Podcasts about new england journal

Many mothers go to the doctor because they feel exhausted, overwhelmed, and they aren't sleeping - and leave with a depression diagnosis and a prescription. The message is: your brain isn't working right, and medication will help you cope. But what if the problem isn't your brain at all? In this episode, I talk with journalist Bob Whitaker, who has spent decades investigating psychiatric treatment in the U.S. We look at how women's distress has been medicalized instead of taken seriously as a response to impossible circumstances. We look at how antidepressants work, which is quite different from what the drug companies have been telling us for years.  He also shares the results of a New Zealand study on postpartum depression that should have changed how we support new mothers - but didn't. Questions this episode will answer Is it burnout or depression? Burnout and depression share a lot of the same symptoms - exhaustion, low mood, difficulty functioning - but they have different roots. Burnout is a response to sustained, unmanageable circumstances. Depression, as it's currently diagnosed and treated, is framed as a brain malfunction. This episode looks at why this difference matters, and why so many mothers get a depression diagnosis when they're experiencing burnout. Why are mothers more likely to be diagnosed with depression? Mothers in the US are frequently carrying an unequal share of household work, childcare, and mental load - often while also working full time - with little support. When that situation becomes unsustainable, the distress it causes is then treated as an individual brain problem rather than a response to a broken system. What prevents postpartum depression? A study out of New Zealand found that consistent, practical support - help with the actual work of running a household - significantly reduced postpartum depression. But even though the findings were significant, more support has not become the standard of care. Should I take antidepressants? Antidepressants may reduce symptoms for some people, but research shows they are far less effective than we've been told - and for mothers whose distress is rooted in unsustainable circumstances, medication addresses the symptom rather than the source. If antidepressants are helping you, that's OK (and do keep taking them!). But antidepressants should be used to help create space for other interventions to work, rather than used long-term. How does society affect women's mental health? When we treat women's distress as a potentially life-long medical problem rather than a signal about unsustainable circumstances, we direct attention away from the structural changes that would actually help. This episode traces how that pattern developed - and what a different approach might look like. What you'll learn in this episode Why the mental load of motherhood is a structural problem, not a brain problem that medication should fixHow psychiatry functions as social control when it diagnoses individuals instead of the broken systems they're living inWhat the New Zealand postpartum depression study found - and why its results were largely ignoredHow drug advertising has shaped what we believe about women's distress - from Valium in the 1960s to antidepressants todayHow to shift from asking "what's wrong with my brain" to "what would actually need to change in my situation" If you want to learn more about Bob's work and the research on depression and antidepressants, go to https://madinamerica.com/. Want to go deeper? The full one-hour conversation with Bob is available to Parenting Membership members. In it, Bob traces exactly how depression came to be understood as a chemical imbalance - not because research proved it, but because psychiatry in the U.S. wanted to rebrand itself as a legitimate medical discipline in the 1980s.  He walks us through how pharmaceutical companies funneled money to academic psychiatrists to become "thought leaders," how Prozac was marketed as making people "feel better than well," and how the industry captured the entire profession so thoroughly that by 1998, the New England Journal of Medicine couldn't find a single academic expert on depression in the US who wasn't taking money from pharmaceutical companies. We went deep on the STAR*D trial - the largest antidepressant study ever conducted. The public was told 70% of patients got better. The actual stay-well rate at one year, once a researcher used a Freedom of Information request to get the raw data: 3%. Bob walks through exactly how that number was inflated - the protocol violations, the patients who were already in remission when they enrolled, the switched measurement scales - and why he calls it a straight-out public betrayal. The whole episode is available to you in your private podcast feed immediately after joining the Parenting Membership.  Inside the membership, you'll find research-based modules on the specific challenges that make family life hard - from navigating parenting as a team to raising siblings who get along. Monthly group coaching calls give you a chance to talk through your specific situation directly with me. And you'll find a community of parents who share your values and are working through parenting challenges together, and with my support. If you've been told the problem is your brain, and something in this episode made you wonder whether that's the whole story - the membership is where you get help to figure out what's right for you and your family. Click the banner to learn more Jump to highlights: 01:50 Introduction to today's episode and guest 05:04 Just remember what the disease model does. It focuses on the problems in the head of the individual, not in the social way we arrange our society. 06:25 From hysteria and electroshock therapy (mostly given to women) in the 1800s, to marketing benzodiazepines to wives in the 1960s, the pattern of pathologizing women's distress has been consistent. 08:32 When benzodiazepines were recognized as addictive in the late 1970s, psychiatry reframed anxiety as a type of depression and switched women to antidepressants, another numbing drug that keeps women quiet and functioning in an impossible situation. 13:31 In the New Zealand study, it says that when women got daily help with housework for six months, postpartum depression was prevented. Yet this support became standard care nowhere, because the system still believes the problem is in people's brains, not in their circumstances. 14:17 Wrapping up today's topic

Myoscience GlyNAC (20% off, exclusive to this community): https://bit.ly/4auv3xW  Pre-order Keto Flex Revised and get free bonuses at: https://bit.ly/4wKG1sM    A 2026 randomized controlled trial called the PERTH trial found that people reduced plastic-related chemicals in their bodies by up to 60% in just seven days by swapping their food, kitchenware, and personal care products. The research behind this is not fringe. A study in the New England Journal of Medicine found microplastics embedded in arterial plaque in over half of 257 surgical patients. Those patients had a 4.5 times higher risk of heart attack, stroke, or death. A 2025 Nature Medicine study found the average human brain now holds roughly a spoonful of microplastic particles, up 50% in just eight years. In dementia brains, the concentration was ten times higher. In this episode, Ben walks through exactly where exposure comes from, what these plastics are doing to your hormones, your metabolism, your inflammation, and your brain, and the simple five-step protocol you can start today. Key takeaways: A single liter of bottled water contains around 240,000 microplastic particles on average One plastic teabag releases 11.6 billion plastic particles into a single cup of hot water BPA mimics estrogen at receptor sites, disrupting testosterone in men and fertility in women Your body stores these chemicals in fat cells through a pathway called PPAR gamma, creating new fat cells if it runs out of room Glutathione is the master molecule your liver uses to neutralize and eliminate these toxins, and modern life depletes it constantly NAC supplies the cysteine your liver needs to produce glutathione internally The five-step protocol: stop heating plastic, filter your water, eat real food, sweat daily, prioritize fiber and hydration Find All The Ben Azadi Show Sponsorship Deals ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.ketokamp.com/sponsorship-deals Learn more about your ad choices. Visit megaphone.fm/adchoices

Scroll down for a transcription of this episode.Intention to Treat: The Race Equation is a new series from the New England Journal of Medicine, investigates how race-specific diagnostic tools harm Black patients and contribute to growing health inequities.Transcription: https://tinyurl.com/36bne7hd

A University of Kentucky epidemiologist convinced 678 Catholic nuns to donate their brains and their entire life records to science, and the autopsies he performed quietly rewrote everything modern medicine thought it knew about Alzheimer’s disease. The findings have been published in JAMA and the New England Journal of Medicine. Almost nobody outside the field… Continue reading The Power of Gratitude

A 25-year-old pregnant woman presents with a 1-day history of progressive pain and swelling. The foot is cold, pulseless and neurologic function is deteriorating by the hour. Imaging shows a massive iliofemoral DVT. Now both the limb and the pregnancy are threatened. Do you anticoagulate, thrombolyse or operate? Join us as we break down the management and decision making behind this rare but devastating case.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 CenterLearning objectives:-       Recognize the clinical presentation and pathophysiology of phlegmasia cerulea dolens-       Describe how pregnancy affects decision making in patients with phlegmasia and venous thromboembolic disease-       Discuss the goals of treatment for patients with DVT's and identify when operative intervention is indicated-       Describe the sequelae of DVT's and how this relates to post thrombotic syndrome-       Review the indications, risks, and limitations of anticoagulation, catheter-directed thrombolysis, thrombectomy, and fasciotomy in the management of DVT and phlegmasia.-       Explain the role of IVUS in managing venous thromboembolic disease and May Thurner syndromeReferences:-       Vedantham, S., Goldhaber, S. Z., Julian, J. A., Kahn, S. R., Jaff, M. R., Cohen, D. J., Magnuson, E., Razavi, M. K., Comerota, A. J., Gornik, H. L., Murphy, T. P., Lewis, L., Duncan, J. R., Nieters, P., Derfler, M. C., Filion, M., Gu, C.-S., Kee, S., Schneider, J., … Kearon, C. (2017). Pharmacomechanical catheter-directed thrombolysis for deep-vein thrombosis. New England Journal of Medicine, 377(23), 2240–2252. https://doi.org/10.1056/NEJMoa1615066-       Gomes, M. S., Guimarães, M., & Montenegro, N. (2019). Thrombolysis in pregnancy: A literature review. Journal of Maternal-Fetal & Neonatal Medicine, 32(14), 2418–2428. https://doi.org/10.1080/14767058.2018.1438402-       Mangla, A., & Hamad, H. (2023). May-Thurner syndrome. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK554377/-       Bates, S. M., Rajasekhar, A., Middeldorp, S., McLintock, C., Rodger, M. A., James, A. H., et al. (2018). American Society of Hematology 2018 guidelines for management of venous thromboembolism: Venous thromboembolism in the context of pregnancy. Blood Advances, 2(22), 3317–3359. https://doi.org/10.1182/bloodadvances.2018024802-       Kahn, S. R., Comerota, A. J., Cushman, M., Evans, N. S., Ginsberg, J. S., Goldenberg, N. A., et al. (2014). The postthrombotic syndrome: Evidence-based prevention, diagnosis, and treatment strategies. Circulation, 130(18), 1636–1661. https://doi.org/10.1161/CIR.0000000000000130 https://pubmed.ncbi.nlm.nih.gov/25246013/Sponsor URL: https://www.goremedical.com/If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listenBehind the Knife Premium: https://behindtheknife.org/premiumOral Board Review: https://behindtheknife.org/oral-boardOral Board Simulator: https://behindtheknife.org/oral-board/simulatorGeneral Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate 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-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Fett ist einer der meistdiskutierten Nährstoffe überhaupt. Lange galt fettarm als besonders gesund, heute werden fettreiche Ernährungskonzepte, Keto-Diäten und einzelne „Superfette“ stark beworben. Doch was stimmt wirklich? In dieser Folge sprechen wir darüber, wie sich die Bewertung von Fett verändert hat, warum die Fettqualität so entscheidend ist und wie sich die optimale Fettmenge je nach Ziel, Alltag und Sport unterscheiden kann. Eine Folge für alle, die Fett nicht verteufeln, aber auch nicht verklären wollen. ------------------------------------------------------------------------ Dominiks Buch zur pflanzenbasierten Sporternährung im UTB-Verlag: https://www.utb.de/doi/book/10.36198/9783838560328 Dominiks Gesundheitscommunity: www.gsundes-hannover.de Dominiks Online-Knie-Kurs: https://gsundes-hannover.de/knieschmerzen/ Dominiks Online-Rücken-Kurs: https://copecart.com/products/34bd5abb/checkout Marcs veganes Online-Fitness-Coaching: https://vegainer-academy.com/ Marcs Online-Kurs: https://www.copecart.com/products/a50f88f2/checkout ------------------------------------------------------------------------ Dieser Podcast wird unterstützt von der Firma Watson Nutrition. Die Firma bietet als einzige umfassend laborgeprüfte Nahrungsergänzungsmittel für eine optimierte Nährstoffversorgung. Zum Angebot zählen Multi-Supplemente, Mono-Supplemente, Sportsupplemente wie Kreatin oder auch Proteinriegel, Shakes und essenzielle Aminosäuren Mit dem Code veganperformance erhältst du 5 % Rabatt auf deine Bestellung.  Zur Firmenwebseite: Watson Nutrition ------------------------------------------------------------------------ Quellen: Aragon, A. A., Schoenfeld, B. J., Wildman, R., Kleiner, S., VanDusseldorp, T., Taylor, L., Earnest, C. P., Arciero, P. J., Wilborn, C., Kalman, D. S., Stout, J. R., Willoughby, D. S., Campbell, B., VanDusseldorp, T. A., & Antonio, J. (2017). International society of sports nutrition position stand: Diets and body composition. Journal of the International Society of Sports Nutrition, 14, Article 16. Burke, L. M., Ross, M. L. R., Garvican-Lewis, L. A., Welvaert, M., Heikura, I. A., Forbes, S. G., Mirtschin, J. G., Cato, L. E., Strobel, N., Sharma, A. P., & Hawley, J. A. (2017). Low carbohydrate, high fat diet impairs exercise economy and negates the performance benefit from intensified training in elite race walkers. The Journal of Physiology, 595(9), 2785–2807. Deutsche Gesellschaft für Ernährung. (o. D.). Ausgewählte Fragen und Antworten zu Fettleitlinie. Deutsche Gesellschaft für Ernährung. (o. D.). Fett, essenzielle Fettsäuren: Referenzwerte für die Nährstoffzufuhr. Deutsche Gesellschaft für Ernährung. (o. D.). Pflanzliche Öle bevorzugen. Deutsche Gesellschaft für Ernährung. (o. D.). Energie: Referenzwerte für die Nährstoffzufuhr. EFSA Panel on Dietetic Products, Nutrition, and Allergies. (2010). Scientific opinion on dietary reference values for fats, including saturated fatty acids, polyunsaturated fatty acids, monounsaturated fatty acids, trans fatty acids, and cholesterol. EFSA Journal, 8(3), 1461. Estruch, R., Ros, E., Salas-Salvadó, J., Covas, M. I., Corella, D., Arós, F., Gómez-Gracia, E., Ruiz-Gutiérrez, V., Fiol, M., Lapetra, J., Lamuela-Raventós, R. M., Serra-Majem, L., Pintó, X., Basora, J., Muñoz, M. A., Sorlí, J. V., Martínez, J. A., Fitó, M., Gea, A., ... Martínez-González, M. A. (2018). Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra-virgin olive oil or nuts. The New England Journal of Medicine, 378(25), e34. European Commission. (o. D.). Trans fat in food. Klug, A., Barbaresko, J., Alexy, U., Bindl, L., Hirschel, J., Kaulitzki, L., Lorkowski, S., Meteling-Eeken, M., Naumann, S., Richter, M., Watzl, B., & Weder, S. (2024). Update of the DGE position on vegan diet: Position statement of the German Nutrition Society. Ernährungs Umschau, 71(7), 60–84. Select Committee on Nutrition and Human Needs. (1977). Dietary goals for the United States. U.S. Senate. U.S. Department of Agriculture & U.S. Department of Health and Human Services. (1980). Nutrition and your health: Dietary guidelines for Americans. Whittaker, J., & Wu, K. (2021). Low-fat diets and testosterone in men: Systematic review and meta-analysis of intervention studies. The Journal of Steroid Biochemistry and Molecular Biology, 210, 105878. World Health Organization. (2023). Saturated fatty acid and trans-fatty acid intake for adults and children: WHO guideline. World Health Organization. (2023). Total fat intake for the prevention of unhealthy weight gain in adults and children: WHO guideline.  

Microplastics and Stroke Risk: What a Landmark 2024 Study Found Inside Human Arteries In 2024, a team of Italian researchers published a study in the New England Journal of Medicine that stopped the cardiovascular science community in its tracks. They found microplastics, tiny synthetic fragments embedded inside the carotid artery plaque of more than half the patients they examined. And the patients who had them faced more than four and a half times the risk of a serious cardiovascular event compared to those who didn’t. This isn’t a distant, theoretical risk. These are living people who had already been identified as having carotid artery disease, and plastics were found inside their arterial walls. For stroke survivors and those at elevated risk of stroke, this study raises important questions that the medical system has not yet caught up with. What the Research Found The study by Marfella et al., published in the New England Journal of Medicine (2024), enrolled 304 patients who were undergoing carotid endarterectomy, a surgical procedure to remove plaque from the carotid arteries. Researchers analysed the excised plaque for the presence of microplastics and nanoplastics. Their findings: 58% of patients had detectable levels of polyethylene, polyvinyl chloride (PVC), or polystyrene in their arterial plaque. This was not contamination from the surgical procedure; it was already there. Over a 34-month follow-up period, patients with microplastics in their plaque had a 4.53 times higher risk of a combined endpoint: non-fatal myocardial infarction, non-fatal stroke, or death from any cause. Inflammatory markers were significantly elevated in the microplastics-positive group. IL-18 and TNF-alpha proteins associated with systemic vascular inflammation were markedly higher in plaque samples that contained plastics. This suggests the mechanism is not simply physical obstruction, but an inflammatory cascade triggered by the presence of synthetic material in arterial tissue. What This Means for Stroke Survivors The carotid arteries are the primary conduits supplying oxygenated blood to the brain. Plaque accumulation in these vessels is one of the leading causes of ischaemic stroke, and carotid artery disease is a condition many stroke survivors are already living with. “The patients with microplastics in their plaque had a 4.53 times higher risk of stroke, heart attack, or death over the 34-month follow-up. That’s not a marginal finding. That’s a signal the research community needed to take seriously.” The NEJM study doesn’t yet tell us whether removing microplastic exposure after the fact reduces risk. It doesn’t confirm that healthy individuals with no existing carotid disease are accumulating plastics at the same rate. And it cannot tell us which plastic sources are most responsible because we’re exposed to microplastics through drinking water, food packaging, air, and a dozen other vectors simultaneously. But what it does tell us clearly and with high statistical significance is that microplastics in arterial plaque are associated with dramatically worse cardiovascular outcomes. What the Research Does Not Yet Tell Us Science at the frontier moves in one direction at a time. This study establishes association, not causation. It cannot yet answer: Whether people without existing carotid disease are accumulating microplastics at comparable rates. Whether reducing exposure actively reverses or slows plaque-associated risk. Which types of microplastics are most biologically harmful? Whether there will be a clinical screening tool for this in the near future. These are the questions the next generation of research will need to answer. In the meantime, it’s reasonable to act on what we do know. Practical Steps to Reduce Exposure No clinical screening currently exists for microplastics in arterial plaque. There is no blood test, no imaging, no biomarker that your GP can order today. What you can do is reduce your ongoing exposure, particularly through food and water contact with plastics. Evidence-informed steps worth discussing with your treating team: Use glass, stainless steel, or ceramic containers rather than plastic for food and drink storage. Avoid microwaving food in plastic containers; heat accelerates the leaching of plastic particles. Filter your drinking water; some filters (carbon block and reverse osmosis) reduce microplastic levels significantly. Reduce consumption of highly processed foods in plastic packaging. Bring this study to your vascular neurologist, cardiologist, or GP and ask whether it’s relevant to your personal risk profile. This is not a recommendation to take a supplement or start a treatment. It’s an invitation to have an informed conversation with the people responsible for your care using the best available evidence. If you found this useful, my book walks through the science of stroke recovery in the same evidence-first, no-hype way. Find it at recoveryafterstroke.com/book. Want to go deeper and support the channel? Join the community at patreon.com/recoveryafterstroke. The post Plastics in Your Arteries: The Stroke Risk Study You Must Know appeared first on Recovery After Stroke.

Send us Fan MailPost-thrombotic syndrome (PTS) affects up to half of patients following deep vein thrombosis and can significantly impair quality of life. Yet treatment options have historically been limited.In this episode of CLOT Conversations, David Airdrie and Dr. Jameel Abdulrehman speak with Dr. Susan Kahn about the recently published C-TRACT trial in The New England Journal of Medicine.The trial evaluated whether endovascular therapy, including iliac vein stenting, could improve outcomes for patients with moderate-to-severe post-thrombotic syndrome and iliac vein obstruction.Dr. Kahn discusses the rationale behind the study, key findings related to symptom burden and quality of life, the increased bleeding risk observed with intervention, practical patient selection considerations, and the unanswered questions that remain regarding long-term management after venous stenting.This episode provides clinicians with practical insights into one of the most important recent studies in the management of post-thrombotic syndrome.Reference:Vedantham S, Kahn SR, Marston WA, Weinberg I, Sista AK, Magnuson EA, Cohen DJ, Wasan SM, Razavi MK, Goldhaber SZ, Sanfilippo KM. Endovascular Therapy for Post-Thrombotic Syndrome—A Randomized Trial. New England Journal of Medicine. 2026 Apr 13.https://www.nejm.org/doi/abs/10.1056/NEJMoa2519001Support the showhttps://thrombosiscanada.caRegister today for our upcoming conference on November 7, 2026 in Montreal at https://thrombosiscanada.ca/2026ConferenceTake a look at our healthcare professional and patient resources, videos and publications on thrombosis from the expert members of Thrombosis Canada

In this episode, Lyell K. Jones Jr, MD, FAAN, speaks with Cheryl Bushnell, MD, MHS, who served as the guest editor of the June 2026 Cerebrovascular Disease issue. They provide a preview of the issue, which publishes on June 3, 2026. Dr. Jones is the editor-in-chief of Continuum: Lifelong Learning in Neurology® and is a professor of neurology at Mayo Clinic in Rochester, Minnesota. Dr. Bushnell is a Professor of Neurology and Director of the Center for Transformative Stroke Care at Wake Forest University School of Medicine in Winston-Salem, North Carolina. Additional Resources Read the issue: continuum.aan.com Subscribe to Continuum®: shop.lww.com/Continuum Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @LyellJ Guest: @CBushnellMD  Full episode transcript available here Dr Jones: One of the core tenets of our field is that we learn neurology one stroke at a time. But what do we have to learn about preventing them altogether? The science of stroke prevention, acute treatment, and recovery are evolving rapidly, and it's hard to keep up. Today, we're speaking with Dr. Cheryl Bushnell, guest editor of our latest Continuum issue on Cerebrovascular Disease, to discuss these topics and much more.  Dr Jones: This is Dr. Lyell Jones, editor-in-chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about subscribing to the journal, listening to verbatim recordings of the articles, and exclusive access to interviews not featured on the podcast.  Dr Jones: This is Dr. Lyell Jones, editor-in-chief of Continuum: Lifelong Learning in Neurology. Today, I'm interviewing Dr. Cheryl Bushnell, who is Continuum's guest editor for our latest issue on Cerebrovascular Disease. Dr. Bushnell is a professor of neurology and the director of the Center for Transformative Stroke Care at the Wake Forest University School of Medicine in Winston-Salem, North Carolina, where she specializes in the care of stroke patients and their social and functional determinants of recovery and health, and is an internationally recognized expert on those topics. Dr. Bushnell, welcome. Thank you for joining us today. Why don't you introduce yourself to our listeners?  Dr Bushnell: Absolutely. Thank you for the invitation. It's really an honor to be here. So, as you mentioned, I am the director of the Center for Transformative Stroke Care at Wake Forest. It's a really fun transition for me to be involved with different care models for stroke, and I think a lot of the Continuum topics are directly relevant to some of the things that I'm doing now as an administrator and sort of a facilitator of new research. So, thanks again for having me.  Dr Jones: Yeah, and, and you have a wonderful perspective, and we're gonna pull that out today in our interview questions, and I'm looking forward to sharing that with our listeners. But before we get to the questions, we're gonna start off today's podcast with another Continuum Audio trivia question for our listeners. Anticoagulation has played a critical role in secondary ischemic stroke prevention for a long time now. While direct oral anticoagulants have taken on a greater role in the treatment of prevention of stroke, there are still some use cases for vitamin K antagonists like warfarin. The trivia question for our listeners is this: How was warfarin discovered, and how did it get its name? Stick around and we'll share the answer to that question toward the end of our interview today. So, Dr. Bushnell, let's get right to it. You alluded to your various roles, and your leadership in the field has been exemplary. The interventions for acute ischemic stroke have really exploded over the last decade or so, and they get a lot of attention and discussion, but prevention and recovery are just as important in the care of these patients. Tell us a little more about how you approached this issue, about the article topics you chose, etc.  Dr Bushnell: Well, once I was chosen to lead the guest editorship, I wanted to come up with a group of topics that were maybe a little bit different from previous issues. So, I kind of looked at the previous issues and saw, as you said, an emphasis on acute stroke, and that's really important because it has been evolving. But my thought was, how about what happens to patients after they get the intervention and they're discharged home? And because a lot of trainees may not get to see these patients ever again, or it's months before they might see them, or if they're readmitted, which is what we don't want to see, but that certainly is a lot of the exposure is in the inpatient setting. So, I thought I would kind of transport the education into the outpatient and transitional setting, as well as prevention, not only secondary, but primary prevention, with an emphasis on brain health. Some of the populations that may not get as much attention. So, sex differences, stroke in women, pregnancy, the transitions of care, and also the emphasis on holistic view of patients and their challenges, which includes the non-medical factors that drive health, otherwise known as social determinants of health.  Dr Jones: I appreciate that perspective, and obviously th-this is an area of your deep expertise, and it's great to have an issue that really digs into some of those topics a little more deeply. As an educator, I'm really glad you mentioned that about the trainee's perspective. You know, especially junior neurology trainees that are in the hospital all the time. They're seeing patients in the middle of a cerebrovascular catastrophe. But there's a long tail of recovery, right? And they'll get to see that in continuity clinic, but it's a good message to share from an evidence and, um, experiential perspective in the issue. So, appreciate that perspective. You've just read all these articles and edited them. Was there anything that you ran across that was a surprise to you?  Dr Bushnell: Well, I personally chose a lot of the authors based on my knowledge of their work. So, I wouldn't say that it was completely surprising, but I do think that I was just genuinely impressed with the quality of the writing and the synthesis of information. I just was incredibly proud of the work that these co-authors have put together. I'd say that that was-- it wasn't surprising so much as just a sense of pride that I had with the product that's coming out. But of course, there have been some new trials that had to be incorporated at the last minute, some of which were presented at the International Stroke Conference just a few weeks ago.  Dr Jones: Yeah. We try to be as up-to-date as we can, and I will completely agree with you. We have some really good writers in our field, and it's really just a pleasure when you read an article that's by an expert, and it's a joy to read. I can tell you it's one of the best parts of this job, and you get to learn a lot. I think one of the more challenging scenarios that I hear about from colleagues in recent years has been optimal management of patients with asymptomatic extracranial atherosclerosis. The pivotal trials that inform how we manage those patients were from a long time ago, decades ago, predating a lot of the more intensive medical management tools that we have today. In that scenario, Dr. Bushnell, what's the latest on that, and what should our listeners know?  Dr Bushnell: Well, obviously, the CREST 2 trial has been long awaited. It's been going on for over ten years, I believe. Of course, it's, uh, two different trials all in one, the carotid stenting and angioplasty versus intensive medical management. And of course, each of the carotid vascularization arms of the trial also had intensive medical management. And then the other trial is the carotid endarterectomy as the form of revascularization. And it interestingly did not show any benefit of carotid endarterectomy compared to intensive medical management. But of course, the somewhat surprising result was that carotid angioplasty and stenting truly was superior, although it was a small number of events in the trial overall. But that stenting plus intensive medical management was somewhat better than intensive medical management alone. And I think stenting has come a long way in terms of safety, and so I think that's been part of the evolution of the field. I do wanna say that I'm a huge fan of the intensive medical management, and I think that what the protocol does in terms of blood pressure management, cholesterol management is very much above and beyond what's done in private practice even. And the health coaching for all the other things related to diabetes and weight loss and smoking cessation and physical activity, that is what we need to be doing to actually decrease the risk of stroke, and I think that it's very effective. I can't say enough about the design of the study for that reason, that everyone gets the intensive medical management, and then you just layer on the type of revascularization on top of it. So, I wouldn't have been surprised if this was a completely negative trial overall. They just happened to have some better outcomes in the stenting arm.  Dr Jones: I recall a few years ago when the series of endovascular therapy trials for acute stroke came out, and I think there was a, a period of time where the field had to adapt to that. I wonder what you think about with the CREST 2 findings on stenting. I mean, is that gonna be a big change? Because obviously atherosclerosis is highly prevalent. Is that gonna be a big change? Is the field ready for that? How much adjustment do we have in store?  Dr Bushnell: I'm not sure it's gonna be a really big change. If you read the editorial that accompanied the trial in the New England Journal, just a few patients in either direction would have changed the outcome. I kind of look at it as an absolute difference that's relatively small. So, I'm not sure that it will have a huge impact on the field. I do think that the specialists who insert the stents may have some differences of opinion of who should be stented and who shouldn't. Because I think, you know, all of the specialists who do procedures were involved with the trial. But I would say there's a larger percentage of vascular surgeons who were involved, and so I'd say they may have a change of their practice. And neurologists may not even get involved at all.  Dr Jones: Right.  Dr Bushnell: That was one of the challenges for getting patients in the trial is that, you know, not all of us see the asymptomatic carotid stenosis, that they tend to get referred to vascular surgery. So, I think maybe in a corner of the practices of vascular surgeons is where you might see the differences.  Dr Jones: Your point about the way the trial was designed or the trials were designed, that intensive medical management is really important, and we have huge gaps in that. In our specialty, it's, you know, we have probably an opportunity in primary care even to address that. And that leads me to my next question. You know, given your perspective and your expertise, what do you think is the biggest practice gap in the care of patients with stroke or with cerebrovascular disease of any kind?  Dr Bushnell: I think by far the biggest gap is transitions of care and access to follow-up in a specialty clinic after discharge and continuous secondary prevention. We only call it secondary prevention because it happened to come after a stroke, but I really feel like we should just focus on prevention and call it that. There are a lot of people who are trying to kind of, get us away from primary versus secondary prevention. And, and Mitch Elkind is phenomenal and had a beautiful chapter weaving in prevention and brain health. So, I highly recommend that people, if they don't read any other chapters of the Continuum to read his, because I think that it's getting to your point about where the gaps are, and I think prevention is the biggest one. I think we could do so much more in models of care to ensure that there is a pathway once patients are discharged. We have no quality metrics. We have no measurement of how well people are doing after they're discharged. We have all of these fancy things and sophisticated acute treatments, but all of those are for naught if somebody goes home and they fall and they have a severe head injury or hip fracture because they weren't properly supervised or they didn't have the help that they needed at home. So, you got me on my soapbox here for a second, but that is definitely what I see as the gap.  Dr Jones: That's an important soapbox, an important gap, and obviously, if it was a simple problem, we could solve it. But it's obviously something that education is a valuable tool for that, and that's part of why we are including so much content in this issue of Continuum. So, if we put that aside as a gap that we would love to close, when you look into the near future or distant future, Dr. Bushnell, and what's the next big thing on the horizon? New interventions, new prevention tools, or something else entirely? What do you think?  Dr Bushnell: There are two things that I would mention. One is sort of the new category of anticoagulants, antithrombotics, the factor XIa inhibitors. We had an amazing presentation of the oceanic stroke trial at the International Stroke Conference, and this is probably going to be a game changer for the arsenal of antithrombotic therapies that we can offer to patients that do not have a reason for anticoagulation. So, they, they don't have atrial fibrillation, for example, or something else that requires anticoagulation. And so, the factor XI, asundexian, is the drug that they used in that trial. The safety profile is pretty amazing. There was very little bleeding complications and a great benefit in those patients with some degree of atherosclerosis, but, you know, of course, not enough to require carotid revascularization, but then also, um, small vessel disease and cryptogenic stroke. I think those are the three categories of patients, and that's a lot of the strokes that we see all benefited from this new drug. So, I think that's gonna be exciting. There, of course, it has to go through the FDA approval process, and so it might take a little bit of time before that's on the market, and we don't know how much it's gonna cost, but I think it is a, a major breakthrough. And of course, there are other similar medications in that category that are coming. And then I think the other thing is the emphasis on brain health and lifestyle factors and the things that we can do to prevent stroke and dementia because they are the same, essentially. Those are really important. And when we have someone in the hospital with a stroke or a TIA in particular, it's a great teaching opportunity for those patients to say, "Hey, here's what you can do to protect your brain." These are things that we always tell people to prevent a stroke, but just think about it as protecting your brain and keeping your brain as healthy as possible.  Dr Jones: That's a great message, and one that you get to share with patients directly. You're joining us today for this interview. You're on stroke service, so you're actively involved in caring for patients with stroke. What in your practice is the most rewarding aspect of caring for these patients? What is it that you find most rewarding?  Dr Bushnell: I've been involved in a clinical trial that has focused on managing blood pressure and also coaching and other aspects of stroke recovery. I think that has probably been the most rewarding aspect of my career. Until I was involved with this trial, I didn't necessarily do intensive blood pressure monitoring, but I'm seeing the benefits of having data from home, what those blood pressures are over a span of time. I see the immediate or intermediate effects of the blood pressure medication changes that I've made, and I see how the patients respond. So, I have to say that this is not part of usual practice, but I think it should be. And I think it's been incredible from the perspective of a neurologist who is really intensively trying to make the patients' lives better. And it's not just what I do, it's what the health coaches do as part of this intervention. And again, very similar to intensive medical management. So, I, I feel like I've been living it in a slightly different setting than in the CREST 2 trials. But there are other trials that have used the intensive medical management as approach as well. But I would say that's the most rewarding. I've seen people who've lost weight, who are physically fit, who are able to get off of blood pressure medications practically by the end of six months, and that's amazing. And then they continue doing it because they see the benefits.  Dr Jones: You've had a front row seat to a lot of that. That's really got to feel rewarding.  Dr Bushnell: It is, absolutely.  Dr Jones: You know, when you put it that way, it makes me want to go home and check my blood pressure, which I haven't done in a while. But I think that's a message to all of our listeners that we do have plenty of opportunity for risk factor optimization and following the evidence that has been generated and is being generated. Huge opportunity, not only at the population level, but I think the, um, individual patient level too. Okay, so now we're back to our Continuum Audio trivia question, and I'll repeat it for our listeners. How was warfarin discovered, and how did it get its name? Dr. Bushnell and I were talking about this earlier, so I'll just go ahead and share the answer. So, in the early 20th century in the U.S. Midwest, there were epidemics of a hemorrhagic disease in cattle, of all places, and this was eventually traced to moldy cattle feed that was made from sweet clover. And in 1940, researchers at the University of Wisconsin discovered that the anticoagulant in the sweet clover was a compound that was later synthesized for therapeutic use in 1954 as warfarin. And the name came from, uh, the support for the research. The research support came from the Wisconsin Alumni Research Foundation, or WARF, and the end of the word came from the underlying compound, which was coumarin. So that was a little bit of trivia that I had never heard. It's not in the issue, everyone, so you're getting something extra here on the podcast. But been using the drug forever. It still has its uses, even though it's become less advantageous than some of the newer agents. But-- And of course, Dr. Bushnell already knew that when I brought it up, but I just thought that was an interesting bit of history. Well, Dr. Bushnell, thank you for joining us. Thank you for such a great conversation about the latest in cerebrovascular disease. I learned a lot today. I learned a lot in reading these wonderful articles. I hope our listeners learned a lot today as well. I'm really grateful for your hard work on the issue, which I think will come in handy for junior readers and subscribers, as well as our more experienced neurologists as well. Sometimes it's hard to keep up with a rapidly changing subspecialty of our field. So, thank you for joining us today.  Dr Bushnell: Thank you for having me. It's been my pleasure.  Dr Jones: Again, today we've been speaking with Dr. Cheryl Bushnell, guest editor of Continuum's most recent issue on cerebrovascular disease. Please check it out, and thank you to our listeners for joining today.  Dr Monteith: This is Dr. Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. Thank you for listening to Continuum Audio.

Dr. Margarita Fedorova discusses the effectiveness of shunting for idiopathic normal pressure hydrocephalus.  Show citation:  Luciano MG, Williams MA, Hamilton MG, et al. A Randomized Trial of Shunting for Idiopathic Normal-Pressure Hydrocephalus. N Engl J Med. 2025;393(22):2198-2209. doi:10.1056/NEJMoa2503109   Show transcript:  Dr. Margarita Fedorova: Welcome to Neurology Minute. My name is Margarita Fedorova and I'm a neurology resident at the Cleveland Clinic. Today we're reviewing a randomized trial that provides high quality evidence for treatment we've been using for decades, shunting for idiopathic normal pressure hydrocephalus. The PENS trial, a placebo controlled effectiveness and iNPH shunting trial was published in the New England Journal of Medicine in December 2025 by Luciano and colleagues. This international multicenter study enrolled 99 patients across the United States candidate in Sweden. While idiopathic normal pressure hydrocephalus or iNPH is characterized by triad of gait impairment, cognitive decline in urinary continence, these findings can be non-specific and we mass factor in radiological findings too. Furthermore, while CSF shunting has long been the standard treatment, its effectiveness has never been rigorously confirmed in a large well-powered randomized trial. In this trial, patients with a clinical improvement in gait velocity after temporary CSF drainage were deemed eligible for shunting and randomizing the trial. What makes this trial particularly elegant is its blending strategy. All 99 participants underwent the same surgical procedure with the same commercially available programmable shunt valve. After surgery, the valve was set either to an open functioning position or to a high resistance placebo setting. Neither patients nor assessors knew who had a working shunt. This is about as close to a true double-blind design as neurosurgery can get. The primary outcome was changing gait velocity at three months. The open shunt group improved by 0.23 meters per second on average, while the placebo group showed essentially no change in 0.03 meters per second. That's a treatment difference of 0.21 meters per second, both statistically significant and clinically meaningful. To put that in perspective, a change of 0.10 meters per second is considered the threshold for substantial meaningful change in the elderly. 80% of the open shunt group exceeded that threshold compared to only 24% of the placebo group.  The Tenet scale, which measures gait imbalance, also showed significant improvement in the open shunt group. However, screening measures for good condition using the MoCA scale and bladder symptoms did not reach significance at three months, though tertiary outcomes for cognitive testing, quality of life and functional independence tended in favor of shunting. Importantly, falls were more common in the placebo group at 46% compared to 25% in the open shunt group. This is a meaningful safety signal given how dangerous falls are in older adults. There were also real risks with active shunting. Subdural hematomas occurred in 12% of the open shunt group versus 2% of placebo and three even required surgical intervention. Positional headaches from low CSF pressure were more common in the open shunt group at 59% versus 28%. The good news is that the adjustable valve allowed non-invasive management of many of these complications. While this trial gives us reasons to be cautiously optimistic about shunting for appropriately selected iNPH patients, it's worth noting that we only have evidence for improvement in gait and follow-up is only three months.  Longer-term data is still being collected so we don't know yet how durable these benefits are. If you want to read more, please find the paper by Mark G. Luciano, et al. It's titled A Randomized Trial of Shunting for Idiopathic Normal Pressure Hydrocephalus published in the New England Journal of Medicine in December 2025. That's your neurology menu for today. Keep exploring and we'll see you next time. 

We bring you an episode of "Intention to Treat: The Race Equation." It's a new series from the New England Journal of Medicine that investigates how race-specific diagnostic tools harm Black patients and contribute to growing health inequities.

Dr. Casandra MacLeod discusses central retinal artery occlusions, recent trials, and those anticipated in the future.  Show citation:  Préterre C, Gaultier A, Obadia M, et al. Intravenous alteplase versus oral aspirin for acute central retinal artery occlusion within 4·5 h of severe vision loss (THEIA): a multicentre, double-dummy, patient-blinded and assessor-blinded, randomised, controlled, phase 3 trial. Lancet Neurol. 2025;24(11):909-919. doi:10.1016/S1474-4422(25)00308-4  Poli S, Grohmann C, Wenzel DA, et al. Early REperfusion therapy with intravenous alteplase for recovery of VISION in acute central retinal artery occlusion (REVISION): Study protocol of a phase III trial. Int J Stroke. 2024;19(7):823-829. doi:10.1177/17474930241248516  Ryan SJ, Jørstad ØK, Skjelland M, et al. A Randomized Trial of Tenecteplase in Acute Central Retinal Artery Occlusion. N Engl J Med. 2026;394(5):442-450. doi:10.1056/NEJMoa2508515 Show transcript:  Dr. Casandra MacLeod Hello, this is Casandra MacLeod, a neurology resident at Cleveland Clinic with today's Neurology Minute. Today we will be discussing central retinal artery occlusions, or CRAOs, and the recent trials that have come out and even those further on the horizon. The 2026 American Heart Association and American Stroke Association guidelines for the early management of patients with acute ischemic stroke were recently published and in them highlight the uncertainty around the treatment of acute CRAOs with intravenous thrombolysis, even when the patient presents within four and a half hours and is otherwise eligible. These guidelines come after two recent trials, which we will further discuss. The thrombolysis in patients with acute central retinal artery occlusion, or the THEIA trial, was published in the November issue of Lancet Neurology. This multicenter trial out of France randomized 70 patients with acute CRAOs presented within four and a half hours of time from last known well to either receive IV alteplase and oral placebo or IV placebo and oral aspirin. While safety measures showed no symptomatic hemorrhage event, although they did have one asymptomatic intracerebral hemorrhage occur, the primary outcomes, which included visual acuity improvement at one month, showed some evidence for a trend of improved acuity in the IV thrombolytic group at 66% compared to 48 in the aspirin group, it did not reach significant. And now more recently, the Tenecteplase in central retinal artery occlusion study, or TenCRAOs, was published in the January 2026 issue of The New England Journal of Medicine. TenCRAOs was a six European country multicenter trial that randomized 78 patients with CRAOs all presenting within four and a half hours of time from last known well to either receive IV Tenecteplase or aspirin, both with placebo-matching as in THEIA. The primary outcomes of TenCRAOs also included visual acuity at one month, but unfortunately this trial also did not show [inaudible 00:02:07]. They showed 20% in the IV TNK group compared to 24% in aspirin. And additionally, there was one fatal intracerebral hemorrhage in the TNK group that should be considered. Overall, the AHA and ASA guidelines state the usefulness of treatment with intravenous thrombolysis is uncertain. And this is based largely on these studies as neither trial showed improved visual recovery. Although both of these trials are underpowered, leading many to believe that the jury is still out on the use of IV thrombolytics in CRAOs. But importantly, stay on the lookout for one last trial. The early reperfusion therapy with intravenous alteplase for recovery of vision and acute central retinal artery occlusion, or the Revision trial, is actively recruiting. Revision is similar in design as THEIA, but with a goal of up to 422 total patients for a goal of a well-powered study to guide decision making. 

Equip Foods Protein (grass-fed beef isolate, no seed oils, third-party tested) Code: BENAZADI - https://bit.ly/49xXaMq  Keto Flex Revised by Ben Azadi (pre-order now, releases July 21st, includes exclusive bonus chapters as a downloadable PDF): https://bit.ly/4wKG1sM    In this episode, Ben Azadi reveals the five foods he eliminated that ended his chronic cravings and led to losing 19 pounds in 30 days. The root issue is not willpower. It's hormones and inflammation. A 2019 NIH study by Kevin Hall had participants eating ultra-processed vs. whole foods at matched calories. On the ultra-processed diet, they ate 500 extra calories per day without realizing it. The food was driving the overconsumption, not a lack of discipline. The five foods to remove: Liquid sugar. Sodas, juices, sports drinks, and flavored coffee drinks don't register as fullness. The Harvard Nurses' Health Study found adding one sugary drink per day led to 358 extra calories consumed daily. Swap for black coffee, plain tea, or sparkling water. Ultra-processed breads and tortillas. Stripped of nutrition and engineered for shelf life, modern bread spikes blood sugar as much as a Snickers bar according to Dr. William Davis. Opt for fermented sourdough or sprouted grain, or remove bread entirely for 30 days. Boxed pastas and processed comfort foods. Hyper-palatable combinations of salt, sugar, fat, and starch that overstimulate the brain's reward centers while leaving the body nutritionally depleted. A follow-up to Hall's study found people eating these foods consumed up to 1,000 extra calories per day. Seed oil-laden dressings, sauces, and condiments. Soybean, canola, corn, sunflower, and related oils produce carcinogenic aldehydes during processing and are in roughly 80% of the food supply. Replace with avocado oil, extra virgin olive oil, grass-fed butter, ghee, coconut oil, beef tallow, or duck fat. Look for seed oil-free brands like Primal Kitchen and Chosen Foods. Alcohol. A 1992 New England Journal of Medicine study found moderate alcohol consumption drops fat oxidation by 70% for hours. The liver prioritizes clearing alcohol above all else, including fat burning, while simultaneously increasing appetite and lowering the brain's stop-eating signals. Find All The Ben Azadi Show Sponsorship Deals ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.ketokamp.com/sponsorship-deals Learn more about your ad choices. Visit megaphone.fm/adchoices

Welcome back, everyone. Today we're diving into one of the most hotly debated topics in obstetrics- should we be treating preeclampsia without severe features with antihypertensive medications during expectant management? Now, if you've been following the literature- and our show, you know that the landmark CHAP trial changed the game for chronic hypertension in pregnancy. It showed us that targeting a blood pressure below 140 over 90 reduces serious maternal complications, without harming the baby. That was a big deal. But here's the thing, CHAP studied chronic hypertension. Then there was the CHIP trial- that also found that tight control of gestational hypertension and nonproteinuric chronic hypertension was also beneficial. These did not address preeclampsia without severe features, and yet, the ripple effects of that trial have sparked a global conversation about whether we should be extending those same treatment principles to women with preeclampsia who don't yet have severe features. And this is where it gets really interesting, because the guidelines don't agree. In the United States, ACOG and the Society for Maternal-Fetal Medicine still say: hold off on antihypertensives unless blood pressures hit the severe range at 160/110. But step outside the US, and you'll find the World Health Organization, the International Society for the Study of Hypertension in Pregnancy, FIGO, NICE, and Hypertension Canada all recommending treatment at 140 over 90, regardless of whether the diagnosis is chronic hypertension, gestational hypertension, or preeclampsia. So who's right? And more importantly what does this mean for the patient sitting in front of you right now, at 34 weeks, with a blood pressure of 150 over 95, some proteinuria, but no severe features? Today, we're going to break this down. We'll review the controversy, walk through the divergent guidelines, and most importantly talk about the real, practical implications that favor treating these patients during expectant management. Because when you're watching someone with preeclampsia, waiting for the right time to deliver, there's a strong argument that controlling their blood pressure isn't just reasonable…may be protective. So grab your coffee, settle in, and let's get into it.1. Society for Maternal-Fetal Medicine Statement: Antihypertensive Therapy For mild chronic Hypertension in Pregnancy-The Chronic Hypertension And Pregnancy Trial. American Journal of Obstetrics and Gynecology. 2022. Society for Maternal-Fetal Medicine; Publications Committee. 2. Preeclampsia. The New England Journal of Medicine. 2022. Magee LA, Nicolaides KH, von Dadelszen P.3. Antihypertensive Drug Therapy for Mild to Moderate Hypertension During Pregnancy.The Cochrane Database of Systematic Reviews. 2018. Abalos E, Duley L, Steyn DW, C.4. Prevention and Treatment of Maternal Stroke in Pregnancy and Postpartum: A Scientific Statement From the American Heart Association. Stroke. 2026. Miller EC, Bello NA, Chen PR, et al.5.Hypertension in Pregnancy: Diagnosis, Blood Pressure Goals, and Pharmacotherapy: A Scientific Statement From the American Heart Association. Hypertension. 2022. Garovic VD, Dechend R, Easterling T, et al.

Hosts: Jake Lancaster MD, Chief Medical Information Officer and Amanda Comer DNP, System Director, Advanced Practice ProvidersDr. Stephen Threlkeld, Baptist Memorial Health Care's medical director of infectious diseases, contributed to a case study published on Thursday, Jan. 8, 2026, in the prestigious New England Journal of Medicine titled “Case 1-2026: A 50-Year-Old Woman With Fever and Abdominal Pain.”The case study, published in Vol. 394, No. 2 of the journal, is part of a century-old series called “Case Records of the Massachusetts General Hospital.” It explores clinical cases that challenge physicians.CME Credit Info:Link to complete brief survey and claim CME credit: https://www.surveymonkey.com/r/C55LKSYCME credit is available for up to 3 years after the stated release dateContact CEOD@bmhcc.org if you have any questions about claiming credit.

Headlines warned us about microplastics in our brains. A chemist says the study may have been measuring brain fat instead. In 2025, a study claiming microplastics accumulate in human brain tissue dominated our feeds. We covered it. Then Dr. Michelle Wong, a chemical scientist and science communicator, flagged a problem with the methodology. So we went to the primary literature, read the critique, and brought in one of the first scientists to publicly challenge the findings: Dr. Oliver Jones, Professor of Analytical Chemistry at RMIT University in Melbourne. In this episode, we unpack what went wrong with the measurement method, what it means for the broader microplastics conversation, and why being willing to say "I was wrong" is so vital for good science. In this episode: How pyrolysis GC-MS works and why it can confuse plastic breakdown products with brain fat Why potassium hydroxide digestion creates soap, which also mimics plastic signatures The contamination problem: body bags, centrifuge tubes, plastic storage containers, and lab air Why 7 grams of microplastic per brain is more than what researchers find in raw sewage The Marfella study in The New England Journal of Medicine: microplastics in arterial plaques and why it also lacked blank controls How microplastics could enter the body: skin absorption, ingestion, and inhalation Why PM2.5 monitoring already captures the most relevant airborne microplastic exposure What the WHO, FDA, and European Food Safety Authority have concluded about microplastic harm What better microplastics research would actually look like Why the real lesson is about how we evaluate headlines, not just microplastics Dr. Oliver Jones is Professor of Analytical Chemistry and Associate Dean of Biosciences and Food Technology at RMIT University in Melbourne. A Fellow of the Royal Society of Chemistry (FRSC) and the Royal Australian Chemical Institute (FRACI), he holds degrees from Imperial College London and Cambridge. He is one of only 118 scientists worldwide named to the IUPAC Periodic Table of Outstanding Younger Chemists. His research focuses on developing methods to measure environmental contaminants, including microplastics, and he was among the first scientists to publicly challenge the methodology of the viral "microplastics in the brain" study. Follow Dr. Jones: @dr_oli_jones RMIT faculty page: rmit.edu.au/oliver-jones Dr. Michelle Wong (Lab Muffin Beauty Science) first flagged the methodological concerns to us. Hosted by Drs. Ayesha & Dean Sherzai Subscribe to The Synapse (free weekly newsletter): https://thebraindocs.com/newsletter  Follow @TheBrainDocs on Instagram

Sleep is one of the most common struggles in the CPTSD community, and one of the least understood. If you've tried the routines, the supplements, the magnesium, the blue light glasses, and you're still lying awake at midnight or waking up at 3am feeling like something is wrong, this episode is for you.Today I break down why sleep is uniquely hard when you have complex trauma, what's actually happening in your nervous system at night, and what might actually help. In this episode:Why sleep requires felt safety and why that's so hard with CPTSDThe two ends of the sleep struggle spectrum: can't fall asleep vs. sleeps but never feels restedHypervigilance at night and why the quiet, dark room can become the triggerNightmares as attempted processing and what's actually getting in the wayThe IFS lens: the protectors, managers, and exiles running the show at nightWhy parts work is nervous system workSleep hygiene that actually makes sense for a dysregulated nervous systemSomatic tools to try before bed and when you wake up at 3amReferences:Dana, D. (2018). The Polyvagal Theory in Therapy: Engaging the Rhythm of Regulation. Norton.Balban, M. Y., Neri, E., Kogon, M. M., Weed, L., Nourski, B., Picard, M., ... & Huberman, A. D. (2023). Brief structured respiration practices enhance mood and reduce physiological arousal. Cell Reports Medicine, 4(1).Southwick, S. M., Bremner, J. D., Rasmusson, A., Morgan, C. A., Arnsten, A., & Charney, D. S. (1999). Role of norepinephrine in the pathophysiology and treatment of posttraumatic stress disorder. Biological Psychiatry, 46(9), 1192–1204.Yehuda, R. (2002). Post-traumatic stress disorder. New England Journal of Medicine, 346(2), 108–114.Thanks for listening to The Complex Trauma Podcast!Be sure to follow, share and give us a review on your favorite podcast platform.Follow on Instagram: @sarahherstichlcsw Follow on TikTok: @sarahherstichlcswLearn more about EMDR & trauma therapy in Pennsylvania with Reclaim TherapyThis podcast is for educational and informational purposes only. It is not intended as a substitute for professional medical, psychological, or nutritional advice, diagnosis, or treatment.Remember, I'm a therapist, but I'm not your therapist. Nothing in this podcast is meant to replace actual therapy or treatment. If you're in crisis or things feel really unsafe right now, please reach out to someone. You can call 988 for the Suicide and Crisis Lifeline, text them, or head to your nearest ER.The views expressed by the host and guests are their own and do not represent the opinions of any organizations or institutions. Reliance on any information provided by this podcast is solely at your own risk.

Send us Fan MailIn this episode, Dr. Mark Holthouse joins Dr. Jaclyn Smeaton and DUTCH founder Mark Newman to take a closer look at a recent peer-reviewed publication from Precision Analytical, Inc. in Frontiers in Reproductive Health, examining how different testing methods hold up when it comes to monitoring male TRT in clinical practice.Their discussion also covers:Common misconceptions about how creams and gels show up in saliva testing and why the numbers can be misleadingWhat the clinical data actually shows about dosing accuracy across different testing modalities When to use serum, urine, and other testing approaches can be leveraged to optimize treatment.How under or overdosing risks can be reduced by matching the right test to the right clinical questionWhy advancing best practices in integrative medicine requires continually revisiting what the evidence supportsShow Notes Read our DUTCH Article on the Frontiers study, Mark Newman's commentary, and the full study here. Check out the resources mentioned in this episode: The topical progesterone cream study in Fertility and Sterility The transdermal progesterone study from Climacteric Good Energy mentioned by Dr. Holthouse The study on the cardiovascular safety of TRT in the New England Journal of Medicine The study on testosterone threshold levels and skeletal muscle strength Become a DUTCH Provider to gain access to comprehensive patient reports, peer-reviewed and validated research, and expert clinical support. 

If you enjoy this episode, we're sure you will enjoy more content like this on The Occult Rejects.  In fact, we have curated playlists on occult topics like grimoires, esoteric concepts and phenomena, occult history, analyzing true crime and cults with an occult lens, Para politics, and occultism in music. Whether you enjoy consuming your content visually or via audio, we've got you covered - and it will always be provided free of charge.  So, if you enjoy what we do and want to support our work of providing accessible, free content on various platforms, please consider making a donation to the links provided below.  Thank you and enjoy the episode!Links For The Occult Rejectshttps://linktr.ee/theoccultrejectsOccult Research Institutehttps://www.occultresearchinstitute.org/Cash Apphttps://cash.app/$theoccultrejectsVenmo@TheOccultRejectsBuy Me A Coffeebuymeacoffee.com/TheOccultRejectsPatreonhttps://www.patreon.com/TheOccultRejectsBibliographyThe Mechanics of Magick: Singing Bowls and the Ritual Physics of ResonanceCore Singing Bowl ResearchStanhope, Jessica, and Philip Weinstein. “The Human Health Effects of Singing Bowls: A Systematic Review.” Complementary Therapies in Medicine 51 (2020): 102412. Use for the honesty frame: promising findings around mental health and cardiovascular measures, but limited evidence and need for stronger study design.Cai, Yiqing, Guo-Yan Yang, Yibo Liu, Xiang-yun Zou, Heng Yin, Xinyan Jin, Xue-han Liu, Chenlu Wang, Nicola Robinson, and Jian-Ping Liu. “Therapeutic Effects of Singing Bowls: A Systematic Review of Clinical Studies.” Integrative Medicine Research 14, no. 2 (2025): 101144. Use for the newer clinical overview. Important correction: this appears as 101144, not 101176. Good for anxiety, depression, sleep quality, cognition, autistic behavior, and EEG-related outcomes while still keeping the evidence cautious.Lin, F. W., et al. “Effects of Tibetan Singing Bowl Intervention on Psychological and Physiological Health in Adults: A Systematic Review.” 2025. Useful as another recent review angle, especially for psychological health, physiological measures, HRV, and brainwave-related discussion. Keep it secondary behind Stanhope and Cai.Landry, Jayan Marie. “Physiological and Psychological Effects of a Himalayan Singing Bowl in Meditation Practice: A Quantitative Analysis.” American Journal of Health Promotion 28, no. 5 (2014): 306–309. Use for the controlled relaxation study: 51 participants, randomized crossover design, singing bowl exposure or silence before directed relaxation.Goldsby, Tamara L., Michael E. Goldsby, Mary McWalters, and Paul J. Mills. “Effects of Singing Bowl Sound Meditation on Mood, Tension, and Well-Being: An Observational Study.” Journal of Evidence-Based Complementary & Alternative Medicine 22, no. 3 (2017): 401–406. Use for reductions in tension, anger, fatigue, depressed mood, anxiety, and stress after singing bowl meditation. Good, but frame as observational, not definitive.Rio-Alamos, Cristina, et al. “Acute Relaxation Response Induced by Tibetan Singing Bowl Sounds: A Randomized Controlled Trial.” European Journal of Investigation in Health, Psychology and Education 13, no. 2 (2023): 317–328. Use for Tibetan singing bowl treatment compared with progressive muscle relaxation and a waiting-list control in anxious nonclinical adults.Walter, Nina, et al. “Neurophysiological Effects of a Singing Bowl Massage.” Medicina 58, no. 5 (2022): 594. Use for EEG, ECG, and respiration during singing bowl massage; the authors interpret the results as a shift toward a more mindful or meditative state.Goldsby, Tamara L., et al. “Mood, Emotional, and Spiritual Well-Being Interrelationships.” Religions 13, no. 2 (2022). Useful follow-up for spiritual well-being, emotional interpretation, and how people understand sound-healing experiences.Sound, Anxiety, HRV, and Brainwave CautionMallik, Adiel, and Frank A. Russo. “The Effects of Music & Auditory Beat Stimulation on Anxiety: A Randomized Clinical Trial.” PLOS ONE 17, no. 3 (2022): e0259312. Use this carefully for the broader point that sound-based treatments can reduce somatic and cognitive state anxiety. Do not use it as proof that singing bowls automatically entrain brainwaves.Ingendoh, Ruth Maria, Ella S. Posny, and Angela Heine. “Binaural Beats to Entrain the Brain? A Systematic Review of the Effects of Binaural Beat Stimulation on Brain Oscillatory Activity, and the Implications for Psychological Research and Intervention.” PLOS ONE 18, no. 5 (2023): e0286023. Very useful caution source. Use it when warning against overclaiming “brainwave entrainment” and frequency-healing claims.Vilímek, et al. 2022. Low-frequency sound / HRV / vibroacoustic-related research. Use cautiously if you want to discuss low-frequency vibration, body sensation, and autonomic response. I'd keep this as a secondary source unless you want a dedicated paragraph on vibroacoustics.Physics, Resonance, and CymaticsTerwagne, Denis, and John W. M. Bush. “Tibetan Singing Bowls.” Nonlinearity 24, no. 8 (2011): R51–R66. Use for the physics section: wall vibrations, water-surface waves, Faraday-wave effects, droplet motion, and the visible demonstration of resonance.Jenny, Hans. Cymatics: A Study of Wave Phenomena and Vibration. Newmarket, NH: MACROmedia, 2001. Use carefully for visual sound-pattern history. Good for imagery and occult imagination, but don't overuse it as clinical proof.Rossing, Thomas D. The Science of Sound. 3rd ed. San Francisco: Addison Wesley, 2002. Useful general acoustics source for resonance, overtones, vibration, sound waves, and instrument physics.Sound Baths, Wellness Culture, and Modern RitualSobo, Elisa J. “Sound Baths, Trauma Talk, and the Wellness Paradox in the USA.” Medical Anthropology 43, no. 5 (2024): 367–382. Excellent for the modern sound-bath/wellness-culture angle, especially trauma language, nervous-system talk, ritual performance, and how providers frame sound baths.Sobo, Elisa J. “A Beginner's Guide to Sound Baths — What They Are, How to Choose a Good One and What the Research Shows.” The Conversation (2024). Useful for accessible show-note language and ethical/practical framing.Sobo, Elisa J. “Healing Vibrations.” Anthropology News 64, no. 5 (2023): 28–32, 49. Good anthropology/public-facing source for sound healing and wellness culture.Tibetan Singing Bowls, History, and Cultural CommodificationGrimes, Samuel. “Where Did ‘Tibetan' Singing Bowls Really Come From?” Tricycle (2020). Use for the contested-history section. Strong source for questioning popular origin stories around “Tibetan” singing bowls.Joffe, Ben. “Anthropology and Tibetan Buddhism / Cultural Commodification / Tibetan Mystique.” 2015. Use for the larger argument about how Tibetan/Himalayan aura gets packaged in Western spiritual markets. Good support for the “Tibet as imagined storehouse of hidden wisdom” point.Scheidegger, Daniel A. “Tibetan Ritual Music.” Use for actual Tibetan Buddhist ritual sound: bells, cymbals, long horns, drums, chant, and liturgical soundscape. This helps separate real Tibetan ritual sound from overblown modern singing-bowl mythology.Lopez, Donald S. Prisoners of Shangri-La: Tibetan Buddhism and the West. Chicago: University of Chicago Press, 1998. Excellent support for Western romanticization of Tibet.Bishop, Peter. The Myth of Shangri-La: Tibet, Travel Writing, and the Western Creation of Sacred Landscape. Berkeley: University of California Press, 1989. Very useful for the “Tibet as fantasy geography” angle.Ritual, Sound, and Religious ExperienceEliade, Mircea. Shamanism: Archaic Techniques of Ecstasy. Princeton: Princeton University Press, 1964. Use carefully. Good for altered-state technologies and ritual sound/trance, but don't treat it as the final word on shamanism.Rouget, Gilbert. Music and Trance: A Theory of the Relations Between Music and Possession. Chicago: University of Chicago Press, 1985. Excellent for sound, music, trance, possession, rhythm, and ritual performance.Becker, Judith. Deep Listeners: Music, Emotion, and Trancing. Bloomington: Indiana University Press, 2004. Strong source for deep listening, music, emotion, trance, and the body.Husserl, Edmund. On the Phenomenology of the Consciousness of Internal Time. Useful if you want to get philosophical about tone, decay, waiting, and how sound reveals time.Ihde, Don. Listening and Voice: Phenomenologies of Sound. Albany: SUNY Press, 2007. Good for sound as experience, listening, voice, and embodied perception.Placebo, Meaning Response, and Healing RitualMoerman, Daniel E. Meaning, Medicine and the “Placebo Effect.” Cambridge: Cambridge University Press, 2002. Use for “meaning response” instead of treating placebo as “fake.”Benedetti, Fabrizio. Placebo Effects: Understanding the Mechanisms in Health and Disease. Oxford: Oxford University Press, 2009. Useful for placebo mechanisms, expectation, physiology, and therapeutic context.Kaptchuk, Ted J., and Franklin G. Miller. “Placebo Effects in Medicine.” New England Journal of Medicine 373 (2015): 8–9. Good short medical source for placebo effects as real psychobiological phenomena.Csordas, Thomas J. The Sacred Self: A Cultural Phenomenology of Charismatic Healing. Berkeley: University of California Press, 1994. Useful for healing, embodiment, ritual, and religious experience.Embodied Cognition, Extended Mind, and Ritual ToolsClAlso want to remind people about the website, if you're into reading we have tons of information by multiple contributors, and we got t-shirts up on the site if you're interested. Fun fact, the art is all based on the eyeball. A

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

O Afya News detalha as mudanças da Anvisa no Sistema Nacional de Controle de Receituários ampliando a digitalização e a rastreabilidade na prescrição de medicamentos controlados. Analisamos um relato do New England Journal of Medicine sobre a associação rara entre o uso do análogo de GLP 1 dulaglutida e o desenvolvimento de hiperplasia linfoide coroidiana bilateral. O episódio também destaca a inauguração do primeiro centro âncora de inovação em saúde do Brasil em Campinas voltado à produção de tecnologias e radiofármacos para o SUS. Afya News. Informação médica confiável e atualizada no seu tempo.Fontes do episódio aqui:https://portal.afya.com.br/podcasts/afya-news/22-05-2026

Dr. Irwin Goldstein didn't set out to become a pioneer of sexual medicine. He was a biomedical engineer turned urology resident who, as he tells it, asked one stupid question during a 1976 surgery: "Could you explain the physiology of erection to me?" The surgeon shrugged. Irwin spent the next decade figuring it out. Along the way, he co-discovered that nitric oxide, the elephant of our air, is what makes erections possible. He published the first paper on it in 1991. Seven years later, he became the first author on the New England Journal of Medicine paper that introduced Viagra to the world. But that's only half the story. The other half is Sue Goldstein, Irwin's college sweetheart turned partner in life, parenting, and eventually the practice itself. Sue spent decades raising their family while quietly absorbing the science her husband brought home. She is now an AASECT-certified educator, a published researcher, and one of the most outspoken patient advocates in the field. Together, they run San Diego Sexual Medicine, a clinic where every patient gets a three-hour visit, full education, and an entire team practicing what they call true bio-psycho social care. In this first half of our two-part conversation, Dr. Jenni Skyler and Daniel Lebowitz sit with the Goldsteins and explore how a field gets built, and how it still leaves so many patients behind. They cover prostate cancer and the silent erectile crisis that follows it. The buccal grafting innovation that's helping women with severe vestibular pain finally get answers. Why women, on average, see ten or twelve doctors before they get a real diagnosis. And Sue's pet peeve, medical gaslighting and what to do when a doctor says "there's nothing that can be done." This is a conversation for anyone who has ever felt unheard by a clinician, dismissed by their own body, or convinced they were the problem. The Goldsteins want you to know — you're not. You just haven't been to the right office yet. Irwin Goldstein, MD, IF (he/him/his)Director, San Diego Sexual Medicine5555 Reservoir Drive, Suite 300, San Diego, CA 92120Director, Sexual Medicine, UC San Diego Health East Campus, San Diego, CAClinical Professor of Urology, University of California at San DiegoVoluntary Clinical Professor of Obstetrics, Gynecology and Reproductive ServicesPast President, International Society for the Study of Women’s Sexual HealthPast President, Sexual Medicine Society of North AmericaEditor Emeritus, Sexual Medicine Reviews, The Journal of Sexual Medicine, International Journal of Impotence Researchphone: 619 265-8865fax: 619 265-7696mobile: 619 987-7432dr.irwingoldstein@gmail.comhttp://www.sandiegosexualmedicine.comLike us on Facebook: https://www.facebook.com/SDSexMedtwitter.com/SDSexualMedSee omnystudio.com/listener for privacy information.

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

In Episode 289 of the Fit Father Project Podcast, Dr. Anthony Balduzzi takes a deep dive into one of the most urgent and underappreciated health threats of our time: microplastics and nanoplastics.While most people know to avoid drinking from single-use plastic bottles, this episode goes far beyond the obvious.Dr. A explains the critical difference between microplastics and nanoplastics, breaks down the five mechanisms by which plastic damages the body, and exposes the hidden sources of plastic exposure most people never think about, including tea bags, table salt, cookware, clothing, seafood, and grocery store receipts.He also covers what the latest research says about how plastic is showing up in human blood, brain tissue, arterial plaques, and even reproductive organs, and what you can realistically do about it.If you're serious about protecting your hormones, your heart, your gut, and your long-term vitality, this episode gives you the research-backed knowledge and practical steps to start reducing your plastic burden today.It is also a must-share episode for parents and grandparents who want to protect the next generation from a growing and largely invisible threat.Rate & Review – If this episode helped you understand the real dangers of microplastics and gave you practical tools to reduce your exposure, please take a minute to rate and review the Fit Father Project Podcast. Your review helps more men and women discover the show and get the information they need to live stronger, healthier, and longer.Join the Fit Father Community – Want support from others who are serious about their health after 40? Join the Fit Father brotherhood and surround yourself with people who are committed to living with more strength, energy, and purpose.Key TakeawaysMicroplastics vs. nanoplastics: size determines where they go in the body and how much damage they causeNanoplastics are 70 times smaller than the width of a human hair and can cross the intestinal wall, enter the bloodstream, and reach the heart, brain, and reproductive tissueA Columbia University study found that 90% of plastic particles in bottled water are nanoplastics, the most dangerous kindThe five mechanisms of plastic harm: endocrine disruption, oxidative stress, chronic inflammation, gut microbiome disruption, and cellular senescenceBPA and phthalates act as xenoestrogens, blocking natural hormones, lowering testosterone in men, worsening perimenopausal symptoms in women, and suppressing thyroid function in both sexesA 2024 New England Journal of Medicine study found that patients with microplastics in their arterial plaques had a 4.5 times higher risk of heart attack, stroke, and deathHidden sources most people miss: plastic-mesh tea bags, table salt, polyester clothing, nonstick cookware, larger fish, and BPA-coated thermal receiptsHimalayan pink salt tested with the highest microplastic load of any salt in a 2023 Australian study; Redmond Real Salt from Utah is currently the cleanest known optionThe body can eliminate microplastics through fiber-rich stool and excrete plasticizer chemicals like BPA and phthalates through sweat and saunaThere is currently no proven method to remove embedded nanoplastics from tissues; reducing total lifetime exposure is the single most important strategyWant To Change Your Life? Check Out Foundations!Foundations is a simple, sustainable, and specific weight loss program designed especially for busy men over 40. With short metabolic training workouts, an easy-to-follow meal plan, and an accountability team there for you every step of the way, Foundations can help you lose weight, regain energy and vitality, and live life to the fullest. Fit Father / Fit Mother LIVE 2026!Come experience the energy of Fit Father / Fit Mother Live in person this August 7–9 in Phoenix. You'll enjoy transformational teaching, nourishing meals, and the kind of real community that leaves you feeling recharged, inspired, and deeply connected. Reserve your spot now and join us for an unforgettable weekend. We look forward to meeting you!

From clinic to the OR, storytelling quietly shapes every decision in clinical care. This episode of BackTable ENT & Allergy examines how narrative medicine and the stories at the heart of each patient encounter can elevate your clinical practice, enhance empathy, and deepen the doctor-patient relationship. Pediatric ENT Dr. Gopi Shah interviews Dr. Alessandra (Alessa) Colaianni, a head and neck surgical oncologist at the University of North Carolina, about the power and relevance of narrative medicine in modern surgical care. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction05:53 - What is Narrative Medicine? 11:36 - Narrative Medicine in Clinic 17:28 - Narrative Medicine in the OR21:09 - Patient Case Presentation and Boundaries 25:05 - Writing For Reflection and the impact of AI 29:35 - Resources And Podcasts33:19 - Final Takeaways --- More about this episode Dr. Colaianni is a published writer whose work has been featured in the New York Times, New Yorker, and the New England Journal of Medicine. She describes her lifelong interest in writing and shares how earning a master's degree in the history and philosophy of science at the University of Cambridge during medical school helped her reconnect with the humanistic side of medicine. She reframes narrative medicine not as an extra task, but as an approach already woven into daily clinical work through history-taking, listening, and documentation. The conversation explores the influence of patient identity, socioeconomic context, and the “characters” in each patient's story on clinical decisions and care. Dr. Colaianni reflects on the role of storytelling in surgical training, the apprenticeship model, and how thoughtful boundaries can foster meaningful doctor-patient relationships. The episode concludes with a discussion of AI's potential impact on empathy and recommended reading for further exploration of narrative medicine. --- Resources Dr.Colaianni's published work https://www.alessandracolaianni.com Columbia University Division of Narrative Medicine https://www.mhe.cuimc.columbia.edu/division-narrative-medicine Columbia University Narrative Medicine Youtube channel https://www.youtube.com/@columbiauniversitynarrativ8472 The Nocturnists podcast https://thenocturnists.org/podcast Autobiography of a Face by Lucy Grealey https://www.amazon.com/Autobiography-Face-Lucy-Grealy The Empathy Exams by Leslie Jameson https://www.graywolfpress.org/books/empathy-exams The Collected Schizophrenias Essays by Esmé Weijun Wanghttps://www.graywolfpress.org/books/collected-schizophrenias My Own Country: A Doctor's Story by Abraham Verghese https://www.amazon.com/My-Own-Country-Doctors-Story --- BackTable ENT & Allergy is the go-to podcast for otolaryngologists, allergists, and head and neck surgeons. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Contributor: Aaron Lessen, MD Educational Pearls: There has long been many questions about which IV fluid is best for ED resuscitation Multiple adult studies have shown no clear benefit of balanced fluid vs normal saline A large pediatric randomized clinical trial published in April compared balanced fluid vs normal saline in children with septic shock  The study included about 9,000 patients from 47 emergency departments in five countries Patients with septic shock were randomized to receive either balanced fluid or normal saline The primary outcome was adverse kidney event (death, dialysis, or persistent kidney dysfunction) at 30 days or hospital discharge Results showed no difference in any safety outcomes and no adverse events occurred The key takeaway is that early fluid resuscitation matters more than which crystalloid you choose   References Balamuth F, Weiss SL, Long E, et al. Balanced Fluid or 0.9% Saline in Children Treated for Septic Shock. New England Journal of Medicine. Published online April 23, 2026. doi:https://doi.org/10.1056/nejmoa2601969   Summarized by Meg Joyce, MS3 | Edited by Meg Joyce & Ahmed Abdel-Hafiz, NREMT-P Donate: https://emergencymedicalminute.org/donate/  

What if the most common diagnostic tool in men's health for the last 30 years was actually failing millions of patients?” For decades, the "blind" prostate biopsy was the gold standard a primitive 'hit or miss' approach that often missed aggressive tumors while over-treating harmless ones. But then came the PRECISION trial, a research earthquake that proved we've been doing it wrong.In this episode, we are joined by the architect of that revolution: Professor Veeru Kasivisvanathan. A Professor of Urology at University College London and a consultant at Cleveland Clinic London, Prof. Veeru is the elite surgeon-scientist who convinced a global medical community to stop stabbing in the dark. He led the landmark trials that made MRI the mandatory gatekeeper for prostate cancer, saving countless men from unnecessary invasive procedures. If you've ever wondered why your doctor is ordering an MRI before a needle, or why "contrast dye" might be a thing of the past, this conversation is your roadmap.In this episode, you'll learn:The Precision Paradigm: Why a third of men can safely avoid a biopsy altogether if their MRI is clear.The Prime Trial Breakthrough: Why high-quality "biparametric" scans mean you can likely skip the Gadolinium contrast without losing accuracy.The Focal Therapy Landscape: How "male lumpectomies" using HIFU and Cryotherapy are preserving potency and continence.The Future of "Robotic Nerve-Sparing": How pre-operative mapping is allowing surgeons to operate with a level of visibility once thought impossible.Timestamps:00:00 – Introduction: Is the "Blind" Biopsy Failing Men?01:30 – Meet Prof. Veeru Kasivisvanathan: The Surgeon-Scientist.04:15 – What Inspired the PRECISION Trial?08:45 – The Problem with the 30-Year "Standard of Care."12:20 – MRI as the Gatekeeper: Avoiding Unnecessary Biopsies.15:45 – The UK vs. US Healthcare Systems: Why Cost and Ethics Matter.21:00 – The PRIME Trial: Biparametric vs. Multiparametric MRI.28:30 – Is Gadolinium Contrast "Toxic"? Understanding the Risks.34:15 – MRI Quality Control: Why the Radiologist Matters More Than the Machine.40:30 – Genomic Biomarkers vs. Imaging: Do We Need Both?44:45 – Treatment Paradigms: Focal Therapy (HIFU/Cryo) explained.49:15 – When to Choose a Robotic Prostatectomy Over Focal Therapy.53:00 – How to Find Prof. Veeru and Closing Thoughts.Key Resources Mentioned:Prof. Veeru's Profile: University College London (UCL) & Cleveland Clinic London.The PRECISION Trial: Published in the New England Journal of Medicine.The BURST Research Collaborative: A global network of 30,000+ patients.___________________________________

En los últimos días ha causado conmoción y alerta el brote de una enfermedad grave en el crucero MV Hondius, un barco que realizaba un trayecto a lo largo del Atlántico, desde Argentina hasta Cabo Verde. Los análisis genéticos indicaron a principios de mayo que el patógeno causante de la enfermedad es el hantavirus de los Andes, un virus que circula entre roedores en el extremo sur de América y que puede transmitirse a humanos. El virus produce una enfermedad grave porque tiene gran afinidad por la pared interior de los vasos sanguíneos, y genera problemas circulatorios, cardíacos y pulmonares. En este episodio de La Brújula os contamos qué sabemos sobre este virus gracias a los brotes que se han documentado en el pasado en Argentina y Chile. Los datos son preliminares porque siempre se ha tratado de brotes pequeños, pero todo indica que el virus se propaga por el aire (a través de las gotículas que exhalamos al respirar) y que no se contagia durante la fase asintomática. Esto sugiere que aislar a las personas con síntomas podría frenar de forma eficaz la propagación, pero en cualquier caso sería prudente también aislar a quienes hayan entrado en contacto con el virus. El largo periodo de incubación, entre 15 y 40 días, nos asegura que esta crisis tardará varios meses en darse por resuelta. Para hablar esta semana del hantavirus nos hemos basado sobre todo en un interesante informe sobre un brote que ocurrió en la localidad argentina de Epuyén a finales de 2018 y principios de 2019. El informe está publicado en el New England Journal of Medicine como "Super-Spreaders and Person-to-Person Transmission of Andes Virus in Argentina", de Valeria Martínez et al. Lo podéis encontrar aquí: https://www.nejm.org/doi/10.1056/NEJMoa2009040 Este programa se emitió originalmente el 8 de mayo de 2026. Podéis escuchar el resto de audios de La Brújula en la app de Onda Cero y en su web, ondacero.es

For decades, a tight carotid stenosis felt like a ticking time bomb — a plaque waiting to throw an embolus and cause the next stroke. We were taught that severe narrowing meant surgery, and trials like ACAS and ACST-1 seemed to prove it. But medicine has changed. Statins, antiplatelets, tighter blood pressure control, even PCSK9 and GLP-1 therapies have quietly slashed stroke risk, and now newer data from CREST-2 suggest that for many asymptomatic patients, the knife — or the stent — may not add much at all. So if modern medical therapy works better than ever… who actually benefits from intervention anymore? Today, we unpack the evidence, the controversies, and how to counsel the patient who feels perfectly fine but has high-grade stenosis.Hosts: Carolyn Judge, Andrew Huang, Luciano Delbono, Frank Davis, Robert BeaulieuInstitution: University of Michigan, Department of Surgery, Section of Vascular SurgeryLearning objectives: Describe how modern intensive medical therapy has transformed the natural history of asymptomatic carotid stenosis and explain why contemporary patients experience substantially lower annual stroke risk than those in earlier eras. Interpret and compare the results of landmark trials—including ACAS, ACST-1, and CREST-2—to assess the relative benefits of medical therapy, endarterectomy, and stenting. Apply current evidence and guideline recommendations to patient care by selecting which asymptomatic patients are most likely to benefit from carotid revascularization versus optimized medical therapy alone. References:SVS Guidelines:Brook, R. D., et al. (2022). Society for Vascular Surgery clinical practice guidelines for management of extracranial carotid artery disease. Journal of Vascular Surgery, 75(1), e1–e67. https://doi.org/10.1016/j.jvs.2021.09.031CREST (1)Brott, T. G., Hobson, R. W., Howard, G., et al. (2010). Stenting versus endarterectomy for treatment of carotid-artery stenosis. New England Journal of Medicine, 363(1), 11–23. https://doi.org/10.1056/NEJMoa0912321CREST-2Brott, T. G., Howard, G., Fong, P., et al. (2024). Randomized trial of carotid artery stenting or carotid endarterectomy vs best medical therapy for asymptomatic carotid stenosis: CREST-2 results. [Manuscript in preparation]. ClinicalTrials.gov Identifier: NCT02089217. Retrieved from https://clinicaltrials.gov/ct2/show/NCT02089217ACST-1Halliday, A., Mansfield, A., Marro, J., et al. (2004). Randomised trial of carotid artery surgery for asymptomatic stenosis. Lancet, 363(9420), 1491–1502. https://doi.org/10.1016/S0140-6736(04)16153-1ACST-2Halliday, A., Bulbulia, R., Bonati, L. H., et al. (2021). Carotid artery stenting versus carotid endarterectomy in patients with asymptomatic carotid stenosis (ACST-2): A randomised trial. Lancet, 398(10291), 1065–1073. https://doi.org/10.1016/S0140-6736(21)01980-1ACASExecutive Committee for the Asymptomatic Carotid Atherosclerosis Study. (1995). Endarterectomy for asymptomatic carotid stenosis. JAMA, 273(18), 1421–1428. https://doi.org/10.1001/jama.1995.03520420033036Sponsor URL: https://www.goremedical.com/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/listenBehind the Knife Premium: https://behindtheknife.org/premiumOral Board Review: https://behindtheknife.org/oral-boardOral Board Simulator: https://behindtheknife.org/oral-board/simulatorGeneral Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate 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-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

En este episodio arrancamos con una reflexión inesperada: nunca ha existido un niño prodigio del humor. Ni uno. Y eso dice mucho sobre lo que es realmente difícil para la inteligencia artificial. Pero luego cambiamos de marcha: si eres de los que lleva semanas mirando Claude de lejos sin saber por dónde entrar, este episodio (y el Premium que lo acompaña) es para ti. Josu, suscriptor Premium, manda un audio confesando que está paralizado: meses desconectado, vuelve, y de repente todo el mundo tiene agentes, proyectos, chats con miles de mensajes y él no sabe ni por dónde empezar. Víctor responde con lo que le diría a un amigo panadero que no sabe nada de nada. ¿Te identificas con Josu? El episodio Premium de esta semana es exactamente eso: la guía desde cero que Víctor le daría a un amigo que nunca ha tocado Claude. 30 minutos, solo audio, con ejemplos concretos para empezar hoy. → Apúntate al Premium Lo que vas a escuchar Por qué nunca ha habido un niño prodigio del humor: la investigación del neurólogo del New England Journal of Medicine y lo que nos dice sobre la complejidad real de hacer reír. Las habilidades simultáneas que exige el humor: gestión de expectativas del público, dominio total del lenguaje, inteligencia emocional y una capacidad de observación fuera de lo común. ChatGPT vs. humor real: Víctor le pide a «Chachi Petit» que invente un chiste y el resultado ilustra perfectamente el problema. Por qué la IA no va a sustituir el humor (ni el cine documental): el argumento de Víctor sobre quién cuenta la historia y desde dónde. El audio de Josu y la parálisis de Claude: la sensación de estar abrumado que tiene mucha gente y cómo salir de ella en minutos. Qué hay en el episodio Premium de esta semana: la guía desde cero para empezar con Claude que Víctor acaba de publicar. El episodio Premium de esta semana Víctor acaba de publicar en el área Premium un episodio de 30 minutos pensado específicamente para quienes se sienten como Josu: personas que llevan semanas (o meses) mirando Claude desde la orilla sin dar el paso. En ese episodio encontrarás: Las mejores formas de empezar con Claude explicadas desde cero, sin asumir conocimiento previo. Herramientas que ya estás pagando y que Claude puede sustituir o mejorar adaptándolas a lo que tú realmente necesitas. Ejemplos concretos de proyectos que puedes arrancar desde el primer día: web personal, proyectos paralelos, ideas que llevas tiempo guardadas en el cajón. La comunidad Premium en Telegram: grupos privados donde cada día se comparten avances, dudas y recursos en tiempo real. → Apúntate a No es Asunto Vuestro Premium y escucha el episodio completo hoy. Transcripción del episodio [00:00] El neurólogo y los niños prodigio: ¿por qué nadie hace reír a los 7 años? El otro día leía un artículo en el New England Journal of Medicine, de un neurólogo, que decía algo curioso: hemos visto niños prodigio capaces de interpretar obras dificilísimas al piano o al violín con 7 años, niños haciendo cálculos matemáticos a una velocidad brutal, grandes maestros del ajedrez con 12 años, bailarines y cantantes infantiles extraordinarios con unas voces increíbles. Pero, curiosamente, nunca hemos visto un niño genuinamente divertido. Un niño haciendo un monólogo durante una hora delante de un público. Tendemos a pensar que disciplinas como las matemáticas, la ciencia, el ajedrez o la música clásica son indicadores de genialidad. Y sí, hay niños muy especiales que lo hacen. Pero contar un chiste sobre un escenario, o en un bar con unos amigos, o en un podcast, exige gestionar simultáneamente un montón de situaciones muy complejas. [01:26] Qué hace que el humor sea tan difícil Para hacer reír necesitas gestionar al mismo tiempo varias cosas. Primero, lo que piensa el público. Segundo, lo que el público cree que tú piensas. Tercero, lo que espera que vayas a decir a continuación. Y luego, cómo esa expectativa genera una brecha y cómo cerrarla con algo totalmente inesperado: el pushline, que es como se conoce en el mundo del humor. Y no es fácil. Además, necesitas un dominio total del lenguaje. Cuando yo voy por ahí y tengo que hacer reír en inglés, me cuesta muchísimo más. Cuanto más dominas el lenguaje, mejor humor haces. Y no solo elegir las palabras exactas, sino decirlas con precisión, en el momento exacto. Hace falta también inteligencia emocional para leer cómo está esa sala en ese momento. Y luego una capacidad excepcional de observar algo que todos hemos visto mil veces y encontrar ahí algo cómico que nadie más ha detectado. [02:40] Por qué los niños no pueden hacer humor: la razón real ¿Por qué hemos visto centenares de niños que tocan el piano como Lang Lang y en cambio no hemos visto a ninguno haciendo algo que en principio parece más simple? Porque no es simple. Porque es muy complejo. Los niños de siete o nueve años no tienen suficiente tiempo de construir todo lo que necesitan intelectualmente para crear humor. [03:05] La IA y el chiste: «Chachi Petit, invéntate un chiste» Y por esa misma razón pasa lo siguiente. «Chachi Petit, invéntate un chiste. El chiste más bueno que te puedas inventar.» Respuesta: «¿Por qué el libro de matemáticas fue a terapia? Porque tenía demasiados problemas.» Espectacular. No sé si más adelante la inteligencia artificial va a poder crear un humor mejor. Seguramente que técnicamente sí. Pero yo estoy seguro de que, igual que siempre digo que no va a sustituir mi core business, que es el cine documental (porque no se puede sustituir la realidad), en el humor creo que va a pasar algo similar. Porque el humor, para mí, va de quién lo cuenta y desde dónde lo cuenta. Pero esto ya es un debate muy largo. [03:47] La piscina nueva: el abrumamiento con Claude En lo que sí que ahora mismo la inteligencia artificial nos pasa la mano por la cara es en muchas otras cosas que nos pueden ayudar en nuestra vida cotidiana. Entiendo que muchos de vosotros, si aún no habéis puesto la puntita de los dedos de los pies en esta piscina nueva que se nos ha abierto hace pocas semanas, estéis un poco abrumados. Y esto es exactamente lo que le pasaba a Josu, que me envió el otro día un audio. Josu es suscriptor de la parte Premium de No es Asunto Vuestro. [04:05] El audio de Josu: «Estoy absolutamente paralizado» Josu explica que ha estado unos meses desconectado por temas de trabajo, el que le paga la hipoteca. Cuando vuelve a No es Asunto Vuestro, se encuentra absolutamente perdido: ve que todo el mundo está súper avanzado en el tema de Claude, hay tanto contenido, empieza a mirar un chat, luego otro, luego la nueva web, y al final está perdidísimo. Su propuesta: «¿Podrías hacer una especie de guion de qué pasos dar? Tú siempre dices que si lo haces tú lo puede hacer cualquiera, pero hay tanto que no sé para dónde tirar. Un paso a paso para alguien que, como yo, ha estado desconectado los últimos meses y de repente se encuentra con todo el mogollón: todo Dios tiene agentes, todo Dios tiene no sé qué… y busco cualquiera de los chats y tengo cuatro mil mensajes por todos los lados. ¿Por dónde empiezo? Estoy absolutamente paralizado.» [05:37] La respuesta de Víctor: quita la tela de la cara Entiendo esta sensación y me estoy encontrando con un montón de gente que me dice lo mismo. Y os digo una cosa: aunque ahora os parezca un muro enorme, os juro que dedicándole unos minutos, o mejor dicho, quitándose esa tela de delante de la cara y afrontando el problema, poniéndote delante de Claude, en un segundo salís de ese estado. Y por eso acabo de publicar en la parte Premium de No es Asunto Vuestro un episodio donde explico lo que le diría a un amigo panadero, o abogado, que me preguntara: «Oye, no sé nada de esto, no he entrado en nada, explícamelo desde cero.» [06:30] Qué encontrarás en el episodio Premium He hecho este episodio intentando ponerlo todo súper fácil: cuáles creo que son las mejores formas de empezar con Claude, con muchos ejemplos de cosas que podéis hacer desde el principio. Como sustituir herramientas que estáis pagando y mejorarlas adaptándolas a lo que realmente os interesa, construir una web personal, arrancar proyectos paralelos con ideas que lleváis tiempo guardadas en el cajón. Un montón de ejemplos que he recopilado de muy buena fe en 30 minutos, solo audio, explicado de la manera más sencilla posible. Y además, si estáis en la parte Premium de No es Asunto Vuestro, tenemos chats en Telegram, grupos privados donde entre todos nos ayudamos cada día. Eso saca humo. Bueno, chavales, nos vemos en la parte Premium de No es Asunto Vuestro. ¡Chao! Menciones y recursos del episodio New England Journal of Medicine: revista científica donde se publicó el artículo del neurólogo sobre niños prodigio y humor. Lang Lang: pianista mencionado como referente de niños prodigio musicales. Claude (Anthropic): el asistente de IA protagonista del episodio y del Premium de la semana. «Chachi Petit»: como llama Víctor a ChatGPT en tono irónico para ilustrar el humor de la IA. Josu: suscriptor Premium que envía el audio sobre su parálisis con Claude. Telegram: plataforma donde la comunidad Premium de No es Asunto Vuestro tiene sus grupos privados. No es Asunto Vuestro Premium: noesasuntovuestro.com/suscripcion ¿Listo para dejar de mirar la piscina desde fuera? El episodio Premium de esta semana es la guía desde cero que Víctor le daría a cualquier persona que no haya tocado Claude en su vida: 30 minutos, ejemplos concretos, y acceso a la comunidad en Telegram donde cada día se comparte todo lo que funciona de verdad. → Apúntate a No es Asunto Vuestro Premium Noesasuntovuestro.com

Jeremías 9:5"No hay nadie que no engañe a su amigo. No hay nadie que diga la verdad. Entrenaron su lengua para la mentira, y sólo saben perpetrar la maldad".Es común que los evolucionistas descarten mucho del gran trabajo de los creacionistas, diciendo que esos documentos no aparecen en sus revistas revisadas por pares. Sin embargo, en la actualidad, los editores de las dos revistas médicas más prestigiosas han dejado constancia de que el proceso de revisión por pares de sus revistas, ya no tiene el mismo peso y ya no significa mucho.Hace varios años, la Dra. Marcia Angell, médico y editora de una de las revistas médicas de más confianza en el mundo, escribió lo siguiente: "Ya no es posible creer mucho de la investigación clínica que se publica, o confiar en el juicio de médicos de confianza o de las directrices médicas autorizadas. No me gusta esta conclusión, a la cual he llegado lentamente y a regañadientes durante mis dos décadas como editor de la revista The New England Journal of Medicine” (revista médica con sistema de revisión por pares).Más recientemente, el Dr. Richard Horton, editor de la revista The Lancet, escribió lo siguiente en su propia revista: "El caso contra la ciencia es una tarea sencilla. Gran parte de la literatura científica, quizá más de la mitad, puede simplemente ser falsa." Añadió que "la ciencia ha dado un giro hacia la oscuridad" y dijo que esto es causado por "flagrantes conflictos de intereses." También dijo algo que hemos estado diciendo por años: "En su búsqueda por contar una historia convincente, los científicos a menudo esculpen datos que encajen con su teoría preferida del mundo".Así que nunca deje que un evolucionista le lance el proceso de revisión por pares en la cara como una marca de la superioridad de la evolución sobre la creación bíblica. A diferencia de las publicaciones revisadas por pares, la Biblia nunca se equivoca.Oración: Padre Celestial, en lugar de poner mi confianza en la palabra falible del hombre, pongo mi confianza en Tu Palabra escrita y viva - el Señor Jesucristo! Amén.Ref: Marcia Angell, "Las compañías farmacéuticas y los médicos: una historia de corrupción." 15 de enero de 2009. The New York Review of Books 56. To support this ministry financially, visit: https://www.oneplace.com/donate/1235/29?v=20251111

In today's conversation, we move beyond the idea of simply recording numbers in the cardiac arrest patient. Instead, we explore how physiological data can be used to guide real-time resuscitation, helping clinicians understand what is happening inside the patient, how interventions are working, and where care should go next. Joining us as the guest to discuss this is Mark Faulkner. Mark is an Advanced Paramedic for Hampshire and Isle of Wight Air Ambulance (HIOWAA), where he provides clinical leadership through his critical care practice. His work spans frontline practice, education, quality improvement, and the development of clinical pathways that shape the delivery of advanced pre-hospital care. This is the reading list associated with the episode:Barreto, A. et al. (2020) ‘Diastolic blood pressure and survival in cardiac arrest', Resuscitation, 155, pp. 1–8.Bernard, S.A. et al. (2024) ‘Physiology-guided resuscitation in cardiac arrest', Journal of Clinical Medicine, 13(12), p. 3527.Brede, J.R. et al. (2019) ‘Prehospital REBOA in cardiac arrest', Resuscitation, 140, pp. 136–143.Butterfield, E. et al. (2024) ‘Prehospital arterial monitoring in cardiac arrest', Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 32(1).Kruit, N. et al. (2025) ‘Prehospital ECPR (PRECARE study)', Resuscitation, 188.Nolan, J.P. et al. (2021) ‘European Resuscitation Council Guidelines', Resuscitation, 161, pp. 98–114.Perkins, G.D. et al. (2018) ‘Epinephrine in OHCA', New England Journal of Medicine, 379(8), pp. 711–721.Rubertsson, S. et al. (2014) ‘LINC trial', JAMA, 311(1), pp. 53–61.Sutton, R.M. et al. (2014) ‘Hemodynamic-directed CPR', Resuscitation, 85(3), pp. 397–402.Yannopoulos, D. et al. (2020) ‘Advanced reperfusion strategies', Circulation, 141(10), pp. 784–796.Rees, P. et al. (2023) ‘Prehospital arterial blood pressure monitoring and outcomes in cardiac arrest', Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.Barrett, J. et al. (2023) ‘Diastolic blood pressure and ROSC in OHCA', Resuscitation.VitalStream from BHA Medical sponsors this podcast: Closing the Haemodynamic Blind Spots in Acute and Pre-Hospital CareVitalStream is a wireless, wearable, non-invasive haemodynamic monitoring platform designed to deliver continuous, real-time physiological data, so you're not relying purely on intermittent cuff readings when patients are unstable, moving, or in non-traditional care environments.Using AI-driven analytics and patented Pulse Decomposition Analysis, it provides continuous blood pressure alongside advanced haemodynamic parameters such as cardiac output, stroke volume, systemic vascular resistance, and fluid status. The aim is simple but critical: to help clinicians understand not just what the blood pressure is, but why, and whether a patient is fluid responsive or in need of a different intervention.BHA Medical's VitalStream solution focuses on integrating this level of monitoring into acute care workflows, streaming real-time data to a centralised platform, supporting earlier recognition of deterioration and more informed clinical decision-making.In corridor medicine, where patients are often managed outside traditional monitored spaces, the challenge is missed deterioration between spot checks. Continuous trending helps reduce those “blind spots,” enabling earlier identification of haemodynamic decline and better prioritisation when systems are under pressure.And in pre-hospital care, the value is in maintaining a clear physiological narrative from first patient contact through to hospital handover. VitalStream is designed for rapid deployment, applied, calibrated, and delivers data within around 90 seconds, using a low-pressure finger sensor that allows teams to follow trends in real time, rather than relying on isolated snapshots.For more information, visit: https://www.bha-medical.com/vitalstream-patient-monitoring

GLP-1 drugs like Ozempic and Mounjaro are now everywhere. But what do they actually do beyond weight loss? And what do you need to know before starting them? In this episode, we're joined by Dr Ania Jastreboff, a world-leading researcher at the forefront of GLP-1 treatments and writer of the New York Times bestselling book Enough: Your Health, Your Weight, and What It's Like To Be Free, co-authored with Oprah Winfrey. Dr Jastreboff explains everything you need to know about Ozempic, Mounjaro, Wegovy and other GLP-1 medications for 2026. You'll learn how GLP-1s may reduce the risk of heart disease, improve blood sugar control, and support conditions like sleep apnoea. We also explore why weight often returns after stopping, and what you need to know about Ozempic side effects and long-term use. If these drugs can change how your brain controls hunger, what does that mean for willpower, weight gain, and how we treat obesity long term?

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What if the clothes you're putting on your body, or your child's body, every single day… were quietly poisoning you? In this explosive solo episode, Darin exposes a shocking and largely ignored reality: fast fashion clothing, especially brightly colored, cheap garments, may be loaded with toxic heavy metals like lead. Backed by a 2026 study from the American Chemical Society, this conversation reveals how these chemicals don't just sit on fabric, they leach into your skin, enter your bloodstream, and accumulate over time. From the hidden chemistry behind synthetic dyes to the devastating neurological effects of lead exposure in children, this episode pulls back the curtain on one of the most overlooked "fatal conveniences" in modern life—and gives you the tools to make safer, smarter choices starting today.     What You'll Learn The shocking discovery: children's clothing exceeding federal lead limits Why bright, cheap fast fashion items are the most toxic How heavy metals like lead are used to fix dyes into fabrics Why your skin is not a barrier, but a direct absorption pathway The connection between clothing, sweat, and chemical absorption The devastating effects of lead exposure on children's brains and development Why there is no safe level of lead exposure The hidden chemical load in fast fashion: PFAS, phthalates, formaldehyde How the fast fashion industry cuts costs at the expense of health Practical steps to protect yourself and your family     Chapters 00:00:00 – Opening: introducing the fast fashion heavy metal crisis 00:00:17 – The "cheap t-shirt" scenario and hidden danger 00:00:46 – Speaking directly to parents and caregivers 00:01:30 – The shocking claim: clothing may contain neurotoxins 00:02:45 – 2026 study: children's clothing tested for lead 00:03:14 – Every sample exceeded federal safety limits 00:04:20 – Lead exposure happening through daily wear 00:05:33 – Fast fashion industry scale: $150B+ and growing 00:06:20 – 1,000 new styles per day: the system behind overproduction 00:07:09 – How cheap clothing is actually manufactured 00:07:49 – Chemical dyes and fixatives explained 00:08:20 – Why lead is used in fabric dyeing 00:08:49 – Study details: methodology and testing process 00:09:21 – Research team and origin of investigation 00:10:52 – Advanced testing: spectroscopy and EPA protocols 00:11:40 – Results: every shirt failed safety standards 00:12:10 – Bright colors = higher toxicity 00:13:05 – Secondary experiment: ingestion and mouthing behavior 00:14:00 – Children chewing clothing: real-world exposure 00:14:49 – Skin is not a barrier—it's a delivery system 00:15:30 – Sweat and heat increase chemical absorption 00:16:28 – Microplastics and chemical leaching through skin 00:17:13 – Exercise increases toxin absorption 00:18:00 – Flame retardants and systemic circulation 00:18:50 – Long-term exposure: accumulation over time 00:19:36 – No safe level of lead exposure—global consensus 00:20:15 – Effects on children: brain damage and development issues 00:21:14 – Behavioral, cognitive, and neurological consequences 00:22:00 – Broader chemical exposure: 8,000+ compounds in clothing 00:23:01 – Solutions begin: awareness and behavior change 00:23:40 – Immediate action: always wash new clothes 00:24:10 – Choosing safer fabrics: organic and natural materials 00:24:50 – Avoiding synthetic blends and bright dyes 00:25:20 – Buy less, buy better philosophy 00:26:01 – Supporting ethical and non-toxic brands 00:26:40 – Using your consumer voice to create change 00:27:10 – Educating others and spreading awareness 00:27:40 – Final message: protecting your body and your children 00:28:00 – Closing: reclaiming control and living a SuperLife     Thank You to Our Sponsors: Our Place – Non-toxic cookware that keeps harmful chemicals out of your food. Get 10% off at fromourplace.com with code DARIN. Tru Niagen – Boost NAD+ levels for cellular health and longevity. Get 20% off with code DARIN20 at truniagen.com.     Find More From Darin: Website: darinolien.com Instagram: @darinolien Book: Fatal Conveniences     Key Takeaway "Your skin is not a shield—it's a gateway. And when you start to realize that the things you wear every day can carry toxic chemicals directly into your body, everything changes. Because this isn't about fear—it's about awareness. And once you're aware, you have the power to choose differently, protect your family, and stop participating in a system that was never designed with your health in mind."     Bibliography/Sources The Primary Study American Chemical Society. (2026, March 23). Initial tests find lead in children's fast-fashion clothing [Press release]. https://www.acs.org/pressroom/presspacs/2026/march/initial-tests-find-lead-in-childrens-fast-fashion-clothing.html Deavers, K., Avello, C., & Espinoza, P. (2026, March 22–26). Lead contamination in fast fashion children's clothing [Paper presentation]. ACS Spring 2026 Meeting, Atlanta, GA, United States. HealthDay. (2026, March 24). Cheap children's clothing tainted with lead, study says. U.S. News & World Report. https://www.usnews.com/news/health-news/articles/2026-03-24/cheap-childrens-clothing-tainted-with-lead-study-says Marian University. (2026, March 23). Marian University students warn of lead in children's fast-fashion clothing. Marian University Newsroom. https://www.marian.edu/newsroom/2026/03/marian-university-students-warn-of-lead-in-childrens-fast-fashion-clothing ScienceDaily. (2026, April 2). Initial tests find lead in children's fast-fashion clothing. https://www.sciencedaily.com/releases/2026/04/260402042737.htm Texfash. (n.d.). Lead found in fast-fashion children's clothing as preliminary tests exceed federal safety limits. Texfash Update. https://texfash.com/update/lead-found-in-fast-fashion-children-s-clothing-as-preliminary-tests-exceed-federal-safety-limits Lead Toxicity & Children's Health Agency for Toxic Substances and Disease Registry. (n.d.). Lead toxicity: What are possible health effects from lead exposure? Centers for Disease Control and Prevention. https://archive.cdc.gov/www_atsdr_cdc_gov/csem/leadtoxicity/physiological_effects.html American Academy of Child & Adolescent Psychiatry. (n.d.). Lead exposure in children affects brain and behavior. https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Lead-Exposure-In-Children-Affects-Brain-And-Behavior-045.aspx Brain Injury Association of America. (2021). Chronic lead exposure: A non-traumatic brain injury. https://biausa.org/public-affairs/public-awareness/news/chronic-lead-exposure-a-non-traumatic-brain-injury Canfield, R. L., et al. (2004). Intellectual impairment in children with blood lead concentrations below 10 μg per deciliter. New England Journal of Medicine, 348, 1517–1526. Centers for Disease Control and Prevention. (2025). Risk factors and children. Childhood Lead Poisoning Prevention. https://www.cdc.gov/lead-prevention/risk-factors/children.html Hubbs-Tait, L., et al. (2005). Neurotoxicants, micronutrients, and social environments: Individual and combined effects on children's development. Psychological Science in the Public Interest, 6(3), 57–121. Lanphear, B. P., et al. (2005). Environmental lead exposure and children's cognitive function. Environmental Health Perspectives. https://pmc.ncbi.nlm.nih.gov/articles/PMC4675165/ Liu, J., et al. (2013). A clinical study of the effects of lead poisoning on the intelligence and neurobehavioral abilities of children. BMC Pediatrics. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3598508/ Needleman, H. L., & Bellinger, D. (2001). Recent developments in low-level lead exposure and intellectual impairment in children. Environmental Health Perspectives. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1247191/ Skin Absorption & Transdermal Chemical Exposure Abafe, O., et al. (2024). Flame retardants leach from microplastics into human sweat; absorption through skin demonstrated. Environment International. Corinti, D., et al. (2018). Chemicals from textiles to skin: An in vitro permeation study of benzothiazole. PubMed Central. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6133113/ EveryRep. (2025). Non-toxic activewear: The BPA, PFAS and polyester risk. https://everyrep.com/synthetic-toxins-endocrine-safety/ University of Birmingham. (2024, April). Toxic chemicals from microplastics can be absorbed through skin. https://www.birmingham.ac.uk/news/2024/toxic-chemicals-from-microplastics-can-be-absorbed-through-skin Fast Fashion: Industry Scale, Chemicals & Health Impacts Cobbing, M., Wohlgemuth, A., & Panhuber, T. (2022). Greenpeace investigation: Hazardous chemicals in SHEIN garments. Greenpeace International. Earth Day Network. (n.d.). Hazardous hems: How fashion wreaks havoc on health. https://www.earthday.org/hazardous-hems-how-fashion-wreaks-havoc-on-health/ Earth Day Network. (n.d.). Toxic textiles: The chemicals in our clothing. https://www.earthday.org/toxic-textiles-the-chemicals-in-our-clothing/ Enhesa. (2026). Toxic chemicals in fast fashion supply chains: Risks, impacts, and regulation. https://www.enhesa.com/resources/article/toxic-chemicals-in-fast-fashion-supply-chains-risks-impacts-and-regulation/ Giró-Palau, A., et al. (2025). The health impact of fast fashion: Exploring toxic chemicals in clothing and textiles. MDPI Encyclopedia, 5(2), 84. https://www.mdpi.com/2673-8392/5/2/84 Green America. (n.d.). Unpacking toxic textiles. https://greenamerica.org/unraveling-fashion-industry/unpacking-toxic-textiles Million Marker. (2024). Fast fashion: A toxic trend and the path to sustainable change. https://millionmarker.com/blogs/blog/fast-fashion-is-toxic OsloMet Clothing Research. (2025). From clothes to skin: Chemical safety in ultra-fast fashion and luxury brands' clothes. https://clothingresearch.oslomet.no/2025/06/03/from-clothes-to-skin-chemical-safety-in-ultra-fast-fashion-and-luxury-brands-clothes/ Fast Fashion Industry Statistics & Environmental Scope Center for Biological Diversity. (n.d.). At what cost? Unravelling the harms of the fast fashion industry. https://www.biologicaldiversity.org/programs/population_and_sustainability/sustainability/fast_fashion Earth.org. (2026). Fast fashion and its environmental impact. https://earth.org/fast-fashions-detrimental-effect-on-the-environment/ Niinimäki, K., et al. (2020). The environmental price of fast fashion. Nature Reviews Earth & Environment. https://www.nature.com/articles/s43017-020-0039-9 The Sustainable Agency. (2026). Environmental & human impact of fast fashion: 2026 facts. https://thesustainableagency.com/blog/impact-of-fast-fashion-stats-and-facts/ Uniform Market. (2025). Environmental impact of fast fashion statistics. https://www.uniformmarket.com/statistics/fast-fashion-statistics Certifications & Resources for Cleaner Clothing bluesign. (n.d.). bluesign standard. https://www.bluesign.com Global Organic Textile Standard. (n.d.). GOTS. https://global-standard.org Oeko-Tex. (n.d.). Oeko-Tex Standard 100. https://www.oeko-tex.com/en/our-standards/oeko-tex-standard-100 Zero Discharge of Hazardous Chemicals. (n.d.). Roadmap to zero. https://www.roadmaptozero.com

A landmark study in the New England Journal of Medicine shows that hypertension control is no longer just about prescribing medications—it's about systems, teams, and sustained engagement.

GLP-1 medications like semaglutide and tirzepatide are everywhere right now—but are they actually solving the problem? In Episode 8 of this 16-part series on ultra-processed foods, Dr. Brendan McCarthy breaks down the truth about GLP-1 medications: how they work, why they can feel like a “miracle,” and where things go wrong when they're used without proper medical guidance. This isn't about shame. It's about understanding. GLP-1s can quiet “food noise” and help regulate appetite—but they don't fix your relationship with food, your metabolism, or the long-term patterns that lead to weight gain. Without structure, nutrition, and proper care, many patients end up with muscle loss, nutrient deficiencies, and rebound weight gain. In this episode, you'll learn: What GLP-1 medications actually do in your body Why they're not a long-term solution on their own The biggest mistakes doctors and clinics make when prescribing them How ultra-processed foods drive weight gain in the first place How to use GLP-1s the right way to create lasting change The goal isn't dependence—it's freedom. If you're currently on a GLP-1 (or considering it), this episode will change how you think about your treatment plan.   Mechanism Anchored References This episode is not anti medication. It is about putting GLP 1 therapy in its proper place. GLP 1 receptor agonists can reduce appetite pressure and alter satiety signaling. That matters. But quieter appetite is not the same as full recovery. Food quality still matters. Protein still matters. Muscle still matters. Structure still matters.   References U.S. Food and Drug Administration. WEGOVY semaglutide injection Prescribing Information. 2025. Wilding, John P H, et al. Once Weekly Semaglutide in Adults with Overweight or Obesity. New England Journal of Medicine, vol. 384, no. 11, 2021, pp. 989 to 1002. Wilding, John P H, et al. Weight Regain and Cardiometabolic Effects After Withdrawal of Semaglutide The STEP 1 Trial Extension. Diabetes Obesity and Metabolism, vol. 24, no. 8, 2022, pp. 1553 to 1564. Hall, Kevin D, et al. Ultra Processed Diets Cause Excess Calorie Intake and Weight Gain An Inpatient Randomized Controlled Trial of Ad Libitum Food Intake. Cell Metabolism, vol. 30, no. 1, 2019, pp. 67 to 77. Neeland, Ian J, et al. Changes in Lean Body Mass with Glucagon Like Peptide 1 Based Therapies and Mitigation Strategies. Diabetes Obesity and Metabolism, 2024. Wilding, John P H, et al. Impact of Semaglutide on Body Composition in Adults with Overweight or Obesity Exploratory Analysis of the STEP 1 Study. 2021. Everitt, Barry J, and Trevor W Robbins. Drug Addiction Updating Actions to Habits to Compulsions Ten Years On. Annual Review of Psychology, vol. 67, 2016, pp. 23 to 50. Monteiro, Carlos A, et al. The UN Decade of Nutrition the NOVA Food Classification and the Trouble with Ultra Processing. Public Health Nutrition, vol. 21, no. 1, 2018, pp. 5 to 17.   Dr. Brendan McCarthy is the founder and Chief Medical Officer of Protea Medical Center in Arizona. With over two decades of experience, he's helped thousands of patients navigate hormonal imbalances using bioidentical HRT, nutrition, and root-cause medicine. He's also taught and mentored other physicians on integrative approaches to hormone therapy, weight loss, fertility, and more. If you're ready to take your health seriously, this podcast is a great place to start.  

Luke Carignan and ASHHRA Executive Director Jeremy Sadlier take a deliberate step back from the doom and gloom to look at what is actually working in healthcare HR right now — and the data is genuinely encouraging.

Send us Fan MailThis week, I'm taking a curious, watch-and-see approach to GLP-1 medications—things like semaglutide, Ozempic, Wegovy. We'll cover the research-backed potential benefits, the side effects, what happens after stopping, and why the conversation is about much more than just weight. No judgment, no pressure, just information, reflection, and a reminder that your choices are personal and worth considering thoughtfully.Tune in if you want to explore GLP-1 medications from a place of curiosity and clarity.Quote of the Week:“We are what we repeatedly do. Excellence, then, is not an act, but a habit.” — Will Durant Citations1.    Wilding, J. P. H., et al. (2021). Once-Weekly Semaglutide in Adults with Overweight or Obesity. New England Journal of Medicine, 384, 989–1002.2.    Rubino, D., et al. (2021). Effect of Continued Weekly Subcutaneous Semaglutide vs Placebo on Weight Loss Maintenance. Diabetes, Obesity and Metabolism.3.    SELECT Trial Investigators (2023). Semaglutide and Cardiovascular Outcomes in Obesity. New England Journal of Medicine.4.    Drucker, D. J. (2018). Mechanisms of Action and Therapeutic Application of GLP-1. Cell Metabolism.5.    Baggio, L. L., & Drucker, D. J. (2007). Biology of Incretins. Gastroenterology.Let's go, let's get it done.Get more information at: http://projectweightloss.org

Send us a Text Message (please include your email so we can respond!)Episode 89! In this episode we talk about HI-PEITHO or catheter directed thrombolysis versus conventional anticoagulation for intermediate risk pulmonary embolism. This was published in the New England Journal of Medicine by Rosenfield et al.HI-PEITHO: http://nejm.org/doi/full/10.1056/NEJMoa2516567HI-PEITHO (pubmed): https://pubmed.ncbi.nlm.nih.gov/41910345/If you enjoy the show be sure to like and subscribe, leave that 5 star review! Be sure to follow us on the social @icucast for the associated figures, comments, and other content not available in the audio format! Email us at icuedandtoddcast@gmail.com with any questions or suggestions! Thank you Mike Gannon for the intro and exit music! 

A randomized trial in the New England Journal of Medicine found prehospital whole blood transfusion did not improve 30-day mortality over standard component therapy in traumatic hemorrhage, supporting current transfusion protocols. A large population-based study showed patients with positive fecal occult blood tests who did not complete follow-up colonoscopy had significantly higher colorectal cancer incidence and more advanced-stage disease. Finally, a study in Nature Medicine of nearly 15,000 individuals found antibiotic exposure reduced gut microbial diversity for up to 4–8 years, with clindamycin and fluoroquinolones causing the most persistent disruption.

Howie and Harlan are joined by trauma surgeon Selwyn Rogers, who reflects on caring for victims of gun violence and speaking with families in their darkest moments—and explains why the problem must be understood as a shared societal responsibility. Harlan examines new evidence suggesting U.S. healthcare spending has grown more slowly than expected; Howie discusses a retracted Lancet article that highlights the risks of undisclosed conflicts of interest. Show notes: Healthcare Costs "Has the United States Bent the Health Care Cost Curve?" David M. Cutler "Baumol's cost disease" Harlan Krumholz: "Out‐of‐Pocket Annual Health Expenditures and Financial Toxicity From Healthcare Costs in Patients With Heart Failure in the United States"  Selwyn Rogers Selwyn Rogers: Healing the Gun Violence Epidemic: Ending Violence, Rebuilding Communities, and a Trauma Surgeon's Vision for Restoring Hope Albert Ko "Selwyn Rogers named associate editor of prestigious New England Journal of Medicine" Selwyn Rogers: "Hope—Beyond Firearm Trauma" Selwyn Rogers: "Structural Racism and Firearm Injury: Operationalizing Health Equity in Trauma Care" Brain Death: What it is, Stages & Criteria New York Times Live Updates: Supreme Court Birthright Citizenship Case  Annual Gun Violence Data 2023 Conflicts of Interest "Retraction: Cosmetic talc powder" "Historians Unearth a Conflict of Interest, Prompting a Retraction by The Lancet Journal" Johns Manville Trust Fund and Lawsuits Mark Lanier Health & Veritas Episode 215: Arya Singh: Beyond Accessibility In the Yale School of Management's MBA for Executives program, you'll get a full MBA education in 22 months while applying new skills to your organization in real time. Yale's Executive Master of Public Health offers a rigorous public health education for working professionals, with the flexibility of evening online classes alongside three on-campus trainings. Email Howie and Harlan comments or questions.

Dr. Monty Pal speaks with internationally acclaimed hematologists Dr. Vincent Rajkumar and Dr. Saad Usmani about the AQUILA trial in high-risk smoldering multiple myeloma, as well as advances in CAR-T and other evolving treatment strategies in the myeloma space. TRANSCRIPT Dr. Monty Pal: Hello everyone and welcome to the ASCO Daily News Podcast. I'm your host, Monty Pal. I'm a medical oncologist, underline medical oncologist, a professor, and vice chair of academic affairs at the City of Hope Comprehensive Cancer Center in Los Angeles. You're going to understand why I underlined "medical oncologist" there. I'm actually on the line today with two amazing hematologists. Today, we're going to actually explore treatments for high-risk smoldering multiple myeloma following the FDA's approval last year of daratumumab for the first-ever treatment of this indication. Now, this is based on the AQUILA trial, and this represents a huge shift in our traditional watch-and-wait approach to active disease interception. We're going to consider whether this landmark trial published in The New England Journal translates to day-to-day practice. I think it does, and we'll certainly make an argument for that. And I'm so fortunate today to have two internationally acclaimed experts here in the conversation: Dr. Vincent Rajkumar, senior author on the manuscript, and Dr. Saad Usmani, also an expert in his own right in myeloma. Dr. Rajkumar is the lead investigator of the AQUILA study. He's a professor of medicine and consultant in the divisions of hematology and hematopathology at the Mayo Clinic in Rochester, Minnesota. He actually chairs the Myeloma, Amyloidosis, Dysproteinemia Program. He is also editor-in-chief of the Blood Cancer Journal. Dr. Usmani, he and I actually go way, way back. We actually did the AACR Molecular Biology in Clinical Oncology course, I want to say in 2006, so this is our 20-year anniversary, Saad. He's the chief of the myeloma service at the MSK Cancer Center and a professor of medicine at the Weill Cornell Medical College in New York.  Saad, Vincent, welcome. Dr. Saad Usmani: Thank you so much for having me, Monty. Dr. Vincent Rajkumar: Yeah, thanks, Monty. A pleasure to be here. Dr. Monty Pal: Thanks. And just a quick note for our listeners, all of our disclosures are available in the transcript of this episode. First off, Saad, did I get that right? Was it 2006 when we did that course together? Dr. Saad Usmani: Yeah, 20 years. We are coming up to our 20-year anniversary. It's remarkable to have seen our careers move the way they have, Monty. Dr. Monty Pal: Oh my gosh. And for all the fellows who are on the line, that AACR Molecular Biology and Clinical Oncology course, it's sometimes overlooked. Wonderful primer on translational science. Okay, now we're going to get to the heart of the matter here, the AQUILA trial. So this was a study, Vincent, that you led. I wonder if you'd walk us through the primary endpoints in the study. What are we looking at in the AQUILA trial specifically? Dr. Vincent Rajkumar: Thanks so much. Again, as you mentioned, smoldering multiple myeloma has just been a condition that we watch and wait. And the first thing that I want to clarify here is that the AQUILA trial is looking at only a subset of smoldering multiple myeloma. That is the high-risk smoldering multiple myeloma. It was defined the way high-risk smoldering myeloma was defined at the time the trial was designed. It randomized 390 patients. One arm got daratumumab single agent in an attempt to delay progression to active myeloma and possibly prolong survival. And the other arm was the traditional observation. The primary endpoint, therefore, was time to active multiple myeloma. Other endpoints included time to when patients needed to start therapy for active multiple myeloma, which can vary based on physician judgment, and overall survival. Of course, response rate, complete response rate, and others were also endpoints. Dr. Monty Pal: That's interesting. And you know, I wanted you to riff a little bit on this definition of high-risk smoldering myeloma. Can you tell our audience how that's sort of evolved over the years? Dr. Vincent Rajkumar: Yes. I mean, if you step back, monoclonal gammopathy of undetermined significance has only a 1% per year risk of progression. Smoldering multiple myeloma, all comers have a 10% per year risk of progression. And over the years, trials have been done in the whole population, and then more recently, we felt we should really focus on the people with high-risk smoldering, defined as a 50-50 risk of progression in 2 years. That's like a 25% per year risk of progression in the first 2 years, which is a very high risk for the patient and something that would justify prophylactic intervention. And that definition initially was based on just high levels of monoclonal protein like more than 3 grams, the IgA subtype of myeloma, the suppression of uninvolved immunoglobulins. Others have used bone marrow flow cytometry markers, cytogenetics. Those combinations of factors were available at the time the AQUILA trial was designed, and a select combination was used. Later on, we found that we could match almost all of that in a very simple risk stratification using just the percentage of bone marrow plasma cells, the level of the M-spike, and the free light chain ratio, all three of which are available to all patients with smoldering at the time of diagnosis. So you don't need any special testing. So more than 20% plasma cells, more than 20 for the light chain ratio, and more than 2 grams for the M-spike. If someone has any two of the three, that is high-risk smoldering multiple myeloma according to the IMWG, but that definition, of course, came in 2020 after the AQUILA trial completed accrual. Dr. Monty Pal: That's interesting because this sort of flips the traditional paradigm where biomarkers get more and more complex as time goes on. Am I right in saying this sort of simplifies things a little bit? It uses standard laboratory or clinical parameters to gauge this category? Dr. Vincent Rajkumar: Absolutely. People were using suppression of uninvolved immunoglobulins, and those levels are not standardized, often vary by race. Also, the other aspect was the abnormal plasma cells on flow cytometry. Again, labs define it differently. So this makes it much more simple. But the IMWG also did a separate exploratory cohort within that paper where we added cytogenetics and we added scoring systems to improve on this further. So it simplified it for regular clinical practice and for like trials. But if you have a patient in front of you, the IMWG paper also has more complex scoring systems where you can take more than 20; 21 is more than 20, so is 51. And so, you can use the actual numbers that a patient has, additional variables like cytogenetics, and get a more refined estimate of what is the true risk of progression. Dr. Monty Pal: That's really helpful. Now, you told us about the primary endpoints, you've helped us define high-risk smoldering myeloma. Can you give us a sense of the top-line results from AQUILA? Dr. Vincent Rajkumar: Yes, I think the most important one was the primary endpoint, time to multiple myeloma, was at 5 years, the progression-free survival was 63% in the daratumumab arm compared to 41% in the observation arm. So, you know, approximately 60% of patients in the observation arm had already progressed by 5 years. And that number was about 40% for the daratumumab arm. We also looked at time to starting myeloma therapy, which is clinically actually quite meaningful because, you know, myeloma therapy means patients get a quadruplet for induction, they get stem cell transplant, they get endless maintenance, they get ongoing therapy virtually for the entire duration. So, preventing the need for myeloma therapy is in and of itself, I think, a major endpoint. And that at 3 years, 40% of people in the observation arm required full myeloma therapy compared to only 20% in the daratumumab arm. So there's a significant reduction in the risk of developing active myeloma as well as the need for myeloma therapy by using a time-limited 3 years of daratumumab single agent. Dr. Monty Pal: Perfect summary of the results. And maybe, Saad, I'm going to bring you into the conversation now. How does this sort of influence your day-to-day practice for smoldering myeloma? Is this something that you've incorporated for that high-risk subset? Dr. Saad Usmani: Thank you, Monty, and I agree. I think that's a really nice summary from Vincent. This study is very important for several reasons. It's actually the third clinical trial that has demonstrated that patients who are in the high-risk smoldering myeloma category benefit from an early intervention that delays the progression to active myeloma or to end-organ damage. And so having a nuanced discussion with our patients in the clinic becomes very important. Having this discussion around as an option becomes very important. And like Vincent said, when we look at that high-risk smoldering myeloma patient population, someone who has 22, 23% plasma cells versus, you know, 45, 50, you know, it's going to be a different discussion each time. But I think it's a very important first step. And I think this sets up the stage for us to design clinical trials where we can ask other questions on what would be better than daratumumab alone in terms of delaying progression in these patients. The other thing that I do want to highlight, and Vincent touched upon this a little bit, that the treatment in this clinical trial was for a fixed duration of treatment. So it was not forever treatment. This is maybe something that Vincent, you can even comment on a little bit more because the question we get after having this discussion is, "Okay, what do we do with patients who are going to be progressing to active myeloma?" Whether we can utilize anti-CD38 therapies for those. So Vincent, I would love your take on this too. Dr. Vincent Rajkumar: Yeah, I think, you know, the main philosophical change for me was previously, the thing was 'don't treat', and now for high-risk smoldering multiple myeloma, the question is, is daratumumab the best treatment or can we do something better? And those trials are thankfully ongoing. One of them has already completed accrual, isatuximab-len-dex versus len-dex. And another one is ongoing in ECOG, almost close to finishing accrual. And in the future, we'll be trying to see if we can use early intervention to even cure and prevent progression altogether.  So we are in this phase where we have one approved regimen, one approved drug, and we are not sure whether we can improve on that. The question is, "is a myeloma-like therapy better than monotherapy" would be the next question, and then what would we do further beyond that? In this context, whenever we have patients like this, one of the questions that comes up, as Saad mentioned, is how does this affect newly diagnosed myeloma therapy if somebody has been treated for smoldering and things like that? How will they be considered for clinical trials? Would they be considered as relapse myeloma or still newly diagnosed myeloma? And those are important discussions for clinical trialists to keep in mind, but I think for clinical practice, your duty is to the patient in front of you. If they have high-risk smoldering myeloma and there's data that there's treatments that can delay progression significantly, delay the need for myeloma therapy significantly, that's the highest priority. We'll cross that bridge.   There are so few patients going on clinical trials right now that if such a patient were to later on progress and wants to enter in a newly diagnosed myeloma trial later, years later, we can figure that out later. I feel like the most important discussion is what to do for that patient today. I still prefer a clinical trial if one was available. If one was not available, I'd prefer early intervention, but have an informed discussion with the patient because some of them may wish to delay therapy still. Some of them may have very borderline numbers that you want to watch them closely. Some of them may be having other comorbidities that prevent need for therapy. Some of them maybe have had the smoldering for a long time and you already know it's stable. So a lot of factors go in, and I think it's not a one-size-fits-all. Dr. Monty Pal: This is a terrific discussion, and you know, it sort of segues into maybe a question around biology. And this is something I was going to get to a little bit later, but Saad, I'm glad you brought it up. I'll liken it to the only thing I know, which is kidney cancer. So, you know, in kidney cancer, we use checkpoint inhibitors as adjuvant therapy. And there's this question of whether or not it breeds some resistance in the localized setting to ultimately what the patient might potentially be exposed to in the metastatic setting. Tell me your thoughts on this, Vincent, then maybe Saad separately. If you treat a patient with daratumumab in this high-risk smoldering setting, could it theoretically sort of limit options in the refractory setting now that we have regimens like DRBD that are kind of being utilized, or daratumumab with teclistamab? Vincent, I'll throw that to you first. Dr. Vincent Rajkumar: This is a great question, and it's usually asked when we've done the lenalidomide trials actually. We try to put the question back. If that was your concern, how would you actually solve it? Is it really biology that's going to answer that? Or is it a randomized trial? So the experiment has been done three times now where early intervention has been given. And if there was some detriment because of that, that would be reflected in the overall survival. In all three trials, there's no such detriment seen. In the first lenalidomide-dex trial, there was an improvement in overall survival. In the AQUILA trial again, the confidence interval doesn't cross one, and patients had better long-term survival on AQUILA, but certainly not less. We've also examined PFS2 data, and that doesn't seem to be affected. So yes, there is a theoretical concern, and that concern cannot be allayed for new treatments which we have not even tried, like tec-dara, and whether that effect would be there or not. But so far, I don't see it. And I think the onus is on proof of that in order to prevent people from getting early therapy. Dr. Monty Pal: Yeah. Saad, your thoughts on that? And before you jump in, I'll mention, we're kind of taking the same approach in kidney cancer, we're trying to really do studies to see whether or not, you know, immunotherapy rechallenge in these contexts, you know, really lends any substantial benefit. So far, the results have been interesting. I don't think we have enough numbers as yet to capture the impact of adjuvant therapy as it translates to metastatic, but I see so many similarities between the scenarios that you're facing in myeloma and what we're facing in RCC. Saad, your thoughts? Dr. Saad Usmani: Thanks, Monty. I'll go back to something that Vincent alluded to a few minutes ago about the way that we risk-stratify patients within smoldering myeloma. Right now, we are relying more on a disease burden-based stratification looking at the percentage of plasma cells in the bone marrow, the monoclonal protein, as well as the involved light chain versus the uninvolved light chain ratio. However, there are efforts underway to actually incorporate genomics into that schema and try to refine that definition of high-risk smoldering. And there have been two papers that came out in the latter half of last year. In fact. Dr. Rajkumar and I are co-senior authors on one effort where we can identify genomic myeloma in patients in precursor conditions. One of the key things that came out of that effort was that within the high-risk smoldering myeloma category, about 90% of the patients are genomically myeloma. So this whole debate of whether we need to intervene for those patients, I think, you know, we have sufficient biologic evidence that yes, we need to intervene for those patients.  I think that the next real step, like Vincent stated, is how do we intervene in those patients? And those clinical trials kind of are ongoing. We will probably need to have more validation of those genomic models being incorporated, but that's what I see in the future. I wouldn't be concerned for the patients being seen today with that query about the disease biology evolving because if I'm seeing a patient today in March of the first quarter of 2026 and offering them monotherapy daratumumab in their high-risk smoldering situation for the next 3 years and then they progress to myeloma after another couple of years, we are talking about what would be the treatment options for them in 2031, 2032. So I think the field is moving so fast, we have a lot of novel therapies coming into that frontline setting rapidly, so our options at that time would be very different. So, you know, I just wanted to kind of set up the stage for saying, you know, our tools are getting better in delineating which patients will need that intervention. And then eventually, I think, you know, we'll have much better options for newly diagnosed myeloma patients at the time when they need it in the future. Dr. Monty Pal: Just absolutely brilliant, absolutely brilliant. I love that summary. I think that you're absolutely right in saying that, you know, you've got to think about what you're going to do for that patient sort of in the moment, what's going to optimize their outcome and agree that the landscape is evolving very rapidly.  I'd be remiss, Saad, if I didn't ask you about something that I've been following in terms of your career trajectory. You've developed quite a reputation for your leadership in trials looking at CAR T-cell therapies for myeloma. Can you give us a sense of where that stands in broad terms? Dr. Saad Usmani: Certainly, Monty. I think the CAR Ts have slowly made their way from late relapse to early relapse. And now we have clinical trials that have completed accrual in the frontline setting comparing them to standard-of-care treatment for both older myeloma patients or transplant-ineligible patients, as well as younger transplant-eligible patients where we're actually trying to replace transplants with BCMA-directed CAR T-cell therapies. The nuance there would be we want to equal or better the survival outcomes that we've accomplished without compromising on the safety side of things for patients. Those therapies are moving into earlier lines. And more excitingly, you know, that's just the first wave of CARs. The next wave of CAR technology is coming, and it's going to be in vivo CARs where we may not need lymphodepleting chemotherapy, we may not even need as stringent regulatory nuances that we do for cellular therapies today. So, you know, I think the field is moving rapidly, and it's going to be a very interesting landscape to see over the next 5 to 6 years. Dr. Monty Pal: Yeah, you know, it's so interesting. I know in the solid tumor space, we're trying to replicate the success that you've had with CAR T and bispecifics, and I do see some light at the end of the tunnel. I'm seeing some really promising agents being developed, but clearly, we have so much to learn from our colleagues in hematology. Well, I have to tell you, this has just been a phenomenal conversation. Vincent, congratulations on your leadership of the AQUILA trial. Clearly, a big paradigm shift in the field. Saad, thank you for offering your expert insights and really giving us also a glimpse at the future of myeloma. Really appreciate having you both on the podcast today. Dr. Vincent Rajkumar: Thank you, Monty. Dr. Saad Usmani: Thank you so much. Dr. Monty Pal: And thank you so much to our listeners for your time today. Finally, if you value the insights that you hear from the ASCO Daily News Podcast, please take a moment to rate, review, and subscribe wherever you get your podcasts. Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Follow today's speakers:      Dr. Monty Pal    @montypal   Dr. Vincent Rajkumar @VincentRK Dr. Saad Z. Usmani @szusmani   Follow ASCO on social media:           ASCO on X     ASCO on Bluesky          ASCO on Facebook           ASCO on LinkedIn           Disclosures:        Dr. Monty Pal:      Speakers' Bureau: MJH Life Sciences, IntrisiQ, Peerview      Research Funding (Inst.): Exelixis, Merck, Osel, Genentech, Crispr Therapeutics, Adicet Bio, ArsenalBio, Xencor, Miyarsian Pharmaceutical    Travel, Accommodations, Expenses: Crispr Therapeutics, Ipsen, Exelixis    Dr. Vincent Rajkumar: Honoraria: Research to Practice, Medscape Patents, Royalties, Other Intellectual Property: Authorship Royalties from Up To Date Dr. Saad Usmani: Consulting or Advisory Role: Janssen Oncology, GlaxoSmithKline, Abbvie, Bristol-Myers Squibb/Celgene, Regeneron, AstraZeneca, Sanofi Research Funding: Janssen Oncology, Bristol-Myers Squibb, K36 Therapeutics, Abbvie, Regeneron  

“Getting Rid of Stupid Stuff,” or GROSS, is a healthcare improvement approach first introduced by Dr. Melinda Ashton at Hawaii Pacific Health in a 2018 New England Journal of Medicine article. Originally focused on empowering clinicians to identify and eliminate unnecessary EHR tasks to reduce administrative burden and improve joy in practice, GROSS has since gained momentum as a broader movement to improve care team safety and wellbeing.At UNC Health, Jennifer Bissram, MSIS, MBA, and Emily Kertcher, PhD, OTR/L, are members of a team focused on ease of practice for clinicians. They took the idea of GROSS, which is often applied in a single unit or department, and scaled it across the organization. They also expanded it beyond the EHR and technical issues to allow clinicians to identify pebbles, rocks and boulders (small irritants to major obstacles) anywhere in their workflows or work environments that cause distraction, create inefficiencies or reduce clinical effectiveness.In this episode of Caring Greatly, Emily and Jennifer talk about the inspiration behind their team's efforts to scale GROSS across the health system, as well asthe steps required to make the scaled-up program work. They also discuss why it's necessary to focus on building trust and relationships to drive program success well beyond operational excellence.Jennifer Bissram and Emily Kertcher are leaders who care greatly.The views and opinions expressed in this podcast are those of the speakers and do not necessarily reflect the views or positions of Stryker. The provided resources may contain links to external websites or third-party content. We do not endorse, control or assume any responsibility for the accuracy, relevance, legality or quality of the information found on these external sites. 

LISTENER DISCRETION IS ADVISED! ADULT THEMES. LANGUAGE. References: Smith, J. E., Cardigan, R., Sanderson, E., Silsby, L., Rourke, C., Barnard, E. B. G., Basham, P., Antonacci, G., Charlewood, R., Dallas, N., Davies, J., Goodwin, E., Hawton, A., Hudson, C., Lucas, J., Keen, K., Lyon, R. M., & Nolan, B. (2026). Prehospital whole blood in traumatic hemorrhage — a randomized controlled trial. The New England Journal of Medicine. https://doi.org/10.1056/nejmoa2516043 Dr. Antevy's Discussion Thread on LinkedIN: https://www.linkedin.com/posts/peter-antevy-md-faems-a9b11726_the-swift-trial-just-published-in-nejm-group-activity-7440071242285625344-1HZP?utm_source=share&utm_medium=member_desktop&rcm=ACoAAF6Ls6YBtNzvNfxmvsyVNOMy6QNK6Bc_pj4

Registered dietitian nutritionist Leyla Muedin discusses a New England Journal of Medicine paper (July 2024, cited via Holistic Primary Care) warning about drug-induced magnesium depletion, especially from diuretics, proton pump inhibitors (e.g., Nexium, Prilosec), and certain antibiotics. She notes magnesium is often not routinely measured despite links between deficiency and cardiovascular, metabolic, and neurological problems, including arrhythmias (AFib, long QT, torsades), endothelial dysfunction, and longer ICU stays. Prevalence estimates range from 7–11% (up to 20%) in hospitalized patients and 2–4% among outpatients, with higher rates among long-term PPI and diuretic users. She reviews symptoms and causes, explains limits of serum magnesium testing, highlights associations with diabetes, alcohol use, low potassium and calcium, and outlines evaluation options and oral repletion approaches, favoring better-absorbed forms like magnesium glycinate over oxide due to diarrhea risk.

Dr. Jessica Ailani and Dr. Richard Lipton discuss future advancements in headache medicine.  Show transcript:  Dr. Jessica Ailani:  Hello and welcome to the Neurology Minute. I'm Jessica Ilani from Georgetown Headache Center in Washington, DC. In the neurology podcast with Richard Lipton from the Montefiore Headache Center, we'll be discussing the latest clinical trials in headache medicine, where our field is going, where it's been, and you'll get lots of great advice on thinking through a clinical trial, what the advances have been, where their pitfalls have been, and really how to think of both positive and negative trials. So Richard, what are you most looking forward to when it comes to new treatment targets within headache? Dr. Richard Lipton:  First, let me say that I'm sure most know about the eight CGRP targeted treatments have been approved for migraine, both as acute and preventive treatments. And it's very clear that those treatments have had incredible benefits for our patients and have really improved headache practice. There's another neuropeptide target also targeted by monoclonal antibodies called PACAP or pituitary adenolyte cyclase activating polypeptide. This peptide is also a potent vasodilator involved in pain signaling like CGRP. While CGRP is primarily linked to sensory pathways, PACAP is found in parasympathetic ganglia. And for that reason, it may have a special role in headaches associated with cranial autonomic symptoms. And that includes both migraine, which commonly has cranial autonomic symptoms and also cluster headache. There's a recent randomized trial published in New England Journal showing that a monoclonal antibody targeting PACAP reduced monthly migraine day frequency and was beneficial in people who failed to respond to CGRP inhibitors. So that's at least one area that I'm hopeful about. Dr. Jessica Ailani:  So Richard, thank you so much. I hope you have a few moments and listen to our full podcast that'll tell you a lot more about the future of headache medicine.