Podcasts about new england journal

Dr. John Ney talks with Dr. Daniele Piomelli about the evolving role of cannabis in neurology, exploring its history, current research, and potential future applications. Read the related article in The New England Journal of Medicine.  Disclosures can be found at Neurology.org. 

Acute Appendicitis explained, including classic and atypical appendicitis symptoms, the pathophysiology of appendicitis, as well as causes, diagnosis (including scores like the Alvarado score) and treatment.PDFs available here: https://rhesusmedicine.com/products/general-surgeryConsider subscribing on YouTube (if you found any of the info useful!): https://www.youtube.com/channel/UCRks8wB6vgz0E7buP0L_5RQ?sub_confirmation=1Patreon: https://www.patreon.com/rhesusmedicineBuy Us A Coffee!: https://www.buymeacoffee.com/rhesusmedicineTimestamps:0:00 What is Appendicitis?0:32 Appendicitis Pathophysiology2:00 Causes of Appendicitis2:59 Appendicitis Symptoms & Signs 5:29 Appendicitis Diagnosis8:44 Appendicitis Treatment / Appendectomy LINK TO SOCIAL MEDIA: https://www.instagram.com/rhesusmedicine/Please remember this podcast and all content from Rhesus Medicine is meant for educational purposes only and should not be used as a guide to diagnose or to treat. Please consult a healthcare professional for medical advice. ReferencesBMJ Best Practice (2026) Acute appendicitis. Available at: https://bestpractice.bmj.com/topics/en-gb/3000094Di Saverio, S., Podda, M., De Simone, B., et al. (2020) 'Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines', World Journal of Emergency Surgery, 15(1), p.27. Available at: https://wjes.biomedcentral.com/articles/10.1186/s13017-020-00306-3Moris, D., Paulson, E.K. and Pappas, T.N. (2021) 'Diagnosis and management of acute appendicitis in adults: a review', JAMA, 326(22), pp.2299-2311. Available at: http://www.ncbi.nlm.nih.gov/pubmed/34905026MSD Manual (2024) Appendicitis. Available at: https://www.msdmanuals.com/professional/gastrointestinal-disorders/acute-abdomen-and-surgical-gastroenterology/appendicitisStatPearls Publishing (2024) Appendicitis. Available at: https://www.ncbi.nlm.nih.gov/books/NBK493193/Bhangu, A., Søreide, K., Di Saverio, S., Assarsson, J.H. and Drake, F.T. (2015) 'Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management', The Lancet, 386(10000), pp.1278-1287. Available at: https://pubmed.ncbi.nlm.nih.gov/26460662Flum, D.R., Davidson, G.H., Monsell, S.E., et al. (2020) 'A randomized trial comparing antibiotics with appendectomy for appendicitis', New England Journal of Medicine, 383(20), pp.1907-1919. Available at: https://pubmed.ncbi.nlm.nih.gov/33017106Addiss, D.G., Shaffer, N., Fowler, B.S. and Tauxe, R.V. (1990) 'The epidemiology of appendicitis and appendectomy in the United States', American Journal of Epidemiology, 132(5), pp.910-925. Available at: https://pubmed.ncbi.nlm.nih.gov/2239906

Michael Bretthauer discusses the results of a large randomized trial on colonoscopy surveillance after removal of advanced adenomas, along with a separate study on sessile serrated lesions. Both papers are published today in the New England Journal of Medicine.

Save 20% on all Nuzest Products WORLDWIDE with the code MIKKIPEDIA at www.nuzest.co.nz, www.nuzest.com.au or www.nuzest.comCurranz Supplement: Use code MIKKIPEDIA to get 20% off your first order - go to www.curranz.co.nz  or www.curranz.co.uk to order yours NZ listeners - save 10% off Calocurb by using the code Mikkipedia10 at www.calocurb.co.nzEpisode SummaryThis week Mikki talks with Dr Robert Kushner, an obesity medicine physician, educator and researcher with over four decades in the field. He is Professor Emeritus at Northwestern University Feinberg School of Medicine, a founder and the first chair of the American Board of Obesity Medicine, and a past president of The Obesity Society. He was also the corresponding author on the STEP 1 semaglutide trial published in the New England Journal of Medicine in 2021, and sat on the steering committee for SELECT — so he has watched this field from the inside, before and after GLP-1 receptor agonists arrived.The conversation traces what clinicians actually understood about obesity in the 1980s and 90s, Bob's own leptin trial and why it did not deliver, and how reframing obesity as a biological disease led researchers to the gut hormones. From there it moves into the practical territory: how the clinical conversation has shifted from counting calories to diet quality, which side effects are real and which are social media noise, what happens to muscle mass and physical function, how dose escalation should actually work, why hunger returning is not the same as weight regain, and what the evidence says about stopping. Bob is careful throughout to separate what the trials show from what is still unknown, which makes this a useful listen whether you work with clients on these medications or are weighing them up yourself.Key TopicsWhat clinicians believed about obesity three decades ago — excess body fat was known to cause system-wide harm, but the mechanisms, and appetite dysregulation in particular, were not understood, and weight regain after lifestyle intervention was already expectedBob's own leptin trial in the 1990s, published in JAMA, and why leptin turned out to be a useful biological signal rather than a treatment — it defends against weight loss but was never built to stop overeatingThe STEP 1 result and why it changed the field: 15% average weight loss at 68 weeks against a previous benchmark of 6–9%, with a third of participants losing 20%How the clinical conversation shifted from quantity to quality — when the medication does the heavy lifting, the questions become whether someone is eating enough, staying hydrated and getting sufficient protein, rather than how to control cravingsWhich side effects are real and which are overstated: GI effects are the genuine shared profile and can be substantially reduced through diet during dose escalation, while hair thinning and facial fat loss follow large weight loss by any routeMuscle mass, sarcopenia and the groups who need watching, alongside the consistent finding that physical function and quality of life improve in trials — possibly because fatty infiltration of muscle resolvesDose escalation in the real world versus the trial protocol, and why there are still no pretreatment predictors of who will respondWhy appetite drifting back is normal and not a failure — Bob's framing of restored appetite regulation at a lower body weight, with "the amplitude smaller than it was before"Benefits beyond weight loss, including SELECT's 20% reduction in cardiovascular events on top of standard care, plus sleep apnoea, knee osteoarthritis, MASH and psoriasis — driven both by weight loss and by independent mechanismsCost and access, microdosing, extending the interval between injections, and where bariatric surgery still fitsChapters00:00 Introduction05:13 Obesity medicine before GLP-1s13:34 Gut hormones and the STEP 1 result21:00 From calorie counting to diet quality25:00 Side effects and social media myths29:54 Muscle mass, function and exercise35:08 Dose escalation and who responds40:30 When hunger comes back46:37 Stopping the drug, cost and access52:24 Benefits beyond weight loss57:37 Long-term safety and microdosing1:01:10 Coming off, surgery and what's nextGuest / ResourcesDr Robert KushnerProfessor Emeritus, Northwestern University Feinberg School of MedicineFounder and first chair of the American Board of Obesity MedicinePast president of The Obesity SocietyAuthor or editor of 15 books, 56 book chapters and 230 original and review articlesWebsite: drrobertkushner.comBooksSix Factors to Fit: Weight Loss that Works for You! — written for the patientPatient-Centered Weight Management: The Six Factor Professional Program and Toolkit — written for the clinicianTrials and studies discussedSTEP 1 — once-weekly subcutaneous semaglutide, New England Journal of Medicine, 2021. 1,961 adults, 68 weeks, ~15% average weight loss. Bob was the corresponding authorSTEP 1 extension — the off-treatment follow-up showing weight regain after stoppingSELECT — semaglutide versus placebo in 17,000 people with obesity or overweight and pre-existing cardiovascular disease but no diabetes, over nearly four years. A 20% reduction in second heart attack, stroke or cardiovascular death, on top of standard care. Bob sat on the steering committeeSURMOUNT-1 extension — participants with pre-diabetes maintained on treatment for three years, with weight remaining stableLook AHEAD — an intensive behavioural therapy trial in diabetes; of those who lost 10% of body weight, around 40% maintained it for about four years without medicationKushner's leptin trial (1990s) — placebo versus leptin injections, published in JAMAA tirzepatide dose-reduction study — 15mg reduced to 5mg, with partial weight regainA randomised microdosing study in people with diabetes — standard monthly dose escalation versus gradual weekly escalation to the same final dose, showing better tolerability and fewer dropouts. Bob refers to this study but does not name it, so it is referred-to-but-not-identifiedResearchers mentionedAndres Acosta, Mayo Clinic — phenotype and biomarker work on predicting treatment responseOrganisationsNorthwestern University Feinberg School of MedicineAmerican Board of Obesity MedicineThe Obesity SocietyObesity Action CoalitionNovo Nordisk — the sponsor of STEP 1Mayo ClinicMedications and hormones discussed GLP-1 receptor agonists; semaglutide; liraglutide; tirzepatide; phentermine; topiramate; naltrexone; bupropion. Gut hormones: GLP-1, GIP, glucagon, amylin. Also leptin, insulin, statins, beta blockers, testosterone and oestrogen.Terms that come up Appetite dysregulation; food noise; leptin resistance; medu...

Contributor: Travis Barlock, MD Educational Pearls: What is pulmonary edema?  Pulmonary edema is the accumulation of fluid initially in the interstitium of the lungs, that when severe enough can also accumulate in the alveolar air sacs. It develops when the rate of fluid filtration through the pulmonary vasculature out-paces the lymphatics ability to drain the fluid.  There are 2 theories for what causes pulmonary edema in the setting of naloxone administration: catecholamine surge vs negative pressure/barotrauma Catecholamine Surge : Naloxone administration precipitates an acute opioid withdrawal in which epinephrine and norepinephrine surge causing marked vasoconstriction on both the heart and the lungs   Negative Pressure/Barotrauma: This mechanism is not directly naloxone related but may be confounded by opioid effects. High dose synthetic opioids can induce sustained laryngospasm that is not mu-opioid mediated (thus not easily reversed by naloxone). With rapid awakening, respiratory muscles induce a negative pressure in the thoracic cavity against a closed glottis. This results in an alveolar barotrauma and a transudative pulmonary edema. What is the treatment for pulmonary edema secondary to opioid overdose reversal? Positive pressure ventilation is the mainstay treatment (CPAP/BiPAP) with oxygen supplementation. Importantly, diuretics are not recommended. The patient is not fluid overloaded like in the case of other pulmonary edemas, and diuresing the patient can worsen kidney injury which is already at an increased risk in opioid overdoses (rhabdomyolysis in particular).     References: Saari TI, Strang J, Dale O. Clinical Pharmacokinetics and Pharmacodynamics of Naloxone. Clin Pharmacokinet. 2024;63(4):397-422. doi:10.1007/s40262-024-01355-6 DailyMed - NALOXONE HYDROCHLORIDE injection, solution. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=201fdedf-1736-4e52-9d7d-de14292547fd Boyer EW. Management of Opioid Analgesic Overdose. New England Journal of Medicine. 2012;367(2):146-155. doi:10.1056/NEJMra1202561 Dezfulian C, Orkin AM, Maron BA, et al. Opioid-Associated Out-of-Hospital Cardiac Arrest: Distinctive Clinical Features and Implications for Health Care and Public Responses: A Scientific Statement From the American Heart Association. Circulation. 2021;143(16):e836-e870. doi:10.1161/CIR.0000000000000958 Kienbaum P, Thurauf N, Michel M, Scherbaum N, Gastpar M, Peters J. Profound Increase in Epinephrine Concentration in Plasma and Cardiovascular Stimulation after [micro sign]-Opioid Receptor Blockade in Opioid-addicted Patients during Barbiturate-induced Anesthesia for Acute Detoxification Anesthesiology. 1998;88(5):1154-1161. doi:10.1097/00000542-199805000-00004 Summarized by Dan Orbidan, OMS3 | Edited by Dan Orbidan & Ahmed Abdel-Hafiz, NREMT-P   Donate: https://emergencymedicalminute.org/donate/   Join our mailing list: http://eepurl.com/c9ouHf

How do you choose between thrombolysis, mechanical thrombectomy, or open surgery for acute limb ischemia, and what options remain when there's no vessel to open? On this episode of the BackTable Podcast, host Dr. Chris Beck is joined by vascular surgeon Dr. Anahita Dua (Massachusetts General Hospital) and interventional radiologist Dr. Ripal Gandhi (Miami Cardiac and Vascular Institute) to explore treatment strategies across the full spectrum of limb ischemia. They discuss presentation and referral patterns, the imaging and exam findings that start the clock, single-session mechanical thrombectomy, the evolving role of lysis, procedural endpoints, and deep vein arterialization for chronic limb-threatening ischemia. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported byStryker Peripheral Vascularhttps://www.stryker.com/us/en/peripheral-vascular.html --- Timestamps 00:00 - Introduction02:27 - Presentation, Referral Patterns, and Imaging06:07 - Acute Limb Ischemia: Treatment Algorithm 12:16 - Thrombectomy Device Selection16:09 - Thrombolysis and Applications Beyond Lower Extremity18:46 - Procedural Endpoints, Closure, and Case Selection24:43 - Deep Vein Arterialization: Patient Selection and Planning31:25 - DVA Technique: Imaging, Anesthesia, and Access34:58 - Step-by-Step DVA Approach 41:56 - Surveillance and Managing Expectations45:59 - Wound Care and Amputation Decisions49:40 - Future Directions in PAD52:43 - Closing Remarks --- More about this episode The conversation moves from acute interventions for the cold leg, where mechanical thrombectomy has become first-line and lysis is held in reserve, to the stepwise management of no-option chronic cases, including pedal access, valve disruption, and inflow for deep vein arterialization. Drs. Dua and Gandhi share practical insights on device selection, preventing distal embolization, and when to consider open embolectomy or hybrid approaches. The episode closes with a discussion of post-procedure surveillance, wound care, and the need for better measures of perfusion to improve limb salvage and patient outcomes. --- Resources Rutherford classification of acute and chronic limb ischemia. https://doi.org/10.1016/S0741-5214(97)70045-4 Global vascular guidelines on the management of chronic limb-threatening ischemia. Conte, Bradbury, Kolh et al., Journal of Vascular Surgery, 2019. https://doi.org/10.1016/j.jvs.2019.02.016 PROMISE II. Transcatheter Arterialization of Deep Veins in Chronic Limb-Threatening Ischemia. Shishehbor et al., New England Journal of Medicine, 2023.https://doi.org/10.1056/NEJMoa2212754 BackTable VI Episode 618, How to Manage Advanced DVA Cases: Techniques and Tips, with Dr. Kumar Madassery and Dr. Sabeen Dhand. https://www.backtable.com/shows/vi/podcasts/618/how-to-manage-advanced-dva-cases-techniques-tips --- BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists. 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

Send us Fan MailFor decades, antiplatelet therapy has been central to secondary prevention following noncardioembolic ischemic stroke. Could factor XIa inhibition offer another approach?Dr. Mike Sharma, principal investigator and first author of OCEANIC-STROKE, joins Dr. Maha Othman and Dr. Jameel Abdulrehman to discuss the phase 3 trial of asundexian for secondary stroke prevention.OCEANIC-STROKE randomized 12,327 patients with noncardioembolic ischemic stroke or high-risk TIA to asundexian or placebo in addition to antiplatelet therapy. Ischemic stroke occurred in 6.2% of patients receiving asundexian versus 8.4% receiving placebo, while rates of ISTH major bleeding were similar.The discussion explores why factor XIa is an attractive therapeutic target, the clinical implications and limitations of the results, patient selection, and why factor XIa inhibition may challenge conventional thinking about antithrombotic therapy.This episode was made possible through financial support from Bayer Inc. Thrombosis Canada maintained full editorial independence, and Bayer had no involvement in the selection of the guest, development of the questions, conduct of the interview, or review or approval of the final content.Sharma M, Dong Q, Hirano T, Kasner SE, Saver JL, Masjuan J, Demchuk AM, Cordonnier C, Bereczki D, Tsivgoulis G, Veltkamp R. Asundexian for secondary stroke prevention. New England Journal of Medicine. 2026 Apr 16;394(15):1467-79.Support 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

Maps Abs and Butt 40% off, a free Muscle Mommy or Muscle Mommy 15 program, a build your butt diet guide, and a supplement guide. Find everything at htpps://mapsabsandbutt.com with code Launch. You cannot shrink yourself into a better body. You have to build it first, then reveal it. That's the whole thesis of this Mind Pump Show episode, and the guys spend every minute proving it with real client stories, hard science, and the kind of blunt coaching most trainers are too scared to deliver. The Guys break down exactly why starting with a cut is the most common, most damaging mistake people make, whether they want a rounder butt, visible abs, or just a leaner physique overall. From the client who tried to bulk on 50 calories above maintenance, to the trainer competition where everyone cut so aggressively they lost muscle instead of fat, to the New England Journal of Medicine data showing a 10% bodyweight loss tanks your metabolism by hundreds of calories a day: the case for building first is airtight. Sponsors: Seed — seed.com/mindpump (code: 25MINDPUMP) 1:07 Opening thesis: build first, then reveal 2:19 Why bulking is so hard to sell, especially to women 2:46 Client story: the 50-calorie surplus that went nowhere 4:47 Personal bulk disasters: dirty bulking and zero muscle gained 8:13 The cut-too-hard trap: body fat percentage going UP 10:35 The real mechanism of muscle loss on aggressive cuts 11:32 Build before you cut: the correct order explained 13:30 Busting the bulky myth: what strength training actually does to a woman's body 24:29 The science case for building first: two key studies 28:00 Best exercises for glutes and abs: progressive overload over the burn 30:09 What the program structure actually looks like 35:59 MAPS Abs and Butt launch details and challenge  

Welcome to the latest Midlife Minute. Today, I'm answering listeners' questions about cardiovascular risk, focusing on Lp(a), LDL, statins, and the changes women experience after menopause. Stay tuned for more! IN THIS EPISODE, YOU WILL LEARN: Why women should have their Lp(a) checked both before and after menopause How Lp(a) works as a risk enhancer, and how cardiovascular risk becomes more significant when elevated Lp(a) occurs alongside high LDL Why family history is particularly helpful for women with a 10-year calculated cardiovascular risk that looks reassuringly low I review the current guidelines for primary prevention Why, even though research has shown reductions in major cardiac events with GLP-1s, GLP-1s do not replace statins for lowering LDL  What a CAC score can reveal about coronary artery calcification, and what it cannot detect How AI-assisted CT angiography (such as Clearly) can map, quantify, and characterize plaque throughout the coronary branches Connect with Cynthia Thurlow   Follow on X, Instagram & LinkedIn Check out Cynthia's website. Submit your questions to support@cynthiathurlow.com  Join other like-minded women in a supportive, nurturing community: The Midlife Pause/Cynthia Thurlow.  Purchase Cynthia's book, The Menopause Gut. Cynthia's Intermittent Fasting Transformation Book The Midlife Pause Supplement Line References: 1.  ​Lipoprotein(a) and Women's Cardiovascular Health: A Review. JACC. Advances. 2026. Michos ED, Saucier S, Mehran R, Koschinsky ML.Recent 2.  ​Sex Differences of Lipoprotein(a) Levels and Associated Risk of Morbidity and Mortality by Age: The Copenhagen General Population Study. Atherosclerosis. 2022. Simony SB, Mortensen MB, Langsted A, et al. 3. Managing Atherosclerotic Cardiovascular Risk in Young Adults: JACC State-of-the-Art Review. Journal of the American College of Cardiology. 2022. Stone NJ, Smith SC, Orringer CE, et al.Review 4. Thirty-Year Risk of Cardiovascular Disease Among Healthy Women According to Clinical Thresholds of Lipoprotein(a). JAMA Cardiology. 2026. Nordestgaard AT, Chasman DI, Moorthy V, et al.RecentObservational 5.  ​Lipoprotein(a).The Journal of the American Medical Association. 2025. Mora S, Kronenberg  6. Clinical Practice Guideline on Lipid Management for Cardiovascular Disease Risk Reduction. Department of Veterans Affairs (2026). 2026. Paul Heidenreich, Lance Spacek, Neil Gregor, et al. Guideline 7. Lipoprotein(a) and Family History Predict Cardiovascular Disease Risk. Journal of the American College of Cardiology. 2020. Mehta A, Virani SS, Ayers CR, et al.Observational 8. 2010 ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology. 2010. Greenland P, Alpert JS, Beller GA, et al.Guideline 9. Prevalence and Prognostic Implications of Coronary Artery Calcification in Low-Risk Women. The Journal of the American Medical Association. 2016. Kavousi M, Desai CS, Ayers C, et al.SR 10. ​Coronary Artery Calcium Scores and Risk for Cardiovascular Events in Women Classified as “Low Risk” Based on Framingham Risk Score: The Multi-Ethnic Study of Atherosclerosis (MESA). Archives of Internal Medicine. 2007. Lakoski SG, Greenland P, Wong ND, et al.Observational 11. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology. 2019. Arnett DK, Blumenthal RS, Albert MA, et al.Guideline 12. HOPE for Rational Statin Allocation for Primary Prevention: A Coronary Artery Calcium Picture Is Worth 1000 Words. Mayo Clinic Proceedings. 2020. Orringer CE, Maki KC.Review 13. Summary of Updated Recommendations for Primary Prevention of Cardiovascular Disease in Women: JACC State-of-the-Art Review. Journal of the American College of Cardiology. 2020. Cho L, Davis M, Elgendy I, et al.Review 14. Health Maintenance in Postmenopausal Women. American Family Physician. 2025. Plesa M, Wong A, Katsaggelos E.Guideline 15.  ​Semaglutide and Cardiovascular Outcomes by Baseline HbA1c and Change in HbA1c in People With Overweight or Obesity but Without Diabetes in SELECT. Diabetes Care. 2024. Lingvay I, Deanfield J, Kahn SE, et al.RCT 16.  ​Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes. The New England Journal of Medicine. 2023. Lincoff AM, Brown-Frandsen K, Colhoun HM, et al.RCT 17. Long-Term Weight Loss Effects of Semaglutide in Obesity Without Diabetes in the SELECT Trial. Nature Medicine. 2024. Ryan DH, Lingvay I, Deanfield J, et al.RCT 18. Interventions for the Prevention and Management of Cardiometabolic Multiple Long-Term Conditions. Lancet. 2026. Valabhji J, Hope D, Sayed NE, et al.RecentReview 19. Glucagon‐Like Peptide‐1 Receptor Agonists and Major Adverse Cardiovascular Events in Patients With and Without Diabetes: A Meta‐Analysis of Randomized‐Controlled Trials. Clinical Cardiology. 2024. Hosseinpour A, Sood A, Kamalpour J, et al.SR 20. ​FDA Orange Book. FDA Orange Book. 2026. 21. 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes-2026. Diabetes Care. 2026. American Diabetes Association Professional Practice Committee for Diabetes*.RecentGuideline 22. Premature Coronary Artery Disease in Women: Sex-Specific Risk Factors, Pathogenetic Mechanisms and Clinical Implications. Annals of Medicine. 2026. Li F, Hong D, Yang M, et al.RecentReview 23. Cardiovascular Disease Risk Factors in Women: The Impact of Race and Ethnicity: A Scientific Statement From the American Heart Association. Circulation. 2023. Mehta LS, Velarde GP, Lewey J, et al.Guideline 24. Preventing CVD in Women: Common Questions and Answers. American Family Physician. 2023. Westfall E, Viere AB, Genewick JE.Review 25. Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention: A Scientific Statement From the American Heart Association. Circulation. 2020. El Khoudary SR, Aggarwal B, Beckie TM, et al.Guideline

This episode is sponsored by BONESUPPORT™, maker of CERAMENT® G with Gentamicin – the one and only FDA authorized, antibiotic-eluting bone void filler. For more information, visit https://www.bonesupport.com/en-us/products/cerament-g/  Paul Matuszewski, MD, from University of Kentucky is joined by Chris Cosgrove, MD and Peter Everson, MD to discuss how they're using new technology and evidence to best care for their patients in today's cost-conscious landscape.  Over the course of forty minutes, they discuss their move towards single-stage surgeries, shortened antibiotic treatment regimens, and how they're even treating some of their patients outpatient with CERAMENT G. They also discuss the new CMS ruling for FY2027 and what it means for CERAMENT G.      Interested in staying in touch? Follow BONESUPPORT on LinkedIn https://www.linkedin.com/company/bonesupport-ab/   References discussed in this episode:  · Conway J, et al. 'Antibiotic Cement-Coated Rods.' Bone Joint J. vol. 96-B, no. 10, 2014, pp. 1349-1354. doi:10.1302/0301-620X.96B10.33799.  · McNally et al. 'Single-stage treatment of chronic osteomyelitis with a new absorbable, gentamicin-loaded, calcium sulphate/hydroxyapatite biocomposite: a prospective series of 100 cases.' Bone Joint J. 2016;98-B(9):1289-96  · Godina M. Early microsurgical reconstruction of complex trauma of the extremities. Plast Reconstr Surg. 1986;78(3):285-292. doi:10.1097/00006534-198609000-00001  · McNally et al. 'Mid- to long-term results of single-stage surgery for patients with chronic osteomyelitis using a bioabsorbable gentamicin-loaded ceramic carrier.' Bone Joint J. 2022;104-B(9):1095-1100.  · Ferguson J et al., 'A Comparison of Clinical and Radiological Outcomes between Two Different Biodegradable Local Antibiotic Carriers Used in the Single- ­stage Surgical Management of Long Bone Osteomyelitis', Bone & Joint Research, 2023; 12(7): 412–22  · Henry et al., 'Long-Term Follow-Up of Open Gustilo-Anderson IIIB Fractures Treated With an Adjuvant Local Antibiotic Hydroxyapatite Bio-Composite', Cureus. 2023; 15(5).   · Li et al. 'Oral versus Intravenous Antibiotics for Bone and Joint Infection.' The New England Journal of Medicine, 2019; 380:425-436  · Major Extremity Trauma Research Consortium (METRC).  'Oral vs intravenous antibiotics for fracture-related infections: the POvIV randomized clinical trial.'  JAMA Surg. 2025;160(3):276-284.  Information discussed regarding CMS:   · Centers for Medicare & Medicaid Services (US). Medicare program; hospital inpatient prospective payment systems for acute care hospitals (IPPS) and the long-term care hospital prospective payment system and policy changes and fiscal year (FY) 2027 rates; requirements for quality programs; other policy changes; and adoption of updated versions of certain health information technology standards. Final rule (CMS-1849-F) [Internet]. Fed Regist. 2026 Aug 4 [cited 2026 Aug 20]. Available from: https://www.federalregister.gov/documents/2026/08/04/2026-15833/medicare-program-hospital-inpatient…. Also available from: https://www.govinfo.gov/content/pkg/FR-2026-08-04/pdf/2026-15833.pdf

Dr. Andrew Holman is a rheumatologist and the CEO of Seattle-based Inmedix, which recently received FDA clearance for the first cloud-based heart rate variability (HRV) diagnostic platform. Dr. Holman shares how a “detective” mindset led him from early interests in orthopedics and cardiology into rheumatology, fibromyalgia research, and ultimately entrepreneurship. He explains how chronic stress, the autonomic nervous system, and conditions like sleep apnea and restless leg syndrome can influence cardiovascular risk and autoimmune disease outcomes, and why measuring stress biology with medical-grade precision matters. Dr. Holman also offers hard-earned advice for physician-innovators, reflects on pivotal study results, and shares what he hopes to be remembered for: never dismissing patients in distress.  Guest links: https://www.inmedix.com | https://www.linkedin.com/company/inmedix-inc Charity supported: Save the Children Interested in being a guest on the show or have feedback to share? Email us at theleadingdifference@velentium.com.  PRODUCTION CREDITS Host & Editor: Lindsey Dinneen Producer: Velentium Medical   EPISODE TRANSCRIPT Episode 088 - Andrew Holman [00:00:00] Lindsey Dinneen: Hi, I'm Lindsey and I'm talking with MedTech industry leaders on how they change lives for a better world. [00:00:09] Diane Bouis: The inventions and technologies are fascinating and so are the people who work with them. [00:00:15] Frank Jaskulke: There was a period of time where I realized, fundamentally, my job was to go hang out with really smart people that are saving lives and then do work that would help them save more lives. [00:00:28] Diane Bouis: I got into the business to save lives and it is incredibly motivating to work with people who are in that same business, saving or improving lives. [00:00:38] Duane Mancini: What better industry than where I get to wake up every day and just save people's lives. [00:00:42] Lindsey Dinneen: These are extraordinary people doing extraordinary work, and this is The Leading Difference. Hello, and welcome back to another episode of The Leading Difference podcast. I'm your host, Lindsey, and today I'm delighted to be welcoming as my guest Dr. Andrew Holman. Dr. Holman is a rheumatologist and the CEO of Inmedix, a Seattle-based medical diagnostics company that recently received FDA clearance for the first cloud-based heart rate variability diagnostic platform. He has 25 years of clinical experience with 16 peer-reviewed papers and clinical trials demonstrating that measuring stress biology with medical grade precision can improve success rates in autoimmune diseases. All right. Andrew, welcome to the show. I'm so glad you're here today. [00:01:30] Andrew Holman: Yes, happy to be here. Thank you for inviting me. [00:01:33] Lindsey Dinneen: Course, of course. Well, I would love, if you wouldn't mind starting out telling us a little bit about who you are, what your background is, and what led you to medtech. [00:01:44] Andrew Holman: Sure. Well, I'm a, a guy from Seattle, Washington. Grew up here, but trained everywhere else, became a rheumatologist. We study autoimmune diseases, lupus, rheumatoid arthritis. I also was very interested in fibromyalgia and pain. We're the immunologists of medicine. So, I started my practice, golly, a while ago. 1992, I finished my prac- my training, and I was the main rheumatologist at a large suburban hospital at the southern end of Seattle. So hometown, circle back to the hometown. I went into rheumatology because you have many choices when you do internal medicine. You can go be a specialist in many things. But I like the puzzles. The immunology has grown and it's a, it's a particularly sort of detective-oriented specialty. So, I didn't set out to be an entrepreneur. That came 25 years later. I was an in-the-trenches doc trying to help the person in front of me with these devastating diseases that are crippling diseases, usually of young women mostly. [00:02:45] Lindsey Dinneen: Yeah. Okay, and I'm sure there's, there's much more we're gonna dive into, but one thing that really stood out really fast was you, you kind of called yourself a detective, which I really love that term. And so I'm curious, is that something that you always thought you wanted to specialize in, in medicine, or was this, you know, detectiving to come later? Was this something that, you know, you ended up learning more about while in med school and thought, "Oh, this sounds really cool. I could put really two interesting passions together"? [00:03:19] Andrew Holman: Yeah, it was-- you know, things just sort of come into play sometime. For those who are not in medicine, they may not realize it takes about ten years to go to college, med school, re- internship, residency, fellowship, you know, and then you, then you finally get to go be a doctor, and you have to go learn how to be a doctor s- a little more. The patients teach you a lot more than people realize. So I was gonna be an orthopedist. I liked orthopedics. I liked architecture, bones, joints. I thought it was a lot of fun. I just had very little aptitude for what they do. I, I don't-- I, I'm not very g- a good carpenter. I just, you know, I didn't-- just wasn't gonna be a great orthopedist. So then I thought, "I really love cardiology." Rhythm disturbances, all kinds of things. In the 1980s, when I was in medical school , all the new stents and procedures and non- less invasive things than bypass surgery were all coming up. Joint valve replacement. You know, it's really exciting. But I never... and I never took a, a f- a course in rheumatology until I was actually an intern in internal medicine program in Denver, all set to be a cardiologist. And there were 12 of us in the, in the program per year, and s- five of us became rheumatologists because of this one doctor who took us out, a guy named Daryl McCarter. Prob- maybe people who know him, he's retired recently. He would bring us in the office, and we'd see every other patient with him because in between the patients, he would give us an X-ray, say, "I want you to look at this. There's a clue here. See if you can find it." Or, "I want you to look at this pathology slide," or something. "There's a secret, you know, to figure this one out." And I go, "Wow, this is really fun stuff." And once you figured it out, we weren't as good at treating it yet, but we were getting better. We were getting better. So it was the cutting edge and very fertile ground for discovery. So, rheumatologists are called the consult of last resort for a reason. There aren't very many of us. You've usually seen everybody else first, and by the time they-- you see us, we're pretty good at figuring out the rare diseases that are not in other people's board exam. But we're also pretty good at figuring out the common disease that presents in a very strange way, you know? And, and that's what our strength is. So we may... Everybody who sees us who gets diagnosed may not have a rheumatology answer, but we try to get them an answer. And now we're really in the golden age of rheumatology in the last 20 years of really making a difference for so many people. The downside, we don't make a difference for enough people, you know? We, we... That's the problem. So we've got these very motivated doctors out there, eager, and we just need, you know, more. And that's why I became an entrepreneur, because I learned more neurology than I was supposed to know and more sleep physiology than I was supposed to know. You just follow the breadcrumbs, you know? [00:06:17] Lindsey Dinneen: Yeah. Okay, so I know you didn't start out wanting to, or maybe even being interested in being an entrepreneur, but that is the path that you chose, and I would love to hear about that, the company, and what you're all doing. And then also would love to hear about your journey into deciding that this is the next right step for me. [00:06:38] Andrew Holman: Yeah. Well, thanks for asking it. It is a little unusual. So I was actually studying and trying to help patients with fibromyalgia about 30 years ago. And fibromyalgia patients terribly dismissed till they're all making this up. There's not 10 million people that can make anything up and be consistent. I mean, they all say the same thing. So I thought that was nonsense, and I was really thrown into the crowd of, you know, "You're, you're crazy too." And I go, "Well, I'm board certified in crazy." So I w- I was interested in it, and I was irritated that these people were dismissed. And I was around other doctors in Seattle who were similarly that way, which was very, very unusual. It's unusual to find people in the '90s who had an avid interest in that disorder. And so I started doing what rheumatologists are good at, incrementally advancing ideas and therapeutics very carefully, very cautiously. We do a lot of things off-label. When I was-- finished my fellowship in 1992, half the diseases on our board exam had no FDA-approved treatment. We had to do something, right? You couldn't just say, "Well, come back when there's a couple of articles in the New England Journal of Medicine." You, you can't do that, right? People are depending on you. So rheumatologists are particularly good at that, and that's not something most doctors want to do. Most doctors find that very uncomfortable. They're very, very careful people. And, and rheumatologists are careful too, but we take this mission seriously that we need to do something for you. So basically, I was looking at off-label ideas and work on fibromyalgia, and I'll share this with your audience. I was actually pulled up-- pulled in by some senior doctors who said, "We wanna talk with you." And I'd been there about three years as a new doctor. Oh, you know, seem to be doing a good job. Maybe they wanna pat me on the back or something. No, not that. It was actually an intervention, which I had never... I mean, I had no familiarity with what an intervention was. And they said, "Look, we like you. You're a great doc, but you're gonna ruin your reputation if you believe all these people, mostly women And you really need to not take it so seriously or write prescriptions for this c-- this and that." I said, "Well, thank you very much." That's polite. That's not what I was thinking. And I, I... But it prompted me to pull all the charts and say, "You know, I think I'm making some progress here with some ideas here, and let me see if I'm getting fooled and just seeing the people who get better to come back. Let me really honestly look at my performance." And so I pulled about 200 charts. It was my first abstract at the national meeting. And you know what? We were making progress. That had morphed into more progress, following the breadcrumbs, looking at neurology, looking at the autonomic nervous system. So that was about a five-year process. Y-you know, I didn't lose my reputation, obviously. I lecture around the world now. But it led to being very careful about getting clinical evidence if I had a hypothesis. And so we were using the office, and we actually finally did a double-blind prospective study where I bought all the drug myself, had it reformulated, little capsules that, you know, and, and worked with the FDA to get permission to do the study. And that study in fibromyalgia to this day has the highest response rate of any fibromyalgia study for pain that's ever been done. Now, we don't use that treatment anymore. It's 20 years later, we have other things to do. But it did prompt Pharmacia, got bought by Pfizer, I believe, and Boehringer Ingelheim, which co-marketed the drug I was using and reporting on, to pay me $10 million for the patents that I had filed, utility patents. I didn't own the drug. I didn't use it for Parkinson's disease, but I thought there was use in fibromyalgia. So before I told the world, I filed utility patents, and they wanted to exploit that discovery. So did two other pharmaceutical companies, and they had to pay for the privilege of doing it. So at 46, I retired. So I didn't intend to do that, but I do come from a family of lawyers and judges, and so the idea of having a utility patent on a n- a new innovative idea was not a foreign concept to me. [00:10:40] Lindsey Dinneen: Yeah. [00:10:41] Andrew Holman: That is something I teach all young doctors. [00:10:46] Lindsey Dinneen: That is awesome, and I, I was thinking, okay, this is a great segue because first of all, that's an incredible story. Secondly, I, I would be very curious to know exactly that, what is your advice for some of these incredible physicians, great ideas, that are potentially going to end up becoming an entrepreneur just because that's the path that, that is sort of presented to them? What is some of your advice for that? 'Cause that can't just be... you, you had the privilege at least of, of, of knowing and having some background in that, the legal aspects of IP protection and whatnot, but what are some of the things that you tell people? [00:11:22] Andrew Holman: Well, a couple things I would say and I have these conversations often 'cause I really like the younger people coming along. I say, first of all, don't define yourself as an ent- as being an entrepreneur. Make sure you have other things in your life that are more important to you. Now, the investors are not gonna like to hear that. They, they want you to live and die on your, on your company, right? But I'm saying, you know, you don't have to tell the VCs, but have other things that matter more in your life. You still gotta work really hard because you may, you may find that it's really a slog, and it's very long, and it's very hard. But, you know, make sure that, that, that what you-- though is important, your family, you know, your integrity the scientific problem at hand, the patients, you know, they're number one. Make sure we don't lose sight of all that, and do a few things. Go for a walk. Do something for yourself. Something. I do this twenty-four seven for the last 10 years, you know, every day 'cause I love doing it. It does wear you out, though. Even if you make-- even if you're successful with milestones, it does wear you out. But that's what I tell them. I say, "You know, make sure that you take care of yourself a little bit, too." It's kinda like a analogy. What do you do for a pregnant woman who has a, who has a, a lupus? Lupus is terribly dangerous for the fetus and for the mom. Though the worst thing you do to-- for the baby is not take care of the mom. Take care of mom, [00:12:44] Lindsey Dinneen: Mm-hmm. [00:12:45] Andrew Holman: then get the baby delivered. So, you know, everybody's talking about the baby, but take care of mom. That's the most important thing you do for that baby. So that's kinda what I would say. [00:12:54] Lindsey Dinneen: Yeah. Yeah, that's great. I appreciate that. Yeah, that, that makes a lot of sense too. We've been talking, actually it's been a, a bit of a theme too lately in some of the conversations that I've been having with folks, especially leaders, to talk about that identity component and, and be aware that your job isn't the only thing that defines you or needs to. There's a lot more to your life. There's a lot more to who you are. And so also, you know, our identities change over time and how you refer to yourself and th- those are, those are good things. That's growth, that's movement. So, being comfortable with who you are outside of your career. Yeah. [00:13:33] Andrew Holman: The other thing too is, you know, people used to joke 20 years ago that participation mem- medals were like a farce and what. That's the l- that's the last thing I would say to anybody. Give yourself a pat on the back for going out there trying to attack the castle, you know. Give yourself some credit there because a lot of people just wouldn't do it. My middle daughter was a hundred-meter hurdler at Boise State. She's a Division I athlete. There's a lot of sprinters out there that don't wanna get anywhere near that hurdle 'cause it really hurts when you hit it, right? And so half of that was not-- was being brave. So be brave, be brave, you know. My other daughter was a Division I athlete at Rice. She was a h- she was a volleyball player. Yeah. So, yeah. So I, I, I, I watch other people, see how they persevere and, you know, okay, gotta pick yourself up. Gotta go. Gotta get up this morning. Gotta go. [00:14:23] Lindsey Dinneen: That's right. That-- Yeah. [00:14:25] Andrew Holman: Then remember, people are depending on you, not just your investors. I take that so seriously. But the s- the people who have decided that they're gonna hook their wagon to you. [00:14:34] Lindsey Dinneen: Yeah. [00:14:35] Andrew Holman: You know, that's a lot of responsibility. [00:14:37] Lindsey Dinneen: It is. Yeah. [00:14:38] Andrew Holman: Give yourself a little credit that you're stepping up. [00:14:41] Lindsey Dinneen: Yes. Great advice. Yeah. Okay, so all right. So let's talk about your company now. So now you're an entrepreneur, in addition to obviously the rest of who, what makes you, you. But and I know that you're also a clinical professor, and I would love to hear about both of those things if you don't mind sharing. [00:14:59] Andrew Holman: Yeah, sure. So, technically I'm an associate clinical professor at the University of Washington. A, a lot of private docs do, and they participate in helping teach the y-young residents and fellows and so forth. So it's a joy to me. I, I think my job is a job of teaching. I'm constantly talk... I'm not-- I don't see patients anymore, although I do maintain my license in malpractice 'cause I get, I get contacted for the fibromyalgia work I did. So it's, my email's on the papers, right? So I, I don't wanna let that go. People need help. But basically, we're constantly teaching patients, you know. Now, we're listening, hopefully do better and better at that, but then I have to make a case. You know, I'd, the-- I'd like you to try this or that. Why do I wanna do that and so forth. We're constantly, you know... We don't-- It, it sounds too trite to call it selling something. We're not doing that. We're in there with you. We're collaborating. But I have to be, I have to have a reason and be persuasive and all that, so that, that academic teaching part's kind of fun. Now, sometimes I go into the lion's den. I will tell you, it's a little nerve-wracking to give rheumatology grand rounds at Harvard. Yeah, yeah, okay. You know, and the University of Washington, they're a little friendlier. It's my hometown. But Guy's Hospital in London and the Hospital for Special Surgeries, I... My first rheumatology grand rounds came at the HSS in 2009. I get there, I completely bomb. All these famous people are in the front row. I'm... They're, they're just not buying any of this thing we call immunoautonomics and how stress affects the immune system. I'm quoting the NIH. I'm doing everything I... I know how to do it, right? Pathology slides, I'm there. Then I find out the way they pick the speakers is the fellows get to find something interesting, and they pick the speakers, not the not the high mucky-mucks. So the only reason I was there is because the fellows, the young folks, thought, "This is an interesting topic. We'd like to hear more." And it turns out they were 15 years ahead of the rest of the world, because this is the most fascinating topic of how the immune system affects the autonomic nervous system affects the immune system, so it inflames it. [00:17:03] Lindsey Dinneen: Yeah. Oh my gosh. Actually, that is one thing I wanted to talk about, 'cause I, I noticed on your LinkedIn profile there was, you know, a reference to how much stress affects cardiovascular health maybe particularly chronic stress. And I would just love to hear more about that and, and maybe some ways... I know there's like, y- of course you always get your standard, "Here are some things that you could do to lower your stress." But, but from your perspective as a physician who's studied this, I'd love to hear more from you about, okay, how does this affect health, especially cardiovascular health, and then really what are some practical things that we can do? [00:17:39] Andrew Holman: Yeah, let me see what I can do. Now I wish I could fast-forward because we will have some magnificent things in the next five to 10 years based on what's being discovered now. But the bottom line is, stress and pain are awful things, but they have a purpose in the near term. So pain is good because it'll keep you from putting your hand back in the fire, right? Just don't do that again. But chronic pain is terrible and not productive. Stress is the same thing. You wanna get away from the lion. You, you, you need to perform. If your child needs you, whatever, you, you need to perform on it instant. But chronic stress is not productive. The problem with the stress response is it's controlled in the brain by the autonomic nervous system, which is called the ANS, and it's divided into two components, the sympathetic fight or flight, which we all know what that feels like. You know, ooh, scary. And the other is the parasympathetic, which is getting more talk now, which is the opposite, which is related to rest, restorative, sleep, recovery, growth hormone, all these things. And both of these systems are on simultaneously all the time, but they jockey for predominance depending on what the demands are around you, right? So turns out the sympathetic part has a significant negative impact on cardiovascular health, as you might expect, right? If you're driving your car at five thousand RPMs-- now, nobody has a stick shift anymore-- but if you're driving at five thousand RPMs, you're gonna wear down your engine, even if you go at the same speed as someone who has a two thousand RPMs, right? It, it's, it's what's going on inside the hood there is really important. So stress responses chronically do have measurable, tangible, well-published effects on cardiovascular mortality in long prospective studies. So if we had a magic something, we would do something to lower that epinephrine adrenaline response. Unless, of course, you're in the military, where someone's-- you need every heightened, m-- you know, response that you can get to survive. But for the rest of us, it's better that that system does not ramp up and activate. And we all have a different propensity to how powerful it is and how much it turns on, and also how poorly it turns off. So the stress response, we think of it like epinephrine, adrenaline. That's the easiest way to do it. So what you'd wanna do is to make sure this magnificent part of your brain that is your-- does all your housekeeping functions, this autonomic nervous system, the command and control center that you just wanna work, you don't wanna think about it, is not on a turbocharged, right? And there are people I take care of that they were just born that way. A lot of them, by the way. So things like all the wellness opportunities you can think of are, are targeted just to simply calm the autonomic nervous system. Tai chi, meditation, diet, exercise, all these things have been around for thousands of years because of that. That's what they do. And the practitioners will share that with you. I mean, the there are monks that can lower their heart rate, you know, to like, you know, what would seem lethal to the rest of us, right? That's the parasympathetic drive that lowers heart rate, lowers blood pressure. So those wellness opportunities are real. It will be important that you can manage whether the-- what you're doing is working or not. [00:21:04] Lindsey Dinneen: Mm-hmm. [00:21:04] Andrew Holman: Right? And that's where my company comes in. But the other is things like obstructive sleep apnea. You might think heavy guys... See, someone's gonna send me for a sleep study for sure, but they're not gonna send you. Big mistake, because it turns out that fifty-three percent of Japanese women with rheumatoid arthritis have unexpected obstructive sleep apnea. Oops. And, and we were just taught that we wouldn't even check those people. Well, turns out sleep apnea untreated is a major cardiovascular risk factor equal to cigarette smoking, according to the Sleep Heart Health Study in 2004. That's a big deal. And also, we learned in rheumatoid arthritis, getting back to my work, world, that patients with rheumatoid arthritis don't die from joint disease, they die from premature heart disease. They can also get cancers. So why is that? Well, there's been a lot of effort to try to figure that out in the last twenty-five years, and their risk factors for cardiovascular disease are not explained by the Framingham risk factor of hypertension, cholesterol, smoking, and all the things we, we look, see. But nobody looked at sleep apnea. [00:22:15] Lindsey Dinneen: Mm-hmm. [00:22:17] Andrew Holman: The other reason it's so relevant, though, is sleep apnea is a potent sympathetic arousal. It, it-- You struggle to breathe, right? You kind of obstruct. And what part of your brain tells you to breathe? Your autonomic nervous system. Breathe, right? And it stimulates this adrenaline response over and over and over, and it pounds your heart over the years, and it can lead to sudden death and arrhythmias. So there's a, there's a link there. Never miss sleep apnea. The other one is we found in our office and published about restless leg syndrome. You know, people tap their toes in the airport or they kick the covers around at night. It's pretty benign for most people, but it looks like it very well might be a sympathetic arousal, and there may be relevance there. The therapies for that may have relevance to what we're talking about. Again, very off-label. We're not talking about FDA-approved here. But it-- You ask what can you do? The other one that's coming is vagus nerve stimulation. That is FDA-approved now for rheumatoid arthritis, and they're going to other opportunities to, again, to, to increase the parasympathetic and to lower the sympathetic, right? So that background activity doesn't harm you. The autonomic nervous system may be the primary reason that two patients respond differently to the same treatment. What you bring to the table. It's no different than if I have two people coming to me for a back problem. One is five foot three and one is seven foot three. The way their spine is designed makes it a whole lot harder to treat the seven-foot back, right? I'm not surprising anybody here. So there are things that the patients can bring to the table that matter. Here's the irony. Ninety-seven percent of patients with rheumatoid arthritis in a survey in England said that stress affected their disease activity. It's no surprise to them. And sixty-five percent said they thought it predated getting the disease, that it actually contributed to getting it in the first place. And now there's evidence to suggest that may be true. [00:24:17] Lindsey Dinneen: Oh, boy. [00:24:19] Andrew Holman: So we can't miss sleep apnea just out there. We can't miss restless leg. We can't miss Ehlers-Danlos type three hypermobility type where people can... you can't see me here, but my fingers can bend backwards. But it's, it basically it's very, very common, and those people tend to have increased sympathetic activity naturally. [00:24:39] Lindsey Dinneen: Fascinating. [00:24:39] Andrew Holman: So yeah, so we're, we're waking up a little bit to some very important features here of individuals that may help us do better with the diseases they also come in. [00:24:50] Lindsey Dinneen: Yeah. Wow. [00:24:52] Andrew Holman: Sorry, long answer. Sorry, but there's a lot. [00:24:54] Lindsey Dinneen: No, that's great. I appreciate it, and yeah, well, then there you go. Managing stress is critical to, to your health. It's not just a nice to have, like yeah, yeah, kind of thing. Okay. Whew. [00:25:07] Andrew Holman: Good learning. [00:25:08] Lindsey Dinneen: Okay, awesome. Yeah, so, I'm curious... Okay, so, so again, I like, I like looking at guests' LinkedIn profiles and, and learning more about, you know, what makes you tick outside of your career as well, and I noticed some very fun things that you have listed. So we've got creative writing, horsemanship, golf, and vintage passenger rail cars. I feel like this warrants... [00:25:33] Andrew Holman: Yeah, it's called... Yeah, the American Association of Private Railcar Owners. Yeah. I get ribbed a lot for that, but they're a great bunch. There are about --I don't know if I know all the numbers now, but about 75 to 80 vintage cars from the '20s, '30s, '40s, '50s, who tag on the back of Amtrak, and Amtrak drags them around, and you can actually go rent them, stay in them, whatever. And they have a a annual meeting where they just get on a private train, and they go on tracks that you wouldn't go on naturally, like private rails in the, you know, middle of nowhere. So that's what they like to do. And it's just a lot of fun, especially the dome cars. [00:26:12] Lindsey Dinneen: Okay. That's so cool. [00:26:14] Andrew Holman: I've been a handful of times. I've got a lot of friends there. I don't own a car, but boy, I'd sure like to have one. [00:26:19] Lindsey Dinneen: Yeah. Okay. That is so cool. And then how about horsemanship? How did you... Have you been riding horses your whole life, or how did that come about? [00:26:29] Andrew Holman: So I went to a high school called Thatcher School in Ojai, California, where there are 50 in a class, and there was a requirement, this is over 100 years old, this school, that you had to have a horse. And they would say s- that something about the "outside of a horse is good for the inside of a boy," right? I was the last all-male class in 1977. Now young women get to go there too. It's of note that I have 15 people from Thatcher investing as family and friends in, Inmedix. So, th-they that, that's pretty special. But it's a boarding school. I was there for four years. My dad had gone there, so I'd heard of it. But I got a tremendous education. Th-there aren't a lot of prep schools on the West Coast, but there are some. And, and that's where I learned how to ride a horse like riding a bicycle. My sister is a thoroughbred horse trainer for 40 years. She's retired. She had three or four or five horses, a har-- not the fancy kind of stuff at the Derby. But they, you know, get up at 4:00 a.m. and ride, you know, that kind of... Tough life, but she loved horses. So yeah, I, I'm as, I'm more comfortable on a horse than I am around anything, probably. [00:27:34] Lindsey Dinneen: That's so cool. Okay. Well, this has been really fun to, to get to hear your incredible life story so far, and I'm excited to see where the company continues to advance medical technology. So, you know, I really appreciate everything you're doing. But I do want to ask, is there a moment that stands out to you along your career path so far where you just thought, "Wow, I am in the right industry at the right time"? [00:28:02] Andrew Holman: Yeah, I'd, I'd say there probably was. When we unblinded the prospective double-blind study that we did looking at this five-minute next generation heart rate variability, this HRV we got through the FDA last year. When we unblinded the study, and although that's not part of the FDA clearance, it was a very important moment for me because it showed that it predicted a year in advance who would respond to treatment of rheumatoid arthritis with ninety percent sensitivity, ninety-five percent specificity. So I wanna emphasize that is not what it's cleared for. It's cleared as an HRV tool that doctors can use at their discretion. But that study is what you asked me to answer. And when you unlock a study and you see the results, two things happen. One is we were happy that I was on the right track. That was nice. You know, positive study. Your hypothesis is valid. But it completely changed the view of immunology, [00:28:58] Lindsey Dinneen: Hmm. [00:28:59] Andrew Holman: Because we would have a test now that could measure the autonomic nervous system with exquisite precision. Nobody cared except me. About 10 years ago, we were waiting for better biologics, the things on TV, right? They asked, "Ask your doctor if it's good for you." Nobody realizes that they work about twenty-five percent of the time in terms of disease control. That's a big gap, but it looks like it's the brain that monitors inflammation. The inflammation the immune system is not firewalled against everything. The brain c-controls it, and it's not the endocrine so much with cortisol, it's the autonomic that works in milliseconds that, that epinephrine response. So that's a... You know, you're pretty nervous when you un-- when you-- someone tells you, "Okay, here is the results." [00:29:48] Lindsey Dinneen: Yeah. Wow. [00:29:50] Andrew Holman: And, and, and that was it. And then it turned out in 2015, the other moment was when I was going through the airport at Seattle and I saw the cover of of Scientific American, Bioelectric Medicine, Setpoint Medical's vagus nerve stimulation, hacking the the vagus nerve to fix the autonomic nervous system to reduce the burden of rheumatoid arthritis. I go, "Okay, now it's time." We had the patent on it. Okay. Ten years forward, we're where we are now. We're launching in June, and we have a software juggernaut here and a literally a vital sign. So, th-the doctors decide what to do with this, but we've put it in their hands, and it's paid for by insurance. So yeah. [00:30:34] Lindsey Dinneen: Amazing. Well, that's, that's so cool. Congratulations on that. That's fantastic. Okay, so to pivot the conversation a little bit just for fun, [00:30:43] Andrew Holman: Hmm? [00:30:43] Lindsey Dinneen: imagine that you were to be offered a million dollars to teach a master class on anything you want. What would you choose to teach? [00:30:53] Andrew Holman: Well, I, I learned that you've all had professors that didn't probably know as much as they should about a subject, but they thought it was just fun. I would probably stick with what I know. So I would do a master class on fibromyalgia because you can actually treat it. And there's published data, but it's very-- it's not widely known. We will be using Inmedix and autonomic testing to do research to validate and get that problem finally solved and put to bed. And then the other is this thing called immunoautonomics. It, the term-- I made up the term 15 years ago. It's in the medical literature. So that's what I would teach. Teach what I know. [00:31:27] Lindsey Dinneen: I love that. Okay, excellent. And how do you wish to be remembered after you leave this world? [00:31:34] Andrew Holman: Well, I, you know, it all come... I define myself by what the patients, how they do and what they say. It's not about five stars and all that, you know, you know, there's plenty of those. But it's, it's... I made a, a commitment if somebody says anything about me, I made a commitment when I was a rheumatologist with all these mostly young women upset, that I would never leave the room with them crying. Didn't matter how far behind I was, didn't matter. We went through a lot of Kleenex. There's a l- it's devastating to get these diseases when you're a young woman. And they can put that on my tombstone, not to dismiss people. We had a saying in the office, "It's gotta be something." You know? It's, it's always something. Drives me crazy when doctors will say, "Oh, that's nothing." Well, well, first of all, we know it's not nothing. It, it is always something, and there's something that defines your success, and there has to be things that define your failure. So let's figure out what the something is, but let's not argue that there's nothing there. So let's not dismiss people who are frightened and worried, and maybe they don't tell the story as clearly as we'd hope. But you know what? It's not, it's not their fault. They're in distress. It's amazing what people are like after you help them with their chronic pain. [00:32:45] Lindsey Dinneen: Yeah. Yeah. That is really cool and makes so much sense. Yeah. Thank you. Okay, and then final question: what is one thing that makes you smile every time you see or think about it? [00:32:59] Andrew Holman: It's making me smile right now. When I talk to the young fellows that are in their training and they're finishing up, so they've done three years or four years of medicine, three years of internal medicine after that, and then they do three or two, three, four years of rheumatology, and then they're gonna go out, I tell them how jealous I am of what they're gonna see. The, the last, the last 40 years we had these young men mostly coming in with terrible weight loss and immune systems, falling apart, and these strange tumors, and they're dying of, of infections like yeast and candida that, you know, everybody did fine with, and it was HIV, right? It had to be figured out. Now HIV is a chronic disease. It's like diabetes. We had so many people die in the '80s. Hepatitis C was... You'd have liver enzymes up, and it wasn't hepatitis A 'cause we could test for that, and it wasn't hepatitis B 'cause we could test for that. So we just called it non-A, non-B. Literally, that's what we called it. And then that got to be called hepatitis C, right? 'Cause it was too embarrassing to call it n- what it wasn't. And now hepatitis C is curable with antiviral agents in, like, three weeks. I mean... And then the biologics showed up. They're not perfect, but they were a big step. And then this immunoautonomics and, and understanding how pain and sleep and the autonomic nervous system work. I'm just really jealous of what those young clinicians are gonna get to see. [00:34:27] Lindsey Dinneen: Yeah. Yeah, that's really... Yeah, I can see why. But it sounds like you are, you know, keeping, keeping your what, what would they say? Like, toe in the water or something so that you're able to, to watch some of this as well and be a part of that next [00:34:40] Andrew Holman: I feel like I'm a ne- I feel like I'm neck deep and I'm just hoping I don't go down any lower. [00:34:47] Lindsey Dinneen: Fair enough. [00:34:48] Andrew Holman: 'Cause I have to find a way to pay for it. [00:34:50] Lindsey Dinneen: Oh, yeah, yeah, yeah. The details, you know. Yeah, yeah. [00:34:53] Andrew Holman: You got those details, yeah. [00:34:54] Lindsey Dinneen: Yeah. Oh my gosh. Well, this has been an incredible conversation. I really appreciate your time today and sharing your insights and, and stories and, yeah, I'm so excited to see the future of medicine, and I appreciate perspectives of, like yours, where you just, you share a lot of hope and optimism, and you're actively working to change lives for a better world. So, thank you. [00:35:16] Andrew Holman: Yeah, I, I irritate a lot of people with that optimism, but I'm sorry, it's just there. I can't fix it. [00:35:22] Lindsey Dinneen: Brilliant. Well, I love it. It makes my heart happy, so thank you so much again, and I hope you have the best rest of your day. [00:35:31] Andrew Holman: Thank you so much. Thanks for having me. [00:35:32] Lindsey Dinneen: Of course. [00:35:34] Dan Purvis: The Leading Difference is brought to you by Velentium Medical. Velentium Medical is a full service CDMO, serving medtech clients worldwide to securely design, manufacture, and test class two and class three medical devices. Velentium Medical's four units include research and development-- pairing electronic and mechanical design, embedded firmware, mobile app development, and cloud systems with the human factor studies and systems engineering necessary to streamline medical device regulatory approval; contract manufacturing-- building medical products at the prototype, clinical, and commercial levels in the US, as well as in low cost regions in 1345 certified and FDA registered Class VII clean rooms; cybersecurity-- generating the 12 cybersecurity design artifacts required for FDA submission; and automated test systems, assuring that every device produced is exactly the same as the device that was approved. Visit VelentiumMedical.com to explore how we can work together to change lives for a better world.

In medical school, Aaron Baugh, like most doctors in training, was taught that Black people have smaller lungs than white people. His professors explained that it came down to evolution and body proportions.A spirometer measures lung capacity and helps doctors diagnose and treat most lung diseases, including asthma, COPD, and cystic fibrosis. And for generations, it had a so-called race equation built into it. When a patient breathes into the machine, their lung capacity is compared to what is considered normal for their age, gender, and race. For Black patients, that normal range was 10 to 15 percent lower than for white patients. For years, doctors believed that a race “correction” made the test more accurate.But after becoming a pulmonary and critical care physician, Baugh discovered that historical assumptions embedded in the spirometer were not only wrong, but were based on racist science that can be traced back to American slavery. And they were leading to misdiagnoses in thousands of Black patients, including military veterans. “This is not a small test,” Baugh says. “It is used in diagnosis of lung disease. It is used for job hiring. It is used for disability assignments. It is used for different medical treatments. So it can touch people in a lot of important ways if you're doing this wrong.”This week on Reveal, we team up with The Race Equation podcast series from the New England Journal of Medicine to examine a standard medical test with a brutal history that is harming Black patients and is still being used in hospitals across the country. Support Reveal's journalism at Revealnews.org/donatenow Subscribe to our weekly newsletter to get the scoop on new episodes at Revealnews.org/weekly Connect with us on Bluesky, Facebook and Instagram Learn about your ad choices: dovetail.prx.org/ad-choices

On Episode 67 of the Stroke Alert Podcast, host Dr. Negar Asdaghi highlights two articles from the August 2026 issue of Stroke: "Diagnostic Yield of Cardiac CT to Detect Cardiac Thrombi in Patients With Acute Ischemic Stroke (AIS of HEARTS)" and "Intensive Versus Conventional Blood Pressure Lowering After Successful Endovascular Thrombectomy: OPTIMAL-BP 1-Year Outcomes." She also interviews Prof. Ulf Landmesser about the CLOSURE-AF trial published in The New England Journal of Medicine. For the episode transcript, visit: https://www.ahajournals.org/do/10.1161/podcast.20260811.265479

Hayden Panettiere died suddenly in Greenville, South Carolina at 36. TMZ reports that Narcan, the nasal spray used to reverse an opioid overdose, was found in the apartment. Dr. Drew is joined by his Celebrity Rehab costars – addiction counselor Bob Forrest and certified chemical dependency counselor Shelly Sprague-Foster – to discuss Hayden's opioid addiction, postpartum depression, and what we know about her tragic and sudden death. Panettiere told People in 2022 that she had been in a cycle of self-destruction, and wrote in her memoir that a doctor warned she would be dead within 5 years if she did not stop drinking. She said she was given pills as a teenager before red carpet appearances, developed an opioid dependency after being prescribed painkillers for an injury, and experienced withdrawal severe enough to send her to a liver specialist. Page Six reports, through a friend, that she had severe back problems in the months before her death. NBC News reports her ex-boyfriend was at the scene when she died. Also on today's show: Dr. James Thorp, a maternal fetal medicine specialist with more than 40 years in practice who was fired by SSM Health after speaking out about COVID-19 vaccines in pregnancy. He says federal officials and the New England Journal of Medicine knew about adverse pregnancy outcomes in early 2021 and hid them. Bob Forrest is a musician, author, and addiction counselor. He served as a counselor on VH1's Celebrity Rehab, works with DNA4Addiction, and authored Running with Monsters: A Memoir. Follow at https://x.com/bobforrestmusic Shelly Sprague-Foster is a Certified Chemical Dependency Counselor–Certified Addiction Specialist who has worked with individuals affected by substance use disorders since 1997. She co-founded Hollywood Recovery Services with Bob Forrest and now directs We Care Outpatient. Find more at https://wecareinla.com Dr. James Thorp is an obstetrician-gynecologist and maternal fetal medicine specialist who served in the SSM Health System in Saint Louis, Missouri. He earned his medical degree from Wayne State University School of Medicine and has practiced for more than 40 years. Follow at https://x.com/jathorpmfm 「 SUPPORT OUR SPONSORS 」 • BIOPRO - BioPro+® is a natural formula of growth factors and peptides that support how you look, feel & perform. Learn more at ⁠⁠https://drdrew.com/biopro⁠⁠ • FATTY15 – The future of essential fatty acids is here! Strengthen your cells against age-related breakdown with Fatty15. 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This episode is for the woman who has done the work.Not halfway. Not partially. She changed her food. She addressed her sleep. She did the nervous system work. She supported her gut, her adrenals, her hormones. She has been consistent and patient and willing to do what the clinical picture asked of her.And she got some better. But she did not get all the way there.This episode is for her. Because there is a category of clinical complexity beneath the foundational layer that most providers, even some functional medicine providers, are not consistently looking for. And the women in that category deserve someone willing to ask what is underneath all of this.Inside this episode, we cover:Why the population of women I am seeing is getting more complex and more depleted, and why the percentage hitting a ceiling after foundational work is climbingThe tree framework: leaves, trunk, roots, and what lives underneath the floor that standard functional medicine tools are not consistently reachingEpstein-Barr virus reactivation: what it looks like, what the lab constellation actually reveals, and why the landmark 2022 New England Journal of Medicine study changes how we should think about long-term EBV consequencesBiotoxin illness and chronic inflammatory response syndrome: the genetic susceptibility, the mold mechanism, the symptom picture that gets dismissed as anxiety and fibromyalgia, and why the building is sometimes the most important clinical variable in the roomThe visual contrast sensitivity test and what it screens forHeavy metals: mercury, lead, arsenic, and cadmium, where the exposure actually comes from, and why standard blood draws often miss the body burden entirelyPsychoneuroimmunology: the science of how trauma and chronic nervous system dysregulation produce measurable physiologic consequences in the immune system, the hormonal terrain, and the inflammatory environmentThe ACE Study and what a dose-response relationship between adverse childhood experiences and adult chronic disease should have changed about how medicine thinks about the origin of illnessA patient story: two years of committed functional medicine work, a ceiling that nothing could move, and the clinical variable no one had thought to ask aboutI am going to be honest with you in this episode about what I know, what I am still learning, and where the science is still being refined. A provider who pretends to have complete certainty in areas where certainty is not yet achievable is not serving the patient well. What I can tell you is this: I will keep looking, I will keep learning, and I will keep asking what is underneath all of this.Share this episode with one woman who has done everything right and still cannot fully arrive. She is not failing. She has not hit her ceiling. Someone just has not looked deep enough yet.Your next steps are below:✨ Free Guide: 9 Hidden Signs Your Metabolism Is Stuck in Survival Mode www.drkaceywallace.com/hiddenmetabolicmess✨ Adrenal Optimization Test (see your cortisol rhythm + DHEA clearly) www.drkaceywallace.com/innercalm✨ Hair Tissue Mineral Analysis (as talked about in this episode) www.drkaceywallace.com/htma✨ The Anchored Journey (one-on-one work) www.drkaceywallace.com✨ Get the book: You Are Not Fine www.youarenotfine.comSupport the show

In this episode from the vault, we're going back to when Sam gave a presentation at the American College of Emergency Physicians (ACEP) Scientific Assembly, making the case for why emergency physicians and clinicians are uniquely positioned to successfully practice in the ketamine therapy space.This is not a generic overview of ketamine. It is a frank, evidence-based conversation directed at clinicians who are feeling the weight of burnout, decreased autonomy, and a healthcare system that is asking more while giving less in return. Sam walks through the science, the mechanism, the financial realities, and the deeper question of purpose that every provider should sit with before taking the leap.If you have ever wondered whether your emergency medicine training could translate into something more fulfilling, this episode makes a compelling and well-researched argument that it can.What You'll Gain:• A clear picture of the mental health and chronic pain crisis driving demand for ketamine therapy, and why the current standard of care is falling short for so many patients• A walk through the key clinical studies supporting IV ketamine for depression, anxiety, PTSD, and chronic pain, including the landmark 2023 New England Journal of Medicine trial comparing ketamine to ECT• An honest look at the mechanism of action behind ketamine therapy, from NMDA receptor antagonism to neuroplasticity and BDNF, explained in language that makes clinical sense• Why emergency physicians bring a uniquely transferable skill set to the ketamine therapy space, and how that advantage plays out in practice• The financial and emotional realities of running a ketamine clinic, including what Sam wishes more providers understood before they opened their doors• Why knowing your why is the single most important thing you can do before starting a ketamine practice, and how it will carry you through the inevitable hard momentsEpisode 63 show notes:00:00:00 Teaser: "This is the why, the purpose, the motivation."00:00:34 Episode Introduction and Overview00:01:45 The Mental Health Crisis: Why This Work Matters Now00:03:48 Burnout and the Changing Landscape of Emergency Medicine00:04:43 Why EM Physicians Are Uniquely Positioned for Ketamine Therapy00:05:02 The Clinical Evidence for Depression: From the Berman 2000 Study to the 2023 NEJM Trial00:07:25 The Clinical Evidence for Anxiety: Dr. Paul Glue's Escalating Dose Study00:08:20 The Clinical Evidence for PTSD: Single and Multiple Infusion Data00:09:41 The Clinical Evidence for Chronic Pain: What Works and What Doesn't00:10:55 Mid-Episode Ad: Free Ketamine Startup Checklist00:11:44 How Ketamine Works: NMDA Receptor Antagonism and Glutamate00:12:19 Multi-Receptor Action, Neuroplasticity, and BDNF00:13:30 Beyond the Mechanism: The Experiential Dimension of Ketamine00:14:40 The EM Skill Set Advantage: Clinical Experience, Procedures, and Scheduling Flexibility00:15:24 Emergency Medicine Is a Mindset, Not a Location00:15:53 Before the How, There Is the Why00:16:39 The Toxic Waste Pool: A Story About Purpose and Motivation00:17:23 The Financial Reality: Don't Open a Clinic for the Money00:18:14 Why You Should Open a Ketamine Clinic: Purpose, Autonomy, and Saving Lives00:18:55 Patient Testimonials: In Their Own Words00:20:17 OutroThanks for listening

If you're exhausted, your gut is expanding, your motivation is gone, and your sex drive has quietly disappeared, someone has probably told you it's male menopause. In this episode of Taboo To Truth, I explain why the term Male Menopause isn't medically accurate, how men's hormonal aging differs from women's, what low testosterone actually feels like versus what just looks like it, and when a symptom deserves a doctor instead of a supplement. I get into the research on testosterone replacement therapy, the difference between libido and erectile function, the tools I recommend for supporting sexual function, and what happens in a relationship when desire changes and nobody talks about it. Your sexuality isn't controlled by one number on a blood test, and getting older doesn't mean the end of desire, pleasure, or satisfying sex.In This Episode:00:00 Intro00:13 Welcome to Taboo to Truth00:35 What We're Covering Today01:41 Does Male Menopause Actually Exist?03:22 Male vs. Female Hormonal Aging04:30 What Low Testosterone Actually Feels Like05:42 Other Causes That Mimic "Male Menopause"06:46 Testosterone, Desire & the 2017 Trials08:24 Libido vs. Erections: Two Different Systems09:51 Tools That Support Sexual Function11:27 How This Affects Your Relationship12:37 When to See a Doctor13:44 How Low T Is Actually Diagnosed15:06 TRT: Benefits & Risks16:49 What Else You Can Do18:17 So... Does Male Menopause Exist?19:05 Final Thoughts & Where to Learn MoreTo watch the video version of this episode, head over to YouTube!Products mentioned: FirmTech Tech Ring – tracks nocturnal/spontaneous erections overnight to give you data on erectile function (not a diagnostic tool, but useful info to bring to a doctor). https://myfirmtech.com/Dr. Joel Kaplan's Pump – a vacuum erection device (penis pump), affiliate link mentioned. https://drjoelkaplan.com/affiliate/affiliates/Bathmate's Pump – a water-based penis pump, affiliate link mentioned. Use code TABOO15 for 15% off at https://bathmatedirect.com/MysteryVibe Tenuto 2 – a wearable vibrator that provides stimulation for both partners during sex, especially helpful when erections need more direct stimulation. Use code TABOO10 for 10% off at https://tidd.ly/4mePTpFUberlube – a lubricant recommended for comfort during sex. https://uberlube.com/

Meanwhile his campaign against James Talarico runs almost entirely on ads about medical transition and children, while he trails in the polling. Second, Michigan Republican Lisa McClain went on Fox and attributed a claim about COVID vaccines and first trimester miscarriage rates to the New England Journal of Medicine. The journal published no such finding. Third, Fox host Sandra Smith cannot work out why Democrats are winning on affordability, an issue Donald Trump ran on in 2024 and now calls a hoax. Hawk's answer is that DSA backed candidates campaign on it and voters respond, and that the segment's fallback to blaming Joe Biden is doing a lot of work eighteen months in. SUPPORT & CONNECT WITH HAWK- Support on Patreon: https://www.patreon.com/mdg650hawk - Hawk's Merch Store: https://hawkmerchstore.com - Connect on TikTok: https://www.tiktok.com/@mdg650hawk7thacct - Connect on TikTok: https://www.tiktok.com/@hawkeyewhackamole - Connect on BlueSky: https://bsky.app/profile/mdg650hawk.bsky.social - Connect on Substack: https://mdg650hawk.substack.com - Connect on Facebook: https://www.facebook.com/hawkpodcasts - Connect on Instagram: https://www.instagram.com/mdg650hawk - Connect on Twitch: https://www.twitch.tv/mdg650hawk ALL HAWK PODCASTS INFO- Additional Content Available Here: https://www.hawkpodcasts.comhttps://www.youtube.com/@hawkpodcasts- Listen to Hawk Podcasts On Your Favorite Platform:Spotify: https://spoti.fi/3RWeJfyApple Podcasts: https://apple.co/422GDuLYouTube: https://youtube.com/@hawkpodcastsiHeartRadio: https://ihr.fm/47vVBdPPandora: https://bit.ly/48COaTB

Dr Swapnil Pawar is joined by Dr Jose Chacko to discuss the LOGICAL trial, published in the New England Journal of Medicine in June 2026. Does limiting oxygen after cardiac arrest protect the brain from reperfusion injury? LOGICAL (the largest randomised trial of oxygen therapy after cardiac arrest to date) randomised 1,840 patients across 53 ICUs in Australia, New Zealand and Ireland to conservative versus liberal oxygen therapy. In this episode: – The pathophysiological rationale: hypoxic-ischaemic encephalopathy, reperfusion injury and free radical damage – Where LOGICAL sits alongside EXACT, ICU-ROX, HOT-ICU and the Danish BOX trial – The Mega-ROX master protocol design, and why the sepsis and non-HIE brain injury arms are still to come – Trial design: SpO₂ upper limit of 95% and FiO₂ down to 0.21 in the conservative arm versus no upper limit and a floor of FiO₂ 0.3 in the liberal arm – The results: no difference in favourable neurological outcome at 180 days (38.2% vs 39.7%), survival, length of stay, quality of life or cognitive function – Strengths, limitations, and what it means at the bedside, including why the hosts have landed in different places on titrating down to room air Reference: The LOGICAL Investigators and the ANZICS Clinical Trials Group. Conservative Oxygen for Unresponsive Patients after Cardiac Arrest. N Engl J Med. 2026 Jun 10. Full summary, outcome tables and references at critcareedu.com.au

What if everything men are told about a prostate cancer diagnosis, biopsy first, surgery next, is built on evidence that was never actually there?In this episode of Integrative Cancer Solutions, Dr. K sits down with Dr. Stephen Petteruti, board certified family physician and author of Fight Cancer Like a Man, to break down the 2023 New England Journal of Medicine study that found no survival difference between surgery, radiation, and doing nothing at all for early stage prostate cancer. Dr. Petteruti explains why he stopped recommending biopsies, how a needle can spread the very cancer it's meant to detect, and why watching PSA and MRI trends over time is often safer than rushing into treatment. He also covers the overlooked role of testosterone in prostate cancer care, including bipolar androgen therapy, and makes the case for tracking the disease like a chronic condition instead of chasing a cure that costs a man his vitality.If you or someone you love is facing a prostate cancer diagnosis, or just navigating an elevated PSA, this conversation lays out the questions worth asking before agreeing to anything.Key Takeaways:0:00 Introduction2:33 The prostate trial that shattered the surgery-first model5:19 Why a biopsy can spread the very cancer it's meant to find8:23 Castration's hidden cost on testosterone and quality of life17:12 Tracking prostate cancer with MRI and PSA instead of biopsy21:58 Repurposed drugs and why DIY protocols backfire38:10 BAM therapy: using testosterone as a weapon against advanced cancer Schedule a Free 15-Min Cancer/Lyme Consultation at The Karlfeldt Center: 208-338-8902Resources:Fight Cancer Like a Man (book) - https://www.intellectualmedicine.com/dr-stephen-petteruti-booksIntellectual Medicine, Dr. Petteruti's practice - https://www.intellectualmedicine.com/The Prostate Protocol - https://assets.ctfassets.net/psmhuxrqomif/4iFYGN6rh0cloFTQyxdit9/a2c3e8e20e335df0ad22f70ca0e0af48/the-prostate-protocol-pdf.pdfProtecT Trial, New England Journal of Medicine, 2023 - https://www.nejm.org/doi/full/10.1056/NEJMoa2214122Johns Hopkins Bipolar Androgen Therapy Research - https://www.hopkinsmedicine.org/news/articles/2023/12/bipolar-androgen-therapy-trials-under-way Medical Disclaimer: This content is for educational purposes only and is not intended to diagnose, treat, cure, or replace professional medical advice. Always consult your physician or qualified healthcare provider regarding any medical condition or treatment decisions.

Today's guest, Dr. Meena Seshamani, ran Medicare at CMS and is now Secretary of Health in Maryland. She is leading one of the country's most ambitious health reform efforts: evolving Maryland's all-payer model, expanding investment in primary care, and using data infrastructure to strengthen coverage and population health—all while navigating the implementation of HR1. In this conversation, recorded at Aspen Ideas Health, Meena makes the case that policy design matters, but implementation is where its promise is realized or lost.Meena and Claudia discuss:How Maryland saved $1.6 billion for MedicareNew primary care investment strategiesHow the state is leveraging CRISP, the state's HIE, to implement HR1 and streamline enrollment in public programsMeena shares how Maryland is strengthening food systems using rural health transformation funding:“We are also taking rural health transformation dollars and investing in cold storage, food aggregators, and distribution hubs for our local Maryland farms, so that when we are doing outreach on healthy eating and providing nutritious food to people, that's actually coming from our local Maryland farms. So it's boosting the local economy in our rural areas as well.“Relevant LinksMaryland's Total Cost of Care Model: Evaluation of the First Four YearsArticle on the impact of Maryland's modelHow CRISP supports Medicaid redeterminationThe state's Rural Health Transformation planAbout Our GuestMeena Seshamani, MD, PhD serves as the Secretary of Health for Maryland in the Moore-Miller Administration, where she stewards a $20 billion health system that encompasses public health, Medicaid, disability, behavioral health, and 11 state-run hospitals. She leads the state's mission to improve the health and well-being of all Marylanders through a focus on accessibility, affordability, and equity.Under her leadership, Maryland has emerged as a national laboratory for healthcare innovation. Dr. Seshamani successfully negotiated a first-of-its-kind, multi-billion dollar healthcare payment model with federal partners and secured $168 million in inaugural funding to transform rural health delivery. Her tenure is also marked by a proactive approach to public health, exemplified by ensuring broad vaccine access in the state through the creation of a landmark program providing free vaccines to uninsured and underinsured residents—codifying health security as a statewide priority.Prior to her cabinet appointment, Dr. Seshamani served as Deputy Administrator and Director of the Center for Medicare at CMS. There, she executed the most significant pharmaceutical reform in decades: the Medicare Drug Price Negotiation program, achieving $6 billion in first-year savings. Her work at CMS fundamentally shifted the Medicare model to value-based care by introducing payments for community health services, caregiver training, and navigating patient care, while simultaneously tightening accountability and oversight.A board-certified head and neck surgeon and an Oxford-trained health economist, Dr. Seshamani's perspective is grounded in how health care policy and operations impact the real lives of patients. She previously served as Vice President of Clinical Care Transformation at MedStar Health, maintaining a surgical practice while leading large-scale system changes.A widely published author in the New England Journal of Medicine and JAMA, her insights are frequently sought by The New York Times, The Wall Street Journal, and major news networks. Dr. Seshamani holds her MD from Johns Hopkins University and her PhD from the University of Oxford, where she was a Marshall Scholar.SourceConnect With UsFor more information on The Other 80 please visit our website - www.theother80.com. To connect with our team, please email claudia@theother80.com and follow us on twitter @claudiawilliams and LinkedInSubscribe to The Other 80 on YouTube so you never miss our video extras or special video episodes!

Send us Fan MailIs aspirin alone enough to prevent venous thromboembolism after total hip or knee arthroplasty?In this episode of CLOT Conversations, Dr. Jameel Abdulrehman speaks with Dr. Sudeep Shivakumar, lead author of the EPCAT III trial, recently published in the New England Journal of Medicine.EPCAT III randomized more than 5,400 patients undergoing hip or knee arthroplasty to receive aspirin alone or rivaroxaban for five days followed by aspirin. Dr. Shivakumar discusses the study's findings, including the low rates of symptomatic VTE observed in both groups, bleeding outcomes, the significance of distal DVT, and how EPCAT III builds on the earlier EPCAT trials.They also explore whether modern surgical care has changed the baseline risk of VTE following arthroplasty and which higher-risk patients may still warrant an anticoagulant-based approach.A practical discussion about translating an important Canadian clinical trial into individualized thromboprophylaxis decisions.Reference:Shivakumar, Sudeep, et al. "Rivaroxaban Then Aspirin vs. Aspirin Alone after Total Hip or Knee Arthroplasty." New England Journal of Medicine (2026). https://www.nejm.org/doi/abs/10.1056/NEJMoa2603649Support 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

Welcome to the latest episode (August 2026) of DOC Updates, where every month Neil Skolnik, MD and John Russell, MD review the most important articles on diabetes, obesity, and cardiometabolic disease. This month on DOC Updates: Hirsh Elhence, Jennifer L. Dodge, Stephen Fuest, et al. National Prevalence of Clinical Obesity by BMI Class: A National Cross-Sectional Study. Ann Intern Med. [Epub 2 June 2026]. doi:10.7326/ANNALS-25-05287 Eva Johnsen, et al. Achieving at Least 15% Weight Loss Within 2 Years of Type 2 Diabetes Diagnosis Is Associated With Lower Risks of Macrovascular and Microvascular Complications: A U.K. Cohort Study. Diabetes Care 20 July 2026; 49 (8): 1480–1489. doi.org/10.2337/dc26-0937 Carel W. le Roux, et al. Survodutide Once Weekly for the Treatment of Adults with Obesity. The New England Journal of Medicine June 2026 DOI: 10.1056/NEJMoa2600751 Yu Wang, Shichao Tang, Xilin Zhou, Ping Zhang. National Trends in Out-of-Pocket Cost for Glucose-Lowering Drugs Among U.S. Adults With Diabetes, 2000–2022. Diabetes Care 20 July 2026; 49 (8): 1414–1419. https://doi.org/10.2337/dc25-2040 Jelle M. Beernink, et al. Effect of Finerenone on Albuminuria in Type 1 Diabetes by Baseline HbA1c Level and Diabetes Duration: An Exploratory Analysis of the FINE-ONE Trial. Diabetes Care 20 July 2026; 49 (8): 1434–1441. https://doi.org/10.2337/dc26-0882 Welch M, Forst T, Jia W et al. Orforglipron compared with dapagliflozin in adults with type 2 diabetes and inadequate glycaemic control with metformin (ACHIEVE-2): a multicentre, randomised, non-inferiority, open-label, phase 3 trial. The Lancet, 2026; 408, 125-140 DOI: 10.1016/S0140-6736(26)00800-7 Presented by: Neil Skolnik, MD, Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Associate Director, Family Medicine Residency Program, Abington Jefferson Health John J. Russell, MD, Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Chair-Department of Family Medicine, Abington Jefferson Health DOC Updates is a monthly podcast that presents and discusses the latest clinically relevant articles from the American Diabetes Association's three science and medical journals—Diabetes, Diabetes Care, and Diabetes, Obesity, and CardioMetabolic CARE. Intended for practicing physicians and health care professionals, DOC Updates discusses how the latest research is relevant in clinical practice. For information about the American Diabetes Association's scholarly journals, visit diabetesjournals.org. For more about this podcast, click here.

Our kidneys do an incredible job filtering our blood every hour of every day. Most of us have two kidneys, and each one has about a million microscopic filters called glomeruli. Unlike the filters in our HVAC system, though, these filters cannot be replaced. But they do their work so well and unobtrusively that most of us don't even think about our kidney function. Although 37 million Americans have kidney trouble, the majority are unaware of their situation. Two tests could reveal how well the kidneys are working. What are they, and how often should you ask about them? At The People's Pharmacy, we strive to bring you up‑to‑date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment. How You Can Listen You could listen through your local public radio station or get the live stream at 7 am EST on Saturday, August 8, 2026, through your computer or smart phone (wunc.org). Here is a link so you can find which stations carry our broadcast. If you can't listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on August 10, 2026. What Are the Two Tests That Reveal Kidney Trouble? Chronic conditions like high blood pressure and diabetes put a strain on the kidneys. They are very common problems that signal the need for kidney function monitoring. Our guest expert, Dr. Samir Parikh, suggests that all of us should know our numbers. One is derived from the level of creatinine in the blood. This is normally part of a basic metabolic panel. Usually, the panel results will include a number for the estimated glomerular filtration rate (EGFR) calculated from the value for blood creatinine. The other crucial test is a urine test for protein. Keeping Kidneys Healthy by Staying Properly Hydrated One of the simplest tactics to keep kidneys healthy is to provide them with enough liquid. We get some fluid from the food we eat, which may be one reason eating fruits and vegetables seems to be good for us. They are full of water! We also need to drink fluid, and plain water is probably the best choice. It would be smart to use thirst as a guideline and make sure to drink when thirsty. We do avoid overdoing water consumption, though, as overloading the kidneys with more fluid than they can handle is dangerous as well. Medicines That Are Hard on the Kidneys We mentioned to Dr. Parikh the experience of an older friend, a devoted runner, who discovered that taking ibuprofen after a run reduced the likelihood of having to get up overnight to urinate. He reminded us and our listeners that nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, naproxen, celecoxib or meloxicam can be hard on the kidneys. That doesn't mean we shouldn't ever take such pain relievers, but perhaps we should try not to make it a habit. When we asked about other medicines that might be tough on the kidneys, he mentioned PPIs. Proton pump inhibitors such as omeprazole (Prilosec) or esomeprazole (Nexium) are often used to treat heartburn or other digestive symptoms. Regular use can put a strain on the kidneys, although the gastroenterologist recommending the medicine might not warn you of that side effect. We asked about environmental toxins and learned that heavy metals such as lead or arsenic can harm the kidneys along with other organs. We should make sure that the food we eat and the water we drink are not contaminated with such compounds. The Possible Benefits of Vitamin B Dr. Parikh has been studying how the kidneys respond to the B vitamin nicotinamide. The preliminary work he and his colleagues have done so far is promising. However, they have not conducted clinical trials to find out whether the vitamin could help people with early kidney disease. Because kidneys work so hard, they need a lot of energy to be produced by the mitochondria in their cells. Those mitochondria need NAD+ (nicotinamide adenine dinucleotide) to function at their best. Providing additional nicotinamide appears to help (Nature Reviews. Nephrology, Feb. 2020).  One to three grams a day appears to be safe and may be beneficial. Medications That Can Promote Kidney Health Some medicines initially developed for other conditions are proving to be helpful in treating kidney disease. In particular, these include diabetes drugs known as SGLT2 inhibitors like dapagliflozin (Farxiga) or empagliflozin (Jardiance). They help slow the decline of kidney function (New England Journal of Medicine, Nov. 4, 2022). GLP-1 agonists may also be familiar because they too are used to treat diabetes. Medications such as semaglutide (Ozempic, Rybelsus, Wegovy) and tirzepatide (Mounjaro, Zepbound) have made headlines as weight loss and diabetes meds, but they also can reduce the risk of kidney failure and other bad outcomes (Lancet. Diabetes & Endocrinology, Jan. 2025). The benefits of these types of drugs should give us hope that we can go from slowing the progression of kidney disease to stopping it in its tracks Taking Care of Your Kidneys We asked Dr. Parikh what we should be doing to care for our kidneys and keep them healthy. He urged us once again to know our numbers: most importantly, the numbers from the two tests we discussed, blood creatinine and urine protein. Other numbers that are important for kidney are our blood pressure and, for those with diabetes, HbA1c. In addition to paying attention to all those numbers, we need to embrace a lifestyle that will help keep them where they belong. That means following a heart-healthy diet, staying physically active and getting adequate sleep. This Week’s Guest Samir M. Parikh, M.D., FASN, is Professor of Internal Medicine and Pharmacology and Chair of Internal Medicine at the University of Texas Southwestern. He holds the Donald W. Seldin Distinguished Chair in Internal Medicine and the Ruth W. and Milton P. Levy, Sr., Chair in Molecular Nephrology. Dr. Samir Parikh, University of Texas Southwestern Listen to the Podcast The podcast of this program will be available Monday, August 10, 2026, after broadcast on Aug. 8. This week's podcast has additional information on a possible role for sodium bicarbonate (baking soda) for kidney function. We also discussed medical silos, and how that leads to gastroenterologists overlooking the kidney risks from PPIs. Also, what should prospective kidney donors consider? You can stream the show from this site and download the podcast for free. Download the mp3, or listen to the podcast on Apple Podcasts or Spotify.

Why Self-Insured Employers and Clinicians Keep Missing Each Other, With Suhas Gondi, MD. The Sleeping Giants of Healthcare: Why Employers and Clinicians Keep Missing Each Other. Episode 523. Dr. Suhas Gondi, MD, MBA, chief medical officer at Health Strategy and an attending physician at Massachusetts General Hospital, co-wrote a New England Journal of Medicine article — "A Sleeping Giant of Health Care Affordability—Self-Insured Employers" — because most clinicians, he found, have little idea a self-insured employer, not an insurance carrier, is the one actually paying for their patients' care. Talking with Stacey Richter, Dr. Gondi argues that self-insured employers and clinicians are both "sleeping giants," each holding real power over cost and access, who rarely communicate directly — leaving patients caught in the gap. WHAT YOU'LL LEARN ✅ Why Dr. Suhas Gondi and his NEJM co-author, Zirui Song, MD, PhD, wrote for clinicians who, they found, have little sense that a self-insured employer — not the carrier name on the card — actually pays for a patient's care ✅ How a GLP-1 prescription can get denied at the pharmacy counter even after a clinician verifies coverage, because the employer has quietly moved GLP-1 coverage exclusively through a single third-party prescribing and coaching vendor ✅ Why GLP-1 spending alone can push a self-insured employer's pharmacy costs up 9% to 20% in a year, and why the roughly eight-year payback period employers are counting on assumes patients stay adherent far longer than most actually do ✅ How oncology site-of-care steering — an employer declining to pay a roughly 40% premium for infusion at a hospital-owned center instead of a physician's office — can look to the patient and oncologist like a denied cancer drug ✅ Why Dr. Gondi says EHRs like Epic are built to optimize revenue for hospital-system customers, not to surface a lower-cost site of care for patients or plan sponsors ✅ Dr. Gondi's advice for closing the gap: clinicians and employers should communicate directly, especially before a coverage change lands on patients, rather than assuming direct contracting is the only fix WHY THIS MATTERS Roughly half to 60% of the US population has commercial insurance, and nearly three-quarters of large employers self-insure that coverage — yet most clinicians have no visibility into the plan-level decisions those employers make, and most employers have no channel to explain those decisions to the doctors whose patients are affected. Both sides, Dr. Gondi says, usually believe they're doing the right thing — covering the GLP-1, covering the cancer drug — and the patient still gets lost in between. Closing that gap doesn't require full direct contracting, he argues, just employers and local provider groups actually talking to each other before a coverage change lands on a patient, not after. MENTIONED IN THIS EPISODE Study: New England Journal of Medicine article, "A Sleeping Giant of Health Care Affordability—Self-Insured Employers," by Suhas Gondi, MD, MBA, and Zirui Song, MD, PhD EP406 with Lauren Vela: Apple Podcasts | Spotify | Other Apps EP519 with Lisa Rosenbaum, MD: Apple Podcasts | Spotify | Other Apps EP509 with Patrick Nelli: Apple Podcasts | Spotify | Other Apps EP494 with Sarah Emond: Apple Podcasts | Spotify | Other Apps EP501 with Ivana Krajcinovic, PhD: Apple Podcasts | Spotify | Other Apps EP468 with Matt McQuide: Apple Podcasts | Spotify | Other Apps Article: Acquired's episode on how Epic quietly powers American healthcare === LINKS ===

A new paper in the New England Journal of Medicine—written by two Canadian critical-care physicians and a Harvard Medical School bioethicist—asks whether the dead donor rule should be "reassessed" for MAiD patients. Specifically, it explores whether organs could be retrieved while a patient is sedated, unconscious, and still alive, with the organ retrieval itself becoming the cause of death.As reported by the National Post, the authors argue that requiring a formal declaration of death before organ retrieval may be "ethically arbitrary," and describe the proposal as "a Pareto improvement: no one would be made worse off."In this episode, we break down:- What the paper actually says, including its important caveats. The authors are not calling for the dead donor rule to be abandoned, no jurisdiction is currently considering this proposal, and they explicitly call for "open, transparent dialogue."- Why this proposal has unmistakable Canadian fingerprints. Canada now leads the world in organ donation after MAiD, with 41 cases in 2021 compared with 20 combined across Belgium, the Netherlands, and Spain. Since 2016, there have been more than 155 MAiD organ donors in Canada.- The five-minute "no-touch" protocol that currently separates death from organ retrieval, and why some researchers believe it should be reconsidered.- The objections from within the medical ethics community, including bioethicist Lainie Friedman Ross, who told NPR: "Which I think is murder."- The broader pattern: 2016 (terminal illness only), 2021 (terminal illness requirement removed), and March 2027 (mental illness eligibility). The phrase "No one is proposing that" has often meant "not yet published." This proposal is now published in one of the world's leading medical journals.I warned for years that euthanasia and organ donation were on a path toward convergence and was repeatedly told it was misinformation.Now, the discussion is appearing in a peer-reviewed medical journal.SOURCESSharon Kirkey, "'Death by organ donation': Doctors raise possibility of retrieving organs from MAID patients while they are still alive," National Post (July 23, 2026):https://unpublished.ca/news-feed-item/2026-07-23/death-by-organ-donation-doctors-raise-possibility-of-retrieving-organs"Contextualizing the Dead Donor Rule in an Era of Voluntary Euthanasia," New England Journal of Medicine:https://www.nejm.org/doi/full/10.1056/NEJMms2601611NPR – Lainie Friedman Ross interview:https://www.northcountrypublicradio.org/news/npr/nx-s1-5883714/a-new-proposal-for-organ-donation-sparks-concernCanadian Blood Services – Professional guidance on organ donation and MAiD:https://professionaleducation.blood.ca/en/organs-and-tissues/professional-guidance/deceased-donation-after-maidNational Post (prior reporting) – American recipient of a heart from an Ontario ALS patient who died by MAiD:https://ca.news.yahoo.com/american-man-gets-heart-38-110042532.htmlPRE-ORDERDo No Harm?: How the Healthcare Industry Legalized Murder (Skyhorse, March 2027)https://www.amazon.com/dp/151078893XBuy me a coffee! - https://buymeacoffee.com/kelsisherenDo No Harm? - https://www.amazon.com/dp/1683585763?ref_=cm_sw_r_ffobk_cp_ud_dp_SC8YGT87SPJ1VB8SAYP1Let's connect!Substack: https://substack.com/@kelsisherenRumble - https://rumble.com/user/TheKelsiSherenPerspectiveInstagram - https://www.instagram.com/thekelsisherenperspective?utm_source=ig_web_button_share_sheet&igsh=ZDNlZDc0MzIxNw%3D%3DX: https://x.com/KelsisherenSUPPORT OUR PEOPLE - - - - - - - - - - - -Ketone IQ- 30% off with code KELSI - https://ketone.com/KELSIGood Livin - 20% off with code KELSI - https://www.itsgoodlivin.com/?ref=KELSIBrass & Unity - 20% off with code UNITY - http://www.brassandunity.com

Cyclospora cases continue to climb in the U.S. but this isn't the first time we've had a multi-state outbreak linked to produce. Back in 1996, there was a major cyclospora outbreak across several states due to imported raspberries. It begs the question, have we learned anything from the past? Or are we repeating history all over again? This week hosts Chris Dall and Dr. Michael Osterholm focus on the cyclosporiasis outbreak, from the latest numbers, to how state and federal officials, as well as the media, have handled it all. They'll break down the latest epidemiologic data and discuss how this response compares to a multi-state outbreak in 1996. Dr. Osterholm also talks about the latest on Ebola in the DRC, the measles outbreaks across the U.S. and a potential uptick in COVID-19 cases.   Links:An Outbreak in 1996 of Cyclosporiasis Associated with Imported Raspberries (The New England Journal of Medicine) When People Got Sick: Cyclospora Outbreak, July 2026 (CDC) The Cyclospora outbreak was, and still is, a communications failure (CIDRAP)  Resources for vaccine and public health advocacy: Voices for Vaccines Families Fighting Flu Vaccinate Your Family Shot@Life Medical Reserve Corps Learn more about the Vaccine Integrity Project MORE EPISODES       SUPPORT THIS PODCAST   Music: "Beauty Flow" Kevin MacLeod (incompetech.com)Licensed under Creative Commons: By Attribution 4.0 License

For decades, we've been told that eating less fat is one of the healthiest things we can do. That advice reshaped the foods we buy, the way we think about weight loss, and even how parents feed their children.But what if we misunderstood fat in the first place?In this episode, nutrition researcher Dr. Arne Astrup traces how the war on fat began, why many of its core assumptions haven't held up under decades of research, and what we've learned instead. Rather than asking whether fat is "good" or "bad," he argues that the more useful questions are: What foods actually keep us healthy? Why do some people gain weight more easily than others? And what happens when we reduce nutrition to single nutrients instead of whole foods?Free course: Improve your metabolic healthGet our free email course on how glucose, nutrition, exercise, sleep, and measurement can help you build habits that support better energy and long-term health: ⁠⁠⁠⁠⁠⁠⁠https://levels.link/wnl⁠

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/Substackhttps://substack.com/@theoccultrejects?r=7auau0&utm_campaign=profile&utm_medium=profile-pageCash Apphttps://cash.app/$theoccultrejectsVenmo@TheOccultRejectsBuy Me A Coffeebuymeacoffee.com/TheOccultRejectsPatreonhttps://www.patreon.com/TheOccultRejectsCore Sleep Paralysis ScienceSharpless, Brian A., and Jacques P. Barber. “Lifetime Prevalence Rates of Sleep Paralysis: A Systematic Review.” Sleep Medicine Reviews 15, no. 5 (2011): 311–315.Sharpless, Brian A. “A Clinician's Guide to Recurrent Isolated Sleep Paralysis.” Neuropsychiatric Disease and Treatment 12 (2016): 1761–1767.Cheyne, J. Allan, Steve D. Rueffer, and Ian R. Newby-Clark. “Hypnagogic and Hypnopompic Hallucinations during Sleep Paralysis: Neurological and Cultural Construction of the Night-Mare.” Consciousness and Cognition 8, no. 3 (1999): 319–337.Cheyne, J. Allan. “Sleep Paralysis and the Structure of Waking-Nightmare Hallucinations.” Dreaming 13, no. 3 (2003): 163–179.Cheyne, J. Allan. “Situational Factors Affecting Sleep Paralysis and Associated Hallucinations: Position and Timing Effects.” Journal of Sleep Research 11, no. 2 (2002): 169–177.Solomonova, Elizaveta. “Sleep Paralysis: Phenomenology, Neurophysiology and Treatment.” In The Oxford Handbook of Spontaneous Thought: Mind-Wandering, Creativity, and Dreaming, edited by Kieran C. R. Fox and Kalina Christoff. Oxford University Press, 2018.Baland Jalal / Panic-Hallucination / TreatmentJalal, Baland. “How to Make the Ghosts in My Bedroom Disappear? Focused-Attention Meditation Combined with Muscle Relaxation (MR Therapy): A Direct Treatment Intervention for Sleep Paralysis.” Frontiers in Psychology 7 (2016): 28. doi:10.3389/fpsyg.2016.00028.Jalal, Baland, and V. S. Ramachandran. “Sleep Paralysis and ‘The Bedroom Intruder': The Role of the Right Superior Parietal, Phantom Pain and Body Image Projection.” Medical Hypotheses 83, no. 6 (2014): 755–757.Jalal, Baland. “The Neuropharmacology of Sleep Paralysis Hallucinations: Serotonin 2A Activation and a Novel Therapeutic Drug.” Psychopharmacology 235, no. 11 (2018): 3083–3091.Jalal, Baland, Lucia Moruzzi, Andrea Zangrandi, Matteo Filardi, Claudio Franceschini, Fabio Pizza, et al. “Meditation-Relaxation (MR Therapy) for Sleep Paralysis: A Pilot Study in Patients with Narcolepsy.” Frontiers in Neurology 11 (2020): 922. doi:10.3389/fneur.2020.00922.Folklore, Myth, and the Old HagHufford, David J. The Terror That Comes in the Night: An Experience-Centered Study of Supernatural Assault Traditions. Philadelphia: University of Pennsylvania Press, 1982.Hufford, David J. “Sleep Paralysis as Spiritual Experience.” Transcultural Psychiatry 42, no. 1 (2005): 11–45.Adler, Shelley R. Sleep Paralysis: Night-mares, Nocebos, and the Mind-Body Connection. New Brunswick: Rutgers University Press, 2011.Davies, Owen. “The Nightmare Experience, Sleep Paralysis, and Witchcraft Accusations.” Folklore 114, no. 2 (2003): 181–203.Bond, John. An Essay on the Incubus, or Nightmare. London: Printed for D. Wilson and T. Durham, 1753.Golzari, Samad E. J., et al. “Sleep Paralysis in Medieval Persia — The Hidayat of Akhawayni (?–983 AD).” Neuropsychiatric Disease and Treatment 8 (2012): 229–234.Cross-Cultural Sleep ParalysisHinton, Devon E., Vuth Pich, Dara Chhean, and Mark H. Pollack. “‘The Ghost Pushes You Down': Sleep Paralysis-Type Panic Attacks in a Khmer Refugee Population.” Transcultural Psychiatry 42, no. 1 (2005): 46–77.Hinton, Devon E., Vuth Pich, Dara Chhean, Mark H. Pollack, and Richard J. McNally. “Sleep Paralysis among Cambodian Refugees: Association with PTSD Diagnosis and Severity.” Depression and Anxiety 22, no. 2 (2005): 47–51.Jalal, Baland, and Devon E. Hinton. “Rates and Characteristics of Sleep Paralysis in the General Population of Denmark and Egypt.” Culture, Medicine, and Psychiatry 37, no. 3 (2013): 534–548.Jalal, Baland, Joseph Simons-Rudolph, Bamo Jalal, and Devon E. Hinton. “Explanations of Sleep Paralysis among Egyptian College Students and the General Population in Egypt and Denmark.” Transcultural Psychiatry 51, no. 2 (2014): 158–175.Jalal, Baland, Andrea Romanelli, and Devon E. Hinton. “Cultural Explanations of Sleep Paralysis in Italy: The Pandafeche Attack and Associated Supernatural Beliefs.” Culture, Medicine, and Psychiatry 39, no. 4 (2015): 651–664.Olunu, Esther, Ruth Kimo, Esther Olufunmbi Onigbinde, Mary-Amadeus Uduak Akpanobong, and Inyene Ezekiel Enang. “Sleep Paralysis, a Medical Condition with a Diverse Cultural Interpretation.” International Journal of Applied and Basic Medical Research 8, no. 3 (2018): 137–142.Sensed Presence / Body Map / Shadow Person NeuroscienceArzy, Shahar, Margitta Seeck, Stephanie Ortigue, Laurent Spinelli, and Olaf Blanke. “Induction of an Illusory Shadow Person.” Nature 443 (2006): 287.Blanke, Olaf, Stephanie Ortigue, Theodor Landis, and Margitta Seeck. “Stimulating Illusory Own-Body Perceptions.” Nature 419 (2002): 269–270.Blanke, Olaf, Theodor Landis, Laurent Spinelli, and Margitta Seeck. “Out-of-Body Experience and Autoscopy of Neurological Origin.” Brain 127, no. 2 (2004): 243–258.Ionta, Silvio, Lukas Heydrich, Bigna Lenggenhager, Michael Mouthon, Eleonora Fornari, Dominique Chapuis, Roger Gassert, and Olaf Blanke. “Multisensory Mechanisms in Temporo-Parietal Cortex Support Self-Location and First-Person Perspective.” Neuron 70, no. 2 (2011): 363–374.Blanke, Olaf, Polona Pozeg, Masayuki Hara, Lukas Heydrich, Andrea Serino, Akio Yamamoto, Toshiro Higuchi, et al. “Neurological and Robot-Controlled Induction of an Apparition.” Current Biology 24, no. 22 (2014): 2681–2686.Alien Abduction / Modern Mythic MaskMcNally, Richard J., and Susan A. Clancy. “Sleep Paralysis, Sexual Abuse, and Space Alien Abduction.” Transcultural Psychiatry 42, no. 1 (2005): 113–122.Clancy, Susan A. Abducted: How People Come to Believe They Were Kidnapped by Aliens. Cambridge, MA: Harvard University Press, 2005.Blackmore, Susan. “Abduction by Aliens or Sleep Paralysis?” Skeptical Inquirer 22, no. 3 (1998): 23–28.Clinical Sleep / Narcolepsy / REM BackgroundAmerican Academy of Sleep Medicine. International Classification of Sleep Disorders. 3rd ed., text revision. Darien, IL: American Academy of Sleep Medicine, 2023.Scammell, Thomas E. “Narcolepsy.” New England Journal of Medicine 373, no. 27 (2015): 2654–2662.Saper, Clifford B., Patrick M. Fuller, Nigel P. Pedersen, Jun Lu, and Thomas E. Scammell. “Sleep State Switching.” Neuron 68, no. 6 (2010): 1023–1042.Brooks, Patricia L., and John H. Peever. “Identification of the Transmitter and Receptor Mechanisms Responsible for REM Sleep Paralysis.” Journal of Neuroscience 32, no. 29 (2012): 9785–9795.Avidan, Alon Y., and Phyllis C. Zee, eds. Handbook of Sleep Medicine. Philadelphia: Lippincott Williams & Wilkins, 2011.Visual / Art HistoryFuseli, Henry. The Nightmare. 1781. Oil on canvas. Detroit Institute of Arts.Myrone, Martin. Gothic Nightmares: Fuseli, Blake and the Romantic Imagination. London: Tate Publishing, 2006.Powell, Nicolas. Fuseli: The Nightmare. London: Allen Lane, 1973.Also 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 landmark international trial published in the New England Journal of Medicine evaluated whether fluid type impacts patient outcomes.

Ready to go deeper? Join the free masterclass and learn the full 5-stage framework: https://www.amenkaur.com/masterclassEver feel like you're moving through molasses, giving maximum effort for minimal output? This episode unpacks the 8% Battery Rule, a simple way to understand why high-achievers hit sudden walls of exhaustion, and the exact signals your nervous system sends before, during, and after a shutdown.In this episode: Why cortisol isn't the villain it's made out to be, and what its natural daily rhythm should look like. How a "flat" stress curve is actually a sign of chronic overload, not calm. Why your recovery speed after a hard day is a better resilience signal than how you feel in the moment. The hidden cost of suppressing grief, anger, and shame while you're "too busy" to feel them. A simple weekly practice for identifying what's quietly draining your energy.Who this is for: high-achievers, entrepreneurs, and high-functioning professionals who keep pushing through exhaustion and want the biological reason their body keeps shutting down, plus a practical way to reverse it.Frequently asked questions: What is the 8% Battery Rule? It describes the tipping point where the nervous system shifts from functioning under pressure into a protective shutdown, often mistaken for laziness or burnout. Why do high-achievers experience sudden shutdowns? They tend to override early stress signals to keep performing, which pushes the body into functional freeze instead of allowing normal recovery. How do I know if my nervous system is recovering? Faster bounce-back time after a hard day is one of the clearest signs your range and resilience are returning.The science behind this episodeThis episode is science-led. Here are the studies behind each claim, in the order they come up.On the cortisol curve flattening under chronic stress: Adam, E. K., Quinn, M. E., Tavernier, R., McQuillan, M. T., Dahlke, K. A., & Gilbert, K. E. (2017). Diurnal cortisol slopes and mental and physical health outcomes: A systematic review and meta-analysis. Psychoneuroendocrinology, 83, 25–41. https://doi.org/10.1016/j.psyneuen.2017.05.018On stress shifting the brain from its slower regulating systems to faster threat-driven ones: Arnsten, A. F. T. (2009). Stress signalling pathways that impair prefrontal cortex structure and function. Nature Reviews Neuroscience, 10(6), 410–422. https://doi.org/10.1038/nrn2648On why the stress response keeps running as long as you keep thinking about the stressor (the "open tabs"): Brosschot, J. F., Gerin, W., & Thayer, J. F. (2006). The perseverative cognition hypothesis: A review of worry, prolonged stress-related physiological activation, and health. Journal of Psychosomatic Research, 60(2), 113–124. https://doi.org/10.1016/j.jpsychores.2005.06.074On allostatic load — the cumulative cost carried across the body's systems: McEwen, B. S. (1998). Protective and damaging effects of stress mediators. New England Journal of Medicine, 338(3), 171–179. https://doi.org/10.1056/NEJM199801153380307A note on the science: These findings describe patterns across large groups of people, not a diagnosis of any individual. The associations are real and consistent, but they're modest in size — which is exactly why nothing in this episode can tell you what's happening in your own body. If you're worried about your symptoms, please see your doctor.Keywords: functional freeze, nervous system shutdown, high functioning anxiety, burnout recovery, why am i so tired, chronic stress, nervous system regulation, cortisol, emotional exhaustion, high achieving women, cant start things, task paralysis, freeze response, allostatic load, HRV, rest and recovery, overwhelm, stress and the body

There is a narrative circulating loudly in certain corners of social media and conventional medicine that what I do is not evidence-based. That functional medicine is supplement selling. That the testing is not validated. That providers like me are operating outside the bounds of legitimate medicine.I want to address that directly. Not because I am interested in a fight. But because the women listening to this deserve to feel certain about the care they are choosing. They deserve not to be destabilized by a confident-sounding voice that has not done the research.This episode is for you. And I am coming with receipts.Inside this episode, we cover:What evidence-based medicine actually means by definition, and why most people using it as a weapon are working with an incomplete version of itWhy the randomized controlled trial is the right tool for certain questions and the wrong tool for others, and what that distinction actually means for root cause medicineWhere the peer-reviewed research supporting functional medicine actually lives: the New England Journal of Medicine, Nature, The Lancet, Frontiers in EndocrinologyThe documented blind spots in conventional medical training: four hours or less of nutritional education across an entire medical school curriculumWhy the Women's Health Initiative may be the single greatest tragedy in women's healthcare, and what has changed in the decades sinceThe supplement accusation: what is true, what is misleading, and what the foundation of functional medicine is actually built onWhy the tests I use are not invented by functional medicine, and what the science actually says about cortisol curves, fasting insulin, comprehensive stool analysis, and full thyroid panelsThe story of a patient who came to me skeptical, and what the data said six months laterWhy the patient getting better is evidence, and why dismissing reproducible clinical outcomes as anecdote is a rhetorical position, not a scientific oneConventional medicine saves lives. Functional medicine restores them. Both of these things are true. And the women who need the second one deserve to pursue it without apology.You are not required to defend your healthcare choices to people who have not examined the research, have not sat with the patients, and have not followed the outcomes. The evidence exists. The research is in the journals. And the medicine that is actually restoring function in women who spent years being managed without being healed deserves to be chosen with confidence.Share this episode with one woman who has been made to second-guess the care that is actually working for her. She deserves the language to stand in it.Your next steps are below:✨ Free Guide: 9 Hidden Signs Your Metabolism Is Stuck in Survival Mode www.drkaceywallace.com/hiddenmetabolicmess✨ Adrenal Optimization Test (see your cortisol rhythm + DHEA clearly) www.drkaceywallace.com/innercalm✨ Hair Tissue Mineral Analysis www.drkaceywallace.com/htma✨ The Anchored Journey (application) www.drkaceywallace.com✨ Get the book: You Are Not Fine www.youarenotfine.com✨ Get our weekly newsletter: Dr. Kacey's Cornerwww.drkaceywallace.com/newslettersignupSupport the show

John Gerardi is joined by Jonathan Keller of California Family Council to unpack the disturbing expansion of Canada's euthanasia program, from proposals to euthanize infants with disabilities to recommendations that minors consent to their own deaths without parental input. This week's mystery clip reveals just how far the MAID program has gone, with roughly half of 2024 recipients citing feeling like a burden rather than terminal illness. The guys then break down how activists quietly corrupt language, sliding from physician assisted suicide to medical assistance in dying to simply assisted death, and why that shift matters. Finally, they take on a New England Journal of Medicine article arguing to contextualize the dead donor rule, a euphemism for harvesting organs from euthanasia patients before death, and explain why the slippery slope keeps proving pro-lifers right.

Reference:  Denninghoff KR et al. Azithromycin for Preschoolers with Wheezing in the Emergency Department. New England Journal of Medicine. May 2026 Date: July 14, 2026 Guest Skeptic: Dr. Zara Ibrahim is a pediatric emergency medicine fellow at Children's National Hospital in Washington DC where she also completed medical school, pediatric residency. Her research interests include […] The post SGEM#515: Now the Azithromycin Don't Work for Preschool Wheeze first appeared on The Skeptics Guide to Emergency Medicine.

Like tens of millions of people, Stephen Dubner thought he had a penicillin allergy. Like the vast majority, he didn't. This misdiagnosis costs billions of dollars and causes serious health problems, so why hasn't it been fixed? We find out in this update of a 2025 episode.   SOURCES: Kimberly Blumenthal, allergist-immunologist and researcher at the Mayo Clinic. Theresa MacPhail, associate professor of science and technology studies at Stevens Institute of Technology. Thomas Platts-Mills, professor of medicine at the University of Virginia. Elena Resnick, allergist and immunologist at Mount Sinai Hospital.   RESOURCES: Allergic: Our Irritated Bodies in a Changing World, by Theresa MacPhail (2023). "Evaluation and Management of Penicillin Allergy: A Review," by Erica S. Shenoy, Eric Macy, and Theresa Rowe (JAMA, 2019). "The Allergy Epidemics: 1870–2010," by Thomas Platts-Mills (The Journal of Allergy and Clinical Immunology, 2016). "Randomized Trial of Peanut Consumption in Infants at Risk for Peanut Allergy," by George Du Toit, Graham Roberts, et al. (The New England Journal of Medicine, 2015).   EXTRAS: "The Freakonomics Radio Guide to Getting Better," series by Freakonomics Radio (2026). "Doctors Know They Prescribe Too Many Antibiotics. Why Don't They Stop?" by Freakonomics, M.D. (2022). Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

This article is for educational purposes only and is not a substitute for individualized medical advice. Always talk to your own healthcare provider before changing your diet, supplements, or medications.Unlocking the Secrets of Ferritin: What Your Iron Levels Are Telling YouYour “normal” bloodwork might be hiding the real reason you're exhausted, foggy, and losing hairTL;DR: * Ferritin is your iron savings account — and most labs only flag it as “abnormal” once it's nearly empty. * A level of 14 or 22 ng/mL might get a “you're fine” from your doctor, but optimal energy, mood, cognition, and hair growth usually need ferritin closer to 70–100 ng/mL. * Low ferritin can come from menstrual blood loss, poor absorption (celiac disease, low stomach acid, H. pylori), or inflammation-driven hepcidin blocking iron uptake.* If you're fatigued, foggy, cold, or shedding hair, ask for a full iron panel — not just a ferritin number — and talk through the results with your doctor.There's an old Japanese proverb: “When the body speaks, the wise person listens. When the body whispers, the fool waits for it to scream.” In health diagnostics, one of the quietest whispers is your ferritin level. It's often overlooked, yet it can be the missing link behind exhaustion, hair loss, brain fog, or the frustrating experience of bloodwork that comes back “normal” while you still feel terrible.What Is Ferritin?Ferritin is your body's iron storage protein. Think of your iron levels like a financial setup: hemoglobin is your checking account, drawn on daily. Ferritin is your savings account, tapped only when things get tight. Under stress, your body will drain the savings account long before it lets the checking account — hemoglobin — run low. That's why you can have “normal” hemoglobin and still be iron-depleted. A low ferritin level means your reserves are running out, and that shows up as fatigue, brain fog, mood changes, and thinning hair.Normal vs. OptimalMost labs flag ferritin as “normal” above roughly 10–20 ng/mL. That threshold mostly means you're not in immediate danger — not that you're thriving. Levels associated with feeling genuinely well tend to run from 70 to 100 ng/mL. So if you've been told your ferritin of 14 or 22 is fine, but you still feel wiped out, you're not imagining it — you're just being measured against a bar set for avoiding crisis, not for feeling good.Why Your Ferritin Might Be Low* Menstrual blood loss. For many women, the cumulative loss over months and years outpaces dietary iron intake, slowly draining reserves.* Absorption issues. Even a solid iron intake doesn't help if it isn't absorbed. Silent celiac disease, low stomach acid, or an H. pylori infection can quietly block uptake for years.* Inhibitors and hepcidin. Coffee, tea, and dairy consumed close to meals can inhibit iron absorption. Separately, inflammation can push your liver to produce hepcidin, a hormone that shuts down iron uptake even when you're eating enough.Symptoms to WatchPersistent fatigue, thinning hair, feeling cold more easily than others, and brain fog are the classic signs. If two or more of these sound familiar, it's worth getting your ferritin checked specifically — not just assumed to be fine because your CBC looked normal.The Bigger PictureIron does far more than carry oxygen. It's involved in thyroid hormone conversion, dopamine production, mitochondrial energy synthesis, and hair follicle health. That means low ferritin can produce symptoms that look a lot like depression or hypothyroidism — even when your thyroid panel and mood screening come back clean.Taking Action* Review your bloodwork. Look specifically at ferritin. Anything under 70 ng/mL is worth a conversation with your doctor.* Ask for a full iron panel. Ferritin alone isn't the whole story — request serum iron, total iron binding capacity (TIBC), transferrin saturation, and CRP (to rule out inflammation skewing the picture).* Adjust absorption habits. Space coffee and tea away from meals, lean into iron-rich foods, and avoid taking calcium and iron supplements together.* Choose the right supplement, if needed. Ferrous sulfate is harsh on the gut for many people. Iron bisglycinate is gentler and pairs well with vitamin C for better absorption — but check with your provider before starting, especially if high ferritin is a concern.* Loop in a professional. This is especially important before making changes if you suspect elevated ferritin, since iron overload carries its own risks.Listening to Your Body's WhisperYour body is constantly sending signals. Ignored long enough, whispers become screams. Taking ferritin seriously — not just as a checkbox on a lab report, but as a meaningful marker — is one concrete way to catch a problem while it's still easy to fix.Final ThoughtsMonitoring and optimizing ferritin can meaningfully change how you feel day to day. It starts with a simple ask: get the right test, read the number in context, and act on what it's telling you. If you want a more personalized look at your own levels and symptoms, consider scheduling a comprehensive health session.Stay informed, stay healthy, and listen closely to what your body is telling you. Until next time, take care.References* Camaschella, C. (2015). Iron-deficiency anemia. New England Journal of Medicine.* WHO guidance on serum ferritin concentrations for the assessment of iron status.* Clinical literature on ferritin thresholds and symptomatic iron deficiency without anemia.* Hepcidin and inflammation's role in iron regulation — recent reviews in Blood and Haematologica. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit tripleplaydoc.substack.com/subscribe

Cognitive Atrophy, Referral Incentives, Fragmented Care: Is Primary Care Inevitable or Fixable? Episode 519. Primary care physicians are leaving traditional practice for concierge medicine in visible numbers—and the question is whether that exodus is an unavoidable consequence of how the system is built, or something we've simply chosen not to fix. Stacey Richter talks with Dr. Lisa Rosenbaum, a cardiologist at Beth Israel Deaconess Medical Center (BIDMC) and national correspondent for the New England Journal of Medicine, who recently devoted an entire season of her NEJM podcast, Not Otherwise Specified, to the state of primary care. Together they test three forces reshaping the field—cognitive atrophy, referral incentives, and care fragmentation—against a single question: inevitable, or fixable? WHAT YOU'LL LEARN ✅ Why Dr. Lisa Rosenbaum calls the risk of "cognitive atrophy" among primary care physicians a generational threat rather than an individual one—and why she believes it is not inevitable ✅ How financial incentives that pay far more for a specialist visit than a primary care visit (roughly 5% of healthcare dollars for close to 35% of outpatient visits) structurally push referrals earlier and more often than necessary ✅ Why "relational expertise"—the judgment a doctor builds by knowing a patient over time—is, in Dr. Rosenbaum's view, primary care's real and undervalued skill set ✅ How care fragmentation, illustrated by Miriam Paramore's LinkedIn essay about her father's end-of-life care, leaves patients bouncing among specialists with no one taking ownership of the whole picture ✅ Why Dr. Rosenbaum argues that blaming everything on structural constraints "strip[s] ourselves of our own agency," and what she thinks physicians and healthcare buyers should each do about it WHY THIS MATTERS Roughly 70% of physicians are employed today, and about 5% of every healthcare dollar goes to primary care despite it covering close to 35% of all outpatient visits—numbers that, per Dr. Rosenbaum, reflect choices the system has made, not laws of nature. When primary care doctors lose the time and incentive to build relationships with patients, the system loses its quarterback, and patients end up fragmented across specialists with no one accountable for the whole picture. Dr. Rosenbaum's core argument is that none of this is inevitable, but fixing it requires both structural change and individual physicians and healthcare buyers reclaiming their own agency. MENTIONED IN THIS EPISODE EP504 with Ryan Jacobs: Apple Podcasts | Spotify | Other Apps EP473 with Kenny Cole, MD: Apple Podcasts | Spotify Other Apps EP391 with Scott Conard, MD: Apple Podcasts | Spotify | Other Apps Article: "Ordinary Rural Death: My Father's End-of-Life Journey" by Miriam Paramore EP409 with Larry Bauer, MSW, MEd: Apple Podcasts | Spotify | Other Apps === LINKS ===

Get the 200+ Page Optimal Living Daily Workbook (PDF) — Free. Want to turn today's episode into an actionable plan? Join the Optimal Living Weekly newsletter and I'll send you our 200-page digital workbook immediately. It's packed with the best takeaways from the show, formatted for easy reading and implementation at home. Get your free PDF workbook here: ⁠https://oldpodcast.eo.page/join⁠ Discover all of the podcasts in our network, search for specific episodes and learn more at:⁠ OLDPodcast.com⁠. Episode 3453: Dr. Jenny Brockis explores the fine line between enjoying caffeine and becoming dependent on it, sharing her own experience of consuming too much tea and the surprising effects it had on her mood and anxiety levels. She also highlights the brain and longevity benefits associated with moderate caffeine intake, offering a balanced perspective on how to find the amount that works best for you. Read along with the original article(s) here: https://drjennybrockis.com/2014/2/3/could-you-be-addicted-to-caffeine/ Quotes to ponder: "It seems that caffeine can be good or bad for you depending on how much you consume on a daily basis. As Goldilocks discovered, it's about not having too much or too little, but just enough." "There are a number of health benefits to the brain that caffeine provides, but like most things, if we overdo it, we can run into trouble." "Certain plants (coffea and citrus) produce nectar that contains just a teensy bit of caffeine, but enough to enhance the honeybee's memory, making them more effective pollinators of those plants." Episode references: Nurses' Health Study: https://nurseshealthstudy.org/ The New England Journal of Medicine – Association of Coffee Drinking with Total and Cause-Specific Mortality: https://www.nejm.org/doi/full/10.1056/NEJMoa1112010 Learn more about your ad choices. Visit megaphone.fm/adchoices

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners.This episode covers the topic of grief with Dr. Cindy Grief, a Geriatric Psychiatrist at Baycrest Health Sciences in Toronto, where she is the Medical Director for Mental Health Services. She is also an Associate Professor at the University of Toronto and has played active roles in postgraduate and continuing education.The learning objectives for this episode are as followsExplain how acute grief becomes integrated over time, and how the dual process model helps us understand this adaptive process.Recognize the clinical features of Prolonged Grief Disorder, understand factors that may increase vulnerability, and distinguish it from trauma-related disorders and depression.Structure a bereavement-focused clinical history, differentiate the management of normative grief from Prolonged Grief Disorder, and approach suicide risk assessment in the context of grief.Guest: Dr. Cindy GriefHosts: Ahmad Khan (incoming PGY1), Dr. Angad Singh (PGY2), and Sara Abrahamson (MS3)Audio editing: Dr. Angad SinghResources:T⁠he Center for Prolonged Grief (https://prolongedgrief.columbia.edu/)Canadian Virtual Hospice  (MyGrief.ca)Association for Death Education and Counseling (https://adec.org)What's Your Grief (https://whatsyourgrief.com/)Podcasts: AllThere Is; Griefcast⁠⁠Books/Memoirs:Joan Didion, The Year of Magical ThinkingHelen Macdonald, H Is for HawkC.S. Lewis, A Grief ObservedChimamand Ngozi Adichie, Notes on GriefArticles:A.C. Shilton, “There Is No Vaccine for Grief,” New York Times, March 2, 2021M. Stroebe, “The Poetry of Grief: Beyond Scientific Portrayal,” OMEGA: Journal of Death and Dying, 2018, 78(1), 67–96References:Shear, K., Frank, E., Houck, P. R., & Reynolds, C. F., III. (2005). Treatment of complicated grief: A randomized controlled trial. Journal of the American Medical Association, 293(21), 2601–2608. https://doi.org/10.1001/jama.293.21.2601Simon, N. M., & Shear, M. K. (2024). Prolonged grief disorder. New England Journal of Medicine, 391(13), 1227–1236. https://doi.org/10.1056/NEJMcp2308707Zisook, S., & Shear, K. (2009). Grief and bereavement: What psychiatrists need to know. World Psychiatry, 8(2), 67–74. https://doi.org/10.1002/j.2051-5545.2009.tb00217.x

Contributor: Travis Barlock, MD Educational Pearls:   First-pass success is critical to limit complications from apnea, hypoxia, and airway trauma.  Complication rate for patients intubated on the first pass is 14% Complication rates increase to 47% after two attempts, 64% after three, and 71% after the fourth attempt   How to improve likelihood of first-pass success: Use Video laryngoscopy (VL). VL increases chance of first-pass success to 85% from 71% Use a bougie, especially in patients with anatomically difficult or otherwise obstructed airways. The BEAM study cites a success rate in these patients of 96% with a bougie, compared to 82% without Use a Checklist mnemonic (SOAPME) Suction – On, ready, and within reach Oxygen – Patient is preoxygenated Adjuncts – Oral/nasal adjuncts and BVM ready Positioning - Patient positioned properly; consider obesity, using semi-Fowler/head-up positioning Medications – Rapid sequence intubation (RSI), sedation, vasopressor, and other medications prepared as necessary Equipment – Laryngoscope (blade), tube, bougie/stylet, syringe, scalpel/cric kit, others ready as necessary References Sakles, J.C., Chiu, S., Mosier, J., Walker, C. and Stolz, U. (2013), The Importance of First Pass Success When Performing Orotracheal Intubation in the Emergency Department. Acad Emerg Med, 20: 71-78. https://doi.org/10.1111/acem.12055 Prekker ME, Driver BE, Trent SA, et al. Video versus Direct Laryngoscopy for Tracheal Intubation of Critically Ill Adults. New England Journal of Medicine. 2023;389(5). doi:https://doi.org/10.1056/nejmoa2301601 Driver BE, Prekker ME, Klein LR, et al. Effect of Use of a Bougie vs Endotracheal Tube and Stylet on First-Attempt Intubation Success Among Patients With Difficult Airways Undergoing Emergency Intubation: A Randomized Clinical Trial. JAMA. 2018;319(21):2179–2189. doi:10.1001/jama.2018.6496 ‌Turner JS, Bucca AW, Propst SL, et al. Association of Checklist Use in Endotracheal Intubation With Clinically Important Outcomes: A Systematic Review and Meta-analysis. JAMA Netw Open. 2020;3(7):e209278. doi:10.1001/jamanetworkopen.2020.9278 Turner, Joseph S et al. "Feasibility of  upright patient positioning and intubation success rates At two academic EDs." The American journal of emergency medicine vol. 35,7 (2017): 986-992. doi:10.1016/j.ajem.2017.02.011   Summarized by Sam Pahl | Edited by Sam Pahl & Ahmed Abdel-Hafiz, NREMT-P   Donate: https://emergencymedicalminute.org/donate/   Join our mailing list: http://eepurl.com/c9ouHf  

World-leading behaviour change expert Katy Milkman details how to change your habits.  --- Become an FSB member: https://get.fsb.org.uk/nudge/ Unlock the Nudge Vaults: https://www.nudgepodcast.com/vaults Katy's book: https://amzn.to/3RF63xA  Katy's podcast: https://www.schwab.com/learn/choiceology  Katy's newsletter: https://www.katymilkman.com/newsletter-milkman-delivers  Subscribe to my newsletter: https://www.nudgepodcast.com/mailing-list  Connect on LinkedIn: https://www.linkedin.com/in/phill-agnew/  --- Today's sources: Beshears, J.Beshears, J., Dai, H., Milkman, K. L., & Benartzi, S. (2021). Using fresh starts to nudge increased retirement savings. Organizational Behavior and Human Decision Processes, 167, 72–87. Dai, H., Milkman, K. L., & Riis, J. (2014). The fresh start effect: Temporal landmarks motivate aspirational behavior. Management Science, 60(10), 2563–2582. Eskreis-Winkler, L., Fishbach, A., & Duckworth, A. L. (2018). Dear Abby: Should I give advice or receive it? Psychological Science, 29(11), 1797–1806. Eskreis-Winkler, L., Milkman, K. L., Gromet, D. M., & Duckworth, A. L. (2019). A large-scale field experiment shows giving advice improves academic outcomes for the advisor. Proceedings of the National Academy of Sciences, 116(30), 14808–14810. Schroeder, S. A. (2007). We can do better — Improving the health of the American people. New England Journal of Medicine, 357(12), 1221–1228.

Your body has been talking to you your whole life. The question is whether anyone ever taught you to listen. In this episode, I want to widen the lens on how you read your own body. We have lost so much of the generational knowledge our mothers and grandmothers once passed down, and now we tend to wait until something hurts before we pay attention. But your body speaks in subtleties long before that. I share one of my great loves, Ayurveda, the 5,000-year-old healing system I studied for three years, and its practice of observation called the eightfold examination. What fascinates me most is how closely it aligns with modern functional nutrition's Nutrition Focused Physical Exam. We walk through what your tongue, skin, hair, nails, and eyes may be reflecting about your gut health, your nutrient status, your oxidative stress, and even your blood sugar, backed by research going back nearly 80 years. Here is what matters most. This is not about self-diagnosis. None of these signs are proof of anything on their own. They are invitations to pay attention, not verdicts to fear. My hope is that noticing your body builds confidence instead of anxiety, the quiet confidence of a woman in a loving conversation with her body rather than at war with it. If you take one small thing from this episode, try this. Tomorrow morning, look at your tongue and just notice. Do it for a week. That is the practice.   Resources Mentioned: Work with Laura: https://www.thebreastcancerrecoverycoach.com/health  Download for iPhone:  https://apps.apple.com/us/app/kajabi/id1485646310 Download for Android:  https://play.google.com/store/apps/details?id=kajabi.kajabiapp&hl=en_US Here is the link to the FREE Ayurveda Mini-Course that I talked about in this episode: https://www.thebreastcancerrecoverycoach.com/mybody   Here are the references: Foundational Asif T, Mohiuddin A, Hasan B, Pauly RR. Importance of Thorough Physical Examination: A Lost Art. Cureus. 2017;9(5):e1212. Newton C. The Functional Nutrition-Focused Physical Exam. IFNA Track 3 Module 2. Tongue Jeghers H. Nutrition: the appearance of the tongue as an index of nutritional deficiency. New England Journal of Medicine. 1942;227:221-8. Khayamzadeh M, Najafi S, Sadrolodabaei P, Vakili F, Kharrazi Fard MJ. Determining salivary and serum levels of iron, zinc and vitamin B12 in patients with geographic tongue. J Dent Res Dent Clin Dent Prospects. 2019;13(3):221-226. Chiang CP, Chang JY, Wang YP, Wu YH, Wu YC, Sun A. Atrophic glossitis: Etiology, serum autoantibodies, anemia, hematinic deficiencies, hyperhomocysteinemia, and management. J Formos Med Assoc. 2020;119(4):774-780. Skin Salem I, Ramser A, Isham N, Ghannoum MA. The Gut Microbiome as a Major Regulator of the Gut-Skin Axis. Front Microbiol. 2018;9:1459. Wang X, Li Y, Wu L, et al. Dysregulation of the gut-brain-skin axis and key overlapping inflammatory and immune mechanisms of psoriasis and depression. Biomed Pharmacother. 2021;137:111065. Jafferany M, Franca K. Psychodermatology: Basics Concepts. Acta Derm Venereol. 2016;96(217):35-7. Reunala T, Salmi TT, Hervonen K, Kaukinen K, Collin P. Dermatitis Herpetiformis: A Common Extraintestinal Manifestation of Coeliac Disease. Nutrients. 2018;10(5):602. Stefanadi EC, Dimitrakakis G, Antoniou CK, et al. Metabolic syndrome and the skin: a more than superficial association. Diabetol Metab Syndr. 2018;10:9. Hair O'Connor K, Goldberg LJ. Nutrition and hair. Clin Dermatol. 2021;39(5):809-818. Arck PC, Overall R, Spatz K, et al. Towards a "free radical theory of graying": melanocyte apoptosis in the aging human hair follicle is an indicator of oxidative stress induced tissue damage. FASEB J. 2006;20(9):1567-9. Zhang B, Ma S, Rachmin I, et al. Hyperactivation of sympathetic nerves drives depletion of melanocyte stem cells. Nature. 2020;577(7792):676-681. Poonia K, Bhalla M. Premature Graying of Hair: A Comprehensive Review and Recent Insights. Indian Dermatol Online J. 2024;15(5):721-731. Nails Singal A, Arora R. Nail as a window of systemic diseases. Indian Dermatol Online J. 2015;6(2):67-74. Cashman MW, Sloan SB. Nutrition and nail disease. Clin Dermatol. 2010;28(4):420-5. Eyes Knapp A. The Eye as a Guide to Latent Nutritional Deficiency Diseases. Bull N Y Acad Med. 1946. Wakamatsu TH, Dogru M, Tsubota K. Tearful relations: oxidative stress, inflammation and eye diseases. Arq Bras Oftalmol. 2008;71(6 Suppl):72-9. Seydou A, Arnould L, Gabrielle PH, et al. Plasma Fatty Acids Pattern and Dry Eye Disease in the Elderly: The Montrachet Population-Based Study. Nutrients. 2022;14(11):2290. Bu Y, Shih KC, Tong L. The ocular surface and diabetes, the other 21st Century epidemic. Exp Eye Res. 2022;220:109099. Rahman A, Yahya K, Ahmed T, Sharif-Ul-Hasan K. Diagnostic value of tear films tests in type 2 diabetes. J Pak Med Assoc. 2007;57(12):577-81. Seifart U, Strempel I. Trockenes Auge und Diabetes mellitus [The dry eye and diabetes mellitus]. Ophthalmologe. 1994;91(2):235-9. Campagnoli LIM, Varesi A, Barbieri A, Marchesi N, Pascale A. Targeting the Gut-Eye Axis: An Emerging Strategy to Face Ocular Diseases. Int J Mol Sci. 2023;24(17):13338. Let's Connect! If this episode helped you breathe a little easier, please share it with a friend or leave a review. Every share helps spread this message of hope, healing, and whole-person wellness.

────────────────────────────────────────[00:02:09]Trump Unilaterally Rewrites the MOU — Demands Iran Spend Frozen Funds Only on US Farm GoodsPoint 11 of the signed MOU says funds are released without conditions; Trump invented the escrow-for-American-corn clause after Kushner pressed him.────────────────────────────────────────[00:05:00]Senate Votes to Halt the Iran War — Resolution Has No Force of Law, White House Dismisses ItPassed 50-48; does not go to the president for signature or veto; four Republicans broke ranks including Rand Paul and Bill Cassidy.────────────────────────────────────────[00:10:18]Ben Gvir: All of Lebanon Must Be Our Playground — For Every Israeli Tear, a Thousand Lebanese Must WeepIsraeli finance minister refuses any restriction on Lebanese territory and demands it all burn; Netanyahu confirmed forces are not leaving.────────────────────────────────────────[00:46:01]Rand Paul's Wife Bought Gilead Stock During Remdesivir Push — Knight Says He Has No Credibility on FauciFauci declared remdesivir standard of care one day after a WHO trial showed it ineffective; Paul's wife held Gilead shares throughout.────────────────────────────────────────[00:47:41]Trump Orders Ford and GM to Make Bombs Instead of Cars — Same Defense Production Act Used for VentilatorsKnight: they don't want people to have independent transportation; commandeering auto production is the same playbook used in 2020.────────────────────────────────────────[00:56:37]VA Study Claims COVID Vaccine Lowers Cardiac Risk — Knight: They Caused the Heart Disease and Now Claim the CureSeven children confirmed dead from the jabs per FDA data; New England Journal of Medicine ex-editor said the journal lost all credibility.────────────────────────────────────────[01:29:16]Tulsi Gabbard's Entire Career Was Guided by a Hare Krishna Cult Leader Named Chris ButlerYear-long Washington Post investigation; former cult members handed over internal records showing Butler shaped her public decisions.────────────────────────────────────────[01:43:44]Ben Gvir Repeats: All of Lebanon Must Burn — No Distinction Between Hezbollah and Lebanese CiviliansSame doctrine applied in Gaza; Knesset member adds they want to drag Hamas leaders across Gaza in front of cameras before prison.────────────────────────────────────────[01:47:00]Jared Kushner Invented the Escrow-for-Farm-Goods Clause — JD Vance Selling It as a Trump DealMOU says nothing about escrow or American goods; Kushner and Qataris fabricated it after signing; Vance repeating the lie publicly.────────────────────────────────────────[01:51:28]Zionist Lobbyist Brags About Sanctioning UN Rapporteur Albanese, Freezing Her Bank Accounts, Demoting Her HusbandAfter boasting of controlling Albanese's finances and barring her from the US, lobbyist Hillel Neuer insists the Jewish lobby does not control America. ──────────────────────────────────────── Money should have intrinsic value AND transactional privacy: Go to https://davidknight.gold/ for great deals on physical gold/silver For 10% off Gerald Celente's prescient Trends Journal, go to https://trendsjournal.com/ and enter the code “KNIGHT” For high quality made in America products go to HomeSteadProducts.shop and use promo code “Knight” for 10% off your purchases Find out more about the show and where you can watch it at TheDavidKnightShow.com If you would like to support the show and our family please consider subscribing monthly here: SubscribeStar https://www.subscribestar.com/the-david-knight-show Or you can send a donation throughMail: David Knight POB 994 Kodak, TN 37764Zelle: @DavidKnightShow@protonmail.comCash App at: $davidknightshowBTC to: bc1qkuec29hkuye4xse9unh7nptvu3y9qmv24vanh7Become a supporter of this podcast: https://www.spreaker.com/podcast/the-david-knight-show--2653468/support.

────────────────────────────────────────[00:02:09]Trump Unilaterally Rewrites the MOU — Demands Iran Spend Frozen Funds Only on US Farm GoodsPoint 11 of the signed MOU says funds are released without conditions; Trump invented the escrow-for-American-corn clause after Kushner pressed him.────────────────────────────────────────[00:05:00]Senate Votes to Halt the Iran War — Resolution Has No Force of Law, White House Dismisses ItPassed 50-48; does not go to the president for signature or veto; four Republicans broke ranks including Rand Paul and Bill Cassidy.────────────────────────────────────────[00:10:18]Ben Gvir: All of Lebanon Must Be Our Playground — For Every Israeli Tear, a Thousand Lebanese Must WeepIsraeli finance minister refuses any restriction on Lebanese territory and demands it all burn; Netanyahu confirmed forces are not leaving.────────────────────────────────────────[00:46:01]Rand Paul's Wife Bought Gilead Stock During Remdesivir Push — Knight Says He Has No Credibility on FauciFauci declared remdesivir standard of care one day after a WHO trial showed it ineffective; Paul's wife held Gilead shares throughout.────────────────────────────────────────[00:47:41]Trump Orders Ford and GM to Make Bombs Instead of Cars — Same Defense Production Act Used for VentilatorsKnight: they don't want people to have independent transportation; commandeering auto production is the same playbook used in 2020.────────────────────────────────────────[00:56:37]VA Study Claims COVID Vaccine Lowers Cardiac Risk — Knight: They Caused the Heart Disease and Now Claim the CureSeven children confirmed dead from the jabs per FDA data; New England Journal of Medicine ex-editor said the journal lost all credibility.────────────────────────────────────────[01:29:16]Tulsi Gabbard's Entire Career Was Guided by a Hare Krishna Cult Leader Named Chris ButlerYear-long Washington Post investigation; former cult members handed over internal records showing Butler shaped her public decisions.────────────────────────────────────────[01:43:44]Ben Gvir Repeats: All of Lebanon Must Burn — No Distinction Between Hezbollah and Lebanese CiviliansSame doctrine applied in Gaza; Knesset member adds they want to drag Hamas leaders across Gaza in front of cameras before prison.────────────────────────────────────────[01:47:00]Jared Kushner Invented the Escrow-for-Farm-Goods Clause — JD Vance Selling It as a Trump DealMOU says nothing about escrow or American goods; Kushner and Qataris fabricated it after signing; Vance repeating the lie publicly.────────────────────────────────────────[01:51:28]Zionist Lobbyist Brags About Sanctioning UN Rapporteur Albanese, Freezing Her Bank Accounts, Demoting Her HusbandAfter boasting of controlling Albanese's finances and barring her from the US, lobbyist Hillel Neuer insists the Jewish lobby does not control America. ──────────────────────────────────────── Money should have intrinsic value AND transactional privacy: Go to https://davidknight.gold/ for great deals on physical gold/silver For 10% off Gerald Celente's prescient Trends Journal, go to https://trendsjournal.com/ and enter the code “KNIGHT” For high quality made in America products go to HomeSteadProducts.shop and use promo code “Knight” for 10% off your purchases Find out more about the show and where you can watch it at TheDavidKnightShow.com If you would like to support the show and our family please consider subscribing monthly here: SubscribeStar https://www.subscribestar.com/the-david-knight-show Or you can send a donation throughMail: David Knight POB 994 Kodak, TN 37764Zelle: @DavidKnightShow@protonmail.comCash App at: $davidknightshowBTC to: bc1qkuec29hkuye4xse9unh7nptvu3y9qmv24vanh7Become a supporter of this podcast: https://www.spreaker.com/podcast/the-real-david-knight-show--5282736/support.

CardioNerds (Amit and Dan), Billy Joe Mullinax, and Saahil Jumkhawala discuss the long term management of pulmonary embolism with Dr. Soophia Naydenov.  The episode focuses on the approach to patients who struggle with persistent symptoms like dyspnea and fatigue even after completing the acute phase of anticoagulation. This spectrum of disease, ranging from mild post-PE impairment to chronic thromboembolic pulmonary hypertension (CTEPH), requires a structured follow-up. The discussion covers the critical importance of identifying CTEPH early, the necessary timelines for follow-up, and the appropriate objective screening tools and invasive testing to guide patient care toward full functional recovery. Audio editing by CardioNerds academy intern, Grace Qiu. Dr. Dinu Balanescu and Dr. Billy-Joe Mullinax are Co-chairs for the CardioNerds PE Series, developed in collaboration with the PERT Consortium.   Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. CardioNerds Pulmonary Embolism PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Acronyms PE: Pulmonary Embolism PERT: Pulmonary Embolism Response Team CTEPH: Chronic Thromboembolic Pulmonary Hypertension QL: Quality of Life VTE: Venous Thromboembolism DASH: D-dimer, Age, Sex, History of non-provoked PE (a risk score) CPET: Cardiopulmonary Exercise Testing PFTs: Pulmonary Function Tests VQ Scan: Ventilation-Perfusion Scan DOACs: Direct Oral Anticoagulants TPA: Tissue Plasminogen Activator (Thrombolytics) ECMO: Extracorporeal Membrane Oxygenation Pearls: Post-PE “Syndrome” is a Spectrum: It is more accurately a spectrum of disease (sequelae of PE) rather than a single syndrome, ranging from mild fatigue/dyspnea to the most severe form, CTEPH. Structured Follow-up is Mandatory: All PE survivors need a structured follow-up, typically with checkpoints at 3, 6, 12, and 16–24 months, with the primary goal being to detect CTEPH, the deadliest, yet potentially curable, disease on the spectrum. Screening Should Be Objective and Practical: When screening for persistent symptoms, use objective assessment tools like the Post-VTE Functional Status (PVFS) scale or the Modified Medical Research Council (MMR-C) scale, as highly comprehensive but cumbersome tools (like the PE Quality of Life questionnaire) may not be practical for routine clinical use. Recurrence Risk Scores Aid in Anticoagulation Duration: Simple scores like the DASH score or the HERDO2 score (for women) can provide guidance when considering the continuation versus discontinuation of anticoagulation after the initial treatment phase. Invasive Testing for Persistent Symptoms: If a patient remains symptomatic at the 6-month mark despite normal non-invasive testing (chest X-ray, ECG, PFTs, six-minute walk, echo, VQ scan, CPET), consider invasive testing such as Right Heart Catheterization (RHC) at rest or with exercise, or an invasive CPET. Notes: Notes drafted by Saahil Jumkhawala. 1. The Spectrum of Post-PE Disease The term “post-PE syndrome” should be used with caution, as it refers to a spectrum of disease rather than a single entity. This spectrum includes symptoms (sequelae) that exist in a patient’s life following an incidental PE event that they did not have before. On one extreme is Chronic Thromboembolic Pulmonary Hypertension (CTEPH): The definition is clear, but it is the most deadly type, though thankfully rare (2% to 4%). It involves a residual clot and pulmonary hypertension identifiable at rest. In the middle is Chronic Thromboembolic Disease (CTED): Patients may have residual defects seen on a VQ or CT scan, but they do not have pulmonary hypertension. On the other side is a milder disease, which can include fatigue, dyspnea, or a patient’s perceived impairment, where the definitions of CTEPH and CTED are not met, but the patient remains symptomatic. 2. Structured Follow-up and Screening for Post-PE Symptoms Structured follow-up is key for all PE survivors, though the structure may vary based on available resources (PCP, Cardiology, Pulmonary, or multidisciplinary clinic). Recommended Timeline for Follow-up: Data from studies like ELOPE and FOCUS suggest checkpoints at 3, 6, 12, and up to 16 to 24 months. This timeline is designed to identify patients who may develop CTEPH. 88% of patients who develop CTEPH will be identified within about a year. A structured follow-up can reduce the delay in CTEPH diagnosis from 10–12 months to 4–6 months. Personal Practice Note: A quick 2–3 week/30-day check-in is recommended for severely ill patients (e.g., those who had TPA, profound shock, or ECMO support) to ensure medication compliance, manage symptoms, and identify red flags. Screening Tools (Objective Assessment): The first step is an inventory of patient symptoms, leaning toward objective rather than subjective assessment. Recommended Simple Tools: Modified Medical Research Council (MMR-C) for dyspnea evaluation. Post-VTE Functional Status (PVFS) scale. The Pulmonary Embolism Quality of Life (QL) questionnaire is comprehensive but long, making it tedious and better suited for research. Future Utility: Technology (AI/electronic tools) may assist in administering these questionnaires before the clinic visit, presenting the information as a “dashboard” for the provider. 3. Management of Persistent Symptoms and Further Testing Initial Non-Invasive Tests (Often done at 3 months): Echocardiogram VQ Scan Full PFTs Six-minute walk CPET Further Evaluation for Persistent Symptoms (e.g., at 6 months): If non-invasive tests (Chest X-ray, ECG, CPET) are normal but symptoms persist, more invasive testing should be considered as the patient has not returned to baseline. Repeat VQ scan or echocardiogram if symptoms have changed. Right Heart Catheterization (RHC) at rest or with exercise. Invasive CPET. PA gram (Pulmonary Angiogram) to assess vasculature. 4. Recurrence Risk and Anticoagulation Duration The decision to continue or discontinue anticoagulation depends on the patient’s risk factors, the situation of the PE (provoked or unprovoked), presence of active cancer, and patient preference. Recurrence Risk Scores: Simple scores are preferred for practicality. DASH Score. HERDO2 Score (particularly for women). The Vienna Score can be considered if the question is whether to restart anticoagulation after a disruption. Role of D-dimer in Abbreviation: While D-dimer can be used to guide the decision to restart anticoagulation after a planned pause (if D-dimer is high, resume), patient symptoms are preferable to guide management decisions like early abbreviation. 5. Prevention of Post-PE Syndrome Currently, there is no clear tool known to prevent the post-PE syndrome/spectrum of disease. Best Current Advice for Prevention/Recovery: Anticoagulation compliance. Pulmonary rehabilitation, which aids in faster recovery. General precautions, such as smoking cessation and body weight management. Future Research: Ongoing trials are investigating whether acute management strategies (e.g., using thrombolytics in intermediate-risk PE) can prevent long-term sequelae. (The PYTHO trial did not show a reduced rate of CTEPH in intermediate-risk PE patients who received thrombolytics). References: Khan, F., Tritschler, T., Kahn, S. R., & Rodger, M. A. “Venous Thromboembolism.” The Lancet, vol. 398, no. 10294, 2021, pp. 64-77. doi:10.1016/S0140-6736(20)32658-1. Kearon, C., & Kahn, S. R. “Long-Term Treatment of Venous Thromboembolism.” Blood, vol. 135, no. 5, 2020, pp. 317-325. doi:10.1182/blood.2019002364. Kahn, S. R., & de Wit, K. “Pulmonary Embolism.” The New England Journal of Medicine, vol. 387, no. 1, 2022, pp. 45-57. doi:10.1056/NEJMcp2116489. Di Nisio, M., van Es, N., & Büller, H. R. “Deep Vein Thrombosis and Pulmonary Embolism.” The Lancet, vol. 388, no. 10063, 2016, pp. 3060-3073. doi:10.1016/S0140-6736(16)30514-1. Chopard, R., Albertsen, I. E., & Piazza, G. “Diagnosis and Treatment of Lower Extremity Venous Thromboembolism: A Review.” JAMA, vol. 324, no. 17, 2020, pp. 1765-1776. doi:10.1001/jama.2020.17272.

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 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

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.