticism For decades, the use of steroids in pneumonia was controversial.Early Use: Steroids entered practice in the 1940s and 50s for autoimmune inflammation, but there was immediate hesitation regarding secondary superinfections.Mixed Data: From the 1980s to the 2000s, small studies emerged on severe pneumonia and ARDS, but the data was inconsistent. Different trials used varying definitions of “severe” pneumonia and different C-reactive protein (CRP) cutoffs, making the data “spread” and easy to “cherry pick” to support or deny a benefit.Past Guidelines: This uncertainty was reflected in official guidelines:2007 (ATS/IDSA): The American Thoracic Society and the Infectious Diseases Society of America did not address the topic due to insufficient data.2019 (ATS/IDSA): Pre-COVID, the guidelines recommended against using corticosteroids in severe CAP. They acknowledged no benefit for non-severe pneumonia, but the data for severe pneumonia was considered too weak to endorse.Pre-Trial Consensus: Prior to 2023, the consensus was to avoid steroids in non-severe pneumonia, while severe pneumonia remained a “gray area” with no treatment showing a clear mortality difference. 📜 The Landmark Cape Cod Trial (NEJM 2023) The Cape Cod trial, published in the New England Journal of Medicine in 2023, reignited the discussion by providing robust, positive data.Trial Design: Phase 3, multi-center, double-blind, randomized, controlled trial.Intervention: 800 patients randomized to two groups, Hydrocortisone as a continuous infusion (200mg/day) versus a placebo infusion.Taper: On day 4, clinicians would decide whether to continue the infusion or begin a taper based on clinical response.Population: Patients with severe CAP, defined by meeting at least one of the following criteria:Pneumonia Severity Index (PSI) > 130.O2 by FiO2 ratio < 300.Need for mechanical or non-invasive ventilation (with PEEP ≥ 5).Need for high FiO2 (>50%) via non-rebreather or heated high flow.Primary Outcomes: Death for any cause 6.2% (hydrocortisone) vs 11.9% (placebo)Secondary outcomes:Death from any cause at 90 days 9.3% (hydrocortisone) vs 14.7% (placebo)Endotracheal intubation 18% (hydrocortisone) vs 29% (placebo)Hospital-acquired infections 9.8% (hydrocortisone) vs 11.1% (placebo)Gastrointestinal bleeding 2.3% (hydrocortisone) vs 3.3% (placebo)Vasopressor initiation by day 28 15.3% (hydrocortisone) vs 25.0% (placebo)Key Findings: The trial demonstrated superiority for hydrocortisone 📋 Updated Guidelines & Current Practice The Cape Cod trial, along with subsequent meta-analyses, has begun to change official recommendations.Society of Critical Care Medicine (SCCM): In 2024, an SCCM expert panel, reviewing the Cape Cod trial and 18 others, strongly recommended corticosteroids for severe CAP. They concluded that steroids reduce mortality and the need for mechanical ventilation.Meta-Analysis (Smit et al.): A 2024 meta-analysis in Lancet Respiratory confirmed the 30-day mortality benefit.European Respiratory Society (ERS): The ERS has issued a recommendation to use steroids for severe pneumonia but still urges caution regarding side effects.ATS/IDSA: As of the podcast recording, the ATS/IDSA had not yet updated their 2019 guidelines. 🛠️ Practical Application for Clinicians Defining “Severe” CAP: The key is to identify patients who qualify as “severe”. This can be done using:Scoring Tools: The PSI is the best validated tool for mortality but is cumbersome. Simpler tools like CURB-65 or SMART-COP are practical and acceptable for defining severity. 2023 meta-analysis from by Zaki et al showed both work well, but CURB-65 has better mortality prediction early on.Cape Cod Criteria: Any patient meeting the trial’s inclusion criteria (e.g., high-flow O2, non-invasive ventilation) qualifies, regardless of location (ED, floor, or ICU).Biomarkers: While not required, a CRP level was used in many studies. A CRP > 150 (Cape Cod) or > 204 (Smit meta-analysis) strongly indicates severe inflammation that would benefit from steroids.Clinical Judgment: A patient who looks “sick,” has “soft” blood pressure, or has dense infiltrates and high oxygen needs (e.g., >50% FiO2 on high flow) is a candidate.Adverse Effects:Hyperglycemia: This was the most significant risk identified, with rates between 6-12%. This is a primary concern, especially in patient populations with high BMI.GI Bleed & Secondary Infection: Fears of these side effects, which contributed to historical skepticism, were not borne out in the Cape Cod trial. The data does not support being overly concerned.Other Side Effects: Mood changes, delirium, insomnia, and agitation in the elderly are known side effects of steroids that were not specifically addressed in the trial but remain clinical concerns. 🔄 Clinical Pathway for Steroids in Severe CAP Unanswered Questions & Future Research Possible remaining questions:Biomarkers: Can we find a more precise CRP level to distinguish moderate from severe disease? Could other markers like ferritin or IL-6 be used? Dosing & Tapering: How much immunomodulation is needed, and when is it truly safe to taper?Gender Differences: Early data suggests females may respond better to steroids and experience fewer side effects. The question of female patients with severe CAP require less corticosteroids needs further exploration. 👉 Clinical Bottom Line The current literature, spearheaded by the Cape Cod trial, now supports the use of corticosteroids in severe community-acquired pneumonia. The best evidence currently points to hydrocortisone, started early (within 24 hours) after severity is identified using a validated tool. While hyperglycemia is a risk, the previous fears of GI bleeding and secondary infections were not substantiated in recent, rigorous trials. 📚 References Chapa-Rodriguez A, Abou-Elmagd T, O’Rear C, Narechania S. Do patients with severe community-acquired bacterial pneumonia benefit from systemic corticosteroids?. Cleve Clin J Med. 2025;92(10):600-604. PMID: 41033846Dequin PF, Meziani F, Quenot JP, et al. Hydrocortisone in Severe Community-Acquired Pneumonia. N Engl J Med. 2023;388(21):1931-1941. PMID: 36942789Chaudhuri D, Nei AM, Rochwerg B, et al. 2024 Focused Update: Guidelines on Use of Corticosteroids in Sepsis, Acute Respiratory Distress Syndrome, and Community-Acquired Pneumonia. Crit Care Med. 2024;52(5):e219-e233. PMID: 38240492 Post Peer Reviewed By: Marco Propersi, DO (Twitter/X: @Marco_propersi), and Mark Ramzy, DO (X: @MRamzyDO) 👤 Show Notes Alex Chapa, MD PGY 5 Pulmonary Critical Care Fellow Cape Fear Valley Medical Center Fayetteville NC 🔎 Your Deep-Dive Starts Here REBEL Core Cast 149: Review of Corticosteroids in Community-Acquired Pneumonia Corticosteroids have long sparked debate in the treatment of bacterial ... Thoracic and Respiratory Read More The post REBEL Core Cast 149: Review of Corticosteroids in Community-Acquired Pneumonia appeared first on REBEL EM - Emergency Medicine Blog.

En este episodio especial de Radio el Respeto, conversamos en profundidad con el Dr. Alfredo Corell, catedrático de inmunología y una de las voces más reconocibles de la divulgación científica en español tras su trabajo durante la pandemia de COVID-19. Alfredo Corell es inmunólogo, catedrático de universidad y divulgador científico español, miembro de la Sociedad Española de Inmunología. Licenciado y doctor en Biología en la UCM, realizó la especialidad de Inmunología y la tesis doctoral en el Hospital 12 de Octubre de Madrid. Durante 18 años realizó labores investigadoras y de diagnóstico inmunológico en diversos hospitales. Su trabajo en Inmunogenética e Histocompatibilidad incluye el descubrimiento de un pseudogen del cromosoma 6 humano: HLA-DRB6. Tiene más de 80 publicaciones científicas de alto impacto incluyendo las prestigiosas New England Journal of Medicine, Lancet, Immunology Today, Lancet Microbe y Mucosal Immunology. En 1999 se incorporó como profesor de Inmunología en la Universidad de Valladolid, catedrático en 2020 y llegó a Vicerrector de Innovación Docente y Transformación Digital. En marzo de 2023 se incorporó como catedrático a la Universidad de Sevilla y como Inmunólogo al Hospital Virgen del Rocío. Corell es el coordinador del proyecto de innovación docente Immunomedia, una plataforma digital de docencia y divulgación, reconocida tanto nacional como internacionalmente. En su faceta de divulgador científico, ha sido colaborador en La Sexta Noche; La hora de la 1; y Está Pasando. También ha participado en Informe Covid, Horizonte, Cuatro al Día, y Las Cosas Claras, entre otros programas. Ha intervenido frecuentemente en los informativos de canales nacionales, locales y autonómicos. Ha colaborado con periódicos impresos y digitales nacionales y autonómicos, y participa asiduamente en plataformas de desmentidos de bulos sobre salud en Maldita.es, Salud sin Bulos y Newtral. Su compromiso con el colectivo LGTBi ha sido reconocido con el premio Triángulo Rosa de la Fundación Triángulo de Castilla y León (2019), Premio “Baeza diversa” (2023) y siendo incluido en la lista de las 100 personalidades españolas LGTBI más influyentes (El Mundo y El Español). Ha recibido diversos reconocimientos como: en 2021 el Premio Innovador al Personaje Único (periódico El Mundo de Castilla y León), Primer Premio CSIC-Fundación BBVA a la Comunicación Científica, o su inclusión en la lista Forbes entre los 100 españoles más creativos del mundo empresarial, en 2022 el Premio Orgullo Friki e Influencers awards de ciencia (revista Influencers), y en 2024 el Premio a la Excelencia Comunicativa de Servicio Público (UVa), y Premio Merco-OdS al Liderazgo Reputacional en la Divulgación Sanitaria. Acaba de publicar su nuevo libro "Inmunidad en Forma", (lo podéis adquirir aquí https://amzn.to/49ISZ0H) en el que Corell nos ofrece una guía completa y práctica sobre el sistema inmunitario: qué es, cómo funciona, qué podemos hacer para cuidarlo y qué NO funciona a pesar de lo que nos venden. Con rigor científico, pero con un lenguaje cercano, desmonta mitos y nos da herramientas reales basadas en evidencia. Lo que exploramos en esta conversación: ¿Qué son realmente las defensas? - Cómo funciona el sistema inmunitario en términos simples - Por qué las mujeres tienen sistemas inmunitarios más potentes pero más autoinmunidad - El papel del intestino: ¿por qué el 70-80% de nuestro sistema inmunitario está ahí? - La inmunosenescencia: cómo envejece nuestro sistema inmunitario ¿Podemos mejorar nuestras defensas? - Nutrición: qué comer (y qué evitar) para cuidar nuestra inmunidad - Vitamina D, C, zinc: ¿qué funciona realmente y qué es mito? - Ejercicio físico: beneficios y el peligro del sobreentrenamiento - Estrés y relaciones sociales: por qué la soledad es tan dañina como fumar 15 cigarrillos al día - Sueño: la epidemia silenciosa que está debilitando nuestras defensas - Tabaco, alcohol y drogas: efectos devastadores en el sistema inmunitario - Tecnología: cómo el uso de pantallas afecta indirectamente nuestra inmunidad Cuando las defensas fallan - Enfermedades autoinmunitarias: ¿por qué el cuerpo se ataca a sí mismo? - Alergias en aumento: la hipótesis de la higiene - Inmunodeficiencias y la revolución del tratamiento del VIH - Vacunas: desmontando mitos y entendiendo la ciencia detrás de ellas - La experiencia personal de Alfredo durante la pandemia Los inmunotimos: desenmascarando productos sin evidencia Síguenos en Redes Twitter: https://twitter.com/radioelrespeto Instagram: https://www.instagram.com/radioelrespeto/ Facebook: https://www.facebook.com/radioelrespeto Redes Sociales del Equipo: | Pablo Fuente | https://www.instagram.com/pablofuente/ | Nacho Sevilla | https://twitter.com/nachorsevilla | Fernando Sierra | https://twitter.com/Peeweeyo1

We have learned a lot about extended spectrum coverage of prophylactic antibiotics for cesarean section. The landmark C/SOAP trial randomized 2,013 women undergoing nonelective cesarean delivery to azithromycin 500 mg IV plus standard prophylaxis versus placebo, demonstrating a 51% reduction in the composite outcome of endometritis, wound infection, or other infection. Adjuvant Zmax (plus standard first-generation cephalosporin) is now recognized as evidence-based antibiotic coverage for intrapartum cesarean, cesarean with ruptured membranes, and patients with obesity. This last patient characteristic comes from the ERAS latest update. But what is ZMAX is not available? Is there an evidence-based peri-op alternative in these cases? Does Gent and Clinda cover mycoplasma/Ureaplasma? What about postop flagyl? Listen in for details. 1. Tita AT, Szychowski JM, Boggess K, et al. Adjunctive Azithromycin Prophylaxis for Cesarean Delivery. The New England Journal of Medicine. 2016. 2. Yang M, Yuan F, Guo Y, Wang S. Efficacy of Adding Azithromycin to Antibiotic Prophylaxis in Caesarean Delivery: A Meta-Analysis and Systematic Review. International Journal of Antimicrobial Agents. 2022. 2. ACOG Practice Bulletin No. 199: Use of Prophylactic Antibiotics in Labor and Delivery. Obstetrics and Gynecology. 2018. Committee on Practice Bulletins-Obstetrics 3. Martingano D, Nguyen A, Nkeih C, Singh S, Mitrofanova A. Clarithromycin Use for Adjunct Surgical Prophylaxis Before Non-Elective Cesarean Deliveries to Adapt to Azithromycin Shortages in COVID-19 Pandemic. PloS One. 2020. 4. Valent AM, DeArmond C, Houston JM, et al. Effect of Post–Cesarean Delivery Oral Cephalexin and Metronidazole on Surgical Site Infection Among Obese Women: A Randomized Clinical Trial. The Journal of the American Medical Association. 2017. 5. Wood, G. E., et al. "In Vitro Susceptibility of Mycoplasma genitalium to Nitroimidazoles." Antimicrobial Agents and Chemotherapy 6. https://www.cdc.gov/std/treatment-guidelines/mycoplasmagenitalium.htm

Most medical encounters are structured as transactions. The patient comes in with a specific complaint, the medical expert identifies a discrete problem, and a specific intervention is prescribed.But at the heart of a medical encounter is a story. When a patient comes in with a medical problem, the problem cannot be disentangled from their life's narrative — doing so risks hollowing out the essence of what it means to care for another person. Our guest on this episode is award-winning author, and primary care physician Suzanne Koven, MD. Following the completion of her residency at Johns Hopkins Hospital, Dr. Koven joined the faculty at Harvard Medical School and practiced primary care medicine at Massachusetts General for 32 years. In 2019, she became the inaugural Writer in Residence at Mass General. Her writings have been published broadly—including in The Boston Globe, The New England Journal of Medicine, The Lancet, and The New Yorker. As a teacher and public speaker, she highlights the relationship between literature and medicine, and is a powerful advocate for female medical trainees. In this episode, Dr. Koven shares her journey to medicine at a time when few women were represented in the field and why she finds her undergraduate English classes to be more relevant to her clinical work than her science classes. We discuss narrative medicine, its value to patients and physicians alike, and how the modern healthcare system struggles to value the patient story. Finally, Dr. Koven leaves us with her advice for up-and-coming trainees: find a place in medicine where you can be yourself – for your own good and for your patients'.In this episode, you'll hear about: 3:00 - Dr. Koven's motivations for going into primary care medicine 15:49 - The impact that Dr. Koven's English degree has had on her approach to medicine 19:36 - What narrative medicine is 24:34 - What is lost when human connection and human story are deprioritized within the practice of medicine 31:15 - The benefits doctors experience when cultivating an appreciation for the arts37:21 - How gender representation in medicine has shaped Dr. Koven's experience as a physician42:54 - The need for the culture of medicine to adapt to changing demographics in the medical workforceIf you enjoyed this episode, please subscribe, rate, and review our show, available for free on Spotify, Apple Podcasts, or wherever you get your podcasts. If you know of a doctor, patient, or anyone working in health care who would love to explore meaning in medicine with us on the show, feel free to leave a suggestion in the comments or send an email to info@thedoctorsart.com.Copyright The Doctor's Art Podcast 2026

Could medications originally designed for diabetes actually help treat addiction, eating disorders, and the biology of cravings?In this part 2 of 2-part episode of Succeed In Medicine Podcast, Dr. Bradley Block sits down with Dr. Sean Wharton, to dig deeper into the science, myths, and emerging uses of GLP-1 agonists. Dr. Wharton explains that these medications don't simply reduce appetite, they calm what he calls “food noise,” the constant mental pull toward eating that many people with obesity experience. This neurological effect has opened the door to exciting possibilities: early research suggests GLP-1 drugs may also reduce cravings for alcohol and other addictive behaviors.  Dr. Wharton also clarifies the confusing world of brand names. Ozempic and Wegovy are both semaglutide; Mounjaro and Zepbound are tirzepatide. The differences are largely about FDA indications and insurance coverage, not completely different medications.The episode tackles common fears patients and clinicians hear every day. Do these medications cause eating disorders? No, in fact, they may help treat them. Are the side effects dangerous? Usually not, and most are manageable with proper dosing. Is “Ozempic face” real? It's simply normal fat loss, not a drug-specific problem. Most importantly, Dr. Wharton reinforces a compassionate, evidence-based message: obesity is a chronic, biological disease, and GLP-1 medications are tools to treat it, just like medications for blood pressure or diabetes.Three Actionable TakeawaysGLP-1 Medications Affect the Brain as Much as the Stomach: These drugs reduce “food noise” and cravings, helping patients regain control over eating behaviors. Their impact is neurological, not simply about willpower or restriction.Side Effects Are Real—but Usually Manageable: Nausea, constipation, and GI symptoms are the most common issues, especially early on. Starting low and increasing doses slowly makes treatment far more tolerable.Treatment Decisions Should Be Individualized:  Not every patient must stay on these medications forever. Conversations about duration, goals, and expectations should be collaborative and tailored to each person.About the Show:Succeed In Medicine covers patient interactions, burnout, career growth, personal finance, and more. If you're tired of dull medical lectures, tune in for real-world lessons we should have learned in med school!About the Guest:Dr. Sean Wharton holds doctorates in Pharmacy and Medicine from the University of Toronto. He is the Director of the Wharton Medical Clinic, a community-based weight management and diabetes clinic, and serves as Assistant Professor at the University of Toronto and Adjunct Professor at McMaster and York Universities.Dr. Wharton is the lead author of the 2020 Canadian Obesity Guidelines, recognized worldwide, and has published extensively in major medical journals including the New England Journal of Medicine. He is a passionate advocate for health equity and improving the way obesity is understood and treated in healthcare.LinkedIn: linkedin.com/in/drseanwhartonWebsite: whartonmedicalclinic.comAbout the Host:Dr. Bradley Block – Dr. Bradley Block is a board-certified otolaryngologist at ENT and Allergy Associates in Garden City, NY. He specializes in adult and pediatric ENT, with interests in sinusitis and obstructive sleep apnea. Dr. Block also hosts Succeed In Medicine podcast, focusing on personal and professional development for physiciansWant to be a guest?Email Brad at brad@physiciansguidetodoctoring.com  or visit www.physiciansguidetodoctoring.com to learn more!Socials:@physiciansguidetodoctoring on Facebook@physicianguidetodoctoring on YouTube@physiciansguide on Instagram and Twitter  This medical podcast is your physician mentor to fill the gaps in your medical education. We cover physician soft skills, charting, interpersonal skills, doctor finance, doctor mental health, medical decisions, physician parenting, physician executive skills, navigating your doctor career, and medical professional development. This is critical CME for physicians, but without the credits (yet). A proud founding member of the Doctor Podcast Network!Visit www.physiciansguidetodoctoring.com to connect, dive deeper, and keep the conversation going. Let's grow! Disclaimer:This podcast is for informational purposes only and is not a substitute for professional medical, financial, or legal advice. Always consult a qualified professional for personalized guidance. Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

A new trial in The New England Journal of Medicine found that exercise, whether done at home or with a physical therapist, helped reduce knee pain in adults with osteoarthritis and meniscal tears Supervised physical therapy (PT) offered a modest short-term advantage over home exercise. Much of PT's value may come from the attention and interaction with therapists rather than the specific therapeutic interventions Avoiding movement worsens knee arthritis over time by weakening muscles and stiffening joint structures, while regular exercise helps maintain mobility and reduce discomfort Surgery, including arthroscopy and meniscectomy, often fails to outperform exercise and carries long-term risks, making structured movement a better starting point Gentle, joint-friendly exercises like sit-to-stands, mini squats, leg raises, step-ups, cycling, and pool walking can help strengthen your knees and support long-term function

Cold plunges are everywhere, and the way people talk about them, you'd think they're a miracle cure for your brain, body, and soul. But in an age of algorithm-fueled evangelism, when a ritual becomes this ubiquitous and loud, we have to ask: how much of the buzz is backed by science… and how much is just marketing? In this episode, we explore the neuroscience of cold exposure: what's real, what's overstated, and why this "discomfort" has become a billion-dollar industry. We discuss: Why cold plunges went viral, and how wellness movements often devolve into identity-driven cultures The difference between cold exposure itself and the monetized "cold plunge movement" What constitutes a "cult" (and how pseudoscience forms around partial truths) The real physiological cold shock response Why the mental "high" after a plunge doesn't automatically equal long-term brain benefit The cardiovascular risks that rarely get discussed, especially for people with underlying heart disease What the research suggests about soreness, pain reduction, and muscle growth (including why cold immersion can blunt hypertrophy) The real story behind brown fat Who should avoid cold plunges altogether (asthma, arrhythmias, coronary disease, vascular conditions) Joining us for this conversation is investigative journalist and bestselling author Scott Carney (What Doesn't Kill Us, The Wedge), who has spent years inside the cold exposure world, first as a skeptic, then as a believer, and eventually as a critic of the culture that formed around it. His work reveals what happens when discomfort becomes identity, and when unfounded "social media science" outruns real science. Your Brain On... is hosted by neurologists, scientists, and public health advocates Drs. Ayesha and Dean Sherzai. SUPPORTED BY: the 2026 NEURO World Retreat. A 5-day journey through science, nature, and community, on the California coastline: neuroworldretreat.com Your Brain On... Cold Plunges • SEASON 6 • EPISODE 7 REFERENCES Cold Water Immersion, Muscle Adaptation, and Recovery Roberts, L. A., Raastad, T., Markworth, J. F., Figueiredo, V. C., Egner, I. M., Shield, A., Cameron-Smith, D., Coombes, J. S., & Peake, J. M. (2015). Post-exercise cold water immersion attenuates acute anabolic signalling and long-term adaptations in muscle to strength training. Journal of Physiology, 593(18), 4285–4301. https://doi.org/10.1113/JP270570 Bleakley, C. M., McDonough, S. M., & MacAuley, D. C. (2004). The use of ice in the treatment of acute soft-tissue injury: A systematic review of randomized controlled trials. American Journal of Sports Medicine, 32(1), 251–261. https://doi.org/10.1177/0363546503260757 Leeder, J., Gissane, C., van Someren, K., Gregson, W., & Howatson, G. (2012). Cold water immersion and recovery from strenuous exercise: A meta-analysis. British Journal of Sports Medicine, 46(4), 233–240. https://doi.org/10.1136/bjsports-2011-090061 White, G. E., & Wells, G. D. (2013). Cold-water immersion and other forms of cryotherapy: Physiological changes potentially affecting recovery from high-intensity exercise. Sports Medicine, 43(8), 695–706. https://doi.org/10.1007/s40279-013-0055-8 Kellmann, M., Bertollo, M., Bosquet, L., Brink, M., Coutts, A. J., Duffield, R., Erlacher, D., Halson, S. L., Hecksteden, A., Heidari, J., Kölling, S., Meyer, T., Mujika, I., Robazza, C., Skorski, S., Venter, R., & Beckmann, J. (2018). Recovery and performance in sport: Consensus statement. International Journal of Sports Physiology and Performance, 13(2), 240–245. https://doi.org/10.1123/ijspp.2017-0759 Inflammation, Pain, and Perceived Recovery Hohenauer, E., Taeymans, J., Baeyens, J. P., Clarys, P., & Clijsen, R. (2015). The effect of post-exercise cryotherapy on recovery characteristics: A systematic review and meta-analysis. PLoS ONE, 10(9), e0139028. https://doi.org/10.1371/journal.pone.0139028 Costello, J. T., Culligan, K., Selfe, J., & Donnelly, A. E. (2012). Muscle, skin and core temperature after –110°C cold air and 8°C water treatment. PLoS ONE, 7(11), e48190. https://doi.org/10.1371/journal.pone.0048190 Brown Adipose Tissue (BAT) – Human Imaging & Metabolism van Marken Lichtenbelt, W. D., Vanhommerig, J. W., Smulders, N. M., Drossaerts, J. M., Kemerink, G. J., Bouvy, N. D., Schrauwen, P., & Teule, G. J. (2009). Cold-activated brown adipose tissue in healthy men. New England Journal of Medicine, 360(15), 1500–1508. https://doi.org/10.1056/NEJMoa0808718 Virtanen, K. A., Lidell, M. E., Orava, J., Heglind, M., Westergren, R., Niemi, T., Taittonen, M., Laine, J., Savisto, N. J., Enerbäck, S., & Nuutila, P. (2009). Functional brown adipose tissue in healthy adults. New England Journal of Medicine, 360(15), 1518–1525. https://doi.org/10.1056/NEJMoa0808949 Betz, M. J., & Enerbäck, S. (2015). Human brown adipose tissue: What we have learned so far. Diabetes, 64(7), 2352–2360. https://doi.org/10.2337/db15-0146 Autonomic Nervous System, HRV, and Cold Exposure Mourot, L., Bouhaddi, M., Regnard, J., Tordi, N., & Rouillon, J. D. (2008). Cardiac autonomic control during short-term exposure to cold water in humans. European Journal of Applied Physiology, 104(3), 541–547. https://doi.org/10.1007/s00421-008-0810-3 Janský, L., Pospíšilová, D., Honzová, S., Uličný, B., Šrámek, P., Zeman, V., & Kamínková, J. (1996). Immune system of cold-exposed and cold-adapted humans. European Journal of Applied Physiology, 72(5–6), 445–450. https://doi.org/10.1007/BF00242276 Cardiovascular Stress and Cold Shock Tipton, M. J., Collier, N., Massey, H., Corbett, J., & Harper, M. (2017). Cold water immersion: Kill or cure? Experimental Physiology, 102(11), 1335–1355. https://doi.org/10.1113/EP086283 Tipton, M. J., & Bradford, C. (2014). Cold water immersion and cold shock response. Extreme Physiology & Medicine, 3(1), 1–10. https://doi.org/10.1186/2046-7648-3-7 Whole-Body Cryotherapy (Distinct From Cold Plunges) Costello, J. T., Baker, P. R., Minett, G. M., Bieuzen, F., Stewart, I. B., & Bleakley, C. (2015). Whole-body cryotherapy (extreme cold air exposure) for preventing and treating muscle soreness after exercise in adults. Cochrane Database of Systematic Reviews, 2015(9), CD010789. https://doi.org/10.1002/14651858.CD010789.pub2 LINKS Scott Carney's website: https://www.scottcarney.com/ FOLLOW US Join NEURO World: https://neuro.world/ Instagram: https://www.instagram.com/thebraindocs YouTube: https://www.youtube.com/thebraindocs More info and episodes: TheBrainDocs.com/Podcast

Amid ongoing discussions about the U.S.-Israel alliance, including recent commentary referencing questions raised by media personality Tucker Carlson about the benefits the United States derives from its relationship with Israel, a new interview highlights the extensive technological and humanitarian contributions Israel provides. Gedaliah Blum, Director of The Heartland Initiative in Israel, sat down for an interview with Alan Skorski. In a social media post on December 22, 2025, Blum addressed Carlson's recurring question — “What exactly does the United States get from Israel?” — by quickly listing more than 25 Israeli innovations that directly benefit the U.S. and its allies. These include advancements in aviation safety, missile defense systems protecting American bases, IED detection technology safeguarding U.S. soldiers in combat zones, battlefield medicine now standard in American emergency rooms, and enhanced airport security protocols used worldwide. During the conversation, Skorski expanded on this list, emphasizing Israel's role as a hub of innovation despite its small size and challenging security environment. Israel has pioneered several key technologies widely adopted in the U.S. and globally: The USB flash drive (originally known as Disk-on-Key), revolutionizing portable data storage. Waze, the real-time GPS navigation app acquired by Google and used by millions for traffic updates and efficient routing. Mobileye, providing advanced driver-assistance systems (ADAS) that enhance vehicle safety and serve as a foundation for autonomous driving technologies. ICQ, one of the earliest popular instant messaging platforms. Significant contributions to Intel processors through R&D by Israeli teams. Medical & Health Innovations Israeli developments have transformed diagnostics and treatment: PillCam (from Given Imaging), a swallowable camera capsule enabling non-invasive internal imaging for gastrointestinal diagnostics. Babysense infant breathing monitors for enhanced child safety. ReWalk bionic exoskeletons assisting individuals with lower-limb paralysis to regain mobility. Agriculture, Water & Other Fields In agriculture and resource management, Israel leads with drip irrigation systems from Netafim, which optimize water use in arid regions; the development of longer-lasting, sweeter cherry tomatoes; and advanced water desalination and purification technologies. Defense & Security Contributions Defense innovations include the Iron Dome missile defense system, advanced UAVs (drones), and cutting-edge cybersecurity solutions that bolster U.S. national security interests. These advancements “barely scratch the surface” of the mutual benefits in the U.S.-Israel partnership, Skorski noted, with many technologies co-developed or shared through joint efforts. Humanitarian Leadership Exemplified in Haiti Beyond technology, Israel's contributions extend to global humanitarian aid. A prominent example is the rapid response to the devastating January 2010 earthquake in Haiti. As detailed in a 2010 report in the New England Journal of Medicine, within 48 hours of the quake striking Port-au-Prince, Israel deployed a 230-person military task force — including 109 support and rescue personnel from the IDF Home Front Command and 121 medical staff from the IDF Medical Corps Field Hospital. The team arrived 15 hours after departing Tel Aviv and immediately began operations. In just 10 days, the field hospital treated over 1,100 patients. 16 babies were delivered in the hospital. IDF search and rescue forces assisted in rescuing or aiding 4 individuals. The swift deployment and high-impact care underscored Israel's commitment to international disaster relief, often arriving among the first responders in crises worldwide. -VIN News Alan Skorski Reports 21JAN2026 - PODCAST

Why are unmarried patients less likely to receive life-saving medical treatments? Peter McGraw talks to professor and author Joan DelFattore about how America's healthcare system disadvantages those who are single or outside the nuclear family model. From TEDx talks to the New England Journal of Medicine, she's sounding the alarm on a silent crisis. If you're Solo—and especially if you live alone—you need to hear this episode.Love the show? Subscribe, rate, review, and share! https://www.petermcgraw.org/solo

We all feel emotions every day, but how often do we stop to understand what they really are and how they work? Joining Michael for this episode is Ethan Kross, a renowned authority on emotion regulation and author of Shift: Managing Your Emotions—So They Don't Manage You, for a conversation about the science behind how our internal dialogue affects health, performance, and relationships. Ethan explains what emotions are, how they function, and the importance of teaching emotional regulation skills from a young age. He also covers various tools and strategies that can help you manage your emotions more effectively, shares examples from his books, and highlights significant studies.Listen and Learn: Why we have emotions and how they quietly shape our thoughts, bodies, and actions in ways most of us don't fully noticeWhy meaningful moments almost always come with emotional friction, and what that reveals about living a purposeful lifeThe 50-year study that shows how early emotion skills shape health, money, and relationshipsWhat happens when logic is pushed too far, and emotions are removed, and how science suggests a more balanced approach that quietly shapes better outcomes in work, relationships, and lifeWhy managing emotions isn't about suppressing them, but learning how you can use the right tools at the right time to keep them working for you instead of against youSimple mental shifts that help you move through discomfort and emotional blocks fasterResources: Shift: Managing Your Emotions--So They Don't Manage You https://bookshop.org/a/30734/9780593444412 Ethan's Website: https://www.ethankross.com/Emotion & Self Control Laboratory: http://selfcontrol.psych.lsa.umich.edu/Connect with Ethan on Social Media: https://www.instagram.com/ethankross/https://www.linkedin.com/in/ekross/About Ethan KrossEthan Kross is one of the world's leading experts on emotion regulation. An award-winning professor and bestselling author in the University of Michigan's top- ranked Psychology Department and its Ross School of Business, he studies how the conversations people have with themselves impact their health, performance, decisions, and relationships.Ethan was born and raised in Brooklyn, New York. He attended the University of Pennsylvania, where he was elected to Phi Beta Kappa and graduated magna cum laude. After earning his PhD in Psychology from Columbia University, Ethan completed a post-doctoral fellowship in social-affective neuroscience to learn about the neural systems that support self-control. He moved to the University of Michigan in 2008, where he founded the Emotion & Self Control Laboratory.Ethan's research has been published in Science, The New England Journal of Medicine, and The Proceedings of the National Academy of Sciences, among other peer-reviewed journals. He has participated in policy discussion at the White House and has been interviewed on CBS Evening News, Good Morning America, Anderson Cooper Full Circle, and NPR's Morning Edition. His pioneering research has been featured in The New York Times, The Wall Street Journal, The New Yorker, Harvard Business Review, USA Today, The Economist, The Atlantic, Forbes, and Time.Ethan is the two-time National Bestselling author of SHIFT: Managing Your Emotions—So They Don't Manage You and CHATTER: The Voice in Our Head, Why it Matters and How to Harness It. His books are routinely featured in the worlds' top media (e.g., New York Times, Wall Street Journal, BBC, The New Yorker), have garnered multiple accolades and been translated into over 40 languages. Related Episodes:309. The Language of Emotions with Karla McLaren265. The Power of Emotions at Work with Karla McLaren183. Permission to Feel: Emotional Intelligence with Marc BrackettSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Are GLP-1 medications truly revolutionizing medicine—or are we just seeing the latest healthcare hype cycle?In this part 1 of 2- part episode of Succeed In Medicine Podcast, Dr. Bradley Block sits down with Dr. Sean Wharton, to explore the real story behind GLP-1 agonists, how they were discovered, how they work, and why they suddenly became cultural blockbusters. Dr. Wharton explains that while the public sees these drugs as new, clinicians in diabetes care have been using them for over a decade. Originally developed to treat type 2 diabetes, GLP-1 medications revealed an unexpected benefit: meaningful weight loss. What began as a “sleeper drug” for glucose control became a global phenomenon once their impact on appetite and cravings was understood.A major theme of the discussion is the concept of “food noise”—the relentless mental pull toward food that many patients experience. Dr. Wharton describes how this biological drive makes long-term weight loss extraordinarily difficult and why willpower alone is rarely enough. GLP-1 medications work by quieting this food noise, helping patients regain control over their eating behaviors.The conversation also tackles tough questions clinicians and patients ask every day:Why do people need to stay on these medications long-term? Why do patients with diabetes lose less weight than those without? Is obesity truly a disease, and how should doctors talk about it? Are the benefits due to the drug itself or simply the weight loss? Dr. Wharton breaks down the biology of GLP-1 hormones, their role in insulin regulation and appetite control, and why these drugs have been such rare “unicorns” in medicine, highly effective with relatively few side effects.This episode sets the stage for Part 2, where they will dive deeper into myths, side effects, and practical prescribing guidance.Three Actionable TakeawaysObesity Is a Biological Disease, Not a Willpower Problem: Food noise and cravings are driven by hormones and brain chemistry. GLP-1 medications treat these biological mechanisms, not a character flaw.Long-Term Treatment Is Often Necessary: Just like medications for blood pressure or cholesterol, GLP-1 drugs address a chronic condition. Stopping treatment usually means the underlying biology—and weight—returns.Language Matters in Patient Care: Clinicians should approach weight with empathy and humility. Inviting patients into a respectful conversation about options is far more effective than blaming or shaming.About the Show:Succeed In Medicine covers patient interactions, burnout, career growth, personal finance, and more. If you're tired of dull medical lectures, tune in for real-world lessons we should have learned in med school!About the Guest:Dr. Sean Wharton holds doctorates in Pharmacy and Medicine from the University of Toronto. He is the Director of the Wharton Medical Clinic, a community-based weight management and diabetes clinic, and serves as Assistant Professor at the University of Toronto and Adjunct Professor at McMaster and York Universities.Dr. Wharton is the lead author of the 2020 Canadian Obesity Guidelines, recognized worldwide, and has published extensively in major medical journals including the New England Journal of Medicine. He is a passionate advocate for health equity and improving the way obesity is understood and treated in healthcare.LinkedIn: linkedin.com/in/drseanwhartonWebsite: whartonmedicalclinic.comAbout the Host:Dr. Bradley Block – Dr. Bradley Block is a board-certified otolaryngologist at ENT and Allergy Associates in Garden City, NY. He specializes in adult and pediatric ENT, with interests in sinusitis and obstructive sleep apnea. Dr. Block also hosts Succeed In Medicine podcast, focusing on personal and professional development for physiciansWant to be a guest?Email Brad at brad@physiciansguidetodoctoring.com  or visit www.physiciansguidetodoctoring.com to learn more!Socials:@physiciansguidetodoctoring on Facebook@physicianguidetodoctoring on YouTube@physiciansguide on Instagram and Twitter  This medical podcast is your physician mentor to fill the gaps in your medical education. We cover physician soft skills, charting, interpersonal skills, doctor finance, doctor mental health, medical decisions, physician parenting, physician executive skills, navigating your doctor career, and medical professional development. This is critical CME for physicians, but without the credits (yet). A proud founding member of the Doctor Podcast Network!Visit www.physiciansguidetodoctoring.com to connect, dive deeper, and keep the conversation going. Let's grow! Disclaimer:This podcast is for informational purposes only and is not a substitute for professional medical, financial, or legal advice. Always consult a qualified professional for personalized guidance. Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

The only certainty in medicine is uncertainty. It touches every aspect of clinical practice, from diagnosis to treatment to prognosis. Despite this, many clinicians view uncertainty as something to tolerate at best or eliminate at worst. But what if we need to rethink and reframe our relationship with uncertainty in medicine? In this episode, we sit down with Jonathan Ilgen and Gurpreet Dhaliwal, co-authors of the New England Journal of Medicine article, "Educational Strategies to Prepare Trainees for Clinical Uncertainty." Together, we explore the nature of uncertainty in clinical practice, its effects on trainees and seasoned clinicians, and strategies to embrace it as a fundamental part of medical reasoning rather than a regrettable byproduct. Jonathan and Gurpreet share insights from research and clinical experience, offering practical methods to help trainees and clinicians recognize, manage, and even embrace uncertainty. Key topics we discuss include: The paradoxical nature of uncertainty: When perceived as a threat, it can provoke anxiety or fear; yet when framed as an opportunity, it can inspire hope and optimism. Why uncertainty is inevitable in medical practice and its impact on clinicians. Is uncertainty a state or a trait? The distinction between epistemic uncertainty (knowledge gaps) and aleatoric uncertainty (randomness in outcomes). How experienced clinicians utilize strategies such as forward planning and monitoring to navigate uncertainty. Communicating uncertainty with patients: how to do it effectively without eroding trust. How to integrate uncertainty into medical education. During the conversation, we explore the emotional responses to uncertainty and how these reactions can influence clinical practice and decision-making. Importantly, Jonathan and Gurpreet emphasize the importance of openly communicating uncertainty with colleagues, supervisors, and patients—a practice that, contrary to common belief, actually strengthens trust, fosters transparency, and encourages collaboration. By normalizing and embracing uncertainty, clinicians can better manage the complexities of medicine and build confidence in their ability to care for patients in the face of the unknown.  

Momofuku Ando is the father of Instant Ramen. Feeding Japan after the war. But how do you get Americans to eat it? Dave Young: Welcome to The Empire Builders Podcast, teaching business owners the not-so-secret techniques that took famous businesses from mom-and-pop to major brands. Stephen Semple is a marketing consultant, story collector and storyteller. I’m Stephen’s sidekick and business partner, Dave Young. Before we get into today’s episode, a word from our sponsor, which is … well, it’s us, but we’re highlighting ads we’ve written and produced for our clients. So here’s one of those. [AirVantage Heating & Cooling Ad] Dave Young: Welcome to the Empire Builders Podcast. I’m Dave Young. Stephen Semple’s right there standing by, and he just told me what we’re going to be talking about and, man, it took me back to college days. In fact, I was looking at photos over the weekend. I have some photos of when I was in college, and this is way back 20 years before the turn of the century, to tell you how long ago this is. Stephen Semple: I hate how you put it that way. Dave Young: This is 20 years before the turn of the century. That’s a lifetime ago. But there were days in college where it’s like, “Well, gosh, Mom and Dad haven’t sent me any money and I haven’t gotten the job that I told myself I’d get,” so you go to the store, and what do you find? It’s either ramen or, if you want an upgrade, Cup O’ Noodles. And the Cup O’ Noodles, as everyone that’s ever been poor knows, is a noodle soup in a cup, and you take the lid off, put some water in it, throw it in the microwave, voila. Am I right? Is that what we’re talking about, or is this some new form? Stephen Semple: No, no, that’s what we’re talking about. That’s what we’re talking about, not some new Tesla called Cup O’ Noodles. No, no, you’re right, but I want you to hold onto that thought of it as being an upgrade from ramen, because we’re going to revisit that. Dave Young: Not an upgrade? Stephen Semple: We’re going to revisit that whole idea, because that’s brilliant. It was started in the 1950s and it was a new idea then, but today there’s over a hundred billion servings of instant noodles eaten every year. And it’s estimated that Cup O’ Noodles sells between 18 and 25 billion servings a year. It’s inside of a larger organization, so it’s hard to know exactly, but that’s the estimates I’ve come across. Dave Young: Dude, that’s like feeding the planet three times in one day. Stephen Semple: Right? Isn’t that crazy? Dave Young: Yeah. Stephen Semple: So, empire? Yeah. Dave Young: Yeah. There’s some guy sitting on top of that noodle money somewhere, and I guess we’re going to hear the story. Stephen Semple: So in the 1950s in the United States, food is boring. Eating out was like literally going to diners, and international food really only existed in big cities that had Chinatowns. Dave Young: Yeah. Stephen Semple: And, following World War II, there was actually a strong anti-Asian feeling in the United States. Meanwhile, back in Osaka, Japan, there’s a food crisis after the war because basically Japan has been decimated, and bread is being distributed by the U.S. and it’s really plentiful, but people wanted more traditional meals. Dave Young: They’re not used to bread. Stephen Semple: Right. It’s not part of what they normally eat. So Momofuku Ando is a 48-year-old businessperson. He’s lost his company. He went to jail for tax evasion. All sorts of bad things went on, but he’s out of jail and he’s looking to start his new business, and he sees people lined up for ramen, so there is a ramen tie in here. Dave Young: There you go, yeah. Just to be fair, I wasn’t talking about ramen from a store or from a vendor. I’m talking about those little bricks of Top Ramen. Stephen Semple: Yeah, yeah. Hold onto that. Hold onto that thought. We are going to come back to that, yes. So, ramen was created when noodles basically came over from China, and 1910 is the earliest record we could find of a ramen shop in Japan, so it looked like it was around 1910. Dave Young: Yep. The Japanese didn’t have noodles till 1910? Stephen Semple: They didn’t have the type of noodles in ramen, yes. Dave Young: Okay. See, I mean, we could go a whole nother direction on this if you wanted to, in the Japanese industrialization of them going around the world and bringing all kinds of new technology back to Japan in the early 1900s. Stephen Semple: Yes. Dave Young: Turns out, including noodle technology. Stephen Semple: Including noodle technology, and we forget how closed Japan was. Dave Young: Oh, yeah. Yeah. Stephen Semple: Basically, the only thing that was imported was silk. Right? That was about it. Very, very closed economy, and then yes, lots of … And when things changed in Japan, boy, they changed in a hurry. It went from basically medieval to industrial in like, that. It was crazy. Dave Young: Yeah. Stephen Semple: Yeah. Dave Young: I mean, you and I are both whiskey fans, and we know that the story of Japanese whiskey is the same story. The Japanese guy goes to Scotland, falls in love with Scotch whiskey, figures out how to make it, comes back to Japan and builds the Japanese whiskey industry. Stephen Semple: Yeah. Dave Young: Let’s go back to noodles. I’m sorry. I will distract us all day long. Stephen Semple: No, but it is an interesting thing. Now, the main drawback to ramen is it’s hard to make at home. The noodles need to be fresh. They’re hand-cut. They’ve got to come from shops. And so what Momofuku decides is he wants to make a ramen product that is tasty, non-perishable, easy to make, affordable, and ready in five minutes with hot water. Dave Young: Wow. Stephen Semple: That’s his goal. Dave Young: That’s a goal. Stephen Semple: On top of that, he has no culinary training. So he invests every last penny into this, because he needs something he can put into a grocery store as well on the non-perishable, because there’s few refrigerators or ovens in Japan at this time. Dave Young: Okay, yeah. Stephen Semple: And the key is the broth, and it can take days to make the broth. So here was his question. If everyone loves ramen, why is it so hard to make? And so he tries drying the noodles, then he gets the broth dried into the noodles, and he spends several years working on this and nothing seems to work. And one day, he notices his wife tempura-frying food and the batter dehydrates immediately the moment it hits the oil, because what does oil do? Removes water. So now what he does is he drops the noodle into this high-heat oil, and it creates a shell. He then takes fresh noodles, cooks them in the broth until it’s saturated, drops it into the oil, and the water is cooked out. It works. Dave Young: Wow. Stephen Semple: It works. He’s now got this dried noodle. Now he needs to get it in the store. So he starts with chicken ramen, and that’s more expensive. It’s about six times the price of regular ramen, but what he finds is people are willing to pay for the convenience. So in 1961, it hits stores in Osaka and it sells like crazy, and it’s called Magic Ramen by customers. Dave Young: Magic Ramen. I like that. Stephen Semple: Yeah, and he gets to the point where he borrows a million yen to open a factory. In the first year they’re doing 13 million packages, and the second year, 50 million packages a year. Now, to put that in perspective, 50 million packages a year, the TV dinners at that time is one half the number of sales of the amount of ramen that they’re selling in Japan, of this instant ramen. Dave Young: Wow. Okay. Stephen Semple: It’s 1962, and this idea is getting very copied. There’s now 70 companies in the space in Japan in a few short years. And some are also cheaper and the economy in Japan is still recovering, so Momofuku decides he’s going to spend a couple of million bucks and he’s going to bring this product to the United States. Dave Young: Okay. Stephen Semple: Now, the timing is really bad. In 1968, there’s a hoax letter written to the New England Journal of Medicine by Dr. Kwok that MSG is unsafe and The New York Times reports on it, and this becomes a placebo effect on all Chinese food. Dave Young: What year was this? Stephen Semple: ’68. Dave Young: ’68, okay. Stephen Semple: The letter was written on a bet by Dr. Howard Steele, who was a pediatric who was having a hard time getting published, and there was this bet that, “Oh, I bet you if you wrote something this way, it would get published,” so he creates this hoax and it gets published. Dave Young: And people still believe it? Stephen Semple: Yeah. He created this fake research facility with a made-up name, and it’s amazing. Sounds kinda familiar for the world we’re in today, and MSG is declared unsafe for years later. Dave Young: Well, my wife thinks MSG doesn’t agree with her. Stephen Semple: Well, some people, it may not. Dave Young: Maybe it doesn’t, but I don’t know. Stephen Semple: But again, that could be just a food intolerance, right? Dave Young: You don’t know, yeah. Stephen Semple: Yeah. So Momofuku travels to the United States. Here’s one of the things he figures out. He runs into a bit of a challenge with the U.S. market. He realizes he needs to do sampling, because it became successful in Japan because it was a familiar food that became convenient, right? So it was only one step away, a familiar food that became convenient. It was not a familiar food in the United States, so he decided he needed to do sampling, so he goes over to the U.S., sets up sampling in grocery stores. This anti-Asia movement is so strong, people won’t even try it. It’s too new. Dave Young: Yeah. Stephen Semple: Won’t even try it. Dave Young: And don’t know what ramen is. Stephen Semple: Right. So when he’s done, he’s got all this product left over and he decides, “I’m not going to take this product back to Japan,” so he leaves it for the staff, but what he notices is the staff are eating it, but very differently. Dave Young: Stay tuned. We’re going to wrap up this story and tell you how to apply this lesson to your business right after this. [Using Stories to Sell Ad] Dave Young: Let’s pick up our story where we left off, and trust me, you haven’t missed a thing. Stephen Semple: So when he’s done, he’s got all this product left over and he decides, “I’m not going to take this product back to Japan,” so he leaves it for the staff, but what he notices is the staff are eating it, but very differently. What he discovers is the staff break up the noodles, and put it in a coffee cup and pour in the hot water, and eat it in the break room. The recipe called for these large noodles to be put in a pot and then you transferred the pot to a bowl. Dave Young: Oh. Okay, yeah. Stephen Semple: So your Cup O’ Noodles, you know when you’re talking about the bricks of ramen? All it is is a brick of ramen, broken up into little bits. Dave Young: Sure. Well, I used to make it. I didn’t like the long noodles, so I would do the same thing just instinctively, because I’m an American from the Midwest. Stephen Semple: Yeah. What he also observed in all of this was that people called it noodles. Yeah. So they took the ramen, broke it up in little bits, put it in a coffee cup, poured in hot water and called it noodles. Dave Young: Noodles. I mean, that’s what Mom made for us when we weren’t feeling so good, right? It was some chicken noodle soup. Stephen Semple: Right. So now we have the familiar, remember? Dave Young: Yes. Stephen Semple: Successful in Japan because it was the familiar made convenient. Now we had the familiar. How do you make it convenient? He goes back to Japan, and he comes up with the idea of a styrofoam cup that you put it in. He added some vegetables, which made it a complete meal. Now, the Asian food scare was still there, but it’s not Asian food any longer, it’s a cup of noodles. Dave Young: Yeah. Brilliant. Stephen Semple: And he stopped calling it ramen. He called it a cup of noodles. And actually, originally it was called Cup Noodle and in 1973 they added the O’, so now it was Cup O’ Noodles. Dave Young: So, I mean, you could start riots in the U.S. There could be millions of idiots, that they’re going to be upset now that they were fooled into eating ramen instead of noodles. Stephen Semple: Well, I’m safely here in Canada. This is your problem to deal with. Dave Young: Yeah? I think you should put some kind of warning label on this episode. Stephen Semple: “Warning, may cause riots.” I like it. We may do that. We may do that. Dave Young: Yeah. “We’re just a victim of Big Ramen.” Stephen Semple: Yeah. Yeah. It’s one more unwanted foreign influence in the United States. Dave Young: Uh-huh. Stephen Semple: Today, the estimate is Cup O’ Noodles is like an $8 billion business, but what I found that was so interesting about this was his innovation all came from observation. Dave Young: Yes. Stephen Semple: He observed that people in Japan were eating ramen but couldn’t eat it at home for a bunch of reasons, so he wanted to make this community thing for home. He observed his wife with the tempura batter, which made for the breakthrough, had this huge success in Japan. But when he came to the United States, it was the whole thing of noticing the people eating it were doing it differently. They’re breaking it up, putting it in a cup, adding hot water. Now, there’s a business innovation lesson here but there’s a marketing lesson as well, because our greatest asset as marketers is observation of people. Dave Young: Exactly. Stephen Semple: It’s observing how people think, observing how people feel, observing how they act, observing how they react to things, and great marketing comes from observation. So does great innovation. Great innovation is seeing something on the right and pulling it over to the left. What I loved was this moment where he suddenly realized, “Wait a minute, ramen was successful in Japan because we took the familiar and made it convenient.” And then once people were looking at it like a soup, he was like, “Ooh, we make this more like a soup. We’re now taking the familiar and making it convenient, rather than making it a new food,” and I thought that was an unbelievably amazing observation. Dave Young: It is. And I think sometimes we get our heads into the books or the business or dealing with the oh, my God, the million little problems that just pop up in front of us every day, and we don’t step back to see the big picture. We don’t step back to observe. Stephen Semple: Well, we lose sight of what’s the customer actually thinking, and really that’s all that matters is what’s the customer thinking, right? What’s in their head? What’s going on in their world? How are they going to react to these things? And the more you understand that, the more you understand the human being on the other side of the … All ideas look great when you’re sitting in a boardroom with four white walls, a dropped ceiling and a spreadsheet. You can make anything work. The real thing is, how about the human being on the other side of that equation? That’s what matters. That’s what matters. Dave Young: I don’t want this to sound … Oh, I don’t care. I don’t care how this sounds. Stephen Semple: We’re already starting a riot, Dave. Go for it. Dave Young: Sometimes I get … I don’t use ChatGPT to write very much, but I will hand it something I’ve written and say, “Dumb it down.” Stephen Semple: Yes. Dave Young: “Make the sentences shorter, make this understandable to a sixth grader,” and it does a pretty decent job of helping me figure that out. Stephen Semple: For sure. Dave Young: It’s not that I’m assuming that people are stupid, but there are some people. Think about this. This is touching on MAGA territory here, but if you think about how smart the average person is, realize that half of the people are less smart than that. When you have a cup of ramen and a word that nobody’s heard, ramen, nobody knew what ramen was in the United States in the 1960s or ’70s. Stephen Semple: No, they didn’t. Dave Young: But they all knew what a noodle is. Stephen Semple: Noodle was. Yes. Dave Young: Grandma’s made us noodles forever. We like noodles. We like them in casseroles. We like them in stroganoff. That’s just beef and noodles, and noodle soup. And so if you change the word ramen, you get over yourself, you get over the fact that, “Well, people need to understand that ramen is not quite the same,” no, no, no, no, no. These are noodles. Stephen Semple: Just call it a noodle. Dave Young: Just call it a noodle. Stephen Semple: And that’s what was brilliant in the name, Cup O’ Noodles. Dave Young: Yeah. I think there are business owners and marketers that feel like the answer is to educate people. Stephen Semple: It never is. Dave Young: Never is. That hardly ever works. You need to associate your product with something they already know and understand. Stephen Semple: Attach the unfamiliar to the familiar, and we’ve talked about that a number of times in this podcast. But one of my favorite business books is Made to Stick by Chip and Dan Heath, and one of the things that they talk about is there’s six things that make a message sticky, and one of them is simple. Simple, I have a different take. I hate the term, dumbing things down. I like instead, let’s simplify it, because when a message is simple, it’s easier for everyone to absorb. It actually takes less brainpower to figure it out, and let’s face it. I’m in a world today where I’m competing with 5,000 messages a day. If it’s complicated and it takes time, it’s not that a person’s lazy, it’s not that they’re dumb. It’s, look, there’s just too much coming at them. The brain is like, “I don’t have time for that, because I got too much stuff coming at me.” So the more you can simplify it down, connect it, make it concrete, attach the unfamiliar to the familiar, the easier the brain just goes, “I get that. I understand it.” We need to make it easy because we’re competing with so much. Dave Young: No, I agree. Stephen Semple: As soon as you go down this path of I got to educate the consumer, give me a break, because I’m supposed to be educated on the food I eat, the air I breathe, the water I drink, the education, how I teach my kids, my health, my finances, my car, my air conditioning. Dude, I don’t have enough time to get educated, all that stuff. I have a busy life, and what I want to do is watch the hockey game at night. Dave Young: I agree. I agree 100% with you. And I’ll add this. There are still people that are stupid that eat three times a day. Stephen Semple: Yes, there are. There are. Dave Young: And they eat three times a day and want a Cup O’ Noodles. Stephen Semple: Absolutely. Absolutely. Dave Young: The simplification works in both directions, right? Stephen Semple: That’s the key. Dave Young: Yeah. Stephen Semple: That’s the key. Dave Young: That’s why it works so well. Stephen Semple: Right, because it wins you actually both ends of the spectrum. What it does is wins you everyone. Dave Young: Yeah. Stephen Semple: Everyone. It wins you everyone. That’s the point I want to make. Dave Young: If the sixth grader can understand it, so can the PhD. Stephen Semple: Correct. Well, and not only that. You’ll attract the attention of the PhD because they too only have so much time. Dave Young: Yeah. Simplify, simplify. Cool. Stephen Semple: This was fun. So here’s the interesting thing, Dave, is going back to your early statement of, “Oh, I didn’t eat ramen, I ate a Cup O’ Noodles.” Dude, you eat ramen. Dave Young: Now you know. You know, I never thought that the ramen had enough carbs in it, so I always crumbled a package of crackers in as well, to make it kind of a paste. Sometimes there’s just not enough carbs in it, so you just add some potato flakes. It thickens right up. Yeah, I was a master at that. Stephen Semple: You there were a connoisseur. Dave Young: You can use it as grout. Thank you for bringing us the story of Cup O’ Noodles, Stephen. Stephen Semple: We’re going to start a riot. Thanks, David. Dave Young: Thanks for listening to the podcast. Please share us. Subscribe on your favorite podcast app, and leave us a big, fat, juicy five-star rating and review at Apple Podcasts. And if you’d like to schedule your own 90-minute empire-building session, you can do it at empirebuildingprogram.com.

Episodio 596 con Francesca e Luca ai microfoni per una scorpacciata di notizie scientifiche dal defunto 2025. Iniziamo con gennaio 2025, quando è stato eseguito il secondo trapianto di un rene geneticamente modificato negli Stati Uniti.Ad aprile la Colossal Biosciences ha riportato in vita tre esemplari di enocione (o lupo terribile), un canide vissuto durante il Pleistocene. Per farlo, ha sequenziato il suo genoma da un dente di enocione di 13.000 anni fa e da un cranio di enocione di 72.000 anni fa, apportato 20 modifiche al DNA di lupo grigio per creare alcuni tratti fisici dell'enocione. A maggio è uscito sul New England Journal of Medicine probabilmente uno studio sul (https://doi.org/10.1056/NEJMoa2504747) primo trattamento personalizzato di editing genetico CRISPR eseguito su un bimbo di neanche un anno affetto da una patologia genetica molto rara. Il bimbo si chiama K.J. Muldoon ed è affetto dal deficit di CPS1, dove CPS sta per carbamoil-fosfato sintetasi 1, un enzima che trasforma l'ammoniaca in carbamoil-fosfato.Nell'esterna di oggi, Leonardo intervista Stefano Della Torre, ricercatore INFN che ci parla di come usando delle GPU (delle schede grafiche) siano riusciti a ridurre moltissimo il tempo necessario per risolvere i modelli che descrivono il comportamento dei raggi cosmici. Dopo una barza terribile, ritorniamo in studio. A giugno 2025 sono usciti due studi (https://doi.org/10.1126/science.adu9677 e https://doi.org/10.1016/j.cell.2025.05.040) in cui si analizzava un cranio quasi completo, risalente al 146000 anni fa, trovato in Cina nord-orientale e soprannominato cranio dell'“Uomo Drago”. (https://pmc.ncbi.nlm.nih.gov/articles/PMC8454562/).Un altro bel risultato per quanto riguarda le malattie genetiche l'ha ottenuto Sarah Tabrizi che, a settembre 2025, ha dichiarato il successo della sua gene-targeting therapy che potrebbe rallentare la progressione dalla malattia di Huntington (https://uniqure.gcs-web.com/news-releases/news-release-details/uniqure-announces-positive-topline-results-pivotal-phase-iii).Ad ottobre, invece, il giornale Psychiatric News ha pubblicato un report in cui veniva segnalata una nuova psicosi, chiamata “Psicosi indotta da IA” (https://doi.org/10.1176/appi.pn.2025.10.10.5). Si tratta di un nuovo disturbo neurologico per cui le persone iniziano a scambiare una chatbot per un essere cosciente, sviluppando allucinazioni, deliri e una vera e propria confusione della realtà.Da novembre 2025 il Canada non è più considerato un Paese libero dal morbillo. Molto probabilmente seguiranno a ruota gli Stati Uniti, per i quali il numero di casi è in largo aumento, con circa 2000 casi confermati in 43 paesi nel solo 2025. Purtroppo questa tendenza ad eludere l'obbligo vaccinale è in aumento, specialmente dopo il Covid-19 e le dichiarazioni di alcuni consulenti sanitari del governo americano di evitare la vaccinazione infantile contro l'epatite B. Tornando alla notizia del morbillo, ricordiamo che il vaccino contro morbillo, parotite e rosolia è estremamente efficace e protegge dal morbillo per tutta la vita, quindi mi raccomando: VACCINATEVI!Concludiamo l'episodio con due belle notizie leggere.Nello specifico di larve di mosconi che confondono le termiti con la loro culo-faccia (https://doi.org/10.1016/j.cub.2025.01.007), esponendo un posteriore mimetico che le confonde tra le termiti per "scroccare" vitto e alloggio.Se non lo sapevate, gli axolotl – che sono delle salamandre con caratteristiche neoteniche, ovvero è una specie che conserva caratteristiche morfologiche e fisiologiche tipiche dei giovani per tutta la vita, e con straordinarie capacità rigenerative – sono una specie a rischio di estinzione. Fortunatamente, però, alcuni ricercatori dell'Università Nazionale Autonoma del Messico sono riusciti ad introdurre axolotl allevati in cattività nel loro habitat naturale, i quali sono sopravvissuti, il che consentirebbe di ripopolare la popolazione selvatica (https://doi.org/10.1371/journal.pone.0314257).Diventa un supporter di questo podcast: https://www.spreaker.com/podcast/scientificast-la-scienza-come-non-l-hai-mai-sentita--1762253/support.

The NACE Journal Club with Dr. Neil Skolnik, provides review and analysis of recently published journal articles important to the practice of primary care medicine. In this episode Dr. Skolnik and guests review the following publications:1. Candesartan for Migraine Prophylaxies. The Lancet 2025 . Discussion by:Guest:Max Schidt, MDResident - Family Medicine Residency ProgramJefferson Health - Abington2. One vs two dose HPV vaccination for prevention of HPV infection – The New England Journal of Medicine 2025. Discussion by:Guest:Neil Skolnik, MDProfessor of Family and Community MedicineSidney  Kimmel  Medical College Thomas Jefferson UniversityAssociate Director - Family Medicine Residency ProgramJefferson Health – Abington3. The Surpass CVOT trial for prevention of MACE in people with Diabetes – The New England Journal of Medicine 2025. Discussion by:Guest:Neil Skolnik, MDProfessor of Family and Community MedicineSidney  Kimmel  Medical College Thomas Jefferson UniversityAssociate Director - Family Medicine Residency ProgramJefferson Health – Abington4. The New American Cancer Society Guidelines for Screening for cervical cancer – that includes self swab for HPV. Discussion by:Guest:Amy Clouse, MD Associate Director - Family Medicine Residency Program Jefferson Health – AbingtonMedical Director and Host, Neil Skolnik, MD, is an academic family physician who sees patients and teaches residents and medical students as professor of Family and Community Medicine at the Sidney Kimmel Medical College, Thomas Jefferson University and Associate Director, Family Medicine Residency Program at Abington Jefferson Health in Pennsylvania. Dr. Skolnik graduated from Emory University School of Medicine in Atlanta, Georgia, and did his residency training at Thomas Jefferson University Hospital in Philadelphia, PA. This Podcast Episode does not offer CME/CE Credit. Please visit http://naceonline.com to engage in more live and on demand CME/CE content.

¡Bienvenidos al ECCpodcast! Hoy discutimos uno de los debates más relevantes en la vía aérea crítica: ketamina versus etomidato para intubación endotraqueal. Basamos esta conversación en el ensayo clínico publicado en diciembre de 2025 por Casey et al. en The New England Journal of Medicine. Puedes leer el blogpost completo con todos los detalles y análisis clínico en:

What does it mean when 6,000 women a day enter menopause but there are only 4,100 certified clinicians to treat them?In this year end solo episode, I'm reflecting on 2025 in women's health. It was a year that felt heavy at the start personally for me after losing my mother, and globally with so much suffering and injustice. But even in all of that, women's health moved forward in meaningful ways. Not perfectly. Not fast enough. But enough that it deserves reflection.I'm covering the moments that shifted conversations this year from the FDA removing the black box warning on estrogen to new cervical cancer screening guidelines allowing self-collection HPV tests. From Addyi finally being approved for women under 65 to the release of comprehensive GSM guidelines that make genitourinary syndrome everyone's business, not just gynecologists'.And I'm getting personal about why I launched a concierge practice this year, what it taught me about the broken healthcare system, and why sexual health cannot be practiced in 10-minute appointments.Highlights:Why you're not too old for screening and what "safe exit criteria" really means.Menopause certification jumped from under 1,000 to over 4,100 practitioners in 2025.Menopause divorce vs. midlife clarity: Why hormonal chaos shouldn't decide your marriage.DARE to PLAY is a new, topical sildenafil launching in 2026 for female arousal disorder.Treating male partners reduces recurrent BV by 50% (New England Journal of Medicine).Hormone therapy for prevention: The nuanced conversation about bone health and cardiovascular risk.Why I launched a concierge practice and what it revealed about what women actually need.Thank you for being here for another year of Gyno Girl Presents: Sex, Drugs & Hormones. Your support, your messages, and your stories are what keep me going you are my why. If this year-in-review resonated with you, please share it with someone who needs to hear that they're not broken, not dramatic, and not asking for too much. And keep following the show in 2026 we've got incredible conversations lined up.Get in Touch with Me: WebsiteInstagramYoutubeSubstack

Today, Dave Furfaro, Luke Hedrick, and Robert Wharton discuss the PREDMETH trial published in The New England Journal of Medicine in 2025. This was a non-inferiority trial comparing prednisone to methotrexate for upfront therapy in treatment-naive sarcoidosis patients. Listen in for a break down of the trial, analysis, and clinically applicable pearls. Article and Reference Todays’ episode discusses the PREDMETH trial published in NEJM in 2025. Kahlmann V, Janssen Bonás M, Moor CC, Grutters JC, Mostard RLM, van Rijswijk HNAJ, van der Maten J, Marges ER, Moonen LAA, Overbeek MJ, Koopman B, Loth DW, Nossent EJ, Wagenaar M, Kramer H, Wielders PLML, Bonta PI, Walen S, Bogaarts BAHA, Kerstens R, Overgaauw M, Veltkamp M, Wijsenbeek MS; PREDMETH Collaborators. First-Line Treatment of Pulmonary Sarcoidosis with Prednisone or Methotrexate. N Engl J Med. 2025 Jul 17;393(3):231-242. doi: 10.1056/NEJMoa2501443. Epub 2025 May 18. PMID: 40387020. https://www.nejm.org/doi/full/10.1056/NEJMoa2501443 Meet Our Hosts Luke Hedrick is an Associate Editor at Pulm PEEPs and runs the Rapid Fire Journal Club Series. He is a senior PCCM fellow at Emory, and will be starting as a pulmonary attending at Duke University next year. Robert Wharton is a recurring guest on Pulm PEEPs as a part of our Rapid Fire Journal Club Series. He completed his internal medicine residency at Mt. Sinai in New York City, and is currently a first year pulmonary and critical care fellow at Johns Hopkins. Key Learning Points Clinical context Prednisone remains the traditional first-line treatment for pulmonary sarcoidosis when treatment is indicated, with evidence for short-term improvements in symptoms, radiographic findings, and pulmonary function—but with substantial, familiar steroid toxicities (weight gain, insomnia, HTN/DM, infection risk, etc.). Despite widespread use, glucocorticoids haven't been robustly tested head-to-head against many alternatives as initial therapy, and evidence for preventing long-term decline (especially in severe disease) is limited. Immunosuppressants (like methotrexate) are often used as steroid-sparing agents, but guideline recommendations are generally conditional/low-quality evidence, and practice varies. Why PREDMETH matters It addresses a real-world question: Can methotrexate be an initial alternative to prednisone in pulmonary sarcoidosis, rather than being reserved only for steroid-sparing later? It also probes a common clinical belief: MTX has slower onset than prednisone (often assumed, not well-proven). Trial design (what to know) Open-label, randomized, noninferiority trial across 17 hospitals in the Netherlands. Included patients with pulmonary sarcoidosis who had a clear pulmonary indication to start systemic therapy (moderate/severe symptoms plus objective risk features like reduced FVC/DLCO or documented decline, plus parenchymal abnormalities). Excluded: non–treatment-naïve patients and those whose primary indication was extrapulmonary disease. Treat-to-tolerability with escalation: both drugs started low and were slowly increased; switch/add-on allowed for inadequate efficacy or unacceptable side effects. Primary endpoint: change in FVC (with the usual caveat that FVC is “objective-ish,” but effort-dependent and not always patient-centered). Noninferiority margin: 5% FVC, justified as within biologic/measurement variation and “not clinically relevant.” Outcomes assessed at weeks 4, 16, 24; powered for ~110 patients to detect the NI margin. Patient population (who this applies to) Mostly middle-aged (~40s) with mild-to-moderate physiologic impairment on average (FVC ~77% predicted; DLCO ~70% predicted). Netherlands-based cohort with limited Black representation (~7%), which matters for generalizability. Would have been helpful to know more about comorbidities (e.g., diabetes), which can strongly influence prednisone risk. Main findings (what happened) Methotrexate was noninferior to prednisone at week 24 for FVC: Between-group difference in least-squares mean change at week 24: −1.17 percentage points (favoring prednisone) with CI −4.27 to +1.93, staying within the 5% NI margin. Timing mattered: Prednisone showed earlier benefit (notably by week 4) in FVC and across quality-of-life measures. By week 24, those early differences largely washed out—possibly because MTX “catches up,” and/or because crossover increased over time. In their reporting, MTX didn't meet noninferiority for FVC until week 24, supporting the practical message that prednisone works faster. Crossover and analysis nuance (important for interpretation) Crossover was fairly high, which complicates noninferiority interpretation: MTX arm: some switched to prednisone for adverse events and others had prednisone added for disease progression/persistent symptoms. Prednisone arm: some had MTX added. In noninferiority trials, heavy crossover can bias intention-to-treat analyses toward finding “no difference” (making noninferiority easier to claim). Per-protocol analyses avoid some of that but introduce other biases. They reported both. Safety signals (what to remember clinically) Adverse events were very common in both arms (almost everyone), mostly mild. Side-effect patterns fit expectations: Prednisone: more insomnia (and classic steroid issues). MTX: more headache/cough/rash, and notably liver enzyme elevations (about 1 in 4), with a small number discontinuing. Serious adverse events were rare; numbers were too small to confidently separate “signal vs noise,” but overall known risk profiles apply. Limitations (why you shouldn't over-read it) Open-label design, and FVC—while objective-ish—is still effort-dependent and can be influenced by expectation/behavior. Small trial, limiting subgroup conclusions (e.g., severity strata, different phenotypes). Generalizability issues (Netherlands demographics; US populations have higher rates of obesity/metabolic syndrome, which may tilt the steroid risk-benefit equation). Crossover reduces precision and interpretability of between-group differences over time. Practice implications (the “so what”) For many patients with pulmonary sarcoidosis needing systemic therapy, MTX is a reasonable initial alternative to prednisone when thinking long-term tolerability and steroid avoidance. Prednisone likely provides faster symptom/QoL relief in the first weeks—so it may be preferable when rapid improvement is important. The trial strengthens the case for a patient-centered discussion: short-term relief vs side-effect tradeoffs, and the possibility of early combination therapy in more severe cases (suggested, not proven).

In this deeply vulnerable solo episode, Darin dismantles one of the great myths of modern self-help: that transformation is something you're meant to "do alone." Drawing from neuroscience, anthropology, physiology, and personal experience, he reveals the biological truth — the human nervous system is designed to heal, grow, and stabilize in relationship, not isolation. This conversation explores why loneliness creates physiological damage, why belonging is a survival requirement (not a luxury), and how to intentionally rebuild the village your cells have been waiting for. If you've ever felt like you're doing all the "inner work" but still feel disconnected, this episode is the medicine.     What You'll Learn in This Episode 00:00:00 - Opening SuperLife intro narration. 00:00:32 - Sponsor: Therasage — family-driven healing technology, infrared and natural frequency support, details on discount. 00:02:11 - Darin begins the episode — "You were never meant to do this alone." 00:02:22 - The forgotten biology of community and why humans are not built for isolation. 00:03:01 - Your nervous system regulates in relationship — the vagus nerve, safety, co-regulation. 00:03:19 - Social engagement system — coherence, cortisol regulation, belonging as biology. 00:04:03 - Social pain = physical pain; the Baumeister research; the architecture of human connection. 00:05:01 - Tribes, proximity, shared life — Dunbar's number and the limits of real human networks. 00:05:30 - Loneliness as physiology — cortisol elevation, inflammation, disrupted sleep, gray-matter changes. 00:07:01 - Personal growth was never meant to be personal — autonomy, competence, relatedness, love. 00:07:55 - If nobody sees you, your nervous system can't relax — mirrors vs willpower. 00:08:31 - Social contagion of behavior — your network shapes your health. 00:09:01 - Who are you wired into? Environment as epigenetic instruction. 00:10:12 - Why online spaces generate stress instead of transformation. 00:10:35 - Darin's vision: community as a practice, not performance. 00:11:29 - Sponsor: Bite Toothpaste — plastic waste, sustainability, clean ingredients, discount code. 00:13:11 - What if growth wasn't a grind? What if healing was tribal again? 00:13:35 - Building intentional space — not fandom, not following, but practice. 00:14:11 - Supporting the nervous system through community; truth over scrolling. 00:15:04 - Why Patreon — structure, privacy, belonging, circle not feed. 00:15:23 - People looking for truth, depth, real connection — not performance. 00:15:51 - Start building your circle; align with those who align with you. 00:16:12 - You need to be seen, not fixed — community as transformation. 00:17:00 - One person can change your life — the power of being mirrored. 00:17:31 - Men's group, friendships, working out — the daily relational fabric. 00:18:01 - If you're lonely or disconnected, the desire for connection already shifts your biology. 00:18:41 - Darin reflects on a hard year, pain, stem cells, and the deeper healing found in being witnessed. 00:19:26 - Every cell responds when you say yes to deeper connection — the universe moves with it. 00:20:07 - Understanding human biology: we want love, connection, safety, belonging. 00:20:36 - Cutting through "what do you eat" questions — the real priority is connection. 00:21:00 - Closing: "Joy and happiness. Connection. We are built for it… I love you."     Thank You to Our Sponsors Therasage: Go to www.therasage.com and use code DARIN at checkout for 15% off Bite Toothpaste: Go to trybite.com/DARIN20 or use code DARIN20 for 20% off your first order.     Join the SuperLife Patreon: This is where Darin now shares the deeper work: - weekly voice notes - ingredient trackers - wellness challenges - extended conversations - community accountability - sovereignty practices Join now for only  $7.49/month at https://patreon.com/darinolien     Find More from Darin Olien: Instagram: @darinolien Podcast: SuperLife Podcast Website: superlife.com Book: Fatal Conveniences     Key Takeaway "You don't need to be fixed. You don't need to be saved. You just need to be seen — and we cannot do that alone."     Bibliography Neuroscience & Biology of Connection Porges, S. W. (2011). The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation. New York: W.W. Norton. Link to Book Information (Norton) Lieberman, M. D. (2013). Social: Why Our Brains Are Wired to Connect. New York: Crown Publishers. Link to Book Information (Penguin Random House) Eisenberger, N. I. (2012). "The pain of social disconnection: examining the shared neural underpinnings of physical and social pain." Nature Reviews Neuroscience, 13(6), 421–434. Link to Study (PubMed) Thayer, J. F. & Lane, R. D. (2000). "A model of neurovisceral integration in emotion regulation and dysregulation." Journal of Affective Disorders, 61(3), 201–216. Link to Study (ScienceDirect) Psychology of Belonging & Motivation Baumeister, R. F. & Leary, M. R. (1995). "The need to belong: desire for interpersonal attachments as a fundamental human motivation." Psychological Bulletin, 117(3), 497–529. Link to Study (PubMed) Deci, E. L. & Ryan, R. M. (2000). "The 'what' and 'why' of goal pursuits: Human needs and the self-determination of behavior." Psychological Inquiry, 11(4), 227-268. Link to Study (SelfDeterminationTheory.org) Adler, A. (1930s). What Life Could Mean to You. Link to Book Information (Google Books) (Note: Various editions exist) Social Networks & Behavioral Contagion Christakis, N. A. & Fowler, J. H. (2007). "The spread of obesity in a large social network over 32 years." New England Journal of Medicine, 357, 370-379. Link to Study (NEJM) Fowler, J. H. & Christakis, N. A. (2008). "Dynamic spread of happiness in a large social network." BMJ, 337, a2338. Link to Study (BMJ) Centola, D. (2018). How Behavior Spreads: The Science of Complex Contagions. Princeton University Press. Link to Book Information (Princeton University Press) Anthropology & Human Ecology Dunbar, R. I. M. (1992). "Neocortex size as a constraint on group size in primates." Journal of Human Evolution, 22(6), 469-493. Link to Study (ScienceDirect) Henrich, J. (2016). The Secret of Our Success: How Culture Is Driving Human Evolution, Domesticating Our Species, and Making Us Smarter. Princeton University Press. Link to Book Information (Princeton University Press) Loneliness, Inflammation & Health Outcomes Holt-Lunstad, J. et al. (2010). "Social relationships and mortality risk: a meta-analytic review." PLoS Medicine, 7(7), e1000316. Link to Study (PLoS Medicine) Cacioppo, J. T. & Cacioppo, S. (2014). "Social relationships and health: The toxic effects of perceived social isolation." Social and Personality Psychology Compass, 8(2), 58-72. Link to Study (PubMed) Cole, S. W. (2014). "Human social genomics." PLoS Genetics (Cited as PLoS Biology in text, corrected to Genetics based on search), 10(8), e1004601. Link to Study (PLoS Genetics) Group Rituals, Synchrony & Physiology Tarr, B., Launay, J., & Dunbar, R. (2014). "Music and social bonding: 'self-other' merging and neurohormonal effects." Frontiers in Psychology, 5, 1096. Link to Study (Frontiers) Konvalinka, I. et al. (2011). "Synchronized arousal between performers and related spectators in a fire-walking ritual." Proceedings of the National Academy of Sciences, 108(20), 8514–8519. Link to Study (PNAS) Digital Communities & Social Learning Lave, J. & Wenger, E. (1991). Situated Learning: Legitimate Peripheral Participation. Cambridge University Press. Link to Book Information (Cambridge University Press) Wenger, E. (1998). Communities of Practice: Learning, Meaning, and Identity. Cambridge University Press. Link to Book Information (Cambridge University Press)  

Send us a textSummary: Microplastics are showing up in our water, food, air—and in human tissues. In this episode, I unpack what the best studies actually show (and don't), why risk is plausible but not proven, and the realistic steps you can take today without panic. In this episode, I cover:What microplastics are and why they're everywhere—from packaging and clothing to tire dust—and why production is still projected to rise ~70% by 2040 (OECD). OECD+2OECD+2The signal that caught my attention: patients with microplastics in carotid artery plaque had a markedly higher 3-year risk of heart attack, stroke, or death (NEJM). Association, not proof—but concerning. The Guardian+3New England Journal of Medicine+3PubMed+3What's turning up in the brain: autopsy work suggests rising microplastic loads in brain tissue, though causality remains unknown (Nature Medicine coverage). Nature+2Nature+2Everyday exposure: a liter of bottled water can contain ~240,000 plastic particles—mostly nanoplastics—using newer detection methods (NIH Research Matters). TIME+3National Institutes of Health (NIH)+3NCBI+3Indoor vs. outdoor air: estimates suggest we inhale tens of thousands of microplastic particles daily, with higher indoor concentrations (PLOS One). PLOS+1My takeaways for you (progress, not perfection):Respect the signal without catastrophizing. Human data are early, but cardiovascular and neurologic signals merit attention. New England Journal of Medicine+1Make the easy swaps: store food in glass, don't microwave plastic, favor loose-leaf tea over plastic-based tea bags, and replace plastic cutting boards with wood or glass. (These trim exposure; they don't eliminate it.) Air matters: consider a HEPA purifier for main living/sleeping areas and vacuum regularly; natural-fiber clothing sheds fewer synthetic particles. Water choices: where safe, use tap water with a quality home filter and a reusable (non-plastic) bottle—especially given the nanoplastic findings in some bottled waters. National Institutes of Health (NIH)Listener corner: You asked for more quick-hit myth busters (yes, we'll do “Does chicken soup speed recovery?”), and thanks for the reminder to wear a

Dr. Carlos Chaccour, physician scientist at the University of Navarra, noticed something fishy about a letter to the editor the New England Journal of Medicine received shortly after it published a paper of his on malaria treatment in July.The letter was riddled with strange errors such as critiques supposedly based on other research Chaccour himself had written. So he and his co-author Matthew Rudd decided to dig deeper.They analyzed patterns of letters to the editor over the last decade and found a remarkable increase in what they call "prolific debutantes" — new authors who suddenly had dozens, even hundreds of letters published, starting right around the time OpenAI's ChatGPT came out.Why would academics want to do this? Marketplace's Meghan McCarty Carino spoke with Chaccour to find out.

Dr. Carlos Chaccour, physician scientist at the University of Navarra, noticed something fishy about a letter to the editor the New England Journal of Medicine received shortly after it published a paper of his on malaria treatment in July.The letter was riddled with strange errors such as critiques supposedly based on other research Chaccour himself had written. So he and his co-author Matthew Rudd decided to dig deeper.They analyzed patterns of letters to the editor over the last decade and found a remarkable increase in what they call "prolific debutantes" — new authors who suddenly had dozens, even hundreds of letters published, starting right around the time OpenAI's ChatGPT came out.Why would academics want to do this? Marketplace's Meghan McCarty Carino spoke with Chaccour to find out.

Carotid artery disease management has come a long way. From the days when every stroke meant an endarterectomy to a modern era defined by precision, evidence, and evolving technology. With advances in medical therapy and newer techniques like TCAR, the vascular surgeon has even more to consider when choosing the best treatment for carotid disease. Join us as we break down the major landmark trials NASCET, CREST and the Asymptomatic Carotid trials, and discuss how their findings shape our clinical decisions in practice today. Hosts: ·      Christian Hadeed -PGY 4 General Surgery, Brookdale Hospital Medical Center ·      Paul Haser -Division Chief, Vascular Surgery, Brookdale Hospital Medical Center ·      Andrew Harrington, Vascular surgery, Brookdale Hospital Medical Center ·      Lucio Flores, Vascular surgery, Brookdale Hospital Medical Center Learning Objectives: · Review the key findings and clinical implications of the NASCET, ACST, and CREST trials. · Discuss patient selection for carotid endarterectomy (CEA) vs carotid artery stenting (CAS). · Understand how age, calcification, and aortic arch anatomy affect stenting outcomes or choice between stent and CEA. · Identify how advances in medical therapy have influenced management of asymptomatic disease.  · Discuss appropriate screening/ follow up plans for patients who do not meet criteria for intervention References: -       North American Symptomatic Carotid Endarterectomy Trial Collaborators. (1991). Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. The New England Journal of Medicine, 325(7), 445–453. https://pubmed.ncbi.nlm.nih.gov/1852179/ -       Brott, T. G., Hobson, R. W. II, Howard, G., Roubin, G. S., Clark, W. M., Brooks, W., ... & Howard, V. J. (2010). Stenting versus endarterectomy for treatment of carotid-artery stenosis. The New England Journal of Medicine, 363(1), 11–23. https://pubmed.ncbi.nlm.nih.gov/20505173/ -       Halliday, A., Mansfield, A., Marro, J., Peto, C., Peto, R., Potter, J., & Thomas, D.; MRC Asymptomatic Carotid Surgery Trial (ACST) Collaborative Group. (2004). Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: Randomized controlled trial. The Lancet, 363(9420), 1491–1502. https://pubmed.ncbi.nlm.nih.gov/15135594/ -       Halliday, A., Bulbulia, R., Bonati, L. H., Chester, J., Cradduck-Bamford, A., Peto, R., & Pan, H., & the ACST-2 Collaborative Group. (2021). Second asymptomatic carotid surgery trial (ACST-2): A randomised comparison of carotid artery stenting versus carotid endarterectomy. The Lancet, 398(10305), 1065-1073. https://doi.org/10.1016/S0140-6736(21)01910-3 Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen Behind the Knife Premium: General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

In this solo episode, Darin reframes one of the most misunderstood forces in life — stress. Instead of seeing it as the enemy, he explores how stress is actually a messenger, guiding you back to alignment, safety, and awareness. Through science, spirituality, and lived experience, Darin breaks down how stress shows us where we're trying to control, where we're disconnected, and where our nervous system is calling for attention. He unpacks the layers of modern stress — from trauma and environment to community and purpose — and offers practical, embodied tools to restore calm, clarity, and resilience.     What You'll Learn 00:00:00 – Welcome to Super Life: Solutions for a Healthier Life and Better World 00:00:32 – Sponsor Spotlight: TheraSauna - Natural Healing Technologies (15% off with code Darrandai) 00:02:10 – The Super Life Podcast: Finding Contentment, Happiness, and Purpose 00:02:51 – Today's Topic: Stress - Reframing Stress as an Ally and Dashboard Light 00:04:54 – The "No Choice" Universe: Reconnecting to Infinite Possibilities 00:05:16 – The Reality of Stress: Statistics and the Impact of Chronic Stress 00:06:21 – Stress is Layered: Beyond a Single Cause, Addressing Chronic Stress 00:08:29 – Solutions for a Super Life: Safety over Calm and the Vagal Response 00:09:38 – The Inner Dialogue Layer: Trauma, Unconsciousness, and Spiritual Bypassing 00:11:47 – The Social Field Layer: Relationships, Community, and Finding Your Way Home 00:14:20 – Sponsor Spotlight: Bite Toothpaste - Sustainable, Non-Toxic Tabs (20% off with code Darin20) 00:16:35 – Creating Your Own Vision: Setting Boundaries with Media and Social Algorithms 00:17:29 – Finding Your Purpose: From Raising Children to Healing Injuries 00:18:35 – Environmental and Existential Stress Layers: Clutter, Noise, and Service 00:19:26 – Stress Load and Resiliency: Why Small Triggers Cause Blow-Ups 00:20:02 – Understanding the Dashboard Light: Acknowledging Unwillingness 00:20:35 – Safety as the Signal: Body Relaxation and Providing Inner Security 00:23:44 – Reframing Trauma: Was it the Protector You Needed at the Time? 00:25:00 – Releasing Trauma: Techniques, The Healing Code, and Waking the Tiger 00:26:06 – Finishing the Survival Response: Shaking, Crying, Screaming, and Stretching 00:26:38 – Stress as a Multiplier: Impact on Immune System, Heart, and Aging 00:28:10 – Stress Slows Repair: Inflammation, Cardiovascular Risk, and Cellular Aging 00:29:48 – The Integrative Approach: Changing Your Environments to Support Anti-Stress 00:30:07 – Actionable Stress Solutions: Circadian Rhythm, Nature, and Noise Reduction 00:30:44 – Actionable Stress Solutions: Gratitude, Conscious Breath, and Movement 00:31:32 – Energy Drains to Eliminate: Conflict, Clutter, Scrolling, and Late Caffeine 00:32:17 – Connecting to Greater Purpose: The Super Life Patreon Platform 00:32:54 – Morning/Night Questions: Letting Go, Creating, and Contributing 00:33:17 – Final Toolkit: Slow Breathing, Movement, Nature, Sauna, and Sleep 00:34:25 – The Invitation: Digging into all Layers of a Super Life on Patreon   Thank You to Our Sponsors Therasage: Go to www.therasage.com and use code DARIN at checkout for 15% off Bite Toothpaste: Go to trybite.com/DARIN20 or use code DARIN20 for 20% off your first order. Find More from Darin Olien: Instagram: @darinolien Podcast: SuperLife Podcast Website: superlife.com Book: Fatal Conveniences   Key Takeaway "Stress isn't your enemy — it's your compass. Every wave of tension points you back to what's asking for care, attention, and love. When you stop fighting stress and start listening to it, you don't just survive — you evolve."       Bibliography (selected, peer-reviewed) Sources: Gallup Global Emotions (2024); Gallup U.S. polling (2024); APA Stress in America (2023); Natarajan et al., Lancet Digital Health (2020); Orini et al., UK Biobank (2023); Martinez et al. (2022); Leiden University (2025). Cohen S, Tyrrell DA, Smith AP. Psychological stress and susceptibility to the common cold. N Engl J Med.1991;325(9):606–612. New England Journal of Medicine Cohen S, et al. Chronic stress, glucocorticoid receptor resistance, inflammation, and disease risk. Proc Natl Acad Sci USA. 2012;109(16):5995–5999. PNAS Kiecolt-Glaser JK, et al. Slowing of wound healing by psychological stress. Lancet. 1995;346(8984):1194–1196. The Lancet Kiecolt-Glaser JK, et al. Hostile marital interactions, proinflammatory cytokine production, and wound healing.Arch Gen Psychiatry. 2005;62(12):1377–1384. JAMA Network Tawakol A, et al. Relation between resting amygdalar activity and cardiovascular events. Lancet.2017;389(10071):834–845. The Lancet Epel ES, et al. Accelerated telomere shortening in response to life stress. Proc Natl Acad Sci USA.2004;101(49):17312–17315. PNAS McEwen BS, Stellar E. Stress and the individual: mechanisms leading to disease. Arch Intern Med.1993;153(18):2093–2101. PubMed McEwen BS, Wingfield JC. Allostasis and allostatic load. Ann N Y Acad Sci. 1998;840:33–44. PubMed Felitti VJ, et al. Relationship of childhood abuse and household dysfunction to many leading causes of death in adults (ACE Study). Am J Prev Med. 1998;14(4):245–258. AJP Mon Online Edmondson D, et al. PTSD and cardiovascular disease. Ann Behav Med. 2017;51(3):316–327. PMC Afari N, et al. Psychological trauma and functional somatic syndromes: a systematic review and meta-analysis.Psychosom Med. 2014;76(1):2–11. PMC Goyal M, et al. Meditation programs for psychological stress and well-being: a systematic review and meta-analysis. JAMA Intern Med. 2014;174(3):357–368. PMC Qiu Q, et al. Forest therapy: effects on blood pressure and salivary cortisol—a meta-analysis. Int J Environ Res Public Health. 2022;20(1):458. PMC Laukkanen T, et al. Sauna bathing and reduced fatal CVD and all-cause mortality. JAMA Intern Med.2015;175(4):542–548. JAMA Network Zureigat H, et al. Physical activity lowers CVD risk by reducing stress-related neural activity. J Am Coll Cardiol.2024;83(16):1532–1546. PMC Holt-Lunstad J, Smith TB, Layton JB. Social relationships and mortality risk: a meta-analytic review. PLoS Med.2010;7(7):e1000316. PMC Chen Y-R, Hung K-W. EMDR for PTSD: meta-analysis of RCTs. PLoS One. 2014;9(8):e103676. PLOS Hoppen TH, et al. Network/pairwise meta-analysis of PTSD psychotherapies—TF-CBT highest efficacy overall.Psychol Med. 2023;53(14):6360–6374. PubMed van der Kolk BA, et al. Yoga as an adjunctive treatment for PTSD: RCT. J Clin Psychiatry. 2014;75(6):e559–e565. PubMed Kelly U, et al. Trauma-center trauma-sensitive yoga vs CPT in women veterans: RCT. JAMA Netw Open.2023;6(11):e2342214. JAMA Network Bentley TGK, et al. Breathing practices for stress and anxiety reduction: components that matter. Behav Sci (Basel). 2023;13(9):756. 

Since Democrats decided to shut down the government over Affordable Care Act subsidies, now's a good time for a deep dive into what they're even talking about. John Hopkins professor Dr. Ge Bai walks us through the ACA subsidies, the hidden mechanics behind the Affordable Care Act, and its illusion of "affordability." Dr. Bai shows us how regulations and subsidies have quietly reshaped the healthcare market - and how the free market can make it work for patients again. Ge Bai, PhD, CPA is a Professor of Accounting at Johns Hopkins Carey Business School and Professor of Health Policy & Management (joint) at Johns Hopkins Bloomberg School of Public Health. An expert on health care accounting, finance, and policy, Dr. Bai has testified before the House Ways and Means Committee and the Senate HELP Committee, written for the Wall Street Journal and the Washington Post, and published her studies in leading academic journals such as the New England Journal of Medicine, JAMA, and Health Affairs. Find her on X at @GeBaiDC and read her recent WSJ oped here: https://www.wsj.com/opinion/let-the-obamacare-enhanced-premium-subsidies-expire-16ef7e1b

Two-time Emmy and three-time NAACP Image Award-winning television Executive Producer Rushion McDonald interviewed Dr. Schenta D. Randolph.

Two-time Emmy and three-time NAACP Image Award-winning television Executive Producer Rushion McDonald interviewed Dr. Schenta D. Randolph.

In "We Can Make a Difference," Dr. Osterholm and Chris Dall discuss the recent publication from CIDRAP's Vaccine Integrity Project, an upcoming collaboration between CIDRAP and NEJM Evidence, and the latest measles and respiratory virus data. Dr. Osterholm also answers an ID Query about how the government shutdown is impacting public health surveillance and shares another "This Week in Public Health History" segment. Updated Evidence for Covid-19, RSV, and Influenza Vaccines for 2025–2026 (Scott et al., New England Journal of Medicine) Vaccine Integrity Project - Response to HHS claims about vaccines (Oct 2025) Resources for vaccine and public health advocacy: Voices for Vaccines Families Fighting Flu Vaccinate Your Family Shot@Life Medical Reserve Corps Learn more about the Vaccine Integrity Project MORE EPISODES       SUPPORT THIS PODCAST

These diseases - West Nile Virus, Lyme disease, and Rocky Mountain Spotted Fever - are named for the places where outbreaks happened. But they're also all things you get from being bitten by mosquitoes or ticks. Research: Balasubramanian, Chandana. “Rocky Mountain Spotted Fever (RMSF): The Deadly Tick-borne Disease That Inspired a Hit Movie.” Gideon. 9/1/2022. https://www.gideononline.com/blogs/rocky-mountain-spotted-fever/ Barbour AG, Benach JL2019.Discovery of the Lyme Disease Agent. mBio10:10.1128/mbio.02166-19.https://doi.org/10.1128/mbio.02166-19 Bay Area Lyme Foundation. “History of Lyme Disease.” https://www.bayarealyme.org/about-lyme/history-lyme-disease/ Caccone, Adalgisa. “Ancient History of Lyme Disease in North America Revealed with Bacterial Genomes.” Yale School of Medicine. 8/28/2017. https://medicine.yale.edu/news-article/ancient-history-of-lyme-disease-in-north-america-revealed-with-bacterial-genomes/ Chowning, William M. “Studies in Pyroplasmosis Hominis.("Spotted Fever" or "Tick Fever" of the Rocky Mountains.).” The Journal of Infectious Diseases. 1/2/1904. https://archive.org/details/jstor-30071629/page/n29/mode/1up Elbaum-Garfinkle, Shana. “Close to home: a history of Yale and Lyme disease.” The Yale journal of biology and medicine vol. 84,2 (2011): 103-8. Farris, Debbie. “Lyme disease older than human race.” Oregon State University. 5/29/2014. https://science.oregonstate.edu/IMPACT/2014/05/lyme-disease-older-than-human-race Galef, Julia. “Iceman Was a Medical Mess.” Science. 2/29/2012. https://www.science.org/content/article/iceman-was-medical-mess Gould, Carolyn V. “Combating West Nile Virus Disease — Time to Revisit Vaccination.” New England Journal of Medicine. Vol. 388, No. 18. 4/29/2023. https://www.nejm.org/doi/full/10.1056/NEJMp2301816 Harmon, Jim. “Harmon’s Histories: Montana’s Early Tick Fever Research Drew Protests, Violence.” Missoula Current. 7/20/2020. https://missoulacurrent.com/ticks/ Hayes, Curtis G. “West Nile Virus: Uganda, 1937, to New York City, 1999.” From West Nile Virus: Detection, Surveillance, and Control. New York : New York Academy of Sciences. 2001. https://archive.org/details/westnilevirusdet0951unse/ Jannotta, Sepp. “Robert Cooley.” Montana State University. 10/12/2012. https://www.montana.edu/news/mountainsandminds/article.html?id=11471 Johnston, B L, and J M Conly. “West Nile virus - where did it come from and where might it go?.” The Canadian journal of infectious diseases = Journal canadien des maladies infectieuses vol. 11,4 (2000): 175-8. doi:10.1155/2000/856598 Lloyd, Douglas S. “Circular Letter #12 -32.” 8/3/1976. https://portal.ct.gov/-/media/departments-and-agencies/dph/dph/infectious_diseases/lyme/1976circularletterpdf.pdf Mahajan, Vikram K. “Lyme Disease: An Overview.” Indian dermatology online journal vol. 14,5 594-604. 23 Feb. 2023, doi:10.4103/idoj.idoj_418_22 MedLine Plus. “West Nile virus infection.” https://medlineplus.gov/ency/article/007186.htm National Institute of Allergy and Infectious Disease. “History of Rocky Mountain Labs (RML).” 8/16/2023. https://www.niaid.nih.gov/about/rocky-mountain-history National Institute of Allergy and Infectious Disease. “Rocky Mountain Spotted Fever.” https://www.niaid.nih.gov/diseases-conditions/rocky-mountain-spotted-fever Rensberger, Boyce. “A New Type of Arthritis Found in Lyme.” New York Times. 7/18/1976. https://www.nytimes.com/1976/07/18/archives/a-new-type-of-arthritis-found-in-lyme-new-form-of-arthritis-is.html?login=smartlock&auth=login-smartlock Rucker, William Colby. “Rocky Mountain Spotted Fever.” Washington: Government Printing Office. 1912. https://archive.org/details/101688739.nlm.nih.gov/page/ Sejvar, James J. “West Nile virus: an historical overview.” Ochsner journal vol. 5,3 (2003): 6-10. https://pmc.ncbi.nlm.nih.gov/articles/PMC3111838/ Smithburn, K.C. et al. “A Neurotropic Virus Isolated from the Blood of a Native of Uganda.” The American Journal of Tropical Medicine and Hygiene. Volume s1-20: Issue 4. 1940. Steere, Allen C et al. “The emergence of Lyme disease.” The Journal of clinical investigation vol. 113,8 (2004): 1093-101. doi:10.1172/JCI21681 Steere, Allen C. et al. “Historical Perspectives.” Zbl. Bakt. Hyg. A 263, 3-6 (1986 ). https://pdf.sciencedirectassets.com/281837/1-s2.0-S0176672486X80912/1-s2.0-S0176672486800931/main.pdf World Health Organization. “West Nile Virus.” 10/3/2017. https://www.who.int/news-room/fact-sheets/detail/west-nile-virus Xiao, Y., Beare, P.A., Best, S.M. et al. Genetic sequencing of a 1944 Rocky Mountain spotted fever vaccine. Sci Rep 13, 4687 (2023). https://doi.org/10.1038/s41598-023-31894-0 See omnystudio.com/listener for privacy information.